Classroom Exercise Breaks and Educational Outcomes in

Transcription

University of South Carolina
Scholar Commons
Theses and Dissertations
1-1-2013
Classroom Exercise Breaks and Educational
Outcomes in Elementary School Students
Erin Kaye Howie
Follow this and additional works at: http://scholarcommons.sc.edu/etd
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Howie, E. K.(2013). Classroom Exercise Breaks and Educational Outcomes in Elementary School Students. (Doctoral dissertation).
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CLASSROOM EXERCISE BREAKS AND EDUCATIONAL OUTCOMES IN ELEMENTARY SCHOOL
STUDENTS
By
Erin Kaye Howie
Bachelor of Science
University of Maryland, 2008
___________________________________
Submitted in Partial Fulfillment of the Requirements
For the Degree of Doctor of Philosophy in
Exercise Science
The Norman J. Arnold School of Public Health
2013
Russell Pate, Major Professor
Michael Beets, Committee Member
Roger Newman-Norlund, Committee Member
Jeffrey Schatz, Committee Member
Lacy Ford, Vice Provost and Dean of Graduate Studies
©Copyright by Erin Kaye Howie, 2013
All Rights Reserved.
ii
DEDICATION
To wiggling, dancing, and jumping children everywhere.
May you keep on moving.
iii
ACKNOWLEDGEMENTS
Thank you to Dr. Pate who has set an example of the teacher, researcher, and
leader I hope to become. I am grateful to Dr. Beets, Dr. Newman-Norlund, and Dr.
Schatz for providing balance and their own individual expertise.
Many thanks to Keely Flynn for the hours of tedious video coding, Dr. Dowda for
statistical guidance and Alisa Brewer for learning and sharing the exercise “moves”.
Thank you to the three girls who have inspired me since we were roaming the
streets of Birdland and who always remind me to be awesome.
I will never be able to thank my family enough for everything they’ve done and
instilling my love of physical activity. Thanks to my mom who put up with my “attitude”
at every feis, my Dad who gave up his time to coach us unruly little girls on the soccer
field, my sister who was the first person I ever knew to run five miles even if only for
those miserable August tryouts, and my “little” brother, who learned all his badminton
skills from me.
And the most sincere and genuine thanks to all the hearts, both big and small
who participated in this study to make hearts healthier. It was the generous support of
the school district, principal, teachers, and parents who made this study possible. Most
importantly thank you for the smiles and honesty of the 4th and 5th graders who always
remind me what this research is for.
iv
ABSTRACT
Previous research has shown that physical activity may have beneficial effects on
cognitive performance and academic achievement in children, but the optimal type and
dose are unknown. Classroom exercise breaks are one type of physical activity
opportunity in schools, with the potential to reach a large number of children. The
purpose of this dissertation was to describe the prevalence and characteristics of
classroom exercise breaks in central South Carolina, and to determine the acute effects
of classroom exercise breaks on executive functions, math performance, on-task
behavior and affective responses in 9 to 12 year-old children. Additionally, the
dissertation examined the dose-response relationship between 5, 10, and 20 minutes of
classroom exercise and these educational outcomes. Finally, the dissertation examined
whether these relationships between the duration of acute classroom exercise breaks
and educational outcomes varied by student characteristics. The dissertation used
multiple designs including cross-sectional surveys and an experimental design.
The first study included surveys and interviews with elementary school
principals. Of the 61 reporting schools, 74 percent of principals reported practicing
classroom exercise breaks, though only 8 percent had school policies requiring exercise
breaks. In interviews with 14 principals, school-specific practices varied greatly. Less
than half of the schools reported practicing regular, school-wide exercise breaks, while
v
almost all schools encouraged teachers to implement them according to teacher
discretion.
For the following three studies in this dissertation, a total of 96 4 th and 5th grade
students participated in the Brain BITES (Better Ideas Through Exercise) intervention. A
within-subjects design was used. Students participated in each of four conditions: 10
minutes of seated classroom exercise, and 5, 10, 20 minutes of classroom exercise
breaks. All sessions were videotaped. Students completed a Trail Making Test,
operational digit recall task, and a one-minute math test before and after each
condition. Two observers coded student on-task behavior before and after the
conditions from video footage using a momentary time sampling protocol. Positive
affect during the sessions was also coded. Focus groups were conducted with students
and teachers after the intervention to discuss acceptability and feasibility of the
classroom exercise breaks. Repeated measures mixed model ANCOVAs with linear
contrasts compared the post-test scores between conditions. Interactions with student
characteristics including gender, intelligence (IQ), fitness, body mass index (BMI),
behavior, school engagement, baseline on-task behavior and physical activity
participation were examined.
The average physical activity intensity during the exercise conditions ranged
from 4.00 to 4.35 (1 is equal to lying down and 5 is equal to being very active). Math
performance improved after 10 minutes of classroom exercise breaks compared to the
sedentary condition (25.6 vs 24.4 math problems correct, d=0.28, p=0.03). On-task
behavior improved after 10 and 20 (87.6% and 83.9% vs 77.1%, d=0.45,0.29,
vi
p=.004,.056) minutes. Positive affect was higher in all three exercise conditions
compared to the sedentary condition (5 minutes=46.6%, d=1.54; 10 minutes=45.5%,
d=1.56; 20 minutes=36.1%, d=1.15; sedentary=7.8%). Students and teachers reported
that the classroom exercise breaks were enjoyable to students, but teachers would only
be able to implement five minutes or less in their classrooms.
Overall, this dissertation found that classroom exercise breaks are common
practices in schools, though the characteristics of the practices vary on a school-toschool basis, and are acceptable to students, teachers, and principals. Ten minutes of
classroom exercise breaks had the most beneficial effects on student educational
outcomes including math performance, on-task behavior and positive affect. Schools
should provide training, resources, and administrator support to provide classroom
exercise breaks of this duration.
vii
TABLE OF CONTENTS
Dedication ........................................................................................................................... iii
Acknowledgements............................................................................................................. iv
Abstract ................................................................................................................................ v
List of Tables ........................................................................................................................ x
List of Figures ..................................................................................................................... xii
Chapter 1: Overall Introduction .......................................................................................... 1
Chapter 2: Manuscript 1 - Classroom Exercise Breaks in Central South Carolina: ‘It’s not a
well-oiled machine’ but ‘Kids are Happy and Productive’ .................................................. 8
Chapter 3: Manuscript 2 - Acute Effects of Classroom Exercise Breaks on Executive
Functions and Math Performance in Elementary School Students: A Dose-Response.... 29
Chapter 4: Manuscript 3 - Acute Classroom Exercise Breaks Improve On-task Behavior in
4th and 5th Grade Students: A Dose-Response .................................................................. 57
Chapter 5: Manuscript 4 - Smiles Count: A Mixed-methods Analysis of the Affective
Response, Acceptability and Feasibility of a Classroom Exercise Break Intervention in
Elementary Schools ........................................................................................................... 82
Chapter 6: Overall Discussion ......................................................................................... 113
Chapter 7: Proposal ........................................................................................................ 124
Introduction................................................................................................................. 124
Aims and Hypotheses .................................................................................................. 125
Significance of the Proposed Study ............................................................................. 128
Review of Literature .................................................................................................... 130
Study One Methods .................................................................................................... 156
viii
Study Two Methods .................................................................................................... 163
Study Three Methods .................................................................................................. 174
Study Four Methods .................................................................................................... 179
Bibliography .................................................................................................................... 211
Appendix A ...................................................................................................................... 236
Appendix B ...................................................................................................................... 237
Appendix C ...................................................................................................................... 240
ix
LIST OF TABLES
Table 2.1: School demographics for sampled school districts .......................................... 24
Table 2.2: Number of schools available in each school demographic stratum (mean %
free-and-reduced lunch, % not meeting state academic standards) ............................... 25
Table 2.3: Percentage of schools reporting classroom exercise breaks, prevalence and
policies .............................................................................................................................. 26
Table 3.1: Operational definitions of primary dependent variables ................................ 46
Table 3.2: Baseline descriptive variables (% or mean ± SD) ............................................. 46
Table 3.3: Average Intensity of Intervention ± SD (Coded from 1-5; MVPA ≥ 4) ............. 47
Table 3.4: Spearman correlations between continuous student variables ...................... 47
Table 4.1: Demographics by classroom group (mean (SD)) ............................................. 73
Table 4.2: Post-test time-on-task by classroom group (SE) ............................................. 74
Table 5.1: Baseline descriptive variables (% or mean ± SD) ........................................... 103
Table 7.1: Percentage of submitting South Carolina schools reporting exercise break
practices over 4 years ..................................................................................................... 184
Table 7.2: Summary of studies examining classroom exercise interventions and
educational outcomes .................................................................................................... 185
Table 7.3: Demographics of sampled school districts .................................................... 186
Table 7.4: Number of schools available in each stratum (mean %FRL, % not meeting
standards) ....................................................................................................................... 187
Table 7.5: Randomization of intervention conditions .................................................... 187
x
Table 7.6: Operational definitions of outcome variables for Study Two ....................... 188
Table 7.7: Proposed timeline .......................................................................................... 189
xi
LIST OF FIGURES
Figure 3.1: Performance on cognitive tasks after 10 minutes of seated classroom activity
or 5, 10, 20 minutes of classroom exercise breaks ........................................................... 48
Figure 3.2: Math scores after seated classroom activity or 5, 10, 20 minutes of classroom
exercise breaks, stratified by baseline characteristics ..................................................... 49
Figure 4.1: Observed time-on-task after 10 minutes of seated classroom activity or 5, 10,
20 minutes of classroom exercise breaks in A) Total group, B) Each classroom
individually ........................................................................................................................ 75
Figure 4.2: Time-on-task after seated classroom activity or 5, 10, 20 minutes of
classroom exercise breaks, stratified by baseline characteristics .................................... 76
Figure 5.1: Percent of positive affect observed by minute ............................................ 104
Figure 5.2: Positive student affect after seated classroom activity or 5, 10, 20 minutes of
classroom exercise breaks, stratified by baseline characteristics .................................. 105
Figure 7.1: Proposed model of mediators and moderators on academic achievement
from Tomporowski (2011) .............................................................................................. 190
Figure 7.2: Meta-Volition model from Yancey (2009) .................................................... 191
xii
CHAPTER 1
OVERALL INTRODUCTION
The majority of children do not meet recommended levels of physical activity.1
Inadequate physical activity results in multiple health consequences,2 thus increasing
the physical activity of youth has become a national priority.3 Schools are a primary
target for reaching large numbers of children, with over 95 percent of children attending
schools.4 Unfortunately, instead of increasing physical activity opportunities, schools are
reducing physical activity opportunities in response to reduced budgets and an
increased focus on standardized testing.5, 6 Ironically, reducing physical activity may
lower the very academic achievement schools are trying to increase.
Research on the connection between physical activity and cognition has been
conducted for over half a century. Large cross-sectional studies have found positive
associations between physical activity,7 fitness,8, 9 and physical education10 with
multiple cognitive assessments and academic achievement measures. Experimental
studies have also shown positive effects of acute11-14 and regular physical activity15, 16 on
cognitive function and academic performance. While the evidence suggests a positive
relationship between physical activity and cognition and academic achievement, there
are remaining concerns about methodology and study rigor.17-20 Even with the
proliferation in the number of studies examining the connection between
1
physical activity and cognition in children,20 little is still known about the ideal duration
and type of physical activity to maximize these benefits.
One way to increase physical activity throughout the school day is through
classroom exercise breaks.21-24 Classroom exercise breaks are short bouts of physical
activity that are integrated throughout the school day. Compared to physical education
and recess, they require few additional resources and a brief amount of time, making
them ideal for schools with reduced budgets and limited time in their rigidly structured
curriculums. Because of these benefits, schools and teachers have begun implementing
these practices.25, 26 Despite the proliferation of classroom exercise breaks, little is know
on how these practices are being implemented in schools as well as the effects on
educational outcomes.
Few studies have examined the effects of classroom exercise breaks on student
cognition or academic achievement. Three studies have looked at the effects of regular
classroom exercise breaks on standardized test scores and found that scores in some
subjects improved but results were inconsitent.23, 27, 28 Mahar et al. and Grieco et al.
directly observed classroom behavior after an acute classroom exercise break and found
that children improved24 or maintained29 on-task behavior compared to when they did
not exercise. Only one study directly compared classroom exercise breaks to longer
doses of physical activity. Kubesch et al. found children improved cognitive performance
after 20 minutes of physical education, but not after a five minute of classroom exercise
break.30 No previous studies have directly compared the acute cognitive effects of
different durations of classroom exercise breaks.
2
To address the gaps in the existing literature surrounding classroom exercise
breaks, this dissertation takes an epidemiological and experimental approach to better
understand classroom exercise breaks in elementary schools. Little is known about the
qualities of classroom exercise breaks that are being implemented in elementary
schools. The purpose of Study One was to evaluate the prevalence and characteristics of
existing classroom exercise breaks in elementary schools in central South Carolina. Using
online surveys and phone interviews with principals, this study described what types of
classroom breaks are being implemented in elementary schools, how they first started,
barriers to implementation and any benefits or disadvantages of implementing these
practices.
Previous studies on the effects of physical activity on cognition and academic
achievement have not identified the ideal type and dose of physical activity to elicit
these educational benefits. The remaining three studies in this dissertation used a
within subjects, experimental design to examine multiple educational effects of
classroom exercise breaks in 4th and 5th grade students and to examine the dose
response relationship between 5, 10, and 20 minutes of classroom exercise breaks. This
was the first study to directly compare the cognitive effects between multiple durations
of classroom exercise. The purpose of Study Two was to determine the acute effects of
classroom exercise breaks on executive functions and math performance and to
examine the dose-response relationship between 5, 10, or 20 minutes of classroom
exercise breaks and these cognitive functions. Additionally, the study examined whether
the relationship between duration of acute classroom exercise breaks and cognitive
3
functions varied by student gender, intelligence (IQ), fitness, body mass index (BMI),
behavior, school engagement, and physical activity participation during the
intervention.
While there have been two previous studies that directly observed on-task
behavior after acute classroom exercise breaks,24, 29 neither of these studies have
directly compared different durations of exercise or examined how the effects varied
based on classroom and individual characteristics. The purpose of Study Three was to
determine the acute effects of classroom exercise breaks on on-task behavior in
elementary school students and to examine the differences between 5, 10 and 20
minutes of exercise. Additionally, the effects were examined by individual classrooms
and several individual student factors including gender, intelligence quotient (IQ),
fitness, BMI, behavior, school engagement and baseline on-task behavior.
The fourth study examined the effects of a classroom exercise break on positive
affect in children. While physical activity has been shown to improve positive affect, and
enjoyment has been shown to improve educational outcomes, no studies have
objectively measured the effects of classroom exercise on positive affect. The purpose
of Study Four was to examine the affective responses, acceptability and feasibility of a
classroom exercise break intervention in elementary school students and to examine if
the effects differed between 5, 10, and 20 minutes of classroom exercise breaks. This
mixed-methods study used direct quantitative observations of positive affect and
qualitative focus groups with students and teachers to provide a holistic description of
the affective response to classroom exercise breaks.
4
References
1. Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity
in the United States measured by accelerometer. Med Sci Sports Exerc.
2008;40(1):181-8.
2. U.S.Department of Health and Human Services. Physical Activity Guidelines
Advisory Committee Report, 2008. Washington, DC: USDHHS; 2008.
3. The U.S. National Physical Activity Plan. Coordinating Committee of the NPAP
2010;Available at: URL: http://www.physicalactivityplan.org/theplan.php.
4. Frumkin H. Introduction: Safe and Healthy School Environments. In: Frumkin H,
Geller RJ, Rubin IL, Nodvin J, editors. Safe and Healthy School Environments.New
York: Oxford University Press; 2006. p. 3-10.
5. Center on Education Policy. Strained schools face bleak future: Districts foresee
budget cuts, teacher layoffs, and a slowing of education reform efforts. Internet.
2011.
6. Center on Education Policy. Choices, changes, and challenges: Curriculum and
instruction in the NCLB era. 2007.
7. Stevens TA, To Y, Stevenson SJ, Lochbaum MR. The importance of physical activity
and physical education in the prediction of academic achievement. J Sport Behav.
2009;31:368-88.
8. Roberts CK, Freed B, McCarthy WJ. Low aerobic fitness and obesity are associated
with lower standardized test scores in children. J Pediatr. 2010;156(5):711-8, 718.
9. Chomitz VR, Slining MM, McGowan RJ, Mitchell SE, Dawson GF, Hacker KA. Is there
a relationship between physical fitness and academic achievement? Positive
results from public school children in the northeastern United States. J Sch Health.
2009;79(1):30-7.
10. Carlson SA, Fulton JE, Lee SM et al. Physical education and academic achievement
in elementary school: Data from the Early Childhood Longitudinal Study. Am J
Public Health. 2008;98(4):721-7.
5
11. Hillman CH, Pontifex MB, Raine LB, Castelli DM, Hall EE, Kramer AF. The effect of
acute treadmill walking on cognitive control and academic achievement in
preadolescent children. Neuroscience. 2009;159(3):1044-54.
12. Stroth S, Kubesch S, Dieterle K, Ruchsow M, Heim R, Kiefer M. Physical fitness, but
not acute exercise modulates event-related potential indices for executive control
in healthy adolescents. Brain Res. 2009;1269:114-24.
13. Budde H, Voelcker-Rehage C, Pietrabyk-Kendziorra S, Ribeiro P, Tidow G. Acute
coordinative exercise improves attentional performance in adolescents. Neurosci
Lett. 2008;441(2):219-23.
14. Tomporowski PD, Davis CL, Lambourne K, Gregoski M, Tkacz J. Task switching in
overweight children: effects of acute exercise and age. J Sport Exerc Psychol.
2008;30(5):497-511.
15. Davis CL, Tomporowski PD, Boyle CA et al. Effects of aerobic exercise on
overweight children's cognitive functioning: a randomized controlled trial. Res Q
Exerc Sport. 2007;78(5):510-9.
16. Kamijo K, Pontifex MB, O'Leary KC et al. The effects of an afterschool physical
activity program on working memory in preadolescent children. Dev Sci.
2011;14(5):1046-58.
17. Fedewa AL, Ahn S. The effects of physical activity and physical fitness on children's
achievement and cognitive outcomes: A meta-analysis. Res Q Exerc Sport.
2011;82(3):521-35.
18. Centers for Disease Control and Prevention. The association between school based
physical activity, including physical educaton, and academic performance. Atlanta,
GA: U.S. Department of Health and Human Services; 2010.
19. Biddle SJ, Asare M. Physical activity and mental health in children and adolescents:
A review of reviews. Br J Sports Med. 2011;45(11):886-95.
20. Howie EK, Pate RR. Physical activity and academic achievement in children: A
historical perspective. Journal of Sport and Health Science. 2012;1:160-9.
21. Liu A, Hu X, Ma G et al. Evaluation of a classroom-based physical activity promoting
programme. Obes Rev. 2008;9 Suppl 1:130-4.
22. Erwin HE, Beighle A, Morgan CF, Noland M. Effect of a low-cost, teacher-directed
classroom intervention on elementary students' physical activity. J Sch Health.
2011;81(8):455-61.
6
23. Donnelly JE, Greene JL, Gibson CA et al. Physical Activity Across the Curriculum
(PAAC): a randomized controlled trial to promote physical activity and diminish
overweight and obesity in elementary school children. Prev Med. 2009;49(4):33641.
24. Mahar MT, Murphy SK, Rowe DA, Golden J, Shields AT, Raedeke TD. Effects of a
classroom-based program on physical activity and on-task behavior. Med Sci Sports
Exerc. 2006;38(12):2086-94.
25. Ratey JJ, Hagerman E. Spark: The revolutionary new science of exercise and the
brain. New York, NY US: Little, Brown and Co; 2008.
26. Lee SM, Burgeson CR, Fulton JE, Spain CG. Physical education and physical activity:
Results from the School Health Policies and Programs Study 2006. J Sch Health.
2007;77(8):435-63.
27. Katz DL, Cushman D, Reynolds J et al. Putting physical activity where it fits in the
school day: preliminary results of the ABC (Activity Bursts in the Classroom) for
fitness program. Prev Chronic Dis. 2010;7(4):A82.
28. Reed JA, Einstein G, Hahn E, Hooker SP, Gross VP, Kravitz J. Examining the impact
of integrating physical activity on fluid intelligence and academic performance in
an elementary school setting: a preliminary investigation. J Phys Act Health.
2010;7(3):343-51.
29. Grieco LA, Jowers EM, Bartholomew JB. Physically active academic lessons and
time on task: the moderating effect of body mass index. Med Sci Sports Exerc.
2009;41(10):1921-6.
30. Kubesch S, Walk L, Spitzer M et al. A 30-minute physical education program
improves students' executive attention. Mind Brain Educ. 2009;3(4):235-42.
7
CHAPTER 2
MANUSCRIPT 1: CLASSROOM EXERCISE BREAKS IN CENTRAL SOUTH CAROLINA: ‘IT’S
1
NOT A WELL -OILED MACHINE ’ BUT ‘KIDS ARE HAPPY AND PRODUCTIVE ’
1
Howie EK, Beets MW, Newman-Norlund RD, Schatz JC, Pate RR. To be submitted to
Teacher Education Journal of South Carolina.
8
Abstract
In order to comply with state physical activity policies and increase physical
activity of students, schools have begun to implement classroom exercise breaks. Little
is known about the characteristics of existing classroom exercise breaks. The purpose of
this study was to evaluate the prevalence and characteristics of existing classroom
exercise breaks in elementary schools in central South Carolina. Principals in elementary
schools in central South Carolina were invited to participate in a brief online survey
about classroom exercise breaks. Principals who reported classroom exercise breaks
occurring in their school were invited to participate in a phone interview about the
characteristics and implementation of classroom exercise breaks. Sixty-one principals
responded to the online survey. Of those responding, 74 percent reported classroom
exercise breaks in their school and only 8 percent reported a school-level policy
requiring classroom exercise breaks. Interviews with 14 principals revealed that the
characteristics of classroom exercise breaks vary widely between schools, with less than
half of schools participating in regular, school-wide morning exercise breaks. Principals
reported many benefits of classroom exercise breaks including improved student
behavior and attention, with little resistance to or disadvantages of implementing
classroom exercise breaks. Providing resources and example activities, training teachers
to implement breaks, and building communities of practice may increase the prevalence
of classroom exercise breaks.
9
Introduction
As children continue to fail to meet physical activity recommendations, 1 many
states have adopted policies to provide physical activity opportunities for children
through schools.2-4 Many of these school-based policies have focused on physical
education and recess.2 Unfortunately, faced by budget cuts and competing priorities,
many school districts report reducing physical education.5, 6 The Center for Education
Policy reports that 68 percent of schools reported funding decreases to staff in non-core
academic areas, including physical education, with another 50 percent anticipating
further cuts in the 2011-2012 school year.6 While physical education and recess
opportunities are being decreased, classroom exercise breaks are an alternative way to
meet physical activity recommendations. Classroom exercise breaks do not require
additional staff or require large amounts of time. These five to ten minute short bouts of
exercise in the classroom are recommended as a tool to increase school physical
activity,7, 8 and many schools have begun to implement them.2, 9
South Carolina is one of the states that adopted a policy to increase physical
activity in schools. In addition to requiring 90 minutes of physical education per week,
South Carolina’s Student Health and Fitness Act requires 60 minutes of physical activity
per week in addition to physical education.10 The physical activity time can include
recess and other physical activity opportunities, including classroom exercise breaks.
Principals must report their minutes of physical activity and physical education to the
South Carolina Department of Education in an annual survey. This survey found that the
number of schools participating in classroom exercise breaks in South Carolina has
10
grown over the past 5 years. Only 12 percent of responding principals reported
classroom exercise breaks occurring in their schools in 2007-2008 compared to 66
percent reporting them in 2010-2011.11 In the most recent report, 38 percent of schools
reported practicing video exercise (including aerobic videos, jazzercise, deskercise,
FitKids, energizers), 35 percent reported morning exercise (including morning stretching,
morning calisthenics, CORE exercise), and 66 percent reported classroom exercise led by
teachers.12 Other than this brief survey, little additional information is known about
these classroom exercise break practices in South Carolina or nationally, including the
specific types of classroom exercise breaks in use, how the practices began in each
school, and any benefits or disadvantages of implementing these practices.
A better understanding of these practices may help to improve and increase the
implementation of classroom exercise breaks. Improving implementation through
research of contextual factors that influence the process is important for school physical
activity interventions.13 While previous studies have looked at the implementation of
broad physical activity policies in other states,14, 15 none have focused exclusively on
classroom exercise breaks and few have used both quantitative and qualitative methods
to uncover the process of implementation as well as perceived benefits and
disadvantages.14, 16, 17 Mixed method approaches provide ideal inductive methods for
uncovering this process.18, 19 The purpose of this study was to evaluate the prevalence
and characteristics of existing classroom exercise breaks in elementary schools in central
South Carolina.
11
Methods
Study Design
This was a cross-sectional study using surveys and interviews to evaluate the
practice of classroom exercise breaks in elementary schools in central South Carolina.
Informed consent was obtained from school districts and participants. Complete
confidentiality was maintained upon participant and school board decision. The study
was approved by the University of South Carolina’s Institutional Review Board.
Participants
The study sampled public elementary schools in central South Carolina. There
were 226 public elementary schools in this geographical location within 14 counties and
25 school districts. In consideration of efficiency in obtaining school district approval,
districts with less than 4 schools were not included, resulting in a total sample of 192
schools, from 11 counties and 19 school districts. The demographic information for the
sampled districts can be found in TABLE 2.1. Principals from all 192 schools were
emailed to participate in an online survey about the prevalence of classroom exercise
breaks and classroom exercise break policies. Principals who reported classroom
exercise breaks in their school were invited to participate in a brief phone interview
about the implementation of classroom exercise breaks.
