an essay about physical education

Essay on Physical Education in School for Students in 1000+ Words

In this article, we have published an essay on physical education in school. It includes its meaning, importance, and benefits. Also, how is physical education good for our  health?

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Essay on Physical Education in School (1000 Words)

Physical education is essential because it improves the fitness of youngsters, makes them  disciplined  and active. It helps them to find out teamwork, test their decision-making capabilities too.

Education  should be mandatory in every school, from preschools, primary, elementary to secondary school and also in colleges, hostels. But we should always not force them to try to do it, and they ought to be made conscious of its benefits.

The goal of education is to assist students in developing healthy habits that can serve them within the long term. In today’s world, things have become easy due to technology, and we are enjoying the facilities like no other generation.

Adults spend their whole day in air-cooled offices; they eat food, don’t find time to exercise. It’s getting to be very tough for our generation.

If we get  good healthy  habits now, once we are within the school, it’ll help us now and within the future. It’s a dire need of your time.

The education system should be proactive and make it mandatory in schools. So allow us to see why do children need physical education?

Healthy Habits

With education, children can improve their  fitness,  body posture, and ultimately it’ll boost their confidence.

It helps students to make good habits from an early age. Running, jogging, weight training, eating, and sleeping on time are a few habits that can help them in the future.

One of the essential aspects of education is  discipline . It’ll help them to plan their studies, finances, and life generally.

They’re going to be ready to allot time to studies and for fun too. Alongside academics, children should get time to be children; it’s the most uncomplicated phase of human life.

Interpersonal Skills & Team Work

Physical education and  sports  improve the interpersonal skills of youngsters. These skills are very crucial at work and within the relationship.

Physical education teaches the way to communicate messages effectively and the way to figure them together.

Stress Buster

Education comes with exams, assignments, projects, and homework, which can stress students.

Alongside this, they even have parents’ expectations burden, Financial worries. In today’s time, the overuse of  social media  makes them suffer from social anxiety, envy, and FOMO.

In this case, education becomes an excellent outlet. It cuts them from these worries and situations. Due to it, they’re going to be ready to focus more on studies and life generally.

Makes you Confident

With improved interpersonal skills, relaxed and calm composure, and healthy habits, one becomes more confident. Physical education plays a notable role during this too.

Alternate Career Opportunity

Everyone is different; not all students will be great at academics, and there is no such rule. Children find themselves in trouble with  selecting a career . Education can help them during this also. One might find the internet in sports and games.

Physical education may be an excellent opportunity to scout for potential athletic talent also. They were within the suitable career matters tons.

If one gets to try to do a thing they like to do, their lives will be happier. Physical education can help them to seek out that or a minimum of narrow down the alternatives.

Health is Wealth

Our current generation is affected by obesity from an early age. They also get spectacles at an old age. Obesity comes with related illnesses too.

An obese child is susceptible to diseases like diabetes, cardiovascular diseases, stress, vital sign, etc. Habits formed with education will make them fit from infancy. It’ll encourage them to enhance and maintain their health in the future.

Children inculcate with the importance of physical education for maintaining a healthy body and teach them the importance of regular fitness activity in daily routine, which successively keeps them happy and energized.

It helps the youngsters to take care of their fitness, develop their muscular strength, and increase their stamina.

Research has proven that children who regularly play different types of sports lead to high self-confidence, which is essential for building a person’s character.

Education instills the will to participate, enjoy the victory, and take defeat positively, developing the character’s general personality.

By making children participate in sports, especially team sports, education also imbibes in them a way of solidarity. Children find out how to figure as a team member, organize themselves, and perform together towards attaining a goal.

It successively improves a child’s overall communication skills and, therefore, urges alongside different people.

Physical education helps one gain knowledge about the general aspects of physical health. Teenagers face many health-related problems like obesity, anemia, bulimia, and even diabetes, which are rampant amongst teenagers.

Through education, teachers can promote the advantages of healthy and nutritious food and discourage them from having food by highlighting their ill effects. They will easily promote sound eating practices and guidelines for nutrition.

Physical education also teaches about the importance of private hygiene and the importance of  cleanliness . They guide the scholars by informing them about the essential hygiene practices for maintaining health and well-being throughout life.

Additionally, to the present, the education classes also cover a crucial aspect that the youngsters need to affect at puberty.

Apart from the health and knowledge benefits that students get from education, they also learn how to unwind and relieve themselves of stress and anxiety. Sports and other fitness activities offered within the education classes are a welcome break for the scholars.

It won’t be wrong to mention that children, who learn the importance of health and hygiene at an early age, tend to get older to be responsible and healthy adults who are conscious of the advantages of a healthy lifestyle.

Children who provided good education are more likely to become responsible adults who know the importance of a healthy lifestyle.

Anti-Depressant

It is proven that physical activities help us to alleviate stress. Though we all know its importance, we make all possible excuses to avoid it.

Physical education helps us to take care of a timely schedule of physical activities. Students become calmer composed; then, they will focus more on their goals.

The Bottom Line

Physical education leads to a more focused, active, composed, and  happy in life . It makes us disciplined and arranged.

Habits formed with the assistance of education tend to remain with us for an extended time. We should bring skilled coaches and needed equipment to colleges.

Students should know its benefits. There are real advantages of education and in the present situation, children, also as adults, need it the foremost.

The opportunity to participate in physical activity daily in schools may increase the probability of adopting a physically active lifestyle.

Choosing to measure a physically active lifestyle is vital to health and wellness. A school’s education department is responsible for assisting students in being involved in and adopting a private lifestyle of regular physical activity.

I hope you liked this essay on physical education in school for students and children.

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The Nature and Values of Physical Education Essay

Physical educators have been recognized as contributors to school curriculum after a long and hard fight. Physical education proponents have claimed alliances with psychology, morality, science and medicine; these are the things that have validated physical education in the educational milieu (Singleton, 2009). These claims have influenced the conception of physical educators about the importance of knowledge in physical education.

Performance pedagogy is an education that is based on experience meaning that it does not related to one’s nature but is connected with what has already been experienced through performing.

It is characterized by technocratic rationality because it may be differentiated from discourses of science, psychology, and medicine, and when it is interpreted and translated to study of human development, it gives knowledge that was important to the early physical educators.

Limits of performance pedagogy are that the methods used in its measure are not valid; it is due to the fact that there is no model or theory used in its measure. Also, the selection criterion for the participants is only clear for the researcher.

Learning in constructivist theory is when individuals create understandings in their own new way basing on the interaction between what they know and what they believe, together with the knowledge and ideas they come across.

