Conceptual physical education (CPE) programs were initially developed in the 1960s at the college level.1 Prompted by an ever-increasing body of knowledge that demonstrated the health benefits of exercise,2,3 these programs included classroom as well as activity sessions with the intent of providing students with key conceptual information related to lifelong physical activity. Over a 40-year period, the CPE innovation became a dominant higher education trend as research evidence accumulated concerning program effectiveness.1 By the turn of the century, virtually all colleges offered required or elective CPE classes under a variety of names.1,4
In the late 1970s and early 1980s, high school programs began to adopt the CPE approach, typically referred to as Fitness Education classes.5 Florida was the first state to require a CPE course (personal fitness) at the high school level in 1983.6,7 Since that time, many states have adopted or established state standards for CPE.4 The CPE approach at the high school level emerged at the same time as the health-related fitness movement8 and was further energized by the public health approach to physical education9–11 and the Surgeon General’s 1996 report on physical activity and health.12 In 2012, the National Association for Sport and Physical Education (NASPE; now SHAPE America) established a fitness education framework to provide standards for K–16 programs.13
Project Active Teen (PAT) was established in 1991 to study the effectiveness of a year-long CPE program in promoting physical activity behaviors at the high school level. Students at a large suburban high school (1500 enrollment at the time the study began) who completed a CPE class as freshmen (1991–1993) were followed as juniors and seniors14 and again several years after high school graduation.15 Results of the first study showed that some groups of juniors and seniors who took CPE as freshmen were more active and less likely to be inactive than controls who took their physical education at another school (see “Methods” section for more details).14 The second PAT follow-up, of students who took CPE in the 1991 to 1993 school years, was conducted 12 to 18 months after graduation and yielded similar results.15
The purpose of this study was to assess the physical activity patterns of the PAT participants 20 years after graduation from high school (24 years after completing a CPE course). As noted in the published report of the first PAT study, “of particular importance was reducing the proportion of teens who are inactive both because inactive lifestyles track to adulthood and because new evidence now indicates that reducing inactive behavior would be especially effective in reducing disease risk in the American population.”14 In the previous quote, the word inactive is substituted for the word sedentary—see later comments regarding current definitions of terms. In addition, recent longitudinal evidence suggests that activity rates decrease over time after the school years as teens progress into adulthood.16 Thus school-based programs that promote active lifestyles and discourage inactivity seem especially important.
Methods
Participants/Settings
Project Active Teen is a longitudinal study of ninth-grade students who completed a year-long CPE course in either 1991–1992 or 1992–1993. These same students (N = 776) were surveyed while 11th and 12th graders to determine their physical activity patterns (PAT1).14 The second follow-up study (N = 250) was completed to assess activity patterns of participants 12 to 18 months after high school graduation (PAT2).15 This study was a third follow-up of the same students 24 years after taking CPE and 20 years after high school graduation (PAT3). Participants in this research study were recruited through the class reunion event. A total of 95 former PAT participants completed a physical activity questionnaire. Of those completing the questionnaire, 91 had completed CPE and 4 were controls in the original PAT study. Twenty-nine participants were male and 62 participants were female. The ethnicity background of 75 participants was reported as White/non-Hispanic, and 13 participants reported a Hispanic heritage. Prior to data collection, the study was reviewed and approved by the Institutional Review Board at Arizona State University. Participants were informed that personal responses were confidential (not identifiable by name) and return of the completed questionnaire constituted informed consent.
Because of the low response rate from the control group (those who took traditional PE), only the data from those who took CPE were analyzed in this study. For PAT1, there were 776 CPE and 298 control responses. For PAT2, there were 250 (151 CPE and 44 control) responses (32% response rate compared with PAT1). The response rate for this 20-year follow-up (PAT3) was 38% (95/250) of the response rate for the previous postgraduation survey (PAT2) and 9% of the response rate for PAT1. The PAT3 response rate for CPE participants was 60% (91/151) and 9% (4/44) for the traditional physical education (TPE) controls compared with PAT2 and 12% and 1%, respectively, compared with PAT1.