All schools in eligible districts were categorized into four school demographic
strata in order to examine variations in practices by school demographics. Stratum were
based on the percentage of free-and-reduced lunch (FRL) and the percentage of
students not meeting English and Math standards on 2010-2011 state assessments. The
12
four categories, as depicted in TABLE 2.2, included: low income/lower achieving, low
income/higher achieving, high income/lower achieving, high income/higher achieving.
These strata were selected based on a preliminary analysis of previously reported data
from the 2010-2011 state physical activity report.12 A logistic model using school-level
demographic and three self-reported classroom exercise break practices (video,
morning exercises, and classroom exercises) from the state physical activity reportwas
examined. There was a trend that schools with a greater percentage of FRL and more
students not meeting state standardized test standards were less likely to report
classroom exercise break practices.
Measures
Online survey
Principals were invited to complete a brief, five minute online survey on
classroom exercise break practices in their school. All school districts were contacted for
approval. Principals who did not respond after the initial email were sent a reminder
approximately two-weeks later.
Principal Interviews
Principals who reported that classroom exercise breaks take place in their
schools were invited by email to participate in a 10 minute, semi-structured phone
interview. Principals who did not respond after the initial email were sent a reminder
approximately one-week later.
13
Interview questions were constructed in advance according to Patton’s suggestions to
include questions that are singular, open-ended, clear and neutral and of various types
including opinion, role playing, and presupposition questions.20
Standards of Validation
To ensure the rigor of this qualitative study, trustworthiness as defined by
Lincoln and Guba, including transferability, dependability and confirmability, 21 was
established through the following methods. Transferability is provided through a “thick
description” of the schools included in the study, so that the results of this study may be
generalized to other populations. Dependability (reliability) and confirmability
(objectivity) were established through an audit trail.21 An audit trail was maintained
throughout the study and included all initial correspondence with school district
personnel and administrators, emails, interview notes, qualitative codes, and any
written documents from schools.
Analysis
Descriptive statistics are presented for the total group, the online survey
responders and the interviewees. Results from the email surveys, including the
prevalence of classroom breaks and classroom break policies are presented for all
responders and by stratum. Using SAS 9.2, logistic models were used to test if the
presence of classroom exercise breaks differed by school demographic strata. Detailed
notes from the interviews were summarized into broad themes. Recurrent themes were
then compiled across interviews.
14
Results
Survey Results
A total of 61 principals responded to the online survey for a response rate of 32
percent. Of those responding to the survey, 33 principals in participating districts and
reporting classroom exercise breaks in their school were contacted to participate in a
brief interview. Fourteen participated for a response rate of 42 percent. Principals
responding to the online survey were in schools with slightly lower percentages of
students receiving FRL, Poverty Indices, and students not meeting math and English
standards as seen in TABLE 2.1. Of the 61 principals who responded to the online
survey, 74 percent reported classroom exercise breaks in their school as seen in TABLE
2.3. Using a logistic model, the prevalence of classroom exercise breaks differed by
school demographic strata (p=.05) with the lowest prevalence in Strata 3 (high FRL, high
achieving) (54%) and the highest in Strata 1 (low FRL, high achieving) (90%). Forty-eight
percent of principals reported that more than half of the classrooms in their school
participate in classroom exercise breaks. Only 8 percent of principals reported a school
policy requiring classroom exercise breaks. There were no differences in the percentage
of classrooms that participate or the presence of a policy requiring classroom exercise
breaks by school demographic strata.
Interview results
The 14 principals interviewed for this study represented 8 school districts in
central South Carolina. They had lower percentages of students receiving FRL, poverty
15
index, and students not meeting state academic standards than all schools in the area. A
summary of the themes from the interviews follows.
School Priorities
When asked what their priorities for their students were, five principals reported
safety as their number one priority for students. Almost all principals reported academic
achievement or learning as a priority for students. The majority of principals reported
multiple priorities beyond solely academic achievement.
Description of Classroom Exercise Break Practices
Each school reported different classroom exercise break practices. Five of the
schools had exercise breaks as part of their regular morning news show. Most principals
emphasized that classroom breaks were up to the discretion of the teacher to, “keep it
fluid, how it fits into each classroom”. As one principal stated in reference to the
organization and practice of classroom breaks in her school, “It’s not a well-oiled
machine.” Even schools that participated in morning exercises as a whole school also
allowed teachers to decide how classroom exercise breaks were implemented during
the rest of the day. Some of the resources used were OrganWise Guys, Brain Breaks,
Brain Gym, CATCH, NFL Play 60, Fit with Fred, and other YouTube videos. While many
schools provided resources to teachers, the most commonly reported resource was
other teachers, with ideas spreading between classrooms. Of the schools with morning
news show exercise breaks, some used videos, others had teacher- or student-led
exercises. Most morning videos lasted 5 minutes, with a range from 3 to 7 minutes.
16
While all grades participated, multiple principals emphasized that movement is
incorporated directly into the curriculum for the younger grades.
Initiation of Classroom Exercise Breaks
Five principals, the ones who had incorporated exercise into the school-wide
morning news show, reported that classroom exercise breaks were implemented in
response to South Carolina’s Student Health and Fitness Act of 2005 as a way to “get in
extra minutes” of physical activity to meet the requirements. Other schools had either
district or individual teachers who initiated the practices. No principal reported
individually initiating classroom exercise breaks in their school. While nine principals
discussed participating in breaks and/or leading by example through engaging other
school physical activity oppotunities, few of the principals had formal or personal
physical activity experience. One principal described her participation in physical activity
as, “Don’t make me breathe too hard.” Two of the principals were former physical
education teachers, and admitted that their physical education background “absolutely”
affects how they lead. Yet, they are cautious to not “push” physical activity. Overall
there was little resistance to implementation, though some principals discussed a little
initial reluctance from students describing the exercises as “hokey”. Several principals
discussed that the reason for limited resistance was because teachers understood the
purpose of it and the practice was not enforced or mandated. “It’s not mandatory, so if
a teacher doesn’t like it, they don’t have to do it.” One principal discussed that if she did
mandate it, she expected that there would be increased resistance from her teachers.
17
Reaction to Classroom Exercise Breaks
The primary response to how the students react was, “The kids love it.” Only two
principals discussed instances where students did not enjoy classroom exercise breaks.
One principal described, “[You] may get a kid who doesn’t like to do it on a particular
day, but it’s usually because of another reason.” Another principal discussed how the
older students in her school were not participating in the exercise. The school staff
conducted a survey of the students, found that it was mostly a peer influence causing
them not to participate, and had the physical education teacher meet with the older
students to emphasize the health benefits and reasoning behind the practice.
Principals discussed few disadvantages of implementing classroom exercise
breaks. Only one principal mentioned any potential disadvantages; “if a teacher does
not have control of their classroom it could be a problem.” All principals discussed the
benefits not only for student physical health, but also improved behavior, attention,
focus, alertness, and “getting the energy out.” Many discussed positive effects on the as
well as increasing student happiness and engagement in school and four specifically
referred to benefits invovling the “brain.”
Discussion
This study provides a description of classroom exercise breaks in central South
Carolina. Overall, the majority of schools reported practicing some type of classroom
exercise break, but the specific practices varied between schools. This variation in
physical activity practices between schools is known, as school plays a large role in a
18
child’s physical activity levels.22-24 Less than half of the principals interviewed had
structured, school-wide morning exercise breaks, and all principals emphasized
individual teacher discretion in implementing classroom exercise breaks throughout the
day.
The emphasis on teacher discretion is pertinent to the discussion about
implementing policies to require classroom exercise breaks. While principals in this
study reported that the state policy, the Student Health and Fitness Act, spurred them
to increase the prevalence of these practices in their schools, very few schools reported
school-level policies requiring teachers to regularly implement the exercise breaks. One
principal even emphasized potential problems with adopting school-level policies, such
as increased resistance from teachers. Because of this resistance, school-level policies
may be inherently difficult to implement. A study of school board members found that a
policy to adopt classroom exercise breaks was the policy least likely to be adopted to
increase physical activity during the school day.25 While school policies may be an
effective technique to increase school-day physical activity,8, 13, 26 other alternative
approaches may also prove to be beneficial.
Training teachers on these benefits and building their skills may increase
implementation without the need for additional policies. The principals in this study
discussed that the reason their schools implemented classroom exercise breaks was
because teachers believed in the purpose and classroom exercise breaks support bestpractice teaching and school priorities. Giving teachers knowledge and skills to
implement classroom exercise breaks increases their autonomy to best implement
19
classroom exercise breaks in their individual classroom while minimizing resistance and
negative reactions to top-down policies. Teachers each have unique classrooms and
need the flexibility and discretion to best implement classroom exercise for their
students. Encouraging teacher autonomy is one of the goals of teacher professional
development to strengthen teachers’ engagement and empowerment in all subject
areas.27-29 Training and resource support to provide classroom exercise is currently not
regularly provided to schools. In a previous study of school physical activity policies, less
than half of administrators felt that they were adequately prepared to improve physical
activity practices.25 In the current study, multiple principals requested training for
teachers as well as resources, such as music and ideas, to help them implement
classroom exercise breaks. Interventions and education agencies should find ways to
provide adequate training and resources to schools to implement classroom exercise
breaks. Creating a community of practice around exercise breaks is a bottom-up
approach that would allow teachers to share knowledge and example activities thereby
spreading effective classroom exercise break practices.
Classroom exercise breaks were viewed very positively by the principals that
were interviewed. All of the principals discussed multiple benefits for students, primarily
that the students enjoy them. It is obvious that principals believe in the cognitive
benefits of exercise for students’ attention, behavior, learning, and engagement and are
aware of the research supporting a positive connection between physical activity and
academic achievement. These strong beliefs in the academic benefits of physical activity
exist despite the inconsistencies remaining in the research on the association between
20
physical activity and academic performance.30, 31 Thus, additional research to further
show the positive associations between exercise and academic achievement may not
convince administrators and teachers to implement school-day physical activity; they
are already convinced. Future research efforts should focus on the best types and doses
of exercise to efficiently maximize the benefits of exercise in school and how to train
teachers to implement these practices. These studies may have greater practical
implications for educators by uncovering ways to help schools to best implement these
practices.
Limitation of this study included a sampling bias and the potential for response
bias. Principals who responded to the survey and participated in interviews may not
have represented the entire sample of schools in central South Carolina. First, it is
possible that principals in schools who practice classroom exercise breaks were more
likely to respond to the survey. The prevalence of classroom exercise breaks in this
study is higher than the prevalence reported by the School Health Policies national
survey which reported less than half of elementary schools participating in classroom
exercise breaks.2 However, that study was conducted over five years ago and evidence
from South Carolina suggests that the prevalence of classroom exercise breaks has been
increasing.12 In South Carolina, sixty-six percent of elementary schools reported teacherled classroom exercise during the 2010-2011 school year, not including morning exercise
breaks,12 which is closer to the estimates found in the current study.
Secondly, only principals who reported classroom exercise breaks in their school
were interviewed for this study. Additional research is needed to understand the
21
barriers and contextual environment of schools who do not participate in classroom
exercise breaks. When examining the demographics of which schools responded to the
survey and the interview, schools who responded had, on average, lower percentages of
students receiving free-and-reduced lunch and higher standardized test performance
than the total sample. However, there was representation from almost all school
districts as well as a full range of school demographic profiles for both the survey and
the interviews. Ideally, a larger sample would be more representative, however, there
was difficulty in obtaining school district approval to conduct research in a large number
of school districts. This difficulty is not new in school-based research.32, 33 Already
overwhelmed school districts have many requests for research and it can be difficult to
prioritize and participate in studies. In order to best support education and children’s
learning, universities and school districts should create on-going and balanced
partnerships to enable research that benefits both entities.33 Hooper and Britnell
propose a model for university-school partnerships for mental health research,32 and
similar models are needed for all aspects of student health and learning.
Additionally, because the breaks were not objectively observed and the reports
were solely self-reported, the actual practices may differ from those reported by
principals. With this response bias, it is possible that due to social desirability, principals
over-reported classroom exercise breaks, and the actual number of teachers
implementing regular, quality classroom exercise breaks is less than reported. Objective
measures of physical activity are needed to determine if students are participating in
these classroom exercise breaks. Finally, the findings of this study can only be
22
generalized to similar schools in South Carolina and further studies are needed to see if
classroom exercise breaks practices are similar in other locations and a larger sample of
schools.
Many schools and principals are implementing innovative classroom exercise
break practices with the hope to improve the health and learning of South Carolina’s
children. Findings from this study can help to expand these effective practices across the
state and set an example nationally. Schools need the support and resources from
educational agencies, and the guidance from findings of additional research in order to
implement high quality classroom exercise breaks.
23
Table 2.1: School demographics for sampled school districts
Total
Sampled
11
Online Survey
Responders
9
Interview
Responders
6
# School Districts
16
15
8
# Schools
192
61
14
% FRL
59.7 (22.5)
53.7 (23.1)
43.0 (28.7)
Poverty Indexa
72.8 (22.2)
68.3 (22.9)
55.6 (29.9)
% Not meeting English Standardb
22.5 (9.6)
20.9 (9.9)
19.4 (13.6)
% Not Meeting Math Standardsb
26.98 (12.5)
23.7 (11.3)
20.8 (13.7)
# Counties
a
Poverty Index calculated by the SC Department of Education based on percentage of
free and reduced lunch and Medicaid eligibility
b
Data from the SC Department of Education 2010-2011Palmetto Assessment of State
Standards
Table 2.2: Number of schools available in each school demographic stratum (mean %
free-and-reduced lunch, % not meeting state academic standardsa)
# Schools
(districts represented)
<60% Free-and-reduced
Lunch
>60% Free-and-reduced
Lunch
Lower Achieving
46
(51.11, 17.45)
45
(79.38, 31.58)
Higher Achieving
48
(30.42, 11.56)
53
(76.82, 25.33)
a
Achievement based on percentage of students meeting 2010-2011Palmetto
Assessment of State Standards according to data from the SC Department of Education
24
Table 2.3: Percentage of schools reporting classroom exercise breaks, prevalence and policies
Response
Nb
Total
61
Strata 1
Low FRL,
High
Achievinga
Strata 2
Low FRL,
Low
Achieving
Strata 3
High FRL,
High
Achieving
Strata 4
High FRL,
Low
Achieving
19
17
13
11
53.8 (7)
63.6 (7)
.05
61.5 (8)
0 (0)
15.4 (2)
23.1 (3)
0 (0)
36.4 (4)
9.1 (1)
36.4 (4)
9.1 (1)
9.1(1)
.52
0 (0)
18.2 (2)
.48
p-valuec
Classroom Exercise Breaks conducted within school
yes
73.8 (45)
89.5 (17)
76.5 (13)
25
Percentage of classrooms that participate (n)
0-25%
39.3 (24)
26.3 (5)
41.2 (7)
25-50%
11.5 (7)
21.1 (4)
11.8 (2)
50-75%
24.6 (15)
26.3 (5)
17.7 (3)
75-100%
23.0 (14)
26.3 (5)
29.4 (5)
Not sure
1(1)
0 (0)
0 (0)
Have policy requiring Classroom Exercise Breaks
yes
8.2 (5)
5.3 (1)
11.8 (2)
FRL=% of students receiving Free-and-Reduced Lunch
a
Achievement was based on the SC Department of Education 2010-2011Palmetto Assessment of State Standards
b
One school opened in 2012-2013 and did not have previous school year data available to group it into a stratum but responses are
included in total
c
p-value from logistic regression
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about physical activity minutes in physical education or during school. J Sch Health.
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18. Fowler FC. Policy Studies for Education Leaders. 3rd ed. Boston, MA: Pearson
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19. Creswell JW. Qualitative inquiry and research design: Choosing among five
approaches (2nd ed.). Thousand Oaks, CA US: Sage Publications, Inc; 2007.
20. Patton MQ. Qualitative Research & Evaluation Methods. 3rd ed. Thousand Oaks,
CA: Sage; 2002.
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22. Kristensen PL, Olesen LG, Ried-Larsen M et al. Between-school variation in physical
activity, aerobic fitness, and organized sports participation: A multi-level analysis.
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23. Davison KK, Lawson CT. Do attributes in the physical environment influence
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28
CHAPTER 3
MANUSCRIPT 2: ACUTE EFFECTS OF CLASSROOM EXERCISE BREAKS ON EXECUTIVE
FUNCTIONS AND MATH PERFORMANCE IN ELEMENTARY SCHOOL STUDENTS: A DOSERESPONSE2
2
Amercan Journal of Preventive Medicine.
29
Abstract
Background Physical activity may be associated with improved cognitive and academic
performance in children. The optimal dose of physical activity to produce these benefits
is unknown. Classroom exercise breaks are a feasible, time efficient way to increase
physical activity of children in schools.
Purpose The purpose of this study was to determine the acute effects of classroom
exercise breaks on executive function and math performance in 9 to 12 year-old
children and to examine the dose-response relationship between 5, 10, or 20 minutes
of classroom exercise breaks compared to 10 minutes of sedentary classroom activity.
Design Within-subjects experimental study conducted over four weeks in the Spring of
2012.
Setting/participants Ninety-six 4th and 5th grade students in an elementary school in
South Carolina.
Intervention Classroom groups were randomized to receive each of four treatments: 5,
10, or 20 minutes of a classroom exercise breaks or 10 minutes of a seated classroom
lesson. The intervention included moderate-to-vigorous physical activities led by
research staff.
Main Outcome Measures The dependent variables were executive function (Trail
Making Test and Operational Digit Recall test) and math performance (One-Minute
Math Worksheet). Students completed these tests immediately before and after each
30
condition. Post-test scores for each variable were compared between conditions using a
repeated measures mixed ANCOVA model, adjusted for gender, classroom group, and
the time-varying pre-test scores. Linear contrasts tested the differences between doses.
Potential effect modifiers including fitness, Body Mass Index (BMI), and IQ were
included as interaction terms.
Results Math scores were higher after 10 minutes of classroom exercise breaks
compared to the sedentary condition (d=0.28, p=0.03). Differences in effects were seen
in groups when stratified by sex, IQ, fitness, BMI, behavior, and school engagement.
There were no significant main effects.
Conclusions A 10-minute classroom exercise break modestly improved math scores in
elementary school students compared to a seated classroom lesson, with no overall
negative effects with any duration.
Introduction
Children are not meeting physical activity recommendations.1, 2 Yet, instead of
increasing opportunities for physical activity, many schools have reduced physical
education and other physical activity opportunities in response to budget reductions
and increased attention on standardized testing.3, 4 Paradoxically, reducing physical
activity, may decrease the academic achievement that schools are trying to improve.
Recent reviews5-8 and cross-sectional studies have shown that physical activity,9-13
physical education,14 and fitness levels15-18 may be positively associated with the broad
outcome of academic achievement, often operationalized as performance on
31
standardized tests. Several experimental studies have explored a possible causal
relationship between acute exercise and cognition in children19-22 with overall positive
support for a causal role between exercise and cognition.23
Of the cognitive abilities shown to improve with exercise, the strongest effects
have been seen in executive function.24, 25 Executive functions are “general purpose
control mechanisms that modulate the operation of various cognitive subprocesses,” or
higher order complex cognitive processes. 26 These functions include working memory,
inhibition and cognitive flexibility as unique, but related, components.26, 27 Executive
function is highly predictive of academic achievement28 and can be improved through
interventions.29 However, many questions remain unanswered regarding the
relationships between physical activity, executive function and academic achievement,
including the appropriate dose of physical activity required to produce optimal
outcomes.5
Time is a critical resource in schools and one of the most common barriers to
implementing physical activity; therefore it is crucial to maximize efficiency in
implementing physical activity throughout the day. Classroom exercise breaks are short
bouts of physical activity that are conducted within the classroom as opposed to
physical education and recess which are extended periods of physical activity. Schools
have begun to implement classroom exercise breaks into their curriculum and practices,
even as research continues to explore the optimal delivery, frequency, timing and
duration of exercise breaks. Preliminary findings suggest that classroom exercise breaks
are acceptable to teachers and may improve physical activity and cognitive outcomes. 30-
32
33
Yet, only three studies have examined the acute cognitive effects of short exercise
bouts (of approximately 10 minutes) in children, with varying effects.34-36 No previous
studies have evaluated the differences in the acute cognitive effects of classroom
exercise breaks of various durations in children.
Therefore, the purpose of this study was to determine the acute effects of
classroom exercise breaks on executive function and math performance in 9 to 12 yearold children. Additionally, the study examined the dose-response relationship between
5, 10, or 20 minutes of classroom exercise breaks and these cognitive functions. The
exercise durations were based on prior research reporting improvements in executive
functions and academic performance following 10 and 20 minutes of physical activity.19,
34
Schools and teachers, however, tend to use shorter durations of 5 minutes as longer
interventions may not be as practically implemented into school policy and practice.37
Currently, it is unknown if these shorter breaks have acute cognitive benefits. Finally,
the study examined whether the relationship between duration of acute classroom
exercise breaks and cognitive functions was moderated by gender, intelligence (IQ),
fitness, body mass index (BMI), behavior, school engagement, and/or physical activity
participation during the intervention.
Methods
Study Design
This study used a within-subjects experimental design. There were four
treatment conditions: 10 minutes of sedentary classroom activity, and 5, 10 and 20
33
minute classroom exercise breaks. Students participated in each of the four conditions.
The within-subject design was used to account for between-subject variation and
increase efficiency with only a small probability of carryover between acute exercise
treatments between weeks. The intervention was administered to 5 classroom groups
of 47 4th graders and 49 5th graders at approximately the same day and time each week
for each classroom. To reduce sequencing and account for practice effects, a balanced
Latin Square design was used to randomize the four treatments at the classroom
level.38, 39 The unit of analysis was the student. The primary dependent variables of
executive function29 and math performance were assessed before and after each
experimental condition. This pretest-posttest design was chosen to account for daily
variation in cognitive abilities within each child and to focus on the change in cognitive
performance with exercise. All participants provided parental consent and student
assent. This study was approved by the IRB at the University of South Carolina and the
research board of the school district.
Participants and Setting
Participants were from four 4th grade and four 5th grade classrooms at an
elementary school in South Carolina. All data was collected during the Spring of 2012.
Participants ranged from 9 to 12 years-old. The overall school population was 18% black,
8% Hispanic, and 70% white; 30% of students received free-and-reduced lunch.
Intervention
The Brain BITES (Better Ideas Through Exercise) classroom exercise break
intervention was designed to maintain moderate-to-vigorous aerobic activity for the
34
duration of the exercise break. Research staff led students in activities that could be
performed in minimal space; physical activities included stationary marching with arm
movements, and various forms of jumping and running in place. Each exercise condition
began with 30 seconds of low-intensity warm-up and ended with a brief deep breathing
and stretching cool-down. Activities performed were similar throughout the
intervention with only the duration of activities varying. During the sedentary condition,
students completed research questionnaires and the research staff delivered a brief
lesson about the importance of physical activity.
The instructor had a brief planning session with the students before the
intervention to select activities and music to increase buy-in and enjoyment. To
encourage participation and high-intensity activity, students were instructed on how to
take heart rates using their carotid or radial pulse. Students were instructed that heart
healthy exercise gets their heart rates to 150 beats per minute. Heart rates were selfassessed and recorded by the students after each condition. The instructor physically
participated, gave verbal cues, and offered positive descriptive encouragement, which
has been shown to increase child activity.31 The exercise sessions were videotaped and
observed for intervention fidelity.
Measures
Information was collected on potential confounding variables and factors that
have been shown to influence the relationship between exercise and cognition. These
included SES, gender, age, student engagement,40, 41 attention-deficit/hyperactivity and
problem behavior symptoms,42, 43 IQ,44 BMI,45-47 daily physical activity,10, 12, 13, 42 and
35
fitness.15-19, 48 Students completed a brief questionnaire to obtain age, physical activity
levels, sports participation, grades on their last report card, and attitudes/motivation for
academics (e.g., I enjoy school/learning).49 Parents completed a brief questionnaire to
obtain socioeconomic status (household income, parent education) and the Conners’
Parent Rating Scales Revised short version, a 27 item checklist to assess attentiondeficit/hyperactivity and problem behavior symptoms.
Prior to beginning the intervention, participants completed height and weight
measurements and a baseline aerobic fitness assessment of the PACER test from the
FITNESSGRAM testing battery administered by research staff during physical education
class. The Kaufmann Brief Intelligence Test- Second Version (KBIT-2) measure of
abbreviated IQ was administered to each child individually and composite IQ scores
were used.
Physical Activity Intensity
Videotapes of all four conditions were coded for intensity of physical activity
using a modified System for Observing Fitness Instruction Time (SOFIT) as modified by
Donnelly. Observations of participating individual children were made at consecutive
10-second intervals during the exercise or sedentary condition, not including cognitive
testing. Each child’s average activity level during the 10-second interval was coded using
a scale from 1 to 5 where 1 is equal to lying down and 5 is equal to being very active
(e.g.. running in place, jumping). Videos were viewed and coded three times for a total
of 4,212 observations. To assess reliability, ten percent of the intervals were recoded
36
four months after the initial coding (n=424). Intervals were randomly selected in groups
of 10. The percent agreement was 91.0% with a weighted kappa of 0.95.
Each video was watched three times. The video was scanned from left to right
during the first viewing, right to left duing the second, and from the center for the third
viewing. If a participant could not be viewed (obstructed by another participant or out
of the frame of view), the next participant was observed. Different participants were
observed during each interval in each of the three viewings. Each participant was
observed for an average of 16.8 intervals during the sedentary condition, 7.5 intervals
during the 5-minute exercise break, 12.5 intervals during the 10-minute break, and 25.5
intervals during the 20-minute break. Mean physical activity intensity scores were
calculated for each participant for each condition.
