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Why PE matters for student academics and wellness right now

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This story about PE teachers was produced by The Hechinger Report , a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for Hechinger’s newsletter .

Amanda Amtmanis, an elementary physical education instructor in Middletown, Connecticut, handed out cards with QR codes to a class of third graders, and told them to start running.

The kids sprinted off around the baseball field in a light drizzle, but by the end of the first lap, a fifth of a mile, many were winded and walking. They paused to scan the cards, which track their mileage, on their teacher’s iPad and got some encouragement from an electronic coach — “Way to run your socks off!” or “Leave it all on the track!”

A boy in a red Nike shirt surged ahead, telling Amtmanis his goal was to run 5 miles. “Whoa, look at Dominic!” another boy exclaimed.

“We don’t need to compare ourselves to others,” Amtmanis reminded him.

The third graders finished a third lap, alternating running and walking, and were about to start on a scavenger hunt when the rain picked up, forcing them inside. Amtmanis thanked her students for their willingness to adjust — a skill many of them have practiced far more often than running these past 18 months.

The full impact of the pandemic on kids’ health and fitness won’t be known for some time. But it’s already caused at least a short-term spike in childhood obesity Rates of overweight and obesity in 5- through 11-year-olds rose nearly 10 percentage points in the first few months of 2020.

Amtmanis’ “mileage club,” which tracks students’ running, both in and out of school, and rewards them with Pokémon cards when they hit certain targets, is an example of how PE teachers around the country are trying to get kids back in shape.

But inclement weather isn’t the only thing PE teachers are up against as they confront what might be called “physical learning loss.” Physical education as a discipline has long fought to be taken as seriously as its academic counterparts. Even before the pandemic, fewer than half the states set any minimum amount of time for students to participate in physical education, according to the Society of Health and Physical Educators (SHAPE), which represents PE and health instructors.

Now, as schools scramble to help kids catch up academically, there are signs that PE is taking a back seat to the core subjects yet again. In some California schools, administrators are shifting instructional minutes from PE to academic subjects — or canceling class altogether so PE teachers can sub for classroom teachers; in others, they’re growing class sizes in the gym, so they can shrink them in the classroom.

Meanwhile, innovative instructors like Amtmanis, who has worked in her district for more than 20 years, are struggling to get their ideas off the ground. Over the summer, the principal of Macdonough Elementary, one of two schools where Amtmanis teaches, approved her request to participate in another running program called The Daily Mile, in which kids walk or run 15 minutes a day during school hours.

Daily running breaks “boost attentiveness, which has positive effects on academics,” Amtmanis argued.

But two weeks into the school year, not a single teacher had bought into the idea.

“The issue is their packed schedule,” Amtmanis said.

Last year, many schools conducted gym class remotely, with students joining in from their bedrooms and living rooms.

The online format presented several challenges. Many students lacked the equipment, space, or parental support to participate fully. And many instructors grappled with how to teach and assess motor skills and teamwork online.

Though instructors found creative ways to keep students moving — substituting rolled-up socks for balls, and “disguising fitness” in scavenger hunts and beat-the-teacher challenges — they still fretted that online gym wasn’t giving students the same benefits as in-person classes.

Compounding their concern was the fact that many students were also missing out on recess and extracurricular sports.

In a March 2021 survey conducted by the Cooper Institute, maker of the popular FitnessGram assessments, close to half the PE teachers and school and district administrators responding said their students were “significantly less” physically active during their schools’ closure than before it.

Schools that reopened last year faced their own set of challenges, including bans on shared equipment that made even a simple game of catch impossible. Schools that were open for in-person learning were also much more likely to cut back on PE instructional time, or eliminate it altogether, the survey found.

The consequences of these reductions in physical activity are hard to quantify, especially since many schools suspended fitness testing during the pandemic and have yet to resume it, but some PE teachers say they’re seeing more kids with locomotor delays and weaker stamina than normal.

“The second graders are like first graders, and some are even like kindergarteners,” said Robin Richardson, an elementary PE instructor in Kentucky. They can jump and hop, she said, but they can’t leap. They’re exhausted after 20 seconds of jumping jacks.

An unusually high number of Richardson’s first graders can’t skip or do windmills. Some lack the spatial awareness that’s essential to group games.

“They don’t know how to move without running into each other,” she said.

Other instructors are seeing an increase in cognitive issues, such as difficulty paying attention or following directions, particularly among kids who remained remote for most or all of last year.

Kyle Bragg, an elementary PE instructor in Arizona, has seen kids sitting with their backs to him, staring off into space when he’s talking. “I say ‘Knees, please,’ so they spin around to face me,” he said.

And some PE teachers say their students’ social-emotional skills have suffered more than their gross motor skills. “They forgot how to share; how to be nice to each other; how to relate to each other,” said Donn Tobin, an elementary PE instructor in New York.

PE has a key role to play in boosting those skills, which affect how kids interact in other classes, said Will Potter, an elementary PE teacher in California.

“We’re uniquely situated to handle the social-emotional needs that came out of the pandemic, in a way classroom teachers are not,” Potter said.

Amtmanis, for her part, worries about her students’ mental health. She sees the little signs of strain daily — the kid who got upset because he couldn’t pick his group, for example, and the one who was distressed that his Mileage Club card had gotten mixed up in the front office.

“Their emotional reserves are low,” she said.

Yet not all instructors are reporting drops in their students’ fitness and skill development. Teachers in some middle- and upper-income districts said they haven’t noticed much of a change at all. In some communities, families seemed to spend more time outdoors.

“We saw the skyrocketing sale of bicycles, we saw families going for walks,” said Dianne Wilson-Graham, executive director of the California Physical Education and Health Project.

But in Title I schools like Macdonough, where more than half the students are low-income, some kids didn’t even have access to a safe place to exercise or play during school closures.

“Not only are they not in soccer leagues, but sometimes they don’t even have a park,” Amtmanis said.

Amtmanis came up with the idea of doing the Daily Mile after spring fitness tests revealed drops in her students’ strength, flexibility and endurance.

But many schools still aren’t sure how much physical learning loss their students have experienced as a result of the pandemic. Most schools pressed pause on fitness testing last year, and some elementary-school instructors are reluctant to restart it. They say the tests aren’t valid with young children, even in ordinary times, and argue the time they take could be better spent on Covid catch-up.

Andjelka Pavlovic, director of research and education for the Cooper Institute, said its tests are scientifically proven to be valid for students who are 10 and up, or roughly starting in fourth grade.

Fitness testing requirements vary by state, county or even district. Some states specify how often students must be tested; others leave it largely to the teacher.

Bragg, the Arizona teacher, said he has put testing “on the backburner” because “right now it’s not at the forefront of what’s important.”

Richardson said she is avoiding testing because she doesn’t want to use up precious instructional time or demoralize her students. “I want my kids to enjoy movement,” she said. If they perform poorly on the tests, “they may not feel as strong.”

In Connecticut, where schools are required to test fourth graders’ fitness annually, Amtmanis approached testing cautiously last year. She didn’t want to embarrass her students, so she made it into a series of games.

Instead of Sit-and-Reach, they had a “flexibility contest,” in which kids broke into teams for tag then had to perform stretches if they were tagged. She measured the distances stretched with curling ribbon, tied the ribbons together, and attached a balloon to the end. The team whose balloon soared the highest won fidget putty.

Pushups became a Bingo game, with the center space representing pushups.

“My goal was to get through it without ever using the words ‘fitness” or ‘testing,’” she said.

As the pandemic drags on, some instructors are taking a similar approach to fitness remediation and acceleration.

Bragg likes a warmup called “ Touch Spots ,” in which first graders listen as the instructor reads off the name of a color, then run and touch a corresponding dot on the floor. It works on reaction time, cardiovascular endurance, spatial awareness and sequencing — but the kids don’t know that.

“Students are having so much fun that they don’t realize how much fitness they are doing,” Bragg said.

Differentiation — tailoring instruction to meet individual students’ needs — has become even more essential, with former remote learners often lagging behind their in-person peers, Bragg said.

When playing catch, for example, he offers his students different sized balls — the smaller ones are more challenging.

Potter, the California teacher, spent the first two weeks of school teaching his students how to connect with their partners, stressing the importance of eye contact and body language.

“When you’re on Zoom, you look at the camera to make eye contact,” he said. “It’s a very different environment.”

Bragg reminds his students how to include kids who are standing on the sidelines, modeling excited body language and tone of voice. Lately, he’s noticed that kids who were remote last year are being excluded from groups.

“Social interaction needs to be practiced, just like how to throw a ball,” he said.

Richardson, the Kentucky PE teacher, is trying to build up her students’ stamina gradually, through progressively longer intervals of exercise.

But she works in a school with pods, so she sees each group of kids for five consecutive days, every third week. The two weeks in between, she has to hope that teachers will provide recess and “movement breaks.” She’s trying to get them to give kids breaks “when they get glassy-eyed and frustrated.”

Recently, Richardson was at a staff training session at which depleted teachers were “popping candy in the back.” When she raised her hand and requested a break in the training, her colleagues cheered. She told them to remember how they felt when their students return to the building.

“I always say, ‘If your bum is numb, your brain is the same,’” she said.

Convincing classroom teachers to set aside more time for movement can be challenging, though. As students return from months of online learning, teachers are under enormous pressure to get them caught up academically.

Kate Cox, an elementary and middle-school PE teacher in California, wishes schools would “realize what they’re missing when they cut PE because of learning loss in other areas.” Physical education is “readying their minds and bodies to be more successful in other areas,” Cox said.

Terri Drain, the president of SHAPE, argued that schools fail students when they treat physical learning loss as less serious than its academic counterpart.

“In the primary grades, children develop fundamental motor skills, such as throwing, catching, running, kicking and jumping,” she said. Unless schools commit to helping kids catch up, “the impacts of this ‘missed learning’ will be lifelong.”

In Connecticut, Amtmanis hasn’t given up on convincing teachers to carve out time for the Daily Mile. She recently sent them a list of suggestions on how to fit 15 minutes of running into the day, including by incorporating it as an active transition between academic blocks.

“While it may seem like there aren’t minutes to spare,” she wrote, “the energizing effect of the active transition should result in more on-task behavior and more efficient working.”

In the meantime, Amtmanis plans to keep using the mileage club to motivate her students to run and to monitor their progress.

“I don’t want to call attention to the fact that not everyone is fit,” she said. “This is an unobtrusive way to keep the data.”

Physical education for healthier, happier, longer and more productive living

The time children and adults all over the world spend engaging in physical activity is decreasing with dire consequences on their health, life expectancy, and ability to perform in the classroom, in society and at work.

In a new publication, Quality Physical Education, Guidelines for Policy Makers , UNESCO urges governments and educational planners to reverse this trend, described by the World Health Organization (WHO) as a pandemic that contributes to the death of 3.2 million people every year, more than twice as many as die of AIDS.

The Guidelines will be released on the occasion of a meeting of UNESCO’s Intergovernmental Committee for Physical Education and Sport (CIGEPS) in Lausanne, Switzerland, (28-30 January).*

UNESCO calls on governments to reverse the decline in physical education (PE) investment that has been observed in recent years in many parts of the world, including some of the wealthiest countries. According to European sources, for example, funding and time allocation for PE in schools has been declining progressively over more than half of the continent, and conditions are not better in North America.

The new publication on PE, produced in partnership with several international and intergovernmental organizations**, advocates quality physical education and training for PE teachers. It highlights the benefits of investing in PE versus the cost of not investing (cf self-explanatory infographics ).

“The stakes are high,” says UNESCO Director-General Irina Bokova. “Public investment in physical education is far outweighed by high dividends in health savings and educational objectives. Participation in quality physical education has been shown to instil a positive attitude towards physical activity, to decrease the chances of young people engaging in risky behaviour and to impact positively on academic performance, while providing a platform for wider social inclusion.”

The Guidelines seek to address seven areas of particular concern identified last year in UNESCO’s global review of the state of physical education , namely: 1. Persistent gaps between PE policy and implementation; 2. Continuing deficiencies in curriculum time allocation; 3. Relevance and quality of the PE curriculum; 4. Quality of initial teacher training programmes; 5. Inadequacies in the quality and maintenance of facilities; 6. Continued barriers to equal provision and access for all; 7. Inadequate school-community coordination.

The recommendations to policy-makers and education stake-holders are matched by case studies about programmes, often led by community-based nongovernmental organizations. Success stories in Africa, North and Latin America, Asia and Europe illustrate what can be achieved by quality physical education: young people learn how to plan and monitor progress in reaching a goal they set themselves, with a direct impact on their self-confidence, social skills and ability to perform in the classroom.

While schools alone cannot provide the full daily hour of physical activity recommended for all young people, a well-planned policy should promote PE synergies between formal education and the community. Experiences such as Magic Bus (India) which uses physical activity to help bring school drop outs back to the classroom highlight the potential of such school-leisure coordination.

The publication promotes the concept of “physical literacy,” defined by Canada’s Passport for Life organization of physical and health educators as the ability to move “with competence and confidence in a wide variety of physical activities in multiple environments that benefit the healthy development of the whole person. Competent movers tend to be more successful academically and socially. They understand how to be active for life and are able to transfer competence from one area to another. Physically literate individuals have the skills and confidence to move any way they want. They can show their skills and confidence in lots of different physical activities and environments; and use their skills and confidence to be active and healthy.”

For society to reap the benefit of quality physical education, the guidelines argue, planners must ensure that it is made available as readily to girls as it is to boys, to young people in school and to those who are not.

The Guidelines were produced at the request of UNESCO’s Intergovernmental Committee for Physical Education and Sport (CIGEPS) and participants at the Fifth International Conference of Ministers and Senior Officials Responsible for Physical Education and Sport (Berlin 2013). UNESCO and project partners will proceed to work with a number of countries that will engage in a process of policy revision in this area, as part of UNESCO’s work to support national efforts to adapt their educational systems to today’s needs (see Quality physical education contributes to 21st century education ).

Media contact: Roni Amelan, UNESCO Press Service, r.amelan(at)unesco.org , +33 (0)1 45 68 16 50

Photos are available here: http://www.unesco.org/new/en/media-services/multimedia/photos/photo-gallery-quality-physical-education/

* More about the CIGEPS meeting

** The European Commission, the International Council of Sport Science and Physical Education (ICSSPE), the International Olympic Committee (IOC), UNDP, UNICEF, UNOSDP and WHO.

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Article Contents

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‘Physical education makes you fit and healthy’. Physical education's contribution to young people's physical activity levels

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S. Fairclough, G. Stratton, ‘Physical education makes you fit and healthy’. Physical education's contribution to young people's physical activity levels, Health Education Research , Volume 20, Issue 1, February 2005, Pages 14–23, https://doi.org/10.1093/her/cyg101

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The purpose of this study was to assess physical activity levels during high school physical education lessons. The data were considered in relation to recommended levels of physical activity to ascertain whether or not physical education can be effective in helping young people meet health-related goals. Sixty-two boys and 60 girls (aged 11–14 years) wore heart rate telemeters during physical education lessons. Percentages of lesson time spent in moderate-and-vigorous (MVPA) and vigorous intensity physical activity (VPA) were recorded for each student. Students engaged in MVPA and VPA for 34.3 ± 21.8 and 8.3 ± 11.1% of lesson time, respectively. This equated to 17.5 ± 12.9 (MVPA) and 3.9 ± 5.3 (VPA) min. Boys participated in MVPA for 39.4 ± 19.1% of lesson time compared to the girls (29.1 ± 23.4%; P < 0.01). High-ability students were more active than the average- and low-ability students. Students participated in most MVPA during team games (43.2 ± 19.5%; P < 0.01), while the least MVPA was observed during movement activities (22.2 ± 20.0%). Physical education may make a more significant contribution to young people's regular physical activity participation if lessons are planned and delivered with MVPA goals in mind.