Survey
The survey was the same as the survey used for PAT1 and PAT2. From the beginning, the survey was kept short to limit the time taken from the classroom. Specifically, questions from the Youth Risk Behavior Surveillance System survey17 were used to assess physical activity patterns in all follow-up studies, including this study. The questionnaire has been used by the centers for disease control and prevention (CDC) to track health behaviors, including physical activity patterns, in national surveys. Reliability and validity data for the entire questionnaire is provided in a surveillance system methodology report.18 As noted in the PAT1 report, the questionnaire was developed by the CDC and was used to assess teen activity levels in the 1996 Surgeon General’s report.12 As noted in the PAT1 publication,14 “Consultations with CDC officials deemed acceptable the segmentation of questions from the instrument, in this case physical activity questions.” The questionnaire was included among “a collection of recommended physical activity questionnaires for health-related research,” at the time of PAT1. The specific survey questions used in this study were identical to those used in PAT1 and PAT2: (1) On how many of the past 7 days did you do moderate physical activity for at least 30 minutes such as walking or riding a bike? (2) On how many of the past 7 days did you exercise or participate in activities for at least 20 minutes that made you sweat and breathe hard such as vigorous aerobic activity or sports? and (3) On how many of the past 7 days did you exercise to strengthen or tone your muscles such as curl-ups, push-ups, or weight training? Responses were reported using a number from 0 to 7 (days of the week). More information about the questionnaire is available in the PAT1 and PAT2 publications.14,15
Participants were considered to be active if they performed: moderate activity (ie, walking or bicycling 5 d, 30 min/d), vigorous activity (3 d, 20 min/d), and muscle fitness activities (3 d/wk). Consistent with terminology prevalent at the time, in the PAT1 and PAT2 studies sedentary behavior was defined as 0 days of moderate and vigorous activity.14 In the years since the initial PAT studies, the terms sedentary (behaviors of low energy expenditure) and inactive (failure to meet physical activity guidelines) have been more precisely defined.19 In this paper, participants failing to meet either the moderate or the vigorous minimums are referred to as inactive, rather than sedentary as in the previous studies.
In addition to the activity questions, 4 additional questions about the CPE class were included in the PAT3 survey. Questions were included to determine if PAT3 participants (1) remembered content from the class, (2) found the course useful after graduation, (3) still use the information, and (4) consider themselves well informed about fitness and physical activity.
Data Collection and Analysis
The online format using surveymonkey.com was used because the participants were living in different places after graduation. The participants’ e-mail addresses and Facebook contacts were collected from the individuals who were in charge of the 20th graduation class reunion. It is worth noting that a similar study was attempted after the 10-year class reunions, but it was abandoned because of lack of response. The current popularity of social media, Facebook in particular, dramatically aided the response rate for this study. Although a larger sample size would be desirable, the methods used in this study resulted in a much higher response rate than a previous attempt and allowed a long-term follow-up not often found in program assessment research.
Data collected from the online survey were exported into an Excel file. Then the data were used for further analyses. As with previous PAT studies, data were analyzed using the chi-square statistic. In the previous studies, data from PAT1 and PAT2 were analyzed using 2 cohort groups—those taking CPE in 1991–1992 and those taking CPE in 1992–1993. For the PAT3 analysis, data from the 2 cohort groups were combined to maximize N for statistical comparisons.
Because of the lack of response from participants taking TPE (controls), this study focused on comparisons from survey to survey (PAT1, PAT2, and PAT3) for each of the 3 activity types (moderate, vigorous, and strength) as well as inactive behavior. Specifically, the proportion of PAT participants who met specific standards (see methods section) were compared from survey to survey for both males and females.
Consistent with previous PAT studies, comparisons were also made between PAT3 participant activity patterns and the activity patterns of participants in a national survey. Specifically, the proportion of PAT3 participants meeting standards for the various types of activity were compared with the proportion from 35- to 44-year-old adults20 who meet the same standards. The national sample was surveyed at the same time as the PAT3 data collection.
Results
Survey-to-Survey Comparisons of Activity Patterns
Table 1 provides a summary of the proportion of CPE participants meeting each of the 3 physical activity standards (see “Methods” section) for each of the 3 PAT surveys. The proportion of the participants who were classified as inactive for each PAT survey is also included in Table 1. Results indicated that a greater proportion of PAT3 participants (both male and female) met the moderate activity standard than PAT1 and PAT2 participants; however, only the differences for PAT3 to PAT2 were statistically significant.
