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Educating the Student Body
BOX 7-2 
CATCH: An Example of a Multicomponent 
Coordinated School Health Promotion Program
The Child and Adolescent Trial for Cardiovascular Health, or CATCH, was 
a “controlled clinical trial that entailed a multicomponent, multiyear 
coordinated school health promotion program designed to decrease fat, 
saturated fat and sodium in children’s diets; increase physical activity; 
and prevent tobacco use” (Perry et al., 1990). 
CATCH included school environmental modifications related to food 
consumption, physical activity, and tobacco use. For physical activity, a 
whole-of-school approach was used (see the discussion of this approach 
in Chapter 1). Physical education teachers were instructed to increase 
the involvement of children and to provide for vigorous- or moderate-
intensity physical activity for at least 50 percent of class time. The CATCH 
classroom curriculum outside of physical education used social cognitive 
theory to target 3rd- to 5th-grade students and focused on multiple 
health behaviors, including eating habits, physical activity, and cigarette 
smoking. CATCH also incorporated family- and home-based programs to 
complement in-school activities (Perry et al., 1990).
The trial was carried out in 1991-1994 in 96 schools (56 intervention 
sites, 40 control sites) in four states (California, Louisiana, Minnesota, 
and Texas) and included more than 5,100 students with diverse cultural 
and ethnic backgrounds. By the time it was completed, CATCH had dem-
onstrated sustainable changes in dietary and physical activity behaviors. 
With respect to physical activity outcomes, students who participated in 
the intervention were more physically active during physical education 
classes and participated in more physical activity outside of school com-
pared with students in the control schools (Luepker et al., 1996).
Further sustainability was demonstrated after the main CATCH trial ended. 
The CATCH students were studied 3 years following the intervention. With 
no continued CATCH intervention, the students who had participated in the 
trial maintained lower fat intakes and higher levels of physical activity com-
pared with those who had not participated (Nader et al., 1999).
Such multicomponent, whole-of-school approaches for increasing physi-
cal activity can be successfully sustained with key elements in place. 
Osganian and colleagues (2003) studied the schools in the original trial 
and concluded that sustainability was enhanced by staff training; a pro-
gram champion; and adequate administrative support and resources, such 
as sufficient funding for materials and equipment.

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Educating the Student Body: Taking Physical Activity and Physical Education to School
The Effectiveness of Physical Activity and Physical Education Policies and Programs
 
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(Story et al., 2009). The World Health Organization, the American Heart 
Association, and the Centers for Disease Control and Prevention (CDC) all 
have called on schools to assume a leadership role in promoting physical 
activity among children and adolescents.
Recent research by Aryana and colleagues (2012) shows the need to 
target obesity prevention strategies at an early age. This study tracked 
changes in California students’ physical fitness, including body mass index 
(BMI), during 5th, 7th, and 9th grades. While the researchers found that 
school-based physical activity can have some effect on reducing obesity 
rates, they continued to find increased obesity rates in incoming 5th-grade 
study participants. Several studies also point to the importance of physical 
activity in obesity interventions. Findings of both Skinner and colleagues 
(2012) and a new Australian study led by Richard Telford (Telford et al., 
2012) show that obese youth consume the same amount of calories as their 
normal-weight counterparts, suggesting that increased physical activity in 
youth may be crucial in reducing obesity prevalence. Likewise, Stallmann-
Jorgensen and colleagues (2007) indicate that a lack of vigorous physical 
activity, rather than excess calorie intake, is related to body fat in youth. 
These findings highlight the need to target physical activity interventions 
and policies at all youth. 
Even though multicomponent approaches to increasing physical activ-
ity in youth often adhere to systems thinking and can be effective and sus-
tained over time, they are complex, and barriers to their implementation 
and sustainability are numerous. Indeed, physical activity interventions 
and initiatives in school are more often defined by a single focus, such as a 
policy or a curriculum. These singular programmatic and policy approaches 
within schools are increasing in prevalence, as indicated in Chapters 5 and 
6. The next section summarizes the evidence on such approaches and their 
outcomes. As demonstrated by variations in the space devoted to each 
approach, many of these approaches have not been evaluated or dissemi-
nated to the fullest extent.