activities in physical education

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46 Unique Phys Ed Games Your Students Will Love

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There’s nothing kids need more to break up a day spent sitting still and listening than a fun PE class to let off some steam. In the old days, going to gym class probably included playing kickball or dodgeball after running a few laps. Since then, there have been countless reinventions of and variations on old classics as well as completely new games. Although there is no shortage of options, we love that the supplies required remain relatively minimal. You can transport to another galaxy using just a pool noodle or two or create a life-size game of Connect 4 using just Hula-Hoops. You’ll want to make sure to have some staples on hand like balls, beanbags, and parachutes. There are even PE games for kindergartners based on beloved children’s TV shows and party games. Regardless of your students’ athletic abilities, there is something for everyone on our list of elementary PE games!

1. Tic-Tac-Toe Relay

Elementary PE games that not only get students moving but also get them thinking are our favorites. Grab some Hula-Hoops and a few scarves or beanbags and get ready to watch the fun!

Learn more: Tic-Tac-Toe Relay at S&S Blog

2. Blob Tag

Pick two students to start as the Blob, then as they tag other kids, they will become part of the Blob. Be sure to demonstrate safe tagging, stressing the importance of soft touches.

Learn more: Blob Tag at Playworks

3. Cross the River

This fun game has multiple levels that students have to work through, including “get to the island,” “cross the river,” and “you lost a rock.”

Learn more: Cross the River at The PE Specialist

4. Head, Shoulders, Knees, and Cones

Line up cones, then have students pair up and stand on either side of a cone. Finally, call out head, shoulders, knees, or cones. If cones is called, students have to race to be the first to pick up their cone before their opponent.

Learn more: Head, Shoulders, Knees & Cones at S&S Blog

5. Spider Ball

Elementary PE games are often variations of dodgeball like this one. One or two players start with the ball and attempt to hit all of the runners as they run across the gym or field. If a player is hit, they can then join in and become a spider themselves.

Learn more: Spider Ball Game at Kid Activities

6. Crab Soccer

We love elementary PE games that require students to act like animals (and we think they will too). Similar to regular soccer, but students will need to play on all fours while maintaining a crab-like position.

Learn more: Crab Soccer at Playworks

7. Halloween Tag

This is the perfect PE game to play in October. It’s similar to tag, but there are witches, wizards, and blobs with no bones!

Learn more: Halloween Tag at The Physical Educator

8. Crazy Caterpillars

We love that this game is not only fun but also works on students’ hand-eye coordination. Students will have fun pushing their balls around the gym with pool noodles while building their caterpillars.

9. Monster Ball

You’ll need a large exercise ball or something similar to act as the monster ball in the middle. Make a square around the monster ball, divide the class into teams on either side of the square, then task the teams with throwing small balls at the monster ball to move it into the other team’s area.

Learn more: Monster Ball at The PE Specialist

10. Striker Ball

Striker ball is an enjoyable game that will keep your students entertained while working on reaction time and strategic planning. We love that there is limited setup required before playing.

Learn more: Striker Ball at S&S Blog

11. Parachute Tug-of-War

What list of elementary PE games would be complete without some parachute fun? So simple yet so fun, all you will need is a large parachute and enough students to create two teams. Have students stand on opposite sides of the parachute, then let them compete to see which side comes out on top.

Learn more: Parachute Tug-of-War at Mom Junction

12. Fleas Off the Parachute

Another fun parachute game where one team needs to try to keep the balls (fleas) on the parachute and the other tries to get them off.

Learn more: Fleas Off the Parachute at Mom Junction

13. Crazy Ball

The setup for this fun game is similar to kickball, with three bases and a home base. Crazy ball really is so crazy as it combines elements of football, Frisbee, and kickball!

Learn more: Crazy Ball at Health Beet

14. Bridge Tag

This game starts as simple tag but evolves into something more fun once the tagging begins. Once tagged, kids must form a bridge with their body and they can’t be freed until someone crawls through.

Learn more: Bridge Tag at Great Camp Games

15. Star Wars Tag

Elementary PE games that allow you to be your favorite movie character are just way too much fun! You will need two different-colored pool noodles to stand in for lightsabers. The tagger will have one color pool noodle that they use to tag students while the healer will have the other color that they will use to free their friends.

Learn more: Star Wars Tag at Great Camp Games

16. Rob the Nest

Create an obstacle course that leads to a nest of eggs (balls) and then divide the students into teams. They will have to race relay-style through the obstacles to retrieve eggs and bring them back to their team.

17. Four Corners

We love this classic game since it engages students physically while also working on color recognition for younger students. Have your students stand on a corner, then close their eyes and call out a color. Students standing on that color earn a point.

Learn more: Four Corners at The Many Little Joys

18. Movement Dice

This is a perfect warm-up that requires only a die and a sheet with corresponding exercises.

Learn more: Roll the Dice Movement Break at Teaching Littles

19. Rock, Paper, Scissors Tag

A fun spin on tag, children will tag one another and then play a quick game of Rock, Paper, Scissors to determine who has to sit and who gets to continue playing.

Learn more: Rock, Paper, Scissors Tag at Grade Onederful

20. Cornhole Cardio

This one is so fun but can be a little bit confusing, so be sure to leave plenty of time for instruction. Kids will be divided into teams before proceeding through a fun house that includes cornhole, running laps, and stacking cups.

Learn more: Cardio Cornhole at S&S Blog

21. Connect 4 Relay

This relay takes the game Connect 4 to a whole new level. Players must connect four dots either horizontally, vertically, or diagonally.

22. Zookeepers

Students will love imitating their favorite animals while playing this fun variation of Four Corners where the taggers are the zookeepers.

23. Racket Whack-It

Students stand with rackets in hand while balls are thrown at them—they must either dodge the balls or swat them away.

Learn more: Racket Whack-It via PEgames.org

24. Crazy Moves

Set mats out around the gym, then yell out a number. Students must race to the mat before it is already filled with the correct number of bodies.

Learn more: Crazy Moves at PEgames.org

25. Wheelbarrow Race

Sometimes the best elementary PE games are the simplest. An oldie but a goodie, wheelbarrow races require no equipment and are guaranteed to be a hit with your students.

Learn more: Wheelbarrow Race at wikiHow

26. Live-Action Pac-Man

Fans of retro video games like Pac-Man will get a kick out of this live-action version where students get to act out the characters.

27. Spaceship Tag

Give each of your students a Hula-Hoop (spaceship), then have them run around trying not to bump into anyone else’s spaceship or get tagged by the teacher (alien). Once your students get really good at it, you can add different levels of complexity.

28. Rock, Paper, Scissors Beanbag Balance

We love this spin on Rock, Paper, Scissors because it works on balance and coordination. Students walk around the gym until they find an opponent, then the winner collects a beanbag, which they must balance on their head!

Learn more: Rock, Paper, Scissors Beanbag Balance at PE Universe

29. Throwing, Catching, and Rolling

This is a fun activity but it will require a lot of preparation, including asking the school maintenance staff to collect industrial-sized paper towel rolls. We love this activity because it reminds us of the old-school arcade game Skee-Ball!

Learn more: Winter Activity at S&S Blog

30. Jenga Fitness

Although Jenga is fun enough on its own, combining it with fun physical challenges is sure to be a winner with young students.

Learn more: Jenga Fitness at S&S Blog

31. Volcanoes and Ice Cream Cones

Divide the class into two teams, then assign one team as volcanoes and the other as ice cream cones. Next, spread cones around the gym, half upside down and half right side up. Finally, have the teams race to flip as many cones as possible to either volcanoes or ice cream cones.

Learn more: Warm-Up Games at Prime Coaching Sport

This fun variation on dodgeball will have your students getting exercise while having a ton of fun! Begin with three balls on a basketball court. If you are hit by a ball, you are out. If you take a step while holding a ball, you are out. There are other rules surrounding getting out and also how to get back in, which can be found in this video.

33. Musical Hula-Hoops

PE games for kindergartners that are similar to party games are some of our favorites! Think musical chairs but with Hula-Hoops! Lay enough Hula-Hoops around the edge of the gym minus five students since they will be in the muscle pot. Once the music starts, students walk around the gym. When the music stops, whoever doesn’t find a Hula-Hoop becomes the new muscle pot!

34. 10-Second Tag

This game is perfect to play at the beginning of the year since it helps with learning names and allows the teacher to get to know the first student in line.

35. The Border

This game is so fun and requires no equipment whatsoever. Divide the gym into two sides. One side can move freely while the other side must avoid letting their feet touch the floor by rolling around, crawling, etc.

36. Freedom Catch

This is a simple throwing, catching, and tag game that will certainly be a hit with your PE class. Captors attempt to tag players so they can send them to jail. You can be freed if someone on your team runs to a freedom cone while throwing a ball to the jailed person. If the ball is caught by the jailed person, they can rejoin the game.

37. Oscar’s Trashcan

As far as PE games for kindergartners goes, this one is a guaranteed winner since it is based on the show Sesame Street . You’ll need two large areas that can be sectioned off to use as trash cans and also a lot of medium-size balls. There are two teams who must compete to fill their opponent’s trash can while emptying their own. Once over, the trash will be counted and the team with the least amount of trash in their trash can wins!

38. 4-Way Frisbee

Divide your class into four separate teams, who will compete for points by catching a Frisbee inside one of the designated goal areas. Defenders are also able to go into the goal areas. There are a number of other rules that can be applied so you can modify the game in a way that’s best for your class.

39. Badminton King’s/Queen’s Court

This one is simple but fun since it is played rapid-fire with kids waiting their turn to take on the King or Queen of the court. Two players start and as soon as a point is earned, the loser swaps places with another player. The goal is to be the player that stays on the court the longest, consistently knocking out new opponents.

40. Jumping and Landing Stations

Kids love stations and they definitely love jumping, so why not combine those things into one super-fun gym class? They’ll have a blast challenging themselves with all the different obstacles presented in this video.

41. Ninja Warrior Obstacle Course

Regardless of whether you’ve ever seen an episode of American Ninja Warrior , you are probably familiar with the concept and so are your students. Plus, you’ll probably have just as much fun as your students setting up the obstacles and testing them out!

42. Balloon Tennis

Since kids love playing keepy-uppy with a balloon, they will love taking it a step further with balloon tag!

43. Indoor Putting Green

If your school can afford to invest in these unique putting green sets, you can introduce the game of golf to kids as young as kindergarten. Who knows, you might just have a future Masters winner in your class!

44. Scooter Activities

Let’s be honest, we all have fond memories of using scooters in gym class. Regardless of whether you do a scooter sleigh or scooter hockey, we think there is something for everyone in this fun video.

45. Pick It Up

This is the perfect PE game to play if you are stuck in a small space with a good-size group. Teams win by making all of their beanbag shots and then collecting all of their dots and stacking them into a nice neat pile.

46. Dodgeball Variations

Since not all kids love having balls thrown at them, why not try a dodgeball alternative that uses gym equipment as targets rather than fellow students? For example, have each student stand in front of a Hula-Hoop with a bowling ball inside of it. Students need to protect their hoop while attempting to knock over their opponents’ pins.

What are your favorite elementary PE games to play with your class? Come and share in our We Are Teachers HELPLINE group  on Facebook.

Plus, check out  our favorite recess games for the classroom ..

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38 Old-School Recess Games Your Students Should Be Playing Now

Ready to feel nostalgic? Continue Reading

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January 4, 2016

PE Activities to Engage Students in the Three Domains of Learning

As all PE teachers know, Physical Education is not just about playing games and getting kids to move; PE teachers also have the tremendous responsibility of building the foundation for healthy physical activity and a positive body image. Let’s not forget, PE teachers must engage their students in authentic, motivating lessons that will build their physical literacies while developing skills in the three domains of learning and health-related fitness (psychomotor, cognitive, and affective). With all of that in mind, where do we begin?

First, let’s take a look at each of the three domains of learning within physical education. After reviewing the domains, we’ll analyze grade-specific PE lessons that you can use as models to seamlessly incorporate each domain into your PE instruction.

Psychomotor Domain (Body)

The psychomotor domain refers to the physical aspects of learning. It addresses motion, reflexes, and how muscles are engaged during physical activity. In your PE classes, you can help students build a number of psychomotor skills, including reflexive skills, perceptual abilities, and complex, higher-order skills that require a combination of physical abilities to yield a motion.

Cognitive Domain (Brain)

The cognitive domain addresses the development of content knowledge and intellectual skills. Teaching and learning in the cognitive domain is essential to PE, as without it, students are less likely to understand rules or develop strategies to excel in activities, sports, and games. You can use  Bloom’s Taxonomy  as a tool to build students’ knowledge of healthy movements.

Affective Domain (Feelings)

The affective domain focuses on students’ feelings, attitudes, and values about movement. Learning in this domain is difficult to measure because it takes place internally. However, you can use the  Bloom’s Affective Taxonomy  as a guide to observe your students’ learning. For starters, focus on a student’s ability to pay attention and place value on the importance of movement.

To learn more about each of the domains of learning and health-related fitness, visit this  link .

Now, let’s review some grade-specific PE activities and reflect on how the learning domains are implemented. These general activities do not focus on specific PE units and can be implemented at any point throughout the school year or as warm-ups at the beginning of class.

Grades K-2:  Line Boogie

In this activity, students line up in groups and move a beanbag from one end of the line to the next without letting it hit the floor. For an added element, you can incorporate music. When the music runs out, the team who has moved the beanbag furthest down the line is the winner.

Psychomotor

Students develop hand-eye coordination, reflex skills, and foundational movement patterns as they transfer the beanbag down the line, catch it to prevent it from falling, and race from one end of the line to the other.

Students analyze which seating positions and strategies will most effectively and quickly move the beanbag down the line (e.g., overhead, side-to-side), and they apply and modify these techniques as they progress through the challenge.

In order to perform well in this challenge, students must pay attention to their teammates’ movements and place value on the importance of preventing the beanbag from hitting the floor.

Grades 3-5:  Tic-Tac-Toe Relay

Students form teams to compete in a tic-tac-toe relay race. Students race from one end of the gym to the next, placing their team’s marker on the tic-tac-toe board. They then race back and tag their teammate, who then races across the gym to place a marker on the board, and so on. The object of the game is to make a row before the opposing team does.

 Students execute line drills; they work on speed, control, and balance as they quickly move to the tic-tac-toe board and pivot to run across the gym.

 Students evaluate the best place to put their marker. In many cases, they will have to predict where their opponent will put the marker first and anticipate how to block the next opponent from making a row.

Affective:  Students challenge themselves to race to the end of the gym as quickly as possible, choose the best place to put their marker, and block their opponents from winning the game. In order to perform well in this activity, students need to place value on their contribution to the team.

Grades 6-8:  Moving Tower Push Ups

Students rebuild a tower by moving each piece to the left without placing a bigger object on a smaller object. The kicker is, they can only make one move at a time. In between moves, they must run to a designated spot and complete a push up to the best of his/her ability.

This is an excellent way to teach students how to effectively execute a push up. Students need to complete a proper push up, race to one end of the gym, run backward, and repeat.

Students evaluate how to recreate the tower in as few steps as possible. They must also assess their push up technique and modify their movement when necessary in order to keep participating in the activity even after it becomes physically difficult.

 Students challenge themselves to race to the end of the gym as quickly as possible, show tolerance for the pain of a push up, and persevere despite challenge and difficulty.

High School Students:  Wacky Walks Heart Rate Monitoring

Students learn how to take their resting and active heart rates. They then practice a variety of walking techniques (e.g., walking lunges and high knees) and take their heart rate after completing each movement. Students also perform a series of triceps dips and push ups to see how their heart rate is affected by using different muscle groups.

Students reproduce activities based on their teacher’s instruction; they work on balance and precision as they execute each new movement; they master the ability to switch between movements; and they engage a variety of muscle groups.

 Students learn how to take their heart rate; they analyze how movement affects their heart rate; and they compare and contrast the differences a variety of movements have on the rise and fall of their heart rate.

 Students develop an understanding of the importance of exercise and which activities will best increase their heart rate in order to get the most out of their workouts.

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Nicki Newman Case, PEC Facebook Post " I wanted to thank PE Central for sending me an email that said I won $50 for a published kid quote. I am going to let the kid who wrote the Valentine help me pick out what he wants from the S&S catalog to use in our gym. I am also going to buy him the "I got Published" t-shirt. THANK YOU! I presented the winner of the Kids Quote of the Week with his T-shirt this morning at assembly! He LOVED it! "

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9 Activity Ideas for STEM in Physical Education

• Lauren Chiangpradit
• November 16, 2023
• Reviewed by Sean Barton
• Reviewed by Haley MacLean

Table of Contents

The Synergy of Movement and Learning

Physical education stem activities for elementary school, stem activities for middle school pe students, advanced stem challenges for high school learners, tech, tools, and resources for stem in physical education.

Integrating STEM (Science, Technology, Engineering, and Mathematics) into Physical Education (PE) classes offers an innovative approach to education. In an era where sports statistics, science, and technology increasingly influence athletics, PE classes are uniquely positioned to blend physical activity with STEM learning and 21st century skills. This article explores how PE educators and facilitators can use STEM learning in their coursework. It also provides a range of curriculum activity ideas to get students at different education and skill levels engaged.

Research indicates that physical activity can significantly bolster cognitive abilities. When students participate in movement-based learning, they benefit physically and experience enhanced concentration, memory, and creativity. This cognitive boost is crucial for comprehending and applying STEM concepts, which often demand high levels of problem-solving and critical thinking. Active learning, where students engage in physical activities while learning STEM concepts, results in more profound understanding and retention of information. Integrating physical and mental challenges not only makes learning more enjoyable, but is more effective, as students apply theoretical concepts in practical settings, leading to better comprehension and recall.

Integrating STEM into elementary physical education presents a fantastic opportunity to lay the foundation for lifelong learning and curiosity in young students. Through these innovative activities, elementary school children can explore and understand key STEM concepts while engaging in fun and physical play. Each activity is designed to be not only educational but highly interactive and suitable for their developmental stage. Here are some engaging activities that blend physical education with STEM learning for elementary students:

• Jump and Measure: Students perform a variety of jumps – like the long jump and high jump – and measure their distances or heights. This activity introduces basic concepts of measurement and physics, encouraging students to understand how force and motion play a role in their physical activities.
• Geometry with Body Movements: In this activity, children use their bodies to create geometric shapes, either individually or in groups. It’s an engaging way for students to learn about basic geometry, spatial awareness, and symmetry. Teachers can challenge students to form complex shapes, enhancing their understanding and teamwork skills.
• STEM Soccer : In a lesson devoted to measuring throw-ins, students collect data in centimeters and convert their data to meters dividing by 100. Students then evaluate measurement systems to decide the best measurement size. This disguised learning,  interactive lesson is a great way for physical education teachers to add STEM into their PE classes.
• Weather and Exercise: Students observe and record weather patterns over a week and discuss how different weather conditions affect physical activities. This integrates meteorology into PE, allowing students to see the real-world application of science in their everyday activities.
• Heart Rate Exploration: After engaging in various exercises, students measure their heart rates to learn about the cardiovascular system and the science behind exercise. This activity not only educates them about their bodies, but about the importance of physical fitness in maintaining health.
• Playground Physics: Utilizing playground equipment, this activity allows students to explore concepts like gravity, force, and motion. They can experience firsthand how these physical laws impact their play and movements, turning the playground into a living laboratory.

As students enter middle school, their capacity for more complex and abstract thinking grows significantly. This developmental stage is an ideal time to introduce more intricate STEM concepts through physical education, enhancing their learning experience with practical applications. The following STEM activities are tailored for middle school students, offering a blend of intellectual challenge and physical engagement. These activities are designed to pique students’ curiosity in STEM fields through the familiar and enjoyable medium of sports and physical exercises. By participating in these activities, students not only deepen their understanding of STEM concepts, but learn valuable lessons in teamwork, problem-solving, and the practical application of classroom knowledge to real-world scenarios. Here’s a look at some stimulating and educational STEM activities for middle school PE:

• Sports Statistics Analysis: Students gather and analyze sports statistics from games or physical activities. This teaches them about data collection, interpretation, and the importance of statistics in understanding and improving athletic performance.
• STEM Football: During a lesson in STEM Football, students collect and graph data of a controlled experiment by using a line graph. Students then explain the relationship between kinetic energy and mass by writing a claim evidence supported by evidence-based reasoning from class data. This lesson highlights the strong classroom connection between physical education and STEM learning, and how it can help create tangible examples for students.
• Energy and Movement: This activity focuses on the concept of kinetic and potential energy in the context of sports. Students explore how energy is transferred and transformed during different physical activities, such as running, jumping, or throwing a ball.
• Biomechanics of Sports: Here, students delve into the study of human movement and mechanics in various sports. They learn about the science behind athletic performance, injury prevention , and how athletes optimize their movements for maximum efficiency and safety.
• Mathletics Relay: A relay race where each leg involves solving a math problem before passing the baton. This combines physical fitness with mathematical skills, emphasizing quick thinking and teamwork.
• Technology in Sports Training: Students explore how technology is increasingly used in sports training and performance analysis. They might look at wearable tech, video analysis software, or other tools that help athletes improve their skills and coaches to make informed decisions.

High school students, with their advanced cognitive skills and heightened interests, are well-positioned to tackle complex STEM challenges through physical education. This section of the curriculum is designed to offer high school learners in-depth, hands-on experiences that combine higher-level STEM concepts with physical activities and sports. These advanced activities are not just about physical exertion; they require students to engage in critical thinking, problem-solving, and creative innovation. They provide an opportunity for students to see the real-world applications of the STEM knowledge they acquire in their classrooms, bridging the gap between theoretical learning and practical implementation. By participating in these activities, high school students can gain a deeper understanding of various STEM fields, such as physics, engineering, biotechnology, and environmental science, observing how these disciplines intersect with sports and physical fitness. Here are some challenging and intellectually stimulating STEM activities designed for high school learners:

• Physics of Sports Equipment Design: Students research and discuss the physics principles involved in the design of sports equipment. This can include topics like material science, aerodynamics, and ergonomics, providing insights into how equipment is optimized for performance and safety.
• Engineering a Miniature Golf Course: Students design and construct a miniature golf course, applying concepts of geometry, physics, and design. This project not only involves creativity, but a practical application of STEM principles by creating functional and enjoyable mini-golf holes.
• Sports Analytics Project: Students undertake a project to analyze a sports game using statistical methods and tools. This activity introduces them to data science in sports, teaching them how to interpret and use data to understand game strategies and player performance.
• Biotechnology in Athletics: This topic explores how biotechnology is used in sports, from equipment design to performance enhancement techniques. Students might study material innovations, genetic research in athletics, or the ethical implications of biotechnology in sports.
• Environmental Science in Outdoor Sports: Students analyze how environmental factors impact outdoor sports activities. They can study topics like climate change, pollution, and natural terrain, understanding the interplay between sports and the environment.
• Virtual Reality Sports Training: Students explore how VR technology is being used for skill development, strategy training, and injury rehabilitation in various sports by discussing the emerging role of virtual reality in sports.

Bringing STEM into PE classes effectively requires the right resources, including technology tools, educational kits, and comprehensive guides. Resources like the STEM Sports® kits provide ready-to-use activities that seamlessly blend physical education with STEM learning. These kits offer an invaluable resource for teachers looking to enrich their curriculum and engage K-8 students through a cross-curricular learning approach. For additional resources, tools, and innovative ideas, please visit STEM Sports® .

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SEL Activities in PE: Strengthening the Mind-Body Connection

• By: Elizabeth Bolger
• January 18th, 2020

One of the reasons I went into teaching physical education is because I wanted to teach students the power of the mind-body connection. I wanted them to develop strength not only in physical skills, but in the mental skills as well.

I also want my students to learn that our thoughts, feelings, beliefs, and attitudes can positively or negatively affect our biological functioning. In other words, our minds can affect how healthy our bodies are. The opposite is true as well. The things we do with our physical body (e.g. what we eat, how much we exercise, how many hours of sleep we get) can impact our mental state, positively or negatively. This results in a complex relationship between our mind and body.

When I was younger, I struggled with anxiety, depression, and panic attacks. I would allow negative thoughts to control me. I struggled with my own self-worth and I had a lot of difficulties managing my emotions.  Participating in physical education and sports gave me the opportunity, as a teenager, to work on my social-emotional skills and allowed me to eventually grow into the confident, happy person I am today. I am blessed to have gone through those past earlier experiences, for I see it as an opportunity to help teach my students and my own children how to manage their emotions and how to positively affect the mind-body connection. What a gift it is to be able to teach my elementary students these skills at a young age.

Social-Emotional Learning (SEL) in Action I am always looking for creative and unique ways to teach about the mind-body connection and SEL (Social Emotional Learning) skills in physical education. Since I enjoy creating Escape Rooms, I created an SEL Escape Room that is based on the CASTEL’s (Collaborative for Academic, Social, and Emotional Learning) 5 core competencies to teaching SEL. These 5 competencies include self-awareness, self-management, social awareness, relationship skills, and responsible decision making.

Activity 1: Emotional Chains I started by tying each team of students up in handcuffs. I made these handcuffs out of elastic and string. I then gave instructions to the students on how to tangle themselves up. Once tangled, I told the students they were in an Escape Room. Then I told the students a story about George The Giant. I explained to the students that they were captured, placed in chains, and locked up by George the Giant. I also mentioned that George use to be a Gentle Giant. He was very sweet and kind but then one day something happened. George let his emotions get built up and he just erupted! He became so angry and out of control! George became the Grizzly Giant. The emotions bothering George became his chains. He kidnapped all the students in Sayville, locked them up in these chains and wouldn’t let them return home.  I then instructed each group to work as a team to help untangle the emotional chains that George had placed them in.

The objective of this game was to teach my students how our emotions can feel like chains and the only way we can break free of these chains is by sorting out our feelings and learning coping skills to help us handle our emotions. When they broke out of the chains, they were given a clue to the next code and instructions to the next activity.

Activity 2: Domino Effect The students were then instructed to create a “ domino effect ” showing George how his display of emotions have affected all of us. The students had to perform different locomotor skills as they raced around the gym collecting domino pieces. They had to follow the clues and eventually create a “ domino effect ” starting at their team base and ending at the finish cone, where a key to the next lock was hidden. This activity teaches the students that we have the exceptional power to feel and that our emotions run the gamut from sad to happy and everything that lies in between. These emotions are waves of energy, but they don’t just affect us; they impact others around us, and still others that those initial people encounter. What you feel and give off radiates all around you. It touches those closest to you and then makes its way to those beyond that initial circle. In other words, we have the capacity to not only feel but to impact others with our display of emotions. These “ dominos ” represent those people we can affect with our displays of emotion.

Activity 3: Labeling Emotions The next clue gave each team a handout of pictures of children displaying different emotions. The teams will try to label these emotions. Posters representing each of the 6 core emotions (Anger, Fear, Surprise, Happy, Disgust, Sad) were hung around the gym. Underneath each of these 6 core emotions posters,  I created a color chart of the different shades of those emotions. The shades of emotions chart help narrow down each of the core emotions. As the colors get darker, the emotions become more specific. For example, the core emotion of anger was the color red. The shades of emotions chart underneath anger started pink with the word hurt and as each emotion on the chart became more specific, the color intensity increased. The end emotion was “ Hostile ” and the color was deep red.

The students will try to correctly identify the emotion in the picture. If the students label the emotions correctly, they will find the code to open the next lockbox. The objective of this activity is to teach the students that to deal effectively with emotions we must first name them. Labeling emotions helps us develop control over them. Being able to accurately identify them is essential to creating a plan to resolve those feelings. We can’t create a plan or decide on coping strategies if we haven’t labeled our feelings accurately.

Activity 4: Learning to Focus In the next activity, the students were told that George “ lost his noodles ”. The students had to help George “ find his noodles ” and help George “gather his thoughts”. I placed swimming pool noodles on the opposite side of the gym. The students were given different teamwork tasks to help move the noodles back to the opposite side of the gym. Once all the noodles were back, the students were given a puzzle to solve. The puzzle had instructions written on it. The instructions said for the students to help teach George the difference between things he can control and things he can’t control. On half of the noodles I wrote examples of things we can control such as how many times we smile today, our effort, time spent worrying, how we act on our feelings, etc. On the other half of the noodles, I wrote examples of things we can’t control such as the weather, what others say, what others feel, your past, your brother/sister, etc. The students had to sort the noodles into two piles: things we can control and things we can’t control. The code was written on the noodles with the things we can control.