Regular physical activity participation throughout childhood provides immediate health benefits, by positively effecting body composition and musculo-skeletal development ( Malina and Bouchard, 1991 ), and reducing the presence of coronary heart disease risk factors ( Gutin et al. , 1994 ). In recognition of these health benefits, physical activity guidelines for children and youth have been developed by the Health Education Authority [now Health Development Agency (HDA)] ( Biddle et al. , 1998 ). The primary recommendation advocates the accumulation of 1 hour's physical activity per day of at least moderate intensity (i.e. the equivalent of brisk walking), through lifestyle, recreational and structured activity forms. A secondary recommendation is that children take part in activities that help develop and maintain musculo-skeletal health, on at least two occasions per week ( Biddle et al. , 1998 ). This target may be addressed through weight-bearing activities that focus on developing muscular strength, endurance and flexibility, and bone health.

School physical education (PE) provides a context for regular and structured physical activity participation. To this end a common justification for PE's place in the school curriculum is that it contributes to children's health and fitness ( Physical Education Association of the United Kingdom, 2004 ; Zeigler, 1994 ). The extent to which this rationale is accurate is arguable ( Koslow, 1988 ; Michaud and Andres, 1990 ) and has seldom been tested. However, there would appear to be some truth in the supposition because PE is commonly highlighted as a significant contributor to help young people achieve their daily volume of physical activity ( Biddle et al. , 1998 ; Corbin and Pangrazi, 1998 ). The important role that PE has in promoting health-enhancing physical activity is exemplified in the US ‘Health of the Nation’ targets. These include three PE-associated objectives, two of which relate to increasing the number of schools providing and students participating in daily PE classes. The third objective is to improve the number of students who are engaged in beneficial physical activity for at least 50% of lesson time ( US Department of Health and Human Services, 2000 ). However, research evidence suggests that this criterion is somewhat ambitious and, as a consequence, is rarely achieved during regular PE lessons ( Stratton, 1997 ; US Department of Health and Human Services, 2000 ; Levin et al. , 2001 ; Fairclough, 2003a ).

The potential difficulties of achieving such a target are associated with the diverse aims of PE. These aims are commonly accepted by physical educators throughout the world ( International Council of Sport Science and Physical Education, 1999 ), although their interpretation, emphasis and evaluation may differ between countries. According to Simons-Morton ( Simons-Morton, 1994 ), PE's overarching goals should be (1) for students to take part in appropriate amounts of physical activity during lessons, and (2) become educated with the knowledge and skills to be physically active outside school and throughout life. The emphasis of learning during PE might legitimately focus on motor, cognitive, social, spiritual, cultural or moral development ( Sallis and McKenzie, 1991 ; Department for Education and Employment/Qualifications and Curriculum Authority, 1999 ). These aspects may help cultivate students' behavioural and personal skills to enable them to become lifelong physical activity participants [(thus meeting PE goal number 2 ( Simons-Morton, 1994 )]. However, to achieve this, these aspects should be delivered within a curriculum which provides a diverse range of physical activity experiences so students can make informed decisions about which ones they enjoy and feel competent at. However, evidence suggests that team sports dominate English PE curricula, yet bear limited relation to the activities that young people participate in, out of school and after compulsory education ( Sport England, 2001 ; Fairclough et al. , 2002 ). In order to promote life-long physical activity a broader base of PE activities needs to be offered to reinforce the fact that it is not necessary for young people to be talented sportspeople to be active and healthy.

While motor, cognitive, social, spiritual, cultural and moral development are valid areas of learning, they can be inconsistent with maximizing participation in health-enhancing physical activity [i.e. PE goal number 1 ( Simons-Morton, 1994 )]. There is no guidance within the English National Curriculum for PE [NCPE ( Department for Education and Employment/Qualifications and Curriculum Authority, 1999 )] to inform teachers how they might best work towards achieving this goal. Moreover, it is possible that the lack of policy, curriculum development or teacher expertise in this area contributes to the considerable variation in physical activity levels during PE ( Stratton, 1996a ). However, objective research evidence suggests that this is mainly due to differences in pedagogical variables [i.e. class size, available space, organizational strategies, teaching approaches, lesson content, etc. ( Borys, 1983 ; Stratton, 1996a )]. Furthermore, PE activity participation may be influenced by inter-individual factors. For example, activity has been reported to be lower among students with greater body mass and body fat ( Brooke et al. , 1975 ; Fairclough, 2003c ), and higher as students get older ( Seliger et al. , 1980 ). In addition, highly skilled students are generally more active than their lesser skilled peers ( Li and Dunham, 1993 ; Stratton, 1996b ) and boys tend to engage in more PE activity than girls ( Stratton, 1996b ; McKenzie et al. , 2000 ). Such inter-individual factors are likely to have significant implications for pedagogical practice and therefore warrant further investigation.

In accordance with Simons-Morton's ( Simons-Morton, 1994 ) first proposed aim of PE, the purpose of this study was to assess English students' physical activity levels during high school PE. The data were considered in relation to recommended levels of physical activity ( Biddle et al. , 1998 ) to ascertain whether or not PE can be effective in helping children be ‘fit and healthy’. Specific attention was paid to differences between sex and ability groups, as well as during different PE activities.

Subjects and settings

One hundred and twenty-two students (62 boys and 60 girls) from five state high schools in Merseyside, England participated in this study. Stage sampling was used in each school to randomly select one boys' and one girls' PE class, in each of Years 7 (11–12 years), 8 (12–13 years) and 9 (13–14 years). Three students per class were randomly selected to take part. These students were categorized as ‘high’, ‘average’ and ‘low’ ability, based on their PE teachers' evaluation of their competence in specific PE activities. Written informed consent was completed prior to the study commencing. The schools taught the statutory programmes of study detailed in the NCPE, which is organized into six activity areas (i.e. athletic activities, dance, games, gymnastic activities, outdoor activities and swimming). The focus of learning is through four distinct aspects of knowledge, skills and understanding, which relate to; skill acquisition, skill application, evaluation of performance, and knowledge and understanding of fitness and health ( Department for Education and Employment/Qualifications and Curriculum Authority, 1999 ). The students attended two weekly PE classes in mixed ability, single-sex groups. Girls and boys were taught by male and female specialist physical educators, respectively.

Instruments and procedures

The investigation received ethical approval from the Liverpool John Moores Research Degrees Ethics Committee. The study involved the monitoring of heart rates (HRs) during PE using short-range radio telemetry (Vantage XL; Polar Electro, Kempele, Finland). Such systems measure the physiological load on the participants' cardiorespiratory systems, and allow analysis of the frequency, duration and intensity of physical activity. HR telemetry has been shown to be a valid and reliable measure of young people's physical activity ( Freedson and Miller, 2000 ) and has been used extensively in PE settings ( Stratton, 1996a ).

The students were fitted with the HR telemeters while changing into their PE uniforms. HR was recorded once every 5 s for the duration of the lessons. Telemeters were set to record when the teachers officially began the lessons, and stopped at the end of lessons. Total lesson ‘activity’ time was the equivalent of the total recorded time on the HR receiver. At the end of the lessons the telemeters were removed and data were downloaded for analyses. Resting HRs were obtained on non-PE days while the students lay in a supine position for a period of 10 min. The lowest mean value obtained over 1 min represented resting HR. Students achieved maximum HR values following completion of the Balke treadmill test to assess cardiorespiratory fitness ( Rowland, 1993 ). This data was not used in the present study, but was collated for another investigation assessing children's health and fitness status. Using the resting and maximum HR values, HR reserve (HRR, i.e. the difference between resting and maximum HR) at the 50% threshold was calculated for each student. HRR accounts for age and gender HR differences, and is recommended when using HR to assess physical activity in children ( Stratton, 1996a ). The 50% HRR threshold represents moderate intensity physical activity ( Stratton, 1996a ), which is the minimal intensity required to contribute to the recommended volume of health-related activity ( Biddle et al. , 1998 ). Percentage of lesson time spent in health enhancing moderate-and-vigorous physical activity (MVPA) was calculated for each student by summing the time spent ≥50% HRR threshold. HRR values ≥75% corresponded to vigorous intensity physical activity (VPA). This threshold represents the intensity that may stimulate improvements in cardiorespiratory fitness ( Morrow and Freedson, 1994 ) and was used to indicate the proportion of lesson time that students were active at this higher level.

Sixty-six lessons were monitored over a 12-week period, covering a variety of group and individual activities ( Table I ). In order to allow statistically meaningful comparisons between different types of activities, students were classified as participants in activities that shared similar characteristics. These were, team games [i.e. invasion (e.g. football and hockey) and striking games (e.g. cricket and softball)], individual games (e.g. badminton, tennis and table tennis), movement activities (e.g. dance and gymnastics) and individual activities [e.g. athletics, fitness (circuit training and running activities) and swimming]. The intention was to monitor equal numbers of students during lessons in each of the four designated PE activity categories. However, timetable constraints and student absence meant that true equity was not possible, and so the number of boys and girls monitored in the different activities was unequal.

Number and type of monitored PE lessons

Student sex, ability level and PE activity category were the independent variables, with percent of lesson time spent in MVPA and VPA set as the dependent variables. Exploratory analyses were conducted to establish whether data met parametric assumptions. Shapiro–Wilk tests revealed that only boys' MVPA were normally distributed. Subsequent Levene's tests confirmed the data's homogeneity of variance, with the exception of VPA between the PE activities. Though much of the data violated the assumption of normality, the ANOVA is considered to be robust enough to produce valid results in this situation ( Vincent, 1999 ). Considering this, alongside the fact that the data had homogenous variability, it was decided to proceed with ANOVA for all analyses, with the exception of VPA between different PE activities.

Sex × ability level factorial ANOVAs compared the physical activity of boys and girls who differed in PE competence. A one-way ANOVA was used to identify differences in MVPA during the PE activities. Post-hoc analyses were performed using Hochberg's GT2 correction procedure, which is recommended when sample sizes are unequal ( Field, 2000 ). A non-parametric Kruskal–Wallis ANOVA calculated differences in VPA during the different activities. Post-hoc Mann–Whitney U -tests determined where identified differences occurred. To control for type 1 error the Bonferroni correction procedure was applied to these tests, which resulted in an acceptable α level of 0.008. Although these data were ranked for the purposes of the statistical analysis, they were presented as means ± SD to allow comparison with the other results. All data were analyzed using SPSS version 11.0 (SPSS, Chicago, IL).

The average duration of PE lessons was 50.6 ± 20.8 min, although girls' (52.6 ± 25.4 min) lessons generally lasted longer than boys' (48.7 ± 15.1 min). When all PE activities were considered together, students engaged in MVPA and VPA for 34.3 ± 21.8 and 8.3 ± 11.1% of PE time, respectively. This equated to 17.5 ± 12.9 (MVPA) and 3.9 ± 5.3 (VPA) min. The high-ability students were more active than the average- and low-ability students, who took part in similar amounts of activity. These trends were apparent in boys and girls ( Table II ).

Mean (±SD) MVPA and VPA of boys and girls of differing abilities

Boys > girls, P < 0.01.

Boys > girls, P < 0.05.

Boys engaged in MVPA for 39.4% ± 19.1 of lesson time compared to the girls' value of 29.1 ± 23.4 [ F (1, 122) = 7.2, P < 0.01]. When expressed as absolute units of time, these data were the equivalent of 18.9 ± 10.5 (boys) and 16.1 ± 14.9 (girls) min. Furthermore, a 4% difference in VPA was observed between the two sexes [ Table II ; F (1, 122) = 4.6, P < 0.05]. There were no significant sex × ability interactions for either MVPA or VPA.

Students participated in most MVPA during team games [43.2 ± 19.5%; F (3, 121) = 6.0, P < 0.01]. Individual games and individual activities provided a similar stimulus for activity, while the least MVPA was observed during movement activities (22.2 ± 20.0%; Figure 1 ). A smaller proportion of PE time was spent in VPA during all activities. Once more, team games (13.6 ± 11.3%) and individual activities (11.8 ± 14.0%) were best suited to promoting this higher intensity activity (χ 2 (3) =30.0, P < 0.01). Students produced small amounts of VPA during individual and movement activities, although this varied considerably in the latter activity ( Figure 2 ).

Mean (±SD) MVPA during different PE activities. ** Team games > movement activities ( P < 0.01). * Individual activities > movement activities ( P < 0.05).

Mean (±SD) VPA during different PE activities. ** Team games > movement activities ( Z (3) = −4.9, P < 0.008) and individual games ( Z (3) = −3.8, P < 0.008). † Individual activities > movement activities ( Z (3) = −3.3, P < 0.008). ‡ Individual game > movement activities ( Z (3) = −2.7, P < 0.008).

This study used HR telemetry to assess physical activity levels during a range of high school PE lessons. The data were considered in relation to recommended levels of physical activity ( Biddle et al. , 1998 ) to investigate whether or not PE can be effective in helping children be ‘fit and healthy’. Levels of MVPA were similar to those reported in previous studies ( Klausen et al. , 1986 ; Strand and Reeder, 1993 ; Fairclough, 2003b ) and did not meet the US Department of Health and Human Services ( US Department of Health and Human Services, 2000 ) 50% of lesson time criterion. Furthermore, the data were subject to considerable variance, which was exemplified by high standard deviation values ( Table II , and Figures 1 and 2 ). Such variation in activity levels reflects the influence of PE-specific contextual and pedagogical factors [i.e. lesson objectives, content, environment, teaching styles, etc. ( Stratton, 1996a )]. The superior physical activity levels of the high-ability students concurred with previous findings ( Li and Dunham, 1993 ; Stratton, 1996b ). However, the low-ability students engaged in more MVPA and VPA than the average-ability group. While it is possible that the teachers may have inaccurately assessed the low and average students' competence, it could have been that the low-ability group displayed more effort, either because they were being monitored or because they associated effort with perceived ability ( Lintunen, 1999 ). However, these suggestions are speculative and are not supported by the data. The differences in activity levels between the ability groups lend some support to the criticism that PE teachers sometimes teach the class as one and the same rather than planning for individual differences ( Metzler, 1989 ). If this were the case then undifferentiated activities may have been beyond the capability of the lesser skilled students. This highlights the importance of motor competence as an enabling factor for physical activity participation. If a student is unable to perform the requisite motor skills to competently engage in a given task or activity, then their opportunities for meaningful participation become compromised ( Rink, 1994 ). Over time this has serious consequences for the likelihood of a young person being able or motivated enough to get involved in physical activity which is dependent on a degree of fundamental motor competence.