The theoretical assumptions of constructivist curriculum include the following: a learner actively constructs the meaning of something around a phenomenon, and whatever he or she constructs is idiosyncratic, or rather unique to an individual and these constructions are influenced by his or her prior experiences.

The current curriculum models of physical education that are informed by constructivist theories are sociological and psychological models. The sociological approach focuses on ways in which political, social and economic factors together with power affect the way a crowd of people create their understandings and form knowledge about their surroundings (Richardson, 2003).

On the other hand, psychological model revolves around ways used to create meaning in an individual’s mind and how the meaning that shared is developed in a group process. However, the two models focus on an individual in a social setting and focuses on him or her as a learner.

Richardson warns that constructivism that is psychologically focused shows how shared meaning is developed in a group process; however, there are some curricula which provide a possibility for students to choose activities. Also, there is no document for curriculum, which mentions students’ possibility of generating shared meanings because they are either decided by their instructors or themselves (Richardson, 2003).

He also warns that sociological model constructivism employ students in the production processes of knowledge, and at the same time examines the manner in which power works to give privileges to some people as it marginalizes others.

However, each curriculum of secondary physical education emphasizes the importance of having young people of different background, needs, abilities as well as interests. Marginalization does not encourage equity for girls and ethnic minorities in physical education, which creates an imbalance in both performance and participation.

In the past, physical education was considered to consist of only physical and practical activities, however, the recent research has justified that physical education can be included in the curriculum on the basis of scientific and intellectual merit. According to Laker (2001), justification of scientific and intellectual merit of physical education has eroded the role of physical education in schools.

In the recent years, research has developed theorized curriculum, which has led to a better understanding of the importance of physical education (McNamee, 2005). Constructivist theories have been used widely to develop programs that take students as active players in learning and teachers as facilitators (lee, 2003).

However, despite the progress, physical education is still considered as a component of leisure by some teachers rather than a contribution to the educational process (Kirk & Tinning, 1990).

The constructivist curricula implemented in physical education have enhanced students learning by developing their own understandings, as well as learning processes (Dyson, 2005). The curricula have also provided opportunities for students to challenge existing beliefs and understanding.

Reference List

Dyson, B. (2005). Integrating cooperative learning and tactical games models: Focusing on social interactions and decision making . London: Routledge.

Kirk, D., & Tinning, R. (1990). Introduction: Physical education, curriculum and culture . London: Falmer.

Laker, A. (2001). Developing personal, social and moral education through physical education . London: Routledge.

Lee, A. (2003). Student learning in physical education: Using research to enhance instruction . London: Routledge.

McNamee, M. (2005). The nature and values of physical education . London: Sage.

Richardson, V. (2003). Constructivist Pedagogy. Teach Coll Rec, 105(9), pp.1623-1637.

Singleton, E. (2009). From Command to Constructivism: Canadian Secondary School Physical Education Curriculum and Teaching Games for Understanding . London: University of Western Ontario.

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Physical Education is just as important as any other school subject

Lecturer in Physical Education, University of Central Lancashire

Senior Lecturer in PE and Sports Studies, University of Central Lancashire

Disclosure statement

Andrew Sprake is affiliated with the North Western Counties Physical Education Association and FIEP in a voluntary capacity.

Clive Palmer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Physical Education (PE) is often viewed as a marginal subject within the curriculum. And many secondary schools actively reduce PE time to make way for what are deemed more “serious” or “important” subjects.

Research from the Youth Sport Trust shows that 38% of English secondary schools have cut timetabled PE for 14- to 16-year-olds. One of the main reasons for this is the increased pressure to produce exam results . Much of the time pupils would usually spend in PE lessons is now spent receiving extra tutoring on topics other than PE.

Despite these cuts, however, PE is still championed for its potential to promote health and encourage lifelong physical activity. This is an important issue given that over 30% of year six pupils are classed as “overweight” or “obese” according to the latest government figures .

PE is also praised for its contribution to improved psychological health , for helping to nurture social and moral development – as well as supporting cognitive and academic performance .

The Association for Physical Education maintains that high quality PE fosters the physical, moral, social, emotional, cultural and intellectual development of pupils. But the many aims for PE – such as health promotion, skills development as well as a focus on social and moral issues – has resulted in confusion about the subject and has done little to further the educational experiences in practice. In fact, it has been argued that PE offers more entertainment than education .

Not intellectual enough

A waste of time and a bit of entertainment, or vitally important to the education and development of a child – which is it?

Part of the problem seems to be that PE is often viewed as an opportunity for pupils to be active and to enjoy themselves. Or in some cases, as a form of stress relief and to serve as a break from traditional learning.

Clearly, these areas are valuable for pupils’ general well-being and there is a growing evidence base to suggest that physical activity has the potential to support learning more broadly . But the role of PE is not merely to prop up and support pupils’ learning in other subjects. Instead, it should provide meaningful learning experiences within the subject itself.

What PE seemingly lacks in comparison to all other subjects is a platform on which pupils’ learning can be communicated and evidenced with clarity and rigour. And while PE is often marginalised to make way for more valuable or academic subjects, it seems the intellectual and academic value of PE itself is largely overlooked.

The potential of PE

PE, sport and physical culture each offer a unique platform on which to explore a multitude of holistic learning opportunities. For instance, the ethical or moral controversies in sport can give teachers a range of educational stimuli for debate, reasoning and critical thinking.

The Sports Monograph is a recent project we worked on, which invited learners to collaborate and share their opinions and experiences about sport and what it means to them. The project included primary and secondary school pupils, as well as undergraduate and postgraduate students, who were all supported by their teachers and lecturers.

As part of the project, not only were the pupils recognised for their written contributions at school awards evenings, but unlike in traditional PE, their work left a trail of learning evidence and intellectual engagement – which the schools recognised and celebrated. PE was effectively standing shoulder to shoulder with other subjects in the curriculum as a valuable educational endeavour, with written evidence to support the claim. These pupils now have publications that are being used to teach undergraduate students at the University of Central Lancashire.

Future health

The spiralling downtrend of PE time in secondary schools is a major cause for concern and it would seem that PE is in urgent need of an overhaul. But while the future of PE may be uncertain, there are certainly many opportunities for cross-curricular links and integrative learning in PE.

A recent project, for instance, explored the link between cycling and wider conceptual learning. Similarly, another recent study explored the physical aspects of learning across all curriculum areas, simply through setting up a tent .

The role that PE can play as part of the wider academic curriculum seems to be, at best understated, and at worst, completely overlooked. Activities like the ones raised here could help to broaden the educational potential of PE, encourage more pupils to engage with the subject and strengthen the place of PE as a unique and valuable educational pursuit. The opportunities are there, but PE must be ready to grasp them and let the pupils write about their sporting passions to reflect what they are said to be learning.

