Is Participation in Physical Education Classes Related to Physical Activity and Sedentary Behavior? A Systematic Review

in Journal of Physical Activity and Health

Click name to view affiliation

Diego Júnio da SilvaStudy and Research Group in the Epidemiology of Physical Activity-GEPEAF, João Pessoa, Paraíba, Brazil

Search for other papers by Diego Júnio da Silva in
Current site
Google Scholar
PubMed
Close
*
,
Arthur Oliveira BarbosaStudy and Research Group in the Epidemiology of Physical Activity-GEPEAF, João Pessoa, Paraíba, Brazil
UPE/UFPB, João Pessoa, Paraíba, Brazil

Search for other papers by Arthur Oliveira Barbosa in
Current site
Google Scholar
PubMed
Close
,
Valter Cordeiro Barbosa FilhoDepartment of Education, Federal Institute of Education, Science and Technology of Ceara, Aracati, Ceará, Brazil

Search for other papers by Valter Cordeiro Barbosa Filho in
Current site
Google Scholar
PubMed
Close
, and
José Cazuza de Farias JúniorStudy and Research Group in the Epidemiology of Physical Activity-GEPEAF, João Pessoa, Paraíba, Brazil
UPE/UFPB, João Pessoa, Paraíba, Brazil
Department of Physical Education, Federal University of Paraiba-UFPB, Campus I, João Pessoa, Paraíba, Brazil

Search for other papers by José Cazuza de Farias Júnior in
Current site
Google Scholar
PubMed
Close
Full access

Background: The aim of this systematic review was to summarize the results and assess the methodological quality of studies that analyzed the relation between physical education participation, physical activity, and sedentary behavior in schoolchildren. Methods: Searches were conducted for original cross-sectional and longitudinal observational studies published in Portuguese, English, and Spanish between January 2007 and August 2020, on the PubMed, Web of Science, Scientific Electronic Library Online, Education Resources Information Center, and Scopus databases. Results: A total of 60 articles (68 independent samples) were included in the revision (58 cross-sectional and 2 longitudinal observational studies). With regard to methodological quality, 27%, 52%, and 21% of the studies were classified as high, moderate, and low methodological quality, respectively. Physical activity was analyzed in 93% of the studies (n = 56) and sedentary behavior in 33% (n = 20). The higher frequency of physical education participation was associated with higher physical activity levels (56 of 68 results – 54/65 cross-sectional and 2/3 longitudinal studies) and less sedentary behavior (14 of 24 results), even after stratifying analyses by type and methodological quality. Conclusion: Physical education class participation may contribute to students being physically more active and less likely to engage in sedentary behavior.

School is considered a strategic space for developing education and health promotion,15 since it is a socially recognized institution, with a role in promoting formal learning, where students spend around one-third of their time.6 It also has the infrastructure and materials to support these activities and allow collaboration between education and health professionals and family members, and in most cases, is involved in the community in which the students live.7 In this perspective, United Nations Educational, Scientific, and Cultural Organization5 suggests that schools be a space for the promotion, protection, and cultivation of health, contributing to the well-being and development of socio-emotional skills, cognitive skills, and healthy habits in schoolchildren.

In this respect, as a curricular component of basic education, physical education (PE) is also committed to participating in the planning, implementation, and assessment of educational activities and health promotion in schools. Moreover, it may contribute to empower students to adopt more physically active and healthier lifestyles8,9 using experiences and contents10 that broaden their knowledge, beliefs, values, and positive attitudes compatible with healthy practices, including physical activity and less time spent on sedentary behavior. These behaviors are amenable to modification, focus of intervention to promote physical activity and health at school, are among the themes and contents related to health that are most closely related to the training of PE teachers and their mastery over them. Thus, they are more likely to be addressed in PE classes.15

However, PE classes have been conducted under adverse conditions, such as poor infrastructure, materials, equipment, low student participation, little class time for moderate to vigorous activities, replacement of classes by other unrelated activities, low professional qualification, little social recognition of the discipline and nonimplementation of a minimum curriculum.11,12 Taken together, these factors may hinder or even preclude educational measures that promote active and healthy lifestyles in these classes,8,9 underscoring physical activity and sedentary behavior, which are among the main PE topics in schools.

Interventions conducted in the context of PE classes to increase physical activity13 and reduce sedentary behavior13 have proven to be effective. They allow testing of different strategies (change in pedagogical practices, materials, or curriculum of PE classes) on an outcome of interest. Although these interventions are important, they have a low capacity to adequately represent daily school life as they are developed mainly with the change/availability of resources (material/financial/pedagogical). This differs from the reality observed particularly in low- and middle-income countries, where the proportion of schools with adequate resources for PE activities is low.5 In practice, what has proved to be effective in increasing physical activity and reducing sedentary behavior can be applied to the daily routine of schools at scale.

Thus, observational studies analyzed the association between PE class participation, physical activity, and sedentary behavior, but have found divergent results.1421 This may be partly explained by the wide diversity of instruments (questionnaires, accelerometers, and pedometers) and ways of operationalizing physical activity measures (total time, minutes/day, and meeting recommendations)14,16 and sedentary behavior; use of instruments without and/or with insufficient validity levels19; different age groups and/or student grade levels; types of studies (longitudinal and cross sectional) and sampling (power and sample selection)15; variations in conditions and class characteristics.22,23 This heterogeneity hinders assessment of the possible influences of PE class participation on the physical activity and sedentary behavior of students. This reinforces the need to summarize the evidence of observational studies that tested whether PE class participation is associated with students’ engaging in physical activity and sedentary behavior.

Systematic reviews on the consequences of participating in PE classes are scarce,8,24,25 even more so when compared with those that discuss the consequences of physical activity and sedentary behavior for the health of children and adolescents. The systematic review identified (searches conducted on the PubMed, Web of Science, Scientific Electronic Library Online, and Education Resources Information Center and Scopus databases) analyzed studies published between 1983 and 2010, on the relation between PE class participation and health indicators and healthy behavior.7 Participation in PE classes was associated with higher physical activity levels. However, it did not include studies published in Portuguese and Spanish or sedentary behavior, searches were limited to 2010 and some databases, and the methodological quality of the studies was not assessed. This disregards the increased number of articles on this issue in the last 10 years (eg, a 49% rise between 2011 and 2020, on PubMed), including studies on sedentary behavior, longitudinal investigations, and students of several countries.23,2527 In this respect, the aim of this review was to summarize the results and assess the methodological quality of studies that analyzed the relation between PE class participation, physical activity, and sedentary behavior in school aged.

Methods

This is a systematic review based on the recommendations suggested by PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) (see Supplement A [available online])28 and registered at PROSPERO (International Prospective Register of Systematic Reviews; CRD42020143162).

Eligibility Criteria

Included were original articles in English, Spanish, and Portuguese, of observational studies (cross sectional and longitudinal) published between January 2007 and August 2020 (chose to adopt an arbitrary search criterion that considered articles published in different languages in at least the last 10 years), observational studies were chosen to evaluate the daily routine of schools at a scale on the relation between PE class participation (any arbitrary variable that represents participation, time in class, enrollment or attendance in PE classes) and some measure of: (1) physical activity (eg, total activity time, or by domains, and number of steps) and/or (2) sedentary behavior (eg, time watching television, screen time, and total time), measured by different instruments (eg, questionnaires, diaries, accelerometers, pedometers), as long as they were dependent variables. The study was included if PE class participation was considered the independent variable.

Excluded were articles with no association/correlation/comparison between PE class participation and the behaviors analyzed, which used cardiorespiratory fitness as an indicator of physical activity, those with samples of special groups (eg, diabetic, hypertensive, and asthmatic patients) and those where the associations analyzed in the present study had been assessed in fewer than 3 studies.

Study Selection

The databases, descriptors, terms, and Boolean operators used in the searches are presented in (see Supplement B [available online]). For the selection of descriptors and search terms the Medical Subject Headings and Health Sciences Descriptors platforms were consulted, in addition to using similar terms and relevant synonyms on the topic.

The articles found were analyzed by Clarivate Endnotes (version 7.0) software and duplicates excluded. The article selection procedures were conducted by an assessor (DJS), and in the event of uncertainty, 2 authors (AOB and JCFJ) were consulted. The references of the articles were analyzed in order to identify studies not found in the electronic search. The article selection stages are described in Figure 1.

Figure 1
Figure 1

—PRISMA flowchart of article identification and selection procedures. aEight articles stratified their analyzes by sex and were counted as independent samples. PRISMA indicates Reporting Items for Systematic Reviews and Meta-Analyses.

Citation: Journal of Physical Activity and Health 19, 11; 10.1123/jpah.2022-0084

Assessment of the Methodological Quality

Assessment of the methodological quality of the studies was carried out independently by 2 assessors (DJS and AOB) and in cases of disagreement, a third assessor (JCFJ) was consulted. An instrument was not identified to assess all the items that the authors considered relevant to adequately assess the articles that included the review.

Thus, based on other checklists, a checklist developed by the authors was used to assess the methodological quality of the studies.2931 It is composed of 13 items, divided into 3 domains: sampling (5 items), variable measurement (4 items), and statistical analysis (4 items) (see Supplement B [available online]). The checklist items were assessed as follows: yes = 1, no = 0, and not informed = NI, except for items 6 and 13 (yes = 2, partially = 1, no = 0, and not informed = NI). Based on the sum of the scores attributed to each checklist item, a score between 0 and 15 points was assigned. According to the score obtained, the studies were classified as high (between 70% and 100% of the maximum score), moderate (between 51% and 69%), and low quality (between 0% and 50%).32

Extraction and Data Synthesis

The following data were retrieved: author, year of publication, country of study, study design, sample size, age group, sex, type of study, main variables, participation in PE classes, instrument used to measure physical activity and/or sedentary behavior, statistical analysis used to determine the association between the variables studied and the main results of the associations. Studies that stratified results by sex and/or age group were counted as independent samples. To extract the main findings, the results of the analysis adjusted for possible confounders were considered,33,34 and crude analyses when the adjusted results were not presented. The data extraction procedures were conducted by DJS and reviewed by AOB.

