摘要：Objectives. We examined whether schools’ participation in the Recess Enhancement Program (REP) in the spring of 2011 was associated with higher rates of children’s vigorous physical activity. Methods. In REP, a coach guides children through age-appropriate games aimed at increasing their physical activity. During recess at 25 New York City public elementary schools (15 REP, 10 non-REP), researchers visually scanned predetermined areas (n = 1339 scans), recording the number of sedentary, walking, and very active children. Results. Multivariate statistical analysis found that participation in REP was a significant predictor ( P = .027) of the rate of vigorous physical activity (percentage very active in scan area) whose least-squares means were 41% in REP schools and 27% in non-REP schools. A significantly higher rate in REP schools persisted when the coach was not in the scan area, suggesting a change in the recess culture of REP schools. Conclusions. The rate of vigorous physical activity in REP schools was 14 percentage points, or 52%, higher than the rate in non-REP schools. This low-cost intervention might be a valuable addition to the tools for combating childhood obesity and worth replicating elsewhere. A substantial number of children fail to engage in any physical activity outside of school, 1 suggesting that school-based physical education classes and recess periods may be especially important opportunities for getting children to meet federal exercise guidelines. These guidelines recommend that children and adolescents engage in physical activity for 1 hour each day, 2 but many schools have cut back on physical education. Dale et al.,3(p241) for example, found that “student participation in physical education classes [in the Unites States] declined from 3.6 days to 3 days per week” between 1984 and 1994 in part because of budgetary constraints. Only “3.8% of public and private elementary schools required daily physical education for all students in 2006.”4(p265) New York City, where our study took place, reflects national trends. A study by the New York City Public Advocate found that “fifty-seven percent of the elementary schools surveyed offer[ed] P.E. only once per week,”5(p3) violating state regulations requiring daily physical education. Recess is offered substantially more frequently than physical education classes, 4 but recess periods may not be used well for physical activity because some schools allow children to stay indoors during recess to finish homework or play games on computers. 3 Increasing children’s physical activity levels is an important public health objective, especially in light of increases in childhood obesity rates. After 1980, “the prevalence of BMI for age at or above the 95th percentile (sometimes termed ‘obese’)… tripled among school-age children and adolescents,”6(p242) and then stabilized at about 17% for most children starting in 1999. High body mass index rates among children have not decreased since then, and have actually increased for boys (6–19 years old) at the highest body mass index-for-age levels (≥ 97th percentile), despite the implementation of a wide range of obesity prevention initiatives. 6 Overweight children are at risk for elevated lipid levels and high blood pressure 7 and for obesity in adulthood. 8,9 Obese adults are at increased risk of morbidity from hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and endometrial, breast, prostate, and colon cancers. Higher body weights are also associated with increases in all-cause mortality.10(pxi) Benefits of physical activity for youth include increased cardiorespiratory fitness and muscular strength, favorable body composition (i.e., lower body fat percentage), increased cardiovascular and metabolic health, bone health, and improved mental health. 11 Inadequacies in schools’ physical education programs may be difficult to remedy if there are substantial fiscal constraints. Capital improvements to add recreational infrastructure and facilities, which are positively correlated with increased physical activity, 12,13 may also be out of reach for many schools. The potential importance of adult encouragement of children to be physically active, 14 as well as structured time and adult supervision, which are associated with increased children’s physical activity, 15,16 suggests that there may be less costly approaches that can work within already existing school activities. Relatively consistent findings in the literature that boys are generally more active than girls 13,16–19 suggest that intervention approaches should aim to be equally inclusive of both genders. A review of previous studies found that “indicators of socioeconomic status were not related to children’s physical activity. Most studies found ethnic minority children were as active as non-Hispanic whites.”13(p965) We examined whether schools’ participation in the Recess Enhancement Program (REP) in the spring of 2011 was associated with higher rates of children’s vigorous physical activity.
