NUTRITION, PHYSICAL ACTIVITY BOOST SCHOOL PERFORMANCE

Four-Year Program Improves Test Scores, Discipline, Attendance

Highlights from the 53rd Annual Meeting of the American College of Sports Medicine

Compiled by Barbara Day, M.S., R.D., C.N.

An innovative program to increase physical activity and improve nutrition at an elementary school has shown dramatic results over four years. The school logged significant gains on standardized tests, and nurse visits declined by 67 percent during the experiment.

Researcher Benjamin Sibley, Ph.D., said the program “Making the Grade with Diet and Exercise” (MGDE) rose out of concerns that increased focus on academic performance would lead schools to cut opportunities for physical activity. “Childhood health is of great concern,” said Sibley. “Children now are developing lifestyle diseases such as Type-II diabetes and atherosclerosis which typically are not seen until adulthood. These conditions can be brought about in part by poor nutrition and low levels of physical activity.”

Tom Yazvac, principal of Springfield Local Elementary School in New Middletown, Ohio, first sought to boost academic performance through more traditional academic interventions such as summer school and after-school programs. Poor results led school officials to develop the MGDE program, which now has been implemented at a second school.

MGDE consists of three core components:

1. A 10-20 minute period of physical activity at the beginning of each school day
2. A simple but nutritionally sound breakfast for all students
3. Recess before lunch, rather than after as is typical in elementary schools

Teachers determine specific physical activities, said Sibley, which increases teacher ownership of the program. Typical activities include walking, running, exercising to videos, calisthenics, resistance training, and gymnasium or playground games.

After the activity period, students pick up brown-bag breakfasts consisting of cereal and/or another bread product served along with milk and juice on most days. Other periods throughout the day are shortened by two to three minutes each to make time for the activity and breakfast periods.

Sibley explained the rationale for scheduling recess before lunch. “After sitting in the classroom all morning,” he said, “children are anxious for recess. When recess comes after lunch — a typical format in many elementary schools — students are likely to rush through their meal, leaving much of it uneaten, to hurry out to the playground.” Furthermore, he noted, “At the end of recess students are frequently over-excited and perhaps quarreling, and it may take classroom teachers several minutes to quiet them down. Placing recess before lunch allows students to burn off pent-up energy, then sit down to eat and return to the classroom ready to learn.”

At Springfield , that's just what they did. The school has improved from passing two of the state indicator proficiency tests prior to the intervention to passing all five tests. A significantly higher percentage of students earned passing scores on each of the tests compared with pre-MGDE levels:

• Reading (+28%)
• Writing (+23%)
• Math (+23%)
• Citizenship (+11%)
• Science (+29%)

Studies are under way to measure the program's impact on student obesity and physical activity levels. One measure is clear, though: visits to the school nurse are down 67 percent, with the number of visits “out of boredom” (as determined by the school nurse) specifically declining in frequency.

Over the four-year intervention, the school noted a steady increase in daily attendance (from 94.3 percent in 1999-2000 to 95.9 percent in 2003-2004.) Discipline referrals were down by 58 percent over the same period.

Costs for the MGDE were mainly for food — about $10,000 annually.

“After observing the results of the program,” said Sibley, “school administrators and school board members have committed to maintaining the program.” He pointed out that schools with a high percentage of students who qualify for free or reduced meals would have minimal costs in implementing such a program.

“We learned several important lessons with this intervention.” said Sibley. “Interventions to increase physical activity and improve nutrition may be an effective method to improve student academic performance. Also, schools can make environmental changes that have the potential to improve student health through diet and physical activity with minimal cost and disruption of the school day. Finally — and perhaps most dramatically, implementation of a program to increase physical activity and improve nutrition at school led to increased attendance, decreases in nurse visits and discipline referrals, and improved achievement test performance by students.”

STUDY WON'T MAKE MOM HAPPY: Skipping Breakfast May Not Affect Fitness of College Students

We know she's right about sending thank-you notes and getting a good night's sleep, but a recent study may not confirm mom's recommendation to eat breakfast every day. Research found that college students who eat breakfast aren't necessarily more fit than those who do not.

Andrea Strey and Gary Liguori, Ph.D. led a study of 244 college students enrolled in a university-required wellness course. The goal, said Liguori, was to determine whether there was a relationship between breakfast and fitness, as measured by heart rates during a three-minute step test. “Current research indicates a strong inverse relationship between frequency of breakfast and obesity — that is, people who eat breakfast regularly are more likely to maintain a healthy weight. There's also an inverse relationship between fitness and obesity. This research was a step toward connecting the dots by looking for a link between breakfast and fitness.”

No such connection was evident among the collegians who participated in the study. “We were interested to find,” said Strey, “that the majority of the students eat breakfast only four or fewer days each week. Those students — even the 30 percent who eat breakfast zero to two days per week — showed no less cardiovascular fitness than the 40 percent who eat breakfast five to seven days per week.” Another 30 percent reported eating breakfast three or four days per week.

In addition to revealing how often they eat breakfast, participants reported their height and weight through an online survey. Each student also performed the YMCA three-minute step test in a group setting, with heart rates measured for one full minute immediately afterward.

“Mom's probably right about the importance of eating a good breakfast,” said Liguori. Proper nutrition, beginning with the first meal of the day, is essential to overall health and can affect academic performance. What we've learned in this study is that frequency of eating breakfast may not tie directly to cardiovascular fitness—at least for this group of students.