As expected, there was high heterogeneity between studies (on methodological and statistical aspects), as well as the different ways of the evaluation of participation in PE and outcomes. The following methodological aspects were observed: (1) characteristics of the participants (sex and age), (2) measurement instruments, (3) operationalization of the variables, and (4) statistical analyses. Thus, we decided to adopt a synthesis approach, summarizing the results according to similar elements of the review question, when possible.

The consistency of the results was estimated according to the sex; year of publication; country; study design (longitudinal and cross sectional); measuring instrument (questionnaires, accelerometers, pedometers, and others); sample size; methodological quality of the studies (low, moderate, and high); and operationalization of the measure (PA: global, school, leisure, commuting, PA in days with vs without PE classes and SB: total, school, screen time, SB in days with vs without PE classes). These variables were chosen because previous reviews have highlighted that the consistency of evidence may change according to study’s characteristics.33,34

In summarizing the main results of the associations the following procedure was followed: significant association being positive (“+”) or negative/inverse (“–”), or no association (“0”). To evaluate the consistency of the associations, a criterion was adopted that considered the number of associations in a given direction, divided by the total number of results analyzed, multiplied by 100. For example, 10 inverse “−” associations (n = 10) in 15 analyzed studies (n = 15): (10/15) × 100 = 66% of the total associations were inverse “−.” The consistency of associations was classified and coded as 00 (when 0%–33% of the studies demonstrated an association), ?? (when 34%–59% of the studies with an association in one direction), and “++” or “--” (when 60%–100% of the studies with an association in one direction; Table 1).34

Table 1

Characteristics of the Studies That Analyzed the Association Between PE Classes’ Participation in PA and Sedentary Behavior, 2007–2020

Variablesn (%)
Year of publication
   ≥201341 (68)
   <201319 (32)
Country
   United States11 (18)
   Brazil14 (23)
   Canada4 (7)
   Multicenter4 (7)
   Other countries27 (45)
Study design
   Cross sectional58 (97)
   Longitudinal2 (3)
Instruments
   Questionnaires29 (48)
   Accelerometer19 (32)
   Pedometer7 (12)
   Othersa5 (8)
Sample
   ≥1000 people27 (45)
   <1000 people33 (55)
Outcome
  PA56 (93)
  Sedentary behavior20 (33)
Operationalization of the measure of PA
   Global40 (72)
   School4 (8)
   Leisure3 (6)
   Commuting1 (2)
   PA in days with versus without PE classes11 (16)
Operationalization of the measure of SB
   Total6 (30)
   School3 (15)
   Screen time7 (35)
   SB in days with versus without PE classes5 (25)
Methodological quality
   High (70%–100%)16 (27)
   Moderate (51%–69%)31 (52)
   Low (0%–50%)13 (22)

Abbreviations: PA, physical activity; PE, physical education; SB, sedentary behavior. Note: n = 60 studies.

aRecording, direct observation, energy expenditure monitor, and diaries.

Results

Of the 11,897 articles identified, after exclusion of duplicates (n = 3275, 39.2% of the total) and 8558 articles (74.4%) in the reading phase, 60 studies6,1321,2327,3582 met the inclusion criteria and were included in the systematic review. Eight of these23,36,44,48,56,58,61,63,68 stratified their analyses by sex and were summarized as independent results, obtaining 68 samples (Figure 1). Of the studies included, 58 were cross sectional6,1318,20,21,23,24,27,3567,6982 and 2 longitudinal observational25,27 (Table 2).

Table 2

Results of Observational Studies That Analyzed the Association of Participation in PE Classes With PA and Sedentary Behavior (Studies Reviewed n = 60, n = 68 Samples)