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‘Physical education makes you fit and healthy’. Physical education's contribution to young people's physical activity levels

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S. Fairclough, G. Stratton, ‘Physical education makes you fit and healthy’. Physical education's contribution to young people's physical activity levels, Health Education Research , Volume 20, Issue 1, February 2005, Pages 14–23, https://doi.org/10.1093/her/cyg101

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The purpose of this study was to assess physical activity levels during high school physical education lessons. The data were considered in relation to recommended levels of physical activity to ascertain whether or not physical education can be effective in helping young people meet health-related goals. Sixty-two boys and 60 girls (aged 11–14 years) wore heart rate telemeters during physical education lessons. Percentages of lesson time spent in moderate-and-vigorous (MVPA) and vigorous intensity physical activity (VPA) were recorded for each student. Students engaged in MVPA and VPA for 34.3 ± 21.8 and 8.3 ± 11.1% of lesson time, respectively. This equated to 17.5 ± 12.9 (MVPA) and 3.9 ± 5.3 (VPA) min. Boys participated in MVPA for 39.4 ± 19.1% of lesson time compared to the girls (29.1 ± 23.4%; P < 0.01). High-ability students were more active than the average- and low-ability students. Students participated in most MVPA during team games (43.2 ± 19.5%; P < 0.01), while the least MVPA was observed during movement activities (22.2 ± 20.0%). Physical education may make a more significant contribution to young people's regular physical activity participation if lessons are planned and delivered with MVPA goals in mind.

Regular physical activity participation throughout childhood provides immediate health benefits, by positively effecting body composition and musculo-skeletal development ( Malina and Bouchard, 1991 ), and reducing the presence of coronary heart disease risk factors ( Gutin et al. , 1994 ). In recognition of these health benefits, physical activity guidelines for children and youth have been developed by the Health Education Authority [now Health Development Agency (HDA)] ( Biddle et al. , 1998 ). The primary recommendation advocates the accumulation of 1 hour's physical activity per day of at least moderate intensity (i.e. the equivalent of brisk walking), through lifestyle, recreational and structured activity forms. A secondary recommendation is that children take part in activities that help develop and maintain musculo-skeletal health, on at least two occasions per week ( Biddle et al. , 1998 ). This target may be addressed through weight-bearing activities that focus on developing muscular strength, endurance and flexibility, and bone health.

School physical education (PE) provides a context for regular and structured physical activity participation. To this end a common justification for PE's place in the school curriculum is that it contributes to children's health and fitness ( Physical Education Association of the United Kingdom, 2004 ; Zeigler, 1994 ). The extent to which this rationale is accurate is arguable ( Koslow, 1988 ; Michaud and Andres, 1990 ) and has seldom been tested. However, there would appear to be some truth in the supposition because PE is commonly highlighted as a significant contributor to help young people achieve their daily volume of physical activity ( Biddle et al. , 1998 ; Corbin and Pangrazi, 1998 ). The important role that PE has in promoting health-enhancing physical activity is exemplified in the US ‘Health of the Nation’ targets. These include three PE-associated objectives, two of which relate to increasing the number of schools providing and students participating in daily PE classes. The third objective is to improve the number of students who are engaged in beneficial physical activity for at least 50% of lesson time ( US Department of Health and Human Services, 2000 ). However, research evidence suggests that this criterion is somewhat ambitious and, as a consequence, is rarely achieved during regular PE lessons ( Stratton, 1997 ; US Department of Health and Human Services, 2000 ; Levin et al. , 2001 ; Fairclough, 2003a ).

The potential difficulties of achieving such a target are associated with the diverse aims of PE. These aims are commonly accepted by physical educators throughout the world ( International Council of Sport Science and Physical Education, 1999 ), although their interpretation, emphasis and evaluation may differ between countries. According to Simons-Morton ( Simons-Morton, 1994 ), PE's overarching goals should be (1) for students to take part in appropriate amounts of physical activity during lessons, and (2) become educated with the knowledge and skills to be physically active outside school and throughout life. The emphasis of learning during PE might legitimately focus on motor, cognitive, social, spiritual, cultural or moral development ( Sallis and McKenzie, 1991 ; Department for Education and Employment/Qualifications and Curriculum Authority, 1999 ). These aspects may help cultivate students' behavioural and personal skills to enable them to become lifelong physical activity participants [(thus meeting PE goal number 2 ( Simons-Morton, 1994 )]. However, to achieve this, these aspects should be delivered within a curriculum which provides a diverse range of physical activity experiences so students can make informed decisions about which ones they enjoy and feel competent at. However, evidence suggests that team sports dominate English PE curricula, yet bear limited relation to the activities that young people participate in, out of school and after compulsory education ( Sport England, 2001 ; Fairclough et al. , 2002 ). In order to promote life-long physical activity a broader base of PE activities needs to be offered to reinforce the fact that it is not necessary for young people to be talented sportspeople to be active and healthy.

While motor, cognitive, social, spiritual, cultural and moral development are valid areas of learning, they can be inconsistent with maximizing participation in health-enhancing physical activity [i.e. PE goal number 1 ( Simons-Morton, 1994 )]. There is no guidance within the English National Curriculum for PE [NCPE ( Department for Education and Employment/Qualifications and Curriculum Authority, 1999 )] to inform teachers how they might best work towards achieving this goal. Moreover, it is possible that the lack of policy, curriculum development or teacher expertise in this area contributes to the considerable variation in physical activity levels during PE ( Stratton, 1996a ). However, objective research evidence suggests that this is mainly due to differences in pedagogical variables [i.e. class size, available space, organizational strategies, teaching approaches, lesson content, etc. ( Borys, 1983 ; Stratton, 1996a )]. Furthermore, PE activity participation may be influenced by inter-individual factors. For example, activity has been reported to be lower among students with greater body mass and body fat ( Brooke et al. , 1975 ; Fairclough, 2003c ), and higher as students get older ( Seliger et al. , 1980 ). In addition, highly skilled students are generally more active than their lesser skilled peers ( Li and Dunham, 1993 ; Stratton, 1996b ) and boys tend to engage in more PE activity than girls ( Stratton, 1996b ; McKenzie et al. , 2000 ). Such inter-individual factors are likely to have significant implications for pedagogical practice and therefore warrant further investigation.