Cognitive Measures
The testing battery was assessed in pilot work to establish feasibility and
acceptability. Outcome variables are operationally defined in TABLE 3.1.
Trail Making Test
The Trail Making Test (TMT) was selected as a theoretically and
neuropsychological valid, feasible and appropriate measure of executive functions in
children. TMT performance has been shown to be affected by exercise in adults.50, 51
The TMT has two parts, A and B. Part A consists of connecting numbers, while Part B
involves alternating between numbers and letters. The TMT Part B has been validated as
a measure of planning52 and set switching also known as cognitive flexibility.53 The TMT
has reliability of 0.64 in children aged 3-654 and 0.56 over 6 months in children 4-12
37
years of age.55 Two alternative forms, mirror images, were used for each testing to
decrease practice effects. The test was modified to be self-timed for group
administration, and a subsample of participants was observed for accuracy of selftiming. As suggested by Sanchez-Cubillo, TMT-A primarily measures visuoperceptual
ability, TMTB measures working memory, and the difference between TMTB and TMTA
(TMTBA) represents executive control. Therefore, TMTBA was used as a measure of
executive function in the current study .53 The correlation of TMTB with TMTBA was
0.94. The TMTBA pre-tests had a one-way intraclass correlation of 0.65.
Digit Recall
Operational digit recall is a validated measure of working memory, as part of the
Working Memory Test Battery for Children.28 To modify the task for increased validity,
students were read a list of numbers, and then given 5 seconds to write them in
chronological order from the lowest to highest. The digit recall score was the number of
sequences the student answered correctly, adjusted for the length of the sequence. The
digit recall pre-tests had an intraclass correlation of 0.63.
Timed Math Test
To assess ecological validity and direct application to academics, a timed math
test was given, similar to a previous study.56 Students completed as many gradeappropriate math problems as possible within 1 minute. The math score was the
number of problems correctly answered. The pre-test math scores had an intraclass
correlation of 0.95.
38
Analysis
Descriptive statistics were calculated for the total group and for each gender
using SAS 9.2. As the cognitive tests may be prone to practice effects, the Time x
Condition interaction was examined in an initial ANOVA to test for order effects. This
interaction was only significant for the digit recall scores. However, when the raw scores
were examined, it was noted that the scores did not improve over time, as expected
from a practice effect. This lack of practice effects, coupled with the randomization to
the order of conditions to counterbalance significant practice effects, allowed the
primary analyses to include all classroom groups together, adjusting for group.
To test for an overall difference between all exercise conditions versus the
sedentary condition, a repeated measures ANCOVA mixed model (PROC MIXED) tested
the difference in post-test scores between conditions, controlling for pre-test scores.
This method of analysis was chosen to account for the within subject correlation in
repeated measures, the ability to use all available data, and the ability to adjust for a
time-varying covariate. Models were adjusted for gender, classroom group, as well as
the time-varying covariate of pre-test scores. Separate analyses were conducted for the
independent variables of TMT, digit recall, and math scores.
To examine the dose-response relationship, linear contrasts tested the
differences between doses of 5, 10, 20 minutes of exercise and 10 minutes of sedentary
activity. Cohen’s d effect sizes were estimated.
Finally, to test whether the effects differed by baseline student characteristics or
by participation in the intervention, interaction terms were added to the model.
39
Potential effect modifiers of abbreviated IQ, fitness levels, BMI, behavior problems from
the Conners’ Parent Rating Scales, and school engagement were split based on median
scores. Interaction terms between the condition and the dichotomous effect modifier
were added to the model in separate analyses. Significance for interactions was set at
p<0.10. To test if the effects on cognitive outcomes were influenced by student exercise
intensity, an interaction between condition and mean physical activity intensity was
added to the model.
Results
A total of 96 students participated in the study. Demographics and baseline
descriptive variables can be seen in TABLE 3.2. The average physical activity intensity
during the exercise conditions ranged from 4.00 to 4.35 as seen in TABLE 3.3. There
were no differences in intensity between exercise conditions.
Main Effect of exercise on cognitive outcomes
There were no significant main effects of the conditions on the dependent
variables of post-test TMT (F=0.92, df=243, p=.43) or math scores (F=2.04, df=249,
p=0.11). There was a significant difference between conditions for digit recall scores
(F=3.35, df=249, p=0.02).
Differences Between Doses
The change in math scores was significantly higher after 10 minutes of exercise
compared to the sedentary condition as seen in FIGURE 3.1. The estimated effect size
was d=0.28. Collapsing the data across all exercise conditions, math scores were
significantly greater than after the sedentary condition (p=0.05). There were no other
40
significant differences between any durations of exercise and the sedentary condition in
digit recall scores or performance on the TMT as seen in FIGURE 3.1.
Effect modification
The third objective examined whether the results differed by gender, IQ, fitness,
BMI, behavior, classroom engagement, and physical activity intensity during the
intervention. Ninety-two students completed the KBIT-2, 89 students completed the
FITNESSGRAM PACER test, 90 students were measured for Body Mass Index, and 73
students had parents complete the Conners’ Behavior Rating Scale at baseline. The
median splits for the variables were 103 for composite IQ, 15 20-meter laps for the
FITNESSGRAM PACER (the healthy fitness zone is ≥23 laps for boys and ≥7 laps for girls),
a BMI of 19 (approximately 85th percentile for 10 year old boys, a Conner’s behavior
score of 13 and a school engagement score of 21.
Students who had higher fitness had higher math scores across all exercise
conditions, including when adjusted for gender, race, parent education and parent
income (p<.001). The Spearman correlations between continuous effect modifiers can
be seen in TABLE 3.4. To test whether several student characteristics influenced their
responses to the exercise, interaction terms between the exercise dose with gender, IQ,
fitness, BMI, behavior, school engagement, and physical activity intensity during the
intervention were tested. The only overall significant interactions were between IQ and
condition for math scores (p=.05, students with lower IQ had larger improvements in
math scores after 10 minutes of exercise), and BMI and condition for digit recall (p=.01,
students with lower BMI improved after 10 minutes). There were no associations
41
between an individual child’s intensity of physical activity and the cognitive outcomes
(p=.73 for math scores, p=.41 for digit recall scores, p=.82 for TMT).
The results for the comparisons between the exercise doses and the sedentary
condition for math scores can be seen in FIGURE 3.2. After 5 minutes of exercise,
students with lower IQ (p=.04, d=-.29), lower fitness (p=.06, d=-.27) and higher BMI
(p<.01, d=-.42) had lower digit recall scores compared to sedentary. After 20 minutes of
classroom exercise breaks, students with higher IQ (p=.08, d=.25) and lower BMI (p<.01,
d=.47) had higher digit recall scores compared to sedentary. The only significant
differences in TMT scores were for students with low engagement who decreased their
performance after 5 and 10 minutes of exercise compared to sedentary (40.60 and
38.54 seconds vs 28.92 respectively).
Discussion
This is the first study to directly compare the acute effects of varying doses of
classroom exercise breaks on acute cognitive outcomes. The current study found that a
10 minute classroom exercise break modestly improved math scores in elementary
school students compared to a sedentary classroom lesson, and there were no effects
after 5 or 20 minutes of exercise though there was a trend towards significance after 20
minutes. These findings are largely consistent with previous research that found
improvements in diverse measures of cognitive functions following 10 to 50 minutes of
various types of physical activity.21, 57-60 Researchers have yet to see significant
improvements in cognition with doses less than 10 minutes, although few studies have
42
examined these shorter durations.35, 56 In one of the few studies to directly compare
multiple doses, Kubesch et al. found improvements in cognitive performance after 20
minutes of a physical education class but no improvements after 5 minutes of a
classroom exercise break.35
In the current study, overall effects were seen in math scores and not in working
memory or the TMT. This may have been due to the much lower reliability and higher
variation in the operational recall and TMT scores compared to the math test. The
reliability of TMT scores in this study was consistent with previous studies. 54, 55
Executive function is a difficult construct to measure due to the low reliability and task
impurity.26, 61 Nonetheless, executive function may be most responsive to exercise,
making it an important outcome to include.24, 62 To counter the modest reliability of
executive function measures, this study used a within subject design and included pretests measures for each condition, including them as a covariate in the model.
Additionally, very recent work suggests that select cognitive functions may be more
sensitive to acute physical activity such as attention and inhibition than working
memory.63
Many hypotheses exist for the mechanisms underlying improvements in
cognitive performance after acute exercise, including increased neuroelectric activity as
measured through electroencephalogram,64 catecholamines,65 and brain oxygenation
and cerebral blood flow during exercise.66 Classroom exercise breaks may also positively
influence psycho-social pathways such as improving self-esteem.67 These mechanisms
may respond differently to different doses, intensities, and types of physical activity, but
43
a clear dose-response pattern has not yet emerged.50, 68 Several researchers have
proposed an inverted-U hypothesis, where the maximum cognitive benefits are received
with a moderate amount of physical activity and with potential declines in performance
with too little or too much exercise.69-72 The results of this study suggest that 5 minutes
of classroom exercise may not be enough to elicit cognitive benefits and longer
durations of 10 or 20 minutes are needed as there was a trend for 20 minutes to
produce positive cognitive benefits. Further research is needed to support or refute the
inverted-U hypothesis.
The findings from this study suggest that different students may react differently
to classroom exercise breaks. Previous studies have shown factors such as student
engagement,40, 41 attention-deficit/hyperactivity and problem behavior symptoms,42, 43
IQ,44 BMI,45-47 regular physical activity,10, 12, 13, 42 and fitness15-19, 48 to influence the
relationship between exercise and cognition. In this study, students with lower IQ,
higher fitness, higher BMI, better behavior or lower school engagement had more
improvement in math scores with the classroom exercise breaks. Prescribing classroom
exercise breaks for individual students, however, may be impractical in the school
setting. Nonetheless, classroom tracking, or the common practice of grouping of
students with similar academic abilities,73 allows for tailored recommendations to
specific classrooms. For example, a classroom of students with lower academic ability
may benefit from 10 minutes of classroom exercise breaks, while a classroom of
students with behavioral problems may seek alternative physical activity opportunities
such as recess.
44
This study was a “real-world” efficacy study, implemented by research staff. This
approach ensured high implementation fidelity, with high participation in moderate-tovigorous physical activity throughout the intervention, but is not easily sustainable.
Nevertheless, the intervention was designed to be easily implemented by classroom
teachers using few resources and some schools have already implemented similar
practices.37 Additionally, the classroom exercise break was delivered as a complete
package of specific exercises, music, encouragement and cool down strategies. The
results can only be generalized to similar classroom breaks and not all types of physical
activity, as effects may differ by type or intensity of exercise74 such as outdoor recess or
lighter intensity activity. These analyses were not adjusted for the multiple comparisons
included in the effect modification analyses. These are preliminary analyses and further
studies are needed to confirm the findings.
While this study did not find cognitive improvements after 5 minutes of
classroom exercise breaks, 10 minutes were sufficient to elicit small improvements in
math scores. Also noteworthy, there were no overall negative effects following any
duration. Unfortunately, with rigid school schedules and curriculums, most exercise
breaks currently being implemented in schools last less than 10 minutes.75-77 Additional
training and resources may help teachers and administrators conduct 10 minute
classroom exercise breaks. If conducting classroom exercise breaks for 10 minutes is not
feasible, schools can implement other physical activity opportunities of similar durations
to receive acute cognitive benefits.
45
Table 3.1: Operational definitions of primary dependent variables
Measure
Operational Definition
Cognitive Flexibility
Trail Making Test
Difference between Part A and Part B
(seconds)
Working Memory
Digit Recall
Number of correct numbers recalled;
number of lists recalled in correct
order
Academic Achievement
Timed Math Test
Number of math problems correct
Table 3.2: Baseline descriptive variables (% or mean ± SD)
N
Age
% Black
% White
% Income <40,000
a
Verbal IQ
a
Matrices
a
IQ
% A student
BMI
th
% BMI ≥ 95 percentile
b
Fitness
c
Physical Activity
d
Behavior
e
School Engagement
Total
Female
Male
96
10.7 ± .6
19.8
68.8
33.8
62
10.7 ± 0.6
19.1
66.7
30.4
34
10.7 ± 0.6
21.2
72.7
40.9
98.4 ± 13.4
102.4 ± 12.0
102.0 ± 15.2
14.3
97.9 ± 14.2
102.4 ± 17.2
102.4 ± 17.2
12.1
99.2 ± 12.1
102.8 ± 11.7
101.5 ± 11.4
19.2
.64
.82
.78
.45
19.9 ± 4.5
21.3
20.7 ± 4.9
25.4
18.4 ± 3.5
8.82
.02
.14
22.1 ± 12.9
5.3 ± 2.0
19.5 ± 10.5
5.3 ± 1.9
26.6 ± 15.4
5.3 ± 2.3
.01
.92
16.2 ± 14.2
20.8 ± 5.7
14.2 ± 12.7
21.2 ± 5.4
20.5 ± 16.5
19.9 ± 6.1
.08
.36
a
Standardized scores from Kaufmann Brief Intelligence Test-Second Version
# 15m laps completed during PACER test
c
>60 minutes per day* (days per week)
d
score >23 may suggest behavioral problems
e
range from 6 to 30, higher scores indicate higher engagement with school
b
IQ, Intelligence Quotient
46
P-value
.68
.85
.19
Table 3.3: Average Intensity of Intervention for each condition ± SD (Coded from 1-5;
MVPA ≥ 4)
Sedentary
5 minutes
10 minutes
20 minutes
# Intervals
Observed
1125
465
862
1760
Student
Intensity
2.01 ± 0.05
4 ± 0.43
4.35 ± 0.33
4.26 ± 0.37
Instructor
Intensity
2
4.58
4.53
4.52
% Compliance
1.01
0.87
0.96
0.94
Table 3.4: Spearman correlations between continuous student variables
IQ
Fitness
BMI
Behavior
Engagement
*p<.05
Fitness
.02
.08
-.05
-.02
BMI
-.51*
.02
.08
Behavior
.02
-.06
47
-.17
TMT
Sedentary
5 min
10 min
20 min
Mean
37.70
38.14
40.84
35.87
SE
2.79
2.55
2.47
2.49
p-value
ref
0.89
0.34
0.57
ES (d)
ref
-.02
0.14
-0.08
48
Digit Recall
Sedentary
5 min
10 min
Mean
17.89
16.77
18.12
20 min
18.63
SE
0.53
0.48
0.47
0.48
p-value
ref
0.08
0.72
0.26
ES (d)
ref
-0.25
0.05
0.16
Math
Sedentary
5 min
10 min
20 min
Mean
24.36
24.81
25.56
25.39
SE
0.51
0.47
0.46
0.47
p-value
ref
0.41
0.03
0.06
ES (d)
ref
0.10
0.28
0.23
*difference from sedentary condition at p<.05, error bars are SE
TMT, Trail Making Test, lower scores are better
Figure 3.1: Performance on cognitive tasks after 10 minutes of seated classroom activity or 5, 10, 20 minutes of classroom
exercise breaks
*difference from sedentary condition at p<.10
†difference between groups at p<.05
IQ, intelligence quotient
Figure 3.2: Math scores after sedentary classroom activity or 5, 10, 20 minutes of
classroom exercise breaks, stratified by baseline characteristics
49
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56
CHAPTER 4
MANUSCRIPT 3: ACUTE CLASSROOM EXERCISE BREAKS IMPROVE ON-TASK BEHAVIOR IN
4TH AND 5TH GRADE STUDENTS: A DOSE-RESPONSE3
3
Journal of School Health.
57
Abstract
Background: This study was the first to directly compare the acute effects of 5, 10, and
20 minutes of classroom exercise breaks on on-task behavior and to examine the
variations by individuals and classrooms. Methods: In this within-subject experiment, 96
4th and 5th grade students, in 5 classroom groups, participated in each of four
conditions: 10 minutes of sedentary classroom activity and 5, 10, 20 minutes of
classroom exercise breaks led by research staff. Time-on-task was directly observed
from videotapes before and after each condition. The post-test time-on-task scores
were compared using a repeated measures mixed ANCOVA, adjusted for age, classroom,
and the time-varying pre-test time-on-task. Comparisons between each exercise
condition and sedentary were made using linear contrasts. Interactions were examined
by several individual student factors including gender, intelligence quotient (IQ), fitness,
Body Mass Index (BMI), behavior, school engagement and baseline on-task behavior.
Results: Time-on-task was significantly higher after 10 minutes of classroom exercise
breaks compared to sedentary (87.6% vs 77.1%, d=0.45, p=.004). Females, students with
lower IQ, lower BMI and higher fitness saw greater effects than males, students with
higher IQ and lower fitness. Conclusion: Ten minutes of classroom exercise breaks
improved time-on-task behavior in children.
Many factors influence students’ performance in school and on standardized
academic tests.1-4 One large influence on academic achievement is student on-task
behavior and attention.5-8 Thus to improve academic achievement, many teachers and
58
interventions have aimed to increase on-task behavior or time-on-task.9-11 Emerging
evidence suggests that one way to increase on-task behavior is through increasing
physical activity opportunities during the school day.12-15 Physical activity in children has
been shown to improve neuroeletrical activity,16 attention and inhibitory control17
which help students to rule out distractions and focus on the task. When researchers
have objectively observed on-task behavior in relation to recess, they found that
students are more on-task after recess.14, 18 Attention and the ability to inhibit
distracters, which both contribute to on-task behavior, have both been shown to
improve after an acute bout of physical activity in children.17, 19 Additionally, an
observational study found that schools where students have greater amounts of recess,
teachers report better classroom behavior.20
Unfortunately, adding physical activity to the school day can be difficult due to
the competing priorities, budget concerns and lack of time reported by teachers and
administrators.21-23 Classroom exercise breaks, short bouts of physical activity integrated
within the school day, provide a low-budget and feasible way to increase physical
activity in students. Components of Take 10!, an example classroom exercise break
curricula, have been integrated into numerous interventions, and have had a generally
positive effect on educational and health outcomes.24
Few studies, however, have examined the acute effects of these short exercise
bouts on on-task behavior in children. Mahar et al. observed on-task behavior before
and after a classroom exercise break and found that on-task behavior increased by 8
percent after the exercise.12 Another study found that exercise breaks can help students
59
maintain on-task behavior.13 Little is known on the optimal dose of these classroom
exercise breaks. Kubesch et al. found positive cognitive effects after 20 minutes of
physical education but not after 5 minutes of a classroom exercise break.25 To our
knowledge, no study has directly compared different durations of classroom exercise
breaks on on-task behavior or attention.
Also unknown are the differential effects of classroom exercise breaks between
classrooms and individual students. In the two studies to observe on-task behavior after
classroom exercise breaks, both found that the effects were different based on student
characteristics.12, 13 In those studies, the beneficial effects of classroom exercise were
the most beneficial in those with attention difficulties12 and with higher body mass
index.13 Other individual differences in responses have not been examined. These
variations in response can be lost when results are examined in unstratified groups.
The purposes of this study were to determine the acute effects of classroom
exercise breaks on on-task behavior in elementary school students and to examine the
differences in responses between 5, 10 and 20 minutes of exercise. Additionally, the
effects were examined by individual classrooms and several individual student factors
including gender, intelligence quotient (IQ), fitness, BMI, behavior, school engagement
and baseline on-task behavior.
Methods
Participants
A convenience sample of a school and classrooms was selected through
agreement of the principal and teachers. Participants ranged from 9 to 12 years of age
60
and were 4th or 5th grade students in one elementary school in central South Carolina.
All students from eight participating classrooms were invited to participate. Classrooms
in the school were grouped on the basis of academic abilities and interests. To
efficiently administer the intervention to consenting students, some classes were
combined and the intervention was delivered to five classroom groups.
Procedures
This study used a within-subjects experimental design with students exposed to
each of four conditions: 10 minutes of sedentary classroom activity and 5, 10, 20
minutes of classroom exercise breaks. The order of conditions was randomized to each
classroom group, using a Latin Square design,26, 27 to counterbalance practice effects.
Time-on-task was measured before and after each condition while the students
performed pencil-and-paper tasks. This pre-post design was used to account for daily
variation in time-on-task. To familiarize students with the classroom exercise breaks,
thus reducing novelty effects, students participated in two days of classroom exercise
breaks per week. Time-on-task was only observed on one day a week. All observations
were held on the same time and day of the week for each classroom group. Parent
consent and student assent were obtained for all participants.
61
Treatments
The Brain BITES (Better Ideas Through Exercise) exercise break intervention was
led by research staff. The exercise breaks were designed to maintain moderate-tovigorous physical activity and to be fun and engaging for the students. Specific exercises
were selected to be feasible within a small classroom setting and included marching in
place with arm movements, various forms of jumping, and running in place. Exercise
sessions were performed to music selected by the students in a brief planning session
prior to the intervention and the instructor verbally encouraged as well as physical
participated in all sessions. To further encourage participation, the instructor
encouraged students to get their heart rates to 150 beats per minute. Students
recorded their own self-palpated carotid or radial pulse rates immediately after each
session.
Activities were similar across the four exercise conditions; only the duration of
activities varied. All intervention conditions were videotaped and coded for physical
activity intensity. The three exercise durations were 5, 10, and 20 minutes of classroom
exercise breaks. These durations were selected because research has found acute
effects in similar outcomes with 10 and 20 minutes of physical activity.12, 28 Limited
evidence has shown that briefer periods of physical activity may not be sufficient to
elicit acute improvements in cognitive functions,25 however, for feasibility and
sustainability, briefer sessions are more likely to be implemented and integrated within
busy classroom schedules.
62
Instruments
Baseline measures were administered prior to the intervention. Standardized
height and weight were used to calculate Body Mass Index (BMI). Participating students
completed the 15m PACER test from the FITNESSGRAM battery as an estimate of
aerobic fitness. Students were individually administered the Kaufmann Brief Intelligence
Test-Second Version (KBIT-2) as a measure of abbreviated IQ. Additionally, students
completed a brief survey on their previous academic grades, physical activity levels,29
and engagement in school.30 Parents completed a brief survey on parent education, race
and socioeconomic status. They also completed the Conners’ Parent Rating Scales
Revised short edition, a 27 item checklist to assess attention-deficit/hyperactivity and
problem behavior symptoms.
Physical Activity Intensity
To asses the fidelity of the intervention, videotapes of all four conditions were
coded for intensity of physical activity using a modified System for Observing Fitness
Instruction Time (SOFIT) as modified by Donnelly.31 Observations were made of
individual children at consecutive 10-second intervals during the exercise or sedentary
condition, not including cognitive testing. Their average activity level during the 10second interval was coded using a scale from 1 to 5 where 1 is equal to lying down and 5
is equal to being very active (ex. running in place, jumping). Videos were viewed and
coded three times with a different child observed for the same intervals during each
viewing. Each participant was observed an average of 16.8 times during the sedentary
condition, 7.5 times during the 5-minute exercise break, 12.5 times during the 10-
63
minute break, and 25.5 times during the 20-minute break. To assess reliability, ten
percent of the intervals were recoded four months after the initial coding (n=424).
Intervals were randomly selected in groups of 10. The percent agreement was 91.0%
with a weighted kappa of 0.95.
Time-on-task
To obtain an ecologically valid measure of time-on-task, children were directly
observed as consistent with previous studies.12, 14 A systematic time sampling
observation system was used. Multiple observation intervals of time-on-task have been
used ranging from 10 seconds12 to 30 seconds14 to 1 minute.15, 32 As used by Riley et al,9
a 15 second observation interval was selected for this study. To be able to assess timeon-task in all participants within the short testing frame, video cameras, placed in the
front of the classroom were used for direct observation. Consented students were
observed for time-on-task during the testing procedure. Time-on-task was determined
by the direction of the student’s gaze, either at the instructor or on the testing
materials.14
Students were observed while completing paper-and-pencil tests before and
after each condition. The videos were edited so only the testing procedures, and not the
treatment condition, were included and the videos were assigned random identification
codes. Both observers were unaware of the time and condition of testing, remaining
blinded to the condition. Each video segment was viewed three times. A student was
viewed for 15 seconds and the number of off-task interruptions was tallied. Off-task
behavior included direction of gaze away from the instructor or testing materials,
64
speaking out of turn, and excessive fidgeting. The observer cycled through all visible
students in three viewings of the complete condition from left to right, right to left, and
beginning in the center of the classroom. Different students were observed at each 15second interval between the 3 viewings. If a student was not visible for at least 5
seconds during the 15-second interval (due to obstructed camera view from another
student or the student was in a position where the observer could not see his or face),
the observer proceeded to the next student.
Videos were watched by two observers (an observer blinded to the study aims,
and the primary investigator). Both observers viewed the same students at the same
time intervals. During the first round of coding, interobserver agreement was 81 percent
with a kappa statistic of 0.41. While the agreement was moderate,33 each interval that
differed between coders were examined a third time by the primary investigator to
reach agreement. For the analysis, if a student was off-task at all during the 15-second
interval, that interval was considered to be off-task (regardless of the total count of offtask interruptions). The percentage of intervals coded as on-task for each student during
each condition was used as the dependent variable.
Data Analysis
Descriptive statistics were calculated for the total group and each classroom
group individually using SAS 9.2. Between-group comparisons were made using ANCOVA
or chi-square tests. The intraclass correlation for pre-test time-on-task scores was 0.525.
Due to this variation, pre-test time-on-task scores for each condition were included in
the model testing the overall effect.