StudyParticipation in PE classesOperationalization of the measureSummary of resultsSummary of results
PASB
Aguilar-Farias et al68Variation from 2.2% in Peru to 37.8% of students in El-Salvador reported participating in 2 or more classes per week.Total time in SB and PA by intensityNo significant associations were observed between participation in PE classes and MVPA (B = 0.1; 95%CI: −0.04, 0.17) and SB (B = −0.1, 95%CI: −0.40 to 0.19).00
Alderman et al36NSNumber of steps per dayUsing ANOVA, it was possible to observe statistical differences between the PA level of students on days with and without the presence of PE classes, with the level of PA being higher on days with PE classes (F1,277 = 5.42, P < .05, ES = 0.76.)+NS
Aljuhani and Sandercock69NSTime of MVPA: in days without PE; and on days with PE; days with PE excluding MVPA time from class scheduleTimes spent in MVPA were 12.9, 14.7, and 14.8 min higher on PE days than on days without PE for all, inactive, and unfit schoolchildren, respectively. Results showed that 40% and 24% of the schoolchildren met the recommended levels of PA on PE days and days without PE, respectively.+NS
Al-Thani et al7066.5% of students reported participating in 2 or more classes per week.Participation in physical activities, sport and exercise, and screen timeParticipation in PE classes was positively correlated with PA (r = .206, P < .001) and not associated with SB (r = .018, P = .18).+0
Amornsriwatanakul et al2891.9% of students reported participating in 2 or more classes per week.Number of days with ≥60 min (active = 60 in 7 d; inactive <7 d)PE was not a significant predictor in sufficient achieving levels of PA (data not shown).0NS
Bergmann et al1484.7% of students reported participating in one or more classes per week.Total PAAdolescents who reported participating in PE classes were more likely to be active (OR = 2.02; 95%CI: 1.05 to 3.89).+NS
Bezerra et al3723.1% in 2006 and 17.4 of students in 2011 reported participating in 2 or more classes per week.PA in leisure time (practice vs nonpractice)Participating in at least one PE class per week increased the chances of teenagers being active (OR = 1.16; 95%CI: 1.09 to 1.24).+NS
Bezerra et al3733.8% in 2006 and 26.3% of students in 2011 reported participating in 2 or more classes per week.PA in leisure time (practice vs nonpractice)Participating in at least one PE class per week increased the chances of teenagers being active (OR = 1.55; 95%CI: 1.40 to 1.71).+NS
Calahorro-Canada et al38NSSB and MVPA time on weekdays with and without PE classesStudents with lower cardiorespiratory capacity accumulated more MVPA (50 min/d, vs 42.7 min/d P ≤ .05) and total PA (155.9 min/d vs 138 min/d, P ≤ .05) on PE class days than days without classes.++
Ceschini et al3949.5% of students reported participating in one or more classes per week.Achievement of the PA guideline 300 min/wkSchoolchildren who reported not participating in PE classes were more likely to be inactive when compared with those who reported participating (OR = 1.39; 95%CI: 1.29 to 1.53; P < .001).+NS
Cheah et al7149.1% of students reported participating in 2 or more classes per week.Achievement of the PA guideline 300 min/wkParticipating in at least one PE class per week increased the chances of adolescents being active (IRR: 1.54; 95%CI: 1.48 to 1.60; P < .001).+NS
Cheah et al40NSNumber of PA days lasting at least 60 minThe authors observed that a day of PE classes increases the time spent on physical activities by 0.200 (unconditional) and 0.151 (conditional) d. The probability of participating in PA also increases by 2.2% when the time spent in face-to-face teaching increases by 1 d.+NS
Chen et al15NSTotal time in MVPA and SB time in days with and without PE classesMVPA and sedentary time in class showed significant positive correlations with daily MVPA and sedentary time, respectively (r = .35, P < .01; r = .55, P < .01).++
Chen et al41NSTime in PA outside the school periodAdolescents who reported attending PE classes less than twice a week were more likely to be in the highest tertile of time in PA (OR = 2.40; 95%CI: 1.41 to 4.10; P < .001).+NS
Cheung72NSTime of MVPA and SB in days with PE, in days with PA after school (sport), and in days without PE or PA after schoolThe results indicated that the groups differed significantly in daily MVPA (F2,108 = 16.62, P < .00) and MVPA during school hours (F2,108 = 36.22, P < .00), and there was no significant difference in children’s sedentary behavior with school-based PA participation.+0
Costa et al4242.7% of students reported participating in one or more classes per week.Time of PA and SB during the school periodChildren who participated in PE classes spent 11.8 min (95%CI: 15.7 to 7.9; P < .01) less in sedentary activities during the school period compared with those who participated.NS
Dargavel et al43NSTotal time in MVPAWe found no significant relationship between total number of PE classes taken during secondary school and PA participation as an emerging adult.+NS
Dauenhauer and Keating23NSNumber of steps per day on days with and without PE classes and excluding steps taken during PE classesThe independent t test indicated that students who had PE classes for 60 min had a higher level of PA than on days with 30-min classes.+NS
Duan et al1676.6% of students reported participating in 3 or more classes per week.Total PAEach 10-unit increase in toward PE was associated with an increased odds of 1.15 (95% CI: 1.09 to 1.20) for spending more than 1 h/d on MVPA.+NS
Duncan et al44NSTotal PAPositive association between time spent in PE classes and higher levels of PA (β = 0.129; P < .01).+NS
El-ammari et al4585.2% of students reported participating in 2 or more classes per week.Achievement of the PA guideline and overexposure to screenAdolescents who reported attending PE classes less than twice a week were more likely to be physically inactive (OR = 2.53; 95%CI: 1.15 to 5.57).+0
El-ammari et al4585.2% of students reported participating in 2 or more classes per week.Achievement of the PA guideline and overexposure to screenThere was no association between low participation in PE classes and physical inactivity (OR = 1.18; 95%CI: 0.51 to 2.760).00
Farias Júnior et al2233.1% of students reported participating in one or more classes per week.Achievement of the PA guidelineAdolescents who participated in 2 or more PE classes were more likely to be physically active, being higher among adolescents who reported participating in 2 or more PE classes (PR = 1.17; 95%CI: 1.02 to 1.34 vs PR = 1.24; 95% CI: 1.12 to 1.37).+NS
Groffik et al73NSPA level classification at schoolParticipants who engaged in PE met the determined PA recommendations significantly more than did their counterparts in all 4 recommendations (P < .001). Participation in PE was a main predictor in fulfillment of all types of PA recommendations: At least 500 steps/h, at least 25% PA, at least 20 min of MVPA (≥3 METs/school time), and at least 20 min of MVPA (≥60% HRmax/school time) – OR = 5.03; 95%CI: 3.67 to 6.90; P < .001.+NS
Herazo-Beltran et al74NSPA level classificationThe PE classes also help students reach the recommended levels of PA: They received 72% of the active ones compared with 34.1% of inactive ones, while 45.5% of the students during the classes of PE in the study were very active were categorized as inactive (P < .05).+NS
Herman et al4622.1% of students reported participating in 3 or more classes per week.Total time in SBAdolescents who reported attending PE classes less than twice a week were more likely to be in the highest tertile of time in sedentary behavior (OR = 2.40; 95%CI: 1.41 to 4.10; P < .001).NS
Hobin et al1734.9% of students reported participating in one or more classes per week.Achievement of the PA guidelinePositive association of participation in PE classes with MVPA (OR = 1.17; 95%CI: 1.02 to 1.34).+NS
Hobin et al4774.7% of students reported participating in 2 or more classes per week.Total time in PAAdolescents who reported attending 2 or more PE classes per week were more likely to have higher levels of PA (OR = 1.86; 95%CI: 1.43 to 2.40).+NS
Kantanista et al48NSPA level classificationOn days with PE classes, adolescents accumulated more steps than on other days (Δ = 0.95, P < .001).+NS
Kantanista et al48NSNumber of days physically activePositive association of participation in PE classes with MVPA (OR = 1.17; 95%CI: 1.02 to 1.34).+NS
Kerr et al75NAMPA and VPA time in days with and without PE classes and total time in SBSedentary time was higher on non-PE days than on PE days (mean difference: 62 min, P < .001), and hard and very hard intensity PA was significantly higher on PE days compared with non-PE days (mean total difference: 33 min, all significant at P < .001).+
Kirkham-King et al18NSTotal time in MVPAAdolescents who reported attending PE more likely to be highest time in PA (OR = 1.80; 95%CI: 1.15 to 2.81; P < .001).+NS
Kobel et al49NSTotal time in MVPA in days with and without PE classesOn days with PE, children spent 144 (68) min in MVPA, whereas on days without PE, this time decreased significantly to 122 (63) min (P ≤ .01).+NS
Lima and Silva5066.4% of students reported participating in one or more classes per week.Fulfillment of PA recommendationNo significant differences were observed between participation in PE classes and meeting the PA recommendation (P = .087).0NS
Loprinzi et al5146.9% of students reported participating in 5 or more classes per week.Number of days physically activeAdolescents who had PE during school days had a higher enjoyment of participating in PE (B = 0.32; P < .01), engaged in more days of being physically active for 60 min/d (B = 1.02; P < .001).+NS
Määta et al76NSTime in SB during school termInverse association of participation in PE classes with sedentary time (P = .035).NS
Martins et al1971.3% of students reported participating in one or more classes per week.Screen timeAmong students who participate in PE classes, the highest proportion watches more than 3 h of television (43.6% vs 56.4%, P = .04).NS+
Marttinen et al52NSNumber of stepsAdolescents were more physically active on days with PE classes than on weekends (Δ mean = 2150 steps; P < .01).+NS
Mayorga-Vega et al6NSTotal PA and SB timeUsing ANOVA for repeated measures, it was possible to observe that on days with PE classes, the proportion of time spent in MVPA among adolescents was greater than on days without PE classes (8.05 [3.25] vs 6.10 [2.47], P < .001).+
Meyer et al20NSMVPA time in days with and without PE classesChildren accumulated more time in MVPA on days with PE classes than on days without classes (16.1 [29.0] min P < .001).+NS
Mooses et al53NSTime of MVPA and SB in days with and without PE classesEach additional minute of MVPA in PE was associated with 1.4 more minutes of MVPA daily. On days with PE, students had 12.8 (95%CI: 10.5 to 15.0) more minutes of MVPA and 9.7 (95% CI: 16.3 to 3.1) less minutes of SB compared with days without PE classes.+
Morgan et al54NSNumber of steps in days with and without PE classesOn days with PE classes, adolescents accumulated more steps than on other days (Δ = 0.95, P < .001).+NS
Naiman et al5576.2% of students reported participating in 2 or more classes per week.Total time of MVPAThe number of PE classes provided in the week prior to collection was associated with a higher probability of students being highly active compared with minimally active (OR = 1.14; 95%CI: 1.05 to 1.24)+NS
Nakamura et al5622% of students reported participating in 2 or more classes per week.PA level classificationBoys who did not participate in PE classes (OR = 0.27; 95%CI: 0.13 to 0.57) had a lower prevalence of total PA than students who attended PE classes.+NS
Nakamura et al5620% of students reported participating in 2 or more classes per week.PA level classificationGirls who did not participate in PE classes (OR = 0.27; 95%CI: 0.13 to 1.57) had not a lower prevalence of total PA than students who attended PE classes.0NS
Pate et al5755% in the eighth grade, 57.7% in the ninth grade, and 9.4% of students in the 12th grade reported participating in 2 or more classes per week.Total MPA and VPA timeMean time spent in physical activities of vigorous intensity significantly higher in adolescents who attended PE classes (OR = 1.17; 95%CI: 1.02 to 1.34).+NS
Peltzer and Pengpid5824.9% of students reported participating in 2 or more classes per week.Fulfillment of PA recommendation (≥5 d with ≥60 min) and leisure time sitting (excluding school period or doing homework)Through logistic regression, it was possible to observe that participation in PE classes were protective factors for physical inactivity (OR = 0.28; 95%CI: 0.17 to 0.45).+0
Peltzer and Pengpid5829.4% of students reported participating in 2 or more classes per week.Fulfillment of PA recommendation (≥5 d with ≥60 min) and leisure time sitting (excluding school period or doing homework)Through logistic regression, it was possible to observe that participation in PE classes were protective factors for physical inactivity (OR = 0.54; 95%CI: 0.38 to 0.79).+0
Rezende et al5981.7% of students reported participating in one or more classes per week.Fulfillment of the PA recommendation; active displacementAmong the adolescents who reached the minimum recommended time for PA domains contributed the following proportions to total PA (PR = 1.36; 95%CI: 1.29 to 1.44).+NS
Reznik et al60NSNumber of steps per day on days with and without PEMultivariate analysis using hierarchical models revealed PE class participation as an independent predictor of schoolchildren’s PA (estimate = 442.6; P < .001).+NS
Sharma et al7749.8% of students reported participating in 5 or more classes per week.Fulfillment of PA recommendationAdolescents who had PE classes 5 times/wk (PR = 0.94; 95%CI: 0.88 to 0.99) were less likely to report insufficient PA.+NS
Sigmund et al61NSSB time at different times of the dayParticipation in classes increased the duration of total MVPA compared with that during the day without PE classes for overweight/obese girls (P < .05; d = 0.67), normal weight girls (P < .05; d = 0.55).+
Sigmund et al61NSSB time at different times of the dayParticipation in classes increased the duration of total MVPA compared with that during the day without PE classes for boys with normal weight (P < .005; d = 0.65).+
Silva et al2624.8% of students reported participating in 3 or more classes per week.MVPA and LPA time during the day, during school hours and out of schoolChildren from countries with low development rates who reported attending PE classes per week were more likely to meet the PA recommendation (OR = 1.80; 95%CI: 1.7 to 2.77).+
Silva et al2624.8% of students reported participating in 3 or more classes per week.MVPA and LPA time during the day, during school hours and out of schoolChildren from countries with low development rates who reported attending PE classes per week were more likely to meet the PA recommendation (OR = 2.17; 95%CI: 1.44 to 3.2).+
Silva et al789.8% of students reported participating in 3 or more classes per week.Achievement of the PA guideline and screen timeAdolescents who reported having PE classes were more likely to meet MVPA recommendations (1–2 PE class/wk – OR = 1.3; 95%CI: 1.1 to 1.5; >2 PE class/wk – OR = 2.0; 95%CI: 1.7 to 2.5), spent more time in PA outside of school hours (1–2 PE class/wk – OR = 1.6; 95%CI: 1.4 to 1.9; >2 PE class/wk – OR = 2.0; 95%CI: 1.5 to 2.6), and accumulated more PA (1–2 PE class/wk–OR = 1.9; 95%CI: 1.6 to 2.2; >2 PE class/wk – OR = 6.0; 95%CI: 4.0 to 8.9) than students who reported not taking PE classes.+
Silva et al6261.4% of students reported participating in one or more classes per week.Total time in PA and SBThe prevalence of SB was higher among students who participated only in one PE class, when compared with those who had a higher frequency of participation PR = 0.73; 95%CI: 0.56 to 0.95, and no significant association was observed with PA.0
Silva et al6376.2% of students reported participating in one or more classes per week.Achievement of the PA guidelineIn adolescents, not participating in PE classes proved to be a risk factor for a low level of PA (PR = 1.05; 95%CI: 1.02 to 1.07).+NS
Silva et al6381.4% of students reported participating in one or more classes per week.Total time in PAThere was no statistical significance for the prevalence ratio between nonparticipation in PE classes and propensity to low level of PA.0NS
Tassitano et al6445.1% of students reported participating in one or more classes per week.Achievement of the PA guideline and screen timeA significant association between participation in 2 or more PE classes and PA (OR = 1.27; 95%CI: 1.06 to 1.53).+
Tenório et al6545.1% of students reported participating in one or more classes per week.Achievement of the PA guideline and screen timeSignificant association between participation in 2 or more PE classes and PA (OR = 1.27; 95%CI: 1.06 to 1.53)+
To et al79NSAchievement of the PA guidelineStudents were more active at school on PE days versus non-PE days and weekdays versus weekends (P < .001).+NS
Vale et al66NSPA level classificationPositive association of participation in PE classes with the number of active days in at least 60 min.+NS
Vancampfort et al80Participation in 5 or more classes ranges from 1.7% in Peru to 34% in the Philippines.Achievement of the PA guidelineThose who participated in PE for ≥5 d/wk (OR = 1.12; 95%CI: 1.10 to 1.15) were more likely to meet PA guidelines.+NS
Viciana et al81NSAchievement of the PA guideline and screen timeResults showed that there was a significant increase in the proportion of adolescents achieving the daily recommendation of MVPA on PE days (23.6%) than on non-PE days (14.6%) (P < .05), and no significant differences were observed between sedentary time in days with (798.0 min) and without PE (805.0), P = .279.+0
Woods et al6710% of students received 120 min of PE per week.Number of steps in days with and without PE classes and screen timePositive association of participation in PE classes with the number of active days in at least 60 min.+NS
Telford et al21NSMVPA time in the day and MVPA time during the school period on days with and without PE classesGreater perception of involvement in PE classes it was associated with a higher level of PA (SE = P < .001).+NS
Telford et al21NSAchievement of the PA guidelineGreater perception of involvement in PE classes not was associated with a higher level of PA (SE = P < .001).0NS
Yli-Piipari et al27NSLPA and MVPA time in days with and without PE classesThe latent growth analysis showed a positive and significant relationship between the growth trajectories of participation in PE class tasks and participation in physical activities (r = .49 P < .05).+NS