In accordance with Simons-Morton's ( Simons-Morton, 1994 ) first proposed aim of PE, the purpose of this study was to assess English students' physical activity levels during high school PE. The data were considered in relation to recommended levels of physical activity ( Biddle et al. , 1998 ) to ascertain whether or not PE can be effective in helping children be ‘fit and healthy’. Specific attention was paid to differences between sex and ability groups, as well as during different PE activities.

Subjects and settings

One hundred and twenty-two students (62 boys and 60 girls) from five state high schools in Merseyside, England participated in this study. Stage sampling was used in each school to randomly select one boys' and one girls' PE class, in each of Years 7 (11–12 years), 8 (12–13 years) and 9 (13–14 years). Three students per class were randomly selected to take part. These students were categorized as ‘high’, ‘average’ and ‘low’ ability, based on their PE teachers' evaluation of their competence in specific PE activities. Written informed consent was completed prior to the study commencing. The schools taught the statutory programmes of study detailed in the NCPE, which is organized into six activity areas (i.e. athletic activities, dance, games, gymnastic activities, outdoor activities and swimming). The focus of learning is through four distinct aspects of knowledge, skills and understanding, which relate to; skill acquisition, skill application, evaluation of performance, and knowledge and understanding of fitness and health ( Department for Education and Employment/Qualifications and Curriculum Authority, 1999 ). The students attended two weekly PE classes in mixed ability, single-sex groups. Girls and boys were taught by male and female specialist physical educators, respectively.

Instruments and procedures

The investigation received ethical approval from the Liverpool John Moores Research Degrees Ethics Committee. The study involved the monitoring of heart rates (HRs) during PE using short-range radio telemetry (Vantage XL; Polar Electro, Kempele, Finland). Such systems measure the physiological load on the participants' cardiorespiratory systems, and allow analysis of the frequency, duration and intensity of physical activity. HR telemetry has been shown to be a valid and reliable measure of young people's physical activity ( Freedson and Miller, 2000 ) and has been used extensively in PE settings ( Stratton, 1996a ).

The students were fitted with the HR telemeters while changing into their PE uniforms. HR was recorded once every 5 s for the duration of the lessons. Telemeters were set to record when the teachers officially began the lessons, and stopped at the end of lessons. Total lesson ‘activity’ time was the equivalent of the total recorded time on the HR receiver. At the end of the lessons the telemeters were removed and data were downloaded for analyses. Resting HRs were obtained on non-PE days while the students lay in a supine position for a period of 10 min. The lowest mean value obtained over 1 min represented resting HR. Students achieved maximum HR values following completion of the Balke treadmill test to assess cardiorespiratory fitness ( Rowland, 1993 ). This data was not used in the present study, but was collated for another investigation assessing children's health and fitness status. Using the resting and maximum HR values, HR reserve (HRR, i.e. the difference between resting and maximum HR) at the 50% threshold was calculated for each student. HRR accounts for age and gender HR differences, and is recommended when using HR to assess physical activity in children ( Stratton, 1996a ). The 50% HRR threshold represents moderate intensity physical activity ( Stratton, 1996a ), which is the minimal intensity required to contribute to the recommended volume of health-related activity ( Biddle et al. , 1998 ). Percentage of lesson time spent in health enhancing moderate-and-vigorous physical activity (MVPA) was calculated for each student by summing the time spent ≥50% HRR threshold. HRR values ≥75% corresponded to vigorous intensity physical activity (VPA). This threshold represents the intensity that may stimulate improvements in cardiorespiratory fitness ( Morrow and Freedson, 1994 ) and was used to indicate the proportion of lesson time that students were active at this higher level.

Sixty-six lessons were monitored over a 12-week period, covering a variety of group and individual activities ( Table I ). In order to allow statistically meaningful comparisons between different types of activities, students were classified as participants in activities that shared similar characteristics. These were, team games [i.e. invasion (e.g. football and hockey) and striking games (e.g. cricket and softball)], individual games (e.g. badminton, tennis and table tennis), movement activities (e.g. dance and gymnastics) and individual activities [e.g. athletics, fitness (circuit training and running activities) and swimming]. The intention was to monitor equal numbers of students during lessons in each of the four designated PE activity categories. However, timetable constraints and student absence meant that true equity was not possible, and so the number of boys and girls monitored in the different activities was unequal.

Number and type of monitored PE lessons

Student sex, ability level and PE activity category were the independent variables, with percent of lesson time spent in MVPA and VPA set as the dependent variables. Exploratory analyses were conducted to establish whether data met parametric assumptions. Shapiro–Wilk tests revealed that only boys' MVPA were normally distributed. Subsequent Levene's tests confirmed the data's homogeneity of variance, with the exception of VPA between the PE activities. Though much of the data violated the assumption of normality, the ANOVA is considered to be robust enough to produce valid results in this situation ( Vincent, 1999 ). Considering this, alongside the fact that the data had homogenous variability, it was decided to proceed with ANOVA for all analyses, with the exception of VPA between different PE activities.

Sex × ability level factorial ANOVAs compared the physical activity of boys and girls who differed in PE competence. A one-way ANOVA was used to identify differences in MVPA during the PE activities. Post-hoc analyses were performed using Hochberg's GT2 correction procedure, which is recommended when sample sizes are unequal ( Field, 2000 ). A non-parametric Kruskal–Wallis ANOVA calculated differences in VPA during the different activities. Post-hoc Mann–Whitney U -tests determined where identified differences occurred. To control for type 1 error the Bonferroni correction procedure was applied to these tests, which resulted in an acceptable α level of 0.008. Although these data were ranked for the purposes of the statistical analysis, they were presented as means ± SD to allow comparison with the other results. All data were analyzed using SPSS version 11.0 (SPSS, Chicago, IL).

The average duration of PE lessons was 50.6 ± 20.8 min, although girls' (52.6 ± 25.4 min) lessons generally lasted longer than boys' (48.7 ± 15.1 min). When all PE activities were considered together, students engaged in MVPA and VPA for 34.3 ± 21.8 and 8.3 ± 11.1% of PE time, respectively. This equated to 17.5 ± 12.9 (MVPA) and 3.9 ± 5.3 (VPA) min. The high-ability students were more active than the average- and low-ability students, who took part in similar amounts of activity. These trends were apparent in boys and girls ( Table II ).

Mean (±SD) MVPA and VPA of boys and girls of differing abilities

Boys > girls, P < 0.01.

Boys > girls, P < 0.05.

Boys engaged in MVPA for 39.4% ± 19.1 of lesson time compared to the girls' value of 29.1 ± 23.4 [ F (1, 122) = 7.2, P < 0.01]. When expressed as absolute units of time, these data were the equivalent of 18.9 ± 10.5 (boys) and 16.1 ± 14.9 (girls) min. Furthermore, a 4% difference in VPA was observed between the two sexes [ Table II ; F (1, 122) = 4.6, P < 0.05]. There were no significant sex × ability interactions for either MVPA or VPA.

