Physical Activity, Physical Fitness, & Academic Performance

Joseph E. Donnelly, ED.D., FACSMProfessor, Internal Medicine

Director, Energy Balance LaboratoryDirector, Center for Physical Activity & Weight Management

The University of Kansas Medical CenterThe University of Kansas-Lawrence

Overview• Metabolic syndrome and obesity in children

and youth• Minimal intervention approach to increase

physical activity and impact learning in schools• Barriers and potential solutions• Summary

Distribution of the Metabolic Syndrome & Its Related Components

0

10

20

30

40

MS HDL-C TG Gluc CO BP

All Boys Girls

Pre

vale

nce

(%)

VariablesDuBose et al., Acta Paediatr, 2006

Theoretical Model to Improve Health & Academic Achievement

Donnelly JE, Lambourne K, Prev. Med., 2011, 52:S36-42.

Schools are Sedentary

• Bus ride can be > 60 min each way• Recess and physical education has declined to

levels that cannot provide adequate stimulus (energy expenditure) for fitness or to protect against fatness

• Motor time off task is discouraged and disciplined

• Traditional teaching paradigm- sit down and be quiet

Physical Education by Itself is not Adequate to Provide Fitness or Prevent Fatness in the

Current Environment• PE and recess have diminished, frequently

offered 2-3 X week• PE duration as little as 20 minutes• MET value frequently just at or below the

definition of moderately vigorous• Inadequate facilities & equipment• PE teacher shared among schools, poor

training/no training

Physical Activity Across the Curriculum (PAAC)

A 3-year, randomized controlled trial of physical activity and academic

achievement for elementary school children in grades 2 & 3

Donnelly et al., Physical Activity Across the Curriculum (PAAC): A randomized controlled trial to promote physical activity and diminish obesity in elementary school children.Prev. Med. 2009, 49:336-41 (DK61489)

Major Aims of PAAC

• Increase physical activity by using classroom teachers to teach existing lessons with using physical activity

• Primary aim-Diminish increases in BMI

• Secondary aims-Determine association between physically active

lessons and academic achievementCharacterize metabolic syndrome

The PAAC Program

•A classroom-based approach to reduce sedentary behavior while maintaining the focus on academics

•NO DECREASE in academic instruction time

•PAAC is a technique to deliver existing academic instruction through movement

Traditional VS. PAAC Classroom

Conceptual Framework

• Minimal intervention• Enhances learning• No additional teacher preparation time• No additional cost• Easily perpetuated and replicated• Desirable for both teacher and student (i.e.,

FUN)• Students “must” participate in classroom lessons

The PAAC Program

Integrate 10 minute periods of physical activity within academic lessons for a total of 90 min/wk (i.e. 1 ten min lesson in morning and afternoon.

• Language art• Math • Science• History

Design

• Cluster randomized, controlled trial N=22• 3 year intervention• Grades 2&3• Target 90 minutes of moderate to vigorous

physical activity/wk• Use classroom teachers to deliver existing

academic lessons using physical activity

Active Lesson

Learning to Spell

Learning Math

Learning Spanish

Intensity of Physical Activity Mean SOFIT by Semester

0

0.5

1

1.5

2

2.5

3

3.5

4

Spring 04 Fall 04 Spring 05 Fall 05 Spring 06

SO

FIT Control

Intervention

38 boys & girlsGrades 2-5PAAC lessons of ≥ 10 min durationAverage MET = 3.4 (lower end of moderate to vigorous)

Will more vigorous exercise provide a greater response for cognitive function (and perhaps academic achievement?) Davis et al., Health Psychol, 2011

Honas et al., MSSE, 2008

Energy Expenditure of Exercise

BMI Change Across 3 Years for PAAC Schools Receiving 75+ min of PA or < 75 min PA

0

0.5

1

1.5

2

2.5

BMI Change

75+

<75

P=0.0003

1.8±0.1

2.4±0.2

9 schools 75+ min5 school <75 min

Academic Achievement- Individual Categories

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98

100

102

104

106

108

110

112

114

PAAC

CON

Reading B 3yr

Math B 3yr

SpellingB 3yr

Donner Adjusted t for Each Category p ≤ 0.01

Relationship Between Teacher Modeling & Physical Activity Levels in Students

(intervene with teachers to benefit students?)

2

2.5

3

3.5

4

4.5

5

None Some what active Active

Level of Teacher Modeling

PA

Lev

el b

y S

OF

IT S

core

*P<0.0001; dose-response relationship between teacher modeling and PA levelGibson et al., IJBNPA, 2008

**

9-Months Post Intervention Teacher Survey

≥1 d 2-4 d/wk most or every did not use0

102030405060708090

100

Percentage Use

A+PAAC Design- Emphasis on Academic Achievement

• Adequately powered, cluster randomized trial• 17 elementary schools, (9 intervention, 8

control)• ~ 20 children from 2nd & 3rd grades followed 3

yrs. to 4th and 5th grades (~40/school, 682 children total)

• 20 minutes of A+PAAC lessons/day

DK85317, Donnelly PI

A+PAAC Outcomes

• Academic achievement measured by Wechsler Individual Achievement Test III

• State administered achievement tests with individual identifiers

• Cognitive function- Flanker, n-back (Hillman)• Anthropometrics, fitness (Pacer), blood

chemistry, blood pressure, attention-to-task (Mahar), energy expenditure of A+PAAC lessons (indirect calorimetry via CosMed)

Relationship Between Fitness and WIAT III

Significant association between fitness and math controlling for grade, gender, BMI, mother’s education, household income and intraclass correlations among classes and schools

How to Increase Physical Activity in Schools Without Decreasing Academic Instruction

• Increase time children are physically active in current physical education and recess

• Provide access to physical activity before and after school

• Promote active transportation• Provide physically active lessons

What is Needed to Avoid Barriers and Promote Non-Traditional Physical Activity

in Schools • Low teacher burden for lesson preparation• Activity disconnected from motor skills• Additional evidence to link physical activity/fitness

& learningPlausible biological model combined with evidence

from well designed interventions linking to state academic achievement tests

• Low cost/no cost, sustainable programs through university teacher preparation (i.e., additional cost = $0.00)

Training Programs

• Physical Activity Across the Curriculum (A+PAAC)

• Take 10!• Let’s Move in School• Energizers• The Kinesthetic Classroom: teaching and

learning through movement. Mike Kuczala Regional Training Center (Randolph, NJ)

• Others

The End

A+PAAC Concept Lessons

MATH ELAPSED TIME – LUNGES, JUMPS, & JUMPING JACKS

The students are in a standing position and hopping in place off of both feet. The teacher gives them a problem involving “elapsed time.” For example, the movie started at 5:00 pm and ended at 8:00 pm. How much time passed? Students continue hopping and give a verbal answer. If the answer is correct, the students are asked to do 3 lunges, each lunge representing 1 hour. Variation: The elapsed time could be in 30 minute periods or 15 minute periods. Jumps and/or jumping jacks would be good movements for this variation. (1 jump or 1 jumping jack = 1 minute)

A+ P A A C

Evidence for Physical Activity & Academic Achievement

• Fitness (aerobic capacity) seems to be associated with academic achievement

• Academic lessons taught with physical activity have been shown to improve academic achievement and attenuate increases in BMI (2 for 1) even without increases in fitness

• Physically active lessons may improve attention-to-task, a behavior associated with learning, and critical to classroom management

There is no evidence that removal of physical activity programs results in greater academic achievement

The End