Abbreviations: ANOVA, analysis of variance; B, beta; IRR, incidence risk ratio; CI, confidence interval; HRmax, maximum heart rate; LPA, low PA; MET, Metabolic Equivalent; MVPA, moderate to vigorous PA; NS, not shown, not evaluated or not analyzed; OR, odds ratio; PA, physical activity; PE, physical education; PR, prevalence ratio; r, correlation coefficient; SB, sedentary behavior; VPA, vigorous PA. Note: −, inverse association; "0," null association; +, positive association.

Most of the studies (68%) were published since 20136,13,14,1618,2327,36,37,3945,4853,55,56,5861,63,6883 with students in the United States (18%),16,21,24,25,35,40,43,51,52,54,57,60,68 Brazil (23%),13,17,20,36,38,41,50,56,59,6265,79 and Canada (7%)15,23,42,45,47,55 (Table 1). Sample size varied from 6768 to 109,10459 students, and student ages from 366 to 2017 years (Table 2). In the longitudinal studies, the follow-up period varied from 126 to 227 years.

Regarding methodological quality, 27%, 52%, and 22% of the studies were classified as high, moderate, and low methodological quality, respectively, with the items “assessor blinding” and “sample power” exhibiting the lowest positive assessment percentage. In longitudinal studies, most were considered moderate quality and the items “sample selection” and “statistical procedures” showed the lowest positive assessment percentage (see Supplement C [available online]).

Physical activity was investigated in 93% (n = 55)6,1321,2327,3568 of the studies and sedentary behavior in 33% (n = 20).6,17,23,24,41,44,45,53,58,61,62,64,65,69,71,73,76,77,79,82 The most widely used instruments to measure these behaviors were questionnaires (48%)1315,17,20,2527,36,38,39,42,44,4648,50,51,55,56,58,59,6265,67 and accelerometers (32%)6,18,23,37,41,53,61,66,83,84 (Table 1). Participation in PE classes was measured in different ways: the number of classes per week (78%), provision of classes by school management (5%), duration of classes (12%), and enrollment and attendance in classes per semester (5%) (Table 3).

Table 3

Characteristics of Observational Studies That Analyzed the Association of Participation in PE Classes With PA and Sedentary Behavior (Studies Reviewed n = 60, n = 68 Samples)

StudyCountry of studySample sizeSexAge groupStudy designVariablesMeasuring instrumentsMQ
Aguilar-Farias et al68Chile148B and G9–11 y oldCross-sectionalDemographic and socioeconomic, psychological, environmental, PA level, time in SB and participation in PE classes (time in classes per week)PA and SB: Accelerometer ActiGraph GT3X+High
Alderman et al36United States279B and G11.8 (0.66) y oldCross-sectionalPA level and participation in PE classes (number of classes per week)PA: Pedometer Walk4Life LS252Moderate
Aljuhani and Sandercock69Saudi Arabia111B12–14 y oldCross-sectionalDemographic and socioeconomic, nutritional status, PA level, and participation in PE classes (one class of 45 min/wk)PA: Accelerometer ActiGraph wGT3X-BTModerate
Al-Thani et al70Qatar5.862B and G12–17 y oldCross-sectionalDemographic and socioeconomic, SB, PA level, and frequency in PE classes (number of classes per week)PA, SB, and PE: GSHS QuestionnaireModerate
Amornsriwatanakul et al28Thailand13.255B and G6–17 y oldCross-sectionalPA level and frequency in PE classes (provide PE classes)PA and PE: Thailand Physical Activity Children SurveyStudent QuestionnaireModerate
Bergmann et al14Brazil1.455B and G10–17 y oldCross-sectionalPA level and participation in PE classes (provide PE classes)PA: Physical Activity Questionnaire for Older Children and AdolescentsHigh
Bezerra et al37Brazil1.690 (2006) and 2.525 (2011)B14–19 y oldCross-sectionalPA level and frequency in PE classes (number of classes per week)PA and PE: Questionnaire Global School-Based Student Health SurveyModerate
Bezerra et al37Brazil2.517 (2006) and 3.739 (2011)G14–19 y oldCross-sectionalPA level and frequency in PE classes (number of classes per week)PA and PE: GSHSModerate
Calahorro-Canada et al38Spain150B and G8–19 y oldCross-sectionalPA level, time in SB, and participation in PE classes (classes of 60 min/wk)PA and SB: Accelerometer ActiGraph GT3xLow
Ceschini et al39Brazil3.845B and G14–19 y oldCross-sectionalPA level and frequency in PE classes (number of classes per week)PA: International Physical Activity QuestionnaireModerate
Cheah et al71Malaysia25.399B and G11–18 y oldCross-sectionalDemographic and socioeconomic, nutritional status, PA level, and frequency in PE classes (number of classes per week)PA and PE: GSHSModerate
Cheah et al40Malaysia2.991B and G16 and 17 y oldCross-sectionalPA level and frequency in PE classes (number of classes per week)PA and PE: Based on GSHS and Youth Risk Behavior Surveillance System QuestionnaireLow
Chen et al15United States67B and G11.75 (0.5) y oldCross-sectionalPA level, time in SB, and frequency in PE classes (number of classes per week)PA and SB: SenseWear MF-SWLow
Chen et al41United States293B and G9.4 (0.9) y oldCross-sectionalPA level and frequency in PE classes (number of classes per week)PA: 3-DayPhysical Activity Recall

PE: Situational Interest Scale
Moderate
Cheung72China242B and G8.7 (1.6) y oldCross-sectionalDemographic and socioeconomic, PA level, time in SB, and participation in PE classes (number of classes per week)PA: Accelerometer ActiGraph GT3X+

PE: Questionnaire
Moderate
Costa et al42Brazil571B and G7–12 y oldCross-sectionalDemographic and socioeconomic, SB, and frequency in PE classes (provide PE classes)SB: Accelerometer ActiGraph  GT3X+

PE: Consult the school administration
Moderate
Dargavel et al43Canada112B and G20.2 (1.78) y oldCross-sectionalPA level and frequency in PE classes (number of classes per week)PA: International Physical Activity QuestionnaireLow
Dauenhauer and Keating23United States71B and G8–11 y oldCross-sectionalPA level and participation in PE classesPA: Pedometer Omron HJ-112Low
Duan et al16China1.793B and G12–15 y oldCross-sectionalPA level and participation in PE classes (time in classes per week)PA and SB: Questionnaire adapted from China Health and Nutrition Survey PE: Students Attitudes toward Physical Education ScaleLow
Duncan et al44United States353G10–14 y oldCross-sectionalPA level and participation in PE classesPA: Accelerometer ActiGraph GT3x+ for adolescents under 12 y old and Youth Risk Behavior Surveillance System Questionnaire for adolescents over 12 y old