Students participated in most MVPA during team games [43.2 ± 19.5%; F (3, 121) = 6.0, P < 0.01]. Individual games and individual activities provided a similar stimulus for activity, while the least MVPA was observed during movement activities (22.2 ± 20.0%; Figure 1 ). A smaller proportion of PE time was spent in VPA during all activities. Once more, team games (13.6 ± 11.3%) and individual activities (11.8 ± 14.0%) were best suited to promoting this higher intensity activity (χ 2 (3) =30.0, P < 0.01). Students produced small amounts of VPA during individual and movement activities, although this varied considerably in the latter activity ( Figure 2 ).

Mean (±SD) MVPA during different PE activities. ** Team games > movement activities ( P < 0.01). * Individual activities > movement activities ( P < 0.05).

Mean (±SD) VPA during different PE activities. ** Team games > movement activities ( Z (3) = −4.9, P < 0.008) and individual games ( Z (3) = −3.8, P < 0.008). † Individual activities > movement activities ( Z (3) = −3.3, P < 0.008). ‡ Individual game > movement activities ( Z (3) = −2.7, P < 0.008).

This study used HR telemetry to assess physical activity levels during a range of high school PE lessons. The data were considered in relation to recommended levels of physical activity ( Biddle et al. , 1998 ) to investigate whether or not PE can be effective in helping children be ‘fit and healthy’. Levels of MVPA were similar to those reported in previous studies ( Klausen et al. , 1986 ; Strand and Reeder, 1993 ; Fairclough, 2003b ) and did not meet the US Department of Health and Human Services ( US Department of Health and Human Services, 2000 ) 50% of lesson time criterion. Furthermore, the data were subject to considerable variance, which was exemplified by high standard deviation values ( Table II , and Figures 1 and 2 ). Such variation in activity levels reflects the influence of PE-specific contextual and pedagogical factors [i.e. lesson objectives, content, environment, teaching styles, etc. ( Stratton, 1996a )]. The superior physical activity levels of the high-ability students concurred with previous findings ( Li and Dunham, 1993 ; Stratton, 1996b ). However, the low-ability students engaged in more MVPA and VPA than the average-ability group. While it is possible that the teachers may have inaccurately assessed the low and average students' competence, it could have been that the low-ability group displayed more effort, either because they were being monitored or because they associated effort with perceived ability ( Lintunen, 1999 ). However, these suggestions are speculative and are not supported by the data. The differences in activity levels between the ability groups lend some support to the criticism that PE teachers sometimes teach the class as one and the same rather than planning for individual differences ( Metzler, 1989 ). If this were the case then undifferentiated activities may have been beyond the capability of the lesser skilled students. This highlights the importance of motor competence as an enabling factor for physical activity participation. If a student is unable to perform the requisite motor skills to competently engage in a given task or activity, then their opportunities for meaningful participation become compromised ( Rink, 1994 ). Over time this has serious consequences for the likelihood of a young person being able or motivated enough to get involved in physical activity which is dependent on a degree of fundamental motor competence.

Boys spent a greater proportion of lesson time involved in MVPA and VPA than girls. These differences are supported by other HR studies in PE ( Mota, 1994 ; Stratton, 1997 ). Boys' activity levels equated to 18.9 min of MVPA, compared to 16.1 min for the girls. It is possible that the characteristics and aims of some of the PE activities that the girls took part in did not predispose them to engage in whole body movement as much as the boys. Specifically, the girls participated in 10 more movement lessons and eight less team games lessons than the boys. The natures of these two activities are diverse, with whole body movement at differing speeds being the emphasis during team games, compared to aesthetic awareness and control during movement activities. The monitored lessons reflected typical boys' and girls' PE curricula, and the fact that girls do more dance and gymnastics than boys inevitably restricts their MVPA engagement. Although unrecorded contextual factors may have contributed to this difference, it is also possible that the girls were less motivated than the boys to physically exert themselves. This view is supported by negative correlations reported between girls' PE enjoyment and MVPA ( Fairclough, 2003b ). Moreover, there is evidence ( Dickenson and Sparkes, 1988 ; Goudas and Biddle, 1993 ) to suggest that some pupils, and girls in particular ( Cockburn, 2001 ), may dislike overly exerting themselves during PE. Although physical activity is what makes PE unique from other school subjects, some girls may not see it as such an integral part of their PE experience. It is important that this perception is clearly recognized if lessons are to be seen as enjoyable and relevant, whilst at the same time contributing meaningfully to physical activity levels. Girls tend to be habitually less active than boys and their levels of activity participation start to decline at an earlier age ( Armstrong and Welsman, 1997 ). Therefore, the importance of PE for girls as a means of them experiencing regular health-enhancing physical activity cannot be understated.

Team games promoted the highest levels of MVPA and VPA. This concurs with data from previous investigations ( Strand and Reeder, 1993 ; Stratton, 1996a , 1997 ; Fairclough, 2003a ). Because these activities require the use of a significant proportion of muscle mass, the heart must maintain the oxygen demand by beating faster and increasing stroke volume. Moreover, as team games account for the majority of PE curriculum time ( Fairclough and Stratton, 1997 ; Sport England, 2001 ), teachers may actually be more experienced and skilled at delivering quality lessons with minimal stationary waiting and instruction time. Similarly high levels of activity were observed during individual activities. With the exception of throwing and jumping themes during athletics lessons, the other individual activities (i.e. swimming, running, circuit/station work) involved simultaneous movement of the arms and legs over variable durations. MVPA and VPA were lowest during movement activities, which mirrored previous research involving dance and gymnastics ( Stratton, 1997 ; Fairclough, 2003a ). Furthermore, individual games provided less opportunity for activity than team games. The characteristics of movement activities and individual games respectively emphasize aesthetic appreciation and motor skill development. This can mean that opportunities to promote cardiorespiratory health may be less than in other activities. However, dance and gymnastics can develop flexibility, and muscular strength and endurance. Thus, these activities may be valuable to assist young people in meeting the HDA's secondary physical activity recommendation, which relates to musculo-skeletal health ( Biddle et al. , 1998 ).

