Editorial

Physical Activity in Schools: Challenges for School Nursing

A recent report from the Institute of Medicine (IOM; Committee on Physical Activity and Physical Education in the School Environment, 2013) sheds light on recommendations bringing schools into the 21st century in terms of schools’ role in addressing the physical activity needs of students. The IOM recommends a whole school approach. The recommendation is for children to have 60 min of strenuous activity a day, with more than 50% incorporated in the school day. The report suggests that physical activity can be spread across the school day including activity before school, during physical education classes, at recess and breaks, and in the classroom. Looking at afterschool, there are approximately 2–3 hr where physical activity can be accomplished in afterschool programs either intramural or extramural sports. One of the recommendations coming from the report is the maintenance of recess which can contribute 40% of the recommended time for physical activity (Ridgers, Stratton, & Fairclough, 2006). Research has shown that recess enhances attention in the classroom and subsequently learning (National Association for Sport and Physical Education, 2001). This recommendation for recess is consistent with the American Academy of Pediatrics’ recommendation supporting recess as ‘‘free play’’ and essential for students’ normal growth and development (Council on School Health, 2013). Unfortunately, the prevalence of recess is not evenly distributed across school communities. Studies have shown that urban schools with high minority enrollment and high poverty rates are the least likely to have recess (Parsad & Lewis, 2005). Introducing 10–15 min of physical activity in the classroom is emerging as an important method to meet the 60 min of activity a day, especially for elementary school children. Sustained classroom breaks have been associated with higher academic performance (Donnelly & Lambourne, 2011). A couple of the classroom programs that provide evidence of effectiveness include Take 10! (Kibbe et al., 2011) and the I-CAN program in Texas (Bartholomew & Jowers, 2011). For classroom physical activity to be widely accepted, school administrations need to be in support and classroom teachers need to develop the skill and buy-in of such programming. If the recommended whole school approach is adopted, what is the role of the school nurse? Because physical activity is the seminal factor to preventing so many problems throughout life, including cardiovascular disease, diabetes mellitus, osteoporosis, and mental health problems, it is

The Journal of School Nursing 2014, Vol. 30(1) 9-10 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1059840513516930 jsn.sagepub.com

really a school nursing issue. As a member of the school health team, the school nurse can bring the IOM report to the school community (http://www.iom.edu/Reports/2013/Educating-the-Student-Body-Taking-Physical-Activity-and-Phy sical-Education-to-School.aspx) and lead an assessment of the total amount of time that is dedicated to physical activity. Additionally, the school nurse has data that illustrate various indicators of the need for physical activity in the health record. Summary reports of body mass index, blood pressure, and prevalence of other indicators can be a powerful tool in the school nurse arsenal. Identification of the barriers to physical activity in school is another step for school nurses to take. No Child Left Behind (P.L. No. 107-110) is a barrier to promoting physical activity in schools because the focus is exclusively on mathematics and reading scores that are tied to federal funding. Physical education is in fact, rated as one of the nonessential classes by No Child Left Behind. Addressing these barriers requires creativity. While teacher skill might be a barrier to classroom breaks, there are programs available for purchase and at no cost to guide teachers in adopting classroom physical activity. Space may be another barrier for classroom physical activity in some cases. Barriers to recess may include shorter school days and lack of adequate resources for recess including equipment and supervision. All of these barriers are magnified in urban schools located where community poverty persists and in secondary schools where classroom physical activity and recess are not applied. In high schools, afterschool engagement in physical activity becomes more important. In underresourced school, community partnerships are essential. Clearly, the solution to the problems goes beyond school nursing, but school nurses can initiate and support efforts to address the whole school approach by providing data to show the need and building coalitions within the school and out of the school to get the momentum going. By capitalizing on the global concern for inactivity among school children, school nurses can and should lead the charge to bring the IOM recommendations to a reality. Julia Muennich Cowell, PhD, RN, APHN-BC, FAAN Executive Editor References Bartholomew, J., & Jowers, E. (2011). Physically active academic lessons in elementary children. Preventive Medicine, 52, S51–S54.

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Committee on Physical Activity and Physical Education in the School Environment; Food and Nutrition Board, Kohl, H. W., & Cook, H. D. (Eds.), Institute of Medicine. (2013). Educating the Student Body: Taking Physical Activity and Physical Education to School. Washington, DC: The National Academies Press. Council on School Health. (2013). The crucial role of recess in school. Pediatrics, 131, 183–188. Donnelly, J., & Lambourne, K. (2011). Classroom-based physical activity, cognition and academic achievement. Preventive Medicine, 52, S36–S42. Kibbe, D., Hackett, J., Hurley, M., McFarland, A., Schubert, H., Schultz, A., & Harris, S. (2011). Ten years of TAKE 10!

Integrating physical activity with academic concepts in elementary school classrooms. Preventive Medicine, 52, 543–550. National Association for Sport and Physical Education. (2001). Integrating physical activity into the complete school day. Reston, VA: American Alliance for Health, Physical Education, Recreation & Dance. Parsad, B., & Lewis, L. (2005). Calories in calories out: Food and exercise in public elementary schools. Washington, DC: National Center for Education Statistics. Ridgers, N. S., Stratton, G., & Fairclough, S. J. (2006). Physical activity levels of children during school playtime. Sports Medicine 36, 359–371.

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Physical activity in schools: challenges for school nursing.

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