PE: Youth Risk Behavior Surveillance System Questionnaire
Moderate
El-ammari et al45Morocco358B14–19 y oldCross-sectionalPA level, SB, and frequency in PE classes (number of class per week)PA and SB: GSHSHigh
El-ammari et al45Morocco406G14–19 y oldCross-sectionalPA level, SB, and frequency in PE classes (number of class per week)PA and SB: GSHSHigh
Farias Júnior et al22Brazil2.874B and G14–19 y oldCross-sectionalPA level and frequency in PE classes (number of classes per week)PA: Questionnaire standardized self-fillingModerate
Groffik et al73Multicenter (Poland and Czech Republic)921B and G16.2 (0.7) y oldCross-sectionalDemographic and socioeconomic, PA level, and frequency in PE classes (number of classes per week)PA: Accelerometer ActiTrainer and PedometerModerate
Herazo-Beltran et al74Colombia3.598B and G10–14 y oldCross-sectionalDemographic and socioeconomic, PA level, and frequency in PE classes (number of classes per week)PA and PE: PAQ-CLow
Herman et al46Canada534B and G8–10 y oldCross-sectionalSB and frequency in PE classes (number of classes per week)SB: Accelerometer ActiGraph and QuestionnaireLow
Hobin et al17Canada22.117B and G9–12 y oldCross-sectionalPA level and frequency in PE classes (number of classes per week)PA: Questionnaire SHAPES Physical Activity Module

PE: Reminder
Moderate
Hobin et al47Canada2.379B and GNSCross-sectionalPA level and frequency in PE classes (number of classes per week)PA: Questionnaire SHAPES Physical Activity Module

PE: Reminder
Moderate
Kantanista et al48Poland3.249B14–16 y oldCross-sectionalPA level and participation in PE classesPA: Physical Activity Screening Measure Questionnaire

PE: Teacher support scale
Low
Kantanista et al48Poland3.249G14–16 y oldCross-sectionalPA level and participation in PE classesPA: Physical Activity Screening Measure

PE: Teacher support scale
Low
Kerr et al75England53B and G11.7 (0.3) y oldCross-sectionalDemographic and socioeconomic, SB, PA level, and participation in PE classesPA and SB: Accelerometer RT3XLow
Kirkham-King et al18United States281B and GNSCross-sectionalPA level and participation in PE classesPA: Accelerometer ActiGraph GT1MModerate
Kobel et al49Germain294B and G7.1 (0.7) y oldCross-sectionalPA level and participation in PE classesPA: Energy expenditure monitor and body movement ActiheartModerate
Lima and Silva50Brazil1.103B and G14–19 y oldCross-sectionalPA level and participation in PE classes (time of classes per week)PA: Brazilian version of Questionnaire Youth Risk Behavior Surveillance System

PE: Adolescent behavior of Santa Catarina Questionnaire
High
Loprinzi et al51United States459B and G12–15 y oldCross-sectionalPA level and participation in PE classesPA and PE: QuestionnaireHigh
Määta et al76Finland717B and G3–6 y oldCross-sectionalDemographic and socioeconomic, school environment, SB, and participation in PE classes (time of classes per week)SB: Accelerometer ActiGraph WGT3XHigh
Martins et al19Brazil964B and G14–20 y oldCross-sectionalDemographic and socioeconomic, SB, and participation in PE classesSB: QuestionnaireModerate
Marttinen et al52United States221B and G11.9 (0.9) y oldCross-sectionalPA level and participation in PE classesPA: Accelerometer MovBandModerate
Mayorga-Vega et al6Spain158B and G13–16 y oldCross-sectionalPA level, SB, and participation in PE classesPA and SB: Accelerometer ActiGraph GT3XModerate
Meyer et al20Switzerland676B and G9.3 (2.1) y oldCross-sectionalPA level and participation in PE classesPA: Accelerometer ActiGraph GT1MHigh
Mooses et al53Estonia504B and G7–12 y oldCross-sectionalPA level, SB, and participation in PE classesPA and SB: Accelerometer ActiGraph GT3XHigh
Morgan et al54United States485B and G9.5 (1.6) y oldCross-sectionalPA level and participation in PE classesPA: Pedometer Walk4Life LS2500Low
Naiman et al55Canada2.449B and GNSCross-sectionalPA level and participation in PE classesPA and PE: SHAPES-PAM QuestionnaireModerate
Nakamura et al56Brazil213B14–17 y oldCross-sectionalPA level and participation in PE classesPE and PA: Physical Activity Questionnaire—ChildrenHigh
Nakamura et al56Brazil254G14–17 y oldCross-sectionalPA level and participation in PE classesPE and PA: Physical Activity Questionnaire—ChildrenHigh
Pate et al57United States5.444G13–18 y oldCross-sectionalPA level and participation in PE classesPA: 3-Day Physical Activity RecallLow
Peltzer and Pengpid58Multicenter (Cambodia, Malaysia, Filipinas, and Vietnam)14.750B13–15 y oldCross-sectionalPA level, SB, and participation in PE classesPA, SB, and PE: GSHSModerate
Peltzer and Pengpid58Multicenter (Cambodia, Malaysia, Filipinas, and Vietnam)15.430G13–15 y oldCross-sectionalPA level, SB, and participation in PE classesPA, SB, and PE: GSHSModerate
Rezende et al59Brazil109.104B and G13–16 y oldCross-sectionalPA level and frequency in PE classes (number of classes per week)PA and PE: Questionnaire based on Global School-Based Student Health Survey and Youth Risk Behavior Surveillance SystemHigh
Reznik et al60United States916B and G6.0 (0.7) y oldCross-sectionalPA level and participation in PE classesPA: Pedometer Yamax Digi-Walker SW 200Moderate
Sharma et al77Peru1.354B and G11–19 y oldCross-sectionalDemographic and socioeconomic, PA level, and frequency in PE classes (number of classes per week)PA and PE: GSHSModerate
Sigmund et al61Czech Republic170G9–11 y oldCross-sectionalPA level, SB, and participation in PE classesPA and SB: Accelerometer ActiTrainerModerate
Sigmund et al61Czech Republic168B9–11 y oldCross-sectionalPA level, SB, and participation in PE classesPA and SB: Accelerometer ActiTrainerModerate
Silva et al26Multicenter (Australia, South Africa, Brazil, Canada, China, Colômbia, United States, Filand, India, Kenya, Portugal, and United Kingdom)2.678B9–11 y oldCross-sectionalPA level, SB, and frequency in PE classes (number of classes per week)PA and SB: Accelerometer ActiGraph GT3X+

PE: Youth Risk Behavior Surveillance System Questionnaire
High
Silva et al26Multicenter (Australia, South Africa, Brazil, Canada, China, Colombia, United States, Filand, Índia, Quênia, Portugal, and the United Kingdom3.196G9–11 y oldCross-sectionalPA level, SB, and frequency in PE classes (number of classes per week)PA and SB: Accelerometer ActiGraph GT3X+

PE: Youth Risk Behavior Surveillance System Questionnaire
High
Silva et al78Brazil12.220B and G11–19 y oldCross-sectionalDemographic and socioeconomic, nutritional status, SB, PA level, and frequency in PE classes (number of classes per week)PA, SB, and PE: GSHSHigh
Silva et al62Brazil5.028B and G15–19 y oldCross-sectionalPA level, SB, and participation in PE classes PA level and frequency in PE classes (number of classes per week)PA, SB, and PE: Adolescents behavior of Santa Catarina QuestionnaireModerate
Silva et al63Brazil1.372G13–18 y oldCross-sectionalPA level and frequency in PE classes (number of classes per week)PA and PE: The Physical Activity Questionnaire for Children And AdolescentHigh
Silva et al63Brazil833B13–18 y oldCross-sectionalPA level and frequency in PE classes (number of classes per week)PA and PE: The Physical Activity Questionnaire for Children And AdolescentHigh
Tassitano et al64Brazil4.210B and G14–19 y oldCross-sectionalPA level, SB, food consumption, and frequency in PE classes (number of classes per week)PA, SB, food consumption and

PE: GSHS
High
Tenório et al65Brazil4.210B and G14–19 y oldCross-sectionalPA level and frequency in PE classes (number of classes per week)PA and PE: GSHSHigh
To et al79Vietnam619B and G9.7–12.6 y oldCross-sectionalDemographic and socioeconomic, PA level, and participation in PE classesPA: Pedometer SW200Moderate
Vale et al66Portugal193B and G3–5 y oldCross-sectionalPA level and participation in PE classesPA: Accelerometer ActiGraph GT1MModerate
Vancampfort et al80Multicentera142.118B and G13.8 (1.0) y oldCross-sectionalDemographic and socioeconomic, PA level, and frequency in PE classes (number of class per week)PA and PE: GSHSModerate
Viciana et al81Chile123B and G13.5 (0.7) y oldCross-sectionalDemographic and socioeconomic, SB, PA level, and frequency in PE classes (number of class per week)PA and SB: Accelerometer ActiGraph GT3X+Moderate
Woods et al,67Iran4.122B and G13–16 yCross-sectionalPA level and frequency in PE classes (number of class per week)PA: Questionnaire prepared for the study PE: Question about class days per week and scale FIPE (Factors Influencing Enjoyment of Physical Education Enjoyment scale)Moderate
Telford et al21Australia175B8 y old in baseline and 12 y in follow-upLongitudinalPA level and perception of involvement in PE classesPA: Pedometer Walk4Life

PE: Questionnaire about competence perceived in class
High
Telford et al21Australia186G8 y old in baseline and 12 y in follow-upLongitudinalPA level and participation in PE classesPA: Pedometer Walk4Life

PE: Questionnaire about competence perceived in class
High
Yli-Piipari et al27Greece812B and G12 and 13 yLongitudinalPA level and participation in PE classesPA and PE: QuestionnaireModerate

Abbreviations: B, boys; G, girls; GSHS, Global School-Based Student Health Survey; MQ, methodological quality; PA, physical activity; PE physical education; SB, sedentary behavior.

aAfghanistan, Benin, Cambodia, Mozambique, Nepal, Tanzania, Bangladesh, Belize, Bolivia, East Timor, Egypt, El Salvador, Ghana, Guatemala, Guyana, Honduras, Indonesia, Kiribati, Laos, Maldives, Mauritania, Mongolia, Morocco, Pakistan, Philippines, Samoa, Solomon Islands, Sudan, Syria, Tonga, Vanuatu, Vietnam, Yemen, Algeria, Antigua, and Barbuda, Argentina, Costa Rica, Dominica, Mauritania, Fiji, Iraq, Namibia, Peru, Suriname, Thailand, and Tuvalu.