The question of whether PE can solely contribute to young people's cardiorespiratory fitness was clearly answered. The students engaged in small amounts of VPA (4.5 and 3.3 min per lesson for boys and girls, respectively). Combined with the limited frequency of curricular PE, these were insufficient durations for gains in cardiorespiratory fitness to occur ( Armstrong and Welsman, 1997 ). Teachers who aim to increase students' cardiorespiratory fitness may deliver lessons focused exclusively on high intensity exercise, which can effectively increase HR ( Baquet et al. , 2002 ), but can sometimes be mundane and have questionable educational value. Such lessons may undermine other efforts to promote physical activity participation if they are not delivered within an enjoyable, educational and developmental context. It is clear that high intensity activity is not appropriate for all pupils, and so opportunities should be provided for them to be able to work at developmentally appropriate levels.

Students engaged in MVPA for around 18 min during the monitored PE lessons. This approximates a third of the recommended daily hour ( Biddle et al. , 1998 ). When PE activity is combined with other forms of physical activity support is lent to the premise that PE lessons can directly benefit young people's health status. Furthermore, for the very least active children who should initially aim to achieve 30 min of activity per day ( Biddle et al. , 1998 ), PE can provide the majority of this volume. However, a major limitation to PE's utility as a vehicle for physical activity participation is the limited time allocated to it. The government's aspiration is for all students to receive 2 hours of PE per week ( Department for Education and Employment/Qualifications and Curriculum Authority, 1999 ), through curricular and extra-curricular activities. While some schools provide this volume of weekly PE, others are unable to achieve it ( Sport England, 2001 ). The HDA recommend that young people strive to achieve 1 hour's physical activity each day through many forms, a prominent one of which is PE. The apparent disparity between recommended physical activity levels and limited curriculum PE time serves to highlight the complementary role that education, along with other agencies and voluntary organizations must play in providing young people with physical activity opportunities. Notwithstanding this, increasing the amount of PE curriculum time in schools would be a positive step in enabling the subject to meet its health-related goals. Furthermore, increased PE at the expense of time in more ‘academic’ subjects has been shown not to negatively affect academic performance ( Shephard, 1997 ; Sallis et al. , 1999 ; Dwyer et al. , 2001 ).

Physical educators are key personnel to help young people achieve physical activity goals. As well as their teaching role they are well placed to encourage out of school physical activity, help students become independent participants and inform them about initiatives in the community ( McKenzie et al. , 2000 ). Also, they can have a direct impact by promoting increased opportunities for physical activity within the school context. These could include activities before school ( Strand et al. , 1994 ), during recess ( Scruggs et al. , 2003 ), as well as more organized extra-curricular activities at lunchtime and after school. Using time in this way would complement PE's role by providing physical activity opportunities in a less structured and pedagogically constrained manner.

This research measured student activity levels during ‘typical’, non-intensified PE lessons. In this sense it provided a representative picture of the frequency, intensity and duration of students' physical activity engagement during curricular PE. However, some factors should be considered when interpreting the findings. First, the data were cross-sectional and collected over a relatively short time frame. Tracking students' activity levels over a number of PE activities may have allowed a more accurate account of how physical activity varies in different aspects of the curriculum. Second, monitoring a larger sample of students over more lessons may have enabled PE activities to be categorized into more homogenous groups. Third, monitoring lessons in schools from a wider geographical area may have enabled stronger generalization of the results. Fourth, it is possible that the PE lessons were taught differently, and that the students acted differently as a result of being monitored and having the researchers present during lessons. As this is impossible to determine, it is unknown how this might have affected the results. Fifth, HR telemetry does not provide any contextual information about the monitored lessons. Also, HR is subject to emotional and environmental factors when no physical activity is occurring. Future work should combine objective physical activity measurement with qualitative or quantitative methods of observation.

During PE, students took part in health-enhancing activity for around one third of the recommended 1-hour target ( Biddle et al. , 1998 ). PE obviously has potential to help meet this goal. However, on the basis of these data, combined with the weekly frequency of PE lessons, it is clear that PE can only do so much in supplementing young people's daily volume of physical activity. Students need to be taught appropriate skills, knowledge and understanding if they are to optimize their physical activity opportunities in PE. For improved MVPA levels to occur, health-enhancing activity needs to be recognized as an important element of lessons. PE may make a more significant contribution to young people's regular physical activity participation if lessons are planned and delivered with MVPA goals in mind.

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Author notes

1REACH Group and School of Physical Education, Sport and Dance, Liverpool John Moores University, Liverpool L17 6BD and 2REACH Group and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 2ET, UK

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Essay on Physical Education

Students are often asked to write an essay on Physical Education in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Physical Education

What is physical education.

Physical Education, often called PE, is a class in school where students do exercises, play sports, and learn about keeping their bodies healthy. It’s not just about playing games; it’s also about learning the rules of sports, teamwork, and staying active.

Benefits of PE

PE helps children stay fit and healthy. It makes their hearts and lungs strong and helps them to move better. Kids also learn to work with others and follow rules. This class can make them feel happier and help them do better in school.

Activities in PE

In PE, children play soccer, basketball, and other games. They might run, jump, or learn dances. Sometimes they also learn about healthy food. PE is fun because it’s a break from sitting in the classroom.

Skills from PE

PE teaches skills like how to throw a ball or swim. But it also teaches kids to be fair and to not give up. These lessons are important in life, not just in sports. PE can help kids become good adults.

Also check:

• Speech on Physical Education

250 Words Essay on Physical Education

Physical Education, or PE for short, is a subject in school where students get to be active and learn about sports and exercises. It’s not just about playing games; it’s also about understanding how to keep our bodies healthy and strong. In PE, teachers show kids how to move their bodies in different ways and play various sports.

Benefits of Physical Education

PE is very important for many reasons. First, it helps students to stay fit and healthy. When kids run, jump, and play sports, they build stronger muscles and bones. It also helps them to stay at a good weight. Second, PE can make your mind sharper and help you focus better in other classes. Lastly, it teaches teamwork and how to get along with others.

What You Learn in PE

In PE, you learn more than just how to play sports. You learn about the rules of games, how to be safe while playing, and how to respect other players. Teachers also talk about healthy eating and how to take care of your body by getting enough sleep and not eating too much junk food.

Fun and Games

PE is also about having fun. When you play games and sports, you can enjoy yourself while exercising. It’s a time in school when you can laugh with friends and enjoy being active.

In conclusion, Physical Education is a key part of school that helps kids learn about staying healthy, working with others, and having a good time. It’s not just about sports; it’s about taking care of your body and mind.

500 Words Essay on Physical Education

Physical Education, often called PE, is a subject in school where students learn about staying active and healthy. It’s not just about playing sports or running around; it’s also about learning how to take care of your body. In PE, you get to learn new games, how to work as a team, and understand the importance of exercise.

