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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Physical Activity.

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Strategy. Comprehensive School Physical Activity Programs

Approach. Implement a comprehensive school physical activity program with a combination of strategies to increase physical activity before, during, and after school

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Overview. Analysis indicates that comprehensive school physical activity programs that use a combination of strategies to increase physical activity before, during, and after school can increase physical activity in children and adolescents. Components in these programs include: physical education, physical activity during school (e.g., recess and classroom physical activity), before- or after-school programs, staff involvement, and family and community engagement. The programs often also include healthy eating or well-being information, but the focus is primarily on physical activity.[1, 2]

Evidence. Emerging Evidence. Strategies based on emerging evidence show promise but have not undergone extensive testing. While these approaches demonstrate potential, their effectiveness remains unconfirmed. Prioritize rigorous monitoring to ensure they achieve desired outcomes for all MCH populations.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Student physical activity monitoring data
  • Student self-reported well-being, enjoyment of PA, and school connectedness survey
  • Parent feedback surveys

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.
  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of schools implementing all components of a comprehensive physical activity program. (Assesses full strategy adoption)
  • Number of before-school, during-school, and after-school physical activity opportunities created. (Evaluates program comprehensiveness)

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

  • Percent of physical activity programs aligned with national guidelines for youth physical activity. (Measures adherence to best practices)
  • Percent of program components that incorporate student input in design and implementation. (Assesses student-centered approach)

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

  • Number of cross-sector partnerships led by Title V formed to support comprehensive program implementation who reports high levels of engagement. (Shows community collaboration)
  • Number of policy changes supported by Title V enacted to support physical activity integration throughout the school day. (Assesses supportive environment creation)
  • Number of students showing improved academic performance correlated with involvement in physical activity programming. (Quantifies educational benefits)
  • Number of schools partnered with Title V serving as model sites for comprehensive physical activity programs that reports improvements in health outcomes. (Assesses program exemplars and potential for scaling)

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

  • Percent of program resources allocated to addressing identified gaps in physical activity opportunities. (Measures strategic resource allocation)
  • Percent of program evaluations that analyze outcomes across various student subgroups and socioeconomic factors. (Ensures impact assessment)
  • Percent reduction in gaps in physical activity participation between different student subgroups. (Measures improvements in health outcomes)
  • Percent increase in physical activity levels among students with previously low activity levels for facing higher health risks. (Evaluates impact on groups facing higher health risks)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

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

References

1 Belton S, McCarren A, McGrane B, Powell D, Issartel J. The Youth-Physical Activity Towards Health (Y-PATH) intervention: Results of a 24 month cluster randomised controlled trial. PLOS One. 2019;14(9):e0221684.

2 Hyde ET, Gazmararian JA, Barrett-Williams SL, Kay CM. Health empowers you: Impact of a school-based physical activity program in elementary school students, Georgia, 2015-2016. Journal of School Health. 2020 Jan;90(1):32-38.

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.