Boys spent a greater proportion of lesson time involved in MVPA and VPA than girls. These differences are supported by other HR studies in PE ( Mota, 1994 ; Stratton, 1997 ). Boys' activity levels equated to 18.9 min of MVPA, compared to 16.1 min for the girls. It is possible that the characteristics and aims of some of the PE activities that the girls took part in did not predispose them to engage in whole body movement as much as the boys. Specifically, the girls participated in 10 more movement lessons and eight less team games lessons than the boys. The natures of these two activities are diverse, with whole body movement at differing speeds being the emphasis during team games, compared to aesthetic awareness and control during movement activities. The monitored lessons reflected typical boys' and girls' PE curricula, and the fact that girls do more dance and gymnastics than boys inevitably restricts their MVPA engagement. Although unrecorded contextual factors may have contributed to this difference, it is also possible that the girls were less motivated than the boys to physically exert themselves. This view is supported by negative correlations reported between girls' PE enjoyment and MVPA ( Fairclough, 2003b ). Moreover, there is evidence ( Dickenson and Sparkes, 1988 ; Goudas and Biddle, 1993 ) to suggest that some pupils, and girls in particular ( Cockburn, 2001 ), may dislike overly exerting themselves during PE. Although physical activity is what makes PE unique from other school subjects, some girls may not see it as such an integral part of their PE experience. It is important that this perception is clearly recognized if lessons are to be seen as enjoyable and relevant, whilst at the same time contributing meaningfully to physical activity levels. Girls tend to be habitually less active than boys and their levels of activity participation start to decline at an earlier age ( Armstrong and Welsman, 1997 ). Therefore, the importance of PE for girls as a means of them experiencing regular health-enhancing physical activity cannot be understated.

Team games promoted the highest levels of MVPA and VPA. This concurs with data from previous investigations ( Strand and Reeder, 1993 ; Stratton, 1996a , 1997 ; Fairclough, 2003a ). Because these activities require the use of a significant proportion of muscle mass, the heart must maintain the oxygen demand by beating faster and increasing stroke volume. Moreover, as team games account for the majority of PE curriculum time ( Fairclough and Stratton, 1997 ; Sport England, 2001 ), teachers may actually be more experienced and skilled at delivering quality lessons with minimal stationary waiting and instruction time. Similarly high levels of activity were observed during individual activities. With the exception of throwing and jumping themes during athletics lessons, the other individual activities (i.e. swimming, running, circuit/station work) involved simultaneous movement of the arms and legs over variable durations. MVPA and VPA were lowest during movement activities, which mirrored previous research involving dance and gymnastics ( Stratton, 1997 ; Fairclough, 2003a ). Furthermore, individual games provided less opportunity for activity than team games. The characteristics of movement activities and individual games respectively emphasize aesthetic appreciation and motor skill development. This can mean that opportunities to promote cardiorespiratory health may be less than in other activities. However, dance and gymnastics can develop flexibility, and muscular strength and endurance. Thus, these activities may be valuable to assist young people in meeting the HDA's secondary physical activity recommendation, which relates to musculo-skeletal health ( Biddle et al. , 1998 ).

The question of whether PE can solely contribute to young people's cardiorespiratory fitness was clearly answered. The students engaged in small amounts of VPA (4.5 and 3.3 min per lesson for boys and girls, respectively). Combined with the limited frequency of curricular PE, these were insufficient durations for gains in cardiorespiratory fitness to occur ( Armstrong and Welsman, 1997 ). Teachers who aim to increase students' cardiorespiratory fitness may deliver lessons focused exclusively on high intensity exercise, which can effectively increase HR ( Baquet et al. , 2002 ), but can sometimes be mundane and have questionable educational value. Such lessons may undermine other efforts to promote physical activity participation if they are not delivered within an enjoyable, educational and developmental context. It is clear that high intensity activity is not appropriate for all pupils, and so opportunities should be provided for them to be able to work at developmentally appropriate levels.

Students engaged in MVPA for around 18 min during the monitored PE lessons. This approximates a third of the recommended daily hour ( Biddle et al. , 1998 ). When PE activity is combined with other forms of physical activity support is lent to the premise that PE lessons can directly benefit young people's health status. Furthermore, for the very least active children who should initially aim to achieve 30 min of activity per day ( Biddle et al. , 1998 ), PE can provide the majority of this volume. However, a major limitation to PE's utility as a vehicle for physical activity participation is the limited time allocated to it. The government's aspiration is for all students to receive 2 hours of PE per week ( Department for Education and Employment/Qualifications and Curriculum Authority, 1999 ), through curricular and extra-curricular activities. While some schools provide this volume of weekly PE, others are unable to achieve it ( Sport England, 2001 ). The HDA recommend that young people strive to achieve 1 hour's physical activity each day through many forms, a prominent one of which is PE. The apparent disparity between recommended physical activity levels and limited curriculum PE time serves to highlight the complementary role that education, along with other agencies and voluntary organizations must play in providing young people with physical activity opportunities. Notwithstanding this, increasing the amount of PE curriculum time in schools would be a positive step in enabling the subject to meet its health-related goals. Furthermore, increased PE at the expense of time in more ‘academic’ subjects has been shown not to negatively affect academic performance ( Shephard, 1997 ; Sallis et al. , 1999 ; Dwyer et al. , 2001 ).

Physical educators are key personnel to help young people achieve physical activity goals. As well as their teaching role they are well placed to encourage out of school physical activity, help students become independent participants and inform them about initiatives in the community ( McKenzie et al. , 2000 ). Also, they can have a direct impact by promoting increased opportunities for physical activity within the school context. These could include activities before school ( Strand et al. , 1994 ), during recess ( Scruggs et al. , 2003 ), as well as more organized extra-curricular activities at lunchtime and after school. Using time in this way would complement PE's role by providing physical activity opportunities in a less structured and pedagogically constrained manner.

This research measured student activity levels during ‘typical’, non-intensified PE lessons. In this sense it provided a representative picture of the frequency, intensity and duration of students' physical activity engagement during curricular PE. However, some factors should be considered when interpreting the findings. First, the data were cross-sectional and collected over a relatively short time frame. Tracking students' activity levels over a number of PE activities may have allowed a more accurate account of how physical activity varies in different aspects of the curriculum. Second, monitoring a larger sample of students over more lessons may have enabled PE activities to be categorized into more homogenous groups. Third, monitoring lessons in schools from a wider geographical area may have enabled stronger generalization of the results. Fourth, it is possible that the PE lessons were taught differently, and that the students acted differently as a result of being monitored and having the researchers present during lessons. As this is impossible to determine, it is unknown how this might have affected the results. Fifth, HR telemetry does not provide any contextual information about the monitored lessons. Also, HR is subject to emotional and environmental factors when no physical activity is occurring. Future work should combine objective physical activity measurement with qualitative or quantitative methods of observation.

During PE, students took part in health-enhancing activity for around one third of the recommended 1-hour target ( Biddle et al. , 1998 ). PE obviously has potential to help meet this goal. However, on the basis of these data, combined with the weekly frequency of PE lessons, it is clear that PE can only do so much in supplementing young people's daily volume of physical activity. Students need to be taught appropriate skills, knowledge and understanding if they are to optimize their physical activity opportunities in PE. For improved MVPA levels to occur, health-enhancing activity needs to be recognized as an important element of lessons. PE may make a more significant contribution to young people's regular physical activity participation if lessons are planned and delivered with MVPA goals in mind.

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Author notes

1REACH Group and School of Physical Education, Sport and Dance, Liverpool John Moores University, Liverpool L17 6BD and 2REACH Group and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 2ET, UK

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New Research Examines Physical Education in America

By Morgan Clennin, PhD, MPH, Kaiser Permanente of Colorado, University of South Carolina, and National Physical Activity Plan

School-based physical education (PE) is recommended by the Community Guide as an effective strategy to promote physical activity among youth. Unfortunately, many have speculated that PE exposure has declined precipitously among U.S. students in the past decade. Limited resources and budgets, prioritization of core academic subjects, and several other barriers have been cited as potential drivers of these claims. However, few large-scale studies have explored the merit of these claims – leaving the answers following questions unknown:

Has PE attendance decreased among U.S. students in the past decades?

What policies and practices are in place to support quality PE?

To answer these questions, the President’s Council on Sports, Fitness & Nutrition tasked the National Physical Activity Plan Alliance (NPAPA) to review the available evidence and summarize their findings. The primary objective of this effort was to better understand PE exposure over time to inform national recommendations and strategies for PE.

The NPAPA began by establishing a collaborative partnership with experts in the federal government, industry, and academia. The group analyzed existing national data sources that could be used to examine changes in PE attendance and current implementation of PE policies and practices. These efforts culminated in a final report and two peer-reviewed manuscripts. A summary of the group’s findings are outlined below.

Key Findings:

• 1/2 of U.S. high school students did not attend PE classes—which is consistent over the 24-year period studied (1991-2015).
• The percentage of U.S. high school students reporting PE attendance did not change significantly between 1991 and 2015 for the overall sample or across sex and race/ethnicity subgroup.
• Daily PE attendance did decrease 16% from 1991 to 1995 then attendance rates remained stable through 2015.
• > 65% of schools implemented 2-4 of the 7 essential PE policies
• Implementation of PE policies varied by region, metropolitan status, and school level.
• Data indicates minority students have been disproportionately affected by cuts to school PE programs during the past two decades.

Recommendations Based on Key Findings:

• Prioritize efforts to expand collection of surveillance data examining trends in PE attendance among elementary and middle school students.
• Develop policies to improve PE access for all students in order for PE to contribute to increased physical activity among youth.
• Adopt policies and programs that prioritize PE to maximize the benefits of PE.
• Utilize the findings of these efforts to target professional development and technical assistance for PE practitioners.

The Education sector of the NPAP provides evidence-based strategies and tactics that can guide efforts to support the provision of quality PE to all students. More information, and links to the respective manuscripts, can be found on the NPAPA website: http://physicalactivityplan.org/projects/physicaleducation.html

The Office of Disease Prevention and Health Promotion (ODPHP) cannot attest to the accuracy of a non-federal website.

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The Benefits of Physical Education: How Innovative Teachers Help Students Thrive

January 16, 2020 | Written By Heather Nelson

For students in elementary, middle, or high school, the long-term benefits of physical education classes are not always evident—but strong teachers with innovative ideas are changing that. These educators find creative and evidence-based ways to help students tune into their bodies, minds, and attitudes.

Here’s a look at the benefits of physical education programs, how educators design their lessons to bring out the best in their students, and what the future may bring to this space.

Advantages of Physical Education

The benefits associated with physical education programming go far beyond accomplishments made in the gym. When students have the opportunity to step away from their desks and move their bodies in a physical education class, they gain the benefits of mental health support, stress relief, heart health, and more.

The Institute of Medicine reported that physically active students are more focused, better retain information, and problem-solve more successfully than their less active peers. While the benefits of physical education are clear, ensuring students get the most from P.E. comes down to innovative and well-trained educators.

Innovation in Physical Education for Today’s Classroom

When most people think of physical education, they think of running laps and climbing a rope in the middle of the school gym. However, the most effective physical education teachers know there’s much more to P.E. than jogging and climbing.

Andrew Alstot, PhD, associate professor in the Department of Kinesiology at Azusa Pacific University, explained that “good physical educators create comprehensive educational programs that go beyond simply getting kids physically active.” He said he encourages teachers to expose students to various physical activities, which helps them find activities they love.

The goal is to help students grow and to provide positive feedback and guidance so that they become comfortable participating in physical activity outside of school. One way teachers do this is through tailored lessons, ensuring activities are accessible yet challenging for each student.

Greg Bellinder, MS, assistant professor at APU, teaches future physical educators to differentiate their instruction to meet the individual needs of all students— a method called Universal Design for Learning (UDL). He explained what this might look like in the classroom:

“Consider a warm-up jog at the beginning of a lesson. The classic approach required all students to jog a lap around the track. Depending on ability level, some students finished in about two minutes and waited much longer than that until the very last students finished. During this downtime, slower students were embarrassed, knowing the rest of the class was waiting for them. Taking a UDL approach, a physical educator would create a warm-up circle with a much smaller radius. Instead of requiring students to run the same distance, she or he would have them jog as many laps around the smaller circle in a set time, challenging each student to complete a number of laps that are personally challenging. At the end of four minutes, for instance, everyone stops jogging. The faster students have been challenged at their level while the slower students have been challenged at their level. No student has been stigmatized. The teacher now has additional instructional minutes for skill-based instruction.”

Innovative physical education means meeting students at their level, providing guidance to strengthen skills, and instilling a lifetime love of movement . As instructors look to the future, including these innovative lessons in their curriculum can pave the way for students to embrace physical education.

The Future of Physical Education

The future of physical education is not only physical! APU’s Janna Sanchez, MS, said educators have the unique responsibility to shift the focus from physical competition and winning to the discoveries that can be made through activity and play. By tapping into students’ capabilities and strengths, physical educators can do more than simply teach a sport, she said.

“Physical education programs should not be based on sports alone, but on positive movement opportunities that enhance self-esteem, worth, dignity, and self-discipline,” said Sanchez. “A child is able to capitalize on their own personal strengths and learn from their weaknesses when they comprehend how to work with others in a variety of settings. That is what physical education and play are all about.”

The best physical education programs provide space for students to develop their bodies and minds—and the future of P.E. is continuing further in that direction. With teachers committed to creating lesson plans that strengthen students from the inside out, the days of dreading gym class may be coming to an end.

Physical Education Schools

What is the impact of physical education on students’ well-being and academic success?

Decreasing time for quality phys-ed to allow more instructional time for core curricular subjects – including math, science, social studies and English – is counterproductive, given its positive benefits on health outcomes and school achievement.

by: Lee Schaefer , Derek Wasyliw

date: June 25, 2018

Download and print the Fact Sheet (232.30 kB / pdf)

Research confirms that healthier students make better learners. The term quality physical education is used to describe programs that are catered to a student’s age, skill level, culture and unique needs. They include 90 minutes of physical activity per week, fostering students’ well-being and improving their academic success. However, instructional time for quality phys-ed programs around the world are being decreased to prioritize other subject areas (especially math, science, social studies and English) in hopes to achieve higher academic achievement. However, several studies have identified a significant relationship between physical activity and academic achievement. Research also demonstrates that phys-ed does not have negative impacts on student success and that it offers the following physical, social, emotional and cognitive benefits:

Quality phys-ed helps students understand how exercise helps them to develop a healthy lifestyle, gain a variety of skills that help them to participate in a variety of physical activities and enjoy an active lifestyle.

Quality phys-ed provides students with the opportunity to socialize with others and learn different skills such as communication, tolerance, trust, empathy and respect for others. They also learn positive team skills including cooperation, leadership, cohesion and responsibility. Students who play sports or participate in other physical activities experience a variety of emotions and learn how to better cope in stressful, challenging or painful situations.

Quality phys-ed can be associated with improved mental health, since increased activity provides psychological benefits including reduced stress, anxiety and depression. It also helps students develop strategies to manage their emotions and increases their self-esteem.

Research tends to show that increased blood flow produced by physical activity may stimulate the brain and boost mental performance. Avoiding inactivity may also increase energy and concentration in the classroom.

Therefore, decreasing time for quality phys-ed to allow more instructional time for core curricular subjects – including math, science, social studies and English – is counterproductive, given its positive benefits on health outcomes and school achievement.

Additional Information Resources

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Physical education and sport in schools: a review of benefits and outcomes

Affiliation.

