School-based physical education enhancements

Evidence Rating  
Evidence rating: Scientifically Supported

Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

Health Factors  
Decision Makers
Date last updated

Efforts to expand or enhance school-based physical education (PE) include lengthening existing classes, adding new PE classes, increasing physical activity during class, training teachers, and updating PE curricula. Such efforts can be implemented via local school policies or state government standards. As of 2016, most school PE classes do not meet the U.S. Centers for Disease Control and Prevention (CDC) recommendation that students spend 50% of PE class time engaged in moderate to vigorous physical activity1.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Increased physical activity

  • Improved physical fitness

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Improved health outcomes

  • Improved weight status

  • Increased self-esteem

What does the research say about effectiveness?

There is strong evidence that enhancing school-based physical education (PE) increases physical activity and physical fitness among school-aged children2, 3, 4, 5, 6, 7. Enhancing or expanding PE classes as part of a multi-component school-based obesity prevention intervention has also been shown to increase physical activity and improve health8, 9, 10.

Interventions to enhance school PE increase the amount of PE class time spent in moderate to vigorous physical activity (MVPA)5, 11, improve physical ability, reduce sedentary time, and decrease the rate of BMI increases for participating students compared to students in traditional PE classes6. Lengthening school-based PE classes has been shown to lower body mass index (BMI) and reduce the likelihood of obesity among 5th graders, particularly boys4.

In a study of the SPARK program, PE classes led by PE specialists or trained teachers provided students with substantially more physically active minutes per week than typical PE classes, and after 2 years, girls in the specialist-led classes maintained an advantage in cardio-respiratory endurance and abdominal strength over girls in typical PE classes12. School-based physical activity interventions have also been shown to improve motor performance13, knowledge of physical activity, and, to a lesser extent, self-concept3. One study suggests that boys also improved their physical fitness test results13.

A Sweden-based study suggests additional school PE time improves muscle strength without affecting fracture risk14. Additional school PE classes over a 7 year period are associated with increased bone mass and density for girls, but not for boys15.

Implementing state regulations for physical education can increase student activity levels by some measures, such as the number of minutes students are active in PE class and the number of days per week that students report exercising16. In general, increases in physical activity result in small improvements in weight status17. Although increasing physical activity in schools increases school-aged children’s physical activity and physical fitness, it has not been shown to result in significant weight changes18.

Cost benefit analysis suggests that school-based interventions to increase physical activity are associated with positive benefits19.

How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples

As of 2014, ten states (Arkansas, California, Illinois, New Mexico, North Carolina, Ohio, Rhode Island, South Carolina, Texas, and Virginia) have enacted legislation or adopted resolutions to improve school-based physical education and physical activity levels20. CDC’s 2013 Prevention Status Reports show 10 states have a mandate for the minutes per week a high school student must participate in physical education21.

The Carol M. White Physical Education Program provides grants to local education authorities (LEAs) and community-based organizations (CBOs) to initiate, expand, or enhance physical education programs22. Michigan’s Exemplary Physical Education Curriculum project team develops, tests, and disseminates materials and procedures that enable schools to promote physical activity23.

Implementation Resources

PFP-School-based PE - Partnership for Prevention (PFP). School-based physical education: Working with schools to increase physical activity among children and adolescents in physical education classes: An action guide. 2008.

CDC-PE 2010 - National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Adolescent and Student Health (DASH). Strategies to improve the quality of physical education. Atlanta: Centers for Disease Control and Prevention (CDC); 2010.

AFHG-PE - Alliance for a Healthier Generation (AFHG). Physical education: Quality PE programs.

HealthPartners-CHA - HealthPartners Institute for Education and Research. Community health advisor (CHA): Resource for information on the benefits of evidence-based policies and programs: Helping communities understand, analyze, and model costs.

SPARK - Sports, Play and Active Recreation for Kids (SPARK). Countering childhood obesity since 1989.

CDC DNPAO-Data - Centers for Disease Control and Prevention (CDC), Division of Nutrition Physical Activity and Obesity (DNPAO). Nutrition, physical activity and obesity: Data, trends and maps online tool.

LHC-Rockeymoore 2014 - Rockeymoore M, Moscetti C, Fountain A. Rural childhood obesity prevention toolkit. Leadership for Healthy Communities (LHC), Center for Global Policy Solutions, Robert Wood Johnson Foundation; 2014.


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1 Hollis 2016 - Hollis JL, Williams AJ, Sutherland R, et al. A systematic review and meta-analysis of moderate-to-vigorous physical activity levels in elementary school physical education lessons. Preventive Medicine. 2016;86:34-54.