The objective of this activity was to teach students that sometimes we have a lot of things going on at one time and it’s hard to focus. We need to gather our “ noodles ” or thoughts and sort through them. Which ones do we have power over? Which ones can we control? Which ones can’t we control? If we have no power over it then why do we waste so much time worrying or thinking about those things? This activity is an opportunity to teach students that they may not be able to prevent something, but they can control how they prepare for it.  In addition, they can’t control how someone else behaves, but you can control how you react. We can teach students to focus on their choices and we can help them develop effective strategies to manage their stress.

Activity 5: Coping Skills Next, the students went on a scavenger hunt to help George find some effective coping skills. The students raced around the gym looking for pictures I made of different ways we can cope with our emotions. Some of these ways included exercise, listening to music, talking to a friend or adult, doing mindful breathing techniques, naming three things you are grateful for, etc. When the students found all the coping strategies, it led them to their final activity.

Activity 6: Positive Self-Talk For the final task, I drew a giant brain on the poster board and cut out holes a little smaller than the size of ping pong balls. On some balls, I wrote examples of positive self-talk and on some balls I wrote examples of negative self-talk. The students had to first sort through the balls and separate them into a pile of positive self-talk and a pile of negative self-talk. The students had to “ fill the brain ” with positive self-talk. The team would work together to try to tip the board to get the ball to land into a hole in the brain. Once successful, they would move on to a new ball. When the brain was “ full of positive self-talk ” they would find the clue to the final box.  Inside the final box, was a thank you letter from George for restoring him to his gentle ways and a thank you gift for the class. The thank-you gift was a class “ Coping Toolkit ” the students could use to prevent them from ever turning into George the Grizzly Giant. Inside the toolkit was crayons, a drawing pad, fidgets, stress balls, aromatherapy bags, bubbles, breathing beads, mindful snow globes, putty, and puzzles.

As teachers, we have a lifelong effect on our students. This impact involves not only the teaching of particular academic skills, but the fostering of students’ social-emotional skills. I hope my students always remember that they need to be their biggest cheerleader. That their self-thoughts have the most impact on their actions. I hope I inspire my students to believe in themselves, challenge their inner negative thoughts and change them to positive affirmations. I hope my students learn to fall, to fail, and to rise and try again. I want them to understand that they have the power to be all they dream of becoming. What do you hope they will remember from you?

For more information, search for @Coach Bolger’s Power PE.  Here you will find my teaching resources and this SEL Escape Room with all activities and posters.

— Contribute an Article on HPE —

Contact: [email protected]

Coach Bolger is the ultimate role model for her students and her colleagues. Her creativity inspires lessons that completely engage all students. We are so lucky to have her at Lincoln Avenue Elementary School!

Not enough positive things can be said about Beth! Her energy, enthusiasm and passion for PE is limitless. If you ever have a chance to observe her classes or participate in one of her workshops, please do so!

Based on the last two articles on this site that I read that were written by Beth, I would have to agree with the last two commenters. Beth rocks! Too bad I’m retiring this year and won’t have an opportunity to put into practice what Beth teaches. At least not in my PE classes. I will try to in other areas of my life. Thanks Beth.

Thank you John for your sweet comments!! Enjoy retirement and stay healthy!!!

Beth, I would love to share your ideas in the G.A.M.E.S. Gazette, an online digital quarterly journal through teachers helping teachers. The Gazette is particularly geared to grades K-6 and I am the social emotional editor. I love what you created for your students in social emotional learning activities. You would be cited for complete credit and you would receive a free edition of the gazette. Please let me know if you feel I could use some of your material. Thanks so much.

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Power-Up Rhythm and Timing in Physical Education Activities

Physical Education class is an optimal setting for students to develop and practice the precursor skills that precede learning. These skills include core strength, balance, weight shift, motor rhythm, motor timing, visual-spatial, and object-perceptual skills. Due to a variety of factors including less opportunity for physical activity throughout the day, more seated classroom time, and fewer foundational motor experiences (swinging, climbing trees, jumping rope, building forts, and kicking the can in the alley), children’s fundamental motor skills are on the decline ( Brian et al., 2019 ;  Hardy et al., 2013 ). 

A recent study reported that 77% of a sample of children ages 3–5 years from across the United States were at or below the 25%tile with approximately 30% of children demonstrating profound developmental delays (<5%tile) in their gross motor skills,  Brian et al., 2020 . Deficits such as these in foundational motor skills have consequences for cognition and achievement.

Motor Skill Activities Enhance Cognition & Learning

Advances in neuroscience have resulted in substantial progress in linking physical activity to cognitive performance, brain structure, and function ( Donnelly et al., 2016 ). Research shows that the motor skill development associated with consistent participation in physical education/activity can improve academic performance, cognition, visual-perceptual skills, attention, memory, and problem-solving skills ( CDC, 2010 ;  de Greeff et al., 2018 ;  Fernandes, et al., 2016 ;  Greco et al, 2023 ;  Shi & Feng, 2022 ).

Moreover, Physical Education promotes cognitive development by stimulating neural pathways associated with socialization and learning. Physical activities improve blood flow and oxygenation to the brain, which enhances cognitive functioning, attention, and memory.

Activities in physical education often teach children important classroom skills including following instructions, making decisions, problem-solving, teamwork, and self-regulation. Practicing these actions through physical activity helps children develop executive function skills such as attention control, working memory, cognitive flexibility, and inhibitory control. Recent evidence suggests that adding developmentally appropriate cognitive demands to patterned movement stimulates executive function and the precursor skills to reading and math ( Paschen et al., 2019 ;  Kolovelonis & Goudas, 2023 ). 

As knowledge of the impact of motor coordination on children’s cognition and academic achievement evolves, physical educators are increasingly integrating rhythmic coordinative movement into their daily classroom activities to prime the brain for learning.

The Importance of Rhythm & Timing in Development

Rhythm and timing play a crucial role in developing cognitive skills, motor coordination, and fine motor skills in children. This connection between rhythm timing and motor coordination has been studied across various fields, including kinesiology, neuroscience, auditory neuroscience, developmental psychology, and education.

Cognitive Skills: 

The link between rhythm timing and cognitive development is established by studies that have shown that children who engage in rhythmic activities tend to have better cognitive skills, including self-regulation, attention, memory, cognitive flexibility, and problem-solving abilities ( Miendlarzewska &Trost, 2013 ). The rhythmic patterns present in music, for example, can help improve a child’s ability to process and remember academic information (See  Bonacina et al., 2019 ;  Frischen et al., 2020 ).

Cross-Modal Integration: 

Rhythm and timing involve the integration of visual, auditory, and kinesthetic sensory inputs. This cross-modal integration enhances the brain’s ability to process the coordinate information from different sensory channels. As a result, children who engage in rhythm-based activities are better equipped to integrate sensory cues and appropriately respond to various stimuli (See  Bharathi et al., 2019 ).

Educational Impact: 

Rhythm and timing activities have been shown to be related to reading prosody, grammar, and early math (See  Lundetrae & Thomson, 2017 ). Children with better rhythm have been shown to learn with greater ease. Using rhythmic patterns to teach math concepts or language skills not only makes learning more engaging, but it also makes learning more effective.

Gross and Fine Motor Skills: 

Rhythm and timing activities often involve a combination of gross motor skills, larger movements involving multiple muscle groups, and fine motor skills with smaller, more precise hand movements. The ability to synchronize movements with rhythm is fundamental to children’s ability to pull to a stand, walk, run, skip, and gallop. As an example, dancing involves both whole-body coordination and intricate footwork at the same time, writing requires planning, visual tracking, core strength, and shoulder stability. Engaging and rhythm-based activities encourages the development of a wide range of motor skills, contributing to the foundational skills associated with learning.

Neurological Development: 

Research suggests that rhythm and timing activities can have a positive effect on the neurological development in children. Engaging in activities that require rhythmic coordination, such as clapping to a beat, dancing, and moving rhythmically, helps strengthen neural connections in the brain, particularly in the areas related to cognition, motor control, and coordination. These activities enhance the communication between different brain regions responsible for attention, planning, previewing, and task initiation.

3  Ways to Incorporate Rhythm and Timing Into Your Physical Education Class

#1: learn the value of 4/4 time.

Action: Teach your students how to think in 4/4 time.

Why: We live in a decimal society which is great for math, measurement, and science yet, it is not as beneficial to cognition and movement. In the western world, the foundation for human movement is actually in 4/4 time. We walk in 4/4 time, we dance in 4/4 time, and we even learn languages in 4/4 time.

How: Teach your students how to move in 4/4 time. Moving in 4/4 time, four beats to a measure, activates the natural musicality in the human body supporting skill development. 

Activity 1: Have your students stand up and count in time together, then move on the fourth beat.

“Can everybody count?”

“Let’s count together 1 2 3 4; 1 2 3 4; 1 2 3 4; 1 2 3 4.”

“Great, now, can everybody stomp? Let’s stomp alternating with our right foot and left foot on beat 4.”

“1 2 3 stomp right. 1 2 3 stomp left. 1 2 3 stomp right. 1 2 3 stomp left. 1 2 3 stomp right. 1 2 3 stomp left.1 2 3 stomp right. 1 2 3 stomp left.”

“Excellent, our bodies walk, talk and move in 4/4 time that is 4 beats per measure.”

Reflection: “Can you think for a moment what activities you do in 4/4 time, that is 4 beats to a measure?”

“Think about it… When you walk 1-2 1-2 you are walking in 4/4 time; When you brush your teeth, you are moving in 4/4 time. Even when you listen to me now, I speak, then you speak, we do that rhythmically in 4/4 time.”

“Great work! We are ready for our next activity.” (You have primed your students’ brains for learning now you can do you regularly planned physical activity lesson).

#2: Practice Static and Dynamic Balance

Action: Practice static and dynamic balance before you start an activity or during a break in the middle of the activity. 

Why: Taking the time to pause right before or during an activity provides an opportunity to practice response inhibition and self-regulation.

How: Teach your students how to balance in 4/4 time. Balancing in 4/4 time, four beats to a measure activates the natural musicality in the human body teaching the foundational skill of balance. 

Activity 1: Have your students stand in “ready position” with their feet aligned beneath their hips, their shoulders aligned above their hips, and their head held nice and tall with proper alignment and posture. Core is tightened, pulled in and up. Next you will teach them static and dynamic balance.

Why: Due to the demands in society, our children have less opportunity to practice and develop static and dynamic balance. Both skills are central to most of the physical activity lessons you will teach your students.

How: “Okay, let’s challenge both our thinking and our motor skills. I want us to count together out loud 1 2 3 4. Let’s do it again 1 2 3 4. Great.” 

“Now the next time we reach beat 4 we are going to all lift our right leg a few inches off the ground and hold that move for 4 beats. Ready count 1 2 3 lift (hold 2 3) and put your foot down on beat 4. Excellent.”

“Now, with our left foot. Count 1 2 3 lift (hold 2 3) down.”

“Easy or hard? You tell me?”

“Alright, now we are going to do the entire sequence twice. This will take some concentration. Are you all ready to focus?”

“1 2 3 Let’s FOCUS.”

“Count out loud 1 2 3 lift right foot (hold 2 3) down.

Count out loud 1 2 3 lift left foot (hold 2 3) down.”

If you wish to add dynamic balance have your students move forward in a lunge on beat four and then back to center. You can even teach your students to Walk Forward 2 3, Lunge (hold 2 3) Up, Walk Back 2 3, Lunge (hold 2 3) Up (return to ready position).

There are so many variations here, use your creativity!

“Wow! That took a lot of focus, good work, now our brains and bodies are primed for our next activity.”

#3: Apply Rhythm in Sport

Action: Teach a motor activity such as a soccer kick or bouncing a playground ball in 4/4 time.

Why: When children learn new motor skills it is easier if they do so in rhythmic time. You can teach a student how to bounce a ball, hit a ball with a racquet, or kick a ball all in rhythm. The cool thing is that once your students become used to moving rhythmically, then they can change things up. The rhythm is simply the scaffold the body relies on to learn the skill.

EXAMPLE: SOCCER

How: Soccer – If you are teaching a foundational soccer kick do so in time.

“Kids, we are going to learn how to kick a soccer ball. When we think about the steps they include: Stand on your non-dominant leg (balance), swing your dominant leg back (dynamic balance) and follow-through to kick the ball. 

This sounds like: 1. Stand (balance) 2. Extend leg back 3. Swing the leg through to kick the ball. See, it’s easy as 1 2 3, then rest.”

“Let’s try each step together.”

Count 1: Balance on your non-dominant leg.

Count 2: Extend your dominant leg back.

Count 3: Swing your dominant leg through to kick the ball.

Count 4: Rest

EXAMPLE: BALL BOUNCE

How: Ball Bounce – The same is true for bouncing a playground ball In Time.

Count 1: Hold the ball with two hands.

Count 2: Push the ball in a vertical path toward the ground.

Count 3: Catch the ball with both hands.

Count 4: Pause (rest).

Children need to experience the “felt-sense” of the pause when they are learning a new skill, so take that moment to teach them to “pause or rest” before they initiate the skill again.

A Few Quick Tips:

• When children are learning to move in time with rhythm it helps for them to count and say what they are doing OUT LOUD together as a team. This action leads to better social cohesion. It also activates biological entrainment which supports the students who may be having difficulty moving and speaking in synchronization.
• Feel free to SLOW Down. If moving (quickly) at 85-120 beats per minute is a challenge, encourage the students to perform the movements (slowly) at half-time 50-85 beats per minute until they get experienced with tempo, timing, and rhythm.
• Have fun with this process, it can be new to students. Encourage them to use their creativity, perhaps on beat four they choose a new movement together like a Superman position or a Clap/Clap, increasing the cognitive demands of the activities while feeling empowered and playful.
• Use your knowledge. You are experienced teachers. Change things up. Add rhythm to other activities you do. All you need is 2-3 minutes of rhythmic coordinative movement at a time to prime your students’ brains for learning.

Conclusion:

Physical education class is the perfect place to develop the foundational skills that precede learning. Research shows that children have lost competencies in vestibular abilities, proprioceptive awareness, motor rhythm, tempo, and timing. When you incorporate what the body biologically knows well, rhythm and timing, motor and cognitive skills develop with greater ease. Importantly, you, as a physical education teacher, contribute in a meaningful way to the skills that underlie your student’s academic achievement.

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Committee on Physical Activity and Physical Education in the School Environment; Food and Nutrition Board; Institute of Medicine; Kohl HW III, Cook HD, editors. Educating the Student Body: Taking Physical Activity and Physical Education to School. Washington (DC): National Academies Press (US); 2013 Oct 30.

Educating the Student Body: Taking Physical Activity and Physical Education to School.

• Hardcopy Version at National Academies Press

3 Physical Activity and Physical Education: Relationship to Growth, Development, and Health

Key messages.

• Regular physical activity promotes growth and development and has multiple benefits for physical, mental, and psychosocial health that undoubtedly contribute to learning.
• Specifically, physical activity reduces the risk for heart disease, diabetes mellitus, osteoporosis, high blood pressure, obesity, and metabolic syndrome; improves various other aspects of health and fitness, including aerobic capacity, muscle and bone strength, flexibility, insulin sensitivity, and lipid profiles; and reduces stress, anxiety, and depression.
• Physical activity can improve mental health by decreasing and preventing conditions such as anxiety and depression, as well as improving mood and other aspects of well-being.
• Physical activity programming specifically designed to do so can improve psychosocial outcomes such as self-concept, social behaviors, goal orientation, and most notably self-efficacy. These attributes in turn are important determinants of current and future participation in physical activity.
• Sedentary behaviors such as sitting and television viewing contribute to health risks both because of and independently of their impact on physical activity.
• Health-related behaviors and disease risk factors track from childhood to adulthood, indicating that early and ongoing opportunities for physical activity are needed for maximum health benefit.
• To be effective, physical activity programming must align with the predictable developmental changes in children's exercise capacity and motor skills, which affect the activities in which they can successfully engage.
• Frequent bouts of physical activity throughout the day yield short-term benefits for mental and cognitive health while also providing opportunities to practice skills and building confidence that promotes ongoing engagement in physical activity.
• Distinct types of physical activity address unique health concerns and contribute in distinct ways to children's health, suggesting that a varied regimen including aerobic and resistance exercise, structured and unstructured opportunities, and both longer sessions and shorter bouts will likely confer the greatest benefit.

The behaviors and traits of today's children, along with their genetics, are determinants of their growth and development; their physical, mental, and psychosocial health; and their physical, cognitive, and academic performance. Technological advances of modern society have contributed to a sedentary lifestyle that has changed the phenotype of children from that of 20 years ago. Children today weigh more and have a higher body mass index (BMI) than their peers of just a generation earlier ( Ogden et al., 2012 ). Behaviorally, most children fail to engage in vigorous- or moderate-intensity physical activity for the recommended 60 minutes or more each day, with as many as one-third reporting no physical activity in the preceding 5 days ( CDC, 2012 ). This lack of participation in physical activity has contributed to a greater prevalence of pediatric obesity, a decrease in fitness (e.g., flexibility, muscular strength, cardiorespiratory capacity), and a greater risk for disease ( Boreham and Riddoch, 2001 ; Eisenmann, 2003 ; Malina, 2007 ; Steele et al., 2008 ). (See Box 3-1 for an overview of the relationship between physical activity and physical fitness.)

Physical Activity and Physical Fitness. As noted in Chapter 1 (see the box titled “Key Terms Used in This Report” on p. 17), physical activity, a behavior, is defined as bodily movement that increases energy expenditure, whereas fitness (more...)

While more can always be learned, the evidence for the health benefits of physical activity is irrefutable ( HHS, 1996 , 2008 ). Adults engaged in regular physical activity have lower rates of chronic disease (e.g., coronary heart disease, cardiovascular disease, type 2 diabetes, hypertension, osteoporosis, and some cancers) and are less likely to die prematurely ( HHS, 1996 , 2008 ; Bauman, 2004 ). And while the ill effects of chronic disease are manifested mainly in adults, it is increasingly better understood that the development of these conditions starts in childhood and adolescence ( Hallal et al., 2006 ; Cook et al., 2009 ; Halfon et al., 2012 ). It appears evident, then, that promotion of health-enhancing behaviors must also start early in life. Indeed, growing evidence points to long-term effects of child and adolescent physical activity on adult morbidity and mortality in addition to its more immediate effects ( Hallal et al., 2006 ) (see Figure 3-1 ).

Conceptual model of how physical activity in childhood and adolescence is beneficial to health. Physical activity has both immediate and long-term health benefits: (a) Physical activity tends to track; early physical activity is associated with physical (more...)

Evidence for both direct and indirect health effects of physical activity has been reported ( Hallal et al., 2006 ), and the need for ongoing participation in physical activity to stimulate and maintain the chronic adaptations that underlie those benefits is well documented. To understand the relationship of physical activity and aerobic fitness to health during childhood, it is important first to recognize the developmental changes that occur throughout maturation. During the early stages of adolescence, for example, participation in physical activity and corresponding physical fitness begin to decline ( Duncan et al., 2007 ). Such differences across stages of development highlight the importance of examining the effects of growth and maturation on physical and cognitive health. Accordingly, this chapter reviews how physical activity may influence developmental processes and other aspects of somatic growth and maturation. A complete review of the effects of physical activity on all tissues and systems is beyond the scope of this report. Rather, the focus is on components of body composition and systems that underlie engagement in physical activity, physical fitness, and chronic disease risk and that in turn influence other aspects of health and academic performance (discussed in Chapter 4 ). Addressed in turn is the relationship between physical activity and physical, psychosocial, and mental health. Structural and functional brain maturation and how physical activity may influence those developmental processes and cognitive health are also reviewed in Chapter 4 .

• PHYSICAL HEALTH

This section reviews what is known about the relationship between physical activity and (1) somatic growth, development, and function and (2) health- and performance-related fitness.

Somatic Growth, Development, and Function

Growth occurs through a complex, organized process characterized by predictable developmental stages and events. Although all individuals follow the same general course, growth and maturation rates vary widely among individuals. Just as it is unrealistic to expect all children at the same age to achieve the same academic level, it is unrealistic to expect children at the same age to have the same physical development, motor skills, and physical capacity. Regular physical activity does not alter the process of growth and development. Rather, developmental stage is a significant determinant of motor skills, physical capacity, and the adaptation to activity that is reasonable to expect (see Box 3-2 ).

Growth, Development, and Maturation. Growth is the normal process of increase in size as a result of accretion of tissues characteristic of the organism; growth is the dominant biological activity for most of the first two decades of life. Changes in (more...)

Developmental Stages

Postnatal growth is commonly divided into three or four age periods. Infancy spans the first year of life. Childhood extends from the end of infancy to the start of adolescence and is often divided into early childhood, which includes the preschool years, and middle childhood, which includes the elementary school years, into the 5th or 6th grade. Adolescence is more difficult to define because of variation in its onset and termination, although it is commonly defined as between 10 and 18 years of age ( WHO, 1986 ). The rapid growth and development of infancy continue during early childhood, although at a decelerating rate, whereas middle childhood is a period of slower, steady growth and maturation. Differences between boys and girls are relatively small until adolescence, which is marked by accelerated growth and attainment of sexual maturity ( Tanner, 1962 ).

Across developmental stages, neurological development and control of movement advance in cephalocaudal and proximodistal directions; that is, they advance “head to toe” (cephalocaudal) and “midline to periphery” (proximodistal), while predictable changes in body proportions also occur. For example, the head accounts for 25 percent of recumbent length in an infant and only 15 percent of adult height, while the legs account for 38 percent of recumbent length at birth and 50 percent of adult height. These changes in body proportions occur because body parts grow at different rates. From birth to adulthood, as the head doubles in size, the trunk triples in length, and arm and leg lengths quadruple.

Coincident with these changes in body proportions, and in part because of them, the capacity to perform various motor tasks develops in a predictable fashion. For example, running speed increases are consistent with the increase in leg length. Neurological development also determines skill progression. Young children, for example, when thrown a ball, catch it within the midline of the body and do not attempt to catch it outside the midline or to either side of the body. As proximodistal development proceeds, children are better able to perform tasks outside their midline, and by adolescence they are able to maneuver their bodies in a coordinated way to catch objects outside the midline with little effort.

Physically active and inactive children progress through identical stages. Providing opportunities for young children to be physically active is important not to affect the stages but to ensure adequate opportunity for skill development. Sound physical education curricula are based on an understanding of growth patterns and developmental stages and are critical to provide appropriate movement experiences that promote motor skill development ( Clark, 2005 ). The mastery of fundamental motor skills is strongly related to physical activity in children and adolescents ( Lubans et al., 2010 ) and in turn may contribute to physical, social, and cognitive development. Mastering fundamental motor skills also is critical to fostering physical activity because these skills serve as the foundation for more advanced and sport-specific movement ( Clark and Metcalfe, 2002 ; Hands et al., 2009 ; Robinson and Goodway, 2009 ; Lubans et al., 2010 ). Physical activity programs, such as physical education, should be based on developmentally appropriate motor activities to foster self-efficacy and enjoyment and encourage ongoing participation in physical activity.

Biological Maturation

Maturation is the process of attaining the fully adult state. In growth studies, maturity is typically assessed as skeletal, somatic, or sexual. The same hormones regulate skeletal, somatic, and sexual maturation during adolescence, so it is reasonable to expect the effect of physical activity on these indicators of maturity to be similar. Skeletal maturity is typically assessed from radiographs of the bones in the hand and wrist; it is not influenced by habitual physical activity. Similarly, age at peak height velocity (the most rapid change in height), an indicator of somatic maturity, is not affected by physical activity, nor is the magnitude of peak height velocity, which is well within the usual range in both active and inactive youth. Discussions of the effects of physical activity on sexual maturation more often focus on females than males and, in particular, on age at menarche (first menses). While some data suggest an association between later menarche and habitual physical activity ( Merzenich et al., 1993 ), most of these data come from retrospective studies of athletes ( Clapp and Little, 1995 ). Whether regular sports training at young ages before menarche “delays” menarche (later average age of menarche) remains unclear. While menarche occurs later in females who participate in some sports, the available data do not support a causal relationship between habitual physical activity and later menarche.

Puberty is the developmental period that represents the beginning of sexual maturation. It is marked by the appearance of secondary sex characteristics and their underlying hormonal changes, with accompanying sex differences in linear growth and body mass and composition. The timing of puberty varies, beginning as early as age 8 in girls and age 9 in boys in the United States and as late as ages 13-15 ( NRC/IOM, 1999 ). Recent research suggests that the onset of puberty is occurring earlier in girls today compared with the previous generation, and there is speculation that increased adiposity may be a cause ( Bau et al., 2009 ; Rosenfield et al., 2009 ). Conversely, some data suggest that excess adiposity in boys contributes to delayed sexual maturation ( Lee et al., 2010 ). Pubescence, the earliest period of adolescence, generally occurs about 2 years in advance of sexual maturity. Typically, individuals are in the secondary school years during this period, which is a time of decline in habitual physical activity, especially in girls. Physical activity trends are influenced by the development of secondary sex characteristics and other physical changes that occur during the adolescent growth spurt, as well as by societal and cultural factors. Research suggests that physical inactivity during adolescence carries over into adulthood ( Malina, 2001a , b ; CDC, 2006 ).

It is critical that adolescents be offered appropriate physical activity programs that take into account the physical and sociocultural changes they are experiencing so they will be inspired to engage in physical activity for a lifetime. As discussed below, adequate physical activity during puberty may be especially important for optimal bone development and prevention of excess adiposity, as puberty is a critical developmental period for both the skeleton and the adipose organ.

Adolescence is the transitional period between childhood and adulthood. The adolescent growth spurt, roughly 3 years of rapid growth, occurs early in this period. An accelerated increase in stature is a hallmark, with about 20 percent of adult stature being attained during this period. Along with the rapid increase in height, other changes in body proportions occur that have important implications for sports and other types of activities offered in physical education and physical activity programs. As boys and girls advance through puberty, for example, biacromial breadth (shoulder width) increases more in boys than in girls, while increases in bicristal breadth (hip width) are quite similar. Consequently, hip-shoulder width ratio, which is similar in boys and girls during childhood, decreases in adolescent boys while remaining relatively constant in girls ( Malina et al., 2004 ). Ratios among leg length, trunk length, and stature also change during this period. Prior to adolescence, boys have longer trunks and shorter legs than girls ( Haubenstricker and Sapp, 1980 ). In contrast, adolescent and adult females have shorter legs for the same height than males of equal stature. Body proportions, particularly skeletal dimensions, are unlikely to be influenced by physical activity; rather, body proportions influence performance success, fitness evaluation, and the types of activities in which a person may wish to engage. For example, there is evidence that leg length influences upright balance and speed ( Haubenstricker and Sapp, 1980 ). Individuals who have shorter legs and broader pelvises are better at balancing tasks than those with longer legs and narrower pelvises, and longer legs are associated with faster running times ( Dintiman et al., 1997 ). Also, longer arms and wider shoulders are advantageous in throwing tasks ( Haubenstricker and Sapp, 1980 ), as well as in other activities in which the arms are used as levers. According to Haubenstricker and Sapp (1980) , approximately 25 percent of engagement in movement-related activities can be attributed to body size and structure.

Motor Development

Motor development depends on the interaction of experience (e.g., practice, instruction, appropriate equipment) with an individual's physical, cognitive, and psychosocial status and proceeds in a predictable fashion across developmental periods. Clark and Metcalfe (2002) provide an eloquent metaphor—“the mountain of motor development”—to aid in understanding the global changes seen in movement across the life span. Early movements, critical for an infant's survival, are reflexive and dominated by biology, although environment contributes and helps shape reflexes. This initial reflexive period is followed quickly by the preadapted period , which begins when an infant's movement behaviors are no longer reflexive and ends when the infant begins to apply basic movement skills (e.g., crawling, rolling, standing, and walking) that generally are accomplished before 12 months of age. The period of fundamental motor patterns occurs approximately between the ages of 1 and 7 years, when children begin to acquire basic fundamental movement skills (e.g., running, hopping, skipping, jumping, leaping, sliding, galloping, throwing, catching, kicking, dribbling, and striking). Practice and instruction are key to learning these skills, and a great deal of time in elementary school physical education is devoted to exploration of movement. Around age 7, during the so-called context-specific period of motor development, children begin to refine basic motor skills and combine them into more specific movement patterns, ultimately reaching what has been called skillfulness . Compensation , the final period of motor development, occurs at varying points across the life span when, as a result of aging, disease, injury, or other changes, it becomes necessary to modify movement.

