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“There tends to be a big drop in physical activity as kids move into their teenage years. And so this is a key moment to try to prevent that from occurring.” - Dr. Michael Prelip
IN THE NATIONAL EFFORT TO PREVENT CHILDHOOD OBESITY, much attention has been paid to promoting healthier eating. While that is undeniably important, a Fielding School professor believes another vital part of the equation is underemphasized.
Most children and adolescents are falling well short of the recommended hour of daily physical activity, notes Dr. Michael Prelip, professor in FSPH’s Department of Community Health Sciences and the school’s associate dean for practice across the life course. And physical education (PE) remains undervalued in many school districts, he says — a missed opportunity to engage students in what is often the only physical activity they experience each day.
“In many cases the funding for physical education has been reduced, and whenever there is a field trip, assembly or standardized testing, it’s the first subject considered expendable,” Prelip says. He notes that this is a particular problem in under-resourced communities, where parent groups may not be able to raise funds to offset any budget cuts and, outside of school, children tend to have fewer opportunities to participate in organized sports as well as less access to parks and other informal spaces for play.
Through a partnership with the Los Angeles Unified School District (LAUSD), a Fielding School team headed by Prelip is currently studying the impact of a program aiming to improve the quality of PE in middle schools. Project Shape, funded by the National Institutes of Health and developed with input from district officials, school administrators, community members, PE teachers and their students, involves 16 low-income middle schools spread throughout LAUSD, and approximately 5,000 students.
The study intends to identify opportunities for PE teachers to increase the amount of moderate-to-vigorous physical activity in their classes while improving students’ attitudes toward PE by making it more fun, less competitive and more inclusive.
Middle school is a key group to target for these goals. “There tends to be a big drop in physical activity as kids move into their teenage years,” Prelip says. “And so this is a key moment to try to prevent that from occurring and help them build a foundation of healthy behaviors that can be carried on into adulthood.”
Through the professional development offered as part of the study, Project Shape has sought to work with middle school PE teachers to overcome some of the challenges they face in resource-strapped urban settings. “They are expected to teach a standards- based curriculum, but because of budget cuts at the elementary school level, many of their students have never previously had a formal PE class, and so they may be learning to play an organized sport or to do push-ups and sit-ups for the first time,” says Lindsay Rice, the FSPH study’s project manager. Although the teachers are trained in PE, she adds, many of those assigned to middle schools have little or no experience with students that age, and PE class sizes in the district are typically as high as 55.
In the face of these challenges, the FSPH research team found that at the onset of the study only 15 percent of students’ PE classroom time was spent in moderate-to-vigorous physical activity, well short of the national recommendation of 50 percent. Much of the idle moments were being spent in class-management activities such as calling roll and receiving verbal instruction, or waiting while other students participated. In addition, the students most likely to engage in higher levels of physical activity tend to be the ones who need it least. “For the kids who are sedentary and overweight or obese, it’s uncomfortable and not fun,” Prelip says. “We want to shift the focus more toward these students in a way that’s non-competitive and inclusive.”
For the study, the FSPH group partnered with SPARK (Sports, Play & Active Recreation for Kids), a program of San Diego State University Research Foundation that provides professional development and curricula designed to make PE more fun and engaging. The participating middle school teachers were offered 12 hours of SPARK certification training in skills such as classroom management, instructional techniques and motivation, all designed to increase physical activity levels. The teachers were given SPARK educational materials as well as vouchers to purchase new sports equipment.
Christine Berni-Ramos, a national board-certified PE teacher at Elizabeth Learning Center in Cudahy, southeast of downtown Los Angeles, says the training helped her to rethink her practices. “When we teach, we aren’t always aware of how much time students spend sedentary as opposed to being physically active,” she says. “So this really served as an ‘aha’ moment and got me thinking about innovative ways to keep my students engaged and moving.”
One of the changes Berni-Ramos has instituted is “active roll call” — rather than sitting passively for several minutes at the beginning of the class period while Berni-Ramos takes roll, her students go straight to their assigned station and place a popsicle stick with their name on it on the “present” side of the station’s cone before proceeding with the activity. To reduce the time spent transitioning from one activity to the next, Berni- Ramos now issues verbal cues and plays music designed to motivate the students to move quickly. Through a strategy known as “disguising fitness,” she introduces exercise as part of a fun activity — for example, students who would normally remain frozen in a game of freeze tag are able to return to active participation by performing calisthenics.
“A lot of kids aren’t initially motivated, but they just need the tools to learn how to be physically active in ways they enjoy,” Berni-Ramos says. “And by making this something they like to do, you’re setting them up for a lifetime of physical activity.”
Project Shape has provided venues for Berni-Ramos and other PE teachers to make their voices heard within the district. The Fielding School team partnered with LAUSD’s director of physical education to revitalize an existing PE task force, providing a forum for the teachers to meet with administrators and others to discuss physical activity programming. The study has also sought to empower PE teachers to take on leadership roles in their schools and communities. After learning from one of the study’s volunteers, Lorena Gonzalez, about a local run/walk event she was involved in to combat childhood obesity, Berni-Ramos joined in the planning process and brought in students from her school to assist. Gonzalez has since entered the Fielding School as an MPH student.
More than a dozen students from FSPH and other parts of the campus, including undergraduates, have participated in Project Shape as student researchers. “Through my work on the project, I have had the opportunity to see the benefits of effective collaboration — not only with the schools and teachers involved in the study, but also with the members of our research team,” says Monique Gill, a doctoral student in FSPH’s Department of Community Health Sciences who has assisted in tasks that include collecting and analyzing data, as well as interviewing teachers in an effort to capture how health fits into their daily school programming.
Alec Chan-Golston, a doctoral student in the Department of Biostatistics who has spent time at the schools collecting, validating and analyzing survey data, says the hands-on experience of seeing how the information is obtained will make him a better biostatistician. “Fieldwork gives a perspective as to how much goes into data collection and leads to better data analysis and interpretation,” he says. “For instance, instead of being discouraged that a few students didn’t fill out their surveys, I was impressed with how many did.”
Beyond serving as a learning experience for the students, Project Shape has helped to draw attention to the work of the teachers. “The importance of PE isn’t fully appreciated as part of a well-rounded education and its contribution to students’ wellbeing,” says Dr. Kate Crespi, an associate professor in FSPH’s Department of Biostatistics and member of the study team. “These teachers don’t always get the credit they deserve or the support they need, so I was excited to have them be the focus of this research.”
“One of our goals has been simply to acknowledge that PE teachers work hard at an important job, and deserve opportunities for further development,” adds Prelip, who explains that the study intervention was designed so that it could be easily scaled up and more widely adopted in LAUSD. “These teachers want their students to be more engaged, and they have been eager to work with us in identifying the best ways to get there.”