Survey-to-Survey Differences in CPE Physical Activity Patterns
| Activity type | Survey | Male, % | P | Female, % | P |
|---|---|---|---|---|---|
| Moderate | PAT3 | 38 | .51 | 37 | .13 |
| PAT1 | 32 | 28 | |||
| Moderate | PAT3 | 38 | .02 | 37 | .01 |
| PAT2 | 18 | 21 | |||
| Vigorous | PAT3 | 69 | .44 | 61 | .98 |
| PAT1 | 75 | 62 | |||
| Vigorous | PAT3 | 69 | .23 | 61 | .07 |
| PAT2 | 58 | 48 | |||
| Strength | PAT3 | 45 | .01 | 32 | .00 |
| PAT1 | 69 | 59 | |||
| Strength | PAT3 | 45 | .40 | 32 | .37 |
| PAT2 | 54 | 39 | |||
| Inactive | PAT3 | 0 | .14 | 5 | .00 |
| PAT1 | 13 | 21 | |||
| Inactive | PAT3 | 0 | .34 | 5 | .25 |
| PAT2 | 9 | 10 |
Abbreviations: CPE, conceptual physical education; PAT, Project Active Teen; PAT1, 2–3 years post CPE; PAT2, 12 to 18 months after high school graduation; PAT3, 24 years after CPE and 20 years after high school graduation.
No significant differences existed between PAT1 and PAT3 or PAT2 and PAT3 for vigorous physical activity for either males or females. For strength exercise, results indicated that a significantly greater proportion of the PAT1 participants (both male and female) met the standard than PAT3 participants. No significant differences existed between PAT2 and PAT3 participants (both male and female).
For PAT3, none of the males and only 5% of the females were classified as inactive. These low rates of inactive behavior were not significantly different from PAT2 participants for either males or females. PAT3 rates for females were statistically lower than the rates for PAT2, but not lower than the rates for PAT1 males. As illustrated in Table 1, all PAT groups had very low rates of inactivity.
Comparisons of the PAT3 participants to national data were not possible for moderate or vigorous activity because current activity data combine moderate and vigorous physical activity into 1 category.20 To allow comparison, the percentage of PAT3 participants who met either the moderate or the vigorous standard was determined. As illustrated in Table 2, both male and female PAT3 participants were significantly more likely to meet the combined moderate/vigorous standard than those in the national sample. For both males and females, the differences in meeting the standard between groups were quite large (see Table 2). PAT3 participants were not significantly more likely to meet the strength exercise standard than those in the national sample.
CPE 20-Year Post Graduate (PAT3) Comparisons to National Activity Data
| Activity type | Survey | Male, % | P | Female, % | P |
|---|---|---|---|---|---|
| Moderate + | PAT3 | 86 | .00 | 68 | .01 |
| Vigorous Activity | National (CDC) | 52 | 50 | ||
| Strength | PAT3 | 45 | .11 | 32 | .21 |
| Exercise | National (CDC) | 34 | 24 | ||
| Inactive | PAT3 | 0 | .00 | 5 | .00 |
| Behavior | National (CDC) | 25 | 27 |
Abbreviations: CPE, conceptual physical education; PAT, Project Active Teen; PAT1, 2–3 years post CPE; PAT2, 12 to 18 months after high school graduation; PAT3, 24 years after CPE and 20 years after high school graduation.
Both males and females in the PAT3 survey were significantly less likely to be classified as inactive then those in the national sample. For both males and females, the differences in meeting the standard between groups were also quite large (see Table 2).
Additional Survey Results
As noted in the “Methods” section, PAT3 participants were asked several questions about their CPE experience. About 56% of respondents indicated that they remembered content from the class, 50% indicated that they still use the information, 47% indicated that they found the class useful after graduation, and 92% indicated that they currently consider themselves to be well informed about fitness and physical activity.