• 1 School of Education, Froebel College, Roehampton University, Roehampton Lane, London SW15 5PU, UK. [email protected]
• PMID: 16978162
• DOI: 10.1111/j.1746-1561.2006.00132.x

This paper explores the scientific evidence that has been gathered on the contributions and benefits of physical education and sport (PES) in schools for both children and for educational systems. Research evidence is presented in terms of children's development in a number of domains: physical, lifestyle, affective, social, and cognitive. The review suggests that PES have the potential to make significant and distinctive contributions to development in each of these domains. It is suggested that PES have the potential to make distinctive contributions to the development of children's fundamental movement skills and physical competences, which are necessary precursors of participation in later lifestyle and sporting physical activities. They also, when appropriately presented, can support the development of social skills and social behaviors, self-esteem and proschool attitudes, and, in certain circumstances, academic and cognitive development. The review also stresses that many of these benefits will not necessarily result from participation, per se; the effects are likely to be mediated by the nature of the interactions between students and their teachers, parents, and coaches who work with them. Contexts that emphasize positive experiences, characterized by enjoyment, diversity, and the engagement of all, and that are managed by committed and trained teachers and coaches, and supportive and informed parents, significantly influence the character of these physical activities and increase the likelihood of realizing the potential benefits of participation.

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Physical Education and Sports: A Backbone of the Entire Community in the Twenty-First Century

Jean de dieu habyarimana.

1 Department of Physical Education and Sports Training, School of Physical Education, Minglun Campus, Henan University, Kaifeng 475001, China; rf.oohay@ueidhdj

Etienne Tugirumukiza

2 Department of Physical Education and Sports Coaching, School of Physical Education and Sports Coaching, Shanghai University of Sport, Shanghai 200433, China; moc.liamg@21arigutenneite

Associated Data

To prevent the assumptions of availability of required data, the authors needed to ensure the availability of required data before further stages of the study.

The current state of physical inactivity of people can be traced back to the people who have been denied their fundamental human right to physical education and participation in school sports (PES). Growing up without the fundamental human right to free movement and participation in sports activities enabled students to stay physically inactive. The purpose of this study was to explore what is currently known about the role of PES in all areas of human development and SDGs and to raise awareness about PES, which has been shown to be on the decline. To increase the study’s overall efficacy, an external desk research approach was employed to gather relevant information published online: reports, policies, charters, recommendations, and other relevant articles from various electronic databases and websites of international organizations responsible for PES, culture, and health. PES benefits are discussed in all domains of human development, including physical and mental health, cognitive, psychosocial, and moral benefits. Contrary to its importance to human growth as a whole, PES has been sidelined since the end of the twentieth century. An awareness of the subject of PES has thus been raised as a backbone of the entire community in the twenty-first century, so as to translate the promises and policies of PES into realities and practices.

1. Introduction

One of the most significant current discussions in physical exercises and public health is that a decline in PES leads to a corresponding decline in physical activity (PA), which contributes to an increase in hypokinetic diseases among school-aged children and adolescents. PES (a planned, sequential K–12 standards-based program with written curricula and appropriate instruction designed to develop the motor skills, knowledge, and behaviors of active living, physical fitness, sportsmanship, self-efficacy, and emotional intelligence), according to SHAPE America [ 1 ], has the potential to make distinctive contributions to the development of children’s fundamental movement skills and physical competences, as well as support the development of social skills and behaviors, self-esteem, and preschool attitudes, and in certain circumstances, academic and cognitive development, according to Bailey [ 2 ].

The overall goal of PES is to make its pedagogical approach of educating the body to be permanent by teaching children about movement and developing the necessary skills to become proficient in many kinds of PA, as stated by Guedes [ 3 ], as well as to develop the patterns and interest in PA, which are essential for healthy development and lay the foundations for adult healthy lifestyle, as reported by ICSSPE [ 4 ]. According to SHAPE America [ 1 ], the purpose of PES is to develop the motor skills, knowledge, and behaviors of active living, physical fitness, sportsmanship, self-efficacy, and emotional intelligence. In other words, UNESCO [ 5 ] elucidated that PES should be effectively implemented in order to provide a platform for broad social inclusion and develop the skills and knowledge necessary to define new forms of global citizenship. In this regard, UNESCO [ 6 ] proclaimed that the practice and full participation in PES is a fundamental human right for all. In this light, Wright et al. [ 7 ] substantiated that the school setting remains one of the conducive environments for promoting a physically active lifestyle among children and adolescents.

However, as stated by UNESCO [ 5 ], Weedon et al. [ 8 ], and Louis [ 9 ], PES is on the decline. PES declination has been strongly evidenced by UNESCO [ 10 ] in its survey conducted in all regions across the globe, revealing that (a) PES is being replaced by core subjects such as mathematics, the science subjects, language, arts, etc.; (b) PES-allocated curriculum time is being diverted to such core subjects; (c) PES teachers are being assigned other duties, such as logistics; and (d) PES is being replaced by cleaning or sending students home. On a related note, UNESCO [ 10 ] has stated that PES has lower esteem and status compared to other subjects. This was especially noticeable in North America, Africa, and the Middle East, with 77%, 69%, and 65%, respectively. Subsequently, the average time allocated to PES in primary and secondary schools remains low, i.e., 97 and 99 min, as against an ideal of 120 and 180 min in primary and secondary schools, respectively. Apart from insufficient curriculum time allocation, cancellation of PES lessons has also been reported to the extent of 100% in North America, 65% in both Africa and the Middle East, and 52% in Latin America/Caribbean, according to UNESCO [ 10 ].

On account of this PES downturn, the prevalence of global physical inactivity among children and youth has been observed to be particularly high. For instance, the findings of a research study conducted by Guthold et al. [ 11 ] reported that 81% of adolescents were not physically active, of which 77.6% and 84.7% were boys and girls, respectively. Another example of what Guthold et al. [ 11 ] meant is that observed by Kimm et al. [ 12 ], who reported a 100% and 64% decline in habitual leisure-time PA for African-American girls and White girls by the age of 16 or 17 years old, respectively. From this standpoint, it was noted that such a decline in PA increases with age, particularly in high-income countries, according to Hallal et al. [ 13 ] and Corder et al. [ 14 ]. More recently, Remmers et al. [ 15 ], Telama and Yang [ 16 ], and Caspersen et al. [ 17 ] published research studies that show that PA decline occurs between the ages of 12 and 13 years onwards. At this point, it is worth noting that Aubert et al. [ 18 ] observed that more than 70% of youngsters in various countries do not meet the PA level needed for a healthy life. Increasingly important is the fact that only 20% of the world’s adolescents are physically active, according to WHO [ 19 ].

In a similar vein, it has been pointed out that one in four, equivalent to 23% of adults, and three in four, equivalent to 81%, of adolescents aged 11–17 years do not meet the global WHO recommendations on PA for health, according to UN-Habitat [ 20 ].

In view of this emerging physical inactivity, sedentary health-based diseases and disorders, as well as the global health crisis, remain unresolved issues. According to Toschke et al. [ 21 ], chronic diseases have been particularly prevalent among children and adolescents, due to a lack of effective PA. To further clarify this, according to WHO [ 22 ] and Lin et al. [ 23 ], over 340 million children and adolescents aged 5–19 were classified as overweight or obese in 2016, while 476.0 million children and adolescents were diagnosed with diabetes mellitus in 2017.

Increasingly, negative consequences in various domains such as physical (worsened bone density, strength, and flexibility), psychological (increase in the occurrence of major depression, poor concentration and self-esteem, negative bullying), and academic (decrease in standardized test grade) have also been reported by Rasberry et al. [ 24 ]. Above all, physical inactivity was ranked third among the six risk factors, accounting for 19% of global fatalities and 7% of global DALYs. Moreover, according to WHO [ 25 ], physical inactivity is responsible for 21–25%, 27%, and 30% of breast and colon cancer burden, diabetes, and ischemic heart disease burden.

In another example, WHO [ 26 ] reported that mental health conditions currently account for 16% of the global burden of diseases and injury in children aged 10–19 years old. In this light, depression has been identified as one of the leading causes of illness and disability among adolescents. Similarly, suicide is reported as the third leading cause of death in children aged 15–19 years old.

Physical inactivity is increasingly recognized as a serious, worldwide public health concern, especially among young people (school-aged children and adolescents). This is happening at a time when PES, which has been shown to be a single subject with the potential to provide the students with various benefits, including health-related ones, UNESCO [ 5 ] (p. 6) is on the decline. In fact, it is evident that the entire community is suffering from a physical inactivity epidemic, especially among young people. As such, research to date has tended to focus on PA rather than PES.

This current paper therefore seeks to remedy these problems by analyzing the significance of PES in various domains identified as cognitive, physical, affective, healthy, social, moral, cultural domains, and SDGs as well as raising an awareness of PES in order to encourage governments, organizations responsible for PES, and schools to translate promises into practice.

2. Brief Background of PES

The starting point of PES can be traced back to the early societies, whereby their education philosophy was, according to Van Dalen and Bennett [ 27 ], education for survival. In this regard, the purpose of education was to ensure the survival of society. Thus, the curriculum was made up of courses such as hunting, throwing, running, jumping, etc., in line with strengthening the people to find food and protect their families against harmful animals and other disasters.

In a similar vein, the philosophical foundation of ancient Greeks on education was the notion of dualism, which, in the Greek curriculum, was featured under two components, namely gymnastics and academics, according to Laker [ 28 ]. In essence, education aimed to ensure the aesthetic and physical development of the body by means of sport; specifically, Sparta promoted PES by targeting military fitness, as opposed to the more holistic education for Athens.

During the Dark Ages, the aims of developing the body and mind equally that came from the Greek civilization, which considered the body as a partner or guardian of the mind and soul, became devalued. Later on, during the Renaissance (rebirth, discovery age), the development of a complete person as a priority was recovered by the Greeks, since such fully educated people were in need to take their place in a polite and cultured society. Hence, PES as a component of holistic education was in service of the needs of the society, according to Laker [ 28 ]. Until around 1820, much of focus of schools was on PES expressed in gymnastics, hygiene training, and care and development of the human body. By the year 1950, major courses in PES had been introduced in over 400 institutes to promote PES.

Even though this was considered an outstanding progress, it did not lead to the success of PES as a legitimate subject in all schools worldwide. The evidence suggests that, later in the 20th century (1970s–1980s), PES suffered a strong decline that is associated with the increased availability of other subjects, whereby the attention, time, and values assigned to PES were shifted to academics, according to Excite Education [ 29 ].

Consequently, it was noted that both pedagogy professionals and practitioners failed to assume their responsibilities of clarifying the nature of the field at the school level and advocating for its restoration in order to address the PES crisis, as claimed by Guedes [ 3 ]. Realizing this crisis, UNESCO initiated and enforced the international charter of PES across the world on 21 November 1978.

With the PES decline, the International Council for Sport Science and Physical Education (ICSSPE) was established to tackle the problem at hand. It is in this context that the first international summit was organized on 3–5 November 1999 in Berlin by ICSSPE with support from the International Olympic Committee (IOC), United Nations Educational Scientific and Cultural Organisation (UNESCO), and WHO, bringing together policymakers, physical education practitioners from around the world, researchers, and administrators to share all necessary information concerning PES.

Reporting his observations, Hardman [ 30 ] documented his findings from the international summit which reaffirmed the perilous position of PES to the extent that the UNESCO’s 1978 international charter of PES was found to be unimplemented. What is more, it was noted that PES was pushed into a defensive position under which it faced a reduction of curriculum time allocation, deficient resources (financial, material, and human), and marginalization associated with low value, status, and esteem by authorities. Until now, there has been a need to turn promises into realities and policies into actions if threats are to be vanquished and a convenient future for PES is to be maintained.

3. Material and Methods

This review was conducted by adopting the external desk research method from Mangal and Shubhra [ 31 ] used to enhance the overall effectiveness of the research. For the purpose of this study, a comprehensive search was carried out to retrieve related reports, policies, charters, guidelines, international position statements, and support statements, as well as other relevant documents and articles. For the sake of documenting the analysis method, as well as inclusion criteria, a search protocol was designed in advance. In so doing, a search strategy for the identification of works in the relevant literature containing key terms in their title and abstract was developed. This search strategy was tailored to Google Scholar, ScienceDirect, PubMed, and Eric. The search terms used with Boolean Operators were “physical education and school sports” AND “cognitive OR physical OR affective OR healthy OR social OR moral OR culture” OR “Sustainable development goals”.

The search focus was mainly on the existing English literature related to the role of PES in the field of social sciences and health sciences. Thus, it was narrowed to subject areas identified as PA, sports, recess, recreation, and dance. The researchers included study publications, reports, and data and information from census or other scientific data-collection procedures to ensure validity and dependability. Thus, in light of preventing personal bias, information and data collected from personal diaries, newspapers, and magazines were excluded from this study. Similarly, the researchers ensured that the relevant data were available before undertaking further stages of this study in order to avoid making assumptions about the availability of the required data.

4. Benefits of Physical Education and School Sports

The European parliament 2007 resolution [ 32 ] declared the following: “PES has the propensity to make significant and distinctive contributions to children, schools and wider society: respect for the body, integrated development of mind and body, understanding of PA in health promotion, psycho-social development (self-esteem and self-confidence), social and cognitive development and academic achievement, socialisation and social skills (tolerance and respect for others, co-operation and cohesion, leadership, team spirit, antidote to antisocial behavior) and aesthetic, spiritual, emotional and moral (fair play, character-building) development, a panacea for resolution of the obesity epidemic, inactivity crisis and sedentary lifestyle, enhancement of quality of life etc.”.

PES, according to SHAPE America [ 1 ] creates a framework of life skills that shapes the whole person, encouraging smart choices and cultivating a healthy lifestyle, while both PA and effective PES are proven essential elements in the formative growth of children and adolescents, as well as an evidence-based approach to improving academics and benefiting students’ physical, cognitive, and mental health. The section hereunder therefore explored the role of PES under cognitive, physical, affective, healthy, social, moral, cultural domains and SDGs.

4.1. Cognitive, Academic Performance and Brain Health

A healthier body, academic performance, cognitive development, and lifelong brain health have all been linked to the time students spent participating in PA either as a one-time event or habitual. As a matter of fact, Plato, Aristotle, and Rousseau, the classical scholars of education in the 18th century, contended that the development of the body has to balance that of the mind [ 33 ].

To bring to light the issue of improved academic performance and cognitive development through PES, several studies have been carried out to establish the contribution of PES in improving students’ cognitive development, brain health, and academic achievements.

As a matter of concern, improvement in measures of cognitive skills and attitudes are positively benefited from improved PA engagement level in PES. Hence, participating in a prolonged PA at school helps the students to increase their cognitive preparation processes because of a more effective working memory network, as reported by Boykin and Allen [ 34 ], Oja and Jürimäe [ 35 ], Reynolds and Nicolson [ 36 ], and Kamijo et al. [ 37 ].

In the same way, cognitive benefits such as executive function are accrued from PA participation no matter how long it lasts or how intense or frequent it is. Rather, Budde et al. [ 38 ] found that even a single occurrence of high-quality PA can improve children’s or teenagers’ executive function scores in an executive function test.

More importantly, Kramer et al. [ 39 ] bolstered that participating in PA improves not only cognitive development and academic performance of the students involved but also contributes significantly to maintaining healthier cognition in adulthood and even at old age. Thus, there is evidence that early childhood participation in PA helps in combating cognitive aging.

Equally important is the fact that improved academic performance has been closely associated with PA participation in conditions where students need to spend a certain period of time with a given intensity or in some cases frequently/repetitively.

In this case, Donnelly and Lambourne [ 40 ] established that regular participation in PES increases the students’ academic performance. This is evident in the case of Bartholomew and Jowers [ 41 ], who noted that better attention in the classroom, as well as on-task behaviors and concentration, is influenced by PES, which, in turn, results in improved academic performance.