65
A repeated measures mixed ANCOVA model tested the difference in post-test
time-on-task between conditions, adjusted for classroom group and age and with pretest time-on-task scores included as a time-varying covariate (PROC MIXED). Mixed
models using maximum likelihood estimation were used to account for the time-varying
covariate of pre-test time-on-task, to utilize all available data, and account for the
within-subject correlation with repeated measures. To examine to differences between
durations of classroom exercise breaks, linear contrasts compared post-test time-ontask for each exercise condition to the sedentary condition.
To examine the differences between classroom groups and individual student
characteristics, these analyses were repeated separately for each classroom group.
Interactions between potential effect modifiers were added to the model of the total
group including gender, IQ,34fitness,19, 35-39 BMI,40-42attention-deficit/hyperactivity
problem behavior symptoms,43, 44, and school engagement. Participants were
categorized based on the median split of the potential modifiers. Students were also
split into the most on-task and the least on-task students using the mean pre-test timeon-task from each of the four conditions. Mahar et al. previously used a cut-off of less
than 50% on-task behavior to classify the least on-task students.12 In this study, only 6
participants averaged less than 50% on-task behavior, therefore, students who were ontask less than 60% of the time were considered to be the least on-task.
66
Results
Of the students participating in the study, 10.7% were black, 68.8% were white,
and 34% had a parent income less than $40,000. There were between classroom group
differences in age (as expected with multiple grade levels), verbal IQ and physical
activity levels as seen in TABLE 4.1. One classroom group did not complete the entire
research protocol due to technical (camera malfunction), logistical (students obstructing
the camera view) and scheduling difficulties that prevented observation of on-task
behavior for all four treatments. Additionally, that classroom was the only classroom
who participated in the intervention at the end of the school day causing disruptions
that precluded that classroom from being exposed to all of the treatments. Therefore,
this classroom was excluded from the analyses.
Seventy-five students in four classroom groups were included in the analyses.
The intervention was implemented with high-fidelity and an average intensity (scale
from 1 to 5 where 1 is equal to lying down and 5 is equal to being very active) of 4.35
(SD 0.47), 4.37 (SD 0.32), and 4.29 (SD 0.33) for the 5, 10, and 20 minutes classroom
exercise break conditions respectively. There was a significant improvement in observed
on-task behavior after 10 (p<.01, d=.50)and 20 minutes (p=.056, d=.32) of exercise
compared to the sedentary condition, see FIGURE 4.1A.
Classroom Analysis
Individual classroom groups displayed unique results when analyzed as separate
groups as seen in FIGURE 4.1B and TABLE 4.2. Classrooms 1, 3, and 4 had higher scores
67
after 10 minutes of exercise, and Classroom 3 also had improvements after 5 minutes of
exercise.
Student Characteristics Analyses
There was a significant interaction between the exercise dose and gender
(p=.0002). Both boys and girls improved time-on-task after 10 minutes, but boys had
lower time-on-task after 5 minutes while girls had higher time-on-task. No other overall
interactions were significant. The individual estimates and linear contrast comparisons
can be seen for each potential modifier in FIGURE 4.2.
Discussion
This study was the first to directly compare the acute effects of different
durations of classroom exercise breaks on on-task behavior. Classroom exercise breaks
improved students’ on-task behavior after 10 minutes of exposure with a trend to
increased on-task behavior after 20 minutes. Similar to the current study, two previous
studies that observed time-on-task after classroom exercise breaks found positive
effects in on-task behavior after 10 minutes of classroom exercise breaks.12, 13 The
current study was the first to look at the effects of less than 10 minutes of classroom
exercise breaks on time-on-task, and found no change in time-on-task after 5 minutes of
classroom exercise. No studies have directly compared the acute effects of physical
activity on on-task behavior. When examing other cognitive outcomes, Kubesch et al.
found no improvement after 5 minutes of classroom activity but did find cognitive
improvements after 20 minutes of a physical education class.
68
When the results from individual classrooms were examined separately,
different classrooms displayed unique results. Three out of the four classrooms
improved on-task behavior after 10 minutes of classroom exercise, one classroom had
no changes in on-task behavior, and one classroom also showed improvement after 5
minutes of exercise. The differences between classrooms are not unexpected, as
classrooms were tracked, or group based on academic abilities and interests. Future
research is needed to confirm and understand these classroom differences.
Understanding these differences may be useful in making specific recommendations for
certain classes. For example, a classroom, such as Classroom 3 may be able to benefit
from 5 minutes of classroom exercise breaks, while other classrooms need 10 minutes.
Only one classroom had decreased time-on-task after any of the exercise breaks,
though the decrease was not statistically significant. During the post-testing of this
condition, a teacher knocked over a bookshelf which caused an obvious disruption and
students’ attention was diverted. This classroom variation points to the complexity of
doing research in uncontrolled settings, where several factors can influence results.
Many of these factors cannot be completely controlled for statistically and must be
considered in the study design and interpretations of findings.
Beyond classroom variation, interesting findings emerged when the results
across all classrooms were stratified by individual student characteristics. Boys were the
only group who had a decrease in time-on-task after any exercise. Students with lower
IQ, higher fitness, and lower BMI showed improvements in time-on-task after 10
minutes of exercise. Grieco et al. found that children with higher BMI showed greater
69
beneficial effects from a classroom exercise break13 Of note, no differences were seen
between students based on school engagement or their baseline on-task behavior.
These results did not support Mahar et al.’s findings that classroom exercise breaks had
the greatest benefits in students who were most off-task.12 However, the current
findings do suggest that on-task behavior can be improved in both the most off-task
students and students with low engagement in school, who are the students with
greater academic needs. More research is needed to understand how physical activity
may have unique cognitive effects in different students and how regular classroom
exercise breaks will affect student on-task behavior. Overall, the effects of classroom
exercise breaks appear to be sensitive to multiple factors.
Limitations
As a “real world” efficacy study, the intervention was implemented by research
staff. Implementation by research staff increased the fidelity of intervention and
enabled direct comparisons between delivered doses. However, classroom exercise
breaks delivered by outside staff are not sustainable for widespread implementation;
teachers need to be trained to implement these practices. Future studies will be needed
to examine if teachers can implement the same intensity and duration classroom
exercise breaks as implemented in this study. Another limitation is the potential for
subjectivity with direct observation. For this study, however, several precautions were
taken to maintain objectivity in coding time-on-task including blinding observers to the
study condition and using an objective and systematic protocol. While the interobserver
correlations were fair, any disagreements between observers were further re-evaluated
70
to reach consensus. While time-on-task is not a perfect proxy for whether a student is
paying attention or engaged with the lesson, it is a tangible, observable metric used by
teachers in the classroom.45, 46
Implications for School Health
This study has immediate practical implications for implementing classroom
exercise breaks into the school day. With strict curriculums and limited time in
elementary schools, administrators and teachers must be creative to integrate physical
opportunities throughout the school day. A primary barrier to implementing physical
activity in the classroom is teachers’ fear that students will not be able to settle back
down into the lesson, as acknowledged by the teachers in this study. This study suggests
that students do not become more off-task after a brief, high intensity, classroom
exercise break, but rather increased their on-task behavior.
Students are suffering from the consequences of sedentary lifestyles. One out of
five children show early signs of cardiovascular disease such as high blood pressure47
and one out of six children are obese.48 Less than half of children are meeting physical
activity recommendations, 49 despite the many health benefits of physical activity for
children including improved cardiorespiratory fitness, metabolic profiles, bone health,
and mental health.50 Classroom exercise breaks are one physical activity opportunity
that have been shown to improve the health of children.24, 51, 52 If teachers can
implement these 10 minute classroom exercise breaks, students may not only receive
health benefits of classroom exercise breaks, but as this study showed, students may be
more on-task to learn.
71
Human Subjects Approval Statement
This study was approved by the University of South Carolina Institutional Review
Board and the research review board of the participating school district.
72
Table 4.1: Demographics by classroom group (mean (SD))
n
1
19
Classroom Group
2
3
4
12
18
26
5
21
p-value
Gender
(% female)
70.0
58.3
72.2
61.5
61.9
.90
Age (years)
11.2
(.39)
11.2
(.29)
11.1
(.36)
10.2
(.34)
10.2
(.39)
<.0001
Verbal IQa
89.3
(10.1)
105
(7.68)
99.1
101.5
(14.36) (14.43)
98.5
(13.17)
.01
Matrices IQa
101.3
(11.03)
105.8
(7.93)
104.8
(15.51)
105
(8.01)
95.5
(14.09)
.06
Composite IQa
99.7
(23.96)
106.6
(4.52)
102.5
(16.22)
105.1
(9.16)
96.8
(13.08)
.33
Fitnessb
19.8
23.9
27.5
21.5
(11.16) (11.97) (14.23) (15.72)
19.1
(8.20)
.32
BMI
18.7
(3.42)
18.6
(2.86)
20.3
(3.89)
20.9
(6.04)
20.0
(4.51)
.48
Physical
Activityc
4.3
(2.35)
6
(1.49)
4.8
(1.86)
5.3
(2.37)
6.3
(1.13)
.03
Behaviord
22.2
21.7
(14.91) (11.39)
11.1
(8.53)
14.8
(14.30)
15.4
(17.67)
.25
Engagemente
22.1
(5.86)
19.3
(7.38)
22.3
(4.10)
19.7
(5.27)
.33
19.3
(5.60)
a
b
c
d
e
73
Table 4.2: Post-test time-on-task for each condition by classroom group* (SE)
Classroom
Group
Sedentary
5 min
10 min
20 min
One
79.44
(4.2)
89.78
(4.3)
91.67
(4.0)
89.60
(3.9)
Two
86.61
(5.2)
83.38
(5.2)
81.53
(5.3)
81.96
(5.8)
Three
72.78
(5.0)
89.90
(6.5)
88.57
(5.6)
82.29
(5.3)
Four
71.11
(5.0)
56.81
(4.6)
88.03
(4.6)
79.53
(4.6)
*adjusted for gender and pre-test time-on-task
74
B
75
Figure 4.1: Observed time-on-task after 10 minutes of seated classroom activity or 5, 10, 20 minutes of classroom exercise breaks in
A) Total group, B) Each classroom individually
** difference from sedentary condition at p<.10
*difference from sedentary condition at p<.05
Figure 4.2: Time-on-task after seated classroom activity or 5, 10, 20 minutes of
76
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81
CHAPTER 5
MANUSCRIPT 4: SMILES COUNT: A MIXED-METHODS ANALYSIS OF THE AFFECTIVE
RESPONSE, ACCEPTABILITY AND FEASIBILITY OF A CLASSROOM EXERCISE BREAK
INTERVENTION IN ELEMENTARY SCHOOLS4
4
Howie EK, Beets MW, Newman-Norlund RD, Schatz JC, Pate RR. To be submitted to The
Elementary School Journal.
82
Abstract
To foster successful students, educators must care for the whole child, including
student physical health. Physical activity is a critical component of physical health. This
mixed-methods, experimental study used quantitative observations and qualitative
focus groups to examine affective responses to, along with the acceptability and
feasibility of a classroom exercise break intervention in 4th- and 5th-graders (n=96). The
effects were compared between various durations of classroom exercise breaks and by
individual student characteristics. Videotapes of 5, 10, and 20-minute classroom
exercise breaks were coded for positive affect using a momentary time sampling
protocol and compared to 10 minutes of sedentary classroom activity. Students had
higher positive affect during all the exercise conditions as compared to the sedentary
condition. Students described multiple benefits of the classroom exercise breaks and
teachers reported that students enjoyed the exercise and that there were no problems
with the students settling down afterwards. Classroom exercise breaks are a feasible
and enjoyable way to increase physical activity in a youth population that is increasingly
sedentary.
Introduction
A whole child approach to education requires that all students be safe, engaged,
supported, challenged and healthy.1 One critical component of student health is regular
participation in physical activity. Children receive numerous health benefits from
physical activity including improved cardiorespiratory fitness, body composition,
83
metabolic profile, muscular fitness, and bone health which ultimately decrease the risk
for chronic diseases and mortality.2 Unfortunately, many children do not meet the
guidelines for recommended levels of physical activity.3 In addition to the numerous
physical health benefits, physical activity is also beneficial for mental health and can
decrease the risk of depression and anxiety while improving self-esteem.4 Acute
exercise has also shown to improve mood in adults5, 6 and children.7
Not only has physical activity been shown to improve mood, but enjoyment of
physical activity may also be important for sustaining regular physical activity.8
Enjoyment of physical activity has consistently been shown to be related to higher levels
of physical activity in children.9 Furthermore, children who enjoy physical activity are
more likely to engage in future physical activity.10 Fortunately, children do enjoy
exercise.11, 12 Fun and enjoyment are the primary reasons that children report for
participating in physical activities.13-15 Both children and teachers believe physical
activity interventions should be enjoyable,16 and levels of enjoyment have been shown
to moderate the effects of exercise interventions.17 Conversely, developmentally
inappropriate physical activities, where children do not have fun, may have negative
effects on children’s future participation in physical activity.18, 19 Thus, creating
enjoyable, appropriate physical activity opportunities is an essential component of
public health policies designed to increase for physical activity levels of youth.
The importance of children having fun during physical activity goes beyond just
enjoyment. Fun and happiness may improve performance in school through associated
cognitive benefits as well as increased engagement in school.20-23 Some studies have
84
observed that children who are happy may learn better.22, 24 Thus, it is important to
provide enjoyable physical activities during school, as it can increase positive affect and
may ultimately influence academic achievement outcomes. Classroom exercise breaks
are one type of physical activity opportunity during the school day that requires few
additional resources or large amounts of time. While many studies have researched the
affective responses of adults to exercise,5 none to our knowledge have objectively
quantified positive affect in response to physical activity in children.
Nonetheless, even if physical activity opportunities increase positive affect, the
physical activity practices are unlikely to be implemented widely if they are not
acceptable and feasible to students and teachers. Qualitative approaches provide
methods to asses the acceptability and feasibility of classroom exercise breaks. The
inductive approach of qualitative research helps to collect participant perspectives
without imposing presupposed research hypotheses.25 When combined with
quantitative measures, qualitative methods can provide a more holistic picture of the
classroom exercise breaks.
Why Positive Affect is Important in Education
Positive affect is a pleasurable state of engagement with the environment that
includes the positive emotions of happiness, joy, excitement, enthusiasm and
contentment.26, 27 Positive affect and positive emotions have shown to have beneficial
effects on cognitive functions. Dreisbach found that positive emotions increase the
flexibility, problem solving and critical thinking in response to a novel stimulus. 20 A
review of the effects of positive affect on cognitive skills found that positive affect
85
improves creative problem solving, negotiation, and decision making.28 A number of
theoretical models capable of explaining the effect of positive affect on cognitive
function have emerged in the last few decades. Fredrickson’s Broaden-and-Build theory
proposes that positive emotions expand the thought-action repertoire which allows
individuals to think critically and broadly. 26 In contrast, negative emotions narrow the
thought-action repertoire and cause quick, impulsive decisions.
In addition to direct effects on cognitive processes, positive affect may also
improve student school engagement. If a student enjoys school, they are more likely to
engage in the classroom29 and be motivated to learn.21 Higher school engagement has
been shown to predict academic achievement.22, 23 A review of the effects of student
engagement on academic achievement found that there is a consistent, positive
association between engagement and achievement.22 A prospective longitudinal study
followed over 300 students from kindergarten through eighth grade and found that
higher positive engagement predicted higher student academic success as measured by
a standardized achievement test.23
As a result of these findings regarding the importance of positive affect and
positive emotions to academic success, many psychologists, including school
psychologists, have adopted approaches grounded in positive psychology. Positive
psychology focuses on happiness and positive emotion, the opposite of deficit based
psychology, as the most effective way to improve student performance.30 Lewis et al.
found that positive affect predicts student school satisfaction and school engagement, 31
and interventions based on positive psychology are associated with improved academic
86
performance.32 Barnes argues for the need for positive emotion in schools, and
advocates that physical education is a key part of providing enjoyment and
engagement.33 As a result of the influence of student enjoyment in school on
educational outcomes, student enjoyment is often an outcome of effective teaching.
Multiple state approved teacher evaluations include an evaluation of student enjoyment
and engagement.34, 35 Taken together, this research highlights the need to improve
positive affect in students.
The Relationship Between Exercise and Positive Affect
There is a reciprocal relationship between physical activity and positive
emotions. Not only are children who enjoy physical activity more likely to participate in
physical activity, but physical activity has also shown to improve positive emotions. First,
several studies have shown that individuals who enjoy exercise participate in more
physical activity.8, 9 The affective response to an acute bout of exercise was measured in
healthy sedentary adults, and then they reported their physical activity levels at 6 and
12 months.8 Those with greater positive affective responses to exercise reported higher
levels of physical activity. These results have been replicated in children. A withinsubjects study of 9 and 10 year-old children found that children had higher positive
mood after 15 minutes of exercise compared to a 15 minute video.7 Similarly,
adolescents who had a more positive affective response to acute exercise had higher
levels of objectively measured physical activity.9
Secondly, physical activity and exercise have shown to improve mood in adults5, 6
as well as children.7 Exercise is thought to improve mood through several plausible
87
physiological and psychosocial pathways including monoamines,36 endorphins,37-39
endocannabinoid receptors,40 improved self-concept,5 and distraction from other
worries.41 While original research showed that exercise increased monoamines and
beta-endorphins, these increases are not always associated with positive changes in
mood.5
The most current hypothesis for the underlying biological mechanism underlying
the positive effect of exercise on mood is through endocannabinoid signaling. The
importance of endocannabinoid signaling for mood and emotion was first identified in
response to THC, the active ingredient in marijuana.42 Endocannabinoids are lipid
receptors that are concentrated in areas of the brain associated with reward and
emotion.42 Exercise increases endocannaboids, which has been correlated to improved
mood, motivation to exercise, and the phenomena known as the “runner’s high.”43
Increased positive affect from exercise may also occur through psychosocial factors such
as self-efficacy and improved self-concept.5 The distraction hypothesis posits that while
exercising, people do not think about other problems or issues that may be causing a
negative mood.41 Additionally, the effects of exercise on emotions have shown to differ
by individual characteristics.44, 45 It is possible that students with lower fitness or higher
BMI may have different affective responses to physical activity.
Fitting Exercise into the School Day through Classroom Exercise Breaks
Physical activity opportunities, particularly physical education and recess, are
being reduced in schools due to budget concerns and increased focus on standardized
testing resulting from No Child Left Behind.46, 47 In a survey of principals, The Center for
88
Education Policy found that seven out of ten schools reported decreasing staff in noncore academic areas, including physical education, with five out of ten anticipating
further cuts.47 Classroom exercise breaks are one way to increase the minutes of
physical activity that students receive, without requiring many additional resources.
Classroom exercise breaks are short bouts of physical activity (they do not interfere with
rigid curriculum time), that occur in the classroom (they do not need additional gym or
outdoor space), and are led by classroom teachers (there is no need for additional staff).
For these reasons, schools across the nation are implementing classroom exercise
breaks. The School Health Policies survey reported that 40 percent of school districts
either require or recommend classroom exercise breaks for elementary schools.48 The
commercial market has also capitalized on this growing market and provides resources
to teachers to implement classroom exercise breaks such as Brain Breaks and
OrganWise Guys. Despite the policies requiring classroom exercise breaks, no previous
studies have examined the acceptability and feasibility of these practices to students
and teachers.
With the growing prevalence of classroom exercise breaks, there has been an
emergence of studies examining the effects of classroom exercise breaks on student
health and health behaviors such as physical activity. Liu et al. found improvements in
Body Mass Index (BMI) after a 9 month daily classroom exercise break intervention.49
Similarly, a randomized control trial of 24 elementary schools found that schools that
implemented daily classroom exercise breaks had improvements in student BMI after
three years.50 Short-term studies have also found that classroom exercise breaks
89
increase overall physical activity.50-52 A few studies have also examined the effects of
classroom exercise breaks on educational outcomes such as cognitive and academic
performance and found positive effects.50, 51, 53-56 The positive effects of exercise on
academics have been studied more commonly in response to overall physical activity,
fitness, physical education and recess,57-60 but classroom exercise breaks may be even
more critical to student academic achievement. Exercise within the classroom, which
occurs directly within the school day and learning environment, may be more likely to
affect students’ disposition and learning. No prior studies have thoroughly examined the
affective response to classroom exercise breaks.
Research Questions
This mixed methods study used quantitative observations and qualitative
interviews to examine the affective responses to, along with the acceptability and
feasibility of a classroom exercise break intervention in elementary school students. This
study answered four research questions. 1) Do classroom exercise breaks influence
positive affect in elementary school students? 2) Do the effects differ by the duration of
the classroom exercise break? 3) Do the effects differ by individual student
characteristics? 4) Are classroom exercise breaks acceptable to students and teachers?
For the purposes of this study, acceptability is operationally defined as the willingness to
participate in or conduct voluntary classroom exercise breaks in the future.
90
Methods
Study Design
This study was a mixed-methods experimental study of a classroom exercise
break intervention. This study used a within-subjects experimental design. Students
participated in each of four treatment conditions: 10 minutes of sedentary classroom
activity, and 5, 10 and 20 minute exercise breaks. Quantitative observations of positive
affect were coded from video footage of all four conditions. Qualitative information was
obtained through teacher and student focus groups after the intervention was
completed.
Participants
Participants were from four 4th grade and four 5th grade classrooms from an
elementary school in South Carolina. Four 4th grade and four 5th grade teachers
participated in the focus groups after the intervention was completed. Student
participants ranged from 9 to 12 years of age. The total school population was 18%
black, 8% Hispanic, and 70% white with 30 percent receiving free-and-reduced lunch.
The demographics of the sample can be seen in TABLE 5.1.
Intervention
The Brain BITES (Better Ideas Through Exercise) intervention was designed to be
implemented within the classroom setting. The exercise breaks were led by research
staff, set to music, and attempted to engage all children in moderate-to-vigorous
physical activity. Activities included jumping, hopping, marching, and running in place.
91
The instructor physically participated and gave positive encouragement to the students.
To encourage higher intensity activity, children were taught to take their own carotid or
radial pulses, with the goal of obtaining 150 beats per minute during exercise. The
intervention was videotaped for intervention fidelity and to objectively code positive
affect.
To asses the fidelity of the intervention, videotapes of all four conditions were
coded for intensity of physical activity using a modified System for Observing Fitness
Instruction Time (SOFIT)61 modified by Donnelly. Observations were made of individual
children at consecutive 10-second intervals during the exercise or sedentary condition.
Their average activity level during the 10-second interval was coded using a scale from 1
to 5 where 1 is equal to lying down and 5 is equal to being very active (ex. running in
place, jumping). Videos were viewed and coded three times with a different child
observed for the same intervals during each viewing. The average intensity of each
condition was 2.01 (SD 0.05) during the sedentary condition, 4.00 (SD 0.43) during the 5
minute exercise condition, 4.35 (SD 0.33) during the 10 minute exercise condition and
4.26 (SD 0.37) during the 20 minute exercise condition.
Measures
Students completed several measures at baseline, including height and weight to
calculate BMI, the 15m PACER test from the FITNESSGRAM battery to estimate aerobic
fitness, and the Kaufmann Brief Intelligence Test-Second Version as a measure of
abbreviated IQ.
Direct Observation
92
To quantitatively measure positive affect, the videotapes of the classroom
physical activity intervention were objectively analyzed. Previous studies have utilized
videotape footage to analyze affect.62, 63 Several objective systems have been used to
code facial expressions for affect.63, 64 As affect and emotion has not been previously
coded in physical activity settings, a modified version based on the Specific Affect
Coding System64 and the System for Observing Children’s Activity and Relationships
during Play (SOCARP) was used.65
The observer was trained using previous footage of child classroom physical
activity. Only consented students were analyzed. Videos were viewed and coded three
times. The observer scanned through all visible students in three viewings of the
complete condition from left to right, right to left, and beginning in the center of the
classroom. Different students were observed at each 10-second interval between the
three viewings. If a student was not visible for at least five seconds during the 10-second
interval (due to being obstructed from the camera by another student or leaving the
frame of view), the observer proceeded to the next student. The observer watched the
selected student for a 10-second interval and coded whether or not they displayed
positive affect. Positive affect is a broad disposition26, differing from specific emotions,
and involves some subjective analysis. Signs of positive affect included smiling and
positive verbal response (i.e. “This is fun” or “I like this”). A total of 4260 observations
were made with 1122 (mean 16.7 per student) during the sedentary condition, 471
(mean 7.5 per student) during the 5 minutes, 876 (mean 12.3 per student) during the 10
minutes, and 1791 (mean 26.3 per student) during the 20 minutes. Retest reliability was
93
tested in ten percent (n=420) of the coded intervals four months after the initial coding.
The intervals were randomly selected in groups of 10. The overall percent agreement
was 95.7 percent with a kappa of 0.91. The primary child-level outcome variable was the
percentage of intervals coded for positive affect for each condition.
Student Focus Groups
Focus groups were held with consenting, participating students within one week
of the completion of the classroom exercise break intervention. The focus groups
assessed acceptability and reactions to the intervention to inform future practices.
Focus groups were conducted with the participating classroom groups (total number of
students per classroom ranged from 12 to 26), for a total of 5 groups. Facilitative
questions included general opinions, how they felt afterwards, and how they would
change it. The discussion were recorded and transcribed.
Teacher Focus Groups
The 4th and 5th grade teachers participated in focus groups at the end of the 5week intervention period to gather information on the implementation, feasibility,
perceived benefits and overall impressions of the intervention. Two focus groups were
conducted, one with the 4, 4th grade teachers and one with the 4, 5th grade teachers.
Focus groups were recorded and transcribed.