The most frequently analyzed physical activities were overall physical activity (72%) and the comparison between physical activity indicators on days with and without PE classes (17%). In 2 studies, physical activity was compared in and out of school, disregarding the time spent during PE classes. Sedentary behavior was operationalized as follows: screen time (35%), total time (30%), and comparison between sedentary behavior indicators on days with and without PE classes (25%) (Table 2).

In most of the study results (82%),6,1316,18,20,21,23,24,3543,4549,5155,5761,6467 PE class participation was associated with greater physical activity (Table 1). This result persisted even after analyses were stratified by study type (53/66 cross sectional and 2/3 longitudinal), methodological quality (12/15 high methodological quality and 32/36 moderate methodological quality), and measuring instrument (28/32 questionnaires and 10/10 accelerometers) (Table 1).

Table 1 shows the results of the consistency of the association between PE class participation and PE for the different study characteristics. Associations were consistent in all the stratifications, indicating that PE class participation is associated with physical activity (> 60%, “++”).

In 52% of the studies, there was an inverse relation6,23,41,45,53,64,65,79 between PE class participation and sedentary behavior. This association was observed in studies with high methodological quality (70%, “++”) and those that used accelerometers to measure sedentary behavior (85%, “++”) (Table 4). No longitudinal studies were found that investigated the relation between PE class participation and sedentary behavior. Stratification of analyses according to how sedentary behavior is operationalized classified the consistency of the association as null for the association between PE class participation and screen time (22%, “00”) and operationalization of sedentary behavior on days with versus without PE classes (25%, “00”) (Table 4).

Table 4

Summary of the Results of Studies on the Relationship Between Participation in PE Classes, Physical Activity, and Sedentary Behavior (n = 68 samples)

Physical activity
Significant associationNo significant associationSummary code
VariablesReferenceAssociation (+/−)Reference%Result
Year of publication
 ≥20131416,18,20,27,40,41,43,48,49,5153,55,59,60,70,71,7375,7781,94,95, B26,37,45,58,61, G26,37,44,58,61,63+28,68,96, G21,45,56, B6343/52 (83%)++
   <201369
17,22,23,36,39,47,54,6467, G57+6213/14 (93%)++
Country
 United States18,23,36,51,52,54,60, B26, G26,44,57+16/16 (100%)++
 Brazil14,22,39,59,64,65,78, B37,56, G37+62,96, B63, G5610/14 (75%)++
 Canada17,43,47,55, B26, G26+6/6 (100%)++
 Outhers countries16,20,27,40,48,49,53,66,67,94,95, B21,45,58,61, G58,61+28, G21,4519/22 (86%)++
Study design
 Cross-sectional1418,20,22,23,36,40,41,43,4749,5155,59,60,6467,70,71,7375,7781,94,95, B26,37,45,56,58,61, G26,37,44,57,58,61,63+28,62,68,96, B63, G45,5643/52 (83%)++
69
 Longitudinal27, B21+G215/6 (83%)++
Instruments
 Questionnaires14,16,17,22,27,39,40,43,47,48,51,55,59,64,65,67,70,71,74,77,78,80, B37,45,56,58, G37,44,58,6328,62,97, B63, G45,5633/39 (85%)
 Accelerometers18,20,53,66,73,75,81,94,95, B26,61, G26,44,61+6815/17 (88%)++
69
 Pedometers23,36,52,54,60,79, B21+G217/8 (87%)
 Others*15,41,49, G57+3/3 (100%)++
Sample
 ≥1000 participants14,16,17,22,28,39,40,47,48,55,59,62,64,65,67,70,71,74,77,78,80,96

B26,37,58

G26,37,57,58,63
30/30 (100%)++
  <100015,18,20,23,27,36,41,43,49,5154,60,66,73,75,79,81,94,95

B21,45,56,61

G44,61
+68, B45,63

G21,56
28/33 (86%)++
69
Sex
 All1418,20,22,23,27,36,3941,43,4749,5155,59,60,6467,70,71,7375,7781,94,95+28,62,68,9644/49 (90%)++
 Boys21,26,37,45,56,58,61+638/10 (80%)++
69
 Girls26,37,44,57,58,61,63+21,45,5630/33 (73%)++
Operationalization of the measure
 Global1418,22,27,36,3941,43,4749,51,52,55,59,64,65,67,71,74,77,78,80,95, B15,21,26,45,56,58,61, G26,41,44,57,58,61,63+28,62,68,96, G21,45,5643/50 (86%)++
 School73, B41,61, G41,61+5/5 (100%)++
 Leisure70, B37, G37+4/4 (100%)++
 PA in days with versus without PE classes20,53,54,60,66,72,75,79,81,94+10/10 (100%)++
Sedentary behavior
Significant associationNo significant associationSummary code
ReferenceAssociation (+/−)Reference%Result
Year of publication
 ≥201342,46,53,95, B26,61, G26,61B45,58, G45,588/12 (66%)??
   <201364,65+2/4 (50%)??
15,19
Country
 United States15+2/3 (66%)??
B26, G26
 Brazil42,64,65,78, B26, G267/7 (100%)− −
 Canada46, B26, G263/3 (100%)− −
 Others countries75,76, B61, G6168,70,81, B45,58, G45,587/10 (70%)00
Study design
 Cross-sectional15,19,62+68,70,81, B45,58, G45,5811/21 (52%)??
42,46,53,64,65,78,95, B26,61, G26,61
Instruments
 Questionnaires19,62,78+68,70,81, B45,58, G45,588/17 (47%)00
64,65,78
 Accelerometer42,53,75,76,95, B26,61, G26,6168,8111/13 (85%)− −
Sample
 ≥1000 students62+B58, G584/7 (57%)??
64,65, B26, G26
   <1000 students15,19+B45, G456/10 (60%)??
42,46,53,96, B61, G61
Sex
 All15,19,62+6/9 (66%)??
42,46,53,64,65,95
 Boys+45,582/4 (50%)??
26,61
 Girls+45,582/4 (50%)??
26,61
Operationalization of the measure
 Total46,75,95, B26,61, G26,61687/8 (88%)− −
 School42,76, B61, G614/4 (100%)− −
 School time64,6570, B45,58, G45,582/9 (22%)00
19,62+2/9 (22%)00
 SB in days with versus without PE classes5372,811/4 (25%)00
15+1/4 (25%)00

Abbreviations: B, boys; G, girls; PE, physical education.

Discussion

The results of the present systematic review demonstrated that PE class participation was associated with increased physical activity and less sedentary behavior. These findings were consistent even after they were stratified by design (cross sectional or longitudinal) and methodological quality of the studies (low, moderate, or high), and measuring instrument (questionnaires or objective measures). The results could not be stratified by sedentary behavior in relation to the type of design due to the absence of longitudinal studies.

These findings may have been explicated by several frameworks that will be presented in 3 possibilities. First, class participation exposes students to physical activities that may improve their knowledge about the importance of such activities and of reducing sedentary behavior for health, thereby contributing to the development of attitudes and beliefs favorable to increase in physical activity and reduction in sedentary behavior. Successful and enjoyable physical activity experiences and PE classes may awaken the interest and pleasure for physical activity, both in and out of school. Interventions performed at school and in PE classes demonstrated that the adolescents who participated increased physical activity away from school.12,83 This may indicate that classes with better structural and pedagogic conditions could contribute to increasing the physical activity of students beyond the school walls.

Second, the physical activity measure used in studies on this topic considered the activities engaged in during classes, and some of these activities are performed in PE classes. In this respect, the relation could be partly explained by the fact that only a fraction of the students’ physical activity time is spent in classes. Systematic reviews85,86 demonstrated that PE classes contribute to an average of 15 minutes of adolescents’ daily low to vigorous physical activity, representing 25% of the daily recommendation.87 Another aspect that should be considered is that approximately 60% of the reviewed studies were conducted with students from middle-income countries.24 Depending on the country and region, despite the short duration of moderate and vigorous activities in PE classes, it may be the adolescents’ only or main opportunity to practice physical activity.

The inverse association between PE class participation and total time spent on sedentary behavior may be related to how class participation contributes to greater student engagement in physical activities (eg, structured and unstructured individual and collective sports), which may reduce the time spent on sedentary behavior.88,89 Physically active children and adolescents spend less time on sedentary behavior.90 However, this association seems to depend on how sedentary behavior time is accumulated, given that no consistent associations were found between PE class participation and screen time or operationalization of sedentary behavior on days with versus without PE classes. Screen time accumulates predominantly in leisure activities that may not be influenced by PE class participation.

