Fight the Fat

Quality Physical Education Works: Now What Do We Do?

Harold W. (Bill) Kohl, Ph.D.

Palm Beach, Aruba June 2012

Professor of Epidemiology and KinesiologyUniversity of Texas and University of Texas School of Public Health, Texas USASteps CATCH Project4-04-08Hoelscher1Thank youDr. Andrew Springer University of Texas School of Public Health

Steps CATCH Project4-04-08Hoelscher2PA Guidelines for Children &Adolescents (ages 6-17)

1 hour or more of PA every day.Most of the 1 hour should be moderate-intensity of vigorous intensity PA.Vigorous intensity activity on at least 3 days per week. Muscle-strengthening and bone-strengthening activity on at least 3 days/ week. (USDHHS 2008)Steps CATCH Project4-04-08Hoelscher3Why Schools?

Its where the children are.Existing resources and infrastructureTrained and committed staff (teachers)Community trust

Steps CATCH Project4-04-08Hoelscher4Institute of Medicine Accelerating Progress for Obesity Prevention

Paradox!

Guidelines for health state goal of 60 minutes/dayEven the best PE classes only accelerate heart rate to a moderate-intensity 15-20 minutesWhere should the remainder (40-45 minutes/day) come from?Steps CATCH Project4-04-08Hoelscher6How can schools promote childrens physical activity beyond PE?

Steps CATCH Project4-04-08Hoelscher7TopicsEcological Perspectives for PA

School-Based Strategies for PA Promotion

Steps CATCH Project4-04-08Hoelscher8Sedentary Behavior: Too Much Sitting!-Review by Owen et al., 2010-AusDiab Accelerometer Study: Increased breaks in sitting beneficially associated with waist circumference, BMI, and other physiological measures., independent of total sedentary time & MVPA. (Healy et al., 2008).

Canada Fitness Survey: Canadians who reported most of day sitting had poorer long-term mortality outcomes. Associations held even among those who were physically active (Katzmarzyk 2009).

Follow up AusDiab Study: Each 1-h increment in TV time associated with increased risk of all cause and CVD mortality rates, respectively (Independent of PA)(Dunstan et al., 2010).

U.S. (n=7744 men): >10hrs sitting/week in cars & more than 23 hrs/week watching TV and in cars = 82% and 64% increased risk of dying from CVD (Warren et al., 2010)

Academic Achievement & Behavioral Benefits of PASubstantial evidence that PA can improve academic achievement (CDC, 2010, Review of 50 studies)

Recess period of >15 minutes/1 or more times/day: improved class behavior scores (Barroso et al 09).

Policy

Ecological Model of Active LivingSallis et al., 2006(Sallis et al 2006)Multiple Dimensions & Levels of Influence: A key concept in ecological models is that interventions will be most effective when they operate on multiple levels and with multiple dimensions. Multiple dimensions may include intrapersonal factors, social and cultural environments, and physical environments. Environments directly influence behaviors: Ecological models direct attention to environmental and policy factors that may be root causes of the epidemic of sedentary lifestyles. Thus, environments may influence behavior directly, not necessarily through psychological processes. Emphasis on place: Behavior-Specific: Specific ecological models will be needed to guide research and intervention for each health behavior. Environmental influences are much more behavior specific. Health behaviors are performed in many behavior settings, and each setting has numerous characteristics that may affect each behavior differently. Interactions of Influence: It is important to understand how the different dimensions of the ecological model interact. Thus, an intervention that succeeds on the intrapersonal level in motivating individuals to consume more fruits and vegetables may fail if those individuals do not have the environmental supports to allow for fruit and vegetable consumption.

Marathon Kids Logic Model, ISBNPA 20085-14-08AE Springer15Dimensions of School-Based Physical ActivityOpportunity for Physical ActivityTimes per weekMinutes per sessionTimes during the day: before, during and after school.

Structured vs. UnstructuredStructured: PE class; structured activity breaks (classroom-based energizers; structured recess); intramural sportsTeacher-Led vs. Student-Led vs. Free-PlayUnstructured: Free-play activity time (e.g., recess)

Quality of Physical ActivityHow much time spent in MVPA? (Nader et al., 2003: 37%)How enjoyable is PA? (e.g., only running?)

RWJF WebinarJune 2010Springer16Strategies for PA promotion in the school settingPolicy/Social EnvironmentMandated PA TimePE Organization/TrainingSupervised Free-Play TimeActivity BreaksCommunity-School PartnershipActive Commuting (i.e., walk/bike to school)

Built Environment

Steps CATCH Project4-04-08Hoelscher17Strategies for PA promotion in the school settingPolicy/Social EnvironmentMandated PA TimePE Organization/TrainingSupervised Free-Play Time (before, during, after school)Activity BreaksCommunity-School PartnershipActive Commuting (i.e., walk/bike to school)Built Environment

Steps CATCH Project4-04-08Hoelscher18Aim: to encourage middle school students to engage in 60 minutes of PA every day.

