Physical Activity Across the Curriculum (PAAC): A randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children
Open accessAbstract
Objective Physical Activity Across the Curriculum (PAAC) was a three-year cluster randomized controlled trial to promote physical activity and diminish increases in overweight and obesity in elementary school children. Methods Twenty-four elementary schools were cluster randomized to the PAAC intervention or served as control. All children in grades two and three were followed to grades four and five. PAAC promoted 90 minutes/wk of moderate to vigorous intensity physically active academic lessons delivered by classroom teachers. BMI was the primary outcome, daily PA and academic achievement were secondary outcomes. Results The three-year change in BMI for PAAC was 2.0 ± 1.9 and control 1.9 ± 1.9, respectively (NS). However, change in BMI from baseline to three years was significantly influenced by exposure to PAAC. Schools with ≥75 minutes of PAAC/wk showed significantly less increase in BMI at three years compared to schools that had <75 minutes of PAAC (1.8 ± 1.8 vs. 2.4 ± 2.0, p=0.02). PAAC schools had significantly greater changes in daily PA and academic achievement scores. Conclusions The PAAC approach may promote daily PA and academic achievement in elementary school children. Additionally, 75 minutes of PAAC activities may attenuate increases in BMI.
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Our findings are in line with recent intervention results suggesting a beneficial intervention effect of school-based PA on academic performance.
“Our findings are in line with recent intervention results suggesting a beneficial intervention effect of school-based PA on academic performance [7–9].”
Most studies investigating the effects of school-based PA interventions on academic performance are implemented among primary school children.
“Most studies investigating the effects of school-based PA interventions on academic performance are implemented among primary school children [7, 8, 10, 11].”
Donnelly and colleagues found improved academic performance on all reported outcome measures (composite scores of reading, spelling and mathematics) when comparing children who received daily bouts of moderate to vigorous physical activity during academic lessons for 3 years (up to 90 min/week) with children who followed the regular curriculum.
“Donnelly and colleagues 42 found improved academic performance on all reported outcome measures (ie, the composite scores of reading, spelling and mathematics), when comparing children who received daily bouts of moderate to vigorous PA during academic lessons for 3 years (up to 90 min/ week) with children who followed the regular curriculum.”
All four studies that reported beneficial effects on maths performance assessed intervention programmes with a minimal frequency of three sessions per week and a minimal programme duration of two school years.
“Interestingly, all four studies 38 41 42 70 that reported beneficial effects on maths performance assessed intervention programmes with a minimal frequency of three sessions per week and a minimal programme duration of two school years.”
Higher levels of physical activity are unlikely to have adverse effects on learning.
“Higher levels of PA are not only fully compatible with schools’ mandate to promote the health of their students, but, according to the literature, they are also unlikely to have adverse effects on learning [16].”
From Physical Activity and Academic Achievement: An Umbrella Review (2020) · cites this paper as [16]
All 4 studies reporting class PA breaks found positive outcomes for MVPA or PA, but the risk of bias (quality and/or sample size) led to a limited-evidence rating.
“In our review, all 4 studies reporting class PA breaks found positive outcomes for MVPA or PA, but the risk of bias (quality and/or sample size) led to a limited-evidence rating.59, 60, 72, 98”
From A mixed-studies systematic review and meta-analysis of school-based interventions to promote physical activity and/or reduce sedentary time in children (2020) · cites this paper as [59]
Class PA breaks appear to have potential for sustainability, with 2 of the 4 studies reviewed reporting good teacher compliance and with all 4 studies having been conducted over at least 8 weeks.
“This type of intervention appears to have potential for sustainability, with 2 of the 4 studies we reviewed reporting good teacher compliance59, 72 and with all 4 studies having been conducted over at least 8 weeks.59, 60, 72, 98”
From A mixed-studies systematic review and meta-analysis of school-based interventions to promote physical activity and/or reduce sedentary time in children (2020) · cites this paper as [59]
For Donnelly 2009, the review judged incomplete outcome data as low risk because there was 2.5% missing data, not likely to affect results.
“Low risk Comment: there was 2.5% missing data, not likely to affect results”
From School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (2013) · cites this paper as Donnelly 2009
For Donnelly 2009, the review judged blinding as low risk because blinding was done where possible: research assistants were blinded to condition for measurement of primary and secondary outcomes and for data entry.