The Importance of Staying Active

Staying active is very important for everyone, especially for students like you. When you move around and play, your body gets stronger, and you feel better. Exercise helps your muscles grow and keeps your heart healthy. It also makes you feel happy because when you exercise, your body releases something called endorphins, which are like natural happiness boosters.

Learning New Skills

In Physical Education, you learn a lot of new skills that can be useful in life. You learn how to throw, catch, jump, and run properly. These skills are not only for playing sports but also for daily activities. For example, being able to catch something quickly can help you in many situations, like catching a bus or even a piece of fruit falling from a table.

Teamwork and Sportsmanship

One of the best things about PE is playing games with classmates. You learn how to work together as a team to win a game. But winning isn’t everything. Physical Education also teaches you about sportsmanship, which means being kind and fair to others, even when you are trying to win.

Health and Fitness Knowledge

PE is not just about playing; it’s also about learning. You learn why eating healthy foods and staying active is good for you. Teachers show you how different exercises can help different parts of your body. For example, jumping rope is good for your heart, and stretching can make you more flexible.

Fun and Enjoyment

Physical Education can be a lot of fun! It’s a time in school when you can play with friends and enjoy different activities. You might play soccer, basketball, or even dance. It’s a break from sitting in a classroom, and it’s a chance to laugh and have a good time.

Challenges and Achievements

Sometimes PE can be challenging. Maybe you’re learning a new game or trying to get better at something. But when you practice and get better, it feels great. You feel proud of what you can do, and that helps you feel more confident in other parts of life too.

Physical Education is an essential part of school. It helps you stay healthy, learn new skills, work with others, and have fun. It’s not just about being the best at sports; it’s about feeling good and living a healthy life. So next time you have PE, remember it’s helping you in many more ways than you might think!

That’s it! I hope the essay helped you.

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Why PE matters for student academics and wellness right now

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This story about PE teachers was produced by The Hechinger Report , a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for Hechinger’s newsletter .

Amanda Amtmanis, an elementary physical education instructor in Middletown, Connecticut, handed out cards with QR codes to a class of third graders, and told them to start running.

The kids sprinted off around the baseball field in a light drizzle, but by the end of the first lap, a fifth of a mile, many were winded and walking. They paused to scan the cards, which track their mileage, on their teacher’s iPad and got some encouragement from an electronic coach — “Way to run your socks off!” or “Leave it all on the track!”

A boy in a red Nike shirt surged ahead, telling Amtmanis his goal was to run 5 miles. “Whoa, look at Dominic!” another boy exclaimed.

“We don’t need to compare ourselves to others,” Amtmanis reminded him.

The third graders finished a third lap, alternating running and walking, and were about to start on a scavenger hunt when the rain picked up, forcing them inside. Amtmanis thanked her students for their willingness to adjust — a skill many of them have practiced far more often than running these past 18 months.

The full impact of the pandemic on kids’ health and fitness won’t be known for some time. But it’s already caused at least a short-term spike in childhood obesity Rates of overweight and obesity in 5- through 11-year-olds rose nearly 10 percentage points in the first few months of 2020.

Amtmanis’ “mileage club,” which tracks students’ running, both in and out of school, and rewards them with Pokémon cards when they hit certain targets, is an example of how PE teachers around the country are trying to get kids back in shape.

But inclement weather isn’t the only thing PE teachers are up against as they confront what might be called “physical learning loss.” Physical education as a discipline has long fought to be taken as seriously as its academic counterparts. Even before the pandemic, fewer than half the states set any minimum amount of time for students to participate in physical education, according to the Society of Health and Physical Educators (SHAPE), which represents PE and health instructors.

Now, as schools scramble to help kids catch up academically, there are signs that PE is taking a back seat to the core subjects yet again. In some California schools, administrators are shifting instructional minutes from PE to academic subjects — or canceling class altogether so PE teachers can sub for classroom teachers; in others, they’re growing class sizes in the gym, so they can shrink them in the classroom.

Meanwhile, innovative instructors like Amtmanis, who has worked in her district for more than 20 years, are struggling to get their ideas off the ground. Over the summer, the principal of Macdonough Elementary, one of two schools where Amtmanis teaches, approved her request to participate in another running program called The Daily Mile, in which kids walk or run 15 minutes a day during school hours.

Daily running breaks “boost attentiveness, which has positive effects on academics,” Amtmanis argued.

But two weeks into the school year, not a single teacher had bought into the idea.

“The issue is their packed schedule,” Amtmanis said.

Last year, many schools conducted gym class remotely, with students joining in from their bedrooms and living rooms.

The online format presented several challenges. Many students lacked the equipment, space, or parental support to participate fully. And many instructors grappled with how to teach and assess motor skills and teamwork online.

Though instructors found creative ways to keep students moving — substituting rolled-up socks for balls, and “disguising fitness” in scavenger hunts and beat-the-teacher challenges — they still fretted that online gym wasn’t giving students the same benefits as in-person classes.

Compounding their concern was the fact that many students were also missing out on recess and extracurricular sports.

In a March 2021 survey conducted by the Cooper Institute, maker of the popular FitnessGram assessments, close to half the PE teachers and school and district administrators responding said their students were “significantly less” physically active during their schools’ closure than before it.

Schools that reopened last year faced their own set of challenges, including bans on shared equipment that made even a simple game of catch impossible. Schools that were open for in-person learning were also much more likely to cut back on PE instructional time, or eliminate it altogether, the survey found.

The consequences of these reductions in physical activity are hard to quantify, especially since many schools suspended fitness testing during the pandemic and have yet to resume it, but some PE teachers say they’re seeing more kids with locomotor delays and weaker stamina than normal.

“The second graders are like first graders, and some are even like kindergarteners,” said Robin Richardson, an elementary PE instructor in Kentucky. They can jump and hop, she said, but they can’t leap. They’re exhausted after 20 seconds of jumping jacks.

An unusually high number of Richardson’s first graders can’t skip or do windmills. Some lack the spatial awareness that’s essential to group games.

“They don’t know how to move without running into each other,” she said.

Other instructors are seeing an increase in cognitive issues, such as difficulty paying attention or following directions, particularly among kids who remained remote for most or all of last year.

Kyle Bragg, an elementary PE instructor in Arizona, has seen kids sitting with their backs to him, staring off into space when he’s talking. “I say ‘Knees, please,’ so they spin around to face me,” he said.

And some PE teachers say their students’ social-emotional skills have suffered more than their gross motor skills. “They forgot how to share; how to be nice to each other; how to relate to each other,” said Donn Tobin, an elementary PE instructor in New York.

PE has a key role to play in boosting those skills, which affect how kids interact in other classes, said Will Potter, an elementary PE teacher in California.