While all children need not be “expert” in all movement skills, those who do not acquire the fundamental motor skills will likely experience difficulty in transitioning their movement repertoire into specific contexts and engagement in physical activity ( Fisher et al., 2005 ; Barnett et al., 2009 ; Cliff et al., 2009 ; Robinson et al., 2012 ). A full movement repertoire is needed to engage in physical activities within and outside of the school setting. Thus, beyond contributing to levels of physical activity, physical education programs should aim to teach basic fundamental motor skills and their application to games, sports, and other physical activities, especially during the elementary years (i.e., the fundamental motor patterns and context-specific periods). At the same time, it is important to be mindful of the wide interindividual variation in the rate at which children develop motor skills, which is determined by their biological makeup, their rate of physical maturation, the extent and quality of their movement experiences, and their family and community environment.

An increasing amount of evidence suggests that people who feel competent in performing physical skills remain more active throughout their lives ( Lubans et al., 2010 ). Conversely, those who are less skilled may be hesitant to display what they perceive as a shortcoming and so may opt out of activities requiring higher levels of motor competence ( Stodden et al., 2008 ). Children who are less physically skillful tend to be less active than their skillful counterparts ( Wrotniak et al., 2006 ; Williams et al., 2008 ; Robinson et al., 2012 ) and thus have a greater risk of overweight and obesity ( Graf et al., 2004 ). Fundamental skills are the building blocks of more complex actions that are completed in sports, physical activities, and exercise settings. For example, throwing is a fundamental skill that is incorporated into the context-specific throw used in activities such as handball, softball, and water polo. Fundamental skills are of primary interest to both physical education teachers and coaches, and physical education classes should be designed to challenge learners to develop their motor skills.

In 1998 the Centers for Disease Control and Prevention's (CDC's) Division of Nutrition and Physical Activity organized a workshop to determine future directions for research on physical activity. The workshop convened 21 experts from a wide range of academic disciplines. One recommendation resulting from the proceedings was for future research to describe the temporal relationship between motor development and physical activity ( Fulton et al., 2001 ), signifying the importance of better understanding of the nature of the relationship between motor competence and physical activity. The assumption of this relationship is implied in multiple models of motor development ( Seefeldt, 1980 ; Clark and Metcalfe, 2002 ; Stodden et al., 2008 ), which emphasize the importance of motor competence as a prerequisite for engagement in physical activity throughout the life span.

Two models that are commonly used to examine this relationship are Seefeldt's (1980) hierarchical order of motor skills development and the dynamic association model of Stodden and colleagues (2008) . Seefeldt proposed a hierarchical order of motor skills development that includes four levels: reflexes, fundamental motor skills, transitional motor skills (i.e., fundamental motor skills that are performed in various combinations and with variations and that are required to participate in entry-level organized sports, such as throwing for distance, throwing for accuracy, and/or catching a ball while in motion), and specific sports skills and dances. With improved transitional motor skills, children are able to master complex motor skills (e.g., those required for playing more complex sports such as football or basketball). At the end of this developmental period, children's vision is fully mature. The progression through each level occurs through developmental stages as a combined result of growth, maturation, and experience. Seefeldt hypothesized the existence of a “proficiency barrier” between the fundamental and transitional levels of motor skills development. If children are able to achieve a level of competence above the proficiency barrier, they are more likely to continue to engage in physical activity throughout the life span that requires the use of fundamental motor skills. Conversely, less skilled children who do not exceed the proficiency barrier will be less likely to continue to engage in physical activity. Thus, it is assumed that “a confident and competent mover will be an active mover” ( Clark, 2005 , p. 44). For example, to engage successfully in a game of handball, baseball, cricket, or basketball at any age, it is important to reach a minimum level of competence in running, throwing, catching, and striking. The assumption of the existence of a relationship between motor competence and physical activity is at the “heart of our physical education programs” ( Clark, 2005 , p. 44). A thorough understanding of how this relationship changes across developmental stages is crucial for curriculum development and delivery and teaching practices.

Lubans and colleagues (2010) recently examined the relationship between motor competence and health outcomes. They reviewed 21 studies identifying relationships between fundamental motor skills and self-worth, perceived physical competence, muscular and cardiorespiratory fitness, weight status, flexibility, physical activity, and sedentary behavior. Overall, the studies found a positive association between fundamental motor skills and physical activity in children and adolescents, as well as a positive relationship between fundamental motor skills and cardiorespiratory fitness. Other research findings support the hypothesis that the most physically active preschool-age ( Fisher et al., 2005 ; Williams et al., 2008 ; Robinson et al., 2012 ), elementary school–age ( Bouffard et al., 1996 ; Graf et al., 2004 ; Wrotniak et al., 2006 ; Hume et al., 2008 ; Lopes et al., 2011 ), and adolescent ( Okely et al., 2001 ) youth are also the most skilled.

An advantage of the “proficiency barrier” hypothesis proposed by Seefeldt (1980) is its recognition that the relationship between motor competence and physical activity may not be linear. Rather, the hypothesis suggests that physical activity is influenced when a certain level of motor competence is not achieved and acknowledges that below the proficiency barrier, there is bound to be substantial variation in children's motor competence and participation in physical activity. The proficiency barrier is located between the fundamental and transitional motor skills periods. The transition between these two levels of motor competence is expected to occur between the early and middle childhood years. Stodden and colleagues (2008) suggest that the relationship between motor competence and physical activity is dynamic and changes across time. In their model the “development of motor skill competence is a primary underlying mechanism that promotes engagement in physical activity” (p. 290).

The relationship between skills and physical activity is considered reciprocal. It is expected that as motor skills competence increases, physical activity participation also increases and that the increased participation feeds back into motor skills competence. The reciprocal relationship between motor skills competence and physical activity is weak during the early childhood years (ages 2-8) because of a variety of factors, including environmental conditions, parental influences, and previous experience in physical education programs ( Stodden et al., 2008 ). Also, children at this age are less able to distinguish accurately between perceived physical competence and actual motor skills competence ( Harter and Pike, 1984 ; Goodway and Rudisill, 1997 ; Robinson and Goodway, 2009 ; Robinson, 2011 ), and thus motor skills are not expected to strongly influence physical activity. The literature supports this hypothesis, as indicated by low to moderate correlations between motor skills competence and physical activity in preschool ( Sääkslahti et al., 1999 ; Williams et al., 2008 ; Cliff et al., 2009 ; Robinson and Goodway, 2009 ; Robinson, 2011 ) and early elementary school–age ( Raudsepp and Päll, 2006 ; Hume et al., 2008 ; Morgan et al., 2008 ; Houwen et al., 2009 ; Ziviani et al., 2009 ; Lopes et al., 2011 ) children.

In older children, perceived competence is more closely related to actual motor skills competence. Older, low-skilled children are aware of their skills level and are more likely to perceive physical activity as difficult and challenging. Older children who are not equipped with the necessary skills to engage in physical activity that requires high levels of motor skills competence may not want to display their low competence publicly. As children transition into adolescence and early adulthood, the relationship between motor skills competence and physical activity may strengthen ( Stodden et al., 2008 ). Investigators report moderate correlations between motor skills competence and physical activity in middle school–age children ( Reed et al., 2004 ; Jaakkola et al., 2009 ). Okely and colleagues (2001) found that motor skills competence was significantly associated with participation in organized physical activity (i.e., regular and structured experiences related to physical activity) as measured by self-reports. A strength of the model of Stodden and colleagues (2008) is the inclusion of factors related to psychosocial health and development that may influence the relationship between motor skills competence and physical activity, contributing to the development and maintenance of obesity. Other studies have found that perceived competence plays a role in engagement in physical activity ( Ferrer-Caja and Weiss, 2000 ; Sollerhed et al., 2008 ).

Motor skills competence is an important factor; however, it is only one of many factors that contribute to physical activity. For instance, three studies have reported negative correlations between girls' motor competence and physical activity ( Reed et al., 2004 ; Cliff et al., 2009 ; Ziviani et al., 2009 ), suggesting that sex may be another determining factor. A possible explanation for these findings is that since girls tend to be less active than boys, it may be more difficult to detect differences in physical activity levels between high- and low-skilled girls. It is also possible that out-of-school opportunities for physical activity are more likely to meet the interests of boys, which may at least partially explain sex differences in physical activity levels ( Le Masurier et al., 2005 ). Previous research suggests that in general boys are more motor competent than girls ( Graf et al., 2004 ; Barnett et al., 2009 ; Lopes et al., 2011 ) and that this trend, which is less apparent in early childhood, increases through adolescence ( Thomas and French, 1985 ; Thomas and Thomas, 1988 ; Thomas, 1994 ), although one study reports that girls are more motor competent than boys ( Cliff et al., 2009 ).

One component of motor competence is the performance of gross motor skills, which are typically classified into object control and locomotor skills. Consistent evidence suggests that boys are more competent in object control skills, while girls are more competent in locomotor skills ( McKenzie et al., 2004 ; Morgan et al., 2008 ; Barnett et al., 2009 ). In light of these sex differences, it is important to examine the relationships of object control and locomotor skills with physical activity separately for boys and girls. For boys, object control skills are more related to physical activity than are locomotor skills ( Hume et al., 2008 ; Morgan et al., 2008 ; Williams et al., 2008 ; Cliff et al., 2009 ), whereas evidence suggests that the reverse is true for girls ( McKenzie et al., 2002 ; Hume et al., 2008 ; Cliff et al., 2009 ; Jaakkola et al., 2009 ). Three studies report a significant relationship between balance and physical activity for girls but not boys ( Reed et al., 2004 ; Ziviani et al., 2009 ). Cliff and colleagues (2009) suggest that object control and locomotor skills may be more related to boys' and girls' physical activity, respectively, because of the activity type in which each sex typically engages.

The relationship between motor competence and physical activity clearly is complex. It is quite likely that the relationship is dynamic and that motor competence increases the likelihood of participating in physical activity while at the same time engaging in physical activity provides opportunities to develop motor competence ( Stodden et al., 2008 ). Despite some uncertainty, the literature does reinforce the important role of physical education in providing developmentally appropriate movement opportunities in the school environment. These opportunities are the only means of engaging a large population of children and youth and providing them with the tools and opportunities that foster health, development, and future physical activity.

Regular physical activity has no established effect on linear growth rate or ultimate height ( Malina, 1994 ). Although some studies suggest small differences, factors other than physical activity, especially maturity, often are not well controlled. It is important to note that regular physical activity does not have a negative effect on stature, as has sometimes been suggested. Differences in height among children and adolescents participating in various sports are more likely due to the requirements of the sport, selection criteria, and interindividual variation in biological maturity than the effects of participation per se ( Malina et al., 2004 ).

Body Weight

Although physical activity is inversely related to weight, correlations are generally low (~r–0.15), and differences in body weight between active and inactive boys and girls tend to be small ( Mirwald and Bailey, 1986 ; Saris et al., 1986 ; Beunen et al., 1992 ; Lohman et al., 2006 ;), except in very obese children and adolescents. Similarly, physique, as represented in somatotypes, does not appear to be significantly affected by physical activity during growth ( Malina et al., 2004 ). In contrast, components of weight can be influenced by regular physical activity, especially when the mode and intensity of the activity are tailored to the desired outcome. Much of the available data in children and adolescents is based on BMI, a surrogate for composition, and indirect methods based on the two-compartment model of body composition in which body weight is divided into its fat-free and fat components ( Going et al., 2012 ). While studies generally support that physical activity is associated with greater fat-free mass and lower body fat, distinguishing the effects of physical activity on fat-free mass from expected changes associated with growth and maturation is difficult, especially during adolescence, when both sexes have significant growth in fat-free mass. The application of methods based on the two-compartment model is fraught with errors, especially when the goal is to detect changes in fat-free mass, and no information is available from these methods regarding changes in the major tissue components of fat-free mass—muscle and skeletal tissue.

Skeletal muscle is the largest tissue mass in the body. It is the main energy-consuming tissue and provides the propulsive force for movement. Muscle represents about 23-25 percent of body weight at birth and about 40 percent in adults, although there is a wide range of “normal” ( Malina, 1986 , 1996 ). Postnatal muscle growth is explained largely by increases in cell size (hypertrophy) driving an increase in overall muscle mass. The increase in muscle mass with age is fairly linear from young childhood until puberty, with boys having a small but consistent advantage ( Malina, 1969 , 1986 ). The sex difference becomes magnified during and after puberty, driven primarily by gender-related differences in sex steroids. Muscle, as a percentage of body mass, increases from about 42 percent to 54 percent in boys between ages 5 and 11, whereas in girls it increases from about 40 percent to 45 percent between ages 5 and 13 and thereafter declines ( Malina et al., 2004 ). It should be noted that absolute mass does not decline; rather, the relative decline reflects the increase in the percentage of weight that is fat in girls. At least part of the sex difference is due to differences in muscle development for different body regions ( Tanner et al., 1981 ). The growth rate of arm muscle tissue during adolescence in males is approximately twice that in females, whereas the sex difference in the growth of muscle tissue in the leg is much smaller. The sex difference that develops during puberty persists into adulthood and is more apparent for the musculature of the upper extremities.

Sex-related differences in muscular development contribute to differences in physical performance. Muscle strength develops in proportion to the cross-sectional area of muscle, and growth curves for strength are essentially the same as those for muscle ( Malina and Roche, 1983 ). Thus the sex difference in muscle strength is explained largely by differences in skeletal muscle mass rather than muscle quality or composition. Aerobic (endurance) exercise has little effect on enhancing muscle mass but does result in significant improvement in oxygen extraction and aerobic metabolism ( Fournier et al., 1982 ). In contrast, numerous studies have shown that high-intensity resistance exercise induces muscle hypertrophy, with associated increases in muscle strength. In children and adolescents, strength training can increase muscle strength, power, and endurance. Multiple types of resistance training modalities have proven effective and safe ( Bernhardt et al., 2001 ), and resistance exercise is now recommended for enhancing physical health and function ( Behringer et al., 2010 ). These adaptations are due to muscle fiber hypertrophy and neural adaptations, with muscle hypertrophy playing a more important role in adolescents, especially in males. Prior to puberty, before the increase in anabolic sex steroid concentrations, neural adaptations explain much of the improvement in muscle function with exercise in both boys and girls.

The skeleton is the permanent supportive framework of the body. It provides protection for vital organs and is the main mineral reservoir. Bone tissue constitutes most of the skeleton, accounting for 14-17 percent of body weight across the life span ( Trotter and Peterson, 1970 ; Trotter and Hixon, 1974 ). Skeletal strength, which dictates fracture risk, is determined by both the material and structural properties of bone, both of which are dependent on mineral accrual. The relative mineral content of bone does not differ much among infants, children, adolescents, and adults, making up 63-65 percent of the dry, fat-free weight of the skeleton ( Malina, 1996 ). As a fraction of weight, bone mineral (the ash weight of bone) represents about 2 percent of body weight in infants and about 4-5 percent of body weight in adults ( Malina, 1996 ). Bone mineral content increases fairly linearly with age, with no sex difference during childhood. Girls have, on average, a slightly greater bone mineral content than boys in early adolescence, reflecting their earlier adolescent growth spurt. Boys have their growth spurt later than girls, and their bone mineral content continues to increase through late adolescence, ending with greater skeletal dimensions and bone mineral content ( Mølgaard et al., 1997 ). The increase in total body bone mineral is explained by both increases in skeletal length and width and a small increase in bone mineral density ( Malina et al., 2004 ).

Many studies have shown a positive effect of physical activity on intermediate markers of bone health, such as bone mineral content and density. Active children and adolescents have greater bone mineral content and density than their less active peers, even after controlling for differences in height and muscle mass ( Wang et al., 2004 ; Hind and Burrows, 2007 ; Tobias et al., 2007 ). Exercise interventions support the findings from observational studies showing beneficial effects on bone mineral content and density in exercise participants versus controls ( Petit et al., 2002 ; Specker and Binkley, 2003 ), although the benefit is less than is suggested by cross-sectional studies comparing active versus inactive individuals ( Bloomfield et al., 2004 ). The relationship between greater bone mineral density and bone strength is unclear, as bone strength cannot be measured directly in humans. Thus, whether the effects of physical activity on bone mineral density translate into similar benefits for fracture risk is uncertain ( Karlsson, 2007 ). Animal studies have shown that loading causes small changes in bone mineral content and bone mineral density that result in large increases in bone strength, supporting the notion that physical activity probably affects the skeleton in a way that results in important gains in bone strength ( Umemura et al., 1997 ). The relatively recent application of peripheral quantitative computed tomography for estimating bone strength in youth has also provided some results suggesting an increase in bone strength with greater than usual physical activity ( Sardinha et al., 2008 ; Farr et al., 2011 ).

The intensity of exercise appears to be a key determinant of the osteogenic response ( Turner and Robling, 2003 ). Bone tissue, like other tissues, accommodates to usual daily activities. Thus, activities such as walking have a modest effect at best, since even relatively inactive individuals take many steps (>1,000) per day. Activities generating greater muscle force on bone, such as resistance exercise, and “impact” activities with greater than ordinary ground reaction forces (e.g., hopping, skipping, jumping, gymnastics) promote increased mineralization and modeling ( Bloomfield et al., 2004 ; Farr et al., 2011 ). Far fewer randomized controlled trials (RCTs) examining this relationship have been conducted in children than in adults, and there is little evidence on dose response to show how the type of exercise interacts with frequency, intensity, and duration. Taken together, however, the available evidence supports beneficial effects of physical activity in promoting bone development ( Bailey et al., 1996 ; Modlesky and Lewis, 2002 ).

Physical activity may reduce osteoporosis-related fracture risk by increasing bone mineral accrual during development; by enhancing bone strength; and by reducing the risk of falls by improving muscle strength, flexibility, coordination, and balance ( Bloomfield et al., 2004 ). Early puberty is a key developmental period. Approximately 26 percent of the mineral content in the adult skeleton is accrued during the 2 years around the time of peak height velocity ( Bailey et al., 2000 ). This amount of mineral accrual represents approximately the same amount of bone mineral that most people will lose in their entire adult lives ( Arlot et al., 1997 ). The increase in mineral contributes to increased bone strength. Mineral is accrued on the periosteal surface of bone, such that the bone grows wider. Increased bone width, independent of the increased mineral mass, also contributes to greater bone strength. Indeed, an increase of as little as 1 mm in the outer surface of bone increases strength substantially. Adding bone to the endosteal surface also increases strength ( Parfitt, 1994 ; Wang et al., 2009 ). Increases in testosterone may be a greater stimulus of periosteal expansion than estrogen since testosterone contributes to wider and stronger bones in males compared with females. Retrospective studies in tennis players and gymnasts suggest structural adaptations may persist many years later in adulthood and are greatest when “impact” activity is initiated in childhood ( Kannus et al., 1995 ; Bass et al., 1998 ). RCTs on this issue are few, although the available data are promising ( McKay et al., 2000 ; Fuchs et al., 2001 ; MacKelvie et al., 2001 , 2003 ; Lindén et al., 2006 ). Thus, impact exercise begun in childhood may result in lasting structural changes that may contribute to increased bone strength and decreased fracture risk later in life ( Turner and Robling, 2003 ; Ferrari et al., 2006 ).

Adipose tissue

The adipose “organ” is composed of fat cells known as adipocytes ( Ailhaud and Hauner, 1998 ). Adipocytes are distributed throughout the body in various organs and tissues, although they are largely clustered anatomically in structures called fat depots, which include a large number of adipocytes held together by a scaffold-like structure of collagen and other structural molecules. In the traditional view of the adipocyte, the cell provides a storage structure for fatty acids in the form of triacylglycerol molecules, with fatty acids being released when metabolic fuel is needed ( Arner and Eckel, 1998 ). While adipocytes play this critical role, they are also involved in a number of endocrine, autocrine, and paracrine actions and play a key role in regulating other tissues and biological functions, for example, immunity and blood pressure, energy balance, glucose and lipid metabolism, and energy demands of exercise ( Ailhaud and Hauner, 1998 ; Frühbeck et al., 2001 ). The role of adipocytes in regulation of energy balance and in carbohydrate and lipid metabolism and the potential effects of physical activity on adipocyte function are of particular interest here, given growing concerns related to pediatric and adult obesity ( Ogden et al., 2012 ) and the associated risk of cardiometabolic disease ( Weiss et al., 2004 ; Eisenmann, 2007 a,b; Steele et al., 2008 ). Metabolic differences among various fat depots are now well known ( Frühbeck et al., 2001 ), and there is significant interest in the distribution of adipose tissue, the changes that occur during childhood and adolescence, and their clinical significance.

Adipocytes increase in size (hypertrophy) and number (hyperplasia) from birth through childhood and adolescence and into young adulthood to accommodate energy storage needs. The number of adipocytes has been estimated to increase from about 5 billion at birth to 30 billion to 50 billion in the nonobese adult, with an increase in average diameter from about 30-40 μm at birth to about 80-100 μm in the young adult ( Knittle et al., 1979 ; Bonnet and Rocour-Brumioul, 1981 ; Chumlea et al., 1982 ). In total the adipose organ contains about 0.5 kg of adipocytes at birth in both males and females, increasing to approximately 10 kg in average-weight-for-height males and 14 kg in females ( Malina et al., 2004 ). There is wide interindividual variation, however, and the difficulty of investigating changes in the number and size of adipocytes is obvious given the invasiveness of the required biopsy procedures; understandably, then, data on these topics are scarce in children and adolescents. Also, since only subcutaneous depots are accessible, results must be extrapolated from a few sites.

Based on such information, the average size of adipocytes has been reported to increase two- to threefold in the first year of life, with little increase in nonobese boys and girls until puberty ( Malina et al., 2004 ). A small increase in average adipocyte size at puberty is more obvious in girls than in boys. There is considerable variation in size across various subcutaneous sites and between subcutaneous and internal depots. The number of adipocytes is difficult to estimate. Available data suggest that the cellularity of adipose tissue does not increase significantly in early postnatal life ( Malina et al., 2004 ). Thus, gain in fat mass is the result of an increase in the size of existing adipocytes. From about 1-2 years of age and continuing through early and middle childhood, the number of adipocytes increases gradually two- to threefold. With puberty the number practically doubles, followed by a plateau in late adolescence and early adulthood. The number of adipocytes is similar in boys and girls until puberty, when girls experience a greater increase than boys.

The increases in the number of adipocytes during infancy and puberty are considered critical for enlargement of the adipose tissue organ and for the risk of obesity. Since size and number are linked, the number of adipocytes can potentially increase at any age if fat storage mechanisms are stimulated by chronic energy surfeit ( Hager, 1981 ; Chumlea et al., 1982 ). Energy expenditure through regular physical activity is a critical element in preventing energy surfeit and excess adiposity. While cellularity undoubtedly is strongly genetically determined, regular physical activity, through its contribution to energy expenditure, can contribute to less adipocyte hyperplasia by limiting hypertrophy.

Fat distribution

Fat distribution refers to the location of fat depots on the body. The metabolic activities of fat depots differ, and small variation can have a long-term impact on fat distribution. Differences in metabolic properties across depots also have clinical implications. Visceral adipose tissue in the abdominal cavity is more metabolically active (reflected by free fatty acid flux) than adipose tissue in other areas ( Arner and Eckel, 1998 ), and higher amounts of visceral adipose tissue are associated with greater risk of metabolic complications, such as type 2 diabetes and cardiovascular disease ( Daniels et al., 1999 ; He et al., 2007 ; Dencker et al., 2012 ). In contrast, subcutaneous fat, particularly in the gluteofemoral region, is generally associated with a lower risk of cardiometabolic disease. Age- and sex-associated variations in fat distribution contribute to age- and sex-associated differences in cardiometabolic disease prevalence. Girls have more subcutaneous fat than boys at all ages, although relative fat distribution is similar. After a rapid rise in subcutaneous fat in the first few months of life, both sexes experience a reduction through age 6 or 7 ( Malina and Roche, 1983 ; Malina and Bouchard, 1988 ; Malina, 1996 ). Girls then show a linear increase in subcutaneous fat, whereas boys show a small increase between ages 7 and 12 or 13 and then an overall reduction during puberty. The thickness of subcutaneous fat on the trunk is approximately one-half that of subcutaneous fat on the extremities in both boys and girls during childhood. The ratio increases with age in males during adolescence but changes only slightly in girls. In males the increasing ratio of trunk to extremity subcutaneous fat is a consequence of slowly increasing trunk subcutaneous fat and a decrease in subcutaneous fat on the extremities. In girls, trunk and extremity subcutaneous fat increase at a similar rate; thus the ratio is stable ( Malina and Bouchard, 1988 ). As a consequence, the sex difference in the distribution of body fat develops during adolescence. It is important to note that changes in subcutaneous fat pattern do not necessarily represent changes in abdominal visceral adipose tissue.

Tracking of subcutaneous fat has been investigated based on skinfold thicknesses and radiographs of fat widths in males and females across a broad age range ( Katzmarzyk et al., 1999 ; Campbell et al., 2012 ). Results indicate that subcutaneous fat is labile during early childhood. After age 7 to 8, correlations between subcutaneous fat in later childhood and adolescence and adult subcutaneous fat are significant and moderate. Longitudinal data on tracking of visceral adipose tissue are not available, but percent body fat does appear to track. Thus children and especially adolescents with higher levels of body fat have a higher risk of being overfat at subsequent examinations and in adulthood, although variation is considerable, with some individuals moving away from high fatness categories, while some lean children move into higher fatness categories.

In cross-sectional studies, active children and adolescents tend to have lower skinfold thicknesses and less overall body fat than their less active peers ( Loftin et al., 1998 ; Rowlands et al., 2000 ; Stevens et al., 2004 ; Lohman et al., 2006 ), although the correlations are modest, reflecting variation in body composition at different levels of physical activity, as well as the difficulty of measuring physical activity. Longitudinal studies indicate small differences in fatness between active and inactive boys and girls. Although some school-based studies of the effects of physical activity on body composition have reported changes in BMI or skinfolds in the desired direction ( Gortmaker et al., 1999 ; McMurray et al., 2002 ), most have not shown significant effects. High levels of physical activity are most likely needed to modify skinfold thicknesses and percent body fat. In adults, visceral adipose tissue declines with weight loss with exercise. In contrast, in a study of obese children aged 7-11, a 4-month physical activity program resulted in minimal change in abdominal visceral adipose tissue but a significant loss in abdominal subcutaneous adipose tissue ( Gutin and Owens, 1999 ). In adults, decreases in fatness with exercise are due to a reduction in fat cell size, not number ( You et al., 2006 ); whether this is true in children is not certain but appears likely. Given that adipocyte hypertrophy may trigger adipocyte hyperplasia ( Ballor et al., 1998 ), energy expenditure through regular physical activity may be important in preventing excess adipose tissue cellularity. Regular physical activity also affects adipose tissue metabolism so that trained individuals have an increased ability to mobilize and oxidize fat, which is associated with increased levels of lipolysis, an increased respiratory quotient, and a lower risk of obesity ( Depres and Lamarche, 2000 ).

Cardiorespiratory System

The ability to perform sustained activity under predominantly aerobic conditions depends on the capacity of the cardiovascular and pulmonary systems to deliver oxygenated blood to tissues and on the ability of tissues (primarily skeletal muscle) to extract oxygen and oxidize substrate. By age 2 the systems are fully functional, although young children lack the cardiorespiratory capacity of older children and adults because of their small size ( Malina et al., 2004 ). Children's aerobic capacity and consequently their ability to exercise for longer periods of time increase as they grow. Maximal aerobic power (liters per minute) increases fairly linearly in boys until about age 16, whereas it increases in girls until about age 13 and then plateaus during adolescence ( Malina et al., 2004 ; Eisenmann et al., 2011 ). Differences between boys and girls are small (~10 percent) during childhood and greater after the adolescent growth spurt, when girls have only about 70 percent of the mean value of boys. Changes with age and sex differences are explained largely by differences in the size of the relevant tissues. Dimensions of the heart and lungs enlarge with age in a manner consistent with the increase in body mass and stature ( Malina et al., 2004 ). The increase in the size of the heart is associated with increases in stroke volume (blood pumped per beat) and cardiac output (product of stroke volume and heart rate, liters per minute), despite a decline in heart rate during growth. Similarly, increase in lung size (proportional to growth in height) results in greater lung volume and ventilation despite an age-associated decline in breathing frequency. From about age 6 to adulthood, maximal voluntary ventilation approximately doubles (50–100 L/min) ( Malina et al., 2004 ). The general pattern of increase as a function of height is similar in boys and girls. In both, lung function tends to lag behind the increase in height during the adolescent growth spurt. As a result, peak gains in lung function occur about 2 years earlier in girls than in boys.