Analysis
Descriptive statistics were calculated for the total group and separately for each
gender using SAS 9.2. Positive affect was approximately normally distributed. To answer
Research Question 1, a repeated measures mixed ANCOVA model tested the difference
94
in positive affect between conditions, adjusted for classroom group and age using PROC
MIXED. To examine the differences between durations of classroom exercise breaks for
Research Question 2, linear contrasts compared positive affect for each exercise
condition to the sedentary condition. Cohen’s d effect sizes were calculated for each
condition compared to sedentary. A minute-by-minute analysis of the time course of
positive affect was also conducted over the duration of the activities. The mean positive
affect was calculated for each minute, and then graphically compared across the four
conditions. To examine the interactions between gender, fitness and BMI, for Research
Question 3, these analyses were repeated with interaction terms. Participants were
categorized based on the median split of the potential modifiers.
Research Question 4 was answered through analysis of focus group transcripts.
Transcriptions from student focus groups and teacher interviews were coded for
emerging themes. In vivo codes were created during open coding using the constant
comparative method.66 Codes were then grouped into final emergent themes using
constant comparative analysis. To ensure the rigor of this qualitative study, validity as
defined by Lincoln and Guba,67 was established through triangulation of the data. The
credibility of the theory, referred to as validity in quantitative studies, was strengthened
through triangulation including multiple sources (students, teachers) and multiple
methods (direct observations, surveys, interviews).
Results
1) Do classroom exercise breaks affect positive affect in elementary school students?
95
There was a significant main effect of the confitions on positive affect (F=60.47,
df=178;).
2) Do the effects differ by time and duration of the classroom exercise break?
All three exercise durations improved positive affect (5 minutes=46.6%, d=1.54;
10 minutes=45.5%, d=1.56; 20 minutes=36.1%, d=1.15) as compared to the sedentary
condition (7.8%). When positive affect was visually examined in relation to time during
the intervention, positive affect began to decrease after 5 minutes, and leveled out at
30 percent (compared to 8% during the sedentary condition) as seen in FIGURE 5.1.
3) Do the effects differ by individual student characteristics?
When results were stratified by gender, fitness level, IQ and BMI, all exercise
conditions still had higher positive affect than during the sedentary condition. During 5
and 10 minutes of classroom exercise breaks, females had higher positive affect than
males (53.6% vs. 37.0%, p=0.01; 50.7% vs. 39.8%, p=0.07) as seen in FIGURE 5.2. During
5 minutes of exercise, children with lower fitness had higher positive affect than those
with higher fitness (53.0% vs. 41.3%, p=0.05). There were no other differences between
IQ or BMI levels.
4) Are classroom exercise breaks acceptable to students and teachers?
The students and teachers found the study approach acceptable. The students
and teachers reported they believed the classroom exercise breaks had multiple
benefits for the students. The following themes emerged from the interviews and focus
groups.
96
The students discussed three primary benefits of the classroom exercise breaks,
the physical benefits of the exercise, the effects on the cognitive and academic tests
afterwards, and their enjoyment of the breaks. The students thought that it was a “fun
way of exercising”, “it’s good for the body”, and that it was a “good workout”. The
students reported enjoyment of the classroom exercise breaks including that they were
“fun” and “awesome.” “I really like the exercise’s cause it’s fun.” “It’s fun and it’s a cool
way of exercising.” The students felt that they were more focused and awake
afterwards. Their responses varied by the length of the classroom exercise break. Many
students reported that the 5 minute break was too short. Some liked the 20 minutes the
best while others preferred the 10 minutes. Some students reported that the tests were
more difficult afterwards because they were tired. One student stated, “It depends on
which one, cause sometimes I did better after exercise, for certain things, but
sometimes I didn’t.” One 4th grade student summed up his experience, “What do you
think of Brain BITES? It’s the best thing ever. What do you like best about it? The
exercising, everything. Why do you like the exercise? Because it helps me, FOCUS.”
The teachers reported that the most positive aspects of the classroom exercise
breaks were that the students looked forward to them and enjoyed them and that they
did not see any problems with the students settling down afterwards. The teachers also
noted that the students seemed to think it helped. For example, a teacher described
how one student began doing the exercises on her own in the middle of standardized
testing, and multiple teachers used a modified version of the exercise break during the
state testing. Despite seeing the benefits, teachers were honest about the difficulty of
97
fitting classroom exercise breaks into their daily routine with the emphasis on
standardized testing, standards and structured curriculums. They felt that they have
little time during the day to integrate these practices. As one teacher put it,
The only way you’re going to get teachers to do it, is to make it part of
the program. Cause you’re going to have some teachers that will say yeah
let’s do it, and most of them are gonna say, yeah I don’t have time.
If the teachers were to implement classroom exercise breaks, the teachers reported that
they would only be able to get in 5 minutes in the morning, perhaps as part of the
morning news show.
Discussion
This was the first study to quantify the affective response to acute classroom
exercise breaks. This study found that children respond positively to classroom exercise
breaks. Directly observed positive affect was higher during all classroom exercise breaks
than during the sedentary control condition. Multiple sources were triangulated and all
showed that the children enjoyed the classroom exercise breaks.
All durations of classroom exercise breaks improved positive affect equally.
When positive affect was examined over the time course of the classroom exercise
break, positive affect did begin to decrease between 5 and 10 minutes. However,
positive affect plateaued at a level still much higher compared to the sedentary
condition. Research suggests that there may be an ideal duration and intensity of
exercise to elicit positive affective responses. Benjamin et al. found that positive affect
decreased in children during a graded exercise test as intensity and duration
98
increased.68 Early research on the dose-relationship between exercise intensity and
affect proposed that higher intensities produce negative affect responses following an
inverted-U pattern.5 More recent work proposes an alternative and more complex doseresponse model where moderate intensity activity elucidates positive affect among
most people, while individual characteristics determine if an individual responds
positively or negatively to higher intensity exercise.45 When the students in the current
study were asked about their responses to the different durations, they responded
inconsistently. While some students said they preferred the 5, and 10 minutes, the
majority said they liked the 20 minutes. Two students said they did not like any of the
durations. Thus, while positive affect did begin to decline as the duration increased, the
overall positive findings show that these durations and intensities of classroom exercise
breaks produce positive affect in the majority of children. Schools and teachers can
implement these durations without causing negative responses in students.
Previous research in adults has shown that positive responses to exercise may
differ based individual characteristics such as baseline self-efficacy44 or frontal cortical
activity.45 In the current study, students responded to the classroom exercise breaks
similarly regardless of IQ and BMI. The only differences between students found in this
study were that females showed higher positive affect than males and students with
lower fitness had higher positive affect during 5 minutes of exercise compared to
students with higher fitness. Importantly, all groups had significantly higher positive
affect during exercise than during the sedentary condition. This homogeneity in
responses shows that even students with lower fitness or higher BMI enjoyed
99
participating in these higher intensity classroom exercise breaks. As all children
improved positive affect in response to the intervention, classroom exercise breaks
appear to provide an appropriate physical activity opportunity for all students.
Despite the improved positive affect during all the durations of classroom
exercise breaks and the children’s slight preference towards the longer breaks, teachers
discussed the ability to only implement exercise breaks of less than 5 minutes in
duration. Teachers suggested that the best options would be to include exercise in the
morning news shows, but this would require support from the principal. Teachers in this
study cited the strict curriculums and limited time as large barriers to implementing
longer breaks, consistent with previous reports from teachers and administrators about
the competing priorities in schools creating barriers to increasing physical activity.69-71
This reluctance to include physical activity in favor of academic time is despite research
that physical activity may improve cognitive performance and academic achievement in
students.58, 59 The increase in positive affect found in this study may even be a
mediating factor in the improved cognitive function by broadening and building
cognitive processes.26 Tomporowski et al. suggest that changes in core affect during
exercise improve cognitive performance.72 Yet other evidence suggests that the
mechanisms underlying improvements in affect after exercise are separate form those
improving cognitive performance.73 Regardless of the mechanism, Diamond suggests
that positive emotional development is critical for the development of executive
functions and other cognitive processes.74 As she eloquently states,
If we want the best academic outcomes, the most efficient and cost-effective route
to achieve that is, counter intuitively, not to narrowly focus on academics, but to
100
also address children's social, emotional, and physical development. Similarly, the
best and most efficient route to physical health is through also addressing
emotional, social, and cognitive wellness. Emotional wellness, similarly, depends
critically on social, cognitive, and physical wellness.74(p780)
Future studies are needed to examine if the increase in positive affect during exercise
improves children’s enjoyment and engagement in school. Additionally, exercise can be
incorporated into academic lessons so as not to take away time from curricular
instruction.
One of the limitations of this study was the third person observation of positive
affect. Outward displays of positive affect may not be genuinely indicative of happier
children as children may be enjoying the activity but not smiling, or smiling and not
enjoying the activity. However, outward displays of positive emotion are what teachers
observe and use to interpret if the students enjoy the activity. Future studies can assess
student perceptions of positive affect through self-reported questionnaires such Profile
of Mood States75 or the Minimood specifically for children.76 Nonetheless, the findings
from these objective observations were confirmed by student focus groups, where the
students reported their positive experiences during the classroom exercise breaks.
While the focus groups were not conducted by an independent evaluator, questions
were designed to elicit both positive and negative responses to the intervention. The
triangulation of multiple sources and multiple methods minimized the limitations from a
single measure and created a holistic picture of the affective response and acceptability
of classroom exercise breaks.
It is important to note that these effects are the results of the entire classroom
exercise break experience, including the brief warm-up and cool down, music, and social
101
interaction and not solely physical activity. However, the sedentary condition was an
attention control with research staff and also included social interaction. Regardless of
the single mechanism for increased positive affect, if children are having fun while
participating in classroom exercise breaks and being physically active, teachers may be
more likely to provide additional opportunities to be physically active.
Overall, students and teachers responded positively to the classroom exercise
breaks. Classroom exercise breaks have shown to be an acceptable practice to increase
physical activity and positive affect during the school day. Some scholars argue that
happiness itself is a goal of education,77 and classroom exercise breaks are one tool to
make children happy. Unfortunately, the teachers expressed reserve in implementing
regular classroom exercise breaks in their classrooms. Top-down policies may be needed
to ensure children participate in daily classroom exercise breaks and incorporate
physical activity ito instructional time as a way to provide for the education of the whole
child.
102
Table 5.1: Baseline descriptive variables (% or mean ± SD)
Total
Female
Male
96
62
34
10.7 ± .6
10.7 ± 0.6
10.7 ± 0.6
.68
% Black
19.8
19.1
21.2
.85
% White
68.8
66.7
72.7
% Income <40,000
33.8
30.4
40.9
.19
Verbal IQa
98.4 ± 13.4
97.9 ± 14.2
99.2 ± 12.1
.64
Matricesa
102.4 ± 12.0
102.4 ± 17.2
102.8 ± 11.7
.82
IQa
102.0 ± 15.2
102.4 ± 17.2
101.5 ± 11.4
.78
14.3
12.1
19.2
.45
19.9 ± 4.5
20.7 ± 4.9
18.4 ± 3.5
.02
21.3
25.4
8.82
.14
22.1 ± 12.9
19.5 ± 10.5
26.6 ± 15.4
.01
5.3 ± 2.0
5.3 ± 1.9
5.3 ± 2.3
.92
Behaviord
16.2 ± 14.2
14.2 ± 12.7
20.5 ± 16.5
.08
School Engagemente
20.8 ± 5.7
21.2 ± 5.4
19.9 ± 6.1
.36
N
Age
% A student
BMI
% BMI ≥ 95th percentile
Fitnessb
Physical Activityc
a
c
d
e
b
103
P-value
104
Figure 5.1: Percent of positive affect observed by minute
*between group differences at p<.10
** between group differences at p<.05
Figure 5.2: Positive student affect after seated classroom activity or 5, 10, 20 minutes of
105
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Press; 2003.
112
CHAPTER 6
OVERALL DISCUSSION
Significance
Many children do not participate in adequate levels of physical activity,1 and
regrettably, schools provide few opportunities for children to be physically active. 1
Recent legislation has increased the focus on standardized testing in schools in the
United States. No Child Left Behind requires that states must develop, implement, and
improve upon standardized assessments in elementary and secondary education in
order to receive federal funding. As a result of the increased focus on standardized
testing, schedules have become less flexible and school resources are more limited. One
way to increase physical activity within tight schedules and limited resources is through
classroom exercise breaks. Several schools report these practices already, yet little is
known about the prevalence and characteristics of classroom exercise breaks in
elementary schools.
Schools are reducing physical activity despite previous research that has shown
that physical activity may improve cognitive function and academic achievement in
adults,2, 3 as well as children.4, 5 In contrast to the plethora of recent studies finding
positive correlations between fitness and academic achievement,5-13 there have been
fewer experimental studies of the acute and long term effects of physical activity on
113
various educational outcomes.14-17 The ideal dose and type of exercise to elicit positive
cognitive benefits is still unknown.
Purpose
The purpose of Study One of this dissertation was to determine the prevalence
and characteristics of classroom exercise breaks in elementary schools in central South
Carolina. The purpose of Study Two was to describe the acute effects of classroom
exercise breaks on cognitive functions including executive function and academic
performance of elementary school students. Study Three described the acute effects of
classroom exercise breaks on on-task behavior of elementary school students. Finally,
the purpose of Study Four was to determine student affective responses to, as well as
the acceptability and feasibility of classroom exercise breaks.
Design and Methods
Two study designs were used in this dissertation. Study One used cross-sectional
surveys and interviews of elementary school principals. Principals in central South
Carolina were invited to complete a brief online survey about the prevalence of
classroom exercise breaks. Fourteen principals were then interviewed by phone about
the characteristics and implementation of classroom exercise breaks in their schools.
Studies Two, Three, and Four used a within-subjects experimental design. A total
of 96 4th and 5th grade students in one elementary school in South Carolina participated
in the Brain BITES (Better Ideas Through ExerciSe) intervention. Students participated in
each of four conditions: 10 minutes of sedentary classroom activity and 5, 10, and 20
minutes of classroom exercise breaks. Students completed the Trail Making Test, an
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operational recall test, and a one-minute math test before and after each condition.
Students were also videotaped and observed for on-task behavior during the cognitive
testing. Videotapes of the exercise were coded for physical activity levels and positive
affect. Focus groups were conducted with the students and teachers after the
intervention. The cognitive scores, on-task behavior, and positive affect were compared
between conditions using repeated measures mixed model ANCOVAs adjusted for age,
classroom group, and time-varying pre-test scores where applicable. Interactions were
tested between the exercise doses and potential effect modifiers of gender, IQ, fitness,
BMI, parent rated behavior, school engagement, baseline on-task behavior and intensity
during the intervention.
Major Findings
Study One found that classroom exercise breaks were prevalent in 74 percent of
responding elementary schools in central South Carolina. Few schools, however, had
policies requiring teachers to conduct classroom exercise breaks. Individual school
practices varied, and included school wide morning exercises, commercially available
videos and activity examples, and unique teacher-developed activities. All exercise
breaks last approximately 5 minutes or less. Principals cited numerous benefits of the
breaks including improved student behavior, attention, and health.
Study Two found that math performance increased after 10 minutes of
classroom exercise breaks compared to the sedentary condition. There were no
decreases in performance on the other cognitive tasks. Students with lower IQ, higher
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fitness, higher BMI, better behavior and lower school engagement had greater
improvement in their math scores.
Study Three found that students had higher on-task behavior after 10 and 20
minutes of classroom exercise breaks compared to the sedentary condition. The results
varied for individual classrooms, with no classrooms having decreased on-task behavior
after any of the exercise conditions. Students with lower IQ, higher fitness, and lower
BMI had the greatest improvements in on-task behavior. Boys decreased on-task
behavior after 5 minutes of exercise, but had higher on-task behavior after 10 minutes
of exercise compared to sedentary.
Study Four found that students had significantly higher positive affect during 5,
10, and 20 minutes of classroom exercise breaks compared to the seated classroom
activity. Females had higher positive affect responses, and students with lower fitness
had greater improvements in positive affect during 5 minutes of classroom exercise.
There were no differences in the positive affect responses between student IQ or BMI.
Overall, this dissertation found that classroom exercise breaks are highly
prevalent in central South Carolina, yet most of the breaks last 5 minutes or less. This
may be problematic as 10-minute classroom exercise breaks were the only duration to
improve math performance, on-task behavior, and positive affect. Ten to 20 minutes of
acute exercise has previously shown to improve cognitive functions14 and on-task
behavior in children.18, 19 While this was the first study to directly compare different
durations of classroom exercise breaks, Kubesch et al. also did not find improvements
after 5 minutes of classroom exercise on cognitive outcomes compared to 20 minutes of
116
physical education.20 The findings from this dissertation confirm previous findings that
longer durations have been more effective than shorter durations on various
educational outcomes.16, 21-24
Limitations
There were several limitations of this dissertation. A limitation of Study One was
the potential for reporting bias by principals. There is a chance that the non-responders
were less likely to participate in classroom exercise breaks. Additionally, due to social
desirability, principals are likely to over-report practicing classroom exercise breaks.
These are concerns with all surveys. However, this was a preliminary study to get an
overview of practices. Further studies with direct observation of practices are needed to
get a reliable and objective description of what schools are practicing.
Studies Two, Three and Four were “real world” efficacy studies. The classroom
exercise breaks were implemented by research staff. The research staff ensured high
fidelity of the intervention and control over the dose delivered, but classroom exercise
breaks implemented by outside staff cannot be easily sustained in a school. This
dissertation only examined the acute effects of classroom exercise breaks. It is possible
that regular implementation would decrease novelty and lead to additional
physiological and psychological effects that would influence the students’ responses in
educational outcomes to classroom exercise breaks.
Practical Implications
Policymakers and administrators should recognize the need to provide training
and resources for teachers to implement 10-minute classroom activity breaks. Training
117
may include professional development workshops where teachers learn the importance
and benefits of physical activity and how to conduct high quality classroom exercise
breaks. Resources could include high quality and student–friendly exercise videos as
well as example activities. One large resource for supplying and generating ideas for
classroom exercise breaks is other teachers who are already implementing these
practices. Educational agencies can provide opportunities for in-person and online ideasharing including professional development workshops or web-based social networks.
To ensure widespread implementation of these practices, administrators may
need to implement top-down policies requiring teachers to implement classroom
exercise breaks. However, successful examples of implementation emphasize the
importance of integrating physical activity into school-wide standard best-practices at
the teacher-level. Both bottom-up and top-down efforts may be needed for successful
implementation. If teachers cannot implement 10-minute classroom exercise breaks,
schools may need to find other physical activity opportunities of this duration to receive
the benefits such as outdoor recess integrated throughout the school day or daily
physical education. They may also be able to integrate physical activity with academic
content. While 10-minute classroom exercise breaks had the most acute benefits in the
current studies, teachers should not be discouraged from conducting shorter exercise
breaks as there were no detrimental effects on executive functions, math performance,
on-task behavior or affect.
118
Considerations for Future Research
The findings from this dissertation elicit additional research questions for future
studies. To verify the reported practices of principals in Study One, direct observation or
other objective measures of duration and student physical activity levels are needed. If
the actual duration and intensity of existing classroom breaks are not satisfactory,
efforts should focus on improving the quality of these current practices.
This dissertation was the first to directly compare the acute effects of various
durations of classroom exercise breaks on educational outcomes. Future studies are
needed to examine the dose response of various durations over the long term and to
examine the relationships among these variables. The routinization and reduced novelty
of regular classroom exercise breaks may have different physiological and psychological
responses, thus leading to different educational as well as health effects. For example,
regular, five-minute classroom exercise breaks may have positive effects on educational
outcomes when implemented multiple times per day.
Further research is needed to explore the individual and classroom variations in
the effects of classroom exercise breaks on cognitive and academic performance. If the
differential effects from this dissertation are confirmed, it may be possible to tailor
classroom exercise break recommendations for different students or classrooms. For
example, some classrooms may benefit from high intensity 10 minute breaks while
others receive greater benefits from lighter intensity or shorter duration breaks.
This dissertation was implemented by research staff, and future studies will need
to explore how teachers can effectively and efficiently be trained to implement these
119
practices. As the principals in Study One reported, the best source of ideas and
encouragement is fellow teachers. Communities-of-practice for school physical activity
need to be established to disseminate these practices.
Conclusion
Classroom exercise breaks of 10 minutes had the most beneficial effects on
student math performance, on-task behavior and positive affect. There were no
beneficial effects on any of the educational outcomes after 5 minutes, however, there
were no detrimental effects on any of the outcomes after any of the durations. Most
classroom exercise breaks being currently implemented in schools are shorter than 10
minutes. Future efforts are needed to train teachers to implement exercise breaks of
this duration or to find other physical activity opportunities of equal duration. Schools
may need to adopt policies requiring longer classroom exercise breaks.
120
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12. Field T, Diego M, Sanders CE. Exercise is positively related to adolescents'
relationships and academics. Adolescence. 2001;36(141):105-10.
13. Tremblay MS, Inman JW, Willms JD. The relationship between physical activity,
self-esteem, and academic achievement in 12-year-old children. Pediatr Exerc Sci.
2000;12:312-23.
15. Stroth S, Kubesch S, Dieterle K, Ruchsow M, Heim R, Kiefer M. Physical fitness, but
not acute exercise modulates event-related potential indices for executive control
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122
123
CHAPTER 7
PROPOSAL
Introduction
In order to meet the academic achievement goals set by No Child Left Behind,
many schools have decreased or eliminated planned physical activity opportunities. 1
The removal of these opportunities has potentially detrimental consequences for
children’s physical, mental and social wellbeing.2 These negative health outcomes could
have adverse effects on the very academic achievement goals that schools were
originally attempting to meet.
Researchers have investigated the link between academic achievement and
physical activity, with promising initial results. Cross–sectional studies have
demonstrated positive correlations between academic achievement and fitness,3, 4
physical activity5 and physical education,6 though it is not possible to draw causal
inferences.7 Some experimental studies have reported significant improvements in
cognitive functioning resulting from exercise interventions.8-10 Executive function, the
component of cognitive functions that includes the ability to plan, organize, prioritize,
and quickly shift between activities, seems to be particularly sensitive to physical
activity.11 Taken together, these data suggest that the current strategy of cutting
124
physical activity in favor of academics may be counterproductive, due to the importance
of executive function in academic outcomes.12, 13
This dissertation focuses on the cognitive effects of a specific type of physical
activity: short bouts of exercise integrated into the classroom. The optimal dose of
classroom exercise breaks is unknown. While the majority of prior research has focused
on the effects of exercise of longer durations (20 to 30 minutes), some schools have
begun implementing breaks of shorter duration. These high intensity exercise breaks
may deliver a dose of physical activity more efficiently than traditional recess14, 15 and
physical education.16, 17 Preliminary findings suggest classroom exercise breaks are
acceptable to teachers and may improve cognitive outcomes.18 Additionally, short
breaks are a fun, cost effective and easy to implement option for increasing physical
activity levels in school-aged children. While, little is known about factors influencing
the implementation of these exercise breaks in schools,19 a better understanding of
such barriers and facilitators will increase the probability that future exercise programs
are successful.
Aims and Hypotheses
Aim 1: Determine the prevalence and characteristics of classroom exercise breaks in
elementary schools in Central South Carolina.
Objective 1a: Determine the prevalence of classroom exercise breaks in elementary
schools in Central South Carolina.
Hypothesis 1a: The prevalence of classroom exercise breaks will be 75 percent.
125
Objective 1b: Describe the characteristics of classroom exercise breaks in elementary
schools in Central South Carolina.
Hypothesis 1b: The majority of classroom exercise breaks will be led by classroom
teachers, be integrated into academic lessons, and will be short
duration.
Objective 1c: Determine characteristics influencing the implementation of classroom
exercise breaks in elementary schools in Central South Carolina.
Hypothesis 1c: Elementary schools implementing classroom exercise breaks will have
fewer barriers and more facilitators than schools not implementing
Aim 2: Describe the acute effects of classroom exercise breaks on cognitive functions
including executive function and academic performance of elementary school
students.
Objective 2a: Determine the acute effects of classroom exercise breaks on cognitive
functions including executive function and academic performance.
Hypothesis 2a: Acute classroom exercise breaks will have a positive effect on
cognitive functions.
Objective 2b: Describe the dose-response relationship between duration of
classroom exercise breaks and post exercise cognitive functions.
Hypothesis 2b: Acute classroom exercise breaks of 5, 10, and 20 minutes will have
progressively more positive effects on cognitive functions.
126
Objective 2c: Identify whether the acute effects of classroom exercise on cognitive
functions are modified by baseline levels of general intelligence,
parent-rated behavior, fitness, or Body Mass Index.
Hypothesis 2c: Students with lower general intelligence, poorer behavior, lower
fitness and higher body mass index will have more positive responses in
cognitive functions to classroom exercise breaks.
Aim 3: Describe the acute effects of classroom exercise breaks on attention of
elementary school students.
Objective 2a: Determine the acute effects of classroom exercise breaks on attention.
attention.
classroom exercise breaks and post exercise attention.
progressively more positive effects on attention.
Objective 2c: Identify whether the acute effects of classroom exercise on attention
are modified by baseline levels of general intelligence, parent-rated
behavior, fitness, or Body Mass Index.
fitness and higher body mass index will have more positive responses in
attention to classroom exercise breaks.
127
Aim 4: Determine student affective responses to classroom exercise breaks.
Objective 3a: Compare student affective responses to classroom exercise breaks
with the response to a sedentary classroom activity.
Hypothesis 3a: Students will have a more positive affective response during
classroom exercise breaks than during a sedentary classroom activity.
Objective 3b: Describe the dose-response relationship between durations of
classroom exercise breaks and student affective response.
non-linear effects on student affective responses.
Objective 3c: Describe student and teacher subjective responses to classroom
exercise breaks.
