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School-based programs to increase physical activity

Public Health & Prevention: School-based
Benefit-cost methods last updated December 2024.  Literature review updated November 2015.
These programs added additional physical activity to the elementary or middle school day through guided activities led by the classroom teacher or physical education teacher. They did not replace standard physical education classes or recess. The format of these interventions varied but most programs incorporated physical activity into the standard classroom curriculum. Some programs included instruction on the importance of physical activity and/or nutrition in addition to the time that students were engaged physical activity time. The intervention length ranged from two months to six school years.
 
ALL
BENEFIT-COST
META-ANALYSIS
CITATIONS
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2023).  The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $4,870 Benefits minus costs $21,527
Participants $11,471 Benefit to cost ratio $38.53
Others $6,047 Chance the program will produce
Indirect ($287) benefits greater than the costs 67%
Total benefits $22,100
Net program cost ($574)
Benefits minus cost $21,527

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the program impacts measured in the research literature (for example, impacts on crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information on how we estimate effect sizes.

The effect size may be adjusted from the unadjusted effect size estimated in the meta-analysis. Historically, WSIPP adjusted effect sizes to some programs based on the methodological characteristics of the study. For programs reviewed in 2024 or later, we do not make additional adjustments, and we use the unadjusted effect size whenever we run a benefit-cost analysis.

Research shows the magnitude of effects may change over time. For those effect sizes, we estimate outcome-based adjustments, which we apply between the first time ES is estimated and the second time ES is estimated. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Treatment age No. of effect sizes Treatment N Effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Obesity
Obese based on clinical guidelines for adults (body mass index of 30 or higher) or children (body mass index at or above the 95th percentile for children of the same age and sex), as appropriate.
10 17 5767 -0.020 0.024 12 0.000 0.101 14 -0.020 0.859
Test scores
Standardized, validated tests of academic achievement.
10 3 528 0.123 0.187 12 0.095 0.205 17 0.123 0.510
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Test scores Labor market earnings associated with test scores $4,869 $11,471 $6,046 $0 $22,386
Obesity Health care associated with obesity $0 $0 $1 $0 $2
Mortality associated with obesity $0 $0 $0 $0 $0
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($287) ($287)
Totals $4,870 $11,471 $6,047 ($287) $22,100
Click here to see populations selected
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $235 2014 Present value of net program costs (in 2023 dollars) ($574)
Comparison costs $0 2014 Cost range (+ or -) 20%
The programs in this analysis added 146 additional hours of physical activity and required an average of seven hours of professional development per teacher. We assume that these costs are spread over two years. The annual per-student cost of the intervention was calculated by adding the teacher time required to incorporate this additional physical activity into the school day and the average number of hours of teacher training required and dividing this sum by the average K-8th grade class size in Washington State (26.55 students). The per-student staff hours were multiplied by the average hourly salary and benefits for elementary school teachers in Washington State.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in discounted dollars. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Citations Used in the Meta-Analysis

Ahamed, Y., Macdonald, H., Reed, K., Naylor, P. J., Liu-Ambrose, T., & McKay, H. (2007). School-based physical activity does not compromise children's academic performance. Medicine and Science in Sports and Exercise, 39(2), 371-376.

Burke, V., Milligan, R.A., Thompson, C., Taggart, A.C., Dunbar, D.L., Spencer, M.J., . . . Beilin, L.J. (1998). A controlled trial of health promotion programs in 11-year-olds using physical activity 'enrichment' for higher risk children. The Journal of Pediatrics, 132(5), 840-848.

Donnelly, J.E., Greene, J.L., Gibson, C.A., Smith, B.K., Washburn, R.A., Sullivan, D.K., . . . Williams, S.L. (2009). Physical Activity Across the Curriculum (PAAC): A randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Preventive Medicine, 49(4), 336-41.

Flores, R. (1995). Dance for health: improving fitness in African American and Hispanic adolescents. Public Health Reports, 110(2), 189-193.

