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Physical Activity: Classroom-based Physically Active Lesson Interventions


What the CPSTF Found

About The Systematic Review

CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to school-based physical activity interventions.

Norris E, van Steen T, Direito A, Stamatakis E. Physically active lessons in schools and their impact on physical activity, educational, health and cognition outcomes: a systematic review and meta-analysis. British Journal of Sports Medicine 2020;54:826-38.

The review included 42 studies (search period through April 2019), of which 34 were included in meta-analyses of physical activity, health, cognition, and education-related outcomes. The team also examined the subset of 18 intervention studies conducted in the United States and abstracted supplemental information about study, intervention, and population characteristics.

The CPSTF finding is based on results from the published review and meta-analyses, additional information from the subset of 18 studies conducted in the United States, and expert input from team members and CPSTF.


The U.S. Department of Health and Human Services recommends that young people ages 6–17 years participate in at least 60 minutes of physical activity daily (HHS 2018). Regular physical activity in childhood and adolescence improves strength and endurance, helps build healthy bones and muscles, helps control weight, improves cognitive function, reduces risk of depression, and may improve cardiovascular health (HHS 2018).

Schools have an important role in promoting and supporting daily and weekly physical activity among students. Classroom-based physical activity interventions can be used to supplement other school programs and policies to promote physical activity among students such as physical education programs, recess breaks, and active travel to school interventions (CDC 2018).

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The published systematic review included 42 studies, of which 34 were included in meta-analyses providing summary effect estimates as standardized mean differences. Interventions lead to the following student outcomes:

  • Increased time spent in moderate-to-vigorous intensity physical activity over the school day
  • Improved lesson-related educational outcomes
  • Improved measurements of student attention to lesson content

The review did not find intervention effects on cognition or measures of physical fitness or body mass index.

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.


Based on results from the review, findings should be applicable to students in preschool, kindergarten, and elementary schools in the United States.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • How do intervention effects vary by participant characteristics, including household income, parents’ level of education, and race/ethnicity in U.S. populations?
  • How do intervention effects vary based on duration and frequency of physically active lessons during the school day?
  • Do physically active lessons contribute to more students meeting recommendations for 60 minutes per day of moderate-to-vigorous intensity physical activity per day?
  • What is the impact of classroom-based physically active lesson interventions on the following outcomes:
    • Cognitive functions
    • Physical fitness, including aerobic fitness, muscle strength and endurance, flexibility, and body composition
    • Other student health outcomes
  • Are these interventions effective for older students in middle and high school settings?
  • What are barriers to teacher and school adoption and sustained implementation?
  • What are solutions to address barriers to teacher and school adoption and sustained implementation?
  • How might physical activity breaks be tailored so they are developmentally appropriate, culturally relevant, and inclusive of students with disabilities?

Study Characteristics

  • Study designs included group randomized controlled trials (27 studies), controlled before-after studies (14 studies), and prospective cohorts (1 study).
  • Studies were conducted in the United States (18 studies), Australia (7 studies), the United Kingdom (5 studies), the Netherlands (4 studies), and Denmark (2 studies), and one study each came from China, Croatia, Ireland, Israel, Portugal, and Sweden.
  • Most study interventions were implemented by teachers (32 studies). Many of them provided fully integrated active lesson plans (24 studies) or sample activities to be integrated into lessons (13 studies).
  • Included studies most often evaluated students in primary school settings (29 studies) or preschool settings (10 studies). One study evaluated interventions among students in grades K-8, and two studies included students in grades 6-9.
  • U.S. studies that reported information about race and ethnicity included students who self-identified as Black or African American (median of 10.9% from 9 studies), Hispanic or Latino (median of 13.1% from 7 studies), and Asian (median of 4.6% from 4 studies). Two studies were conducted in schools where a high proportions of students qualified for free (89%) or reduced-price (94%) lunch.