Third, physically active young people would be more likely to adopt healthy behavior such as being physically more active, having a healthy diet and spending less time on sedentary behavior.91,92 As such, students that participate more in classes would already enjoy physical activities and engage in them on a daily basis. Despite the fact that greater class participation is associated with an increase in physical activity, and that this relation has been observed in longitudinal studies and those with high methodological quality, the possibility that students who take part in the classes are more physically active, derive greater satisfaction and view the classes as yet another opportunity to engage in physical activity, cannot be overlooked.

One aspect that must be considered in relation to the associations found in this review does justice to the political education policies that determine the role (in terms of curriculum) of PE in schools around the world. There are significant differences concerning the curriculum assigned to the discipline.97 It seems likely that this reality would attenuate any possible association between PE, PA, and SB.

As such, this evidence must be interpreted with caution given a large number of cross-sectional studies included6,1318,20,21,23,24,27,3567 and the absence of longitudinal studies on the relation between PE and sedentary behavior. The different concepts and lack of clarity in the operational description adopted in the studies to define PE class participation compromises the assessment of the natural effect of PE class participation on the outcomes. There was a lack of uniform measuring of physical activity and sedentary behavior, including the use of different instruments and ways of operationalizing.

The high heterogeneity of the methodological procedures hindered meta-analyses and other analyses on the relation between PE class participation, physical activity, and sedentary behavior. New longitudinal studies are needed with students from different grades and school systems (public and private) that consider different physical activity indicators (eg, structured and unstructured individual and collective sports) and sedentary behavior (screen time and total time). It is important that studies not include time students spend on physical activity during the class as part of the PA measure. Rather, activities performed in and out of school should be considered and instruments/methods that assess real class participation, as well as the use of instruments to measure, present a structure that can segment the periods in which each physical activity is performed. Finally, it is recommended that analyses be adjusted for potential confounders, such as sex, self-efficacy, perceived competence, and nutritional status, given that they may influence these associations.1,23,59,64

This review presents a number of strong points: searches conducted in different databases, languages, and reference lists of the articles included in the review; use of a reference protocol for review writing (Reporting Items for Systematic Reviews and Meta-Analyses28); assessment of the methodological quality of studies based on the protocols used in previous studies; assessment of different operationalizations of outcomes. Our review is the first to include studies with an observational design (cross sectional and longitudinal), this type of study allows for establishing relationships between variables in the student’s daily life without the influence of any intervention model. The study search and selection process conducted by a single author is a limitation of this review. However, the author took a training course to minimize this limitation before performing the different database searches.

The results of the present review demonstrated that students who participated in PE classes are more physically active and spend less daily time on sedentary behavior.

Implications for School Health

The results of this review reinforce the importance of teachers’ addressing “physical activity” and “sedentary behavior” (eg, concepts, definitions, determinants, assessment, health consequences, physical activity recommendations, and sedentary behavior, as well as being physically more active and less sedentary) in PE classes; providing enjoyable physical activities in a PE setting; developing guidelines on the types of activities and how students can reduce time spent on sedentary behavior and be physically active in different contexts during their school years.

These findings also reinforce the importance of PE classes in promoting more physically active lifestyles, as recommended by education and health agencies.1,3 The Centers for Disease Control and Prevention,1 United Nations Educational, Scientific, and Cultural Organization5, the Organization for Economic Cooperation and Development,93 and the World Health Organization (WHO)3 recommend that PE at school promote healthy behavior by implementing measures that increase physical activity and reduce the sedentary behavior of students.

These results may prompt teachers, students, managers, and society as a whole to promote physical activity and reduce sedentary behavior. The findings may also interest researchers, providing knowledge to develop school-based measures in education and health.

Acknowledgments

Author Contributions: DJS participated in the conception, writing, collection and analysis of data; AOB participated in the writing, collection and analysis of data; VCBF participated in the critical analysis of the article and made substantial considerations to the text; and JCFJ participated in the conception, writing and critical analysis of the manuscript.

References

  • 1.

    Centers for Disease Control and Prevention. Make a Difference at Your School. University of North Texas Health Science Center, Centers of Disease Control and Prevention; 2013:9.

    • Search Google Scholar
    • Export Citation
  • 2.

    Hallal PC. Promoção da atividade física no Brasil: chegou a hora da escola. Rev Bras Ativ Fís Saúde. 2012;15(2):7677.

  • 3.

    WHO. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. OMS; 2013:103.

  • 4.

    UNESCO. Quality Physical Education (QPE) Guidelines for Policy-Makers. UNESCO; 2015:86.

  • 5.

    Batista MSA, Mondini L, Jaime PC. Ações do Programa Saúde na Escola e da alimentação escolar na prevenção do excesso de peso infantil: experiência no município de Itapevi, São Paulo, Brasil, 2014. Epidemiol Serv Saúde. 2017;26(3):569578. doi:10.5123/S1679-49742017000300014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Mayorga-Vega D, Martínez-Baena A, Viciana J. Does school physical education really contribute to accelerometer-measured daily physical activity and non sedentary behaviour in high school students? J Sports Sci. 2018;36(17):19131922. doi:10.1080/02640414.2018.1425967

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Erwin H, Beighle A, Carson RL, Castelli DM. Comprehensive school-based physical activity promotion: a review. Quest. 2013;65(4):412428. doi:10.1080/00336297.2013.791872

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Pate RR, O’Neill JR, McIver KL. Physical activity and health: does physical education matter? Quest. 2011;63(1):1935. doi:10.1080/00336297.2011.10483660

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Kjonniksen L, Fjortoft I, Wold B. Attitude to physical education and participation in organized youth sports during adolescence related to physical activity in young adulthood: a 10-year longitudinal study. Eur Phy Educ Rev. 2009;15(2):139154. doi:10.1177/1356336X0934

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Pate RR, Trilk JL, Byun W, Wang J. Policies to increase physical activity in children and youth. J Exerc Sci Fit. 2011;9(1):114. doi:10.1016/S1728-869X(11)60001-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Hardman K, Murphy C, Routen A, March ST. World-Wide Survey of School Physical Education: Final Report. UNESCO; 2014.

  • 12.

    Osborne R, Belmont RS, Peixoto RP, Azevedo IOS, Carvalho AFP Jr. Obstacles for physical education teachers in public schools: an unsustainable situation. Motriz. 2016;22(4):310318.

    • Search Google Scholar
    • Export Citation
  • 13.

    Brusseau TA, Hannon J, Burns R. The effect of a comprehensive school physical activity program on physical activity and health-related fitness in children from low-income families. J Phys Activ Health. 2016;13(8):888894. doi:10.1123/jpah.2016-0028

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Bergmann GG, Bergmann MLD, Marques AC, Hallal PC. Prevalence of physical inactivity and associated factors among adolescents from public schools in Uruguaiana, Rio Grande do Sul State, Brazil. Cad de Saude Publica. 2013;29(11):22172229. doi:10.1590/0102-311x00077512

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Chen SL, Kim YW, Gao Z. The contributing role of physical education in youth’s daily physical activity and sedentary behavior. BMC Public Health. 2014;14(1):110117. doi:10.1186/1471-2458-14-110

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Duan J, Hu H, Wang G, Arao T. Study on current levels of physical activity and sedentary behavior among middle school students in Beijing, China. PLoS One. 2015;10(7):e0133544. doi:10.1371/journal.pone.0133544

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Hobin E, Leatherdale S, Manske S, Dubin J, Elliott S, Veugelers P. A multilevel examination of factors of the school environment and time spent in moderate to vigorous physical activity among a sample of secondary school students in grades 9-12 in Ontario, Canada. Int J Public Health. 2012;57(4):699709. doi:10.1007/s00038-012-0336-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Kirkham-King M, Brusseau TA, Hannon JC, Castelli DM, Hilton K, Burns RD. Elementary physical education: a focus on fitness activities and smaller class sizes are associated with higher levels of physical activity. Prev Med Rep. 2017;8:135139. doi:10.1016/j.pmedr.2017.09.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Martins JS, Souza EA, Filho NT. Factors associated with screen time among high school students in Fortaleza, Northeastern Brazil. Sci Med. 2015;25(4):16.

    • Search Google Scholar
    • Export Citation
  • 20.

    Meyer U, Roth R, Zahner L, et al. Contribution of physical education to overall physical activity. Scand J Med Sci Sports. 2013;23(5):600606.

    • Search Google Scholar
    • Export Citation
  • 21.

    Telford RM, Telford RD, Olive LS, Cochrane T, Davey R. Why are girls less physically active than boys? Findings from the LOOK Longitudinal Study. PLoS One. 2016;11(3):e0150041. doi:10.1371/journal.pone.0150041

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Farias Júnior JC, Lopes AS, Mota J, Hallal PC. Prática de atividade física e fatores associados em adolescentes no Nordeste do Brasil. Rev Saude Publica. 2012;46(3):505515. doi:10.1590/S0034-89102012000300013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Dauenhauer BD, Keating XD. The influence of physical education on physical activity levels of urban elementary students. Res Q Exerc Sport. 2011;82(3):512520. doi:10.1080/02701367.2011.10599784

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Dudley D, Burden R. What effect on learning does increasing the proportion of curriculum time allocated to physical education have? A systematic review and meta-analysis. Eur Phys Educ Rev. 2020;26(1):85100. doi:10.1177/1356336X19830113

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Lonsdale C, Rosenkranz RR, Peralta LR, Bennie A, Fahey P, Lubans DR. A systematic review and meta-analysis of interventions designed to increase moderate-to-vigorous physical activity in school physical education lessons. Prev Med. 2013;56(2):152161. doi:10.1016/j.ypmed.2012.12.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Silva DAS, Chaput JP, Katzmarzyk PT, et al. Physical education classes, physical activity, and sedentary behavior in children. Med Sci Sports Exerc. 2017;50(5):9951004. doi:10.1249/MSS.0000000000001524

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Yli-Piipari S, Barkoukis V, Jaakkola T, Liukkonen J. The effect of physical education goal orientations and enjoyment in adolescent physical activity: a parallel process latent growth analysis. Sport Exerc Perform Psychol. 2013;2(1):1531. doi:10.1037/a0029806

    • Search Google Scholar
    • Export Citation
  • 28.

