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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 8: Physical Activity

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Strategy. Active Recess

Approach. Promote an active, semi-structured, or recess break from the school day, typically before lunch.

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Overview. Research indicate using active recess strategies are effective in increasing daily time in moderate to vigorous physical activity (MVPA) for elementary and middle school children. Examples of studies with positive outcomes were those that used supervised inclusive games and activities; multicomponent investments in playground or activity equipment, marking or painting on equipment; or training and support for teachers and supervisors to promote physical activity in the school day.1 2 3

Evidence. Scientifically Rigorous. Semi-structured or structured recess breaks in elementary school, typically before lunch, involve a variety of planned, inclusive, and actively supervised games or activities. These recess breaks engage all students. Multi-compenent interventions include investments in playground and activity equipment, patiented markings on playgrounds, and training for teacher or specialists to lead activities. This strategy has been tested more than once and results trend positive overall. See the references at the bottom of the page for specific studies related to active recess break. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Children/Schools.

Outcome. Increase in overall physical activity in elementary and middle school children. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the “Intervention Results” for each study.

Examples from the Field. Access descriptions of current ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

In South Carolina, efforts were made to increase the number of professional development opportunities for school staff to provide a minimum of 30 minutes per day of physical activity and ensure physical education interventions in schools were sustainable.

The Role of Title V. Title V agencies can support organizations to offer more recess or school-based programs through a number of approaches:

Sample ESMs. Using the approach “Implement 30-minute, semi-structured or structured recess breaks in elementary schools,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of elementary schools agreed to implement recess breaks.
  • Number of teachers receiving training or technical assistance to promote active recess.
  • Number of schools that sign on to the 3-4-50 community health improvement strategy, including a commitment to daily recess.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of elementary schools agreed to implement recess breaks.
  • Percent of districts offering training or technical assistance to promote active recess and a healthy school environment.
  • Percent of schools evaluating their recess structures.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of elementary schools who implemented recess breaks with at least 80% of children actively participating most days of the week.
  • Number of teachers that report increased knowledge as a result of training and technical assistance on active recess.
  • Number of teachers who report implementing semi-structured games or other activities during recess.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of elementary schools who implemented recess breaks with at least 80% of children actively participating most days of the week.
  • Percent of students engaged in actively supervised games or activities during recess.
  • Percent of teachers who report increased overall physical activity in students after training in an active recess curriculum.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


1 Frost MC, Kuo ES, Harner LT, Landau KR, Baldassar K. Increase in physical activity sustained 1 year after playground intervention. American Journal of Preventive Medicine. 2018 May;54(5 Suppl 2):S124-S129.

2 Gutiérrez-Martínez L, Martínez RG, González SA, Bolívar MA, Estupiñan OV, Sarmiento OL. Effects of a strategy for the promotion of physical activity in students from Bogotá. Revista de Saúde Pública. 2018 Aug;52:79.

3 Morris JL, Daly-Smith A, Archbold VSJ, Wilkins EL, McKenna J. The Daily Mile™ initiative: Exploring physical activity and the acute effects on executive function and academic performance in primary school children. Psychology of Sport and Exercise. 2019a Nov;45:101583.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.