“We’re uniquely situated to handle the social-emotional needs that came out of the pandemic, in a way classroom teachers are not,” Potter said.

Amtmanis, for her part, worries about her students’ mental health. She sees the little signs of strain daily — the kid who got upset because he couldn’t pick his group, for example, and the one who was distressed that his Mileage Club card had gotten mixed up in the front office.

“Their emotional reserves are low,” she said.

Yet not all instructors are reporting drops in their students’ fitness and skill development. Teachers in some middle- and upper-income districts said they haven’t noticed much of a change at all. In some communities, families seemed to spend more time outdoors.

“We saw the skyrocketing sale of bicycles, we saw families going for walks,” said Dianne Wilson-Graham, executive director of the California Physical Education and Health Project.

But in Title I schools like Macdonough, where more than half the students are low-income, some kids didn’t even have access to a safe place to exercise or play during school closures.

“Not only are they not in soccer leagues, but sometimes they don’t even have a park,” Amtmanis said.

Amtmanis came up with the idea of doing the Daily Mile after spring fitness tests revealed drops in her students’ strength, flexibility and endurance.

But many schools still aren’t sure how much physical learning loss their students have experienced as a result of the pandemic. Most schools pressed pause on fitness testing last year, and some elementary-school instructors are reluctant to restart it. They say the tests aren’t valid with young children, even in ordinary times, and argue the time they take could be better spent on Covid catch-up.

Andjelka Pavlovic, director of research and education for the Cooper Institute, said its tests are scientifically proven to be valid for students who are 10 and up, or roughly starting in fourth grade.

Fitness testing requirements vary by state, county or even district. Some states specify how often students must be tested; others leave it largely to the teacher.

Bragg, the Arizona teacher, said he has put testing “on the backburner” because “right now it’s not at the forefront of what’s important.”

Richardson said she is avoiding testing because she doesn’t want to use up precious instructional time or demoralize her students. “I want my kids to enjoy movement,” she said. If they perform poorly on the tests, “they may not feel as strong.”

In Connecticut, where schools are required to test fourth graders’ fitness annually, Amtmanis approached testing cautiously last year. She didn’t want to embarrass her students, so she made it into a series of games.

Instead of Sit-and-Reach, they had a “flexibility contest,” in which kids broke into teams for tag then had to perform stretches if they were tagged. She measured the distances stretched with curling ribbon, tied the ribbons together, and attached a balloon to the end. The team whose balloon soared the highest won fidget putty.

Pushups became a Bingo game, with the center space representing pushups.

“My goal was to get through it without ever using the words ‘fitness” or ‘testing,’” she said.

As the pandemic drags on, some instructors are taking a similar approach to fitness remediation and acceleration.

Bragg likes a warmup called “ Touch Spots ,” in which first graders listen as the instructor reads off the name of a color, then run and touch a corresponding dot on the floor. It works on reaction time, cardiovascular endurance, spatial awareness and sequencing — but the kids don’t know that.

“Students are having so much fun that they don’t realize how much fitness they are doing,” Bragg said.

Differentiation — tailoring instruction to meet individual students’ needs — has become even more essential, with former remote learners often lagging behind their in-person peers, Bragg said.

When playing catch, for example, he offers his students different sized balls — the smaller ones are more challenging.

Potter, the California teacher, spent the first two weeks of school teaching his students how to connect with their partners, stressing the importance of eye contact and body language.

“When you’re on Zoom, you look at the camera to make eye contact,” he said. “It’s a very different environment.”

Bragg reminds his students how to include kids who are standing on the sidelines, modeling excited body language and tone of voice. Lately, he’s noticed that kids who were remote last year are being excluded from groups.

“Social interaction needs to be practiced, just like how to throw a ball,” he said.

Richardson, the Kentucky PE teacher, is trying to build up her students’ stamina gradually, through progressively longer intervals of exercise.

But she works in a school with pods, so she sees each group of kids for five consecutive days, every third week. The two weeks in between, she has to hope that teachers will provide recess and “movement breaks.” She’s trying to get them to give kids breaks “when they get glassy-eyed and frustrated.”

Recently, Richardson was at a staff training session at which depleted teachers were “popping candy in the back.” When she raised her hand and requested a break in the training, her colleagues cheered. She told them to remember how they felt when their students return to the building.

“I always say, ‘If your bum is numb, your brain is the same,’” she said.

Convincing classroom teachers to set aside more time for movement can be challenging, though. As students return from months of online learning, teachers are under enormous pressure to get them caught up academically.

Kate Cox, an elementary and middle-school PE teacher in California, wishes schools would “realize what they’re missing when they cut PE because of learning loss in other areas.” Physical education is “readying their minds and bodies to be more successful in other areas,” Cox said.

Terri Drain, the president of SHAPE, argued that schools fail students when they treat physical learning loss as less serious than its academic counterpart.

“In the primary grades, children develop fundamental motor skills, such as throwing, catching, running, kicking and jumping,” she said. Unless schools commit to helping kids catch up, “the impacts of this ‘missed learning’ will be lifelong.”

In Connecticut, Amtmanis hasn’t given up on convincing teachers to carve out time for the Daily Mile. She recently sent them a list of suggestions on how to fit 15 minutes of running into the day, including by incorporating it as an active transition between academic blocks.

“While it may seem like there aren’t minutes to spare,” she wrote, “the energizing effect of the active transition should result in more on-task behavior and more efficient working.”

In the meantime, Amtmanis plans to keep using the mileage club to motivate her students to run and to monitor their progress.

“I don’t want to call attention to the fact that not everyone is fit,” she said. “This is an unobtrusive way to keep the data.”

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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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Home — Essay Samples — Education — Physical Education — Importance of Physical Education in Schools

Importance of Physical Education in Schools

• Categories: Physical Education

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Published: Jan 30, 2024

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History and evolution of physical education, benefits of physical education, role of physical education in promoting social skills, challenges and controversies in physical education.

• Centers for Disease Control and Prevention. (2010). The association between school-based physical activity, including physical education, and academic performance. Retrieved from https://www.cdc.gov/healthyyouth/health_and_academics/pdf/pa-pe_paper.pdf
• Ministry of Education, Culture, Sports, Science and Technology. (2016). Physical education: Educational benefits of PE. Retrieved from https://www.mext.go.jp/en/education/lesson/kentokako/1402471.htm
• World Health Organization. (2018). Global action plan on physical activity 2018-2030: More active people for a healthier world. Retrieved from https://www.who.int/publications/i/item/9789241514187

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Why is physical education a student's most important subject?