Cumulative Results
One limitation of research with multiple dependent variables is the risk of alpha inflation. In PAT1, for example, 28 comparisons were made between CPE and TPE groups. Of the total 28 comparisons, about 1.5 would be significant by chance. In fact, there were 4 statistically significant differences, and all favored the CPE groups. Further, of the 28 comparisons, 79% favored the CPE group. For PAT2, a total of 16 comparisons were made between CPE and TPE groups and 4 comparisons between CPE and national survey groups for a total of 20 comparisons. One significant difference would be expected by chance, but there were 4 significant differences between CPE and TPE groups, with all favoring the CPE groups. Of the group differences, 85% favored the CPE groups. For PAT3, 6 comparisons were made between CPE and national survey groups. All (100%) favored the CPE groups, and 4 of the 6 were statistically significant. In total 50 comparisons were made over the 3 PAT studies. A total of 12 statistical differences were found, all favoring the CPE groups, and 82% of group differences favored the CPE groups.
The more statistical comparisons are made, the greater the number of significant results will occur, risking a type I error. However, there is also risk of a type II error if the consistency of the direction of data is not considered in a longitudinal study such as this. The data, presented above, make a convincing case that, in spite of the many statistical tests made over time, the CPE effects found are real.
Discussion
Today the importance of health and fitness-enhancing physical activity is well documented.21,22 SHAPE America (formerly NASPE) has published a framework of benchmarks for CPE (fitness education) programs13 and standards for achieving physical literacy through physical education.23 Central to meeting the standards and becoming physically literate is participation in lifelong physical activity. The federal government has also emphasized the importance of physical activity for all Americans22 with the publication of physical activity guidelines for all ages. It is interesting to note that the guidelines for youth have not been well disseminated, resulting in lack of parental attention to children’s health behaviors24; thus, the importance of an educational program to promote lifelong active lifestyles is magnified.
When CPE was first introduced at the high school level, there were no published physical education standards, nor was there a national fitness education framework. The first physical activity guidelines for teens were not published until the early 1990s.25 The health-related fitness movement had just begun8 and the first Healthy People Objectives for 1990 were just published.26 However, as PAT was beginning, the Surgeon General’s report on physical activity and health12 was published, establishing an evidence base for physical activity promotion.
Project Active Teens is a longitudinal study of students who completed a year-long CPE class in high school. The specific intent of CPE was to promote lifelong healthy behaviors, including regular physical activity. To accomplish this goal, CPE emphasized the teaching of fitness, physical activity, and healthy lifestyle concepts as well as self-management skills such as self-assessment, goal setting, program planning, and self-monitoring. Central to the program was (and is) acquiring problem-solving and decision-making skills that lead to healthy lifestyle adoption.27 The goals of CPE seem especially relevant given research indicating decreases in required high school physical education, active commuting, and outdoor play as well as increases in electronic entertainment and computer use among youth during the first decade of the 21st century.28
Findings from PAT1 in 199814 demonstrated that the students who took a CPE course were more active in some activity categories and less likely to be inactive, compared with the controls who took TPE. CPE groups met Healthy People 2000 goals for moderate physical activity and inactive behavior more frequently than controls, but not more frequently for vigorous physical activity and strength exercise. Data from PAT2 showed similar results.15 Of the significant differences in activity patterns and inactive behaviors between CPE and controls, all favored the CPE group. In addition, CPE groups were less likely to be inactive than national samples (both males and females).
As noted earlier, the lack of responses from TPE participants made it impossible to make CPE to TPE comparisons in PAT3. However, other comparisons were possible. Survey-to-survey response comparisons made it possible to see if activity patterns of previous CPE participants, shown to be higher than TPE and national survey responses, persisted over time. PAT3 participants did, in fact, maintain or exceeded moderate activity levels, maintained vigorous activity levels, and exhibited similar or less inactive behavior compared with earlier surveys. Strength exercise levels were lower among PAT3 compared with PAT1 participants but similar for PAT3 and PAT2.
It is important to note that there is very little longitudinal research investigating the long-term effectiveness of education programs—especially physical education programs. In spite of the limitations, the data presented in the PAT studies, including this 24-year follow-up, revealed consistent findings favoring CPE, suggesting that CPE does make a difference in promoting health-enhancing physical activity, a paramount goal of physical education, an important national health goal, and a central component of physical literacy.23,29,30 CPE seems most effective in promoting moderate activity and lower rates of inactive behavior.