Blood volume is highly related to body mass and heart size in children and adolescents, and it is also well correlated with maximal oxygen uptake during childhood and adolescence ( Malina et al., 2004 ). Blood volume increases from birth through adolescence, following the general pattern for changes in body mass. Both red blood cells and hemoglobin have a central role in transport of oxygen to tissues. Hematocrit, the percentage of blood volume explained by blood cells, increases progressively throughout childhood and adolescence in boys, but only through childhood in girls. Hemoglobin content, which is related to maximal oxygen uptake, heart volume, and body mass, increases progressively with age into late adolescence. Males have greater hemoglobin concentrations than females, especially relative to blood volume, which has functional implications for oxygen transport during intense exercise.

Growth in maximal aerobic power is influenced by growth in body size, so controlling for changes in body size during growth is essential. Although absolute (liters per minute) aerobic power increases into adolescence relative to body weight, there is a slight decline in both boys and girls, suggesting that body weight increases at a faster rate than maximal oxygen consumption, particularly during and after the adolescent growth spurt ( Malina et al., 2004 ). Changes in maximal oxygen consumption during growth tend to be related more closely to fat-free mass than to body mass. Nevertheless, sex differences in maximal oxygen consumption per unit fat-free mass persist, and maximal oxygen consumption per unit fat-free mass declines with age.

Improvements in cardiorespiratory function—involving structural and functional adaptations in the lungs, heart, blood, and vascular system, as well as the oxidative capacity of skeletal muscle—occur with regular vigorous- and moderate-intensity physical activity ( Malina et al., 2004 ). Concern about the application of invasive techniques limits the available data on adaptations in the oxygen transport system in children. Nevertheless, it is clear that aerobic capacity in youth increases with activity of sufficient intensity and that maximal stroke volume, blood volume, and oxidative enzymes improve after exercise training ( Rowland, 1996 ). Training-induced changes in other components of the oxygen transport system remain to be determined.

Health- and Performance-Related Fitness

Physical fitness is a state of being that reflects a person's ability to perform specific exercises or functions and is related to present and future health outcomes. Historically, efforts to assess the physical fitness of youth focused on measures designed to evaluate the ability to carry out certain physical tasks or activities, often related to athletic performance. In more recent years, the focus has shifted to greater emphasis on evaluating health-related fitness ( IOM, 2012a ) and assessing concurrent or future health status. Health- and performance-related fitness, while overlapping, are different constructs. Age- and sex-related changes in the components of both are strongly linked to the developmental changes in tissues and systems that occur during childhood and adolescence. Although genetic factors ultimately limit capacity, environmental and behavioral factors, including physical activity, interact with genes to determine the degree to which an individual's full capacity is achieved.

Health-Related Fitness

Cardiorespiratory endurance, muscular strength and endurance, flexibility, and body composition are components of health-related fitness historically assessed in school-based fitness assessment programs ( IOM, 2012a ). These components of health-related fitness are considered important since they can be linked to the risk of cardiometabolic disease and musculoskeletal disability, chronic hypokinetic-related diseases.

Cardiorespiratory endurance

Cardiorespiratory (aerobic) endurance reflects the functioning of the pulmonary and cardiovascular systems to deliver oxygen and the ability of tissues (primarily skeletal muscle) to extract oxygen from the blood. Defined clinically as the maximum oxygen consumption during a maximal graded exercise test, in practice it is usually measured indirectly as performance on a field test of endurance, such as 1- or 2-mile run time ( IOM, 2012a ). During childhood, aerobic capacity approximately doubles in both boys and girls, although girls on average possess a lower capacity. Males continue to improve during adolescence, up to ages 17-18, while aerobic capacity plateaus around age 14 in females ( Malina et al., 2004 ), resulting in an approximately 20 percent difference between males and females ( Rowland, 2005 ).

Favorable associations have been found between aerobic endurance and high-density lipoproteins, systolic blood pressure, diastolic blood pressure, BMI, measures of fatness, arterial stiffness, and measures of insulin sensitivity ( Boreham et al., 2004 ; Imperatore et al., 2006 ; Hussey et al., 2007 ; Ondrak et al., 2007 ). Some evidence suggests a decline in aerobic endurance among U.S. youth in recent decades ( Eisenmann, 2003 ; Carnethon et al., 2005 ; Pate et al., 2006 ), coincident with increased sedentariness and obesity and a greater prevalence of metabolic syndrome in youth. Aerobic exercise has been shown to increase cardiorespiratory endurance by about 5-15 percent in youth ( Malina et al., 2004 ; HHS, 2008 ). The programs that produce this benefit involve continuous vigorous- or moderate-intensity aerobic activity of various types for 30-45 minutes per session at least 3 days per week over a period of at least 1-3 months ( Baquet et al., 2002 ); improvements are greater with more frequent exercise ( Baquet et al., 2003 ).

Muscle strength and endurance

Muscle strength is defined as the highest force generated during a single maximum voluntary contraction, whereas muscle endurance is the ability to perform repeated muscular contraction and force development over a period of time. Muscle strength and endurance are correlated, especially at higher levels of force production. Muscle strength is proportional to the cross-sectional area of skeletal muscle; consequently, strength growth curves parallel growth curves for body weight and skeletal muscle mass ( Malina et al., 2004 ).

Both males and females show impressive increases in muscle strength from childhood to adolescence. Strength in children increases linearly, with boys having a slight advantage over girls. However, these sex differences are magnified during the adolescent years as a result of maturation ( Malina and Roche, 1983 ). Differences in muscle strength between boys and girls become more apparent after puberty, primarily as a result of the production of sex steroid hormones. In boys the increase in strength during adolescence lags behind the growth spurt by at least a year (peak height velocity), which may explain why some boys experience a brief period of clumsiness or awkwardness during puberty, as they have not yet acquired the muscle strength necessary to handle the changes associated with their larger bodies. Muscle strength increases at its greatest rate approximately 1 year after peak height velocity in boys, whereas for girls the strength spurt generally occurs during the same year as peak height velocity ( Bar-Or, 1983 ).

A compelling body of evidence indicates that with resistance training children and adolescents can significantly increase their strength above that expected as a result of normal growth and maturation, provided that the training program is of sufficient intensity, volume, and duration ( Committee on Sports Medicine Fitness, 2001 ). Both boys and girls can benefit, and strength gains in children as young as 5-6 have been reported ( Faigenbaum et al., 2009 ), although most studies are of older children and adolescents. Gains in muscle strength of about 30 percent are typical, although considerably larger gains have been reported. Adolescents make greater gains than preadolescents in absolute strength, whereas reported relative (percent above initial strength) gains in strength during preadolescence and adolescence are similar. A variety of programs and modalities have proved efficacious ( Council on Sports Medicine Fitness, 2008 ), as long as load (~10-15 repetitions maximum) and duration (~8-20 weeks) are adequate. As in adults, training adaptations in youth are specific to the muscle action or muscle groups that are trained, and gains are transient if training is not maintained ( Faigenbaum et al., 2009 ).

Youth resistance training, as with most physical activities, does carry some degree of risk of musculoskeletal injury, yet the risk is no greater than that associated with other sports and activities in which children and adolescents participate ( Council on Sports Medicine Fitness, 2008 ; Faigenbaum et al., 2009 ) as long as age-appropriate training guidelines are followed. A traditional area of concern has been the potential for training-induced damage to growth cartilage, which could result in growth disturbances. However, a recent review found no reports of injury to growth cartilage in any prospective study of resistance training in youth and no evidence to suggest that resistance training negatively impacts growth and maturation during childhood and adolescence ( Faigenbaum et al., 2009 ). Injuries typically occur in unsupervised settings and when inappropriate loads and progressions are imposed.

In addition to the obvious goal of gaining strength, resistance training may be undertaken to improve sports performance and prevent injuries, rehabilitate injuries, and enhance health. Appropriately supervised programs emphasizing strengthening of trunk muscles in children theoretically benefit sport-specific skill acquisition and postural control, although these benefits are difficult to study and thus are supported by little empirical evidence ( Council on Sports Medicine Fitness, 2008 ). Similarly, results are inconsistent regarding the translation of increased strength to enhanced athletic performance in youth. Limited evidence suggests that strength-training programs that address common overuse injuries may help reduce injuries in adolescents, but whether the same is true in preadolescents is unclear ( Council on Sports Medicine Fitness, 2008 ). Increasing evidence suggests that strength training, like other forms of physical activity, has a beneficial effect on measurable health indices in youth, such as cardiovascular fitness, body composition, blood lipid profiles and insulin sensitivity ( Faigenbaum, 2007 ; Benson et al., 2008 ), bone mineral density and bone geometry ( Morris et al., 1997 ; MacKelvie et al., 2004 ), and mental health ( Holloway et al., 1988 ; Faigenbaum et al., 1997 ; Annesi et al., 2005 ; Faigenbaum, 2007 ). Some work has shown that muscle fitness, reflected in a composite index combining measures of muscle strength and endurance, and cardiorespiratory fitness are independently and negatively associated with clustered metabolic risk ( Steene-Johannessen et al., 2009 ). Moreover, children with low muscle strength may be at increased risk of fracture with exercise ( Clark et al., 2011 ). Finally, muscle hypertrophy, which adds to fat-free mass, contributes to resting metabolic rate and therefore total daily energy expenditure. Resistance training may be particularly useful for raising metabolic rate in overweight and obese children without the risk associated with higher-impact activities ( Watts et al., 2005 ; Benson et al., 2007 ).

Flexibility

Flexibility has been operationally defined as “the intrinsic property of body tissues, including muscle and connective tissues, that determines the range of motion achievable without injury at a joint or group of joints” ( IOM, 2012b , p. 190). At all ages, girls demonstrate greater flexibility than boys, and the difference is greatest during the adolescent growth spurt and sexual maturation. Perhaps the most common field measure of flexibility in children and youth is the sit-and-reach test ( IOM, 2012b ) of low-back flexibility. Low-back flexibility as measured by this test is stable in girls from age 5 to 11 and increases until late adolescence. In boys, low-back flexibility declines linearly starting at age 5, reaching its nadir at about age 12, and then increases into late adolescence. The unique pattern of age- and sex-associated variation is related to the growth of the lower extremities and the trunk during adolescence. In boys the nadir in low-back flexibility coincides with the adolescent growth spurt in leg length. In both boys and girls, the increase during adolescence coincides with the growth spurt in trunk length and arm length, which influences reach. Flexibility in both males and females tends to decline after age 17, in part as a result of a decline in physical activity and normal aging.

The principal health outcomes hypothesized to be associated with flexibility are prevention of and relief from low-back pain, prevention of musculoskeletal injury, and improved posture. These associations have been studied in adults, with equivocal results ( Plowman, 1992 ). Although flexibility has long been included in national youth fitness tests, it has proven difficult to establish a link between flexibility and health ( IOM, 2012a ). In contrast to other fitness components that are general or systemic in nature, flexibility is highly specific to each joint of the body. Although appropriate stretching may increase flexibility, establishing a link to improved functional capacity and fitness is difficult. A few studies suggest that improvements in flexibility as measured by the sit-and-reach test may be related to less low-back pain ( Jones et al., 2007 ; Ahlqwist et al., 2008 ), but the evidence is weak. Consequently, the Institute of Medicine (IOM) Committee on Fitness Measures and Health Outcomes in its recent report elected to forego recommending a flexibility test for a national youth fitness test battery pending further research to confirm the relationship between flexibility and health and to develop national normative data ( IOM, 2012a ).

Body composition

Body composition is the component of health-related fitness that relates to the relative amount of adipose tissue, muscle, bone, and other vital components (e.g., organs, connective tissues, fluid compartments) that make up body weight. Most feasible methods for assessing body composition are based on models that divide the body into fat and fat-free (all nonfat constituents) components ( Going et al., 2012 ). Although fat mass and adipose tissue are not equivalent components, fat mass is easier to estimate than adipose tissue, and it is correlated with performance and disease risk. In settings in which estimation of body fat is difficult, weight-for-height ratios often are used as surrogates for body composition. Indeed, definitions of pediatric overweight and obesity have been based on BMI, calculated as weight in kilograms divided by height squared. Child and adolescent obesity defined by BMI remains at all-time highs. Population surveys indicate that approximately 33 percent of all boys and girls are overweight, and nearly one in five are obese ( Ogden and Flegal, 2011 ). The tendency for excess fatness to persist from childhood and adolescence into adulthood ( Daniels et al., 2005 ), coupled with the strong association between obesity and chronic disease ( Weiss and Caprio, 2005 ; Barlow, 2007 ), has caused great concern for future obesity levels and the health of youth and adults alike ( IOM, 2005 , 2012b ).

The increase in prevalence of obesity is undoubtedly due to a mismatch between energy intake and expenditure. Population surveys have shown that few children and youth meet recommended levels of daily physical activity (see Chapter 2 ). Prospective studies have shown a significant and inverse relationship between habitual physical activity and weight gain ( Berkey et al., 2003 ), and in some studies physical activity is a better predictor of weight gain than estimates of calorie or fat intake ( Berkey et al., 2000 ; Janssen et al., 2005 ). These relationships are better established in adults than in children and youth, although even in preschool children, low levels of physical activity, estimated from doubly labeled water, were found to be indicative of higher body fat content ( Davies et al., 1995 ). While studies of exercise without caloric restriction generally show only small effects on body weight, significant albeit moderate reductions of body fat are generally reported ( Eisenmann, 2003 ). Moreover, even in the absence of significant weight loss, exercise has beneficial effects on risk factors for cardiometabolic disease ( Ross and Bradshaw, 2009 ; Gutin and Owens, 2011 ).

Body mass index

Changes in weight for height with growth and maturation for U.S. boys and girls are described in CDC growth curves ( Kuczmarski et al., 2000 ). Current growth curves were derived from U.S. population surveys conducted before the increase in weight for height that defines today's pediatric obesity epidemic. In boys and girls, BMI declines during early childhood, reaching its nadir at about ages 5-6, and then increases through adolescence. A gender difference emerges during puberty, with males gaining greater fat-free mass than females. Both the period of “adiposity rebound” (the increase in BMI in midchildhood following the decline in early childhood) and puberty are times of risk for excess fat gain that correlates with future adiposity ( Rolland-Cachera et al., 1984 ). Physical activity and BMI are inversely correlated in children and adolescents, although the correlations are modest ( Lohman et al., 2006 ), reflecting the difficulty of measuring physical activity, as well as variation in body composition and physical activity at a given weight ( Rowlands et al., 2000 ). Indeed, when studied separately, fat mass index (FMI, or fat mass divided by height squared) and fat-free mass index (FFMI, or fat-free mass divided by height squared) are both inversely related to physical activity. With FMI controlled, however, FFMI is positively related to physical activity, indicating that, for a given level of body fat, individuals with more fat-free mass are more active ( Lohman et al., 2006 ). BMI cut-points for defining overweight and obesity have historically been based on age- and gender-specific population distributions of BMI. Recent work has shown good correspondence between BMI standards and percent fat standards that are referenced to health criteria ( Laurson et al., 2011 ). These new standards should prove useful for identifying children and adolescents at risk for higher levels of cardiometabolic risk factors.

Percent body fat

Direct measures of body fat as a percent of weight provide a better index of adiposity and health risk than BMI ( Zeng et al., 2012 ), which is confounded by variation in lean tissue mass relative to height. Recently, percent fat growth curves were established for representative samples of U.S. boys and girls using National Health and Nutrition Examination Survey (NHANES) data ( Laurson et al., 2011 ; Ogden and Flegal, 2011 ). Median percent fat for boys aged 5-18 ranged from 14 to 19 percent and for girls across the same ages 15 to 28 percent. In both boys and girls, percent fat increases slowly during early childhood, with girls having a consistently greater relative fatness than boys after ages 5-6. In girls, percent fat increases gradually throughout adolescence in the same manner as fat mass. In boys, percent fat increases gradually until the adolescent growth spurt and thereafter gradually declines until about age 16-17, reflecting the rapid growth in fat-free mass relative to fat mass. After age 17, percent fat in males gradually increases again into adulthood.

The increased prevalence of child and adolescent obesity as defined by BMI presumably also reflects increased adiposity, although the degree is not certain as population-based estimates of percent fat have only recently been developed ( Laurson et al., 2011 ). Health-related percent fat standards recently were developed by determining levels of body fat associated with greater occurrence of chronic disease risk factors defined by metabolic syndrome ( Going et al., 2011 ). In boys and girls aged 12-18, body fat above 20-24 percent and above 27-31 percent, respectively, was predictive of metabolic syndrome.

Physical activity is inversely correlated with percent body fat ( Rowlands et al., 2000 ; Lohman et al., 2006 ), although the correlations are modest, and changes in overall fatness as well as subcutaneous adipose tissue with habitual physical activity are reasonably well documented in children and adolescents ( Gutin and Humphries, 1998 ; Gutin and Owens, 1999 ; Dionne et al., 2000 ). In youth, as in adults, the effects of exercise without caloric restriction are modest and are influenced by the initial level of body fat and the duration and regimen of exercise ( Going, 1999 ). Experimental studies have documented reductions in percent body fat with aerobic exercise, especially in children and adolescents who are overweight or obese at the initiation of an exercise program ( Davis et al., 2012 ). Regular physical activity also affects adipose tissue metabolism ( Gutin and Owens, 1999 ). Individuals who engage in aerobic endurance exercise training have an increased ability to mobilize and oxidize fat, which is associated with increased levels of lipolysis ( Depres and Lamarche, 2000 ). Similar information on adipose tissue metabolism in children and youth is lacking, although one can reasonably expect similar adaptations in older adolescents.

Metabolic syndrome

The tendency for risk factors for cardiometabolic disease to cluster, now called metabolic syndrome, is well recognized in adults ( Alberti and Zimmet, 1998 ). Similar clustering occurs in older children and especially adolescents ( Cook et al., 2003 ), and interest in metabolic syndrome has increased, driven by the increased prevalence of pediatric obesity and the increasing incidence and earlier onset of type 2 diabetes in youth. There is as yet no accepted definition of metabolic syndrome for use in pediatric populations ( Jolliffe and Janssen, 2007 ). Typically, adult definitions are extrapolated to children and adolescents, with appropriate adjustments of the thresholds for the defining variables. Perhaps the most common approach is to emulate the National Cholesterol Education Program (NCEP), which defines metabolic syndrome as exceeding thresholds on three of five components: waist circumference, blood pressure (systolic or diastolic), blood lipids (high-density lipoprotein [HDL] and triglycerides), and blood glucose levels ( NIH, 2001 ).

The concept of metabolic syndrome is useful as it provides an integrated index of risk, and it recently was used to derive health-related percent-body-fat standards ( Laurson et al., 2011 ). Based on NHANES data, the prevalence of metabolic syndrome varies with the degree of obesity, and it is estimated at 4-6 percent of children and adolescents ( Cook et al., 2003 ; Dubose et al., 2007 ); among obese youth it may be as high as 30-50 percent ( Weiss et al., 2004 ). Youth with metabolic syndrome have an increased risk of type 2 diabetes and cardiovascular disease. In adults a loss of 5-10 percent of body weight through calorie restriction and exercise has been shown to reduce the risk of cardiometabolic disease by improving risk factors ( Diabetes Prevention Program Research Group, 2002 ; Ross and Janiszewski, 2008 ). In particular, weight loss results in reduced visceral adipose tissue, a strong correlate of risk ( Knowler et al., 2002 ), as well as lower blood pressure and blood glucose levels due to improved insulin sensitivity. Even without significant weight loss, exercise can have significant effects in adults by improving glucose metabolism, improving lipid and lipoprotein profiles, and lowering blood pressure, particularly for those who are significantly overweight ( Ross and Bradshaw, 2009 ). Similar benefits have been observed in adolescents.

A growing body of literature addresses the associations of physical activity, physical fitness, and body fatness with the risk of metabolic syndrome and its components in children and especially adolescents ( Platat et al., 2006 ; McMurray et al., 2008 ; Rubin et al., 2008 ; Thomas and Williams, 2008 ; Christodoulos et al., 2012 ). Studies in adults have shown that higher levels of physical activity predict slower progression toward metabolic syndrome in apparently healthy men and women ( Laaksonen et al., 2002 ; Ekelund et al., 2005 ), an association that is independent of changes in body fatness and cardiorespiratory fitness ( Ekelund et al., 2007 ). Few population studies have focused on these relationships in children and adolescents, and the use of self-reported activity, which is imprecise in these populations, tends to obscure associations. In a large sample of U.S. adolescents aged 12-19 in the 1999–2002 NHANES, for example, there was a trend for metabolic syndrome to be more common in adolescents with low activity levels than in those with moderate or high activity levels, although the differences among groups were not statistically significant ( Pan and Pratt, 2008 ). Moreover, for each component of metabolic syndrome, prevalence was generally lower with higher physical activity levels, and adolescents with low physical activity levels had the highest rates of all metabolic syndrome components.

The association between cardiorespiratory fitness and metabolic syndrome also was examined in the 1999–2002 NHANES ( Lobelo et al., 2010 ). Cardiorespiratory fitness was measured as estimated peak oxygen consumption using a submaximal treadmill exercise protocol, and metabolic syndrome was represented as a “clustered score” derived from five established risk factors for cardiovascular disease, an adiposity index, insulin resistance, systolic blood pressure, triglycerides, and the ratio of total to HDL cholesterol. Mean clustered risk score decreased across increasing fifths (quintiles) of cardiorespiratory fitness in both males and females. The most significant decline in risk score was observed from the first (lowest) to the second quintile (53.6 percent and 37.5 percent in males and females, respectively), and the association remained significant in both overweight and normal-weight males and in normal-weight females. Other studies, using the approach of cross-tabulating subjects into distinct fitness and fatness categories, have examined associations of fitness and fatness with metabolic syndrome risk ( Eisenmann et al., 2005 , 2007a , b ; Dubose et al., 2007 ). Although different measures of fitness, fatness, and metabolic syndrome risk were used, the results taken together across a wide age range (7–18) show that fitness modifies the influence of fatness on metabolic syndrome risk. In both males and females, high-fit/low-fatness subjects have less metabolic syndrome risk than low-fit/high-fatness subjects ( Eisenmann, 2007 ).

That many adult chronic health conditions have their origins in childhood and adolescence is well supported ( Kannel and Dawber, 1972 ; Lauer et al., 1975 ; Berenson et al., 1998 ; IOM, 2004 ). Both biological (e.g., adiposity, lipids) and behavioral (e.g., physical activity) risk factors tend to track from childhood and especially adolescence into adulthood. Childhood BMI is related to adult BMI and adiposity ( Guo et al., 1994 , 2000 ; Freedman et al., 2005 ), and as many as 80 percent of obese adolescents become obese adults ( Daniels et al., 2005 ). Coexistence of cardiometabolic risk factors, even at young ages ( Dubose et al., 2007 ; Ramírez-Vélez et al., 2012 ), has been noted, and these components of metabolic syndrome also have been shown to track to adulthood ( Bao et al., 1994 ; Katzmarzyk et al., 2001 ; Huang et al., 2008 ). Landmark studies from the Bogalusa Heart Study ( Berenson et al., 1998 ; Li et al., 2003 ) and others ( Mahoney et al., 1996 ; Davis et al., 2001 ; Morrison et al., 2007 , 2008 ) have demonstrated that cardiometabolic risk factors present in childhood are predictive of adult disease.

The benefits of exercise for prevention and treatment of cardiometabolic disease in adults are well described ( Ross et al., 2000 ; Duncan et al., 2003 ; Gan et al., 2003 ; Irwin et al., 2003 ; Lee et al., 2005 ; Sigal et al., 2007 ; Ross et al., 2012 ). Prospective studies examining the effects of exercise on metabolic syndrome in children and adolescents remain limited, and it is important to refrain from extrapolating intervention effects observed in adults to youth, although one might reasonably assume the benefits in older adolescents to be similar to those in young adults. Indeed, based on the inverse associations of physical activity and physical fitness with metabolic syndrome ( Kim and Lee, 2009 ) and on the available intervention studies, some experts have recommended physical activity as the main therapeutic tool for prevention and treatment of metabolic syndrome in childhood ( Brambilla et al., 2010 ). Comparative studies in adults have shown that the effect of exercise on weight is limited and generally less than that of calorie restriction ( Brambilla et al., 2010 ). Moreover, the relative effectiveness of diet and exercise depends on the degree of excess fatness ( Brambilla et al., 2010 ). Comparative studies in children and youth are few, as behavioral interventions in overweight children and adolescents commonly combine exercise and dietary restriction, making it difficult to disentangle their independent effects. Nonetheless, diet and exercise have different effects on body composition: While both contribute to fat loss, only exercise increases muscle mass and thus has a direct effect on metabolic health. In children and youth, as in adults, the effect of exercise on cardiometabolic risk factors is greater in overweight/obese youth than in their normal-weight peers ( Kang et al., 2002 ; Lazaar et al., 2007 ).

Exercise also may have important benefits even without significant modification of body composition ( Bell et al., 2007 ). Experimental studies in overweight and obese youth have shown that exercise leads to reductions in visceral fat ( Owens et al., 1999 ; Gutin et al., 2002 ; Lee at al., 2005 ; Barbeau et al., 2007 ; Kim and Lee, 2009 ) without a significant change in BMI, as well as improvement in markers of metabolic syndrome, primarily fasting insulin and insulin resistance ( Treuth et al., 1998 ; Ferguson et al., 1999 ; Carrel et al., 2005 ; Nassis et al., 2005 ; Meyer et al., 2006 ; Shaibi et al., 2006 ; Bell et al., 2007 ). Results from experimental studies of the effects of exercise on lipids and lipoproteins ( Stoedefalke et al., 2000 ; Kelley and Kelley, 2008 ; Janssen and LeBlanc, 2010 ) are mixed. Although some studies have shown improved lipid and lipoprotein profiles, primarily a decrease in low-density lipoprotein (LDL) cholesterol and triglyceride concentrations and an increase in HDL cholesterol ( Ferguson et al., 1999 ), other studies have shown no improvement in these outcomes ( Kelley and Kelley, 2008 ). In part, such conflicting results are likely due to initial differences in body composition and severity of hyperlipidemia. Well-controlled exercise training studies in obese children ( Escalante et al., 2012 ) and children with adverse blood lipid and lipoprotein profiles have shown positive alterations in their profiles ( Stoedefalke et al., 2000 ), whereas results in normolipid-emic children and adolescents are equivocal. Similarly, exercise has little effect on resting blood pressure in normotensive children and adolescents ( Kelley and Kelley, 2008 ), whereas reductions in resting systolic and sometimes diastolic pressures have been reported in youth with high blood pressure ( Hagberg et al., 1983 , 1984 ; Danforth et al., 1990 ; Ewart et al., 1998 ; Farpour-Lambert et al., 2009 ; Janssen and LeBlanc, 2010 ).

In adults, physical activity is inversely associated with low-grade inflammation ( Wärnberg et al., 2010 ; Ertek and Cicero, 2012 ), which is now recognized as a significant feature of metabolic syndrome and an independent predictor of cardiometabolic disease ( Malina, 2002 ). In obese children and adolescents, as in their adult counterparts, elevation of inflammatory markers is evident, and observational studies have shown significant relationships among physical activity, physical fitness, and inflammation ( Isasi et al., 2003 ; Platat et al., 2006 ; Ruiz et al., 2007 ; Wärnberg et al., 2007 ; Wärnberg and Marcos, 2008 ). These relationships are better studied and stronger in adolescents than in children. In one study of boys and girls aged 10-15, those who were obese and unfit had the highest levels of systemic inflammation, whereas those who were obese yet fit had levels as low as those who were lean and fit ( Halle et al., 2004 ). In another study, low-grade inflammation was negatively associated with muscle strength in overweight adolescents after controlling for cardiorespiratory fitness, suggesting that high levels of muscle strength may counteract some of the negative consequences of higher levels of body fat ( Ruiz et al., 2008 ). Experimental studies of the effects of exercise and markers of low-grade inflammation in children and adolescents are lacking. Improved cardiorespiratory fitness in adults ( Church et al., 2002 ), however, has been shown to be inversely related to concentration of C-reactive protein (CRP), a marker of low-grade inflammation. In a small study of a lifestyle intervention entailing 45 minutes of physical activity 3 times per week for 3 months, a small reduction in body fat and an overall decrease in inflammatory factors (CRP, interleukin [IL]-6) were seen in obese adolescents ( Balagopal et al., 2005 ).