Graf, C., Koch, B., Falkowski, G., Jouck, S., Christ, H., Staudenmaier, K., . . . Dordel, S. (2008). School-based prevention: Effects on obesity and physical performance after 4 years. Journal of Sports Sciences, 26(10), 987-994.

Grydeland, M., Bjelland, M., Anderssen, S.A., Klepp, K.I., Bergh, I.H., Andersen, L.F., Ommundsen, Y., ... Lien, N. (2014). Effects of a 20-month cluster randomised controlled school-based intervention trial on BMI of school-aged boys and girls: the HEIA study. British Journal of Sports Medicine, 48(9), 768-773.

Harrell, J.S., McMurray, R.G., Bangdiwala, S.I., Frauman, A.C., Gansky, S.A., & Bradley, C.B. (1996). Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: the Cardiovascular Health in Children (CHIC) study. The Journal of Pediatrics, 128(6), 797-805.

Harrell, J.S., McMurray, R.G., Gansky, S.A., Bangdiwala, S.I., & Bradley, C.B. (1999). A public health vs a risk-based intervention to improve cardiovascular health in elementary school children: the Cardiovascular Health in Children Study. American Journal of Public Health, 89(10), 1529-1535.

Hopper, C.A., Munoz, K.D., Gruber, M.B., & Nguyen, K.P. (2005). The effects of a family fitness program on the physical activity and nutrition behaviors of third-grade children. Research Quarterly for Exercise and Sport, 76(2), 130-139.

Katz, D.L., Cushman, D., Reynolds, J., Njike, V., Treu, J.A., Walker, J., . . . Katz, C. (2010). Putting physical activity where it fits in the school day: Preliminary results of the ABC (Activity Bursts in the Classroom) for fitness program. Preventing Chronic Disease, 7(4). Retrieved June 15, 2011 from http://www.cdc.gov/pcd/issues/2010/Jul/pdf/09_0176.pdf

Kriemler, S., Zahner, L., Schindler, C., Meyer, U., Hartmann, T., Hebestreit, H., . . . Puder, J.J. (2010). Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: Cluster randomised controlled trial. BMJ, 340(c785). doi: 10.1136/bmj.c785

Lubans, D.R., Morgan, P.J., Okely, A.D., Dewar, D., Collins, C.E., Batterham, M., . . . Plotnikoff, R.C. (2012). Preventing obesity among adolescent girls: One-year outcomes of the Nutrition and Enjoyable Activity for Teen Girls (NEAT Girls) cluster randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 166(9), 821-7.

Manios, Y., Moschandreas, J., Hatzis, C., & Kafatos, A. (2002). Health and nutrition education in primary schools of Crete: changes in chronic disease risk factors following a 6-year intervention programme. The British Journal of Nutrition, 88(3), 315-24.

Pate, R.R., Ward, D.S., Saunders, R.P., Felton, G., Dishman, R.K., & Dowda, M. (2005). Promotion of physical activity among high-school girls: a randomized controlled trial. American Journal of Public Health, 95(9), 1582-1587.

Reed, K. E., Warburton, D. E., Macdonald, H. M., Naylor, P. J., & McKay, H. A. (2008). Action Schools! BC: A school-based physical activity intervention designed to decrease cardiovascular disease risk factors in children. Preventive Medicine, 46(6), 525-531.

Salmon, J., Ball, K., Hume, C., Booth, M., & Crawford, D. (2008). Outcomes of a group-randomized trial to prevent excess weight gain, reduce screen behaviours and promote physical activity in 10-year-old children: Switch-play. International Journal of Obesity, 32(4), 601-612.

Simon, C., Schweitzer, B., Oujaa, M., Wagner, A., Arveiler, D., Triby, E., . . . Platat, C. (2008). Successful overweight prevention in adolescents by increasing physical activity: A 4-year randomized controlled intervention. International Journal of Obesity, 32(10), 1489-1498.

Sollerhed, A.-C., & Ejlertsson, G. (2008). Physical benefits of expanded physical education in primary school: findings from a 3-year intervention study in Sweden. Scandinavian Journal of Medicine & Science in Sports, 18(1), 102-107.