The next similarity is an assertion made by Hillman et al. [ 42 ], emphasizing the function of PES in improving attention allocation and working memory to a single cognitive activity completed, regardless of the intensity and time constraints. A supportive view of Hillman et al.’s assertion was articulated by McNaughten and Gabbard [ 43 ], who stressed that even a short bout of PA equivalent to 30 min positively affects cognitive functioning in school-aged children.

Other researchers have also revealed that the positive effect of PES is more likely to be achieved provided that PA is delivered over a long period of time. In this regard, Gabbard and Barton [ 44 ] emphasized that a significant improvement in academic achievement such as mathematics performance is achieved through long participation in PA for at least 50 min. On a related note, the CDC [ 32 ] insisted that PES serves a positive impact on academic achievement if the overall PES time is increased.

In a similar light, it has been indicated that students’ executive functions such as attention and inhibition, healthy attentional process, perceptual skills, intellectual quotient, verbal tests, mathematics tests, memory, readiness, cognition, and emotional regulation and balance are increased when PES subject is given a high priority by allocating more time to engage students in moderate-to-vigorous PA, which results in overall academic performance, according to Sallis and Owen [ 45 ]; Verdine et al. [ 46 ]; Etnier and Sibley [ 47 ]; and Stevens [ 48 ].

As far as brain health is concerned in relation to PES, different researchers have conducted a variety of studies and come up with different views about the benefits of PA to brain health. PA affects the physiology of the students’ brain by increasing cerebral capillary growth, blood flow, oxygenation, production of neurotrophins, growth of nerve cells in the hippocampus, neurotransmitter levels, development of nerve connections, density of neural network, and brain tissue volume, according to Trudeau and Shephard [ 49 ], Hillman et al. [ 50 ]; and Rosenbaum et al. [ 51 ]. Greater attention, information processing, storage, and retrieval; improved coping and positive effect; and reduced cravings and pain sensations have all been linked to physiological changes in the brain.

Hills [ 33 ] argued that active engagement in PES improves academic performance by increasing blood flow to the brain, increasing mental alertness, enhancing mood, and increasing self-esteem. Consistent with the findings of Hills is the findings of Shephard [ 52 ], which stated that changes in cognitive functioning (increased blood flow into the brain, increased level of arousal, and stimulated brain development) are a reflection of any improvement in academic performance after engaging in PES.

Contrary to the above are the opposing views obtained from other studies undertaken to ascertain the cognitive, academic performance, and brain health benefits achieved through participation in PES; they revealed no relationship between these variables, even though the former determined the significant impact. Such contradictions are dependent on the dose prescribed to PES so as to offer the benefits ascribed to it.

Fisher et al. [ 53 ] argued that active participation in PES has no correlation with academic performance. Moreover, Ahamed et al. [ 54 ] found no significant difference between the treatment and control group in a standardized cognitive abilities test after 16 months of a classroom-based PA intervention under a cluster randomized trial.

In the same way, Tinning and Kirk [ 55 ] found no difference in academic subjects between the students who were allocated 90 min/day participating in PA and those who had not been engaged in such a program. Parallel to these opposing views, Melnick et al. [ 56 ] found no or a trivial correlation between active participation in PES and academic achievement.

Another point to note is the null findings that were revealed between the contribution of PA and the cognitive or healthier brain. According to the null findings, PES is established neither to harm nor to benefit the students with cognitive development, academic performance, and brain health while engaging in PES. In this specific instance, on the completion of his study, Bailey [ 57 ] noted that increased PES time does not negatively affect cognition. Moreover, Trudeau et al. [ 58 ] and Trudeau and Shephard [ 59 ] confirmed that PES has no ill effect on academic learning.

The aforementioned existing literature that we reviewed presented contradictory views about the contributing benefits of PA to cognitive development, academic performance, and brain health of the concerned students, whereby some researchers revealed a significant association between these variables, while others found no relationship, regardless of those that claimed null findings.

Due to this inconsistency, in contrast to several research studies that undoubtedly confirmed various benefits of PES, it is clear that robust longitudinal cause-and-effect research is needed to explore the role of participation in a particular PA on cognitive development, academic performance, and brain health, since disagreements remain rampant on whether the relationship between PA and academic achievement is causal. It is also clear that further understanding is needed to ascertain the level of intensity and duration that children need to reach so as to fully gain the cognitive benefits available by participating in PA. However, much work still needs to be performed in order to examine the appropriate type of physical exercises to be undertaken concerning culture, gender, and age level of students such as children and adolescents that can lead to cognitive benefits, since educational demands change as children and adolescents change. Therefore, PES should be one of the compulsory subjects that is allocated appropriate time on schools’ timetable to expose students to a planned exercises providing the students with the opportunity to gain such benefits regardless of dose or intensity.

4.2. Physical Domain

PA has been established as one of the leading factors influencing physical health by curbing the causes of diseases, reducing the risk of chronic diseases, enhancing efficient functioning of the body, and providing remedial benefits, as well as health-related fitness within childhood and adolescence; and it continues throughout adulthood and old age toward a satisfactory future life, according to Sallis and Owen [ 45 ]; Bailey [ 57 ]; and Fernandes and Sturm [ 60 ].

In essence, Bailey [ 57 ] emphasized that PES significantly benefits the participants with general health through efficient functioning of the body; the remedial benefits include the correction of poor posture and the developmental benefits such as assisting the natural pattern of growth of the child.

Consistent with the view of Bailey are the emerging points documented by several researchers who argued that participating in quality PES improves the physical status of the participants in terms of body mass index, resulting in a normal weight within the school period and in the future. Fernandes and Sturm [ 60 ] pointed out that effective participation in PES diminishes the potential for future mass increase among children. In their own words, Madsen et al. stated, “more physical education is associated with lower Body Mass Index scores” [ 61 ]. On a related note, Cawley et al. [ 62 ] made it clear that PES lowers both body mass index and the probability of obesity among grade-five male students. This was also exemplified in the work undertaken by Freedman et al. [ 63 ], who substantiated that engaging in quality PES from early childhood prevents obesity, which, indeed, starts at childhood and persists all through life, leading to the risk of being affected by hypokinetic diseases such as coronary heart diseases and diabetes.

Another supporter of PES and health-related fitness, Sdrolias [ 64 ], in his study undertaken in secondary schools, contended that quality PES results in a significant improvement in health-related fitness and psychological well-being in high-school students. Similarly, it has been noted that PES reduces the odds of being an overweight adult by 5% each day per week, while normal-weight children are 25% more likely to be normal-weight adults if they participate in PES at least five days per week, according to Mensschik et al. [ 65 ].

The most obvious and important benefit of active PA engagement is the significant improvement in health-related fitness components (aerobic fitness, muscle strength and endurance, flexibility, and body shape) in both school-aged children and adolescents, due to active PA participation. To bring this assertion to light, Chen et al. [ 66 ] examined the relationship between students’ physical fitness components and PA and noted that engaging in PES and recess, as well as sports/dance, significantly influences the overall health-related physical fitness. This finding is in line with the findings of the study conducted by Sallis et al. [ 67 ], who ascertained a significant association between the level of PA and health-related physical fitness among school-aged children and adolescents.

Unfortunately, PES, a single curriculum subject under which school-aged children and adolescents are supposed to gain opportunities to engage in quality Pas, UNESCO [ 5 ] (p. 6), has been mostly sidelined to the extent that physical inactivity has been declared one of the leading causes of death, disability, and insufficient quality of life, particularly in the Western world, according to USDHHS [ 68 ]. On the other hand, UNESCO [ 10 ] reported that PES is globally cancelled at 44%, despite the fact that it has been confirmed globally to be a compulsory subject, at 97%. This is a fact that indicates the inconsistency in translating policies into implementations. It is therefore clear that PES needs to be fully restored and maintained in schools by exposing the students to quality PES instruction within a recommended time depending on school level (elementary/secondary) or gender to serve its physical benefits to the students.

4.3. Affective Domain

Currently, affection is understood as a psychological and emotional well-being with associated components, namely mastery motivation, sense of autonomy, moral character, confidence, emotion, preference, choice, feeling, beliefs, attitudes, and appreciations, according to NRCIM [ 69 ].

At the same time, many affective benefits, such as happiness, enjoyment, and self-confidence, have been associated with active participation in PA. WHO [ 70 ], in its study about sports and children, validated that participation in PES improves self-esteem, self-perception, and psychological well-being of the participants.

As Gilman [ 71 ] has noted, the students who participate in PA experience more happiness compared to those who do not participate. A view that supported Gilman’s assertion is articulated by Bailey et al. [ 72 ], who pointed out that the 1909 syllabus clearly points out the affective outcomes of physical exercises as producing a cheerful and a joyful mood, as well as the expression of emotion. Some other interested researchers went further to determine the role of such happiness/enjoyment in future PA participation. Williams and Gill [ 73 ] and Sonstroem [ 74 ] reported that such happiness experienced within PA reinforces self-esteem, which, in turn, enhances further participation. Kimiecik and Harris [ 75 ] made it clear that such happiness also improves intrinsic motivation, which lowers anxiety, thus increasing participation.

Along the same lines, other studies have revealed some psychological benefits of PES participation. Mutrie and Parfitt [ 76 ] indicated that a positive correlation exists between PA participation and psychological benefits such as the reduction of stress, anxiety, and depression, as well as emotional growth and expression. Active engagement in PES reduces anxiety and depression and increases positive mood, self-esteem, and restful sleep, according to Dunn et al. [ 77 ] and Landers [ 78 ].

Although these aforementioned findings may be valid, a view that contradicts the former is that of Steptoe et al. [ 79 ], who rejected the opinion of a positive association between PA and affective domain of human development after he conducted a study across 21 countries which involved 16,000 undergraduate students. He established a negative correlation between PA, exercises, and depression symptoms.

After all, not much is known about the mechanisms by which such dimensions of affective development occur, according to Dishman [ 80 ]. Increasingly, Thirlaway and Benton [ 81 ] raised an existing confusion that it is unknown whether some forms of PA are more or less beneficial to the improvement of the affective domain than others. Whereas other arguments have rejected the idea that all groups experience psychological benefits from being active.

To this end, it is clear that PES needs to be resumed and should serve the students with all affective benefits discussed in the aforementioned literature. Although much research still needs to be performed in order to ascertain the genuine mechanism and appropriate form of PA that is more likely to serve affective benefits to the students, qualified, trained, and competent teachers are needed to instruct the students through some instructional curriculum models such as sports education, teaching personal and social responsibility, cooperative learning, etc., that are evidenced to promote the affective domain.

4.4. Healthy Domain

Earlier in the middle of the 20th century, PES targeting health-related fitness came into existence. This is undoubtedly due to the evidence that indicates the function of PES in improving the quality of life through its benefits to the muscles, bones, joints, heart, and mental health, just to mention a few, among school-aged children and adolescents who continue to adulthood and old age. In this regard, several studies have been conducted to find out the role of PES in maintaining health and preventing the causes of some diseases that emerge as a result of a sedentary health style.

According to the Institute of Medicine (IOM) [ 82 ], PA has several benefits in regard to various aspects of health, such as improved aerobic capacity, muscle and bone strength, flexibility, insulin sensitivity, and lipid profiles, resulting in the reduction of the risk of heart diseases, mental illness, and other chronic diseases, such as diabetes mellitus, osteoporosis, obesity, etc. These findings of IOM are in line with the findings of Bloomfield et al. [ 83 ], who carried out a research study on the role of PA on the life of the participants’ skeleton, bones, joints, and muscles. The findings of their study revealed that there is an increase in mineral accrual; an increase in bone strength which, in turn, reduces the risk of osteoporosis-related fracture; and, ultimately, an improvement in muscle strength, flexibility, coordination, and balance, as these are found to be significantly influenced by PA participation. A supportive view was observed in the study conducted by Masurier and Corbin [ 84 ], who reported that active participation in regular PA significantly reduced the risk of major chronic diseases such as heart diseases, high blood pressure, stroke, some forms of cancer, diabetes, and osteoporosis. On a related note, WHO [ 85 ] substantiated that PA enhances physical fitness in the areas of cardiorespiratory and muscular fitness; improves cardiometabolic health, particularly in blood pressure, dyslipidemia, glucose, and insulin resistance; improves bone health, mental health, and cognitive achievement; and reduces visceral adiposity.

More importantly, the literature shows that PA is beneficial to people of all ages, including children, adolescents, adults, and the elderly, provided people effectively participate in it. Hallal et al. [ 86 ] noted that the future morbidity (risk of fracture) is influenced by early PA, which is of great importance in the treatment, as well as the reduction in the rate and the severity of, some hypokinetic diseases in children and adolescents. Focusing particularly on children, the CDC [ 87 ] elucidated that engaging in PES and recess at school contributes much to improving cardiorespiratory and muscle fitness, as well as the promotion of a healthier body weight and body composition in children. Supporting this advancement of the CDC, the USDHHS [ 68 ], the CDC [ 87 ], and Bauman [ 88 ] asserted that a lower rate of chronic diseases such as coronary heart diseases, cardiovascular diseases, diabetes mellitus, hypertension, osteoporosis, and some types of cancer; and the reduction of premature death are some of the benefits adults gain due to actively engaging in PA.

Nonetheless, a controversy has erupted over the most effective PA dose, including the type, intensity, and frequency required to provide students with such health-related benefits. On the one hand, some scholars claimed that no matter how long, how intensely, or repetitively you engage in PA, benefits will be accrued. On the other hand, the researchers emphasized that there is need for a specific dose standard that must be met in PES so as to obtain the benefits accruable in PES. Of utmost importance is the fact that intense and frequent aerobic PA has been strongly evidenced to provide many health-related benefits.

Boreham et al. [ 89 ] and Imperatore et al. [ 90 ] ascertained that aerobic endurance corresponds with high-density lipoproteins, systolic and diastolic blood pressure, body mass index, measures of fatness and insulin sensitivity, and arterial stiffness. Associated with the views of Boreham et al. [ 89 ] and Imperatore et al. [ 90 ] are the findings of the experimental study undertaken by Davis et al. [ 91 ] which indicated a reduction in body fat among children and adolescents suffering from obesity or overweight when made to start aerobic exercises early in the program.

Taking into account the intensity and duration of aerobic PA, Baquet et al. [ 92 ] bolstered that regular moderate or vigorous intensified aerobic exercises undertaken within 30–45 min per session three days per week within three months resulted in increased cardiorespiratory endurance by 5–15% in youth. Similar to frequent PA, Corbin et al. [ 93 ] revealed that participating in PA improves immunological function and curbs the symptoms of arthritis, asthma, and fibromyalgia.

Masurier and Corbin [ 84 ] stressed that early PA in life acts similar to a vaccine for many diseases which attack the body later in life, and it also reduces the risk of diseases, thus improving the quality of life. Equally important are the health-related benefits from anaerobic physical activities, i.e., strength training or resistance exercises. In this case, Faigenbaum [ 94 ] established that anaerobic physical exercises positively enhance the quality of different aspects of the health of participants such as cardiovascular fitness, body composition, blood lipid profiles, and insulin sensitivity. Consistently, MacKelvie [ 95 ] insisted that strength training improves bone mineral density and bone geometry.

