Review and special article
Physical Activity Policies and Legislation in Schools: A Systematic Review

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Context

Current physical activity levels of youth are alarmingly low. One way to promote higher levels of physical activity to youth is through school-based government policies. The current review examines evaluation of school-based physical activity policies for youth over the past 10 years.

Evidence acquisition

Articles included met the following criteria: was an original research study published in an academic journal in English; examined or was related to physical activity behavior; applied to a youth population in a school setting; highlighted a law, bill, or policy reflective of physical activity based on government initiatives; and involved an evaluation. After searching five databases in January 2011, a total of 13 articles were selected for inclusion.

Evidence synthesis

All policies came from the U.S.; seven studies highlighted the federal Child Nutrition and Women, Infants, and Children Reauthorization Act of 2004 whereas the other six studies highlighted state-level policies dealing with safe routes to schools, physical activity–only initiatives, or physical activity as well as other initiatives. Eight articles evaluated policy implementation, three examined policy implementation and impact, and two articles considered only policy impact.

Conclusions

This evaluation of the impact of policies on school-based physical activity indicates that such policies can affect health outcomes, specifically by increasing levels of physical activity. This study highlights the value of policy reform and calls attention to the need for independent evaluation of such policies.

Introduction

Across North America, many youth do not meet recommended physical activity levels.1, 2 This trend is seen in Europe also but to a lesser degree.3 To increase youth activity levels, schools continue to receive attention as a place to promote and engage in physical activity.4, 5 School-based interventions can be an appropriate and effective means of increasing youth physical activity,6, 7, 8, 9, 10, 11 especially when combined with other interventions.12, 13

In their review, Timperio and colleagues11 identified three common strategies (policy, curriculum, or environmental) for physical activity interventions in schools. In terms of specific curriculum strategies, Kahn et al.8 noted that changes to the physical education curriculum typically involve one of three things: students being provided with more or longer classes or being encouraged to be more active during the classes. Policy is a key part of social ecologic models.14 Within Schmid and colleagues' policy framework,15 the influence of policy on behavior may be direct or indirect. One way policy change can occur is through government legislation.15 This contrasts with health promotion interventions that attempt to “encourage” changes in school policy, or the physical education curriculum, or the school environment16, 17 through negotiation or working with a school champion. When considering physical activity policy, Schmid et al.15 acknowledge the importance of examining and understanding the various facets of policy; not only should the resulting impact of a policy be assessed but also how or why the policy initially was conceptualized and then put into practice.15

Although researchers may not always investigate the entire policy process from start to finish, individuals have begun to examine parts of the process. For example, Dodson and colleagues18 examined the policy prediction and identification phases from Schmid's15 framework, whereas Boehmer et al.19 assessed the policy prediction phase. A recent review20 identified legislation and standards affecting U.S. schools in the area of physical education/activity as well as nutrition, BMI assessment, and wellness. Eyler and colleagues21 further collated all U.S. legislation related to physical education and examined both the number of legislative bills and their content (e.g., funded, degree of evidence present).

Within Canada, Patton and McDougall's22 review identified physical activity interventions in schools categorized by province. Only a handful of the interventions were mandatory initiatives put forth by the respective provincial governing body. It also was observed that the actual implementation and impact of such legislative policies remain understudied.22 Further, using a previous review as well as a search of the literature between 2005 and 2007, Lagarde and LeBlanc23 summarized a range of school-based interventions/programs/policies that they then classified as policy strategies that were untested, promising, or effective. Unfortunately, these authors did not address specifically which pieces of evidence were from articles based on school-based physical activity or obesity interventions versus government-enacted legislative policy (if any).

There clearly is a need for school-based physical activity policy evaluation.24, 25 Thus, the purpose of the current review is to move beyond identifying government-enacted legislative policy for physical education/physical activity at schools into synthesizing the evidence regarding the implementation of and outcomes of such policies over the past 10 years. This process includes reviewing available evidence regarding legislative policy implementation evaluation (e.g., how the policies were implemented) and impact evaluation (e.g., whether the specific policy/legislation affected student outcomes such as physical activity level).26

Section snippets

Evidence Acquisition

To obtain articles evaluating school legislated policy since 2000, five databases (PubMed, Medline, PsycINFO, CINAHL, and SPORTDiscus) were searched in January 2011 (see Table 1 based on Stalsberg and Pedersen27). Search terms were: law or bill or policy or legislation or memorandum and physical activity or sport or physical education or active transport or active commuting and child or adolescent and school. Other limitations were included as appropriate given the particular database. These

Evidence Synthesis

The 13 papers included in this review assessed six school-related physical activity policies (see Appendix A, available online at www.ajpmonline.org for a description of each policy). All policies were U.S.-based at either the state (five policies35, 36, 37, 38, 39, 47) or federal (one policy40, 41, 42, 43, 44, 45, 46) level. Eight studies assessed implementation evaluation,35, 40, 41, 42, 43, 44, 45, 46 two evaluated policy impact,39, 47 and three examined both policy implementation and impact.

Discussion

Of the 13 studies reviewed, outcomes for only three policy reforms were reported. These studies found that school-based policies were effective in increasing youth activity levels, with enhanced physical activity outcomes ranging from attaining a certain percentage of time students are active in physical education class36, 37 to increased active travel following construction projects to create safer routes to school.39, 47 These findings support the position that school-based physical activity

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      This is not surprising as policy reforms often do not incorporate provisions for funding for conducting impact evaluation (Robertson-Wilson et al., 2012). A lack of timely funding for evaluation purposes is often associated with an absence of baseline data that would allow for investigation of the impact of a policy (Robertson-Wilson et al., 2012; Anderson et al., 2013). Policy reforms are one example of natural experiments, and adequate planning and funding can help provide opportunities for more rigorous investigations of their impact on PA outcomes.

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      We found ten reviews that addressed PA promoting policies for children within the school setting. Five of these evaluated overarching public policies (Basch, 2011; Langford et al., 2014; Metos and Murtaugh, 2011; Robertson-Wilson et al., 2012; Williams et al., 2013). Evidence from the US suggests that policies at the state level can result in an increase in the number of physical education (PE) specialists in schools as well as in additional policies against using PA as a form of punishment in schools (Robertson-Wilson et al., 2012).

    • The Association Between State Physical Education Laws and Student Physical Activity

      2020, American Journal of Preventive Medicine
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      Many youth fall short of these recommendations: Only 26% of high school (HS) students in the U.S. participate in PA for at least 60 minutes/day.2,3 Policymakers and advocates have long considered physical education (PE) laws as potential effective policies to increase youth PA and PE engagement during the day,4–23 particularly those requiring specific amounts of PE time.8,19,21,23 The Institute of Medicine and SHAPE America recommend HS students spend an average of 45 minutes/day or 225 minutes/week in PE.24–26

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