Hypothesis 3c: Student and teachers will report positive subjective responses to
Significance of the Proposed Study
This project has immediate practical implications. The media has highlighted
schools incorporating classroom exercise breaks into the school day.20 Yet no research
studies have examined the prevalence and characteristics of these increasingly common
practices, including the optimal duration of classroom exercise breaks. Once the
proposed aims are achieved, schools can potentially implement efficient physical
activity breaks and schedule physical activity throughout the day to not only improve
student health but also maximize learning and academic achievement. Time is a critical
128
resource in schools and one of the most common barriers to implementing physical
activity; therefore it is crucial to maximize efficiency in implementing physical activity
breaks throughout the day. Thus, it is important to discern what dose is necessary for
positive outcomes. Future research that builds on this preliminary work could inform
administrators on how to best allocate time for physical activity. If the relationship
between exercise and executive function is scientifically validated, and the optimal
exercise protocol is determined, classroom exercise breaks will be a legitimate tool for
increasing children’s physical activity, and possibly improving classroom learning.
Understanding the barriers and facilitators for implementing these practices can help
other schools implement classroom exercise breaks.
Limitations
During the intervention, children may not participate in moderate to vigorous
physical activity for the entire duration. The instructor will encourage and give support,
and offer other activity type options. At no time will the participants be forced to
exercise, and noncompliance will be noted. All results will be analyzed using intent to
treat analysis with additional sensitivity analyses.
Due to the short window for testing, a limited testing battery was selected.
Ideally, administering more tests would include a more comprehensive assessment of
executive function. However, the simple and short battery provides a broad assessment
of critical educational outcomes.
A limitation to testing executive function is the potential for practice effects. To
limit practice effects, the testing is spread over four weeks, and classrooms are
129
randomized to the order of conditions. It is expected that the effect of exercise will be
greater than the practice effects. Other results are possible, however, as this is an
exploratory study. If no change is seen, this may be evidence that 20 minutes of exercise
is not sufficient to elicit cognitive changes seen in previous studies, there was a failure of
the cognitive battery to detect these changes, or practice effects obfuscated any
intervention effects. It is also possible that a decrement in cognitive function and/or
attention may occur due to hyperarousal from exercise.
The complex stratified sampling to obtain a representative sample for Study One
may result in a non-representative sample of schools participating in interviews and
observations due to selection bias. Though the schools will be selected randomly,
schools willing to participate may have different classroom exercise breaks than schools
refusing participation. In interviews, it is possible that the participant will give socially
desirable answers. This will present a bias favoring the classroom exercise breaks.
During observations, because of outsider observers, it is possible the teachers may
change their behavior so that it is not representative of regular classroom practices.
Review of Literature
Definitions
There are multiple goals of education. The Thoughtful Classroom Teacher
Effectiveness Framework, used in New York, New Jersey, and Michigan suggests that
successful learners are engaged and enjoy learning. Students are energetic and
enthusiastic, display effort, enjoy themselves in the classroom, express their own
130
interests and ideas, are on-task and motivated, stretch their minds with different forms
of thinking. Therefore, several educational outcomes will be examined including
academic achievement, cognitive functions, executive function and affect, all
operationalized as unique constructs. While several organizations have differing, specific
definitions of academic achievement (i.e. scores on a particular state achievement test),
academic achievement will be broadly defined as the quality and quantity of a student’s
work. Cognition encompasses a wide array of mental processes including, but not
limited to attention, executive functions, and perception.
Executive function includes the ability to plan, organize, prioritize, and quickly
shift between activities based on the inter-related skills of response inhibition, working
memory, and set shifting.21, 22
Affect is consciously accessible feelings that can be separated from a specific
circumstance: a part of emotions.23 Affect is experienced broadly on a continuum
ranging from positive to negative.
Classroom exercise breaks are short bouts of exercise integrated into the
classroom. Exercise is physical activity performed to improve fitness, while physical
activity is any body movement that raises energy expenditure above resting.24
Moderate-to-vigorous physical activity (MVPA) has been shown to have the greatest
health benefits and is defined in youth as greater than 4 METS. 25
Implementation is putting policy into action or turning policy into practice. 26
Interventions and policies that have been enacted are not directly translated into
outcomes; they must be implemented.
131
Physical Activity and Children’s Health
The Surgeon General's Report on Physical Activity and Health described the
strong association between physical activity and heart disease, stroke, hypertension,
cancer, diabetes, obesity and many other diseases and conditions.27 These negative
health consequences do not affect just adults, but children as well. The World Health
Organization cites physical activity as essential for muscle and bone development,
cardiovascular health, coordination, maintenance of a healthy body weight, as well as
social and psychological benefits in children.28
America’s children and youth have a poor health profile. Fitness has decreased in
developed countries, with the greatest decline in the United States.29 According to
National Health and Nutrition Examination Survey, 7.5 million or 33.6 percent of
adolescents have low cardiorespiratory fitness.30 Of all elementary students in
California, only 45 to 48 percent of students passed at least one of the tests of muscular
strength and endurance.31 In a sample of 375 7 to 9 year old children in Kansas, 5
percent had metabolic syndrome, 37 percent had high blood pressure, 18 percent had
high triglycerides, and half had at least one symptom of metabolic syndrome. 32
Seventeen percent of children and adolescents from 2 to 19 are overweight or obese. 33
In addition to increased adiposity, the timing of the adiposity rebound has become
earlier,34 and an early adiposity rebound may lead to increased adiposity later in life. 35
The adiposity rebound is when BMI begins to increase between the ages of 4 to 6, after
reaching its lowest point.
132
Physical activity has been shown to improve cardiorespiratory fitness by 5 to 20
percent,36 increase muscular strength,37 improve metabolic health,38 improve bone
health,39 decrease rates of adiposity,40, 41 and may relate to a later adiposity rebound.41
Physical activity also improves self-esteem and reduces depression in children and
youth.42 Thus it is recommended that children between the ages of 6 and 17 participate
in at least 60 minutes a day of physical activity including muscle and bone strengthening
activities on three days per week.43
Physical Activity Prevalence in Children
Physical inactivity is one of the greatest public health concerns of the 21 st
century. America is in an obesity and physical activity crisis, and the problem is not just
in adults. According to the National Youth Risk Behavior Surveillance System, in 2009,
only 18.4 percent of high school students were active at the recommended levels of 60
minutes every day and only 37 percent were active 5 days of the week.44 Girls are much
less active than boys with only 11.4 percent of girls meeting the recommendations as
compared to 24.8 percent of boys. In addition, black males and females are less active
than their white counterparts with 10 percent of black females meeting
recommendations and 24.4 percent of black males. And physical activity decreases with
increasing age; 21.3 percent of ninth graders met recommended levels compared to
only 15.3 percent of twelfth graders.44 In children aged six to eleven, 46 percent meet
recommended guidelines as measured directly by accelerometry.45
South Carolina is one of the least active states in the nation. Only 17.1 percent of
high school students were active for at least 60 minutes a day in the past seven days. 44
133
Accurate physical activity prevalence data for elementary age children is unavailable.
Physical activity begins to decline starting at age nine throughout young adulthood. 46, 47
Instilling the importance of physical activity in children is important.
Physical Activity Interventions in Children
Fortunately, physical activity is a modifiable behavior, and several approaches
have been taken to increase physical activity. In 2002, the Task Force for Community
Preventive Services reviewed and evaluated the effectiveness of multiple approaches to
increasing physical activity.48 They found evidence in support of informational
campaigns (point of decision prompts and community-wide campaigns), environmental
and policy approaches, and behavioral and social interventions (such as school-based
physical education).
Afterschool
The afterschool setting has been intervened upon in attempt to increase overall
physical activity. In a meta-analysis of 11 afterschool interventions, Beets et al. found a
positive effect of .44 for increasing physical activity.49 In another review of nine
afterschool physical activity interventions, Atkin et el. found three of the nine studies
reported positive changes in physical activity.50 Intervention approaches have ranged
from fitness-based interventions51 to multi-sport programs.52 There have been mixed
results in afterschool interventions. The Girls Health Enrichment Multi-site Studies
(GEMS) included four site-specific interventions to decrease obesity and increase
physical activity in young African American girls. Each site was individually tailored for
the local population. Two of the programs were successful: a parent and child group
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meeting in Tennessee and community dance classes in California. These two
interventions are now being conducted as full-sized randomized control trials.53
Home and Community
Perhaps the most difficult setting to reach has been the home and family setting.
Interventions in this setting have included family group meetings with pedometers54 and
preschool children with parent pairs.55 Other types of interventions have included
community-based and media campaigns. A wide-scale media campaign VERB, also had
successful results. VERB was a national social marketing and branding campaign
conducted by the CDC to increase physical activity levels in “tweens” aging from nine to
thirteen. After four years, a dose response relationship was found between media
exposure and physical activity levels.56 Unfortunately, funding ran out and the campaign
had to be discontinued.
Current environmental level interventions are identifying the determinants of
and ways to promote active commuting to school in children. As part of the 2005 Safe,
Accountable, Flexible, Efficient Transportation Equity Act, the Safe Routes to School
program includes funding for infrastructure to promote active commuting to school,
including sidewalks and bicycle lanes.57
Policy
One way to establish physical activity practices, such as classroom exercise
breaks, are by creating policies. Policy interventions, whether at the federal, state or
school level also offer promise for increasing physical activity. The Centers for Disease
Control58 and National Physical Activity Plan59 advocate for physical activity programs in
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schools. Policies are a guide to discretionary action60 and can range from federal
legislation to policies implemented by school boards or school administrators. One
sector that has received a large focus of physical activity policy is the school setting. A
review of school health policies found that 70 percent of schools nationwide have
adopted policies to follow national physical education guidelines.61 In South Carolina,
the Student Health and Fitness Act of 2005 (SHFA) requires minimum physical education
and physical activity minutes in elementary schools across the state. The SHFA requires
150 minutes of physical education and physical activity combined, with 90 minutes of
physical activity.
The Exercise is Medicine campaign is trying to influence healthcare policy to
incorporate physical activity as a compensated vital sign that is assessed at each
doctors’ visit and prescribed. For example, a child may wear an accelerometer to track
physical activity levels, and then if levels are inadequate, the family may be referred to
an exercise specialist. The consultation and future exercise sessions would be
compensated through health insurance. Individual primary care interventions have been
implemented in pediatric settings with limited success.62
Evidence shows that despite increased policy efforts, there are many gaps in the
process of translating these school-based policies into positive outcomes. Nanney et al.
reviewed school nutrition and physical activity policy adoption and found that only 38
percent of the 148 physical activity policy objectives selected by Nanney et al. were
adopted by state governments, showing the limited reach of these policies.63
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In addition to traditional school-based, community, environmental and policy
interventions, there are innovative strategies being used. In Arkansas, school-wide
reports of Body Mass Index are being sent home with each child 64, and rapidly
developing technological advances, such as cell phone activity monitors, are being
piloted for physical activity promotion.
Physical Activity in Schools
School settings offer a large potential to increase physical activity and several
interventions have successfully increased physical activity in this population. Over 95
percent of children, over 50 million children, between the ages of 5 and 17 attend
school.65 Because children are required to attend school, schools have the potential to
increase physical activity in a large percentage of the population through recess,
physical activity in the classroom and physical education. The American Heart
Association described the essential role that schools should play in establishing physical
activity promoting policies and practices.66 School day physical activity accounts for at
least 70 percent of children’s MVPA.67 Schools also play a critical role in helping children
to meet physical activity guidelines.68 In a time when family backgrounds and home
environments are shown to be critical to health behaviors, school based interventions
may provide an equal opportunity for all children. School-based interventions affect
physical activity similarly across family backgrounds.69
Despite specific objectives in Healthy People 2010 to increase physical education
requirements and participation,70 and only 56 percent of children report having physical
education at least once a week.44 The School Health Policies and Programs Study
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surveyed schools nationwide and found the percentage of schools requiring physical
education ranged from 20 percent of schools in eleventh and twelfth grades to 60
percent in elementary school grades.71 While physical education is not the only
opportunity for physical activity, it is the most publicized and has had the largest
advocacy efforts. Only 11 percent of states and 57 percent of local districts require
recess in elementary school.
The school setting has been one of the most common settings for youth physical
activity interventions. Several reviews have been conducted of school-based physical
activity interventions. In a meta-analysis of 8 studies, Katz et al. found reductions in
body weight with combined physical activity and nutritional interventions but no
reduction with physical activity interventions alone.72 However, Durant critiqued the
review citing small effects, limited reliability, and emphasized the need to employ novel
strategies in new school based interventions.73 A recent review of 26 school-based
studies concluded that there was no evidence of negative effects and some evidence of
positive effects from school-based interventions and recommended the continued
promotion of physical activity in this setting.74 School based interventions had positive
outcomes on the duration of physical activity while in school, cholesterol and fitness,
but did not improve blood pressure, or body mass index. There has been large
heterogeneity among school-based intervention studies, so further research is needed.
The Child and Adolescent Trial for Cardiovascular Health (CATCH) is one of the
most popular school-wide interventions, and its curriculums are currently being
disseminated. CATCH was a multi-center intervention in third graders to reduce
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cardiovascular risk factors. It consisted of 30 minutes of physical education three times
per week and goals to decrease the intake of fat and sodium in school food. After two
and a half years, there were no significant changes in overall cardiovascular profile, but
moderate to vigorous physical activity increased during physical education classes.75
Comprehensive interventions, such as CATCH, including physical education,
recess, and education components, have had varied results. In 3rd and 4th graders in
North Carolina, the only significant findings after the 8-week Cardiovascular Health in
Children intervention were increased physical activity knowledge and self-reported
physical activity.76 Action Schools! BC in Canada increased daily step counts in 9 to 11
year-old boys but not girls.77 In 15 elementary schools in Switzerland, a multicomponent intervention increased physical activity and fitness and decreased
adiposity.78
While there have been a large number of school-based interventions, many have
been of weak methodology. In concurrence with the Task Force for Community
Preventive Services’ recommendations, physical activity interventions should continue
to be implemented in schools, because they have the potential to affect a large number
of children. It is necessary to continue to test the efficacy and effectiveness of
innovative school-based interventions. In addition to providing students knowledge,
they should teach skills to children to improve self efficacy and increase lifelong physical
activity as well as include efforts to increase parental support. Due to these issues, there
is a need to test different approaches beyond broad school-wide interventions.79
Physical Education
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Despite recommendations, few schools provide mandatory daily physical
education. The National Association for Sport and Physical Education as well as new
school health guidelines from the Centers for Disease Control recommend 30 minutes of
daily PE for elementary students and 45 minutes for secondary school students.58 While
69.3 percent of elementary schools require physical education, only 3.8 percent of
elementary schools provide daily physical education.71
These organizations and agencies also distinguish the need for quality physical
education. Physical education does not necessarily include physical activity; “Education
for a physically active lifestyle does not always involve participation in vigorous activity”
(p. 484).80 Teachers may have students waiting in lines, or standing and doing drills,
which are not opportunities for physical activity. One study involving timed observations
of physical education classes found that only 9 percent of class time involved moderateto-vigorous physical activity16 while another found 3rd graders to participate in MVPA
36.2 percent of their 30 minute physical education class.17
Physical education interventions have been shown to increase MVPA during
physical education class, but have thus far not shown increases in physical activity out of
school or over the long term.81 Even physical education classes with at least 50 percent
of class time in MVPA make a small contribution to meeting physical activity guidelines.
For example, Sports, Play and Active Recreation for Kids (SPARK) provided 40 minutes of
MVPA in physical education per week, which is 13 percent of the total recommended
level of physical activity.82
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The now highly marketed physical education intervention, SPARK, was a physical
activity intervention for fourth-graders in California schools. It consisted of 30 minutes
of physical education three times per week as well as weekly classroom lessons on selfmanagement. After two years of implementation, students in SPARK schools spent twice
as much time in moderate to vigorous physical activity than control schools (40.2 and
17.8 minutes respectively) but there were limited fitness gains seen only in girls. 82 Move
it Groove it, a physical education intervention in Australia, non-significantly increased
MVPA by 4.5 percent or less than one minute per physical education class.83 This
intervention included project teams, teacher training and resources, and small
equipment grants. The Middle School Physical Activity and Nutrition (M-SPAN)
intervention provided staff development for middle school physical education teachers
to increase MVPA in existing curriculums.84 M-SPAN increased the percentage of time in
MVPA from 48 percent to 52 percent, which was a non-significant increase compared to
control schools.
Recess
School recess has been found to be the most active opportunity throughout the
school day85 and is also important for children’s emotional and social development.86
Only 11.8 percent of schools require recess and 25.5 percent recommend regular
recess.71 Even when children get out to the playground, actual physical activity levels at
recess are often lower than expected and girls are less active than boys at recess.14, 15, 87,
88
Thus recess only makes up 15 to 20 percent of school day MVPA,14 but may
contribute more for the least active children.89
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Recess interventions have attempted to increase physical activity levels on the
playground. Providing markings and play equipment did not increase physical activity
levels of preschoolers who only engaged in MVPA for 11 percent of recess.88 Small pilot
studies in elementary schools including staff training, activity zones and portable
equipment have shown small increases in recess activity measured through
accelerometers and pedometers.90, 91 Some recess interventions have shown null or
negative effects on physical activity.92, 93 Stellino et al. tested multiple recess
interventions for elementary school students including a circuit course, obstacle course
and Frisbee games.92 They found these activities decreased children’s MVPA.
Classroom Exercise Breaks
Many school districts report cutting physical education in response to No Child
Left Behind (NCLB). The Center for Education Policy reports that 68 percent of schools
report funding decreases to staff in non-core academic areas, including physical
education, with another 50 percent anticipating further cuts the 2011-2012 school
year.94 Physical activity and physical education often come secondary to primary
subjects that are tested in standardized tests.95, 96 Evidence from Arkansas suggests that
NCLB has increased overweight and physical inactivity in children.97 An alternative way
to meet physical activity recommendations with limited time and resources for intensive
physical education and recess are classroom exercise breaks. These five to ten minute
sessions integrate short bouts of exercise in the classroom and are recommended as a
tool to increase school physical activity.58, 98
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The School Health Policies and Programs study found 43.6 percent of elementary
schools self-reported including physical activity breaks outside of physical education and
recess.71 In adults, research has shown that bouts as short as 10 minutes confer health
benefits, with little research on bouts shorter than 10 minutes.99 Using cross-sectional
NHANES data, Mark and Janssen found that bouts of physical activity predicted
decreased adiposity, independent of the volume of physical activity in youth. 100 Liu et
al.’s Happy 10 program incorporated at least one 10 minute exercise break in first
through fifth grade classrooms and found an improvement in BMI after a school year. 101
The sessions were of moderate to vigorous intensity with 25 to 35.1 kcals per session. In
another study, schools that implemented at least 75 minutes per week of short exercise
breaks had less of an increase in BMI compared to controls and schools that did not
implement at least 75 minutes.102
A review of exercise breaks found that school-based exercise breaks increased
physical activity, though most physical activity measures were self-report.103 Some of
the studies included in the review reported positive changes in fitness or determinants,
but there was little evidence of changes in BMI. Objective pedometers have shown
classroom exercise breaks to increase physical activity.89, 104
In South Carolina, the Student Health and Fitness Act requires 90 minutes of
physical activity beyond physical education. The physical activity time can include recess
and other physical activity opportunities including exercise breaks. The Department of
Education annually collects information from district representatives on opportunities
for physical education and physical activity in kindergarten through 5 th grade and
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compiles the information annually as the Report for the Implementation of Physical
Education and Physical Activity Minutes for Students in Grades Kindergarten through
Five as Required by the Students Health and Fitness Act of 2005.105 The design of the
survey used for evaluation report of SHFA is closed response, with “yes/no”, “check all
that apply”.
In the most recent report, 38 percent of schools reported practicing video
exercise (including aerobic videos, jazzercise, deskercise, FitKids, energizers), 35 percent
reported morning exercise (including morning stretching, morning calisthenics, CORE
exercise), and 66 percent reported classroom exercise led by teachers.106 While these
practices have increased since 2007-2008, they have decreased from the previous two
years; See TABLE 7.1.
Physical Activity Implementation
Despite the large number of physical activity interventions, few studies have
collected in-depth information on the process of implementation. There has been
slightly more research on physical activity policy implementation particularly in the
school setting. Although there are many definitions of implementation, implementation
is operationally defined as putting policy into action or turning policy into practice. 26
With the proliferation of state level physical activity policies, researchers have
attempted to analyze these policies in several states. Researchers in Colorado and North
Carolina have taken preliminary steps to assess the policy implementation process
through interviews and surveys of district representatives. Belansky et al. conducted
interviews with key informants in elementary schools in Colorado to assess the success
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of Colorado State Bill 05-81, a wellness policy bill passed in 2005.107 These interviews
uncovered details about the implementation process, including barriers to
implementation such as academic pressures, inadequate resources, lack of knowledge,
and lack of enforcement. These are similar to the top barriers reported to implementing
the Student Health and Fitness Act in South Carolina which included scheduling issues
and funding.106
In North Carolina, Evenson, Ballard, Lee, and Ammerman distributed online
surveys to district representatives in evaluation of the state’s 2005 Healthy Active
Children Policy.108 Several school-level strategies, positive benefits and barriers (lack of
time and academic pressures) were reported, though the authors noted that district
responders were not representing individual schools. Kelder et al. used both surveys and
direct observation and found that while school and physical education teachers
reported physical activity minutes at or above required levels, students reported levels
well below these requirements.109 There was no evaluation of the implementation
process.
Brownson et al. stress the need to better understand the real-world factors that
influence the implementation at the school level.19 Qualitative approaches provide
appropriate methods for uncovering this process. Despite the usefulness of qualitative
research to understand the process of policy implementation by school administrators,
few qualitative studies have been conducted.107, 110, 111 In his argument for increased
qualitative and ethnographic research in education policy analysis, Odden emphasized
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the importance of going beyond assessing whether a program is implemented, but
assessing the quality of implementation as well.112
Currently, physical activity implementation analysis has been primarily limited to
quantitative evaluation which has produced limited information on the process of
implementation. Qualitative assessments can also capture the contextual elements that
are crucial to success or failure of an intervention. For example, there is not a culture of
physical activity promotion in schools which is a primary barrier to increasing school
physical activity. As one superintendent explained, “What we continue to hear is ‘No
Child Left Behind.’ I haven’t heard ‘Don’t leave fat kids behind.’ It’s about keeping kids
academically fit. That’s foremost on our minds.”107(p S155) Physical activity policy research
needs more research using quantitative and qualitative study designs.26
The design of the survey used for evaluation report of South Carolina’s SHFA is
closed response, with “yes/no” and “check all that apply” responses and reporting of
minutes of opportunity by classroom.105 Qualitative interviews, such as focus groups
directly with implementers (teachers), would provide a more detailed account of
implementation.
Most physical activity implementation research has focused on reports from
district-level administrators. Self-reports from district-level administrators are not
accurate sources for implementation evaluation. First, self-report is not consistently
reliable. For example, one school reported 375 minutes of physical activity and 300
minutes of physical education per week.105 Such a total would constitute two hours a
day of physical activity time during each school day; such an extreme outlier can be
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assumed not to reflect the actual practice in the school. In addition, in the 2010-2011
data from the PEPA report, 17 schools had discrepancies between the two or more
administrators reporting school level data. Secondly, district administrators do not
accurately represent local school-level implementation and school-level personnel often
do not represent individual classrooms.108 There is large within district variation in
implementation of state level education policies.113 Local educators are more likely to
accurately report local implementation.
Physical Activity and Educational Outcomes
Large cross-sectional studies have shown that physical activity,114-122 physical
education6 and fitness levels3, 4, 31, 123-127 are associated with the broad outcome of
academic achievement, often performance on standardized tests. Some cross-sectional
studies have examined more specific cognitive outcomes.10, 128-130 Longitudinally, fitness
has shown to be predictive of academics over time.131 More specifically, several studies
have attempted to uncover the causal relationship between acute exercise and
cognition in children10, 132-134 with overall positive effects.135 Fewer longitudinal
experimental designs have assessed the effects of chronic exercise on cognition in
children. Davis et al. has found that a 9 month aerobic afterschool program increased
planning skills, achievement, and fMRI activity.8, 136 Kamijo et al. demonstrated that a
similar afterschool intervention improved working memory and event-related potentials
using electroencephalography.9 In adults, a recent meta-analysis of randomized control
trials did find a consistent positive effect of physical activity on cognition. 137 A review of
147
the acute effects of exercise on cognition found that exercise may improve response
speed, response accuracy, complex thinking and problem solving.138
Specifically, effectiveness studies have examined various types of school day
physical activity and cognitive or academic outcomes. Acute physical activity exposure
has ranged from stretching,139 to outdoor recess,140 to physical education classes141-144
and inclusive long-term interventions.145-150 There have been varied outcomes used as
well ranging from attention140, 142 to math scores.144, 151 Recently, there have been
effectiveness studies examining classroom physical activity and various outcomes. See
TABLE 7.2.
Only three studies have examined the acute effects of these short exercise bouts
in children. Mahar et al. examined time-on-task after 10 minutes of integrated physical
activity and found a positive effect.152 Kubesch et al. examined cognitive performance
on the flanker and dots tasks and found no improvement after 5 minutes of classroom
physical activity.141 Grieco et al. found that an integrated classroom exercise
intervention improved time-on-task.153 Three other primary studies have examined
chronic effects of teacher implemented classroom exercise. Donnelly et al.,102 Katz et
al.,154 and Reed155 all examined the effects of regularly implemented classroom physical
activity and found positive effects on academic achievement. Reed et al. also found
positive improvements in fluid intelligence.155 Additionally, components of Take 10!
have been integrated into numerous interventions, and in a review, have had a
generally positive effect on educational and health outcomes.156
148
These studies have had varied outcomes and limited process evaluations.
