Obesity is a complex disease and the mechanisms targeted thus far in childhood obesity prevention/intervention strategies include behavioral, biological processes, genetics, social, and environmental approaches (19
). Behavioral and environmental approaches are accepted as important frontline therapies for children, primarily due to ethical considerations. However, it is also becoming increasingly apparent that more novel approaches beyond encouraging children to eat less and be more physically active are needed (24
). In the present study we focused on a novel school-based environmental approach to the obesity epidemic in children.
We first compared physical activity levels, measured using validated technology (12
), between a traditional school environment and an activity permissive school environment, ‘The Neighborhood’. The Neighborhood was associated with a 50% increase in physical activity (). In general, the increase in physical activity was dispersed throughout the school day, for example children would walk or play games while they reviewed lessons with mobile learning technologies.
To determine if the increase in physical activity associated with The Neighborhood was because the students were given the opportunity to move or because of the building per se we replaced the chairs and desks in the children’s traditional classroom with the same standing desks and educational technology that were used in The Neighborhood. Physical activity levels of students attending class in the traditional school environment and the physical activity levels of students attending class in the Standing Classroom were remarkably similar to each other. It therefore appeared that The Neighborhood building was associated with the increase in physical activity rather than the educational technologies. Interestingly, the increased physical activity associated with The Neighborhood enabled the children to be as active as similarly aged-children would be during their summer vacation, where the activity-restricting effects of school are absent.
Presently, there is little information about modifying the school environment to increase physical activity in children (25
). There has been an association with physical activity levels and the number of activity-related equipment and structures (such as balls and soccer nets) (26
). For example if children have greater access to the soccer balls and goals with nets during recess, they are more likely to be active compared to when the equipment and structures are absent. This observation appears to be more robust when children are under adult supervision.
In a different approach, one group modified the school environment by using colorful, fluorescent playground markings to encourage play in school children (28
). Heart rate monitoring was used to compare time spent in moderate vigorous physical activity and vigorous physical activity of children (n = 99, 51 boys, 48 girls) attending school in either intervention or control schools. This interesting and low-cost approach to modifying the school environment was associated with increased time spent in moderate vigorous and vigorous physical activity in intervention schools compared with control schools. It has also been reported that larger school space is associated with higher levels of physical activity in middle school students (29
). Children attending school in the largest spaces who had their physical activity monitored by accelerometry were walking approximately 2 extra miles over the course of a school week.
Although our study demonstrates that changing the school environment can impact students’ physical activity levels, we recognize that there are limitations to our study. This study focused on a single classroom of students during part of the school year. Future studies with more classrooms and for a longer period of time may address the sustainability of such an intervention. We also only monitored physical activity during the school day. It would be interesting to monitor all daily physical activity in future studies to more thoroughly understand the impact of school environmental changes on children’s physical activity levels. With our study design, there was a potential for period effects. It would have been helpful if we had monitored physical activity in another classroom that had been transformed into the Standing Classroom before experiencing the activity permissive environment in The Neighborhood. We did not evaluate the impact of this intervention on academic performance. However we included the District Elementary Facilitator with our study team to help ensure that academics were not compromised during the research protocol. The Facilitator’s role is to oversee curriculum and Minnesota Academic Standards for elementary grades in the district. Finally, there may be various psychosocial factors (such as enthusiasm of teacher, social acceptance for exercise and movement) that impacted our observations of physical activity in the three environments. Future studies in this area will include psychosocial measurements to help us to better understand how these factors impact physical activity levels in children.
One way to address the recent increase in childhood obesity is to develop new approaches to increase daily physical activity levels during school. If our studies are confirmed in larger future studies, these data suggest that we may need to design activity-promoting buildings so that children can move more. Reversing low physical activity and obesity in children may require broad-based collaboration whereby physical infrastructure becomes coupled to health.