“Low risk Comment: blinding was done where possible -research assistants were blinded to condition for measurement of the primary and secondary outcomes and for data entry”
From School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (2013) · cites this paper as Donnelly 2009
For Donnelly 2009, the review judged allocation concealment as low risk because the criterion was not applicable: all participants were allocated at one point in time following recruitment, so allocation was not known at recruitment.
“Low risk Comment: criterion not applicable because all participants were allocated at 1 point in time following recruitment, so at time of recruitment allocation was not known”
From School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (2013) · cites this paper as Donnelly 2009
For Donnelly 2009, the review judged data collection methods as low risk because data collection tools were reported to be valid and reliable.
“Low risk Comment: data collection tools reported to be valid and reliable”
From School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (2013) · cites this paper as Donnelly 2009
For Donnelly 2009, the review judged selective reporting as low risk because all outcomes identified a priori were reported on.
“Low risk Comment: all outcomes identified a priori were reported on”
From School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (2013) · cites this paper as Donnelly 2009
For Donnelly 2009, the review judged random sequence generation as unclear risk because no description of the randomization process was given.
“Unclear risk Comment: no description of the randomization process given”
From School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (2013) · cites this paper as Donnelly 2009
For Donnelly 2009, the review judged confounders as controlled (low risk) because all relevant confounders were taken into account.
“Low risk Comment: all relevant confounders taken into account”
From School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18 (2013) · cites this paper as Donnelly 2009
In 3 studies assessing changes in physical activity over intervention periods of 12 weeks to 3 years, students in the intervention classrooms increased their physical activity during school, whether assessed by questionnaire, pedometer, or accelerometer.
“In 3 studies assessing changes in physical activity over intervention periods of 12 weeks to 3 years, students in the intervention classrooms increased their physical activity during school, whether assessed by questionnaire, pedometer, or accelerometer.253–255”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [255]
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“This type of intervention appears to have potential for sustainability, with 2 of the 4 studies we reviewed reporting good teacher compliance(59,72) and with all 4 studies having been conducted over at least 8 weeks.(59,60,72,98) Physically active learning differs from class PA breaks in that PA was integrated into co…”
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Self-citation
- Authors
- Donnelly, J. E., Greene, J. L., Gibson, C. A., Smith, B. K., Washburn, R. A., Sullivan, D. K., DuBose, K., Mayo, M. S., Schmelzle, K. H., Ryan, J. J., Jacobsen, D. J., & Williams, S. L.
- Affiliations
- University of Kansas (US)
- East Carolina University (US)
- University of Kansas Medical Center (US)
- University of Central Missouri (US)
- International Life Sciences Institute (US)
- Corresponding author
- Donnelly, Joseph E.
- ORCID
- Venue
- Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2009-10
- Volume
- 49
- Issue
- 4
- Pages
- 336-341
- ISSN
- 0091-7435 (ISSN-L)
- PMC
- PMC2766439
- OpenAlex
- W2068047340
- Semantic Scholar
- 1937f33507e60aa4f89e2d5ee4b7dce30007f439
- Cited by
- 595
- References
- 34
- Citations by year
- 2026: 16 · 2025: 13 · 2024: 24 · 2023: 16 · 2022: 29 · 2021: 41 · 2020: 48 · 2019: 53 · 2018: 51 · 2017: 44 · 2016: 50 · 2015: 51 · 2014: 44 · 2013: 47 · 2012: 32
- FWCI
- 22.86
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- KU ScholarWorks (University of Kansas) (submittedVersion, cc-by-nc-nd)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (DK R01 061489, R01DK085317, R01DK061489)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Keywords
- physical activity promotion, overweight and obesity prevention, elementary school students, classroom physical activity, body mass index, academic performance, moderate-to-vigorous physical activity, school-based intervention
- MeSH terms
- Adolescent, Analysis of Variance, Child, Curriculum, Educational Status, Female, Health Promotion, Humans, Kansas, Longitudinal Studies, Male, Motor Activity, Obesity, Schools, Students, United States, Exercise, Body Mass Index, Cluster Analysis, Program Development, Social Marketing, Overweight
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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