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Children spend over half of their waking hours in school for a major portion of the year. Schools are increasingly in the spotlight for not only enhancing children's learning and well-being, but are also a critical point of engagement for promoting children's physical health. In the context of the national obesity epidemic, schools have further been complimented or criticized for both dietary and physical activity influences,1 as discussed in Chapters 181 and 185. A major focus within the context of the obesity epidemic has been school food—the National School Lunch Program, competitive foods, removing vending and sodas, and school breakfast, but increasingly physical education and physical activity programming are a major focus.2,3 In a concerted effort to address the many different personal and environmental factors that holistically shape the integral link between student health and educational attainment, the Centers for Disease Control and Prevention (CDC) in collaboration with the Association for Supervision and Curriculum Development (ASCD) developed the “Whole School, Whole Community, Whole Child” (WSCC) model. Under this framework, the Comprehensive School Physical Activity Program (CSPAP) is one of eight central components that are addressed for health promotion and disease prevention and underlies many of the school-based physical activity approaches described in this chapter.1

Over the past decade, there has been a greater focus on children's physical activity and movement within the school setting given the contribution of physical activity to energy balance, but also in part due to the decline in physical education offerings throughout the elementary, middle, and high school years given tighter budgets. Beyond obesity prevention, efforts to address physical activity in schools have gained momentum in recent years given mounting evidence surrounding the impact of these behaviors on student behavior, attention-to-task, cognitive health, and academic achievement.4 Importantly, there is also renewed attention on increasing children's fitness levels in terms of military preparedness. Historically, physical education and school-based fitness testing were aligned with the goals of having a healthy military. A 2018 report from the Council for a Strong America, “Unhealthy and Unprepared,” estimated that an alarming 71% of individuals between the ages of 17–24 do not qualify for military service and obesity prevents 31% of youth from serving if they choose to, which has major implications for recruitment and the future of our armed services.5,6

Given the breadth of potential benefits of enhancing school-time physical activity, the National Academy of Sciences (formerly the Institute of Medicine) recommends that elementary school children and middle/high school children engage in 30 minutes and 45 minutes of school-time moderate-to-vigorous physical activity (MVPA) per day, respectively.7 Contextually, children should be accruing approximately half of the current U.S. Physical Activity Guidelines recommendation of 60 minutes of MVPA per day in school.8 Objective national and international data using accelerometry indicate that anywhere from less than 50% to 3–5% of children (depending on the cut-points used for analysis—see following section) are reaching ...

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