While this study showed little correlation between breakfast consumption and fitness, Strey points out that longstanding habits can have a cumulative effect. “If we were to follow up with these same subjects in future years,” she said, “evidence supports the likelihood that those who continue to skip breakfast would become overweight. Statistically, these subjects would tend to be less fit, which has significant implications for overall health and mortality.”

“ACTIVE COMMUTING” BOOSTS KIDS' ACTIVITY LEVELS
ACSM and Mars, Inc. to Promote Walk-to-School Programs as Part of Youth Health Initiative

DENVER – Walking, biking or skating to school has a positive and significant impact on kids' physical activity levels, particularly in young girls.

Outcomes from the study was featured as part of an initiative in ACSM's Active Nation program, promoting back-to-school walking and commuting programs for children in elementary and middle school. With the support of Mars, Incorporated, ACSM will launch the active commuting concept later this summer.

“ACSM is concerned most about the lack of understanding and practice of energy balance in children and adolescents. Television watching, computer use, and video games are sedentary activities often favored by children before and after school, and active commuting is one way to get school-aged children active without it being competitive, scheduled or complicated,” said J. Larry Durstine, Ph.D., ACSM's President-elect. “Obesity and poor health are outcomes of a variety of habits and behaviors, but the lack of activity alone is a great threat to a generation of kids. The back-to-school season later this summer is the perfect occasion to show parents and kids a few simple ideas to improve their health and wellness.”

Although recommendations for appropriate amounts of physical activity for school-age youth have been developed by several organizations and agencies, rates of childhood inactivity and obesity have increased dramatically in the past decade. Both the benefits of regular physical activity for the health of youth and its potential to reduce the risk of chronic diseases later in life are clear and proven in the scientific literature. ACSM experts recommend children and adolescents engage in 60 minutes or more of daily physical activity, which should be enjoyable, developmentally appropriate, and of various types.

Physical inactivity is a strong contributor to overweight and obesity. Research suggests the increasing prevalence of risk of overweight and actual overweight exists because many youth are not engaging in sufficient amounts of physical activity to balance energy intake. Further, children's activities tend to be intermittent rather than continuous and the level of physical activity tends to decline, on average, during adolescence.

Active Nation will be a multi-organizational initiative to combat childhood obesity through the promotion of increased participation in sports and physical activity. As part of its four-tiered structure (policy, community, project and demonstration), Active Nation focuses on community solutions to promote physical activity in children.

In the “active commuting” study, 168 girls and boys wore accelerometers and reported modes of transportation to and from school for four consecutive days on two separate occasions. Overall, boys logged 21 percent more daily physical activity than girls. However, there was only a six percent difference in daily activity between boys and girls who were active commuters half of the time, suggesting that girls who were active commuters maintained daily activity levels equivalent to those of the boys.

“It is well known that girls acquire less physical activity throughout the day compared with boys of the same age,” said Kate Heelan, Ph.D., the study's lead author. “But we wanted to more closely examine walking to school, in association with gender, to determine its benefits.”

Researchers concluded the results suggest frequent active commuting would significantly impact daily physical activity levels of young girls and may attenuate the common decrease in daily levels as they progress through grade school. Overall, walk-to-school programs aimed at increasing the number of girls who actively commute and the frequency of which they do are warranted to maintain daily physical activity levels of at least 60 minutes per day.

CLASSROOM-BASED PHYSICAL ACTIVITY HELPS KIDS STAY ON TASK
Dual Benefits Seen in Academic Instruction and In-School Physical Activity Levels

Physical activity in the classroom helps improve on-task behavior during academic instruction time and increases daily in-school physical activity levels among children. Results of this classroom-based program add to evidence that students benefit both physically and academically from time devoted during the school day to physical activity.

Researchers equipped 243 third- and fourth-grade students with pedometers to assess physical activity during school hours. One group of students participated in a classroom-based physical activity program, called “Energizers”. Energizers activities last approximately 10 minutes, integrate grade-appropriate learning materials, involve no equipment, and require little teacher preparation. By allowing students to stand and move during academic instruction, these activities provide students with an opportunity to increase daily physical activity levels during the school day. (Energizers activities can be downloaded at no charge from the following Web address: www.ncpe4me.com/energizers.html .)

The remaining students served as the control group and did not participate in the Energizers activities. The research team evaluated both sets of students on their on-task behavior during academic instruction time. On-task behavior includes verbal and motor behavior that follows the class rules and is appropriate to the learning situation. Off-task behavior includes any motor, noise, or other response that breaks the classroom rules or interrupts the learning situation.

The active students took significantly more in-school steps than the control-group students. Further, after the Energizers activities were systematically implemented into the classrooms, on-task behavior improved by eight percent. Importantly, the students who were least on-task improved their behavior during academic instruction time by 20 percent after the Energizers activities.

“Unfortunately, few states require daily physical education programs, contributing to a missed opportunity for students to be active during the day,” said Matthew T. Mahar, Ed.D. “Adding physical activity to the classroom not only increases levels of physical activity during the school day, but also improves behaviors that are likely to lead to better learning.”

Barbara Day, M.S., R.D., C.N., is a nutritionist with a masters degree in clinical nutrition who is also registered dietitian and has over 30 years of experience in promoting healthy active lifestyles to consumers.