Donnelly et al.,102 had the most extensive process evaluation on the fidelity of
implementation,157 while other studies ranged from no monitoring to single random site
visits. Without complete monitoring of the intervention, it is impossible to quantify the
dose needed to elicit positive outcomes in these effectiveness trials. The dose of
physical activity has also ranged from 90 minutes per week in 10 minute bouts to a total
of 10 to 15 minutes per day integrated with classroom lessons.
Basch argues that current physical activity interventions in schools are not
designed for the best educational outcomes.158 Diamond recommends that to best
improve executive functions, interventions should be fun, involve student interests,
vigorous activity, and involve social interaction.159
Mechanisms
The mechanism for improved cognition and academics is still unknown with
many controversial findings. One hypothesized model of mediators is shown in FIGURE
7.1. Exercise influences the whole body system and may have multiple points of
influence.160 Concurrent research has identified plausible evidence of the underlying
biological mechanisms for chronic adaptations, namely increases in Brain-Derived
Neurotrophic Factor (BDNF) and increased hippocampal neurogenesis,161 which support
these mental improvements. After three days of aerobic exercise in animal models,
BDNF modulated synapsin I and synatophysin, docking proteins needed for synaptic
transmission.162 In humans, Ferris et al. found that serum BDNF increases with high
intensity exercise, but these changes were not correlated with cognitive function
149
scores.163 However, Ferreira found that exercise may induce hippocampal plasticity
independent of BDNF,164 and in rats, there may be differential effects in adults and
adolescents.165 The type of exercise may influence BDNF response.166 Pereira et al.
showed an increase in cerebral blood volume in the dentate gyrus with exercise,
indicative of neurogenesis.167 Cross-sectional associations have been found between
fitness, hippocampal volume, and relational memory performance.168 In a small number
of children, Davis et al. found increased prefrontal and decreased posterior parietal
activation following a year long aerobic exercise program.136 The prefrontal region is
important for executive control and higher thinking tasks while the posterior parietal is
involved in planned actions.
Improvements in cognitive function following acute exercise have been related
to increased neuroelectric activity.169 Yanagisawa et al. found increased activity of the
left dorsolateral prefrontal cortex during a Stroop test in human adults.170 The
dorsolateral prefrontal cortex is important for working memory and organizing other
executive functions. In children, Hillman et al. found increased P3 amplitude indicative
of increased attentional allocation following 20 minutes of walking.10 Another theory is
that exercise increases arousal through the release of catecholamines which improves
cognitive processes.171 However most of this research has been correlational, limiting
causal inferences. McMorriss did not find that catecholamines, including serotonin and
endorphins, were directly related to cognitive performance during exercise, but there is
a more complex correlational relationship.172 Another hypothesis is the increased
oxygenation in the brain from increased cerebral blood flow from exercise improves
150
cognitive metabolism and performance. A review of 21 studies using near-infrared
spectroscopy found acute exercise increased oxygen in the brain.173
Executive Functions
Of the cognitive abilities shown to improve exercise or fitness, the strongest
effects have been seen in executive function.11 Exercise studies in children have
confirmed these improvements in executive function.10 Executive function, as defined
by Mikaye, are “general purpose control mechanisms that modulate the operation of
various cognitive subprocesses,”22(p50) or higher order complex cognitive process
including working memory, inhibition and cognitive flexibility as unique, but related,
components of executive function.174 Executive function has been researched
extensively in relation to learning disabilities, including ADHD, in clinical populations, 175
and have shown to be highly predictive of academic achievement with early
assessments of executive functions predicting later academic success.176 Executive
function is also a successful target of interventions.177
Attention
Attention has also been shown to be highly predictive of academic achievement
and learning in school.178 Based on Luria’s model, attention is the first functional unit of
mental processes, upon which higher order functions, such as planning and executive
functions are built.179 Specifically, selective attention depends on the ability to inhibit
distracters,179 which may relate to the inhibitory component of executive function.
Attention has been shown to improve with exercise,10, 152, 153 and the effects may be the
151
most beneficial in those with attention difficulties152 and with higher body mass
index.153
Affect
Some scholars argue that happiness itself is a goal of education.180 Having fun is
related to positive school engagement. One component of school engagement is
emotional engagement, or how much the student enjoys being at school.181 If a student
has fun at school, they are more likely to engage in the classroom182 and be motivated
to learn.183 A longitudinal study of students found that higher school engagement
predicted academic achievement.181, 184 Research has found that students who find
school boring and not fun have lower achievement.181 Positive affect also has been
shown to improve creative thinking and problem solving.185 Fredrickson proposed a
Broaden and Build theory by which positive affect and positive emotions expand the
individual’s thought-action repertoire and personal resources.23 Through multiple
experiments, Dreisbach found that positive affect modulates cognitive control in
changing situations and helps a person to become more cognitively flexible. 186
Fun is also important in increasing physical activities. Fun is the primary reason
children report for participating in physical activities187; children consider physical
activity to be fun.188 Diamond also suggests that positive emotional development is
critical for executive function and cognitive development.159 Barnes et al. argue for the
need for smiles and positive emotion in schools with a curriculum including physical
education.189
152
Summary
Previous studies examining the relationship between these educational
outcomes, particularly cognition, and physical activity have produced inconsistent
results, partly due to weak methodology. Measures chosen to assess executive function
have ranged in their psychological validity and field studies have had poor physical
activity fidelity measures. A review by Etnier et al. found that of 128 different measures
used to study cognitive processes and exercise, only 10 have been identified as common
neuropsychological measures of executive function.190 Gioia raised the issue of
ecological validity in executive function measurements.191 Many measures lack
verisimilitude (how testing demands and conditions reflect actual demands) and
veridicality (does the test predict everyday functioning), as most cognitive tests are
highly specific tasks administered in controlled laboratory settings. The results of these
tests are more difficult to directly apply to school outcomes. Recent work by Chaddock
and colleagues used a complex real-life, multi-tasking situation (street crossing) and
found higher fit children were better able to successfully cross the street, independent
of differences in physical performance.192 As a result of problems with methodology, the
optimal duration of exercise breaks throughout the day is unknown and the case to
convince policy makers of the value of physical activity for children in schools is not
optimized.
The purpose of this dissertation is to examine multiple educational outcomes of
classroom physical activity breaks. The overarching goal of this research is to inform
administrators and policy makers of the multiple benefits of physical activity beyond
153
health, in order to propose and enact school physical activity policies. This dissertation
will include a description of current classroom exercise break practices and an objective
examination of the cognitive and academic dose response to classroom activity breaks
and subjective, affective responses of students, teachers and administrators to
implementation of these breaks. I hypothesize that classroom exercise breaks will have
positive effects on cognitive, academic, and affective outcomes.
Theoretical Framework
This dissertation is framed by multiple theoretical frameworks from education
and health promotion. Including movement in the school day is consistent with multiple
educational theories including the whole child perspective, multiple intelligences theory,
and meta-volition theory.
Educational Theories
Both the multiple intelligences and whole child theories are similar educational
theories that emphasize multiple components of learning beyond typical cognitive and
content based intelligence. Movement is critical for kinesthetic learners and Gardner
argues for multi-modal instruction for all students.193 Gardner describes multiple
intelligences including linguistic, logical-mathematical, intrapersonal. Naturalistic,
spatial, musical, interpersonal intelligences may also be reached through classroom
exercise breaks through incorporation of musical songs, movement around the
classroom, and social interactions. Diamond, a developmental cognitive neuroscientist,
insists on the inclusion of physical play for the development of the whole child. 159 She
clearly articulates,
154
If we want the best academic outcomes, the most efficient and cost-effective route
to achieve that is, counter intuitively, not to narrowly focus on academics, but to
also address children's social, emotional, and physical development. Similarly, the
best and most efficient route to physical health is through also addressing
emotional, social, and cognitive wellness. Emotional wellness, similarly, depends
critically on social, cognitive, and physical wellness.159(p780)
Interventions using a whole child approach address academic, emotional and social
factors influencing youth.194 This method of education has been challenged by needs to
meet standards from No Child Left Behind. Schools have focused more on academic
achievement through teaching subjects explicitly included on state tests, often at the
expense of the whole child.
Meta-Volition Theory
Classroom exercise breaks as an intervention are supported by the meta-volition
model. Yancey’s meta-volition theory incorporates elements of the social ecologic
model to explain the success of institutionalized exercise break practices.195 Key
concepts in the meta-volition model include compulsory, ubiquitous and
institutionalized physical activity that is culturally adapted, fun, and socially supported.
In this dynamic theoretical framework, incorporating brief exercise breaks into
organizational routine affects multiple levels of the social ecological model including
interpersonal and environmental levels of behavior change. See FIGURE 7.2 for a
descriptive figure of the meta-volition model. The social ecological model as applied to
physical activity includes multiple levels influencing behavior including interpersonal,
environmental and policy.196 Classroom exercise breaks are policy-based and employ
the social environment to increase physical activity. The fun approach also relies on
social interactions and personal motivation.
155
In this model, action is initiated through an enthusiastic leader and a behavioral
catalyst; exercise breaks serve as the behavioral catalyst and a principal or teacher may
be the enthusiastic leader. Next, the process is automated as it becomes regular
practice. A viral marketing phase follows, where students and teachers began to talk of
the classroom exercise break practices and the perceived benefits. Eventually, these
practices will be spread to other schools and larger educational agencies. This
dissertation will consist of the beginning of the process by examining how educational
leaders influenced the implementation process.
Study One Methods
Purpose
The purpose of this study is to evaluate the prevalence and characteristics of
existing classroom exercise breaks in Central South Carolina. If classroom exercise
breaks are of low prevalence and quality, improving these classroom exercise breaks
may become the target of future physical activity interventions.
Aim 1: Determine the prevalence and characteristics of classroom exercise breaks in
Objective 1a: Determine the prevalence of classroom exercise breaks in
Hypothesis 1a: The prevalence of classroom exercise breaks will be 75 percent.
Objective 1b: Describe the characteristics of classroom exercise breaks in
156
Hypothesis 1b: The majority of classroom exercise breaks will be led by classroom
teachers, be integrated into academic lessons, and will be of short duration.
Objective 1c: Determine characteristics influencing the implementation of
classroom exercise breaks in elementary schools in Central South Carolina.
Hypothesis 1c: Elementary schools implementing classroom exercise breaks will
have fewer barriers and more facilitators than schools not implementing
Study Design
This is a cross-sectional study with surveys and interviews to evaluate the practice of
classroom exercise breaks in Central South Carolina.
Methods
Participants
The sample will include a representative sample of public elementary schools in
the Central Midlands of South Carolina. There are 226 public elementary schools in this
geographical location within 14 counties and 25 school districts. Districts with less than
4 schools will not be included, resulting in 192 schools, from 11 counties and 19 schools
districts. The demographic information for the sampled districts can be found in TABLE
7.3.
A stratified random sample of schools will be drawn and invited to take part in
the study. All schools in eligible districts will be categorized into four stratum. Stratum
will be based on the percentage of free and reduced lunch and the percentage of
students not meeting English and Math standards and state assessments. The four
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categories, as depicted in TABLE 7.4, will include: low income/lower performing, low
income/higher performing, high income/lower performing, high income/higher
performing. To examine the potential influence of these factors on exercise break
practices, a logistic model with 2010-2011 school level demographic and three selfreported classroom exercise break practices (video, morning exercises, and classroom
exercises) was run. There was a trend for schools with a greater percentage of free and
reduced lunch and more students not meeting state standardized test standards were
less likely to report these practices and schools.
Principals or physical activity coordinators will be emailed for a brief 5 minute
survey on classroom exercise break practices in their school. After one week, principals
that have not replied will be sent a follow-up email. Two weeks following the second
email, if 20 schools from each stratum have not replied or a total of 90 schools,
remaining principals will be called by the primary investigator. Following the phone call,
principals who have still not replied will not be included in the study. If a school declines
to participate, a replacement will be selected from the same stratum. Of the schools
reporting classroom exercise breaks, 10 schools from each stratum will be selected for
direct observations and a longer in-depth interview. If the schools do not consent to
participating, another school from that stratum will be selected. The districts will be
contacted for approval before contacting school principals and one classroom teacher
from each school for in-depth interviews. In-depth interviews will include questions to
determine the specific practices in each school and facilitators and barriers to those
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practices. If the intended number of interviews or schools implementing classroom
exercise practices is not reached, additional school districts will be contacted.
Measures
Email survey
Principals or physical activity coordinators from all schools in identified school
districts within Central South Carolina will be contacted through email. The brief survey
will be conducted with the principal or physical activity coordinator where contact
information is available, unless the principal refers the researcher to a more
knowledgeable administrator (Vice Principal, PE director, etc). See Appendix for email
questions.
Principal Interviews
Ten schools who report participating in classroom exercise breaks from each
stratum will be randomly selected to participate in in-depth interviews and direct
observations. In-depth interviews will be scheduled at participant convenience and will
be conducted at the participant’s chosen location (most likely their school or by phone)
for approximately one hour by the primary investigator. If available, the administrator
who played a role in implementing the classroom exercise breaks will be interviewed.
Interviews will be digitally recorded using a digital voice recorder (Olympus America,
Pennsylvania). Interview questions were constructed in advance according to Patton’s
suggestions to include questions that are singular, open-ended, clear and neutral and of
various types including opinion, role playing, and presupposition questions.197 See
Appendix B for a list of guiding initial questions.
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Classroom Teacher Interviews
Principals or physical activity coordinators will identify and provide contact
information for one classroom teacher at their school who practices classroom exercise
breaks. The teacher will be contacted for an interview at their convenience. If they do
not agree to participate, the principal or physical activity coordinator will provide an
alternative teacher to contact. The interview will be conducted by the primary
investigator and will include questions describing their classroom exercise break
practices, perceived benefits to their classroom, and barriers and facilitators to
implementing these practices. Sample interview questions can be found in the
Appendix. A total of 40 classroom teachers will be interviewed.
A primary concern of many critics of qualitative research is a lack of rigor.198
Qualitative studies have differing ontological and epistemological views than
quantitative research making the standards of external validity, internal validity,
reliability and objectivity not relevant to qualitative research conducted with a post
positivist, social constructivist view. There are equivalent criteria by which qualitative
studies are held. To ensure the rigor of this qualitative study, trustworthiness as defined
by Lincoln and Guba, including credibility, transferability dependability and
confirmability,199 will be established through the following methods.
The credibility of the theory, referred to as validity in quantitative studies, will be
strengthened through triangulation including multiple sources (administrators,
teachers) and multiple methods (surveys, interviews). Various sources will help to
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eliminate single source bias. Triangulation will serve as confirmation in addition to
providing a holistic portrayal of the process of implementation.198
Transferability in qualitative research is the approximation of external validity.
However, according to social constructivist theory and the specificity of grounded
theory to the empirical data, the same theory may not be applicable to other samples.
To be able to extrapolate the findings of a qualitative study, the details of the
population must be provided through “thick description” so that readers can determine
whether the theory would apply to another population. The selection process and a
description of the schools included in the study will be provided.
Dependability (reliability) and confirmability (objectivity) will be established
through an audit trail.199 An audit trail will be maintained throughout out the study and
will consist of all initial correspondence with school district personnel and
administrators, emails, interview transcripts and recordings, in vivo codes and coding
schemas, and written documents from schools.
Confidentiality and Ethics
Written informed consent will be obtained from school districts and participants.
Complete confidentiality will be maintained upon participant and school board
discretion. Participants will have the option of retaining school identity for potential use
in media relations to portray their schools as positive examples of physical activity. If
participants waive this confidentiality, stories and notes will be returned and reviewed
by participants before distributing any information.
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All interview transcripts and observation forms will be stored in a locked, secure
location. Digital files will be on a password protected computer in a locked location.
Unless specific consent from principals and schools districts waives confidentiality, no
participant names will be used. Participant ID numbers will be assigned and only the
primary investigator will have access to the linked names and participant IDs.
Sample Size
As this is primarily a descriptive study, the sample size was selected based on
generalizability, feasibility and ability to estimate the prevalence of classroom exercise
break practices. A standard deviation of 29 was obtained from reported classroom
exercise breaks from the previous four years. Using a cross-sectional, one group power
analysis, 90 schools are needed to detect a prevalence of 75 with a range from 69 to 81.
A total of 90 schools will be contacted for brief interviews. To obtain a representative
sample, at least 20 schools will be selected from each stratum.
Interviews will continue until theoretical saturation occurs, or no new theoretical
constructs emerge and further data collection is redundant. Creswell estimates
approximately 20 to 30 interviews are needed.200 In-depth interviews will be conducted
with principals and classroom teachers at 40 schools.
Analysis
Analysis of interview transcripts will be facilitated using NVivo 9 (QSR
International) by the primary investigator. The computer software will be used as a tool
and does not replace the skill and analysis of the investigator.197 Objective 1a will be
answered through descriptive statistics of the 80 brief surveys. Objective 1b will be
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addressed through descriptive statistics and qualitative analysis of the 90 brief surveys
and 40 in-depth interviews with principals and classroom teachers. Objective 1c will be
answered through descriptive statistics and qualitative analysis of school demographic
factors and the 40 in-depth interviews with principals and teachers. Logistic regression
will test the group differences in presence of the classroom breaks between the school
demographic sub-groups.
Study Two Methods
Purpose
The purpose of this study is to determine if brief classroom exercise breaks of
varying durations result in improvements in acute cognitive function and to examine the
dose-response relationship. The proposed study will use valid and reliable measures of
cognitive function that are easily administered in a classroom setting and sensitive to
change in a non-clinical population to measure the effects of these interventions in 9 to
12 year-old children.
Aim 2: Describe the acute effects of classroom exercise breaks on cognitive functions
including executive function and academic performance of elementary school
students.
Objective 2a: Determine the acute effects of classroom exercise breaks on
cognitive functions including executive function and academic performance.
cognitive functions.
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classroom exercise breaks and post exercise cognitive functions.
Hypothesis 2b: Acute classroom exercise breaks of 5, 10, and 20 minutes will
have progressively more positive effects on cognitive functions.
Objective 2c: Identify whether the acute effects of classroom exercise on
cognitive functions are modified by baseline levels of general intelligence,
parent-rated behavior, fitness, or Body Mass Index.
fitness and higher body mass index will have more positive responses in cognitive
functions to classroom exercise breaks.
Study Design
This study will use a within-subjects, crossover experimental design. There will
be four treatment conditions: 10 minutes of seated classroom activity, and 5, 10 and 20
minute exercise breaks. All participants will participate in each of the four conditions.
The crossover design was used to account for between-subject variation and to increase
efficiency, with little carryover of acute exercise treatments. To administer the
intervention and testing in groups, randomization to the order of conditions will occur
at the classroom level. To reduce sequencing effects, a balanced Latin Square design will
be used to randomize the four treatments. See TABLE 7.5. Randomization will control
for practice effects, with all classrooms receiving all conditions. The classroom setting,
as opposed to a controlled laboratory setting, was chosen to improve external validity
and to better facilitate research to practice applications.
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The primary outcomes are cognitive functions operationally defined as executive
functions and a math task. Executive function for this study is defined as the mental
skills needed to perform complex planning tasks and composed of working memory,
flexibility and inhibition as defined by Diamond.177 The primary outcomes will be
assessed pre and post each condition, and the differences will be compared between
conditions. This pretest-posttest design was chosen to account for daily variation in
cognitive abilities within each child and to focus on the change in executive function and
math performance with exercise.
Methods
Participants
Participants will be recruited from four 4th grade and four 5th grade classrooms
from elementary schools in South Carolina. A convenience sample will be selected
through agreement of the principal and teachers. Participants will range from 9 to 12
years of age. This age was selected for multiple reasons. The students are able to read
to provide assent as well as complete reading tasks, the chosen outcome assessments
have been validated for this age population, and executive functions are not as
developmentally volatile in this age group as in younger ages.174 Parents will be asked to
provide informed consent and children to provide assent prior to participation, including
permission to video tape intervention and testing sessions.
Intervention
The Brain BITES (Better Ideas Through Exercise) exercise break intervention will
be designed to be fun and feasible in a classroom setting. It will also be designed to
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maintain moderate-to-vigorously aerobic activity for the entire duration of the exercise
break. The sessions will be led by an exercise science graduate student with previous
experience implementing similar breaks in a classroom setting. Activities will be context
specific. The instructor will have a brief planning session with the students before the
exercise to select activities to increase buy-in and enjoyment during initial baseline
testing. Students will be asked about their current interests and favorite music.
Activities will be compiled from Take 10!,156 Physical Activity Across the Curriculum,102
and instructor field experience. Example activities include prompted dancing,
“marathon running”,141 and active classroom “Adventures” (for example climbing over
the mountain, running through the desert, etc.). As some children will have difficulty
maintaining longer durations of vigorous activity, body weight activities with less
cardiovascular demand will be included intermittently to maintain intensity without
reaching exhaustion. Activities will be similar throughout the intervention; only the
duration of activities will vary.
The exercise durations were selected based on previous studies. Research has
found effects in executive function and academics with 20 minutes of walking at a
moderate intensity.10 Mahar et al. has found relevant outcomes with 10 minutes of
similar aerobic physical activity breaks.152 Schools and teachers have also used shorter
durations of 5 minute as longer interventions may not be practically implemented into
school policy and practice. Kubesch et al. found no effects on cognitive outcomes after 5
minutes of physical activity.141 It is unknown if these shorter duration breaks have acute
cognitive benefits.
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During baseline assessment, students will be instructed on how to take heart
rates using their carotid or radial pulse. To encourage participation, students will be
instructed that heart healthy exercise gets their heart rates to 150. Heart rates will be
self-assessed after all exercise breaks, including the practice sessions, and recorded.
Fidelity of the intervention will be monitored by heart rate. The instructor will physically
participate, give verbal cues, and offer positive descriptive encouragement, which has
been shown to increase child activity.102 The exercise session will be video-taped and
observed for intervention fidelity. The research lab has previous experience objectively
observing physical activity levels.
Measures
Information will be collected on potential confounding variables and factors that
have been shown to influence the relationship between exercise and cognition.
Potential confounders include SES, gender, age, student engagement,181, 184 attentiondeficit/hyperactivity and problem behavior symptoms,175, 201 IQ,202 BMI,203-205 regular
physical activity,5, 115, 117, 201 and fitness.3, 4, 10, 31, 123, 128 Students will complete a brief
questionnaire to obtain age, physical activity levels, sports participation,
attitudes/motivation for academics (ex, I enjoy school/learning).206 Parents will
complete a brief questionnaire to obtain socioeconomic status (household income,
eligibility for free or reduced lunch), children’s academic history (ex, Is your child an A,
B, C student? Has he/she ever had behavior problems?) and the Conners’ Parent Rating
Scales Revised short version, a 27 item checklist to assess attention-deficit/hyperactivity
and problem behavior symptoms.
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During the week of baseline testing, anthropometric and IQ measurements will
be taken individually for each participant. Standardized measures of students’ height
and weight will be used to calculate BMI. The group of participants will complete a
baseline aerobic fitness assessment of the PACER test from the FITNESSGRAM testing
battery as well as the Kaufmann Brief Intelligence Test- Second Version (KBIT-2)
measure of abbreviated IQ. The administration of the KBIT-2 assessment will be by staff
trained by a clinical psychologist and the results of the assessment will not be
interpreted or shared with parents as a valid clinical assessment.
Physical Activity
Videotapes of the intervention will be coded for intensity of physical activity
using a modified System for Observing Fitness Instruction Time (SOFIT) (Donnelly,
unpublished). Assuming 10 participating students per classroom, each video segment
will be viewed three times by the primary investigator. Each viewing, three or four
students will be selected. A student will be observed for 10 seconds, and observations
will be recorded for 10 seconds. With 35 minutes of intervention per student and 10
students per classroom, each student will be observed for 35 intervals for a total of
2,800 intervals.
Cognitive Measures
A test battery was developed to assess the primary outcome of executive
function. As mentioned, previous studies of exercise and cognition have been limited by
their cognitive measures.190 Inherent difficulties exist in measuring executive function,
including task-impurity, low test-retest reliability and lack of construct validity in adults22
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as well as in children.207 Executive function is used most during novel tasks, therefore
limiting repeatability of assessments. It is difficult to isolate executive function skills due
to questions of task-impurity and the complex tasks which utilize executive function also
rely on several other mental processes such as attention.22 Etnier suggests using a
combination of measures to asses the construct.190 In addition, executive function
assessments in controlled environments are limited in external validity, as executive
function is most used in uncontrolled situations (real world distractions, changes in
environments, etc).207
The testing battery has been assessed in pilot work to establish reliability,
feasibility and acceptability. Objective measures were chosen as opposed to teacher
rating scales to eliminate potential biases from teacher relationships with the children.
The tests will be administered to the entire classroom simultaneously. While this may
introduce additional confounding variables, Manly suggested that often measures of
executive function are tested in settings that are too controlled and have no
applicability to real world settings, such as a noisy classroom.208 It is these uncontrolled
settings where executive function may be most utilized. While there is a potential for
confounding cognitive demands (i.e. interference between children), this resembles the
practical settings where task performance is required. Since executive functions highly
influence other cognitive processes, it would be impossible to clearly isolate them in any
setting. Previous measures to assess executive function have been lengthy and staff
intensive (one-on-one interviews). Methods need to validly assess executive functions in
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classroom setting reliably while minimizing disruption to class time through the
assessment of multiple subjects simultaneously.
Total administration time will not exceed 15 minutes. The tasks are kid-friendly
and easily administered. The tests and measured constructs have been connected to
academic achievement. While most executive function tasks are validated through
frontal lobe lesions, limiting application to non-clinical populations,22 these tests have
shown variation in the general population. Outcome variables are operationally defined
in TABLE 7.6.
