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Educating the Student Body
are effective in increasing physical activity among students (see Box 7-1). 
Although systematic reviews of the literature identify evidence for the 
promise of such approaches, the context for and generalizability of this evi-
dence vary greatly (Salmon et al., 2007; Naylor and McKay, 2009; Craggs 
et al., 2011). Perhaps one of the most notable examples of a multicom-
ponent intervention is the Child and Adolescent Trial for Cardiovascular 
BOX 7-1 
The ENERGY Project
The aim of the ENERGY (EuropeaN Energy balance Required to prevent 
excess weight Gain among Youth) project is to develop a theory- and 
evidence-based multicomponent intervention promoting the adoption 
or continuation of behaviors that can lead to a healthy energy balance 
(available online at http://www.projectenergy.eu/flash.html; accessed 
March 1, 2013). This program also includes a component called UP4FUN, 
a 6-week school-based project to reduce and break up time spent sitting 
in school and at home. The preliminary findings of the ENERGY project 
suggest that increased breaks in sedentary behavior can be achieved 
through a school- and home-based intervention. 
An intervention must take certain circumstances into consideration: 
national and cultural traditions and social disparities need to be recog-
nized, along with variations in family structure, ethnicity, and education 
levels. All of these factors may influence the opportunity for intervention 
and the intervention’s form and content. For this reason, it is valuable 
to involve the intended participants—especially teachers, parents, and 
youth themselves—in an intervention’s development. 
The most successful interventions tend to combine dietary behavioral 
change with increased physical activity and reduced sedentary behavior 
instead of focusing on only one of these behaviors. Failed interventions 
did not combine educational with environmental change strategies, did 
not involve the family and home environment, and did not conduct care-
ful pretesting before larger-scale implementation. Multifaceted school-
based programs with an active physical education component have been 
shown to be most cost-effective. 
SOURCE: Brug et al., 2010, 2012.

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Copyright © National Academy of Sciences. All rights reserved.
Educating the Student Body: Taking Physical Activity and Physical Education to School
The Effectiveness of Physical Activity and Physical Education Policies and Programs
 
315
Health (CATCH). This 3-year rigorously designed randomized controlled 
intervention included improvements in physical education classes, a health 
promotion curriculum, and food service changes, as well as a family com-
ponent. Results indicated more intense physical activity during physical 
education classes and more daily vigorous physical activity in intervention 
groups compared with controls (Luepker et al., 1996). (See Box 7-2 for a 
more detailed description of this intervention.)
In a recent review, van Sluijs and colleagues (2007) found strong evi-
dence for the effectiveness of multicomponent school-based interventions 
including family or community components (Craggs et al., 2011). With 
increasing recognition of the importance of these integrated approaches, 
programs such as Playful City USA (Kaboom, 2013) and Playworks (www.
playworks.org) are being launched as national campaigns to promote phys-
ical activity. Playful City USA is a national recognition program honoring 
cities and towns that make play a priority and use innovative programs to 
get children active, playing, and healthy. Playful City USA designees map 
local play spaces; complete a needs assessment; and develop an action plan 
that identifies a minimum of three policies, programs, or initiatives aimed 
at increasing access to play at school, in neighborhoods, and through com-
munity engagement. In 2012, 213 cities and towns in 41 different states 
earned Playful City USA recognition. 
Playworks is another program promoting physical activity through 
integrative means. The Playworks mission is to improve the health and 
well-being of children by increasing opportunities for physical activ-
ity and safe, meaningful play at recess and throughout the school day. 
Trained adult program coordinators go to low-income schools, where 
they enhance recess and play to make both a positive experience that 
helps students and teachers get the most out of every learning opportunity 
throughout the school day. This program has the potential to enhance not 
only physical activity but also classroom learning and social culture (see 
Chapter 4). 
The interest in and prevalence of these multicomponent programs 
for increasing child and adolescent physical activity are growing. As has 
been brought to light by reviews of these interventions, well-developed 
evaluation methodology is needed to strengthen the evidence base for their 
effectiveness. 
Cost-effectiveness is another important feature of these interventions. 
Growing evidence indicates that population-level environmental interven-
tions are a more cost-effective preventive health measure than interventions 
targeting individuals, although more research is needed in this area (Choski 
and Farley, 2012). As discussed in Chapter 1, schools, where children spend 
the majority of their waking hours, are important locations for obesity 
prevention activities, such as those designed to increase physical activity 

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Copyright © National Academy of Sciences. All rights reserved.
Educating the Student Body: Taking Physical Activity and Physical Education to School
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