Performance-Related Fitness

Speed, muscle power, agility, and balance (static and dynamic) are aspects of performance-related fitness that change during body development in predictable ways associated with the development of tissues and systems discussed above ( Malina et al., 2004 ). Running speed and muscle power are related, and both depend on full development of the neuromuscular system. Running speed and muscle power are similar for boys and girls during childhood ( Haubenstricker and Seefeldt, 1986 ). After puberty, largely because of differences in muscle mass and muscle strength, males continue to make significant annual gains, while females tend to plateau during the adolescent years. Sociocultural factors and increasing inactivity among girls relative to boys, along with changes in body proportion and a lowering of the center of gravity, may also contribute to gender differences ( Malina et al., 2004 ).

Balance—the ability to maintain equilibrium—generally improves from ages 3 to 18 ( Williams, 1983 ). Research suggests that females outperform males on tests of static and dynamic balance during childhood and that this advantage persists through puberty ( Malina et al., 2004 ).

Motor performance is related in part to muscle strength. Increases in muscle strength as a result of resistance exercise were described above. A question of interest is whether gains in strength transfer to other performance tasks. Available results are variable, giving some indication that gains in strength are associated with improvement in some performance tasks, such as sprinting and vertical jump, although the improvements are generally small, highlighting the difficulty of distinguishing the effects of training from changes expected with normal growth. Changes in body size, physique, and body composition associated with growth and maturation are important factors that affect strength and motor performance. The relationships vary among performance measures and with age, and these factors often are inadequately controlled in studies of components of performance-related fitness and performance tasks.

• PSYCHOSOCIAL HEALTH

Research supports the positive impact of physical activity on the overall psychological health and social engagement of every student. A well-designed physical education curriculum provides students with social and emotional benefits ( NASPE, 2001 ). Simultaneously, exposure to failure experiences, emphasis on competitive sports, and elitism for naturally inclined athletes, along with bullying and teasing of unfit, uncoordinated, and overweight youth, may be important factors discouraging participation in current and future physical activity ( Kohl and Hobbs, 1998 ; Sallis et al., 2000 ; Allender et al., 2006 ). School-based physical activity, including physical education and sports, is designed to increase physical activity while also improving motor skills and development, self-efficacy, and general feelings of competency and engaging children socially ( Bailey, 2006 ). The hoped-for psychosocial outcomes of physical education and other physical activity programs in the school setting have been found to be critical for continued physical activity across the life span and are themselves powerful long-term determinants of physical activity ( Bauman et al., 2012 ). Unfortunately, significant gaps exist between the intent and reality of school-based physical education and other activity programs ( HHS, 2013 ).

A large number of psychological and social outcomes have been examined. Specific aspects of psychosocial health showing a beneficial relationship to physical activity include, among others, self-efficacy, self-concept, self-worth ( Haugen et al., 2011 ), social behaviors ( Cradock et al., 2009 ), pro-school attitudes, motivation and goal orientation ( Digelidis et al., 2003 ), relatedness, friendships ( de la Haye et al., 2011 ; Macdonald-Wallis et al., 2011 ), task orientation, team building, bullying, and racial prejudice ( Byrd and Ross, 1991 ). Most studies are descriptive, finding bidirectional associations between psychosocial outcomes and physical activity. Reviews and meta-analyses confirm a positive association between physical activity and self-esteem, especially for aerobic activities ( McAuley, 1994 ).

Among psychosocial factors, self-efficacy (confidence in one's ability to be physically active in specific situations) has emerged as an important correlate of physical activity from a large body of work based on the durable and practically useful social learning theory ( Bandura and McClelland, 1977 ; Bandura, 1995 ). Bandura's theory compels consideration of the psychosocial and physical environments, the individual, and in this case the behavior of physical activity. Using this framework, physical activity itself has been shown to be a consistent positive correlate as well as a determinant of physical activity in children and adolescents. A large amount of reviewed research has found that physical education and physical activity experiences can increase children's confidence in being active and lead to continued participation in physical activity ( Bauman et al., 2012 ). RCTs have shown that both self-efficacy and social interactions leading to perceived social support influence changes in physical activity ( Dishman et al., 2009 ). Skill mastery, confidence building, and group support are well-known strategies for advancing student learning and well-being in many educational domains in the school setting and apply equally to school physical education and other physical activity. Early observational studies of physical, social, and environmental determinants of physical activity at home, school, and recess indicated that prompts to be active (or not) from peers and adults accounted for a significant amount of the variance in directly observed physical activity ( Elder et al., 1998 ). One longitudinal study following the variability and tracking of physical activity in young children showed that most of the variability in both home and recess activity was accounted for by short-term social and physical environmental factors, such as prompts from others and being outdoors ( Sallis et al., 1995 ). Another study, examining activity among preschool children, found that, contrary to common belief, most of the time spent in preschool was sedentary, and correlates of activity were different for preschool boys and girls ( Byun et al., 2011 ). In addition, significant variation in activity by preschool site was noted, indicating that local environmental conditions, including physical environment and equipment, policies, and teacher and administrative quality characteristics, play an important role in promoting physical activity ( Brown et al., 2009 ).

Studies in middle and high school populations have strengthened the evidence base on relationships among self-efficacy, physical activity, and social support (from adults and peers). This research has highlighted the central contribution of self-efficacy and social support in protecting against a decline in activity levels among adolescent girls ( Dishman et al., 2009 , 2010 ). Evidence indicates further that these impacts spread to activities outside the school setting ( Lytle et al., 2009 ). Findings of a related study suggest that leisure-time physical activity among middle school students was linked to motivation-related experiences in physical education ( Cox et al., 2008 ).

A recent review of reviews ( Bauman et al., 2012 ) found that population levels of physical activity are low and that consistent individual-level correlates of physical activity are age, sex, health status, self-efficacy, and previous physical activity. Physical activity declines dramatically as children progress from elementary through high school ( Nader et al., 2008 ). Boys are consistently found to be more active than girls from ages 4 to 9. For other age groups of children and adolescents, sex is correlated with but not a determinant of activity ( Bauman et al., 2012 ). These findings suggest the need to tailor physical education and physical activity programs for youth specifically to increase self-efficacy and enjoyment of physical activity among girls ( Dishman et al., 2005 ; Barr-Anderson et al., 2008 ; Butt et al., 2011 ).

In summary, a broad range of beneficial psychosocial health outcomes have been associated with physical activity. The promotion of more physical activity and quality physical education in the school setting is likely to result in psychosocially healthier children who are more likely to engage in physical activity as adults. Schools can play an important role in ensuring opportunities for physical activity for a segment of the youth population that otherwise may not have the resources to engage in such activity. It makes sense to assume that, if physical activity experiences and environments were once again structured into the daily school environment of children and adolescents, individuals' feelings of self-efficacy regarding physical activity would increase in the U.S. population.

• MENTAL HEALTH

Mental illness is a serious public health issue. It has been estimated that by 2010 mental illness will account for 15 percent of the global burden of disease ( Biddle and Mutrie, 2008 ; Biddle and Asare, 2011 ). Young people are disproportionately affected by depression, anxiety, and other mental health disorders ( Viner and Booy, 2005 ; Biddle and Asare, 2011 ). Approximately 20 percent of school-age children have a diagnosable mental health disorder ( U.S. Public Health Service, 2000 ), and overweight children are at particular risk ( Ahn and Fedewa, 2011 ). Mental health naturally affects academic performance on many levels ( Charvat, 2012 ). Students suffering from depression, anxiety, mood disorders, and emotional disturbances perform more poorly in school, exhibit more behavioral and disciplinary problems, and have poorer attendance relative to mentally healthy children. Thus it is in schools' interest to take measures to support mental health among the student population. In addition to other benefits, providing adequate amounts of physical activity in a way that is inviting and safe for children of all ability levels is one simple way in which schools can contribute to students' mental health.

Impact of Physical Activity on Mental Health

Several recent reviews have concluded that physical activity has a positive effect on mental health and emotional well-being for both adults and children ( Peluso and Guerra de Andrade, 2005 ; Penedo and Dahn, 2005 ; Strong et al., 2005 ; Hallal et al., 2006 ; Ahn and Fedewa, 2011 ; Biddle and Asare, 2011 ). Numerous observational studies have established the association between physical activity and mental health but are inadequate to clarify the direction of that association ( Strong et al., 2005 ). It may be that physical activity improves mental health, or it may be that people are more physically active when they are mentally healthy. Most likely the relationship is bidirectional.

Several longitudinal and intervention studies have clarified that physical activity positively impacts mental health ( Penedo and Dahn, 2005 ; Strong et al., 2005 ). Physical activity has most often been shown to reduce symptoms of depression and anxiety and improve mood ( Penedo and Dahn, 2005 ; Dishman et al., 2006 ; Biddle and Asare, 2011 ). In addition to reducing symptoms of depression and anxiety, studies indicate that regular physical activity may help prevent the onset of these conditions ( Penedo and Dahn, 2005 ). Reductions in depression and anxiety are the commonly measured outcomes ( Strong et al., 2005 ; Ahn and Fedewa, 2011 ). However, reductions in states of confusion, anger, tension, stress, anxiety sensitivity (a precursor to panic attacks and panic disorders), posttraumatic stress disorder/psychological distress, emotional disturbance, and negative affect have been observed, as well as increases in positive expectations; fewer emotional barriers; general well-being; satisfaction with personal appearance; and improved life satisfaction, self-worth, and quality of life ( Heller et al., 2004 ; Peluso and Guerra de Andrade, 2005 ; Penedo and Dahn, 2005 ; Dishman et al., 2006 ; Hallal et al., 2006 ; Ahn and Fedewa, 2011 ; Biddle and Asare, 2011 ). Among adolescents and young adult females, exercise has been found to be more effective than cognitive-behavioral therapy in reducing the pursuit of thinness and the frequency of bingeing, purging, and laxative abuse ( Sundgot-Borgen et al., 2002 ; Hallal et al., 2006 ). The favorable effects of physical activity on sleep may also contribute to mental health ( Dishman et al., 2006 ).

The impact of physical activity on these measures of mental health is moderate, with effect sizes generally ranging from 0.4 to 0.7 ( Biddle and Asare, 2011 ). In one meta-analysis of intervention trials, the RCTs had an effect size of 0.3, whereas other trials had an effect size of 0.57.

Ideal Type, Length, and Duration of Physical Activity

Intervention trials that examine the relationship between physical activity and mental health often fail to specify the exact nature of the intervention, making it difficult to determine the ideal frequency, intensity, duration, and type of physical activity involved ( Penedo and Dahn, 2005 ; Ahn and Fedewa, 2011 ; Biddle and Asare, 2011 ).

Many different types of physical activity—including aerobic activity, resistance training, yoga, dance, flexibility training, walking programs, and body building—have been shown to improve mood and other mental health indicators. The evidence is strongest for aerobic physical activity, particularly for reduction of anxiety symptoms and stress ( Peluso and Guerra de Andrade, 2005 ; Dishman et al., 2006 ; Martikainen et al., 2013 ), because more of these studies have been conducted ( Peluso and Guerra de Andrade, 2005 ). One meta-analysis of RCTs concluded that physical activity interventions focused exclusively on circuit training had the greatest effect on mental health indicators, followed closely by interventions that included various types of physical activity ( Ahn and Fedewa, 2011 ). Among studies other than RCTs, only participation in sports had a significant impact on mental health ( Ahn and Fedewa, 2011 ). The few studies that investigated the impact of vigorous- versus lower-intensity physical activity ( Larun et al., 2006 ; Biddle and Asare, 2011 ) found no difference, suggesting that perhaps all levels of physical activity may be helpful. Among adults, studies have consistently shown beneficial effects of both aerobic exercise and resistance training. Ahn and Fedewa (2011) concluded that both moderate and intense physical activity have a significant impact on mental health, although when just RCTs were considered, only intense physical activity was significant ( Ahn and Fedewa, 2011 ). While physical activity carries few risks for mental health, it is important to note that excessive physical activity or specialization too early in certain types of competitive physical activity has been associated with negative mental health outcomes and therefore should be avoided ( Peluso and Guerra de Andrade, 2005 ; Hallal et al., 2006 ). Furthermore, to reach all children, including those that may be at highest risk for inactivity, obesity, and mental health problems, physical activity programming needs to be nonthreatening and geared toward creating a positive experience for children of all skill and fitness levels ( Amis et al., 2012 ).

Various types of physical activity programming have been shown to have a positive influence on mental health outcomes. Higher levels of attendance and participation in physical education are inversely associated with feelings of sadness and risk of considering suicide ( Brosnahan et al., 2004 ). Classroom physical activity is associated with reduced use of medication for attention deficit hyperactivity disorder ( Katz et al., 2010 ). And participation in recess is associated with better student classroom behavior, better focus, and less fidgeting ( Pellegrini et al., 1995 ; Jarrett et al., 1998 ; Barros et al., 2009 ).

Strong evidence supports the short-term benefits of physical activity for mental health. Acute effects can be observed after just one episode and can last from a few hours to up to 1 day after. Body building may have a similar effect, which begins a few hours after the end of the exercise. The ideal length and duration of physical activity for improving mental health remain unclear, however. Regular exercise is associated with improved mood, but results are inconsistent for the association between mood and medium- or long-term exercise ( Dua and Hargreaves, 1992 ; Slaven and Lee, 1997 ; Dimeo et al., 2001 ; Dunn et al., 2001 ; Kritz-Silverstein et al., 2001 ; Sexton et al., 2001 ; Leppamaki et al., 2002 ; Peluso and Guerra de Andrade, 2005 ). Studies often do not specify the frequency and duration of physical activity episodes; among those that do, interventions ranged from 6 weeks to 2 years in duration. In their meta-analysis, Ahn and Fedewa (2011) found that, comparing interventions entailing a total of more than 33 hours, 20-33 hours, and less than 20 hours, the longer programs were more effective. Overall, the lack of reporting and the variable length and duration of reported interventions make it difficult to draw conclusions regarding dose ( Ahn and Fedewa, 2011 ).

In addition to more structured opportunities, naturally occurring physical activity outside of school time is associated with fewer depressive symptoms among adolescents ( Penedo and Dahn, 2005 ). RCTs have demonstrated that physical activity involving entire classrooms of students is effective in alleviating negative mental health outcomes ( Ahn and Fedewa, 2011 ). Non-RCT studies have shown individualized approaches to be most effective and small-group approaches to be effective to a more limited extent ( Ahn and Fedewa, 2011 ). Interventions have been shown to be effective in improving mental health when delivered by classroom teachers, physical education specialists, or researchers but may be most effective when conducted with a physical education specialist ( Ahn and Fedewa, 2011 ). Many physical activity interventions include elements of social interaction and support; however, studies to date have been unable to distinguish whether the physical activity itself or these other factors account for the observed effects on mental health ( Hasselstrom et al., 2002 ; Hallal et al., 2006 ). Finally, a few trials ( Larun et al., 2006 ; Biddle and Asare, 2011 ) have compared the effects of physical activity and psychosocial interventions, finding that physical activity may be equally effective but may not provide any added benefit.

Subgroup Effects

Although studies frequently fail to report the age of participants, data on the effects of physical activity on mental health are strongest for adults participating in high-intensity physical activity ( Ahn and Fedewa, 2011 ). However, evidence relating physical activity to various measures of mental health has shown consistent, significant effects on individuals aged 11-20. A large prospective study found that physical activity was inversely associated with depression in early adolescence ( Hasselstrom et al., 2002 ; Hallal et al., 2006 ); fewer studies have been conducted among younger children. Correlation studies have shown that the association of physical activity with depression is not affected by age ( Ahn and Fedewa, 2011 ).

Few studies have examined the influence of other sociodemographic characteristics of participants on the relationship between physical activity and mental health ( Ahn and Fedewa, 2011 ), but studies have been conducted in populations with diverse characteristics. One study of low-income Hispanic children randomized to an aerobic intensity program found that the intervention group was less likely to present with depression but did not report reduced anxiety ( Crews et al., 2004 ; Hallal et al., 2006 ). A study that included black and white children (aged 7-11) found that a 40-minute daily dose of aerobic exercise significantly reduced depressive symptoms and increased physical appearance self-worth in both black and white children and increased global self-worth in white children compared with controls ( Petty et al., 2009 ). Physical activity also has been positively associated with mental health regardless of weight status (normal versus overweight) or gender (male versus female) ( Petty et al., 2009 ; Ahn and Fedewa, 2011 ); however, results are stronger for males ( Ahn and Fedewa, 2011 ).

Improvements in mental health as a result of physical activity may be more pronounced among clinically diagnosed populations, especially those with cognitive impairment or posttraumatic stress disorder ( Craft and Landers, 1998 ; Ahn and Fedewa, 2011 ; Biddle and Asare, 2011 ). Evidence is less clear for youth with clinical depression ( Craft and Landers, 1998 ; Larun et al., 2006 ; Biddle and Asare, 2011 ). Individuals diagnosed with major depression undergoing an intervention entailing aerobic exercise have shown significant improvement in depression and lower relapse rates, comparable to results seen in participants receiving psychotropic treatment ( Babyak et al., 2000 ; Penedo and Dahn, 2005 ). One program for adults with Down syndrome providing three sessions of exercise and health education per week for 12 weeks resulted in more positive expectations, fewer emotional barriers, and improved life satisfaction ( Heller et al., 2004 ; Penedo and Dahn, 2005 ). Ahn and Fedewa (2011) found that, compared with nondiagnosed individuals, physical activity had a fivefold greater impact on those diagnosed with cognitive impairment and a twofold greater effect on those diagnosed with emotional disturbance, suggesting that physical activity has the potential to improve the mental health of those most in need.

In sum, although more studies are needed, and there may be some differences in the magnitude and nature of the mental health benefits derived, it appears that physical activity is effective in improving mental health regardless of age, ethnicity, gender, or mental health status.

Sedentary Behavior

Sedentary behavior also influences mental health. Screen viewing in particular and sitting in general are consistently associated with poorer mental health ( Biddle and Asare, 2011 ). Children who watch more television have higher rates of anxiety, depression, and posttraumatic stress and are at higher risk for sleep disturbances and attention problems ( Kappos, 2007 ). Given the cross-sectional nature of these studies, however, the direction of these associations cannot be determined. A single longitudinal study found that television viewing, but not playing computer games, increased the odds of depression after 7-year follow-up ( Primack et al., 2009 ; Biddle and Asare, 2011 ), suggesting that television viewing may contribute to depression. Because of design limitations of the available studies, it is unclear whether this effect is mediated by physical activity.

Television viewing also is associated with violence, aggressive behaviors, early sexual activity, and substance abuse ( Kappos, 2007 ). These relationships are likely due to the content of the programming and advertising as opposed to the sedentary nature of the activity. Television viewing may affect creativity and involvement in community activities as well; however, the evidence here is very limited ( Kappos, 2007 ). Studies with experimental designs are needed to establish a causal relationship between sedentary behavior and mental health outcomes ( Kappos, 2007 ).

Although the available evidence is not definitive, it does suggest that sedentary activity and television viewing in particular can increase the risk for depression, anxiety, aggression, and other risky behaviors and may also affect cognition and creativity ( Kappos, 2007 ), all of which can affect academic performance. It would therefore appear prudent for schools to reduce these sedentary behaviors during school hours and provide programming that has been shown to be effective in reducing television viewing outside of school ( Robinson, 1999 ; Robinson and Borzekowski, 2006 ).

It is not surprising that physical activity improves mental health. Both physiological and psychological mechanisms explain the observed associations. Physiologically, physical activity is known to increase the synaptic transmission of monoamines, an effect similar to that of anti-depressive drugs. Physical activity also stimulates the release of endorphins (endogenous opoids) ( Peluso and Guerra de Andrade, 2005 ), which have an inhibitory effect on the central nervous system, creating a sense of calm and improved mood ( Peluso and Guerra de Andrade, 2005 ; Ahn and Fedewa, 2011 ). Withdrawal of physical activity may result in irritability, restlessness, nervousness, and frustration as a result of a drop in endorphin levels. Although more studies are needed to specify the exact neurological pathways that mediate this relationship, it appears that the favorable impact of physical activity on the prevention and treatment of depression may be the result of adaptations in the central nervous system mediated in part by neurotropic factors that facilitate neurogenerative, neuroadaptive, and neuroprotective processes ( Dishman et al., 2006 ). It has been observed, for example, that chronic wheel running in rats results in immunological, neural, and cellular responses that mitigate several harmful consequences of acute exposure to stress ( Dishman et al., 2006 ). A recent study found that children who were more physically active produced less cortisol in response to stress, suggesting that physical activity promotes mental health by regulating the hormonal responses to stress ( Martikainen et al., 2013 ).

Psychological mechanisms that may explain why physical activity improves mental health include (1) distraction from unfavorable stimuli, (2) increase in self-efficacy, and (3) positive social interactions that can result from quality physical activity programming ( Peluso and de Andrade, 2005 ) (see also the discussion of psychosocial health above). The relative contribution of physiological and psychological mechanisms is unknown, but they likely interact. Poor physical health also can impair mood and mental function. Health-related quality of life improves with physical activity that increases physical functioning, thereby enhancing the sense of well-being ( McAuley and Rudolph, 1995 ; HHS, 2008 ).

Physical activity during childhood and adolescence may not only be important for its immediate benefits for mental health but also have implications for long-term mental health. Studies have shown a consistent effect of physical activity during adolescence on adult physical activity ( Hallal et al., 2006 ). Physical activity habits established in children may persist into adulthood, thereby continuing to confer mental health benefits throughout the life cycle. Furthermore, physical activity in childhood may impact adult mental health regardless of the activity's persistence ( Hallal et al., 2006 ).

Physical activity can improve mental health by decreasing and preventing conditions such as anxiety and depression, as well as improving mood and other aspects of well-being. Evidence suggests that the mental health benefits of physical activity can be experienced by all age groups, genders, and ethnicities. Moderate effect sizes have been observed among both youth and adults. Youth with the highest risk of mental illness may experience the most benefit. Although evidence is not adequate to determine the ideal regimen, aerobic and high-intensity physical activity are likely to confer the most benefit. It appears, moreover, that a variety of types of physical activity are effective in improving different aspects of mental health; therefore, a varied regimen including both aerobic activities and strength training may be the most effective. Frequent episodes of physical activity are optimal given the well-substantiated short-term effects of physical activity on mental health status. Although there are well-substantiated physiological bases for the impact of physical activity on mental health, physical activity programming that effectively enhances social interactions and self-efficacy also may improve mental health through these mechanisms. Quality physical activity programming also is critical to attract and engage youth of all skills level and to effectively reach those at highest risk.

Sedentary activity may increase the risk of poor mental health status independently of, or in addition to, its effect on physical activity. Television viewing in particular may lead to a higher risk of such conditions as depression and anxiety and may also increase violence, aggression, and other high-risk behaviors. These impacts are likely the result of programming and advertising content in addition to the physiological effects of inactivity and electronic stimuli.

In conclusion, frequently scheduled and well-designed opportunities for varied physical activity during the school day and a reduction in sedentary activity have the potential to improve students' mental health in ways that could improve their academic performance and behaviors in school.

Good health is the foundation of learning and academic performance (see Chapter 4 ). In children and youth, health is akin to growth. An extensive literature demonstrates that regular physical activity promotes growth and development and has multiple benefits for physical, mental, cognitive, and psychosocial health that undoubtedly contribute to learning. Although much of the evidence comes from cross-sectional studies showing associations between physical activity and various aspects of health, available prospective data support this cross-sectional evidence. Experimental evidence, although more limited for younger children, is sufficient among older children and adolescents to support the notion that children and young adults derive much the same health benefits from physical activity.

Moreover, many adult diseases have their origins in childhood. This finding, together with the finding that health-related behaviors and disease risk factors may track from childhood into adulthood, underscores the need for early and ongoing opportunities for physical activity.

Children's exercise capacity and the activities in which they can successfully engage change in a predictable way across developmental periods. For example, young children are active in short bursts, and their capacity for continuous activity increases as they grow and mature (see Figure 3-2 ). In adults and likely also adolescents, intermittent exercise has much the same benefit as continuous exercise when mode and energy expenditure are held constant. The health benefits of sporadic physical activity at younger ages are not well established. However, the well-documented short-term benefits of physical activity for some aspects of mental and cognitive health suggest that maximum benefit may be attained through frequent bouts of exercise throughout the day.

Changes in physical activity needs with increasing age of children and adolescents. SOURCE: Adapted from Malina, 1991. Reprinted with permission from Human Kinetics Publishers.

Children require frequent opportunities for practice to develop the skills and confidence that promote ongoing engagement in physical activity. Physical education curricula are structured to provide developmentally appropriate experiences that build the motor skills and self-efficacy that underlie lifelong participation in health-enhancing physical activity, and trained physical education specialists are uniquely qualified to deliver them (see Chapter 5 ). However, physical education usually is offered during a single session. Therefore, other opportunities for physical activity can supplement physical education by addressing the need for more frequent exercise during the day (see Chapter 6 ). In addition to the immediate benefits of short bouts of physical activity for learning and for mental health, developmentally appropriate physical activity during those times, along with the recommended time in physical education, can contribute to daily energy expenditure and help lessen the risk of excess weight gain and its comorbidities. Specific types of activities address specific health concerns. For example, vertical jumping activities contribute to energy expenditure for obesity prevention and also promote bone development (via the resulting ground reaction forces), potentially contributing to lower fracture risk. Other activities contribute to prevention of chronic disease. Since different types of physical activity contribute to distinct aspects of physical, mental, and psychosocial health, a varied regimen is likely to be most beneficial overall.

The quality of physical activity programming also is critical; psychosocial outcomes and improvements in specific motor skills, for example, are likely the result of programming designed specifically to target these outcomes rather than just a result of increases in physical activity per se. These psychosocial outcomes also are likely to lead to increased levels of physical activity in both the short and long terms, thereby conferring greater health benefits. Unstructured physical activity or free play also confers unique benefits and is an important supplement to more structured opportunities. Quality physical activity programming that makes these activities attractive, accessible, and safe for children and youth of all skill and fitness levels is critical to ensure that all youth participate in these activities and can therefore derive the health benefits.

Sedentary activities, such as screen viewing and excessive time spent sitting, may contribute to health risks both because of and independent of their impact on physical activity. Thus specific efforts in school to reduce sedentary behaviors, such as through classroom and playground design and reduction of television viewing, are warranted.

In sum, a comprehensive physical activity plan with physical education at the core, supplemented by other varied opportunities for and an environment supportive of physical activity throughout the day, would make an important contribution to children's health and development, thereby enhancing their readiness to learn.

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• Pete Charrette

Engaging At-Home PE Activities for Effective Distance Learning in Physical Education

In an era where distance learning and at-home education have become increasingly prevalent, the role of physical education has evolved yet remains fundamentally vital. Physical education, traditionally known for its structured classes in the confines of a gym or oversized classroom, now faces the challenge of adapting to remote and home environments. However, this new setting brings a unique opportunity to underscore the importance of physical activity, not just for physical well-being but also for mental health and overall skill development. In the confines of a living room, backyard, or a small apartment space, physical education can be a dynamic tool to keep students engaged, active, and learning. It serves as a crucial outlet for energy, a mechanism for stress relief, and a platform for teaching valuable life skills such as self-discipline, goal-setting, and personal responsibility.

This article aims to provide physical educators with a suite of creative, fun, and easily accessible physical education activities tailored for at-home implementation. Recognizing the constraints and challenges of home environments, these activities are designed to be versatile, requiring minimal equipment and space, while maximizing student engagement and fitness/skill benefits. From fitness-based exercises to yoga poses, each activity is chosen to cater to a wide range of student needs and preferences, ensuring that every child can participate and benefit. Alongside these activities, I'll share tips and strategies to help educators effectively integrate these exercises into their online classes or as engaging homework assignments. The goal is to empower educators with the resources and ideas they need to continue delivering high-quality physical education, fostering a love for physical activity and a commitment to health, even outside the traditional school setting.