Trail Making Test
The Trail Making Test (TMT) was carefully selected as a theoretically and
neuropsychological valid, feasible and appropriate measure of executive function in
children. The TMT has been shown to be sensitive to acute exercise in adults. 209 A recent
review of randomized control trials by Smith et al. found the largest cognitive effects in
response to physical activity intervention in the Trail Making Test Part B.137 Developed in
1944 as part of the Army Individual Test Battery, it has consistently been used as a
neuropsychological test to evaluate frontal lobe injuries, including in children.210 The
TMT Part B has been validated as a measure of planning211 and set switching or
cognitive flexibility.212 Functional MRIs have confirmed the frontal involvement in
completing Part B of the TMT.213 Dikmen et al. showed the test-retest reliability of 0.79
for Part A and 0.89 for part B in over 300 adults.214 The TMT has also shown to be
reliable in children with 0.64 in children aged 3-6215 and 0.56 over 6 months in children
4-12 years of age.216 Administration time is less than 5 minutes. Alternative forms will be
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used for each testing to decrease practice effects and maintain novelty which places
stronger executive demands.22
The test will be self-timed, reducing the time burden on classroom teachers from
individual testing. A sub-sample will be timed by researchers to confirm the validity of
self-timed measures. Students will be given the trail making task and an individual
stopwatch. Upon instruction, they will start their own stopwatch, complete the test,
stop the stopwatch, and record the time on the test. The final score will be composed of
the time to take the test and an error score. As suggested by Sanchez-Cubillo,212 a ratio
of TMTA to TMTB will be used as a measure of executive function.
Digit Recall
Digit recall is a validated measure of working memory as part of the Working
Memory Test Battery for Children.176 In pilot testing of a group-administered testing
session, children did not complete the task as intended. To modify the task for increased
validity, students will be read a list of numbers, and then given 5 seconds to write them
in chronological order from lowest to highest. This will maintain the integrity of recalling
and cognitively manipulating number sequences, but discourage task diversion.
Timed Math Test
To assess ecological validity and application to academics, a timed math test will
be given, similar to previous studies.217 A math worksheet appropriate for the specific
age-group will be used. Children will be given the worksheet face down. On instructor
instruction, they will turn over the paper and begin, completing as many problems as
possible within 1 minute. When instructor says “STOP”, all participants must stop
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working and put pencils down. The score will be the number of problems correctly
answered.
Procedures
At the initial visit, the study will be described and children whose parents have
consented will complete written assent. Assenting participants will complete height and
weight measures, the PACER test, and the Kaufmann Brief Intelligence Test- Second
Version within the first week. The study will occur over five weeks, with one week for
baseline testing and one week for each exercise condition. Classrooms will be
randomized to the order of conditions and all students will participate in all four
conditions. To help reduce novelty effects and allow the participants to practice, the
participants will receive one day of the exercise or sedentary condition prior to cognitive
testing. Four classes will participate in testing in the morning and four classes will
participate in the afternoon. All cognitive assessments will be held on the same time and
day of the week to account for day-to-day variation. The pretest will be given after 5
minutes of seated classroom activity. Posttest cognitive testing will occur after heart
rate returns to 10% resting or an average of 5 minutes post exercise.10
The control condition will have similar procedures. Measures will take place
before and after 10 minutes of seated classroom activity such as academic worksheets,
puzzles, or coloring. Students will be required to remain seated. The timeline is seen in
TABLE 7.7.
Sample Size
172
G*Power 3.1.3 was used to calculate power for a repeated measures, withinbetween interaction design. Using a crossover, within-subject design, a sample size of 80
with 4 groups would have the power to detect an effect size of 0.15 between four
conditions with an alpha of .05. This is based on reliability of 0.56 on the TMTB over 6
months in children.216 With 8 classrooms, it is underpowered to detect small effects if
analyzed at the classroom level. However, it will be possible in this exploratory study to
examine variation between classrooms and find effect sizes to be used in future studies.
Analysis
To test for a sequencing effect, an initial ANOVA with a time and treatment
interaction will be run. If this interaction term is significant, the four sequences of
treatments will be analyzed separately. Post-test differences executive function and
timed math test will be compared between the four conditions. Using SAS 9.2, a
repeated measures analysis of covariance to account for within-subject correlations,
with pre-test scores included as a time varying covariate, will be used. Separate analyses
will be used with independent variables of Trail Making Test change scores, Digit Recall
change scores and math change score. Basic models will be adjusted for SES, baseline
executive function scores, and mean physical activity coded from SOFIT video
observation. Linear contrasts will be used to test the differences between all three
exercise conditions and doses of 5, 10, 20 minutes of exercise as compared to 10
minutes of sedentary activity. To examine Objective 2c, potential continuous effect
modifiers will be dichotomized using a median split and included as an interaction term.
Interactions will an alpha of less than 0.1 will be considered significant. The potential
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effect modifiers to be examined include sex, abbreviated IQ, attention disorder
symptoms, fitness levels, and BMI, and engagement in school.
Study Three Methods
Purpose
The purpose of this study is to determine if brief classroom exercise breaks of
varying durations result in improvements in acute attention and to examine the doseresponse relationship in 9 to 12 year-old children.
Aim 2: Describe the acute effects of classroom exercise breaks on on-task behavior of
elementary school students.
Objective 2a: Determine the acute effects of classroom exercise breaks on ontask behavior.
Hypothesis 2a: Acute classroom exercise breaks will have a positive effect on ontask behavior.
classroom exercise breaks and post exercise on-task behavior.
have progressively more positive effects on on-task behavior.
Objective 2c: Identify whether the acute effects of classroom exercise on on-task
behavior are modified by baseline levels of general intelligence, parent-rated
behavior, fitness, or Body Mass Index.
174
fitness and higher body mass index will have more positive responses in on-task
behavior to classroom exercise breaks.
Study Design
This study will use a within-subjects, crossover experimental design. There will
be four treatment conditions: 10 minutes of seated classroom activity, and 5, 10 and 20
minute exercise breaks. All participants will participate in each of the four conditions.
The crossover design was used to account for between-subject variation and to increase
efficiency, with little carryover of acute exercise treatments. To administer the
intervention and testing in groups, randomization to the order of conditions will occur
at the classroom level. To reduce sequencing effects, a balanced Latin Square design will
be used to randomize the four treatments similar to Study Two. Randomization will
control for practice effects, with all classrooms receiving all conditions. The classroom
setting, as opposed to a controlled laboratory setting, was chosen to improve external
validity and to better facilitate research to practice applications.
The primary outcome is on-task behavior as measured by observed time-on-task.
Attention is defined as the ability to selectively focus and inhibit distracters. 218 The
primary outcome will be assessed pre and post each condition, and the differences will
be compared between conditions. This pretest-posttest design was chosen to account
for daily variation in cognitive abilities within each child and to focus on the change in
on-task behavior with exercise.
175
Methods
Participants
Participants will be the same as those in Study Two, and will be recruited from
four 4th grade and four 5th grade classrooms from elementary schools in South Carolina.
A convenience sample will be selected through agreement of the principal and teachers.
Participants will range from 9 to 12 years of age. developmentally volatile in this age
group as in younger ages.174 Parents will be asked to provide informed consent and
children to provide assent prior to participation, including permission to video tape
intervention and testing sessions.
Intervention
The Brain BITES (Better Ideas Through Exercise) exercise break intervention will
be designed to be fun and feasible in a classroom setting and will be the same
intervention as used in Study Two.
Measures
Information will be collected the same as in Study Two on potential confounding
variables and factors that have been shown to influence the relationship between
exercise and cognition.
Physical Activity
Videotapes of the intervention will be coded for intensity of physical activity
using a modified System for Observing Fitness Instruction Time (SOFIT) as in Study Two
(Donnelly, unpublished).
176
Attention
To obtain an ecologically valid measure of attention, direct observation of the
children during testing will be used similar to previous studies.152, 219 To establish intrarater reliability and be able to assess attention in all participants within the short testing
frame, video cameras, placed in the front of the classroom will be used for direct
observation. A systematic time sampling observation system will be used. Attention will
be determined by the direction of the student’s gaze, either at the instructor or on the
testing materials.219
Consented students will be observed for time-off-task during the testing
procedure. The videos will be edited so only the testing procedures are included and the
observer remains blinded to the condition. As a measure of overall classroom testing
efficiency, the duration of testing administration was recorded from the time the
instructor said “Go” to begin the TMT test to “Stop” to signal the end of the math test.
To make comparisons to previous studies, observations will be made through similar
sampling procedures as in-person observations. Each video segment will be viewed
three times. The videos will be assigned random codes so both observers will be
unaware of the time and condition of testing. Student will be viewed for 15 seconds and
the number of off-task interruptions will be tallied. Off-task behavior will include
direction of gaze away from instructor or testing materials, speaking out of turn, and
excessive fidgeting. The observer will cycle through all visible students in three viewings
of the complete condition from left to right, right to left, and beginning in the center of
the classroom. Different students will be observed at each 15-second interval between
177
the 3 viewings. If a student is not visible for at least 5 seconds during the 15-second
interval, the observer will proceed to the next student. Videos will be watched by two
observers (an observer blinded to the study aims, and the primary investigator). Videos
will have a time stamp. Both observers will observer the same students at the same
time stamps. Intervals that differ between coders will be examined a third time by the
primary investigator. Only consented students will be analyzed.
Procedures
At the initial visit, the study will be described and children whose parents have
consented will complete written assent. Assenting participants will complete height and
weight measures, the PACER test, and the Kaufmann Brief Intelligence Test- Second
Version within the first week. The study will occur over five weeks, with one week for
baseline testing and one week for each exercise condition. Classrooms will be
randomized to the order of conditions and all students will participate in all four
conditions. To help reduce novelty effects and allow the participants to practice, the
participants will receive one day of the exercise or sedentary condition prior to cognitive
testing. Four classes will participate in testing in the morning and four classes will
participate in the afternoon. All observations will be held on the same time and day of
the week to account for day-to-day variation.
The control condition will have similar procedures. Measures will take place
before and after 10 minutes of seated classroom activity such as academic worksheets,
puzzles, or coloring. Students will be required to remain seated.
178
Analysis
Group/grade/sex differences were tested using ANOVA and Chi-square tests. To
test for a sequencing effect, an initial ANOVA with a time and treatment interaction will
be run. If this interaction term is significant, the four sequences of treatments will be
analyzed separately. Pre to post differences in on-task behavior will be compared
between the four conditions.
Using SAS 9.2, a repeated measures analysis of covariance to account for withinsubject correlations will compare post-test on-task behavior between exercise
conditions and the sedentary condition. Basic models will be adjusted for classroom
group, age, and time-varying pre-test on-task behavior. The overall F-statistic will be
used answer Objective 2a. To answer Objective 2b, linear contrasts will be used to test
the differences between doses of 5, 10, 20 minutes of exercise and 20 minutes of
sedentary activity. To examine Objective 2c, potential effect modifiers will be examined
through stratified analysis, including sex, abbreviated IQ, attention disorder symptoms,
fitness levels, and BMI.
Study Four Methods
Purpose
The purpose of this study is to examine the affect of children during classroom
exercise breaks and their subjective response to the practice. The practice is less likely
to be implemented if it is not enjoyable to students.
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Aim 4: Determine student affective responses to classroom exercise breaks.
Objective 4a: Compare student affective responses to classroom exercise breaks
with the response to a sedentary classroom activity.
Hypothesis 4a: Students will have a more positive affective response during
classroom exercise breaks than during a sedentary classroom activity.
Objective 4b: Describe the dose-response relationship between durations of
classroom exercise breaks and student affective response.
have non-linear effects on student affective responses.
Objective 4c: Describe student and teacher subjective responses to classroom
exercise breaks.
Hypothesis 4c: Student and teachers will report positive subjective responses to
Study Design
This study will use a within-subjects, crossover experimental design. This study
will use the same participants and intervention from Study Two. The classrooms will be
randomized to the order of conditions. Quantitative data will include objectively coded
positive affect during the intervention conditions, student focus groups and teacher
interviews.
Methods
Participants
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This study will use the same participating schools as Study Two. Teachers of
participating classrooms will also be included.
Measures
Direct Observation
To quantitatively measure positive affect, the video tapes of the classroom
physical activity intervention from Study Two will be analyzed. Several objective systems
have been used to code facial expressions for affect. As affect and emotion has not been
previously coded in physical activity settings, a modified version based on the Specific
Affect Coding System220 and the System for Observing Children’s Activity and
Relationships during Play (SOCARP) will be used.221 Previous studies have utilized
videotape footage to analyze affect.222, 223 The sampling procedure will be consistent
with the observation system used for attention in Study Three.
Positive affect is a broad disposition,23 differing from specific emotions, and will
involve some subjective analysis. Signs of positive affect will include smiling and positive
verbal response. Observers will be trained using previous footage of child classroom
physical activity. Videos will be watched by two observers (an observer blinded to the
study aims, and the primary investigator). Videos will have a time stamp. Only
consented students will be analyzed. Assuming 10 participating students per classroom,
each video segment will be viewed three times by the primary investigator. A student
will be observed for 10 seconds, and observations will be recorded. With 55 minutes of
intervention per student and 10 students per classroom, each student will be observed
181
for 55 intervals for a total of 4,400 intervals. The primary outcome variable will be the
percentage of intervals coded for positive affect.
Focus Groups
Focus groups will be held with consenting, participating students within one
week of the completion of the classroom exercise break intervention. The focus groups
will assess acceptability and reactions to the intervention to inform future studies.
Sample questions are included in Appendix C. Groups will be 10 to 20 students and the
time and location will be determined by the teacher. Discussions will take no longer
than 30 minutes and will be recorded.
Interviews
Each classroom teacher and school principal will complete an in-depth interview
at the end of the 5-week intervention period to gather information on the
implementation, feasibility, perceived benefits and overall impressions of the
intervention. Sample interview questions are included in Appendix C. Interviews will be
recorded and will include discussion of the feasibility and acceptability of classroom
exercise breaks.
The same standards of validation used in Study One will be applied.
Sample Size
Using a crossover, within-subject design, a sample size of 80 would have the
power to detect an effect size in percentage of positive affect between the two
conditions of 0.15 with an alpha of .05. With 8 classrooms, it is underpowered to detect
182
small effects if analyzed at the classroom level. However, it will be possible in this
exploratory study to examine variation between classrooms and find effect sizes to be
used in future studies. There will be 8 focus groups, which is compatible with healtheducation research224 and 8 teacher interviews.
Analysis
To examine Objective 4a, descriptive statistics of the frequency and type of
positive affects during intervention and control conditions will be reported from video
observation. The directly observed positive affect codes will be averaged for each
condition and compared using a repeated measures analysis of covariance adjusted for
classroom group and gender. To answer Objective 4b, linear contrasts will be used to
test the differences in positive affect between doses of 5, 10, 20 minutes of exercise and
10 minutes of sedentary activity. To answer Objective 4b, analysis of focus group and
interview transcripts will be examined for emergent themes. The emergent themes will
be integrated with the positive affect data to depict an overall description of the
affective response to classroom physical activity breaks. This combination of qualitative
and quantitative research maximizes the strength of the study.225, 226 To ensure the rigor
of this qualitative method, dependability (reliability) and confirmability (objectivity) will
be established through an audit trail.199 The findings of the study will be shared with
participating teachers and school administrators.
183
Table 7.1: Percentage of submitting South Carolina schools reporting exercise break
practices over 4 years
Type of Exercise
2007-08
2008-09
2009-10
2010-11
Video
23
52
57
38
Morning
16
n/a
40
35
Classroom
12
64
76
66
Percent of Schools
reporting
91
92
71
66
184
Table 7.2: Summary of studies examining classroom exercise interventions and educational outcomes
Chronic Effects
79
Donnelly et al., 2009
Physical Activity Across
the Curriculum
155
Katz et al., 2010
Study Design
Participants
Cluster
randomized
controlled trial
1,527 2 and 3
graders
Randomizedgroup design
Activity Bursts in the
Classroom for Fitness
nd
rd
Intervention
Teacher led, integrated
academic, 90 minutes per
week in 10 min bouts, 3
years
Teacher led, nonacademic, approximately
30 minutes daily,
approximately 8 months
Wechsler Individual
nd
Achievement Test-2
Edition (academic
achievement)
Missouri Academic
Performance (MAP),
Independence School
District progress reports,
classroom behavior
academics, 30 minutes
per day, 3 days, 3 days
per week, approximately
3 months
Standard Progressive
Matrices (Fluid
intelligence); Palmetto
Achievement Challenge
Tests (academic
achievement)
academic, 10-15 minutes
Pre and post direct
observation of on-task
behavior using momentary
time sampling
th
Teacher led, nonacademic, 5 minutes
rd
academic, 10 minute
activities
Pre and post computerized
Flanker and Dots tasks
(executive functions)
Pre and post direct
observation of on-task
behavior using momentary
time sampling
24 schools
nd
403 2 graders
rd
403 3 graders
th
408 4 graders
5 schools
Reed et al., 2010
236
Randomizedgroup design
rd
155, 3 graders
6 classes
185
Acute Effects
117
Grieco et al., 2009
Texas I-CAN
Kubesch et al., 2009
Mahar et al., 2006
Energizers
166
188
Outcome Measure
rd
2x2x3
repeatedmeasures
factorial design
97, 3 graders
Randomized
within-subject
cross-over
Multiplebaseline across
classrooms,
repeated
measures
design
81, 7 graders
9 classes
62, 3 graders
th
25, 4 graders
4 classes
Results
Intervention improved
reading, math, spelling,
and composite compared
to control
No difference in MAP
scores, on progress
reports intervention
group improved in math,
control group improved
in reading
Intervention did better in
Social Studies compared
to control
Time-on-task decreased
in control compared to
intervention, largest
decrease in overweight
children
No significant effects
Post on-task behavior
increased by 8%
compared to pre, no
change during baseline
Table 7.3: Demographics of sampled school districts (FRL: Free-and-reduced lunch)
Race
(% Black)
Pop Density
(per sq mile)
RuralUrban
b
Code
% Not
Meeting
c
English
% Not
Meeting
c
Math
186
# Schools
% FRL
Income
Poverty
a
Index
Aiken
20
56.3
$44,296
77.3
25.7
157.7
2
22.1
31.7
Edgefield
4
58.3
$44,391
78.5
40.2
53.9
2
25.3
32.1
Fairfield
4
78.6
$32,120
95.7
56.3
34.9
2
33.9
40.2
Kershaw
11
54.4
$45,035
77.4
26
84.9
2
21.3
23.9
Lancaster
9
54.3
$38,590
75.0
25.9
139.6
4
24.5
24.6
Lexington 1
15
35.5
$60,061
53.5
7.6
360.6
2
15.2
17.4
Lexington 2
5
58.5
$41,521
81.3
19.6
686.3
2
23.7
28.2
Lexington 5
12
30.5
$66,101
49.1
19.0
698.9
2
15.3
16.2
Newberry
8
63.5
$41,080
77.6
29.7
59.5
6
27.3
24.1
Orangeburg 3
4
78.7
$29,335
97.1
63.6
73.5
4
39.2
60.3
Orangeburg 5
8
75.5
$31,593
96.0
67.5
125.1
4
27.8
38.1
Richland 1
29
65.2
$38,098
86.4
52.2
448.6
2
25.8
32.6
Richland 2
18
40.8
$59,328
60.7
44.8
802.6
2
18.5
24.4
Sumter 17
15
64.3
$37,219
83.6
49.8
1004.3
3
23.9
29.0
Sumter 2
15
73.6
$38,070
89.4
44.6
93.1
3
28.4
30.6
York 1
5
58.2
$41,294
74.2
17.5
100.5
1
25.0
33.1
York 2
6
32.3
$57,754
51.0
9.6
257.9
1
15.9
14.7
York 3
16
52.6
$47,175
70.3
26
602.9
1
23.6
23.8
York 4
7
20.2
$70,978
28.9
7.3
926.3
1
8.5
11.4
South Carolina
578
63.5
$38,916
75.6
34.7
153.9
3.7
39
21
42.9
$50,046
12.3
87.4
United States
Study Sample
192
55.3
$45,475
72.9
33.3
353.2
2.4
22.6
27.1
Poverty Index calculated by the SC Department of Education based on percentage of free and reduced lunch and Medicaid eligibility
b
Based on 2003 Rural-Urban Continuum Codes
c
Data from the SC Department of Education 2010-2011Palmetto Assessment of State Standards
a
Table 7.4: Number of schools available in each stratum (mean %FRL, % not meeting
standards)
# Schools
<60% FRL
>60% FRL
(districts represented)
46
45
Lower Performing
(51.11, 17.45)
(79.38, 31.58)
48
53
Higher Performing
(30.42, 11.56)
(76.82, 25.33)
Table 7.5: Randomization of intervention conditions*
Classroom
Week 1
Week 2
Week 3
Group
Week 4
Week 5
1
Baseline
A
B
C
D
2
Baseline
B
D
A
C
3
Baseline
C
A
D
B
4
Baseline
D
C
B
A
5
Baseline
B
D
A
C
*Condition A - 10 minutes in classroom seated activity (reading, coloring, worksheets)
Condition B- 5 minutes staff facilitated exercise break daily
Condition C- 10 minutes staff facilitated exercise break daily
Condition D- 20 minutes staff facilitated exercise break daily
187
Table 7.6: Operational definitions of outcome variables for Study Two
Measure
Operational Definition
Difference between Part A and Part B
Cognitive Flexibility
Trail Making Test
(seconds)
Working Memory
Digit Recall
Academic Achievement
Timed Math Test
188
Number of correct numbers recalled;
number of lists recalled in correct
order
Number of math problems correct
Classroom
4th-1
School 1
189
School 2
Classroom
4th-2
Classroom
5th-3
Classroom
5th-4
Classroom
4th-5
Classroom
4th-6
Classroom
5th-7
Classroom
5th-8
Classroom Info
Session
Consent to
parents
Parent
questionnaire
and Conners
X (am)
Child
Focus
Groups
Children /
Teacher
Interviews
X (pm)
X (am)
X (pm)
Classroom Info
Session
Consent to parents
Parent questionnaire
and Conners
X (am)
X (pm)
X (am)
X (pm)
Child
Focus
Groups
Children /
Teacher
Interviews
May 2012
Apr 2012
Mar 2012
Feb 2012
Jan 2012
Table 7.7: Proposed timeline
Send home
follow-up
letter to
parents,
teachers,
schools
Figure 7.1: Proposed model of mediators and moderators on academic achievement
from Tomporowski (2011)
190
191
Figure 7.2: Meta-Volition model from Yancey (2009)
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235
APPENDIX A
CHANGES TO PROPOSAL
Study One
It was originally proposed to interview 40 principals and 40 classroom teachers,
10 from each strata. However, school district approval provided a major barrier to
accessing principals. Therefore, 14 interviews were completed with principals.
Saturation was reached and the responders did not differ largely from the sampled
population on key school demographic variables. Interview participants had slightly
lower percentage of students receiving free-and-reduced lunch and not meeting English
and Math standards.
236
APPENDIX B
STUDY ONE SURVEY AND INTERVIEW QUESTIONS
Interview Questions for Principals
Brief Survey (email)
Classroom exercise breaks are short bouts of exercise integrated into the classroom (this
does not include recess or physical education).
1. To your knowledge, do teachers in your school conduct classroom exercise
breaks?
2. In your school, approximately what percentage of teachers conducts classroom
exercise breaks?
3. If your school conducts in classroom exercise breaks, what grades participate in
classroom exercise breaks?
4. Does your school have a policy requiring teachers to conduct classroom exercise
breaks? If yes, briefly describe.
In-Depth Semi-structured Interviews
Principals
1. Do you have a school policy (formal or informal) requiring exercise breaks? What
is the policy?
237
2. How long has your school practiced these exercise breaks?
3. How did classroom exercise breaks start in your school?
4. Was there any resistance to implementation?
5. What was the reaction from teachers? Parents? Students?
6. What benefits or disadvantages do you perceive from exercise breaks for
students? Teachers?
7. What are your top priorities for your students?
8. What is your physical activity experience?
9. Do you have any additional thoughts or comments on classroom exercise breaks
in elementary schools?
10. We are learning about physical activity opportunities, and your school is a great
example. Would it be possible to speak with one of your classroom teachers
who conducts classroom exercise breaks?
Classroom Teachers
1. How often do you have exercise breaks in the classroom? When do you usually
have them?
2. What types of activities do you do? Do you lead them (or video)?
3. How long do they typically last?
4. How do the children behave before and after the practices?
5. Why do you practice these exercise breaks?
238
6. If you were going to try to convince another teacher to begin these practices,
what would you tell them?
7. Do you have any additional thoughts or comments on classroom exercise breaks
in elementary schools?
239
APPENDIX C
STUDY FOUR FOCUS GROUP QUESTIONS
Student Focus Group Sample Questions
1. What did you think of the Brain BITES?
2. Which was your favorite week?
3. Did you feel different afterwards?
4. What was your favorite part?
5. Would you like to keep doing Brain BITES?
6. How would you change it?
Teacher Questions
1. Do you or have you implemented similar practices in your classroom? If yes,
please describe.
2. What do you think of the Brain BITES intervention?
3. What were your students’ reactions to the exercise?
4. What was the difference in the students on days we did Brain BITES?
5. Did you notice a difference between weeks?
6. Would you be willing to implement this intervention? For how long of a
duration? If yes, why? If no, why not?
7. What support would you need to implement Brain BITES?
8. What is your physical activity experience?
240

Classroom Exercise Breaks and Educational Outcomes in

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