As far as PES and mental health are concerned, mental illness has been regarded as a global burden. This is because, by 2010, mental illness accounted for 15% of the global disease burden, according to Biddle and Mutrie [ 96 ] and Biddle and Asare [ 97 ]. Young people are particularly vulnerable to mental illnesses such as depression, anxiety, and the rest of the mental health disorders. Though mental illness may seem alarming, evidence has shown that PA can help to reduce and avoid mental illnesses such as anxiety and depression, as well as improve other elements of well-being, leading to long-term mental health, according to Ahn and Fedewa [ 98 ], and IOM [ 82 ]. Similarly, Ahn and Fedewa [ 98 ], Simms et al. [ 99 ], Biddle and Mutrie [ 96 ], and Dishman et al. [ 100 ] reported that active participation in PA lowers or reduces depression and its symptoms, anxiety and its sensitivity (a precursor to panic attacks and disorders), physiological distress, state of confusion, anger, and stress. It also improves mental health, dietary choices, and mood.

From the aforementioned literature we reviewed, PES has a substantial association with various aspects of health, including the body, skeleton, organs, and mental health.

In contrast, a sedentary health lifestyle is currently a major determinant of people’s health outcomes throughout their lives; an issue that could be linked to a lack of effective PES, which increases the risk of developing chronic diseases such as hypertension and coronary heart disease; mental health issues such as anxiety and depression; cancers such as colon and breast cancer; and even diabetes mellitus, osteoporosis, etc.

The crux of the matter is that, among the American adult population, 66% are overweight and 32% are obese. Approximately 19% of children and 17% of adolescents are overweight, and 37% of children and 34% of teenagers are either overweight or at risk of being overweight, according to Masurier and Corbin [ 84 ]. These facts indicate that several mandates that maintain PES as a compulsory and inclusive subject delivered to both boys and girls remain elusive. Therefore, there is need for a rationale to raise awareness about PES to be recognized as an important subject whereby trained PES teachers, materials and equipment, weekly time allocated to PES on the timetable, and an adequate budget are put in place to serve its purpose for school-aged children and adolescents.

4.5. Social Domain

PES is seen as a single bedrock subject that equips students with social interaction within this technological era, which is no longer providing the opportunity for people to meet and socialize, as it should naturally be. In some respects, students, to some extent, enjoy various opportunities of meeting and communicating, developing leadership skills, and ultimately learning social skills and behavior, while curbing, at the same time, the anti-social behaviors through PES.

In view of this perspective, Hellison et al. [ 101 ] indicated that participation in PES instils positive social behaviors in school-aged children and adolescents, such as cooperation, personal responsibility, and empathy. Afterwards, such participation in some circumstances helps in curbing current youth epidemics such as depression, crime, alcoholism, and drug abuse. In its recent report, SHAPE America [ 1 ] pointed out constructive competition, conflict resolution, decision-making, cooperation, and leadership assumption aspects as some of the benefits students gain through their interaction in PES.

In a similar vein, the Europe report asserted that only PES provides students with the opportunities of meeting and communicating with others and developing leadership qualities. More importantly, it instructs the participants about relevant social skills such as tolerance, respect for others, adjusting collectivism aspects including teamwork-spirit, cooperation, and cohesion, just to name a few, according to Svoboda [ 102 ]. Another emerging view which supports this assertion was articulated by Bailey et al. [ 72 ], who addressed the influence of PES on current global cleavage by arguing that PES has the potential to connect children of different social/economic classes and even those coming from different nations.

Of particular concern, the Qualifications and Curriculum Authority (QCA) [ 103 ] reported the constructive and corrective impact of PES, whereby it helps in improving students’ attendance, behavior, and attitudes within the school, as well as lowers the anti-social and criminal behaviors, according to Andrews and Andrews [ 104 ]. Indeed, the views of (QCA) and the Andrews corroborated with the assertion articulated by Sport England (SE) [ 105 ] that stated that participation of school-aged children and adolescents in PES assists them to gain social outcomes such as opportunities for active citizenship, increasing their attitude for learning as well as reducing youth crime and truancy.

In contrast to the social benefits ascertained by several researchers and scholars introduced herein, PES has been being devalued through different forms pushing it into a defensive position identified as (a) attributing low status to PES teachers; (b) assigning alternative duties to PES teachers such as logistics; (c) diverting PES time, which is already insufficient, to core subjects; and, in some schools, (d) replacing PES time with cleaning, etc., according to UNESCO [ 10 ]. As a consequence of this PES devaluation, students are still experiencing unpleasant social behaviors such as disrespect among themselves and some other related behaviors, such as truancy, absenteeism, alcohol and drug abuse, crime, and intolerance, just to name a few, as reported by Jean de Dieu and Andala [ 106 ].

Therefore, there is the need to call upon governments of nations to enforce PES in schools, as stated not only in international policies but also in their national PES policies such as to remedy the status of PES teachers through adequate continuous professional development (CPD) so as to update their pedagogical content knowledge (PCK) and current pedagogical models appropriate to serve social benefits such as teaching personal and social responsibility model, allow them to regularly teach PES following timetable, and make PES a compulsory subject with accountability for attendance and performance such as the other compulsory subjects so as to bridge the gap between agreements and actions.

4.6. Moral Domain

Moral behavior refers to activities conducted by following the rules which apply in a certain social context such as formal school/class rules, informal societal norms, and even the expectations related to behavior. Thus, moral values include honesty, fairness, fair play, justice, and responsibility, as reported by Wright and Taylor [ 107 ], Lumpkin and Stokowski [ 108 ], and Stoll and Beller [ 109 ]. According to this perspective, the existing evidence suggests that many moral benefits, such as experiencing moral socialization, moral values, ethical behavior, citizenship education, and social and moral characters, are accrued from participating in PES when students are given the opportunity to engage in an effectively planned PES.

A notable example of these moral benefits was found in studies undertaken by Bloom and Smith [ 110 ] and Sabock [ 111 ], who elucidated that PES provides the students with many opportunities to experience moral values such as cooperation, competition, role-playing, rules, regulations, and goal-based discipline. Moreover, PES assists in gaining self-discipline and order, manual dexterity, and even determination, according to Bloom and Smith [ 110 ], and Bailey [ 57 ].

In his own words, Sabock [ 111 ] (p. 271) argued that “the arena of sport can provide one of the greatest opportunities for a student to learn honesty, integrity, and ethical behaviour”. It is becoming increasingly important that PES has been proven to be a paramount subject, simultaneously instilling in the students social and moral characteristics such as cooperation with teammates; negotiation and creation of solutions against moral conflicts; development of self-control, fairness, and good work ethics; and displaying courage and learning of virtues such as teamwork, as reported by Shields and Bredemeier [ 112 ] and Weiss and Bredemeier [ 113 ]. The next likeness was the view articulated by Romance et al. [ 114 ], who argued that active participation in PES has been established as a source of positive moral socialization, and, to some extent, deliberate interventions in PES settings can improve moral conduct.

Another emerging feature of a moral aspect through PES is a view that effective PES has been indicated as a foundation for good citizenship. Engh [ 115 ] suggested that quality PES results in a good citizen education, which is, indeed, what PES teachers are supposed to teach in educational athletics as they teach other PES components. Supporting Engh, Raakman [ 116 ] substantiated that participation in PES could help develop engaged and balanced citizenship.

Despite the fact that PES positively influence the students’ moral development, the contrarians against this prevailing knowledge argued that PES participation may be a causal agent of negative moral development among participants, according to Bredemeier and Shields [ 117 ], Priest et al. [ 118 ], and Collin [ 119 ]. Another view that contradicts the view of a positive association between PES and moral education was found in the study conducted by Collin [ 119 ], who noted that unethical and aggressive behavior, which destroys the development and well-being of young athletes and the whole society, can be the result of a win-at-all-costs philosophy.

Despite these contradictions in moral benefits accrued from PES participation, it is important to note, however, that the quality PES delivered by professionally trained and qualified PES teachers adopting some of the current pedagogical models acknowledged to promote moral aspects of the students through their constructivism approach, including sports education, which focuses not only on playing roles but also duty roles, has been acknowledged to serve the needful under the moral domain. Thus, PES needs to be welcomed in schools to serve all moral benefits attributed to it.

4.7. Cultural Domain

UNESCO [ 120 ] defined culture as the set of distinctive spiritual, material, intellectual, and emotional features of society or a social group that encompasses not only art and literature but also lifestyle, ways of living together, value systems, traditions, and beliefs. In a similar vein, Zimmerman [ 121 ] made it clear that culture involves religion, food, language, marriage, music, dressing style, the dualism of what is right and wrong, rituals, ceremonies, etc.

In contrast to the other domains, finding existing works in the literature that addressed the contribution of PES to maintaining or improving the culture of a given society, turned out to be complex. However, some views have been pointed out by some relevant organizations and scholars, indicating that PES plays a significant role in encouraging school-aged children and adolescents to recognize and respect each other’s cultural characteristics, resulting in the prevention of some bad feelings such as extremism and racism, among others.

An example of this act was found in the International Charter of PES, UNESCO [ 6 ] which justified that the right and freedom of participating in PES should be granted without discrimination of any characteristics, including color, gender, language, religion, national or social origins, political or other opinions, property, birth, or other considerations. A supporting view of this assertion was put forward by Wright [ 122 ], who advised that PES teachers should not conceive that their task tool is technical; rather, they should aim at nurturing certain qualities required for a democratic society, such as self-confidence leavened by an agreeable humility, curiosity, courage, persistence, kindness, gentleness, care for the less fortunate, and care for other forms of life.

Before approaching the end of this cultural aspect, it is worth sounding a note of caution in the context that such a relationship can be bidirectional; that is, quality PES can help the students to learn and maintain their respective cultural characteristics and values while respecting those of others, resulting in a harmonious society. On the other hand, there is a possibility that some of such variety of cultural characteristics, e.g., religion, gender, dressing style, etc., may negatively affect PES participation at school.

In this regard, having completed their study about the influence of family and culture on PA among female adolescents from the Indian diaspora, Ramanathan and Crocker [ 123 ] revealed that female adolescents are not adequately participating in PA as males do. This was explained as due to the cultural belief that they are scared of losing their femininity while engaging in PA, and the issue of the belief that they need to stay at home supposed and be engaged with domestic duties. Similarly, religious belief is another example of a cultural characteristic that lowers the desire to participate in PA in certain societies. For example, female students from Muslim countries do not experience opportunities to effectively get involved in PA because of restrictions based on their culture, such as the dress codes; prohibited close contact with males; and lack of related facilities such as a prayer room, clean washroom with clean water, and women’s sport and fitness foundations [ 124 ].

The upshot of all of this is that some cultural characteristics and values are still preventing all school-aged children and adolescents from fully participating in PES, and this, in turn, violates the PES international charter of 21 November 1978, that allowed PES participation for all, without any kind of discrimination. Another emerging cultural aspect is the concern that some situations whereby PES is not given a top priority for its successful implementation can results in violation of cultural norms. To this end, all institutions responsible for PES should ensure adequate CPD for in-service teachers or supply trained PES teaches who have necessary PCK to help students with different cultures to learn regardless of culture differences.

4.8. PES on Sustainable Development Goals (SDGs)

It is important to signal our concern to the contribution of PES to the SDGs—a universal call to action that aims to create an equal and inclusive community with improved health by 2030. This ambitious plan consists of 17 goals with their corresponding 169 specific targets.

After the establishment of the SDGs, researchers in the field of education, particularly PES, conducted several studies to ascertain the contribution of PES in the context of SDGs and revealed that the majority of the SDGs can be achieved through the involvement of school-aged children and adolescents in quality PES. There is considerable evidence indicating that PES has a potential to create a favorable context which allows the promotion of different aspects associated with the development of the current SDGs, such as coeducation, entrepreneurship, cooperation, and respect.

The international conference of ministers and senior officials responsible for PES (MINEPS VI), UNESCO [ 125 ] established 9/17 and 36/169 goals and associated targets whereby sports-based approaches could make a significant contribution. To support the view of MINEPS VI, the study undertaken by Baena-Morales et al. [ 126 ] (pp. 7–10) explained the way in which 10/17 SDGs equivalent to 58.8% and 24/169 targets; that is, 40.5% could be achieved through PES.

Of little difference, Baena-Morales and Gonzalez-Villora, [ 127 ], who have made great strides in analyzing the role of PES to SDGs in three major dimensions, namely social, environmental, and economical dimensions, commented that SDGs should not be given much consideration as a reference, since they are too generic, but the specific targets make up SDGs.

Though some research studies raise a concern that the contribution of PES to the SDGs is slightly explored, according to Fröberg and Lundvall [ 128 ] and Baena-Morales and González-Víllora [ 127 ], others have explored the role of PA, sports, or exercises in general, Dai and Menhas [ 129 ]; focused their attention to the contribution of PES in relation to some selected SDGs, with particular aspects such as health and well-being partnership as explored by Lynch [ 130 ], it is clear that PES is a transcendental subject toward the achievement of SDGs, provided that it is given a top priority in schools worldwide. It is important to note that PES teachers should plan their lessons by linking the lesson instructional objectives with those of SDGs.

This paper provides an important opportunity to advance the understanding of the significance of PES in promoting a physically active health style in school-aged children and adolescents and the entire community, as well. It is therefore important to raise an alarm about PES enforcement to the governments of nations so as to empower PES in schools and make it serve its purpose for all students across the world.

5. Conclusions

PES has been evidenced to play a significant role in a holistic education to the extent of being considered as a backbone of the whole community in the 21st century, on account of the fact that school-aged children and adolescents are the ones that gradually become adults and later old people in their respective communities. That is to say, delivering quality PES to school-aged children is, at the same time, delivering an active lifestyle to the entire community throughout the life course. This is established based on the benefits obtainable from PES in all areas of human development, namely the cognitive, physical, affective, health, social, moral, and cultural aspects of human life, as discussed in this study.

The hindrances that impede PES from delivering all that it could offer to the school-aged children and adolescents which later affect the whole society include the following: (a) inadequately qualified teaching personnel; (b) insufficient time allocated to PES; (c) limited facilities, equipment, and materials; (d) deficit budget allocated to this subject; and (e) PE teachers detraction among others. Subsequently, a sedentary lifestyle has been mostly discussed as a pandemic among children and adolescents of this current century, resulting in suffering from hypokinetic diseases (coronary heart diseases, obesity, hypertension, osteoporosis, diabetes, etc.), as well as mental diseases such as depression and anxiety. Moreover, nowadays some students are still facing poor academic achievement, leading to increased repetition rate, drop-out rate, and ultimately on-time completion rate, an issue associated with the current sedentary lifestyle among students. From all such drawbacks of physical inactivity, one should wonder how perilous this coming society will be in the case that all of these challenges against quality PES remain unresolved.

To this end, it is important to raise these questions for the concerned leaders and related practitioners across the world, so as to come up with an effective and sustainable solutions. Apart from international charters, conventions, national policies, and international and national guidelines and endorsements, civil and private organizations (agencies) promulgated to address the promotion of PES. Considering also the fact that majority of parents’ perceptions support inclusive and quality PES for the benefits of their children, as well as the consequences of sedentary health style among all children, adults, and old people. Why are the governments of nations still inconsistent in their effort to convert their promises (agreements) of promoting PES into implementation/practice? Why are the governments of nations not willing to initiate mechanisms that aim to produce the required professionally trained personnel with the required PES resources and adequate budget? Why are school leaders still reducing or diverting allocated PES time to other subjects? Who would be held accountable for violating the universal right of quality PES for all and thwarting PES subjects from delivering all benefits claimed under its name?