2 CG-Physical activity - The Guide to Community Preventive Services (The Community Guide). Physical activity.

3 Demetriou 2012 - Demetriou Y, Höner O. Physical activity interventions in the school setting: A systematic review. Psychology of Sport and Exercise. 2012;13(2):186-96.

4 Cawley 2013 - Cawley J, Frisvold D, Meyerhoefer C. The impact of physical education on obesity among elementary school children. Journal of Health Economics. 2013;32(4):743–55.

5 Lonsdale 2013 - Lonsdale C, Rosenkranz RR, Peralta LR, et al. A systematic review and meta-analysis of interventions designed to increase moderate-to-vigorous physical activity in school physical education lessons. Preventive Medicine. 2013;56(2):152-161.

6 Sacchetti 2013 - Sacchetti R, Ceciliani A, Garulli A, et al. Effects of a 2-year school-based intervention of enhanced physical education in the primary school. Journal of School Health. 2013;83(9):639-646.

7 Story 2009 - Story M, Nanney MS, Schwartz MB. Schools and obesity prevention: Creating school environments and policies to promote healthy eating and physical activity. Milbank Quarterly. 2009;87(1):71–100.

8 Nixon 2012 - Nixon CA, Moore HJ, Douthwaite W, et al. Identifying effective behavioural models and behaviour change strategies underpinning preschool- and school-based obesity prevention interventions aimed at 4-6-year-olds: A systematic review. Obesity Reviews. 2012;13(Suppl 1):106-17.

9 Cochrane-Waters 2011 - Waters E, de Silva-Sanigorski A, Burford BJ, et al. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews. 2011;(12):CD001871.

10 Cochrane-Dobbins 2013 - Dobbins M, Husson H, DeCorby K, LaRocca RL. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database of Systematic Reviews. 2013;(2):CD007651.

11 Bassett 2013 - Bassett DR, Fitzhugh EC, Heath GW, et al. Estimated energy expenditures for school-based policies and active living. American Journal of Preventive Medicine. 2013;44(2):108-113.

12 Sallis 1997 - Sallis JF, McKenzie TL, Alcaraz JE, et al. The effects of a 2-yr physical education program (SPARK) on physical activity and fitness in elementary school students. American Journal of Public Health. 1997;87(8):1328–34.

13 Dallolio 2016 - Dallolio L, Ceciliani A, Sanna T, Garulli A, Leoni E. Proposal for an enhanced physical education program in the primary school: Evaluation of feasibility and effectiveness in improving physical skills and fitness. Journal of Physical Activity and Health. 2016;13(10):1025-1034.

14 Lofgren 2013 - Löfgren B, Daly RM, Nilsson JÅ, Dencker M, Karlsson MK. An increase in school-based physical education increases muscle strength in children. Medicine & Science in Sports & Exercise. 2013;45(5):997-1003.

15 Fritz 2016 - Fritz J, Duckham RL, Rantalainen T, Rosengren BE, Karlsson MK, Daly RM. Influence of a school-based physical activity intervention on cortical bone mass distribution: A 7-year intervention study. Calcified Tissue International. 2016;99(5):443-453.

16 Cawley 2007 - Cawley J, Meyerhoefer C, Newhouse D. The impact of state physical education requirements on youth physical activity and overweight. Health Economics. 2007;16(12):1287–1301.

17 Cochrane-Shaw 2006 - Shaw KA, Gennat HC, O’Rourke P, Del Mar C. Exercise for overweight or obesity. Cochrane Database of Systematic Reviews. 2006;(4):CD003817.

18 Harris 2009a - Harris KC, Kuramoto LK, Schulzer M, Retallack JE. Effect of school-based physical activity interventions on body mass index in children: A meta-analysis. Canadian Medical Association Journal. 2009;180(7):719–26.

19 WSIPP-School PA 2017 - Washington State Institute for Public Policy (WSIPP). Benefit-cost results: School-based programs to increase physical activity. Benefit-cost estimates updated December 2017.

20 NCSL Winterfeld 2014a - Winterfeld A. State actions to reduce and prevent childhood obesity in schools and communities: Summary and analysis of trends in legislation. National Conference of State Legislators (NCSL); 2014.

21 CDC-NPAO PSR 2013 - Centers for Disease Control and Prevention (CDC). Nutrition, physical activity, and obesity: Prevention status reports (PSR). 2013.

22 US ED-Carol M. White - U.S. Department of Education (U.S. ED). Carol M. White physical education program.

23 EPEC - Exemplary Physical Education Curriculum (EPEC). A comprehensive and flexible K-5 physical activity system.