Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 8: Physical Activity

MCH Best Logo five children on bicycles

Strategy. School-based Programs and Activities: Active Recess

Approach. Implement 30-minute, semi-structured or structured recess breaks in elementary schools.

Return to main MCH Best page >>

Overview. Semi-structured or structured recess breaks throughout the school day have been found to be effective for increasing physical activity among elementary school children.1

Evidence. Scientifically Rigorous.2 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. Access additional peer-reviewed evidence through the Cochrane Library. (Read more about understanding evidence ratings).

Target Audience. Children/Schools.

Outcome. Increased level of physical activity. 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 30-minute recess breaks.

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

  • Percent of elementary schools agreed to implement 30-minute recess breaks.

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

  • Number of elementary schools who implemented 30-minute recess breaks with at least 80% of children actively participating most days of the week.

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

  • Percent of elementary schools who implemented 30-minute recess breaks with at least 80% of children actively participating most days of the week.

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.


References:

1 Erwin, H.E., Ickes, M., Ahn, S. & Fedewa, A. (2014). Impact of recess interventions on children's physical activity - A meta-analysis. American Journal of Health Promotion, 28(3), 159-167.

2What Works for Health. Robert Wood Johnson. 2021 County Health Rankings. available: What Works for Health 2021

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.