“ Knowing is not enough, we must apply. Willing is not enough, we must do ”. —Goethe [ 131 ]

Acknowledgments

The effort of authors toward the successful accomplishment of this paper and funding organization is highly acknowledged.

Funding Statement

This study was funded by The National Social Science Fund of China, grant number 17BTY078.

Author Contributions

J.d.D.H. conceived the study and drafted the original manuscript. E.T. retrieved the data and checked their eligibility. K.Z. supervised the study. All authors contributed to the interpretation of the findings and discussion. All authors have read and agreed to the published version of the manuscript.

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Data availability statement, conflicts of interest.

The authors declared no potential conflict of interest.

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Physical Education and Physical Activity

Schools are in a unique position to help students attain the nationally recommended 60 minutes or more of moderate-to-vigorous physical activity daily. 1 Regular physical activity in childhood and adolescence is important for promoting lifelong health and well-being and preventing various health conditions. 1–3

To learn more about benefits of physical activity, physical activity behaviors of young people, and recommendations, visit Physical Activity Facts . For more information on the Physical Activity Guidelines , 2 nd edition, visit Physical Activity Guidelines for School-Aged Children and Adolescents . Find out what CDC is doing nationwide to help more adults, children, and adolescents become physically active.

Figure 1. The 5 components of a Comprehensive School Physical Activity Program PDF [PDF – 247 KB] | JPEG | PNG

Comprehensive School Physical Activity Program Framework [PDF – 3 MB]

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A CSPAP can increase physical activity opportunities before, during, and after school. This graphic explains how 60 minutes of daily moderate-to-vigorous physical activity can benefit a  student’s health and directly impact teachers and the community.

Comprehensive School Physical Activity Program: A Guide for Schools [PDF – 6 MB]

CDC, in collaboration with SHAPE America, developed a step-by-step guide for schools and school districts to develop, implement, and evaluate comprehensive school physical activity programs. The guide can be read and used by an existing school health council or wellness committee, or by a new group or committee made up of physical education coordinators and teachers, classroom teachers, school administrators, recess supervisors, before- and after-school program supervisors, parents, and community members. It can be used to develop a new comprehensive school physical activity program or assess and improve an existing one.

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The purpose of this module  is to familiarize you with the components of a Comprehensive School Physical Activity Program and the process for developing, implementing, and evaluating one. After this module , you should be able to take the next steps to begin the process of developing a Comprehensive School Physical Activity Program .

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• Understand the importance and benefits of youth physical activity.
• Recognize the components of a Comprehensive School Physical Activity Program.
• Learn the process for developing, implementing, and evaluating a Comprehensive School Physical Activity Program .
• US Department of Health and Human Services. Physical Activity Guidelines for Americans, 2 nd edition. Washington, DC: US Department of Health and Human Services; 2018.
• Association for Supervision and Curriculum Development (ASCD), Centers for Disease Control and Prevention. Whole School, Whole Child, Whole Community: A Collaborative Approach to Learning and Health. 2014. Retrieved from  http://www.ascd.org/ASCD/pdf/siteASCD/publications/wholechild/wscc-a-collaborative-approach.pdf [PDF – 2.24 MB] .
• Centers for Disease Control and Prevention. School health guidelines to promote healthy eating and physical activity. MMWR. 2011;60(No. RR-5):28–33.

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• Volume 109, Issue 7
• Associations of excessive internet use, sleep duration and physical activity with school absences: a cross-sectional, population-based study of adolescents in years 8 and 9
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• http://orcid.org/0000-0002-2881-8299 Silja Kosola 1 , 2 ,
• Marianne Kullberg 3 ,
• Katja Melander 4 , 5 ,
• Janne Engblom 6 ,
• Klaus Ranta 7 , 8 ,
• Katarina Alanko 3
• 1 Research, Development and Innovations , Western Uusimaa Wellbeing Services County , Espoo , Finland
• 2 Pediatric Research Center , Helsingin ja uudenmaan sairaanhoitopiiri , Helsinki , Finland
• 3 Faculty of Arts, Psychology and Theology , Åbo Akademi University , Abo , Finland
• 4 Doctoral Programme in Population Health , University of Helsinki , Helsinki , Finland
• 5 Faculty of Medicine , Tampere University , Tampere , Finland
• 6 Department of Mathematics and Statistics , University of Turku , Turku , Finland
• 7 Department of Psychiatry , University of Helsinki , Helsinki , Finland
• 8 Faculty of Social Sciences , Tampere University , Tampere , Finland
• Correspondence to Dr Silja Kosola, Research, Development and Innovations, Western Uusimaa Wellbeing Services County, Espoo, 02033 Länsi-Uudenmaan hyvinvointialue, Finland; silja.kosola{at}helsinki.fi

Background Internet use has increased and sleep and physical activity (PA) have decreased in recent years among adolescents. Besides sleep and PA, another determinant of future health for adolescents is education. Our aim was to evaluate the associations of excessive internet use (EIU), short sleep duration and low PA with both unexcused absences and medical absences during lower secondary school.

Methods The School Health Promotion study is a national survey of adolescents conducted biennially in Finland. We used data collected in 2019, when EIU was assessed for the first time. Cumulative odds ratio analysis was conducted with unexcused absences and medical absences as outcome variables. Besides EIU, sleep duration and PA, the associations of maternal education and parental relations were assessed.

Results The mean age of the 86 270 participants was 15.3 years. Girls scored higher than boys on EIU. In all, 34.7% of participants slept less than 8 hours per night during the school week, and 34.3% reported low PA (ie, less than 3 days per week with minimum 1 hour of PA per day). EIU, short sleep and low PA were associated with both unexcused absences and medical absences from school. Longer sleep during weekends showed no association with absences, but good parental relations had the strongest protective association with both unexcused and medical absences.

Conclusions EIU, short sleep duration and low PA were associated with both unexcused and medical absences from school. This has important implications for both the promotion of general health and the support offered to students with alarming school absences.

• Adolescent Health
• Epidemiology
• Primary Health Care

Data availability statement

Data may be obtained from a third party and are not publicly available. Data from the School Health Promotion study are available for researchers from the study coordinators at the Finnish Institute for Health and Welfare.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/archdischild-2023-326331

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WHAT IS ALREADY KNOWN ON THIS TOPIC

Previous research has established a relationship between short sleep duration and school absences.

The connections of excessive internet use, short sleep and physical activity (PA) with school absences have remained unclear.

WHAT THIS STUDY ADDS

Excessive internet use was associated with an increased risk for both unexcused and medical absences from school, while longer sleep duration and higher PA showed a protective association.

A trusting relationship with parents emerged as an important protective factor for both unexcused and medical absences.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

Highlights the vitality of collaboration between health and education sectors to improve long-term health outcomes among adolescents.

Introduction

Education is an essential determinant of future health for adolescents, but it can be jeopardised by school absences. School absences can be either unexcused (also called truancy) or excused, most commonly for medical reasons. School absences can be caused by physical and mental health problems, but they may also be associated with different types of risky behaviour or an unhealthy lifestyle involving excessive use of screen-based media, insufficient sleep and limited physical activity (PA). 1 2

The internet, online gaming and the upsurge of social media during the last decade have dramatically changed the lives of adolescents. 3 4 Among adolescents, excessive gaming and social media use have been associated with school absences, poor numeracy skills, anxiety and poorer sleep. 5–9 Although variance between assessment instruments of excessive internet use (EIU) complicates comparisons, digital media may be a factor tempting adolescents to stay home from school, and may also hinder learning through lack of sleep. 10

Sleep is necessary for all aspects of health and development. To promote optimal health, adolescents aged 13 to 18 should sleep 8–10 hours per night. 11 Meta-analyses have found that insufficient or disturbed sleep among children and adolescents is associated with obesity and depressive symptoms. 12 13 Insufficient sleep and poor sleep quality are also associated with poor educational attainment, possibly through school absences. 14–16 The direct impact of sleep on unexcused and medical absences, however, remains unclear.

Besides contributing a positive impact on general health throughout the life course, regular PA is important for the brain health of school-aged children and adolescents because it improves both cognition and mental health. 17 Adolescents should engage in 60 min or more of moderate-to-vigorous PA daily. 18 No consensus has been reached on the association of PA with school absences. Some studies have found higher rates of absences in both inactive and highly active children than among children with medium levels of PA. 19 De Groot et al found no direct association between PA and medical absences from school. 20

The objective of this study was to examine the associations of EIU, short sleep and PA with unexcused absences and medical absences from school among adolescents. We hypothesised that EIU would be associated with a higher risk of both unexcused and medical absences, whereas sleep and PA would have a protective association.

Study population and procedure

This study used data from the School Health Promotion study, a national biennial survey conducted in Finland and managed by the Institute for Health and Welfare. 21 All students in years 8 and 9 and present at school on the day of the survey administration are invited to participate. Both adolescents and their parents may opt out of participation. An anonymous survey was administered to adolescents in classrooms, with both online and pen-and-paper options available, and under teacher supervision. In this study, we utilised responses from the nationally representative sample of year 8 and 9 students in 2019, when EIU was assessed for the first time. These age cohorts comprised 118 178 adolescents, of whom 86 283 (73.0%) participated. Responses were geographically evenly distributed and considered nationally representative.

In Finland, education is compulsory and free of charge from the year a child turns seven until age 18 years. In school years 8 and 9, students are typically 14–16 years old. As advised by the Institute for Health and Welfare, we excluded responses if self-reported age was below 13 or exceeded 18. Year 9 marks the end of lower secondary school, and during the spring term students apply to either academic upper secondary school or vocational education. Thus, school absences in lower secondary school have special significance.

Demographics

Self-reported gender was based on the two response options (boy or girl) to the question ‘What is your official gender?’ Students also reported their school year.

Socioeconomic status was based on maternal education level, reported by the students. The question ‘What is the highest educational level your mother has achieved?’ had four response options: ‘comprehensive school or equivalent’ (meaning 9 years of education), ‘upper secondary school, high school or vocation education’ (meaning 12 years of education), ‘occupational studies in addition to upper secondary school, high school or vocational education’ and ‘university, university of applied sciences or other higher education’.

One question, ‘Can you talk about things that concern you with your parents?’, described parental relations. Response options were ‘hardly ever’, ‘occasionally’, ‘fairly often’ and ‘often’.

Excessive internet use (EIU)

The EIU scale is short and has shown good internal consistency in previous studies. 22 23 Cronbach’s alpha was 0.77 overall and 0.74 in Finland. 23 The EIU scale has five statements: ‘I have tried spending less time online but I have failed’, ‘I should spend more time with my family, friends or doing homework, but I spend all my time online’, ‘I have found that I was online even though I did not really feel like it’, ‘I have felt anxious when I do not get online’ and ‘I have failed to eat or sleep because of being online’. Respondents were asked to estimate how often they experienced each of the above on a four-point Likert scale from ‘never’ to ‘very often’, which translated to numeric values of 1–4. EIU was defined as the mean value of the five scores.

Sleep duration

Sleep duration was calculated from two questions: ‘At what time do you usually go to bed?’ and ‘At what time do you usually wake up?’ For both questions, responses were collected separately for weekdays and weekends. Response options for bedtime were provided at half-hour intervals from ‘about 7 p.m. or earlier’ to ‘about 4 a.m. or later’. Response options for wake-up times were also at half-hour intervals from ‘about 5 a.m. or earlier’ to ‘about 1 p.m. or later’.

Physical activity (PA)

PA was assessed through two questions. The first measured overall PA: ‘Think about all the moving around you have done over the past 7 days. On how many days have you been on the move for at least 1 hour per day?’ Response options ranged from zero to 7 days. The second question evaluated vigorous PA: ‘During your spare time, how many hours per week do you usually engage in physical exercise that causes shortness of breath and sweating?’, and response options were ‘none’, ‘about 0.5 hours’, ‘about 1 hours’, ‘about 2–3 hours’, ‘about 4–6 hours’ and ‘about 7 hours or more’.

Unexcused and medical absences from school

The question ‘During this school year, how often have you experienced the following’ had two subcomponents: ‘Being absent without permission, skipping school’ and ‘Absences due to illness’. Both had the same five response options: ‘not at all’, ‘a few times in the year’, ‘every month’, ‘every week’ and ‘daily or almost daily’. Because some medical absences are natural and unexcused absences have been associated with delinquent behaviour, unexcused and medical absences were classified slightly differently into three categories.

• View inline

Statistical analyses

Descriptive statistics included percentages and means (with SD). Gender differences were estimated with independent sample t-tests and odds ratios. Cumulative odds ratio (COR) with 95% confidence intervals (CI) was used to measure the association of independent variables (gender, school year, maternal education, parental relations, EIU, sleep duration on weekdays and weekends, overall and vigorous PA) with unexcused and medical absences separately. For ordinal variables, CORs were calculated pairwise, with each category compared separately with the reference category. First, if COR >1, the distribution of absence is more concentrated to ‘higher’ values in the first category of the categorical independent compared with the reference category. Second, this concentration increases when a numeric independent has greater values. We ran the analyses separately for genders, but since CORs were mostly similar for both genders, overall CORs are presented and the few significant differences between genders are flagged. Model fit was estimated using Somers’ D. Results are reported as unstandardised estimates, and p<0.05 was considered significant. Analyses were conducted using Mplus version 8.7 and SAS 9.4.

Missing data

Data availability is reported for all variables separately. Since the proportion of missing data for different variables was low, complete cases were used in COR calculations.

The study was approved by the Working Group on Research Ethics of the Institute for Health and Welfare (THL/1578/6.02.01/2018 §807).

The 86 270 participants (response rate: 73.0% of respective age group) showed even gender and age distribution ( table 1 ). Mothers most commonly had university or other higher-level education, and parental relations were most often good.

Demographics and background variables of 86 270 study participants

The EIU scale average score was 1.9 (SD 0.7; table 2 ). Girls yielded a higher EIU score than boys (2.0 vs 1.8; p<0.001, Cohen’s d=0.4), and 1881 participants (2.3%) reported the maximum EIU score of 4.

Excessive internet use, sleep duration, frequency of physical activity and absences from school for adolescent boys and girls

Participants slept an average of 8.0 hours per night during the school week, and 9.2 hours per night during the weekend ( table 2 ). More than one-third (34.7%) slept less than 8 hours per night on weekdays, and 10.9% slept less than 8 hours per night on weekends.

Participants reported overall PA on average on 4 days during the preceding week and vigorous PA for 2–3 hours per week. Among boys, both no PA and daily PA were more frequent than among girls ( table 2 ).

In all, 3.2–4.0% of the study population reported high rates of school absences ( table 2 ). Boys reported more unexcused absences than girls did, while girls reported more medical absences than boys did (p<0.001 for both).

In cumulative odds ratio, EIU was associated with an increased risk for both unexcused and medical absences ( table 3 ). Older age was associated with an increased risk of unexcused absences. Maternal education level, parental relations (talking about concerns with parents), longer sleep duration during weekdays and PA showed a significant protective dose–response relationship with both unexcused and medical absences from school. Talking about concerns with parents often showed the strongest protective association. Overall, the model fit was moderate (0.35) for unexcused absences and low (0.22) for medical absences.