Components Get ur 60 wristbands and cardsDiscounts with community partner organizations (25+ organizations )Prizes for wearing wristband/ being activeIncreased opportunities for activity: Open Gym

Percentage of Open Gym Time 6-8th Grade Students Engaged in MVPA (n=5 schools) Spring 2010

Mean time: 24 min.Students: 45-100Kelder, Springer et al., in processY-axis is % of time, x-axis is 5 schools observed. The % of time students were vigorously active is stacked on top of the %of time the students were moderately active so that the audience can easily see the total. The % of time in either category was dependent on the get ur 60 rules set by the CATCH Champion, the actual activity(walking, frisbee, football, basketball, etc.), location, equipment ratio/options and involvement of the supervising teacher/coach.20Menu of Options/ZonesTodays PA Menu (Delicious!)Zone A: Four Square

Zone B: Soccer

Zone C: Hula Hoops

Zone D: Freeze TagStrategies for PA promotion in the school settingPolicy/Social EnvironmentMandated PA TimePE Organization/TrainingSupervised Free-Play TimeActivity BreaksCommunity-School PartnershipActive Commuting (i.e., walk/bike to school)

Built Environment

Steps CATCH Project4-04-08Hoelscher22Activity BreaksPromoting Lifetime Activity in Youth (PLAY) (Pangrazi et al., 2003; Ernst et al., 1999)

Teacher-led games. (Connolly & McKenzie, 1995)

TAKE 10! (Stewart et al, 2004)

KISS(RCT: Switzerland) (Kriemler et al., 2010)

ABC Activity Bursts in the Classroom (Katz et al., 2010)

Steps CATCH Project4-04-08Hoelscher23Energy Expenditure Profiles876543216789101112123456789a.m.p.m.METS24

25The ProgramIntegrates 10 minute periods of physical activity into school day combined with age-appropriate lessons of math, science, language arts, etc.

26The ProgramDesigned to complement, not replace, other physical activity opportunities such as physical education and after-school programs.

27Primary Core Academic Objectives

GradeLanguageArtsMath

Social StudiesScienceKindergarten13 Lessons10 lessons7 Lessons7 lessons1st Grade14 Lessons9 Lessons7 Lessons4 Lessons2nd Grade13 Lessons7 Lessons5 Lessons5 Lessons3rd Grade12 Lessons7 Lessons6 Lessons5 Lessons4th Grade12 Lessons7 Lessons5 Lessons7 Lessons5th Grade12 Lessons6 Lessons5 Lessons7 Lessons

28Materials Highlight Core Academic ObjectivesMaterials have strong link to the Core Objectives in the 4 primary academic areas.Nature of lessons provide a consistent link to language arts (oral and written communication)Also linked with core objectives in Math, Social Studies and/or science. GradeHealth andNutritionCharacterEducationPhysicalEducationKindergarten3 Lessons6 Lessons30 Lessons1st Grade3 Lessons4 Lessons30 Lessons2nd Grade7 Lessons4 Lessons30 Lessons3rd Grade7 Lessons4 Lessons30 Lessons

4th Grade10 Lessons5 Lessons30 Lessons5th Grade7 Lessons6 Lessons30 LessonsSecondary Curriculum Objectives

29Materials also include Health and PE curriculum ObjectivesAge/grade appropriate movement patterns and general physical activity are a part Health and nutrition concepts reinforced throughout Currently a national push to include character education in public educationCurrently 23 states have enacted legislation for this initiative; for this reason we havealso included lessons that include some of the 35 identified key character traits.

Frequency of Teacher Implementation, TAKE 10! 1999 - 2001

Times per weekPercent30

31Active Play ProjectInvestigators: Springer, Kelder, Ranjit (UTSPH);Rusnak, Werner, Lunoff (AISD)Texas SB 19/530: 30 minutes daily structured PAAustin Independent School District WOW Time

Objective: To assess the effect of low-cost strategies for promoting childrens MVPA during recess and WOW time (3rd grade).

Strategies:Peer-led Games ApproachTeacher-led ApproachPlayground Markings

Funding: Michael & Susan Dell Foundation

Active Play Project Peer-Led Games ProcessStudent Teams (3rd Grade)

Leadership Roles

High Activity Games (CATCH)

Process & GuidelinesLessons Learned so far Students = capable High satisfaction Training neededFree-Play Recess in 3rd Graders(n=8 low income, elementary schools in central TX)MethodsSOFIT-R8 schools (>60% econ disadvantage)October, November, Dec 20092 classes/school, n=77 observationsMean minutes of recess = 21

Initial Findings:66.4% of time in MVPABoys: 71.2% vs. 61.6% in girls (p