Fitness-Based Tasks for Students in their Homes

In this section, we explore a variety of engaging fitness-based tasks tailored for at-home physical education, ensuring students stay active and healthy during remote learning

Maintaining Fitness in Remote Learning Scenarios

Fitness is not just a physical endeavor; it's a holistic approach to well-being, crucial for students learning from home. The absence of traditional PE settings and routines can lead to a sedentary lifestyle, impacting both physical health and mental agility. In remote learning scenarios, maintaining fitness becomes not just an activity, but a necessary discipline to ensure students stay active, engaged, and healthy. Fitness tasks at home can serve as a catalyst for building resilience, improving concentration, and boosting overall mood — key factors in successful learning and personal development.

Specific Fitness-Based Tasks

Bodyweight Exercises:  Introduce a series of bodyweight exercises such as push-ups, sit-ups, and lunges. These exercises don’t require any special equipment and can be easily adapted to various fitness levels. Use your visuals to demonstrate correct postures and sequences.

Jump Rope Challenges:  A jump rope is a simple yet effective tool for cardiovascular fitness. Propose challenges like '100 jumps a day' or 'jump rope alphabet', where each letter represents a different jumping style. This can be a fun and engaging way to keep students motivated.

Flexibility (Static and Dynamic) Movements:  Incorporating stretching routines help to improve students' flexibility while reducing their stress. Share easy-to-follow flexibility sequences and stretching routines, suitable for small spaces.

Circuit Training at Home:  Design circuit training sessions that combine several exercises into one high-intensity workout. Circuits can include a mix of cardio, strength, and flexibility exercises, tailored to be done in limited space.

Dance and Movement:  Encourage students to stay active with dance-based fitness. Choreograph simple routines or collaborate with students to create a 'class dance', fostering creativity along with physical activity.

Tips for Incorporating Fitness Tasks into Online Classes and Assignments

Structure and Routine:  Create a weekly fitness schedule for students to follow. This provides structure and helps in setting clear expectations. This is especially effective for middle school and high school students to enhance learning.

Engagement and Interaction:  Use online resources and tools like Google Classroom or Zoom to interact with students to implement virtual physical education classes. Live sessions for group workouts or posting recorded demonstrations can be highly effective for online learning.

Personalization and Adaptation:  Recognize that each student's home environment and fitness level is different. Offer variations and alternatives to cater to diverse needs.

Feedback and Encouragement:  Regularly check in with students to provide feedback. Celebrate achievements, no matter how small, to keep students motivated.

Family Involvement:  Encourage students to involve family members in their fitness tasks. This not only adds a fun element but also promotes a healthy lifestyle for the entire family.

By integrating these fitness-based tasks into remote PE classes, we not only keep our students physically active but also engaged and motivated. It's about creating a culture of fitness that transcends the boundaries of the traditional classroom and enters the homes of our students, empowering them to lead healthier, more active lifestyles.

Tossing and Catching Tasks for Students at Home

Tossing and Catching Tasks for Students at Home focuses on accessible and enjoyable activities designed to enhance students' coordination and motor skills right in the comfort of their homes.

Enhancing Hand-Eye Coordination and Gross Motor Skills

Tossing and catching are foundational activities in physical education that significantly enhance hand-eye coordination and develop gross motor skills. These skills are essential not just for sports, but they also play a crucial role in daily activities and cognitive development. In a home learning environment, where students might have limited access to traditional sports equipment, it becomes even more important to find creative ways to maintain and develop these skills. Tossing and catching activities can be adapted to any space and can be performed with a variety of household items, making them ideal for at-home PE sessions.

Tossing and Catching Challenges - At-Home PE Activities

Sock Ball Toss and Catch:  Create a DIY ball by rolling up a pair of socks, ideal for a safe indoor tossing and catching game. This activity helps students enhance their hand-eye coordination and agility in a confined space. They can practice tossing and catching the sock ball in various ways - 2 hand, 1 hand, clap and catch, under leg, behind back, from a foot, etc.

Playground Ball/Basketball Toss, Bounce & Catch:  Utilize a playground or basketball (or any ball a student might possess around home) for a versatile activity that combines tossing, catching, and bouncing, challenging students to maintain control and accuracy in each movement.

Grocery Bag/Scarves Toss and Catch:  Employ lightweight grocery bags or ultra light scarves for an imaginative catch challenge, where students can use one, two, or three bags to practice tricks and juggling maneuvers, developing their coordination and reflex skills. They can also move around in small spaces while tossing and catching the scarves.

Partner Toss and Catch:  Invite students to involve a family member in a partner toss and catch exercise, using items like a rolled-up sock, a ball, or grocery bags, to promote interpersonal bonding and simultaneously enhance their catching and throwing skills.

Target Toss:  Set up a target toss at home, where students aim to accurately throw an object at a designated spot, such as a laundry basket, trash bin or table top, to improve focus and precision.

Integrating Tossing and Catching in Virtual PE

Interactive Challenges:  Host live tossing and catching challenges during your online virtual learning classes. Students can demonstrate their skills on camera, providing a sense of competition and camaraderie.

Skill Progression Assignments:  Assign tasks that progressively increase in difficulty. Students can start with simpler activities and gradually move to more complex tasks, documenting their progress.

Use of Household Items:  Encourage creativity by allowing students to use different household items for their activities. This not only makes the tasks more accessible but also adds an element of fun and innovation.

Family Participation:  Involve family members by encouraging them to participate in these activities. This not only makes the activity more fun but also fosters a sense of community and support.

Feedback and Encouragement:  Provide constructive feedback on the videos or live demonstrations. Celebrate achievements and offer tips for improvement to keep students motivated.

Adapt for Space and Safety:  Always remind students to adapt the activities based on their available space and to ensure safety. For instance, softer objects like sock balls or balloons are safer for indoor use.

Incorporating tossing and catching tasks into at-home PE activities offers a unique opportunity to develop essential motor skills and coordination. With creativity and adaptation, these activities can become a fun and engaging part of the students' home physical education experience.

Small Space Movement Tasks for the Home Environment

In this section, we explore a variety of movement tasks specifically designed for small spaces, ensuring that students can stay active and develop key physical skills even in limited areas at home.

Overcoming the Challenges of Limited Space

One of the most significant challenges in at-home physical education is the constraint of limited space. Many students may not have access to large, open areas typically found in school gyms. However, limited space should not limit the opportunity to stay active. This section focuses on how to turn small spaces into effective arenas for physical activity, ensuring students can continue their physical development regardless of their environment. Adapting to confined spaces requires creativity and a focus on safety, ensuring movements are suitable and do not risk injury or damage to the home.

Movement Activities for Confined Areas

Agility Drills: Students can   set up a mini agility courses using household items like pillows, water bottles or chairs, allowing students to practice quick directional changes and improve their agility in a confined space.

Plyometrics/Jumping Challenges: Introduce plyometric exercises like squat jumps, jumping on to paper plates, or hopping on one leg, which are perfect for building leg strength and explosive power, even in limited spaces.

Balancing Challenges: Challenge students with static and dynamic balancing activities, such as standing on one foot or walking along a taped line (or string) on the floor, to enhance their stability and core strength in a fun, space-efficient way

Partner Activities: For those with a family member present, suggest engaging in simple partner activities like limbo using a broomstick, partner hurdles with stacked cushions, circle jumps, or a walk and jump challenge using a pool noodle, promoting teamwork and physical activity.

Locomotor Movement/Animal Walks: Encourage students to move around the room in various ways (skipping, galloping, hopping, etc.) or mimic different animal movements, such as crab walks or bear crawls, offering a creative way to develop coordination and strength within a small area

Customizing Activities for Different Age Groups and Skill/Fitness Levels

Younger Students:  For younger kids, turn these activities into games or challenges. Use storytelling or imaginative scenarios to make the exercises more engaging and age-appropriate.

Older Students:  Increase the complexity and intensity for older students. Introduce timed challenges or more advanced versions of the exercises to keep them challenged and engaged.

Adapting for Different Skill/Fitness Levels:  Offer modifications for each activity. For example, provide low-impact alternatives for students who may find certain movements challenging.

Safety Tips:  Always remind students about the importance of clearing their space of any obstacles and practicing exercises safely.

Incorporating Educational Elements:  Combine physical movements with educational components. For instance, while doing spot jogging, students can practice math problems or language skills, adding a cognitive aspect to the physical activity.

Remember, the goal is to ensure that every student, regardless of their living situation, can participate in meaningful physical activity. These small space movement tasks are designed to be inclusive, adaptable, and effective, providing students with the opportunity to stay active and healthy, even in limited spaces.

PE Manipulative Skill Tasks for Students at Home

Exploring manipulative skills at home, this section delves into activities that enhance students' coordination and control, using everyday items to master essential physical skills in a fun and engaging manner.

Developing Essential PE Motor Skills Outside of School

Manipulative skills are a cornerstone of physical education, involving movements that require controlling objects with the hands, feet, or other body parts. These skills include activities like throwing, catching, kicking, striking, dribbling, and more. While traditionally honed in a gym or outdoor setting, many of these skills can be creatively adapted for the home environment. Developing these skills is vital for physical literacy, coordination, and confidence in various physical activities. In a remote learning scenario, focusing on these skills ensures that students continue to develop their motor abilities, even outside the traditional PE setting.

Skill-Focused Activities for Home Practice

Balloon Volleying:  Encourage students to keep a balloon in the air using their hands, feet, or head, a simple yet effective activity to improve hand-eye coordination and reaction time in a fun, low-risk way.

Target Practice:  Set up targets using household items and practice throwing with accuracy. This can be done with soft balls, bean bags, or even crumpled paper, focusing on both underhand and overhand throws.

Foot Fun:  Challenge students with foot-based activities like soccer ball dribbling or toe-tapping (foot volleying) a balloon, fostering agility and control through engaging and playful foot coordination tasks.

Ball Handling/Maneuvering:  Use any type of small ball to practice dribbling, bouncing, or rolling around their bodies or obstacles, enhancing control and precision while engaging in a variety of ball-handling skills suitable for limited spaces.

Homemade Bowling:  Set up a simple bowling alley using recycled bottles as pins and a soft ball or sock ball. This activity helps in developing aiming and rolling skills.

Strategies for Remote Student Assessment and Feedback

Video Submissions:  Have students record and submit videos of themselves performing the tasks. This allows for direct observation and provides an opportunity to give personalized feedback regarding student learning.

Digital Skill Logs:  Encourage students to maintain a digital log of their practice sessions, noting their progress and any challenges faced. This can be a part of their regular PE homework.

Online Quizzes and Reflections:  Create quizzes or reflection prompts related to the skills learned. This can include questions on techniques, rules of games, or even personal experiences with the activities.

Peer Review:  Utilize peer review systems where students can watch each other’s videos and provide constructive feedback under teacher supervision. This not only aids in assessment but also fosters a sense of community.

Use of Apps and Digital Platforms:  Leverage technology, like fitness tracking apps or educational platforms, to monitor student progress and maintain a record of their activities.

Adaptation Challenges:  Challenge students to modify or invent new activities using household items, encouraging creativity and problem-solving.

By integrating these manipulative skill tasks into the home environment, PE teachers can effectively continue the development of essential physical skills. It's about finding creative ways to adapt traditional activities to new settings, ensuring that learning and skill development remain uninterrupted and engaging.

Yoga Poses (Mindfulness) for Students at Home

Embrace the calm and focus of yoga with this section, introducing students to various poses that not only enhance physical flexibility and strength but also promote mindfulness and mental well-being, making them ideal for a home setting.

Embracing Yoga and Mindfulness for Holistic Health

In the realm of at-home physical education, incorporating yoga and mindfulness practices offers profound benefits for both physical and mental health. Yoga, known for its gentle yet effective stretches and poses, enhances flexibility, balance, and strength. Moreover, its inherent mindfulness aspect plays a crucial role in reducing stress, improving concentration, and fostering an overall sense of well-being. Particularly during remote learning, where students may experience increased levels of anxiety or feel disconnected, yoga can be a grounding and calming practice, offering a much-needed balance to their daily routine.

Yoga Poses and Sequences for Young Minds

Basic Poses:  Introduce simple poses such as Mountain Pose (Tadasana), Warrior Poses (Virabhadrasana), and Tree Pose (Vrikshasana). These are foundational poses that help in building balance and focus.

Sun Salutations:  Teach the Sun Salutation sequence (Surya Namaskar) as a warm-up or a standalone routine. This sequence is excellent for building energy and warming up the body.

Restorative Poses:  Include restorative poses like Child's Pose (Balasana) and Lotus Pose (Padmasana) for relaxation. These poses are essential for winding down and promoting mindfulness.

Partner Yoga:  If family members can join, suggest simple partner yoga poses. This can be a fun way for students to engage in yoga with their siblings or parents, enhancing bonding and making the practice more enjoyable.

Breathing Exercises and Meditation:  Incorporate basic breathing exercises (Pranayama) and short meditation sessions to conclude the yoga practice. This helps in enhancing mindfulness and relaxation.

Conducting Virtual Yoga/Mindfulness Sessions

Structured Online Classes:  Run live yoga sessions, guiding students through poses and sequences. Use your visuals to demonstrate poses and offer modifications for different skill levels.

Recorded Sessions:  Provide pre-recorded yoga sequences for students to practice at their own pace. This can be particularly helpful for students who might feel self-conscious about live participation.

Interactive Feedback:  Encourage students to share their yoga experiences and any challenges they face. Offer personalized tips and modifications during live sessions or via your online platform.

Engagement Activities:  Create yoga challenges, such as maintaining a pose for a certain duration or mastering a new sequence. Offer positive reinforcement and rewards like digital badges or certificates.

Family Involvement:  Invite family members to join the yoga sessions, making it a family activity. Provide tips for family yoga and how parents can encourage mindfulness in children.

As a physical education teacher, incorporating yoga and mindfulness into the at-home physical education curriculum offers students a way to nurture their bodies and minds. This section not only outlines specific poses and sequences but also provides practical tips for PE teachers to effectively conduct and integrate these practices into their remote teaching.

Final Thoughts

In today's rapidly evolving educational landscape, the significance of at-home physical education cannot be overstated. This article has highlighted a diverse array of activities and strategies, tailored to ensure that students remain active, engaged, and healthy, even outside the traditional classroom setting. The impact of these at-home PE activities extends far beyond physical fitness; they play a crucial role in students' mental and emotional wellbeing, social skills development, and overall quality of life. By integrating these varied and inclusive activities, we not only cater to the immediate physical needs of our students but also contribute profoundly to their holistic development.

To all physical education teachers navigating this new terrain of remote and hybrid learning: your adaptability, creativity, and dedication have never been more vital. The unique challenges of teaching PE outside the traditional school environment call for an innovative approach, and your willingness to embrace these challenges is commendable. Remember, your role in students' lives is invaluable – you're not just teaching them how to stay active; you're instilling lifelong habits of health and wellbeing. Your efforts in creating dynamic, accessible, and enjoyable PE experiences help lay the foundation for a healthier, more active generation. Continue to inspire, motivate, and guide your students, knowing that every lesson you craft extends far beyond the confines of a physical space – it touches the lives of each student, fostering a healthier, more active, and resilient community.

Download a FREE Visual: 12 COOL Ways to Move in Your Home

12 cool ways to move in your home.

This Distance Learning Visual- Twelve Cool Ways to Move in Your Home serves as a practical instructional graphic for teachers to use to share a variety of home-based movement experiences with their students. The visual can be shared as a graphic in a synchronous (live) remote lesson or included as a resource in an asynchronous assignment or packet.

Fill in the form below  to download this "12 COOL Ways to Move in Your Home" PDF file. The Twelve Cool Ways to Move in Your Home movement experiences are easy for students to understand and implement at home with minimal equipment. Any equipment showcased would be something a student could typically find in their home. The visual is downloadable in 6 color schemes displaying twelve fitness or skill based movements. The graphics utilized in the visual are attractive, kid friendly and relatable.

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What Resources are in the PE Distance Learning Series: 5 Set SUPER BUNDLE for Home?

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5. 24 YOGA Poses for Students at Home

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• At-Home/Distance Learning
• Activities and Games
• Creative Movement

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What is Physical Education? A Comprehensive Overview for Physical Educators

• Open access
• Published: 19 April 2024

‘We get to learn as we move’: effects and feasibility of lesson-integrated physical activity in a Swedish primary school

• Robert Larsson   ORCID: orcid.org/0000-0002-1965-7147 1 ,
• Eva Ljung 2 ,
• Sara Josefsson 2 &
• Thomas Ljung 1  

BMC Public Health volume  24 , Article number:  1087 ( 2024 ) Cite this article

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Metrics details

Physical activity (PA) promotes health in adults as well as children. At the same time, a large proportion of children do not meet the recommendations for PA, and more school-based efforts to increase PA are needed. This study investigates the effectiveness and feasibility of lesson-integrated PA in a Swedish primary school.

We evaluate a new method called ‘Physical Activity and Lesson in Combination’ (abbreviated FALK in Swedish) using a mixed methods approach; a quasi-experimental study followed by qualitative interviews. Two schools participated in the study, one constituting the intervention group (I-school, n  = 83) and the other the control group (C-school, n  = 81). In addition to regular physical education, the I-school had three 30-minute FALK lessons each week. A total of 164 students aged 7–9 years wore pedometers for a whole week, four times over two semesters, and the number of steps per day (SPD) and the proportion of students with < 10,000 SPD were compared. Statistical differences between the schools were tested with ANOVA, Chi2, t-tests, and ANCOVA. Interviews with students ( n  = 17), parents ( n  = 9) and teachers ( n  = 9) were conducted and analysed using qualitative content analysis.

The results show that FALK led to the I-school getting more SPD and fewer students with < 10,000 SPD. Also, FALK was experienced as a positive, clear, and flexible method, simultaneously encouraging PA and learning. Challenges experienced concerned the teachers’ work situation, time, finding suitable learning activities, outdoor school environment changes, and extreme weather conditions.

Conclusions

This study indicates that FALK has the desired effects on PA and is a feasible method of integrating PA into theoretical teaching. We conclude that FALK is worth testing at more schools, given that implementation and sustainment of FALK considers both general enablers and barriers, as well as context-specific factors at the individual school.

Peer Review reports

In recent years, there has been a stream of reports and surveys showing that children and young people have limited physical activity (PA) [ 1 , 2 ]. For example, a Swedish study shows that only 43 per cent of adolescent boys and 23 per cent of girls of the same age meet the World Health Organisation (WHO) recommendations of engaging in at least 60 minutes of PA a day of moderate to vigorous intensity [ 3 ]. Physical inactivity is a well-known risk factor for ill health and disease; at the same time, there is strong scientific evidence for PA and its health-promoting and preventing effects among children and adolescents [ 4 , 5 ]. Additionally, previous research shows that PA can have positive effects on cognitive abilities and academic achievements [ 6 , 7 , 8 ].

As children spend a lot of time in school, it is an important health-promoting arena and a supportive environment for developing both positive health-related behaviours and learning [ 9 ]. The school is also important for health equity given that physical inactivity is more common among families and children where the parents have lower education and socioeconomic status [ 3 , 10 ].

Previous research shows that school-based health interventions focusing on PA can have beneficial effects on physical and mental health among children and adolescents [ 3 , 11 ]. Some research has focused on increasing PA during physical education lessons [ 12 ]. At the same time, it does not seem to be enough to increase PA during physical education lessons; school children also need to increase PA outside physical education lessons to increase their total level of PA.

Both internationally and in Sweden, various projects and studies have explored new ways to increase PA before , during and after school. A well-known Swedish example is the Bunkeflo project, which aimed to increase the daily PA among school children [ 13 ]. Other initiatives deal with lesson-integrated PA (also called movement integration), which incorporates PA, at any intensity level, within normal classroom education and in other school subjects than physical education [ 14 ]. Among these initiatives, there is a wide range of activities including active lessons and active breaks [ 14 , 15 ]. Research shows that active lessons can have positive effects on both PA and academic achievement [ 8 , 16 ]. However, there are also challenges with implementing active lessons and lesson-integrated PA in primary schools. One challenge is the limited time for physical education in the curriculum, and conducting PA within other lessons can create tensions as lesson-integrated PA can be perceived as stealing valuable time from teaching the subject. Previous research shows several enablers and barriers when lesson-integrated PA is implemented in primary schools. In a systematic review by Michael et al. [ 17 ], teachers’ motivation and self-confidence together with organisational support, time and resources are crucial factors. However, there is a need for further research about what effects can be expected under real-world circumstances (effectiveness) and how lesson-integrated PA works in practice. The latter involves the need for in-depth knowledge about the feasibility and implementation of lesson-integrated PA [ 18 ].

The present study investigates the effects and experiences of a new method integrating PA into theoretical teaching. The method is called ‘Physical Activity and Lesson in Combination’ (abbreviated FALK in Swedish; hereafter we use the Swedish abbreviation) [ 19 , 20 ]. FALK is intended to encourage students to be physically active, and to practice pulse-raising activities during theoretical teaching in all subjects. The overall goal of FALK is to develop a pragmatic method for increased total PA among students. Thereby, the FALK method follows calls for pragmatic approaches in public health research, meaning interventions focusing on issues and information relevant to decision-making and action-taking, and balancing results relevant to stakeholders without abandoning scientific rigour [ 21 ]. Consequently, the study aims to investigate the effectiveness and feasibility of lesson-integrated PA in a primary school. The following research questions are explored:

To what extent does lesson-integrated PA affect the students’ total PA?

How are enablers and barriers experienced by students, parents and teachers when conducting lesson-integrated PA?

What improvements regarding lesson-integrated PA do students, parents and teachers identify?

A mixed methods approach was used to investigate the effects of FALK and the experiences of lesson-integrated PA. More specifically, the study used an explanatory sequential mixed methods design [ 22 ] in which a quasi-experimental study of PA effects was followed by qualitative interviews, focusing on experiences of FALK under real-world conditions in a primary school setting.

Intervention characteristics and research setting

The goal of FALK was to develop a pragmatic method that increases student’s total level of PA by integrating PA in ordinary lessons, thereby achieving lesson-integrated PA (i.e. FALK lessons; see Additional file 1 ). The intervention used a quasi-experimental design with students in the intervention school completing three FALK lessons for 30 minutes a week, in addition to regular physical education lessons (two 40 minute lessons per week). Students from another primary school served as a control group and participated in regular physical education (two 40 minute lessons per week). PA was the primary outcome measure of the intervention and was objectively measured using pedometers.

In the present study, the FALK intervention was conducted with students in grades 1 to 3 (7–9 years old) at a municipal primary school located in a small community outside a medium-sized city in Sweden. The intervention took place during the academic year, in the autumn of 2020 and spring of 2021. Before the FALK intervention began the principal gave her approval and support. Two teachers (SJ and EL), who had participated in a pilot study, informed all teachers at both the intervention and control school (I-school and C-school) about FALK, and at the I-school, a total of twelve teachers conducted FALK lessons. Several FALK lessons, and related work materials, had already been prepared from the pilot study. Thereafter, more FALK lessons and work materials were developed, in preparation for the start of FALK at the intervention school. The FALK study was approved by the Swedish Ethical Review Authority in Stockholm (dnr 2020 − 00922).

Participants

In the quasi-experimental study, students from two primary schools were recruited (7–9 years old) and with one school’s students participating in the FALK intervention (i.e. intervention group, I-school) and the other school’s students acting as the control group (C-school). A total of 164 students participated (see Table  1 ).

The I-school and C-school are located a few kilometres apart in a rural community outside the city. The two schools showed no major differences in terms of lesson content, outdoor school environment or student living conditions. The same principal is responsible for both schools, the teachers at the two schools have common planning of the educational content and the students at both schools engage in the same kind of leisure activities both during warm and cold seasons. Therefore, we consider the risk of selection bias to be small. In more detail, the groups at the C-school and I-school participated in the FALK study as follows:

C-school (control group)

Regular physical education lessons twice a week for 40 minutes, plus the possibility of voluntary or organised recreational activities with physical movement.

I-school (intervention group)

In addition to regular physical education lessons, and the possibility of voluntary or organised recreational activities with physical movement, three FALK lessons of 30 minutes each were carried out continuously every week over two semesters (i.e. one academic year). Class teachers, leisure leaders and/or physical education teachers organised and carried out the FALK lessons based on the curriculum for each grade and the student’s knowledge levels and maturity.

The qualitative interview study involved three groups of participants: students, parents (guardians), and teachers. Purposeful sampling was used to select the participants based on their experience of FALK [ 23 ]. In practice, the sampling was made by selecting students who had participated in FALK lessons, parents of students participating in FALK lessons, and teachers responsible for conducting FALK lessons.

Data collection

The quantitative data collection was conducted using a pedometer (Yamax LS2000/SW200). Students and parents were instructed on how to use the pedometer. All readings and documentation of pedometer data were carried out by staff at the I-school and C-school. The pedometers were worn by students at both schools during all waking hours for seven consecutive days on four measurement occasions:

Sep-20 (week 37) immediately before the start of the intervention (baseline measurement).

Nov-20 (week 46) at the end of the autumn term.

Feb-21 (week 6) at the beginning of the spring term.

May-21 (week 18) at the end of the intervention.

Qualitative data were collected by semi-structured interviews [ 24 ], and in total, 17 students (nine girls and eight boys representing grades 1 to 3), nine parents (five women and four men), and nine teachers (eight women and one man) were interviewed. All interviews were individual, face-to-face, and conducted using an interview guide with open-ended questions. The interview questions were straightforward and focused on what had worked well, less well, and what could be improved in FALK. The interviews were conducted by two of the authors (EL and SJ) and were documented by taking notes. For interviews with students, written informed consent was obtained from parents (guardians) and verbal consent was obtained for interviews with parents and teachers. All interviews were conducted after the intervention (i.e. May-June 2021).

In the study design phase, sample size and power were calculated. Based on a previously conducted pilot study (2018, unpublished), the approximate mean number of steps per day (SPD) was expected to be 11,000 and the standard deviation 3,000. Clinically relevant differences/changes were estimated to be 1,500 SPD (equivalent to, approximately, a one-kilometre walk). Sample size calculations showed that with a statistical power of 80% and α = 0.05, 63 students per group were required.

The statistical analysis began with calculating an average value for the number of SPD for each student. Calculations were conducted for weekdays (Monday morning to Friday afternoon), weekend days (Friday afternoon to Monday morning) and all seven days of the week (total PA of the week). An analysis of variance, specifically a mixed between-within-subjects ANOVA, was conducted to examine differences in total PA (measured as the average number of SPD for the entire week) between schools over time. Independent t-tests were then carried out on each of the four measurement occasions to examine the difference in SPD average values between the I-school and C-school on weekdays, weekends, and for all seven days in the current measurement week. A one-way between-groups analysis of covariance (ANCOVA) was conducted to adjust for the (non-significant) baseline difference in SPD. Finally, we examined the percentage of students at each school who did not achieve 10,000 SPD per day on average for the entire week at each measurement time. These results are presented in cross tables, for all students and girls and boys separately. Differences in these proportions were analysed with the Chi2 test on each of the four measurement occasions. All statistical analyses were conducted using SPSS Statistics version 26.

The interview data were analysed using qualitative content analysis [ 25 ]. We started the analysis by reading the interview notes to familiarise ourselves with the data, and thereafter we started the open coding by searching for keywords, phrases, and meaningful sentences. In the open coding process, initial codes were identified and sorted into potential subcategories, which were later collapsed into broader generic categories. After this process, subcategories and categories were reviewed and further refined. The interview material was first analysed inductively and separately for the three interview groups (i.e. students, parents, and teachers) and then brought together to form a holistic picture. All authors were involved in the final stages of the analysis, and the results were discussed to ensure credibility.

First, the quantitative results are presented, followed by the qualitative results. All results are interpreted and discussed in the discussion section.

Quantitative results

Differences in PA between the I-school and the C-school are reported here first as SPD, then as the proportion of students with fewer than 10,000 SPD. The analysis of variance showed no significant interaction between measurement time and school, Wilk’s Lambda = 0.93, F(3.83) = 2.06, p  = 0.11, partial eta squared = 0.07. There was a significant main effect of measurement occasion, Wilk’s Lambda = 0.57, F(3.83) = 20.50, p  < 0.01, partial eta squared = 0.43. There was also a significant main effect of school, F(1.85) = 4.64, p  < 0.05, partial eta squared = 0.05. This indicates that FALK contributes to increased total PA. The students included in the analysis of variance and their SPD at each measurement point are presented in Table  2 .