Given the importance of health-enhancing physical activity in our society, some discussion of the possible reasons for the success of the CPE program seems warranted. As noted in the Instructional Framework for Fitness Education (CPE) in Physical Education, “fitness education is a subcomponent of the total physical education program, focusing on helping students acquire knowledge and higher-order understanding of health-related physical fitness (the product), as well as habits of physical activity and other healthy lifestyles (the process) that lead to good health-related physical fitness, health and wellness.”13 Fitness education (CPE) is not intended as a substitute for comprehensive quality physical education programs. Rather, it is intended to be one important part of the total quality program designed specifically to promote lifelong physical activity for all youth, not just those who are good at sports and games. The CPE program was designed to help students self-assess personal needs, set personal goals, plan their own personal programs, and self-monitor personal progress, all self-management skills for use later in life. Also of importance was the training that helped teachers prepare for the program and program fidelity resulting from administrative support and teacher commitment to the program.
Limitations
This longitudinal study was not without its limitations. As noted in the PAT1 and PAT2 publications, a survey was used to assess physical activity behaviors. Objective measurement devices, such as pedometers and accelerometers, were not widely available at the time the study was initiated. The survey chosen for the PAT studies was easy and quick to administer in the school setting and was recommended as a tool for adolescent research.17 A more detailed justification is provided in the previous publications.14,15
As with most longitudinal studies, a limitation is participation rates. As noted in the “Methods” section, the response rates for PAT1 to PAT2 (32%) and for PAT2 to PAT3 (38%) were acceptable compared with other similar studies. The PAT1 to PAT3 response rate was 12%, low but not unexpected for a survey conducted 20 years post-high school. The response rate for TPE participants makes CPE to TPE comparisons impossible. However, the relatively high (60%) rate of response for CPE participants (PAT2 to PAT3) was encouraging and allowed PAT1, PAT2, and PAT3 comparisons as well as PAT3 to national standard comparisons. The lower response rate for males compared with females may have been due to the fact that the organizers of the 20-year class reunion were mostly female, and for this reason more female contacts were available for soliciting survey responses. In addition, research indicates that females are more likely to use social media to sustain relationships than males.31 Staying in touch with former classmates, in this case via a class reunion, was a way of sustaining past relationships and may partially have accounted for the fact that more females responded than males. As with previous PAT studies, male and female responses were analyzed separately. The lower response rate among males renders conclusions for males more limiting than for females.
Finally, it is possible that the participants who chose to respond to the survey were those who are active and for this reason were happy to respond, and that those who are currently less active may have chosen not to respond.
Implications
The results of PAT suggest that CPE programs can be effective in reaching stated goals. It is also worth mentioning, however, that TPE participants in PAT1 and PAT2, while less active in some categories than CPE students, were more active than teens in national samples for many types of activity. TPE students were also less likely to be inactive than national samples. These TPE findings support the conclusion of previous research indicating that teens who have physical education during school “had greater enjoyment of PE, were more physically active and performed better on several muscular fitness-related tests.”32 Currently high school physical education programs are often not well supported and, unfortunately, many students today do not have any physical education at all, CPE or TPE. The results of the PAT longitudinal studies suggest that CPE can be a vital part of a total quality physical education program that promotes lifelong physical activity and complements quality TPE programs.
Acknowledgments
The authors want to thank the 20-year reunion committees (Christine Vanderpool, Sarah Mauel, Danielle Platt, and Shaun Shultz) at the PAT high school for their assistance with class lists and the physical education teachers at the PAT high school for their assistance with each of the PAT studies. The names of the teachers and the school are not disclosed. Those thanked above were former students who helped solicit participation. No affiliations or personal information is disclosed. C.B.C. is the author of a high school textbook for use in CPE classes. He helped design the study, helped locate reunion committee members, provided the survey questionnaire used in previous studies, and assisted with writing the manuscript. To avoid conflict of interest, he did not participate in data collection or entry of the data. No outside funding was used to support this research.
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