Results of cumulative odds ratio: risk and protective factors for unexcused and medical absences from school

In this nationally representative population-based study, adolescent girls reported more excessive internet use (EIU) than did boys, more than one-third of adolescents slept less than 8 hours per night during the school week and more than half of adolescents engaged in vigorous exercise for less than 3 hours weekly. EIU, short sleep duration during weekdays and low PA were all associated with both unexcused and medical absences from school among 14–16 year old students. Talking about concerns with parents often emerged as the strongest protective factor for both unexcused and medical absences.

Of the study participants, 2% yielded a maximum score for EIU. Previous studies have reported a prevalence of 6% for problematic mobile phone use. 24 The EIU specifically reflects the symptoms of addiction instead of measuring excessive time spent online. 25 Girls scored higher than did boys on the EIU scale. We suspect this may be due to social media, which girls use more than boys. 26 27 A recent meta-analysis supported the hypothesis that different patterns of internet addiction may be seen among men and women. 8

Shorter sleep duration especially during the school week showed direct associations with unexcused and medical school absences. Short sleep (less than 8 hours per night) during the school week showed a significant independent association with school absences, and this association was not compensated by longer sleep during weekends. This is in line with previous research, where weekend recovery sleep failed to protect against metabolic dysregulation. 28

Overall PA was associated with both unexcused and medical school absences: the more frequent light PA was, the fewer absences the adolescents reported. When PA was reported daily, however, the protective association of PA was smaller than for any other frequency of PA. It seems logical that a break is also needed from PA for optimal well-being. 29 In all, the findings between PA and school absences may reflect that adolescents who are supported to commit to a physically active lifestyle are also supported to attend school. 30 We also found a stronger relationship between overall than vigorous PA and fewer medical absences. Potentially a more active general lifestyle is healthier than a modern combination of a sedentary lifestyle and competitive sport hobbies. 31

In this study, a trusting relationship with parents was the strongest protective factor against school absences. Nearly half of the study participants reported that they often talk with their parents about their concerns. Trusting, open relationships between parents and their adolescent children also protect them against EIU. 32 Furthermore, adolescents also need their parents’ support to maintain a regular sleep schedule, because longer sleep during weekends is insufficient to protect against school absences.

The strengths of this study include a large, population-based cohort with a high participation rate, and distinguishing between unexcused and medical absences from school. Participation rates were even geographically and across schools in cities. The first limitation is the cross-sectional, self-reported nature of data, and thus, causal relationships cannot be determined. The most important group of non-participants were adolescents who were absent from school on the day of data collection. This could plausibly have included students with high rates of absences, which may cause bias especially in a study focusing on absences from school. When comparing our dataset with national statistics, the proportion of boys was slightly lower than among the entire population (49.3% vs 50.9%, respectively). Our proxy measure for socioeconomic status was maternal education. At population-level, education is only collected based on age and gender instead of parenthood. 33 The study participants reported a higher frequency of university level education among their mothers than recorded among women aged 35–54 at the population-level in Finland (45.1% vs 42.2%, respectively). Childlessness is, however, more common among persons with low or medium education, 34 and thus, potential bias associated with socioeconomic status remains unknown. The School Health Promotion study included no information on the type of internet use adolescents engaged in, and thus, no conclusions can be drawn related to gaming and social media. In this study, we only utilised data on the self-reported official gender, but population-based research on adolescents identifying as non-binary is urgently needed.

Despite its limitations, our results have important implications for promotion of health and education attainment. Our results are relevant for professionals organising and working in school health and well-being services, especially when professionals meet students whose school absences raise concern. Besides direct school-related factors, the lifestyle factors associated with absences should also be assessed, and support should be provided according to need.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

This study involves human participants and was approved by THL Working Group on Research Ethics, Finland (THL/1578/6.02.01/2018 §807) Participants gave informed consent to participate in the study before taking part.

• Gubbels J ,
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X @SiljaKosola

SK and MK contributed equally.

Contributors SK: conception, design, interpretation of results, first draft, revisions, guarantor. MK: conception, data curation, interpretation of results, revisions. KM: conception, interpretation of results, revisions. JE: data acquisition, statistical analyses, interpretation of results, revisions. KR: conception, design, interpretation of results, revisions. KA: conception, design, data acquisition and curation, interpretation of results, revisions. All authors approved the final version of the manuscript.

Funding Silja Kosola was supported by a grant from The Foundation for Pediatric Research. Marianne Kullberg was supported by a grant from The Swedish Cultural Foundation in Finland, grant number 180773. Klaus Ranta was funded by the Strategic Research Council established within the Academy of Finland to the Imagine Research Consortium, grant number 352700, and to Tampere University, grant number 353048. Katarina Alanko was funded by the C.G. Sundell Foundation. The funders had no role in the study design, data collection, analysis, interpretation of data, decision to publish, or in writing the manuscript.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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Health Lesson: Learning About Muscles

Information on this page is mapped to national science and health education standards and is for students in grades 4 through 6 who are learning about the human body. Teachers may also use these resources to inform their lesson plans.

On This Page

• For Students : Find all classroom materials and activities about muscles
• Kahoot! Quiz : Test your knowledge about muscles on your own or as a class!
• Vocabulary : See all of the medical terms in this lesson defined
• Teacher's Corner : See the National Education Standards covered in these lessons

For Students

What are your muscles for? When you think about muscles, you probably think about the ones in your arms, legs, back, or abs. But muscles do more than help you lift heavy things. Did you know that muscles also help you breathe, pump your blood, and move food through your gut?

On this page, you can learn about muscles, what happens when they get hurt, and how to keep them healthy.

What are muscles?

Muscles control all movement in the body. There are more than 650 muscles in the human body.

Muscles work together with bones to help you move. Muscles and bones (your skeleton) are part of the musculoskeletal (muh-skyuh-low-SKEH-luh-tl) system .

Muscle is a type of tissue , a group of cells that work together to accomplish a specific job, like movement.

You control some of your muscles, but others work on their own. Even when you sit perfectly still, muscles in your body are constantly working!

Muscles do a lot to keep your body healthy. They:

• Help you move, sit still, and stand up straight.
• Allow you to move your eyes to look around.
• Push food through your digestive system.
• Pump blood through your heart and blood vessels.

Watch this video to see heart muscles pumping blood.

• Move air in your body so that you can speak and breathe.

A special muscle in your chest called the diaphragm (DAI-uh-fram) helps the lungs fill with air when you breathe. Make a model to see how the diaphragm works.

How do muscles work?

Muscles help you move because they are connected to bones with a special kind of tissue called a tendon (TEN-dn) .

Muscles are made up of thousands of small elastic fibers, similar to rubber bands, that contract and relax to cause movement. When the fibers contract, they get shorter, which pulls the bones they’re connected to closer together. Learn more about bones .

What are the types of muscles?

There are three main types of muscle: skeletal, smooth, and cardiac.

Skeletal muscles

Skeletal (SKEH-luh-tuhl) muscles help you move, sit up straight, and keep your balance. Skeletal muscles are sometimes called voluntary muscles because you can control them.

You can move skeletal muscles just by thinking about it and then doing it. To make skeletal muscle move, the brain sends electrical messages to your skeletal muscles. The messages tell the muscles to do things like contract or relax when you want to raise your hand, move your jaw to chew food, or kick a soccer ball into a goal.

Skeletal muscles lie under the skin. They work with your bones and joints to give your body power and strength.

Did You Know?

Your face is filled with muscles! The muscles in your face allow you to make dozens of different types of expressions. Stick out your tongue! Did you know your tongue is a muscle? It helps you talk and chew your food.

Smooth muscles

Smooth muscles work to keep your body healthy without you having to think about moving them. Because you can’t control these muscles, they are sometimes called involuntary muscles. Smooth muscles help you focus your eyes, move food through your body, and go to the bathroom.

In your eyes, smooth muscles help you focus your vision and adjust to different levels of light.

Smooth muscles help you move food through and out of your body. Waves of smooth muscle contractions called peristalsis (peh-ruh-STAAL-suhs) help move food through your digestive system. Have you heard your stomach growling when you’re hungry or after you eat a meal? Those sounds are created by peristalsis!

Smooth muscles at the end of your digestive system help you push waste out of your body as feces (poop). Smooth muscles in your bladder contract and relax to hold in or push out urine (pee).

Cardiac muscles

Cardiac (KAAR-dee-ak) muscles make up the heart. Like smooth muscles, cardiac muscles are involuntary. They contract and relax automatically to pump blood through your body.

You do not need to think about telling the heart to beat. A special area of muscle in your heart sends electrical messages in a steady rhythm to help your heart beat.

Heart muscles help make sure that your blood flows in the right direction with structures called valves . Try this activity to learn how heart valves work!

What happens when muscles get hurt?

A strain happens when a muscle or tendon stretches too much or tears. Some people describe muscle strains by saying they “pulled a muscle.” If you exercise too much, too intensely, or don’t stretch enough, you may get a strain.

Strains that happen from tearing a muscle or tendon are more serious than strains from overstretching a muscle or tendon. Strains can cause pain, swelling, and bruising. Your body heals strains by creating new muscle fibers to fill in the damaged area.

Tendons—the tissues that connect muscles to bones—can also get hurt. Tendinitis (ten-duh-NAI-tuhs) is a condition in which repetitive or intense motions injure the tendon, causing pain and swelling.

If you think you have a muscle strain or tendon injury, you can try resting, putting ice on the painful area, and asking an adult for over-the-counter pain medication. Go to the doctor if your injury doesn’t get better. Doctors may treat some strains with a splint or temporary cast.

How can I help keep my muscles healthy?

Exercise to work your muscles..

Being physically active keeps your muscles healthy, which helps you work, play, and do other activities without getting hurt or tired.

You don’t need to lift weights to exercise your muscles! You can walk, jog, play sports, dance, swim, and bike. Exercising in different ways helps make sure you work all your muscles.

Remember, your heart is a muscle! Any activity that makes your heart pump blood faster will exercise this important muscle.

Bigger muscles are not necessarily better. Working out helps your muscles get stronger. Sometimes they also get bigger, but your muscles can be strong and healthy without being big.

Avoid muscle injuries.

• Warm up and cool down . Before exercising or playing sports, warm-up exercises, such as stretching and light jogging, may make it less likely that you’ll strain a muscle. They are called warm-up exercises because they make the muscles warmer and more flexible. Cool-down exercises, such as stretching, are also very important to do after exercising. They help you to loosen the muscles that have tightened during exercise or while playing sports.
• Wear the proper protective gear for your sport, such as pads or helmets. This will help reduce your risk of injuring yourself.
• Remember to drink lots of water while you’re playing or exercising, especially in warm weather. Dehydration (dee-hai-DRAY-shn) is when your body’s water level gets too low. If you become dehydrated, you could get dizzy or even pass out. Dehydration can cause many medical problems.
• Don’t try to “play through the pain.” If something starts to hurt, STOP exercising or playing. You might need to see a doctor, or you might just need to rest for a while.
• If you have been inactive, “start low and go slow” by gradually increasing how often and how long you are active. Increase physical activity gradually over time.
• Be careful when you lift heavy objects . Keep your back straight and bend your knees to lift the object. This will protect the muscles in your back and put most of the weight on the strong muscles in your legs. Get someone to help you lift something heavy.
• Don’t try to “bulk up” by using weights that are too heavy for you . This can cause injury. Start with smaller weights and build your way up. You do not need to be able to lift very heavy weights to have healthy muscles. Instead, try doing exercises with smaller weights, but repeat the exercise more times.

Eat a healthy diet.

There is no special diet to keep your muscles healthy. Try to eat a balanced diet with fruits and vegetables, whole grains, low-fat dairy, and lean proteins .

MYTH BUSTED!

Some people think that they need protein shakes and powders to get big muscles. But most kids get plenty of protein just by eating a balanced diet. In fact, eating too much protein can be harmful to your body.

Test your knowledge about muscles with this Kahoot! quiz

This Kahoot! quiz tests your knowledge about what muscles do and how to keep them healthy.

Check out our other webpages to learn about bones , joints , and skin .

Cardiac (KAAR-dee-ak) muscles . These muscles make up your heart. You cannot control these muscles.

Cells . The smallest building blocks of life. Your body is made of trillions of cells!

Contraction . Tightening or shortening of muscle fibers.

Dehydration (dee-hai-DRAY-shn) . When your body’s water level gets too low. If you become dehydrated, you could get dizzy or even pass out. Dehydration can cause many medical problems.

Diaphragm (DAI-uh-fram) . A muscle in your chest that helps the lungs fill with air when you breathe.

Musculoskeletal (muh-skyuh-low-SKEH-luh-tl) system . All the muscles, bones, and other tissues that work together to give your body its basic shape and ability to move.

Peristalsis (peh-ruh-STAAL-suhs) . Waves of smooth muscle contractions that help move food through your digestive system.

Skeletal (SKEH-luh-tuhl) muscles. These are the muscles you can control. They help you move, sit up straight, and keep your balance.

Smooth muscles . You cannot control these muscles. They help you focus your eyes, move food through your body, and go to the bathroom.

Strain . When a muscle or tendon stretches too much or tears. Some people describe a muscle strain by saying they “pulled a muscle.”

Tendinitis (ten-duh-NAI-tuhs) . A condition in which repetitive or intense motions injure the tendon, causing pain and swelling.

Tendon (TEN-dn) . A special kind of tissue that connects muscles to bones.

Tissue . A group of cells that work together to accomplish a specific job, like movement.

Valves . Special structures in your heart that make sure your blood flows in the right direction. 

Teacher’s Corner

The content on this NIAMS webpage aligns with the following national standards:

Next Generation Science Standards

• NGSS Standard 4-LS1-1 “Animals have internal and external structures that serve various functions in growth, survival, behavior, and reproduction.”
• NGSS MS-LS1-1 “All living things are made up of cells , which are the smallest units that can be said to be alive. An organism may consist of one single cell (unicellular) or many different numbers and types of cells (multicellular).”
• NGSS MS-LS1-3 “In multicellular organisms, the body is a system of multiple interacting subsystems. These subsystems are groups of cells that work together to form tissues and organs that are specialized for particular body functions.”

National Health Education Standards

• NHES 2.5.2 “Identify the influence of culture on health practices and behaviors.”
• NHES 1.5.5 “Describe when it is important to seek health care.”
• NHES 1.5.1 “Describe the relationship between healthy behaviors and personal health.”
• NHES 1.5.4 “Describe ways to prevent common childhood/adolescent injuries and health problems.”

CDC Healthy Schools

• CDC Characteristics of an Effective Health Education Curriculum, Characteristic 4: “Address social pressures and influences”

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The self-concept and its relationship with parental socialization and environment in primary school students.

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Sánchez-Urrea, A.; Izquierdo-Rus, T.; Baena-Morales, S.; Gómez-Mármol, A. The Self-Concept and Its Relationship with Parental Socialization and Environment in Primary School Students. Behav. Sci. 2024 , 14 , 518. https://doi.org/10.3390/bs14070518

Sánchez-Urrea A, Izquierdo-Rus T, Baena-Morales S, Gómez-Mármol A. The Self-Concept and Its Relationship with Parental Socialization and Environment in Primary School Students. Behavioral Sciences . 2024; 14(7):518. https://doi.org/10.3390/bs14070518

Sánchez-Urrea, Antonio, Tomás Izquierdo-Rus, Salvador Baena-Morales, and Alberto Gómez-Mármol. 2024. "The Self-Concept and Its Relationship with Parental Socialization and Environment in Primary School Students" Behavioral Sciences 14, no. 7: 518. https://doi.org/10.3390/bs14070518

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