On weekdays, there was no statistically significant difference in mean SPD at the baseline measurement (i.e. immediately before the intervention), but when the FALK lessons were ongoing (measurements 2 to 4), the I-school had more SPD than the C-school. On weekends, the I-school had more SPD than the C-school at all four measurements, a difference that was statistically significant at measurements 3 and 4. For total PA (‘whole week’), there was no statistically significant difference between the I-school and C-school students at the first measurement, but at the three subsequent measurement weeks, the I-school had more SPD than the C-school (see Table  3 ; Fig.  1 ).

Average number of SPD for students at I-school and C-school at each measurement occasion for weekdays, weekend days and the whole week (SD shown in Table  3 )

At the first measurement (M1 Whole week, before the start of the intervention), the I-school had an average of 886 more SPDs than the C-school. Although this difference was not statistically significant, one could argue for using statistical methods to adjust for differences between the groups in baseline values. A one-way between-groups analysis of covariance (ANCOVA) was conducted. After adjusting for the difference in pre-intervention SPDs between the groups at M1, there was no longer a statistically significant difference between the groups at M2 ( p  = 0.08) but the statistically significant differences remained at M3 and M4 ( p  < 0,01).

Moreover, girls had fewer SPD on average than boys (Table  4 ). There was also a higher proportion of girls, compared to boys, who did not reach 10,000 SPD (Table  5 ). A large proportion of students fell below 10,000 SPD. Before the intervention, the proportion was similar in both schools. During the weeks of measurement when FALK lessons were taking place, the I-school had significantly fewer students with less than 10,000 SPD (Table  5 ).

Qualitative results

In the analysis, three descriptive categories were created. The categories focus on the students’, parents’, and teachers’ experiences with FALK illustrated with quotes.

A new way of working meets students, parents, and teachers

Students, parents, and teachers express positivity about the new way of working that FALK entails. The students experience FALK as rewarding: “We get to learn a lot of things at the same time as we move” (student, grade 2). Also, students enjoy the fun aspects and appreciate participating in developing PA exercises. Like the students, parents support FALK for combining movement and learning, expressing a need for increased student movement during school days.

Teachers perceive FALK as clear, flexible, and enhancing the joy of movement and learning. Teachers emphasise that FALK does not need to be complicated, but instead FALK is seen as a flexible method that can be varied based on subject, class size, weather, and season. Also, teachers value that FALK lessons are explicitly integrated into schedules, emphasizing their compulsory nature akin to other subjects.

A positive effect of FALK emphasised by all involved is the calming influence on the classroom after the FALK lesson. Both students and parents say it is positive for students to reduce excess energy, and the teachers emphasise the students’ enhanced educational focus in subsequent lessons.

“I think they [the students] are calmer after an outdoor lesson. We have good lessons afterwards in the classroom.” Teacher.

The students talk about challenges in FALK with inattentive classmates creating anxiety when the teacher gives instructions and FALK lessons being less enjoyable when they perceive the learning activities as too difficult. A few teachers also find FALK too ‘controlled’ and struggle with the integration of pulse-raising activities with subject teaching, such as finding the right balance between PA and relevant learning activities.

“To combine this [traditional lesson] with the fact that it has to be physical activity with increased heart rate… This has become a bit too artificial for me to achieve.” Teacher.

Teachers can also face challenges in fostering motivation, commitment, and calm during FALK briefings. Despite these challenges, the teachers note that achieving student motivation and calmness during lessons are universal and not exclusive to FALK teaching.

Parents see improved information dissemination as desirable; they wish to know more about FALK and are curious about the results. Parents find FALK inspiring and advocate sharing information with other classes and schools in the municipality.

A new way of working meets the school and the teacher’s working day

The new way of working that FALK entails influences how the teachers work. Teachers express that FALK foster innovative thinking on combining PA and teaching. FALK encourages collaboration, allowing teachers to share work material, draw inspiration, and create new material together.

“We have taken turns to make different materials, and it has been rewarding to get new ideas from another colleague.” Teacher.

Collaboration is also encouraged by two teachers facilitating FALK lessons. For example, tasks can be divided between the teachers, simplifying student reporting of assignments, and making it easier to support students.

A challenge teachers describe is FALK lesson planning, requiring time to adopt the ‘FALK mindset’ and creating work materials for lessons. Also, it can be challenging to introduce substitutes in the FALK way of working if regular teaching staff is absent.

While FALK enhances collaboration, teachers working alone with FALK lessons ask for more cooperation and collegial support. Some teachers suggest better informing on FALK in the teaching team before implementation and call for improved structuring and organisation of work material by grade and subject.

The influence of the surrounding school environment

Changes in the surrounding school environment and weather conditions affects FALK implementation. According to students and teachers, a schoolyard rebuilding has occasionally made FALK lessons challenging, with the schoolyard temporarily reduced and having other students in the schoolyard. This posed difficulties for students to concentrate on the FALK lesson due to distractions in the schoolyard.

“It was tough in the fall when there were several students who couldn’t focus due to various reasons and it made it difficult to be out with many distractions. The rebuilding of the schoolyard has made the work somewhat difficult”. Teacher.

Concerning the external school environment, teachers suggest a dedicated pre-lesson gathering spot where students can meet before FALK lessons, like the football field or a nearby wooded area. Heavy rain and cold winter days sometimes pose challenges in carrying out FALK lessons as planned. Teachers have on occasions been forced to rethink, leading to indoor PA activities like active breaks as part of regular lessons. Students also express less enjoyment in FALK lessons during wet and cold conditions.

In this study, we investigate the effects of FALK and how students, parents and teachers have experienced its feasibility at a municipal primary school. As far as we know, our study is the first Swedish study exploring lesson-integrated PA in primary schools, and one of just a few European studies investigating movement integration (MI) interventions in a primary school setting using a researcher-teacher collaboration approach [ 15 ].

It is recommended that children and adolescents 6–17 years of age should be physically active for at least 60 minutes every day [ 4 ]. This equates to just over 10,000 SPD, slightly more for boys than girls [ 26 ]. To detect students who are most likely to fall short of the recommendations, this study used an average value of 10,000 SPD for both girls and boys as the upper limit for insufficient PA.

The reason for measuring the number of steps on seven consecutive days (i.e. also on weekends although the FALK lessons were conducted during school hours on weekdays) is that we wanted to measure children’s total PA during the whole week. This is in line with the ActivityStat Hypothesis [ 27 ], which states that if you increase your PA in one area (e.g., during school hours), you will compensatively decrease your PA in another area (e.g., during the weekend) to maintain a stable level of total PA (or energy consumption). Therefore, we wanted to know whether increasing PA at school would lead to less PA during the weekend (which would be undesirable).

One might think it is a given that the total PA level will increase if school-based interventions to increase PA are implemented. However, it must be remembered that a small ‘dose’ of increased PA during the school day is still a relatively limited fraction of the total time available to be physically active, or inactive, which again relates to the the ActivityStat Hypothesis [ 27 ]. Previous research shows that the majority of MI interventions have a PA dose of 10–20 minutes per day [ 15 ], and while interventions can have positive impacts on total PA, there is also variability and uncertainties in results [ 8 , 16 ]. With this said, the quantitative results show that FALK increased the proportion of students exceeding 10,000 SPD. We see this result as an indication that FALK has a positive and significant effect on PA among students who, for various reasons, are at risk of falling short of the recommended PA level [ 4 ]. The ambition of FALK is not for students to become athletes, but rather for the students ‘most in need’ to move enough to reach a minimum level of PA from a health perspective.

It has been shown that school children move less on weekends compared to school days [ 3 , 28 ], which is consistent with our results. This further underlines the importance of the school as a health-promoting setting enabling PA for all students, making the school setting especially important for those students most in need of increased PA.

Not surprisingly our results show that outdoor temperature appears to impact the SPD among the students. Compared to the first measurement (week 37), the average SPD at both schools decreased at the second and third measurements (week 46 and week 6 respectively) and then increased at the final measurement (week 18). However, there was a large difference between schools in terms of seasonal variation in the proportion of students with less than 10,000 SPD. At the C-school, this proportion increased sharply in late autumn (measurement 2) and winter (measurement 3), while the change in the I-school was comparatively small.

The quantitative results demonstrate significant differences in average SPD between the two schools at the measurements when FALK is ongoing at the I-school, which we believe helps to provide a clearer picture of the effects of FALK. The difference between our two schools in SPD for the ‘whole week’ increases with the duration of the FALK intervention, and we believe that comparison at measurement 4 is the most interesting, as students at the I-school had conducted FALK lessons for almost two full semesters. At the fourth measurement, the difference between the schools was 2,495 SPD and adjusted for baseline values (i.e. the difference of 886 SPD at measurement 1), the difference at measurement 4 is 1,609 SPD. One might think that a difference in total PA of just over 1,600 SPD on average is not very impressive, but the change contributed by FALK seems to have occurred mainly in students with less than 10,000 SPD, which means it can improve health among students most in need.

Several studies have shown that girls are less physically active than boys [ 2 , 3 , 10 ], and we found the same pattern in our study. The FALK intervention did not close the gender gap in total PA, but we did see a step in the closing direction as there was a significant reduction in the proportion of girls at the I-school who did not reach 10,000 SPD. The latter, to some extent, contradicts previous studies suggesting that school-based interventions increase PA and produce the desired results for boys, but not to the same extent for girls [ 29 , 30 ].

Moreover, the qualitative results are well in line with previous research on enablers and barriers in the implementation of lesson-integrated PA in primary schools [ 17 ]. FALK is perceived as a clear and flexible method by teachers, and positive perceptions and ease of implementation of the new method are among the enablers in previous studies [ 17 ]. The results that teachers consider FALK as a clear and flexible method is important as one goal of FALK is to provide a pragmatic method for the integration of PA and learning. Another important result is that FALK contributes to the students being calmer in the classroom after FALK lessons. This creates a learning environment that, most likely, is more beneficial for student learning. However, how FALK influences the learning environment and learning is a question for future research.

The qualitative results also reveal challenges (barriers) mostly linked to the teachers’ work situation, working time and practical challenges in combining PA and teaching. Time constraints and competing demands to meet the curriculum are highlighted in previous research [ 17 , 31 , 32 ]. In our study, competing demands are not so prominent, but a few teachers perceive FALK as ‘controlling’ because pulse-raising PA needs to be combined with theoretical teaching. This kind of challenge could possibly be solved with the help of other teachers finding suitable FALK lessons for the subject concerned. However, the teachers’ work situation needs to be considered when deciding to implement FALK in schools. As with any organisational change, it is important to have a dialogue and involve those affected by the change, which in the long run paves the way for successful implementation [ 33 ].

The qualitative results also point towards possible improvements in FALK, with the teachers emphasising the need for even more consensus on the method and better coordination of work materials. Improvements involve better communication in the teaching team and organising work materials more clearly by subject and grade. We believe these improvements are ‘low-hanging fruits’ and are relatively easy to improve. Furthermore, the need for improvements will most likely emerge when FALK is tested on a larger scale in more schools with varying preconditions.

Finally, we want to discuss FALK in relation to the school leader role and sustainability. Leadership, organisational support, and resources are factors commonly reported on in implementation research [ 34 ], as well as research on implementation of school-based health interventions [ 35 , 36 ] and successful implementation of lesson-integrated PA [ 17 ]. Even though the school leader’s role was not evident in our results, it was fundamental for setting up our researcher-teacher collaboration and for providing resources and thereby creating good conditions for staff to put FALK into practice. As indicated in previous research, attitudes among school leaders are crucial for implementing health-promoting initiatives in schools in general [ 37 ], as well as for providing resources and creating structures and processes for lesson-integrated PA to be sustainable over time [ 14 , 15 ]. Sustainability is an urgent research task in school-based health interventions, and this also applies to FALK to become part of organisational routines in schools and result in long-lasting effects on the children’s total PA levels [ 35 , 38 ].

Strengths and limitations

We consider the mixed methods approach a strength of the study as the explanatory sequential design contributes to a more in-depth understanding of the effectiveness and implementation of the FALK intervention. Below, we discuss the strengths and limitations of the included quantitative and qualitative approaches.

The study was conducted on a limited number of students and with only two primary schools involved. The relatively small size of the study and the fact that schools in Sweden have varying preconditions means that the generalisability of the study is somewhat limited. Another limitation of the study could be the quasi-experimental design, i.e. individual students were not randomised to the intervention group or the control group. For obvious reasons, it is difficult to randomise students when the groups are located in different schools. The fact that the intervention and control groups were in different schools can also be considered a strength of the study because the groups did not affect each other (i.e. there was no ‘spillover effect’).

Different methods can be used to objectively measure PA. Pedometers measure the number of steps while accelerometers measure changes in the speed of movement. The advantages of pedometers used in the present study are that participants can monitor their own activity progress, and pedometers are suitable for use in interventions. On the other hand, a disadvantage of the ‘number of steps’ measure is that it does not tell us anything about intensity, but pedometers can still be used to measure an individual’s total PA over time. An advantage of the accelerometer is that in addition to total PA, it also shows intensity, duration, and frequency. A disadvantage of the accelerometer is its price. Both pedometers and accelerometers are insensitive to activities such as swimming, cycling and arm movements. Nevertheless, both devices can provide a good picture of total PA [ 39 , 40 ].

It is common practice to report the results of intervention studies, such as the evaluation of a new drug or a manual-based programme, with a detailed description of the methods so that other researchers can repeat (replicate) the study. The FALK method has to be adapted to the different conditions in different schools and is therefore difficult to describe in detail, using a step-by-step approach. The core of FALK is to integrate PA into theoretical, compulsory lessons. In addition to the influence of the level of knowledge and maturity of the students, the implementation of FALK is also influenced by the individual school’s staffing resources, the availability of outdoor activities, the composition of the student group, the group dynamics, the preferences of students and teachers, and the current weather conditions.

The FALK lessons in the present study are designed for students in grades 1–3, i.e. children aged 7–9 years (see Additional file 1 ). For other age groups, the content of the lessons needs to be adapted. The proportion of students with insufficient PA increases in higher grades [ 3 ], which motivates the development of school-based methods that increase PA also in older students.

A strength of the interview study is that it explores enablers and barriers of lesson-integrated PA from three perspectives. The interviews with students, parents and teachers contribute to a more nuanced and credible picture of the implementation process [ 23 ], and it is a strength that the voices of students are heard because they are the ones participating in the FALK lessons.

A limitation is that the study only reflects experiences from one medium-sized municipal primary school in Sweden. At the same time, the study’s results can be transferable to similar methods (interventions) within primary schools given that contextual conditions are considered [ 18 , 23 ]. Finally, a limitation is the short and non-recorded interviews. A consequence of this approach is that it provides a more limited interview material compared to audio-recorded interviews, which can affect the depth of the qualitative analysis. Another risk is bias, with notetaking being influenced by the researcher’s preunderstanding and interpretations. We have handled this risk by having interviews and research questions covering both enablers and barriers with FALK, as well as being several authors involved in both taking notes and the analysis. However, the difficulty of capturing all the details when taking notes should be taken into account. Considering that the interview questions were straightforward (what was good, less good and suggestions for improvement) and did not touch on sensitive issues, we still deemed it sufficient and pragmatic to document the interviews through notes. A recent review shows that rapid (interview) methods, despite their limitations, can be an alternative to traditional qualitative methods [ 41 ].

Future research and practical implications

We have four suggestions for future research in addition to investigating the sustainability of FALK. First, we suggest investigating FALK effectiveness in older age groups and under varying circumstances, meaning schools located in both high and low socioeconomic areas. This is important as we know from previous research that a student’s PA follows a social gradient, with students from high-income areas having higher levels of PA [ 3 , 10 ]. Second, to explore the effectiveness of FALK for students with special needs, and to study the implementation of FALK in special needs education and what kind of adaptations are needed. Third, although FALK is not a manual-based method, the balance between fidelity and adaptation in varying school contexts needs further study [ 42 ]. Fourth, to explore how FALK influences the learning environment in the schools and how FALK influences the student’s learning.

Under the right circumstances, the practical implication of FALK is that it is a method worth trying. FALK does not require extensive financial investment, extra facilities, extra school staff or lessons outside the regular schedule. However, what is needed is the courage to think ‘outside the box’ in teaching– implying that teaching can take place in other ways than sitting indoors in a classroom. Also needed are acceptance among teaching staff, and support from the school leader.

We conclude that FALK is a useful and feasible method for integrating PA into theoretical teaching. FALK effectively increases the average number of SPD and reduces the number of students not reaching the recommended level of PA. Moreover, FALK is experienced as a positive, clear, and flexible method encouraging PA and concurrent learning. FALK also contributes to professional development, collegial learning, and collaboration among teachers. Challenges experienced concern the teachers’ work situation, time, finding suitable learning activities, outdoor school environment changes, and extreme weather conditions. Suggested improvements in FALK include consensus on the way of working among teachers, and better organisation of work materials. The results taken together, we conclude that FALK is worth testing at more schools, given that implementation and sustainment of FALK considers both general enablers and barriers, as well as context-specific factors at the individual school.

Data availability

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Swedish abbreviation for ‘Physical Activity and Lesson in Combination’

• Movement integration
• Physical activity

Steps per day

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Acknowledgements

The authors thank all students, parents and teachers participating in the study. Special thanks to Karin Wäckelgård Nordin, Principal at both the intervention and the control school, for making the study possible.

This research was funded by Folksam Research Foundation. The research funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

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TL, EL, and SJ conceptualised, designed, and collected the data of the study. The formal analysis was performed by TL and RL, with EL and SJ providing reviewing comments on the quantitative and qualitative results. The first draft of the manuscript was written by RL and TL. All authors read, reviewed, and approved the final manuscript.

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The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Swedish Ethical Review Authority (dnr 2020 − 00922). Informed consent was obtained from all participants or their legal guardian(s).

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The first author (RL) is a senior lecturer in public health sciences with experience in health promotion, implementation, evaluation, and qualitative research. The second (EL) and third (SJ) authors are teachers working in a primary school in Borlänge municipality, Sweden. EL is a registered teacher with over 38 years of experience in teaching physical education and health. SJ is also a registered teacher with 16 years of teaching experience and with an interest in PA. The fourth author (TL) is a licensed physician by profession and an associate professor and senior lecturer in public health sciences with extensive experience in teaching and research on lifestyle factors, especially PA, and health.

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Larsson, R., Ljung, E., Josefsson, S. et al. ‘We get to learn as we move’: effects and feasibility of lesson-integrated physical activity in a Swedish primary school. BMC Public Health 24 , 1087 (2024). https://doi.org/10.1186/s12889-024-18509-7

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Beyond Weight Loss: Five Yale Experts on the Benefits of Exercise

Listen to "beyond weight loss: five yale experts on the benefits of exercise".

Most of us know that regular physical activity can strengthen muscles, burn fat, and lower our risk of heart disease. But many advantages of exercise go beyond physical fitness and cardiovascular health, according to Yale School of Medicine experts.

Five Yale Department of Internal Medicine specialists in areas ranging from infectious diseases to allergy and immunology discuss why exercise is key to optimal health.

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Studies led by Gerald I. Shulman, MD, PhD , George R. Cowgill Professor of Medicine (Endocrinology) and Cellular and Molecular Physiology, Investigator Emeritus of the Howard Hughes Medical Institute, and co-director of the Yale Diabetes Research Center, have demonstrated that exercise can reverse muscle insulin resistance.

“Insulin resistance in skeletal muscle is a major factor in the pathogenesis of type 2 diabetes, fatty liver disease, heart disease, and obesity-associated cancers,” said Shulman, who recommends daily exercise to promote cardiometabolic health. “There is also increasing evidence that insulin resistance may be a contributing factor in the progression of Alzheimer’s disease.”

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Exercise can reduce the risk of poor outcomes when infections occur, according to Scott Roberts, MD , assistant professor of medicine (infectious diseases). “For many infections, such as influenza, COVID-19, and RSV, comorbidities such as obesity, diabetes, and poor respiratory health are all major contributors to severe disease,” he said. “Exercise can help mitigate these risks and boost the odds of a speedy recovery.”

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There is evidence that light to moderate aerobic exercise, like walking or jogging, can help the immune system work better, says Elise Liu, MD, PhD , instructor of medicine (rheumatology, allergy and immunology). “People who regularly get this type of exercise get sick less frequently than people who are sedentary,” she said. “This could be because several types of immune cells have been shown to work better shortly after exercise.”

4. Exercise contributes to a healthy gut.

Evidence suggests that exercise leads to a more diverse gut microbiome and an increase in butyrate, a short-chain fatty acid that may prevent disease, according to Avlin Imaeda, MD, PhD , associate professor of medicine (digestive diseases). “Butyrate is one of the key fuels that the cells lining the colon need to grow, divide, and stay healthy, and higher levels of butyrate can reduce the severity of inflammatory bowel disease and the risk of colon cancer, as well as general inflammation,” she said.

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Exercising during the day can help you sleep at night, notes Brienne Miner, MD, MHS , assistant professor of medicine (geriatric medicine). “Exercise is an external cue to your circadian clock, sending a physiologic message that lets your brain and body know when it is time to be awake versus when it is time to sleep,” she said. “A robust and regular circadian clock allows more regular and restorative sleep.”

Regular physical activity also contributes to better physical and mental health, decreasing the risk of developing sleep problems and potentially improving existing sleep problems, Miner said.

The Department of Internal Medicine at Yale School of Medicine is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators, educators, and staff in one of the world's top medical schools. To learn more, visit Internal Medicine.

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What’s Your Role?

As a school administrator or education professional, you can help improve the health of your students, faculty, staff, and community.

The education sector can take a lead role in providing opportunities for age-appropriate physical activity in all educational settings, from preschool to college.

For example, K–12 schools can make sure their students and staff have ways to be physically active before, during, and after school as part of a Comprehensive School Physical Activity Program (CSPAP) . They can also promote safe ways for students and staff to actively commute to and from school.

Colleges and universities can promote physical activity by creating pedestrian- and bicycle-friendly campuses and adopting policies that encourage walking and biking. They can educate future professionals—not just those in health fields, but also those studying architecture, business, and community design—on the importance of walking and biking as ways to improve individual and community health.

• What Can You Do?

You can use the following strategies to encourage physical activity in and around schools.

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Promote community plans and policies to design areas around schools to support safe and easy places for people to walk, bike, wheelchair roll, and be physically active.

• Build schools within walkable or bikeable distances of homes and other places that students and staff regularly use.
• Create pedestrian- and bicycle-friendly campuses and encourage walking and biking to and around campuses. Provide information to support these activities, such as point-of-decision prompts and wayfinding signs.
• Join coalitions and planning processes to influence community designs and development decisions in areas around schools.

Adopt policies that make it easier for students to be physically active before, during, and after school as part of a CSPAP.

• Adopt Safe Routes to School or similar programs that promote walking or biking to school.
• Provide daily physical education for students in grades K–12 and daily recess for elementary school students.
• Add opportunities for movement for students and staff as part of regular classroom activities and lessons.
• Set up formal policies or agreements, such as shared-use agreements, that expand physical activity options for schools and communities. For example, schools can open facilities to community residents outside of normal school hours, and schools can use nearby community facilities, such as fields and parks.

Promote programs and policies that make it safe and easy to walk, bike, wheelchair roll, and be physically active.

• Adopt worksite policies that encourage school staff to be physically active. Examples include flextime, paid activity breaks, and discounts for using off-site exercise facilities or active commute options.
• Set up groups, buddy systems, and other forms of social support that help people walk, bike, or be active each week.

Teach relevant professionals how to promote physical activity and activity-friendly communities through their profession.

• Train administrators and classroom teachers how to add more physical activity throughout the school day.
• Add physical activity to higher education curricula across majors to promote interdisciplinary training.
• Offer continuing education that promotes physical activity for relevant professionals.

Active People, Healthy Nation SM has many strategies that work . Visit the website to find options that fit your needs. Look for ways to collaborate with other sectors.

These communities are using effective strategies to increase physical activity in and around schools.

Building Activity-Friendly Schools in Minnesota State laws that recommended minimum acreage for new schools forced communities into a one-size-fits-all approach. The result was schools that were unwalkable and unconnected to the rest of their communities. Activists across Minnesota came together to change state law to allow communities to renovate historic buildings in walkable locations instead of building new schools on large plots of land at the edge of town.

Promoting Cycling at Community Colleges in Texas and California Texas Southmost College and Santa Monica College were recognized as Bicycle Friendly Universities for their work to promote biking. Both schools used as variety of resources to make it easier for people in the community to bike to and on campus. These efforts included providing infrastructure such as bike parking, showers and lockers, lighting and cameras, bike repair stations, and bike share options. They also promoted local bicycling events, provided bicycle-related workshops, and gave free bikes to students receiving financial assistance.

• Comprehensive School Physical Activity Programs: A Guide for Schools [PDF-6.34MB] This tool provides step-by-step guidance for schools and school districts to develop, use, and evaluate comprehensive school physical activity programs.
• Healthy Out-of-School Time Assessment This assessment tool helps school districts and school staff create a healthier out-of-school time environment for kids. They can use this tool to track what they are already doing to support health and wellness at their location and highlight opportunities for growth and improvement.
• Infographic: Benefits of school-based physical activity This graphic explains how 60 minutes of daily moderate-to-vigorous physical activity can benefit a student’s health and directly impact teachers and the community.
• Increasing Physical Education and Physical Activity: A Framework for Schools [PDF-3.19MB] This document describes the Comprehensive School Physical Activity Program framework. It is for school health professionals, school administrators, physical education teachers, other school staff, and parents. It identifies key professional development opportunities and resources to help schools use the framework.
• Inclusive School Physical Education and Physical Activity This website shares information that schools and school districts can use to create an inclusive culture for physical education and physical activity in schools.
• Strategies for Classroom Physical Activity in Schools [PDF-3.41MB] This document describes 10 evidence-based strategies that school staff can use to promote and plan classroom physical activity.
• Integrate Classroom Physical Activity in Schools: A Guide for Putting Strategies into Practice [PDF-4.18MB] This guide provides key questions and activities, along with practical templates that teachers and other physical activity champions can use to help them adopt, promote, enhance, or sustain the strategies in Strategies for Classroom Physical Activity in Schools .
• National Physical Activity Plan: Education Sector [PDF-9.39MB] The  National Physical Activity Plan  provides policy and programmatic recommendations to increase physical activity. It includes strategies and tactics that communities, organizations, and individuals in the education sector can use to support physically active lifestyles.
• Strategies for Recess in Schools [PDF-2.64MB] This document shares evidence-based strategies that school district leaders and school staff can use to plan and provide recess in schools to increase physical activity and improve academic achievement (e.g., performance, behavior, attention).
• Strengthen Physical Education in Schools [PDF-767KB] This data brief helps schools and school districts define physical education. It provides a snapshot of current practices in the United States and highlights ways to improve physical education through national guidance and practical strategies and resources.
• Bicycle Friendly University The Bicycle Friendly University program recognizes institutions of higher education that promote and provide more bikeable campuses for students, staff, and visitors. It was created by the League of American Bicyclists.

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Registrar at place of residence of the individual entrepreneur: Mezhraionnaia inspektsiia Federalnoi nalogovoi sluzhby №23 po Moskovskoi oblasti (tax office code – 5081). Tax authority with which was registered: Inspektsiia Federalnoi nalogovoi sluzhby po g. Balashikhe Moskovskoi oblasti (tax office code – 5001). Date of registration with the tax authority: 05/05/2010.

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Registrar at place of residence of the individual entrepreneur: Mezhraionnaia inspektsiia Federalnoi nalogovoi sluzhby №23 po Moskovskoi oblasti (tax office code – 5081). Tax authority with which was registered: Inspektsiia Federalnoi nalogovoi sluzhby po g. Balashikhe Moskovskoi oblasti (tax office code – 5001). Date of registration with the tax authority: 08/31/2004.

