Promoting the Health of Our Youth: Title and subTitle BreakWhy Physical Activity Policies Are Critical

As a result of the current focus on reversing the obesity epidemic, the benefits of increased physical activity are becoming more widely discussed. What is not discussed is that lack of physical activity may be a far greater public health problem than obesity. There is compelling evidence that aerobic fitness and physical activity may be stronger predictors of cardiovascular health than weight status.¹ Despite the current focus on the importance of physical activity, youth do not come close to meeting recommendations, and disparities among communities in access to facilities, neighborhood safety, and family resources exacerbate the problem in high-risk populations. Schools can play a critical role in the solution because they act as “equalizers” when, across diverse communities, they provide youth with equal opportunities for physical activity within the school day.

The study by Slater et al² in this issue of the Archives of Pediatrics & Adolescent Medicine examines factors that influence key school-day opportunities for physical activity: physical education (PE) and recess. Slater et al demonstrate that if policies related to school-day physical activity are in place at the local or state level, schools report allocating more time to physical activity. This, of course, is to be expected. Given the benefits of physical activity to cardiovascular health, classroom behavior, learning, and obesity prevention, why, then, are there not more such policies?

Half of the 47 states in the Slater et al study had no law requiring or recommending minimum weekly minutes of PE and two-thirds of the districts surveyed had no PE-related policy. Even fewer states or districts had laws or policies relating to recess. Response bias notwithstanding (ie, having laws on the books certainly might influence how schools respond to questions about PE and recess time), if more states and districts adopt policies, youth will have more opportunities for physical activity during the school day. What stands in the way of schools' adoption of PE and recess policies?

The most frequently cited barrier to providing recommended minutes of PE and recess was competing demands in the academic day. Schools are under increasing pressure to “make the grade” with standardized testing, which has led to cutting many nonacademic activities. To counter the perception that eliminating PE and recess might lead to academic improvements, we must promote awareness among decision makers at the local, state, and national levels of the evidence regarding the benefits of PE and recess. Research consistently demonstrates cognitive benefits and improved classroom behavior with increased school-day physical activity. While experimental data on the effects of physical activity on grades or standardized test scores are split between positive and neutral results,³ there is compelling evidence that increasing time for PE, even by reducing time allotted to academic subjects, does not harm grades or test scores. Given the significant health benefits of physical activity, the combined evidence should impel decision makers to adopt policies promoting school-day physical activity.

An additional barrier to the adoption of laws and policies to increase school-day physical activity is funding; such policies are unlikely to be adopted as unfunded mandates. However, there is an underused funding solution that would promote children's nutrition and at the same time provide needed resources to support adoption of exemplary nutrition and physical activity standards and programs: the taxation of highly sweetened beverages and nutrient-poor junk food. Implementing a tax on unhealthy beverages and foods would be expected to reduce consumption of unhealthy foods and generate revenue.⁴ Proceeds from such a tax could be used to support a variety of health promotion strategies in schools, such as increasing support for PE programming.

One concerning finding from the Slater et al study is that recess and PE can compete with each other for time in the school day; schools that offered more time in recess offered less time in PE, and vice versa. While schools appear to use PE and recess somewhat interchangeably, PE and recess make unique and separate contributions. Recess provides children an opportunity for free play to break up the school day and is associated with improved classroom behavior among elementary students.⁵ Quality PE, like academic subjects, follows a curriculum that is designed to teach youth developmentally appropriate motor skills that form a foundation for participating in physical activity throughout life. Additionally, opportunities for structured physical activity promote more moderate to vigorous physical activity than opportunities for free play as students move into middle and high school,⁶ a time when physical activity drops precipitously for many youth. Therefore, any replacement of PE with recess would be a step backward in the promotion of schooltime activity for children's health and well-being.

Clinicians and researchers are needed to speak up and inform policy makers, school officials, educators, and parents of the substantial benefit of adopting policies promoting school-day physical activity for youth of all ages. The solution is not limited to the local, state, or national level, but rather, the solution rests with decision makers at each level. We must work together to advocate for our nation's greatest resource—our youth.