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• Associations of excessive internet use, sleep duration and physical activity with school absences: a cross-sectional, population-based study of adolescents in years 8 and 9
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• http://orcid.org/0000-0002-2881-8299 Silja Kosola 1 , 2 ,
• Marianne Kullberg 3 ,
• Katja Melander 4 , 5 ,
• Janne Engblom 6 ,
• Klaus Ranta 7 , 8 ,
• Katarina Alanko 3
• 1 Research, Development and Innovations , Western Uusimaa Wellbeing Services County , Espoo , Finland
• 2 Pediatric Research Center , Helsingin ja uudenmaan sairaanhoitopiiri , Helsinki , Finland
• 3 Faculty of Arts, Psychology and Theology , Åbo Akademi University , Abo , Finland
• 4 Doctoral Programme in Population Health , University of Helsinki , Helsinki , Finland
• 5 Faculty of Medicine , Tampere University , Tampere , Finland
• 6 Department of Mathematics and Statistics , University of Turku , Turku , Finland
• 7 Department of Psychiatry , University of Helsinki , Helsinki , Finland
• 8 Faculty of Social Sciences , Tampere University , Tampere , Finland
• Correspondence to Dr Silja Kosola, Research, Development and Innovations, Western Uusimaa Wellbeing Services County, Espoo, 02033 Länsi-Uudenmaan hyvinvointialue, Finland; silja.kosola{at}helsinki.fi

Background Internet use has increased and sleep and physical activity (PA) have decreased in recent years among adolescents. Besides sleep and PA, another determinant of future health for adolescents is education. Our aim was to evaluate the associations of excessive internet use (EIU), short sleep duration and low PA with both unexcused absences and medical absences during lower secondary school.

Methods The School Health Promotion study is a national survey of adolescents conducted biennially in Finland. We used data collected in 2019, when EIU was assessed for the first time. Cumulative odds ratio analysis was conducted with unexcused absences and medical absences as outcome variables. Besides EIU, sleep duration and PA, the associations of maternal education and parental relations were assessed.

Results The mean age of the 86 270 participants was 15.3 years. Girls scored higher than boys on EIU. In all, 34.7% of participants slept less than 8 hours per night during the school week, and 34.3% reported low PA (ie, less than 3 days per week with minimum 1 hour of PA per day). EIU, short sleep and low PA were associated with both unexcused absences and medical absences from school. Longer sleep during weekends showed no association with absences, but good parental relations had the strongest protective association with both unexcused and medical absences.

Conclusions EIU, short sleep duration and low PA were associated with both unexcused and medical absences from school. This has important implications for both the promotion of general health and the support offered to students with alarming school absences.

• Adolescent Health
• Epidemiology
• Primary Health Care

Data availability statement

Data may be obtained from a third party and are not publicly available. Data from the School Health Promotion study are available for researchers from the study coordinators at the Finnish Institute for Health and Welfare.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/archdischild-2023-326331

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WHAT IS ALREADY KNOWN ON THIS TOPIC

Previous research has established a relationship between short sleep duration and school absences.

The connections of excessive internet use, short sleep and physical activity (PA) with school absences have remained unclear.

WHAT THIS STUDY ADDS

Excessive internet use was associated with an increased risk for both unexcused and medical absences from school, while longer sleep duration and higher PA showed a protective association.

A trusting relationship with parents emerged as an important protective factor for both unexcused and medical absences.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

Highlights the vitality of collaboration between health and education sectors to improve long-term health outcomes among adolescents.

Introduction

Education is an essential determinant of future health for adolescents, but it can be jeopardised by school absences. School absences can be either unexcused (also called truancy) or excused, most commonly for medical reasons. School absences can be caused by physical and mental health problems, but they may also be associated with different types of risky behaviour or an unhealthy lifestyle involving excessive use of screen-based media, insufficient sleep and limited physical activity (PA). 1 2

The internet, online gaming and the upsurge of social media during the last decade have dramatically changed the lives of adolescents. 3 4 Among adolescents, excessive gaming and social media use have been associated with school absences, poor numeracy skills, anxiety and poorer sleep. 5–9 Although variance between assessment instruments of excessive internet use (EIU) complicates comparisons, digital media may be a factor tempting adolescents to stay home from school, and may also hinder learning through lack of sleep. 10

Sleep is necessary for all aspects of health and development. To promote optimal health, adolescents aged 13 to 18 should sleep 8–10 hours per night. 11 Meta-analyses have found that insufficient or disturbed sleep among children and adolescents is associated with obesity and depressive symptoms. 12 13 Insufficient sleep and poor sleep quality are also associated with poor educational attainment, possibly through school absences. 14–16 The direct impact of sleep on unexcused and medical absences, however, remains unclear.

Besides contributing a positive impact on general health throughout the life course, regular PA is important for the brain health of school-aged children and adolescents because it improves both cognition and mental health. 17 Adolescents should engage in 60 min or more of moderate-to-vigorous PA daily. 18 No consensus has been reached on the association of PA with school absences. Some studies have found higher rates of absences in both inactive and highly active children than among children with medium levels of PA. 19 De Groot et al found no direct association between PA and medical absences from school. 20

The objective of this study was to examine the associations of EIU, short sleep and PA with unexcused absences and medical absences from school among adolescents. We hypothesised that EIU would be associated with a higher risk of both unexcused and medical absences, whereas sleep and PA would have a protective association.

Study population and procedure

This study used data from the School Health Promotion study, a national biennial survey conducted in Finland and managed by the Institute for Health and Welfare. 21 All students in years 8 and 9 and present at school on the day of the survey administration are invited to participate. Both adolescents and their parents may opt out of participation. An anonymous survey was administered to adolescents in classrooms, with both online and pen-and-paper options available, and under teacher supervision. In this study, we utilised responses from the nationally representative sample of year 8 and 9 students in 2019, when EIU was assessed for the first time. These age cohorts comprised 118 178 adolescents, of whom 86 283 (73.0%) participated. Responses were geographically evenly distributed and considered nationally representative.

In Finland, education is compulsory and free of charge from the year a child turns seven until age 18 years. In school years 8 and 9, students are typically 14–16 years old. As advised by the Institute for Health and Welfare, we excluded responses if self-reported age was below 13 or exceeded 18. Year 9 marks the end of lower secondary school, and during the spring term students apply to either academic upper secondary school or vocational education. Thus, school absences in lower secondary school have special significance.

Demographics

Self-reported gender was based on the two response options (boy or girl) to the question ‘What is your official gender?’ Students also reported their school year.

Socioeconomic status was based on maternal education level, reported by the students. The question ‘What is the highest educational level your mother has achieved?’ had four response options: ‘comprehensive school or equivalent’ (meaning 9 years of education), ‘upper secondary school, high school or vocation education’ (meaning 12 years of education), ‘occupational studies in addition to upper secondary school, high school or vocational education’ and ‘university, university of applied sciences or other higher education’.

One question, ‘Can you talk about things that concern you with your parents?’, described parental relations. Response options were ‘hardly ever’, ‘occasionally’, ‘fairly often’ and ‘often’.

Excessive internet use (EIU)

The EIU scale is short and has shown good internal consistency in previous studies. 22 23 Cronbach’s alpha was 0.77 overall and 0.74 in Finland. 23 The EIU scale has five statements: ‘I have tried spending less time online but I have failed’, ‘I should spend more time with my family, friends or doing homework, but I spend all my time online’, ‘I have found that I was online even though I did not really feel like it’, ‘I have felt anxious when I do not get online’ and ‘I have failed to eat or sleep because of being online’. Respondents were asked to estimate how often they experienced each of the above on a four-point Likert scale from ‘never’ to ‘very often’, which translated to numeric values of 1–4. EIU was defined as the mean value of the five scores.

Sleep duration

Sleep duration was calculated from two questions: ‘At what time do you usually go to bed?’ and ‘At what time do you usually wake up?’ For both questions, responses were collected separately for weekdays and weekends. Response options for bedtime were provided at half-hour intervals from ‘about 7 p.m. or earlier’ to ‘about 4 a.m. or later’. Response options for wake-up times were also at half-hour intervals from ‘about 5 a.m. or earlier’ to ‘about 1 p.m. or later’.

Physical activity (PA)

PA was assessed through two questions. The first measured overall PA: ‘Think about all the moving around you have done over the past 7 days. On how many days have you been on the move for at least 1 hour per day?’ Response options ranged from zero to 7 days. The second question evaluated vigorous PA: ‘During your spare time, how many hours per week do you usually engage in physical exercise that causes shortness of breath and sweating?’, and response options were ‘none’, ‘about 0.5 hours’, ‘about 1 hours’, ‘about 2–3 hours’, ‘about 4–6 hours’ and ‘about 7 hours or more’.

Unexcused and medical absences from school

The question ‘During this school year, how often have you experienced the following’ had two subcomponents: ‘Being absent without permission, skipping school’ and ‘Absences due to illness’. Both had the same five response options: ‘not at all’, ‘a few times in the year’, ‘every month’, ‘every week’ and ‘daily or almost daily’. Because some medical absences are natural and unexcused absences have been associated with delinquent behaviour, unexcused and medical absences were classified slightly differently into three categories.

• View inline

Statistical analyses

Descriptive statistics included percentages and means (with SD). Gender differences were estimated with independent sample t-tests and odds ratios. Cumulative odds ratio (COR) with 95% confidence intervals (CI) was used to measure the association of independent variables (gender, school year, maternal education, parental relations, EIU, sleep duration on weekdays and weekends, overall and vigorous PA) with unexcused and medical absences separately. For ordinal variables, CORs were calculated pairwise, with each category compared separately with the reference category. First, if COR >1, the distribution of absence is more concentrated to ‘higher’ values in the first category of the categorical independent compared with the reference category. Second, this concentration increases when a numeric independent has greater values. We ran the analyses separately for genders, but since CORs were mostly similar for both genders, overall CORs are presented and the few significant differences between genders are flagged. Model fit was estimated using Somers’ D. Results are reported as unstandardised estimates, and p<0.05 was considered significant. Analyses were conducted using Mplus version 8.7 and SAS 9.4.

Missing data

Data availability is reported for all variables separately. Since the proportion of missing data for different variables was low, complete cases were used in COR calculations.

The study was approved by the Working Group on Research Ethics of the Institute for Health and Welfare (THL/1578/6.02.01/2018 §807).

The 86 270 participants (response rate: 73.0% of respective age group) showed even gender and age distribution ( table 1 ). Mothers most commonly had university or other higher-level education, and parental relations were most often good.

Demographics and background variables of 86 270 study participants

The EIU scale average score was 1.9 (SD 0.7; table 2 ). Girls yielded a higher EIU score than boys (2.0 vs 1.8; p<0.001, Cohen’s d=0.4), and 1881 participants (2.3%) reported the maximum EIU score of 4.

Excessive internet use, sleep duration, frequency of physical activity and absences from school for adolescent boys and girls

Participants slept an average of 8.0 hours per night during the school week, and 9.2 hours per night during the weekend ( table 2 ). More than one-third (34.7%) slept less than 8 hours per night on weekdays, and 10.9% slept less than 8 hours per night on weekends.

Participants reported overall PA on average on 4 days during the preceding week and vigorous PA for 2–3 hours per week. Among boys, both no PA and daily PA were more frequent than among girls ( table 2 ).

In all, 3.2–4.0% of the study population reported high rates of school absences ( table 2 ). Boys reported more unexcused absences than girls did, while girls reported more medical absences than boys did (p<0.001 for both).

In cumulative odds ratio, EIU was associated with an increased risk for both unexcused and medical absences ( table 3 ). Older age was associated with an increased risk of unexcused absences. Maternal education level, parental relations (talking about concerns with parents), longer sleep duration during weekdays and PA showed a significant protective dose–response relationship with both unexcused and medical absences from school. Talking about concerns with parents often showed the strongest protective association. Overall, the model fit was moderate (0.35) for unexcused absences and low (0.22) for medical absences.

Results of cumulative odds ratio: risk and protective factors for unexcused and medical absences from school

In this nationally representative population-based study, adolescent girls reported more excessive internet use (EIU) than did boys, more than one-third of adolescents slept less than 8 hours per night during the school week and more than half of adolescents engaged in vigorous exercise for less than 3 hours weekly. EIU, short sleep duration during weekdays and low PA were all associated with both unexcused and medical absences from school among 14–16 year old students. Talking about concerns with parents often emerged as the strongest protective factor for both unexcused and medical absences.

Of the study participants, 2% yielded a maximum score for EIU. Previous studies have reported a prevalence of 6% for problematic mobile phone use. 24 The EIU specifically reflects the symptoms of addiction instead of measuring excessive time spent online. 25 Girls scored higher than did boys on the EIU scale. We suspect this may be due to social media, which girls use more than boys. 26 27 A recent meta-analysis supported the hypothesis that different patterns of internet addiction may be seen among men and women. 8

Shorter sleep duration especially during the school week showed direct associations with unexcused and medical school absences. Short sleep (less than 8 hours per night) during the school week showed a significant independent association with school absences, and this association was not compensated by longer sleep during weekends. This is in line with previous research, where weekend recovery sleep failed to protect against metabolic dysregulation. 28

Overall PA was associated with both unexcused and medical school absences: the more frequent light PA was, the fewer absences the adolescents reported. When PA was reported daily, however, the protective association of PA was smaller than for any other frequency of PA. It seems logical that a break is also needed from PA for optimal well-being. 29 In all, the findings between PA and school absences may reflect that adolescents who are supported to commit to a physically active lifestyle are also supported to attend school. 30 We also found a stronger relationship between overall than vigorous PA and fewer medical absences. Potentially a more active general lifestyle is healthier than a modern combination of a sedentary lifestyle and competitive sport hobbies. 31

In this study, a trusting relationship with parents was the strongest protective factor against school absences. Nearly half of the study participants reported that they often talk with their parents about their concerns. Trusting, open relationships between parents and their adolescent children also protect them against EIU. 32 Furthermore, adolescents also need their parents’ support to maintain a regular sleep schedule, because longer sleep during weekends is insufficient to protect against school absences.

The strengths of this study include a large, population-based cohort with a high participation rate, and distinguishing between unexcused and medical absences from school. Participation rates were even geographically and across schools in cities. The first limitation is the cross-sectional, self-reported nature of data, and thus, causal relationships cannot be determined. The most important group of non-participants were adolescents who were absent from school on the day of data collection. This could plausibly have included students with high rates of absences, which may cause bias especially in a study focusing on absences from school. When comparing our dataset with national statistics, the proportion of boys was slightly lower than among the entire population (49.3% vs 50.9%, respectively). Our proxy measure for socioeconomic status was maternal education. At population-level, education is only collected based on age and gender instead of parenthood. 33 The study participants reported a higher frequency of university level education among their mothers than recorded among women aged 35–54 at the population-level in Finland (45.1% vs 42.2%, respectively). Childlessness is, however, more common among persons with low or medium education, 34 and thus, potential bias associated with socioeconomic status remains unknown. The School Health Promotion study included no information on the type of internet use adolescents engaged in, and thus, no conclusions can be drawn related to gaming and social media. In this study, we only utilised data on the self-reported official gender, but population-based research on adolescents identifying as non-binary is urgently needed.

Despite its limitations, our results have important implications for promotion of health and education attainment. Our results are relevant for professionals organising and working in school health and well-being services, especially when professionals meet students whose school absences raise concern. Besides direct school-related factors, the lifestyle factors associated with absences should also be assessed, and support should be provided according to need.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

This study involves human participants and was approved by THL Working Group on Research Ethics, Finland (THL/1578/6.02.01/2018 §807) Participants gave informed consent to participate in the study before taking part.

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Twitter @SiljaKosola

SK and MK contributed equally.

Contributors SK: conception, design, interpretation of results, first draft, revisions, guarantor. MK: conception, data curation, interpretation of results, revisions. KM: conception, interpretation of results, revisions. JE: data acquisition, statistical analyses, interpretation of results, revisions. KR: conception, design, interpretation of results, revisions. KA: conception, design, data acquisition and curation, interpretation of results, revisions. All authors approved the final version of the manuscript.

Funding Silja Kosola was supported by a grant from The Foundation for Pediatric Research. Marianne Kullberg was supported by a grant from The Swedish Cultural Foundation in Finland, grant number 180773. Klaus Ranta was funded by the Strategic Research Council established within the Academy of Finland to the Imagine Research Consortium, grant number 352700, and to Tampere University, grant number 353048. Katarina Alanko was funded by the C.G. Sundell Foundation. The funders had no role in the study design, data collection, analysis, interpretation of data, decision to publish, or in writing the manuscript.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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40 facts about elektrostal.

Written by Lanette Mayes

Modified & Updated: 02 Mar 2024

Reviewed by Jessica Corbett

Elektrostal is a vibrant city located in the Moscow Oblast region of Russia. With a rich history, stunning architecture, and a thriving community, Elektrostal is a city that has much to offer. Whether you are a history buff, nature enthusiast, or simply curious about different cultures, Elektrostal is sure to captivate you.

This article will provide you with 40 fascinating facts about Elektrostal, giving you a better understanding of why this city is worth exploring. From its origins as an industrial hub to its modern-day charm, we will delve into the various aspects that make Elektrostal a unique and must-visit destination.

So, join us as we uncover the hidden treasures of Elektrostal and discover what makes this city a true gem in the heart of Russia.

Key Takeaways:

• Elektrostal, known as the “Motor City of Russia,” is a vibrant and growing city with a rich industrial history, offering diverse cultural experiences and a strong commitment to environmental sustainability.
• With its convenient location near Moscow, Elektrostal provides a picturesque landscape, vibrant nightlife, and a range of recreational activities, making it an ideal destination for residents and visitors alike.

Known as the “Motor City of Russia.”

Elektrostal, a city located in the Moscow Oblast region of Russia, earned the nickname “Motor City” due to its significant involvement in the automotive industry.

Home to the Elektrostal Metallurgical Plant.

Elektrostal is renowned for its metallurgical plant, which has been producing high-quality steel and alloys since its establishment in 1916.

Boasts a rich industrial heritage.

Elektrostal has a long history of industrial development, contributing to the growth and progress of the region.

Founded in 1916.

The city of Elektrostal was founded in 1916 as a result of the construction of the Elektrostal Metallurgical Plant.

Located approximately 50 kilometers east of Moscow.

Elektrostal is situated in close proximity to the Russian capital, making it easily accessible for both residents and visitors.

Known for its vibrant cultural scene.

Elektrostal is home to several cultural institutions, including museums, theaters, and art galleries that showcase the city’s rich artistic heritage.

A popular destination for nature lovers.

Surrounded by picturesque landscapes and forests, Elektrostal offers ample opportunities for outdoor activities such as hiking, camping, and birdwatching.

Hosts the annual Elektrostal City Day celebrations.

Every year, Elektrostal organizes festive events and activities to celebrate its founding, bringing together residents and visitors in a spirit of unity and joy.

Has a population of approximately 160,000 people.

Elektrostal is home to a diverse and vibrant community of around 160,000 residents, contributing to its dynamic atmosphere.

Boasts excellent education facilities.

The city is known for its well-established educational institutions, providing quality education to students of all ages.

A center for scientific research and innovation.

Elektrostal serves as an important hub for scientific research, particularly in the fields of metallurgy, materials science, and engineering.

Surrounded by picturesque lakes.

The city is blessed with numerous beautiful lakes, offering scenic views and recreational opportunities for locals and visitors alike.

Well-connected transportation system.

Elektrostal benefits from an efficient transportation network, including highways, railways, and public transportation options, ensuring convenient travel within and beyond the city.

Famous for its traditional Russian cuisine.

Food enthusiasts can indulge in authentic Russian dishes at numerous restaurants and cafes scattered throughout Elektrostal.

Home to notable architectural landmarks.

Elektrostal boasts impressive architecture, including the Church of the Transfiguration of the Lord and the Elektrostal Palace of Culture.

Offers a wide range of recreational facilities.

Residents and visitors can enjoy various recreational activities, such as sports complexes, swimming pools, and fitness centers, enhancing the overall quality of life.

Provides a high standard of healthcare.

Elektrostal is equipped with modern medical facilities, ensuring residents have access to quality healthcare services.

Home to the Elektrostal History Museum.

The Elektrostal History Museum showcases the city’s fascinating past through exhibitions and displays.

A hub for sports enthusiasts.

Elektrostal is passionate about sports, with numerous stadiums, arenas, and sports clubs offering opportunities for athletes and spectators.

Celebrates diverse cultural festivals.

Throughout the year, Elektrostal hosts a variety of cultural festivals, celebrating different ethnicities, traditions, and art forms.

Electric power played a significant role in its early development.

Elektrostal owes its name and initial growth to the establishment of electric power stations and the utilization of electricity in the industrial sector.

Boasts a thriving economy.

The city’s strong industrial base, coupled with its strategic location near Moscow, has contributed to Elektrostal’s prosperous economic status.

Houses the Elektrostal Drama Theater.

The Elektrostal Drama Theater is a cultural centerpiece, attracting theater enthusiasts from far and wide.

Popular destination for winter sports.

Elektrostal’s proximity to ski resorts and winter sport facilities makes it a favorite destination for skiing, snowboarding, and other winter activities.

Promotes environmental sustainability.

Elektrostal prioritizes environmental protection and sustainability, implementing initiatives to reduce pollution and preserve natural resources.

Home to renowned educational institutions.

Elektrostal is known for its prestigious schools and universities, offering a wide range of academic programs to students.

Committed to cultural preservation.

The city values its cultural heritage and takes active steps to preserve and promote traditional customs, crafts, and arts.

Hosts an annual International Film Festival.

The Elektrostal International Film Festival attracts filmmakers and cinema enthusiasts from around the world, showcasing a diverse range of films.

Encourages entrepreneurship and innovation.

Elektrostal supports aspiring entrepreneurs and fosters a culture of innovation, providing opportunities for startups and business development.

Offers a range of housing options.

Elektrostal provides diverse housing options, including apartments, houses, and residential complexes, catering to different lifestyles and budgets.

Home to notable sports teams.

Elektrostal is proud of its sports legacy, with several successful sports teams competing at regional and national levels.

Boasts a vibrant nightlife scene.

Residents and visitors can enjoy a lively nightlife in Elektrostal, with numerous bars, clubs, and entertainment venues.

Promotes cultural exchange and international relations.

Elektrostal actively engages in international partnerships, cultural exchanges, and diplomatic collaborations to foster global connections.

Surrounded by beautiful nature reserves.

Nearby nature reserves, such as the Barybino Forest and Luchinskoye Lake, offer opportunities for nature enthusiasts to explore and appreciate the region’s biodiversity.

Commemorates historical events.

The city pays tribute to significant historical events through memorials, monuments, and exhibitions, ensuring the preservation of collective memory.

Promotes sports and youth development.

Elektrostal invests in sports infrastructure and programs to encourage youth participation, health, and physical fitness.

Hosts annual cultural and artistic festivals.

Throughout the year, Elektrostal celebrates its cultural diversity through festivals dedicated to music, dance, art, and theater.

Provides a picturesque landscape for photography enthusiasts.

The city’s scenic beauty, architectural landmarks, and natural surroundings make it a paradise for photographers.

Connects to Moscow via a direct train line.

The convenient train connection between Elektrostal and Moscow makes commuting between the two cities effortless.

A city with a bright future.

Elektrostal continues to grow and develop, aiming to become a model city in terms of infrastructure, sustainability, and quality of life for its residents.

In conclusion, Elektrostal is a fascinating city with a rich history and a vibrant present. From its origins as a center of steel production to its modern-day status as a hub for education and industry, Elektrostal has plenty to offer both residents and visitors. With its beautiful parks, cultural attractions, and proximity to Moscow, there is no shortage of things to see and do in this dynamic city. Whether you’re interested in exploring its historical landmarks, enjoying outdoor activities, or immersing yourself in the local culture, Elektrostal has something for everyone. So, next time you find yourself in the Moscow region, don’t miss the opportunity to discover the hidden gems of Elektrostal.

Q: What is the population of Elektrostal?

A: As of the latest data, the population of Elektrostal is approximately XXXX.

Q: How far is Elektrostal from Moscow?

A: Elektrostal is located approximately XX kilometers away from Moscow.

Q: Are there any famous landmarks in Elektrostal?

A: Yes, Elektrostal is home to several notable landmarks, including XXXX and XXXX.

Q: What industries are prominent in Elektrostal?

A: Elektrostal is known for its steel production industry and is also a center for engineering and manufacturing.

Q: Are there any universities or educational institutions in Elektrostal?

A: Yes, Elektrostal is home to XXXX University and several other educational institutions.

Q: What are some popular outdoor activities in Elektrostal?

A: Elektrostal offers several outdoor activities, such as hiking, cycling, and picnicking in its beautiful parks.

Q: Is Elektrostal well-connected in terms of transportation?

A: Yes, Elektrostal has good transportation links, including trains and buses, making it easily accessible from nearby cities.

Q: Are there any annual events or festivals in Elektrostal?

A: Yes, Elektrostal hosts various events and festivals throughout the year, including XXXX and XXXX.

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About 1 in 5 U.S. teens who’ve heard of ChatGPT have used it for schoolwork

Roughly one-in-five teenagers who have heard of ChatGPT say they have used it to help them do their schoolwork, according to a new Pew Research Center survey of U.S. teens ages 13 to 17. With a majority of teens having heard of ChatGPT, that amounts to 13% of all U.S. teens who have used the generative artificial intelligence (AI) chatbot in their schoolwork.

Teens in higher grade levels are particularly likely to have used the chatbot to help them with schoolwork. About one-quarter of 11th and 12th graders who have heard of ChatGPT say they have done this. This share drops to 17% among 9th and 10th graders and 12% among 7th and 8th graders.

There is no significant difference between teen boys and girls who have used ChatGPT in this way.

The introduction of ChatGPT last year has led to much discussion about its role in schools , especially whether schools should integrate the new technology into the classroom or ban it .

Pew Research Center conducted this analysis to understand American teens’ use and understanding of ChatGPT in the school setting.

The Center conducted an online survey of 1,453 U.S. teens from Sept. 26 to Oct. 23, 2023, via Ipsos. Ipsos recruited the teens via their parents, who were part of its KnowledgePanel . The KnowledgePanel is a probability-based web panel recruited primarily through national, random sampling of residential addresses. The survey was weighted to be representative of U.S. teens ages 13 to 17 who live with their parents by age, gender, race and ethnicity, household income, and other categories.

This research was reviewed and approved by an external institutional review board (IRB), Advarra, an independent committee of experts specializing in helping to protect the rights of research participants.

Here are the  questions used for this analysis , along with responses, and its  methodology .

Teens’ awareness of ChatGPT

Overall, two-thirds of U.S. teens say they have heard of ChatGPT, including 23% who have heard a lot about it. But awareness varies by race and ethnicity, as well as by household income:

• 72% of White teens say they’ve heard at least a little about ChatGPT, compared with 63% of Hispanic teens and 56% of Black teens.
• 75% of teens living in households that make $75,000 or more annually have heard of ChatGPT. Much smaller shares in households with incomes between $30,000 and $74,999 (58%) and less than $30,000 (41%) say the same.

Teens who are more aware of ChatGPT are more likely to use it for schoolwork. Roughly a third of teens who have heard a lot about ChatGPT (36%) have used it for schoolwork, far higher than the 10% among those who have heard a little about it.

When do teens think it’s OK for students to use ChatGPT?

For teens, whether it is – or is not – acceptable for students to use ChatGPT depends on what it is being used for.

There is a fair amount of support for using the chatbot to explore a topic. Roughly seven-in-ten teens who have heard of ChatGPT say it’s acceptable to use when they are researching something new, while 13% say it is not acceptable.

However, there is much less support for using ChatGPT to do the work itself. Just one-in-five teens who have heard of ChatGPT say it’s acceptable to use it to write essays, while 57% say it is not acceptable. And 39% say it’s acceptable to use ChatGPT to solve math problems, while a similar share of teens (36%) say it’s not acceptable.

Some teens are uncertain about whether it’s acceptable to use ChatGPT for these tasks. Between 18% and 24% say they aren’t sure whether these are acceptable use cases for ChatGPT.

Those who have heard a lot about ChatGPT are more likely than those who have only heard a little about it to say it’s acceptable to use the chatbot to research topics, solve math problems and write essays. For instance, 54% of teens who have heard a lot about ChatGPT say it’s acceptable to use it to solve math problems, compared with 32% among those who have heard a little about it.

Note: Here are the  questions used for this analysis , along with responses, and its  methodology .

• Artificial Intelligence
• Technology Adoption
• Teens & Tech

Many Americans think generative AI programs should credit the sources they rely on

Americans’ use of chatgpt is ticking up, but few trust its election information, q&a: how we used large language models to identify guests on popular podcasts, striking findings from 2023, what the data says about americans’ views of artificial intelligence, most popular.

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