    Amornsriwatanakul A, Lester L, Bull FC, Rosenberg M. Are Thai children and youth sufficiently active? Prevalence and correlates of physical activity from a nationally representative cross-sectional study. Int J Behav Nutr Phys Act. 2017;14(1):72. doi:10.1186/s12966-017-0529-4

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1e34. doi:10.1371/journal.pmed.1000100

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000. http://www.ohri.ca/programs/clinicalepidemiology/oxford.htm. Accessed on May 12, 2018.

    • Search Google Scholar
    • Export Citation
  • 31.

    von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296. doi:10.1371/journal.pmed.0040296

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377384. doi:10.1136/jech.52.6.377

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Barbosa Filho VC, Minatto G, Mota J, Silva KS, Campos W, Lopes AS. Promoting physical activity for children and adolescents in low- and middle-income countries: an umbrella systematic review. A review on promoting physical activity in LMIC. Prev Med. 2016;88:115126. doi:10.1016/j.ypmed.2016.03.025

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Craggs C, Corder K, van Sluijs EMF, Griffin SJ. Determinants of change in physical activity in children and adolescents: a systematic review. Am J Prev Med. 2011;40(6):645658. doi:10.1016/j.amepre.2011.02.025

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Mendonça G, Cheng LA, Mélo EN, Farias Júnior JC. Physical activity and social support in adolescents: a systematic review. Health Educ Res. 2014;29(5):822839. doi:10.1093/her/cyu017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Alderman BL, Benham-Deal T, Beighle A, Erwin HE, Olson RL. Physical education’s contribution to daily physical activity among middle school youth. Pediatr Exerc Sci. 2012;24(4):634648. doi:10.1123/pes.24.4.634

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Bezerra J, Silva Lopes A, Duca GF, Barbosa Filho VC, Barros MVG. Leisure-time physical activity and associated factors among adolescents of Pernambuco, Brazil: from 2006 to 2011. Rev Bras Cineantropom Desempenho Hum. 2016;18(1):114126. doi:10.5007/1980-0037.2016v18n1p114

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    Calahorro-Canada F, Torres-Luque G, Lopez-Fernandez I, Carnero EA. Is physical education an effective way to increase physical activity in children with lower cardiorespiratory fitness? Scand J Med Sci Sports. 2017;27(11):14171422. doi:10.1111/sms.12740

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39.

    Ceschini FL, Andrade DR, Oliveira LC, Araujo JF, Matsudo VKR. Prevalence of physical inactivity and associated factors among high school students from state’s public schools. J Pediatr. 2009;85(4):301306. doi:10.1590/S0021-75572009000400006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40.

    Cheah YK, Lim HK, Kee CC, Ghazali SM. Factors associated with participation in physical activity among adolescents in Malaysia. Int J Adolesc Med Health. 2016;28(4):419427. doi:10.1515/ijamh-2015-0030

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

    Chen SL, Sun HC, Zhu XH, Chen A. Relationship between motivation and learning in physical education and after-school physical activity. Res Q Exerc Sport. 2014;85(4):468477. doi:10.1080/02701367.2014.961054

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42.

    Costa BG, Silva KS, George AM, Assis MA. Sedentary behavior during school-time: sociodemographic, weight status, physical education class, and school performance correlates in Brazilian schoolchildren. J Sci Med Sport. 2017;20(1):7074. doi:10.1016/j.jsams.2016.06.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Dargavel M, Robertson-Wilson J, Bryden PJ. The relationship between secondary school physical education and postsecondary physical activity. Phys Educat. 2017;74(3):551569. doi:10.18666/TPE-2017-V74-I3-7213

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44.

    Duncan SC, Strycker LA, Chaumeton NR. School influences on the physical activity of African American, Latino, and White girls. J Sch Health. 2015;85(1):4352. doi:10.1111/josh.12218

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    El-ammari A, El Kazdouh H, Bouftini S, El Fakir S, El Achhab Y. Level and potential social-ecological factors associated with physical inactivity and sedentary behavior among Moroccan school-age adolescents: a cross-sectional study. Environ Health Prev Med. 2017;22(47):19. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46.

    Herman KM, Sabiston CM, Mathieu ME, Tremblay A, Paradis G. Correlates of sedentary behaviour in 8 to 10-year-old children at elevated risk for obesity. Appl Physiol Nutr Metab. 2015;40(1):1019. doi:10.1139/apnm-2014-0039

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47.

    Hobin EP, Leatherdale ST, Manske SR, Robertson-Wilson J. A multilevel examination of school and student characteristics associated with moderate and high levels of physical activity among elementary school students (Ontario, Canada). Can J Public Health. 2010;101(6):495499. doi:10.1007/BF03403971

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 48.

    Kantanista A, Osinski W, Bronikowski M, Tomczak M. Physical activity of underweight, normal weight and overweight Polish adolescents: the role of classmate and teacher support in physical education. Eur Phy Educ Rev. 2013;19(3):347359. doi:10.1177/1356336X13505188

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49.

    Kobel S, Kettner S, Lammle C, Steinacker JM. Physical activity of German children during different segments of the school day. J Public Health. 2017;25(1):2935. doi:10.1007/s10389-016-0755-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 50.

    Lima TR, Silva DAS. Prevalence of physical activity among adolescents in southern Brazil. J Bodyw Mov Ther. 2018;22(1):5763. doi:10.1016/j.jbmt.2017.03.022

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 51.

    Loprinzi PD, Cardinal BJ, Cardinal MK, Corbin CB. Physical education and sport: does participation relate to physical activity patterns, observed fitness, and personal attitudes and beliefs? Am J Health Promot. 2018;32(3):613620. doi:10.1177/0890117117698088

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 52.

    Marttinen R, Fredrick RN, Silverman SS. Middle school students’ free-living physical activity on physical education days, non-physical education days, and weekends. Montenegrin J Sports Sci Med. 2018;7(1):512. doi:10.26773/mjssm.180301

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 53.

    Mooses K, Pihu M, Riso EM, Hannus A, Kaasik P, Kull M. Physical education increases daily moderate to vigorous physical activity and reduces sedentary time. J Sch Health. 2017;87(8):602607. doi:10.1111/josh.12530

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 54.

    Morgan CF, Beighle A, Pangrazi RP. What are the contributory and compensatory relationships between physical education and physical activity in children? Res Q Exerc Sport. 2007;78(5):407412. doi:10.1080/02701367.2007.10599440

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 55.

    Naiman DI, Leatherdale ST, Gotay C, Masse LC. School factors associated with the provision of physical education and levels of physical activity among elementary school students in Ontario. Can J Public Health. 2015;106(5):E290E296. doi:10.17269/cjph.106.4899

    • Search Google Scholar
    • Export Citation
  • 56.

    Nakamura PM, Teixeira IP, Papini CB, de Lemos N, Nazario MES, Kokubun E. Physical education in schools, sport activity and total physical activity in adolescents. Rev Bras Cineantropom Desempenho Hum. 2013;15(5):517526. doi:10.5007/1980-0037.2013v15n5p517

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 57.

    Pate RR, Ward DS, O’Neill JR, Dowda M. Enrollment in physical education is associated with overall physical activity in adolescent girls. Res Q Exerc Sport. 2007;78(4):265270. doi:10.1080/02701367.2007.10599424

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 58.

    Peltzer K, Pengpid S. Leisure time physical inactivity and sedentary behaviour and lifestyle correlates among students aged 13-15 in the Association of Southeast Asian Nations (ASEAN) Member States, 2007-2013. Int J Environ Res Public Health. 2016;13(2):217232. doi:10.3390/ijerph13020217

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 59.

    Rezende LFM, Azeredo CM, Canella DS, et al. Sociodemographic and behavioral factors associated with physical activity in Brazilian adolescents. BMC Public Health. 2014;14(485):111. doi:10.1186/1471-2458-14-485

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 60.

    Reznik M, Wylie-Rosett J, Kim M, Ozuah PO. Physical activity during school in urban minority kindergarten and first-grade students. Pediatrics. 2013;131(1):E81E87. doi:10.1542/peds.2012-1685

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 61.

    Sigmund E, Sigmundova D, Hamrik Z, Madarasova Geckova A. Does participation in physical education reduce sedentary behaviour in school and throughout the day among normal-weight and overweight-to-obese Czech children aged 9-11 years? Int J Environ Res Public Health. 2014;11(1):10761093. doi:10.3390/ijerph110101076

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 62.

    Silva KS, Nahas MV, Peres KG, Lopes AS. Fatores associados à atividade física, comportamento sedentário e participação na Educação Física em estudantes do Ensino Médio em Santa Catarina, Brasil. Cad de Saude Publica. 2009;25(10):21872200. doi:10.1590/S0102-311X2009001000010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 63.

    Silva RJS, Silva DAS, Oliveira AC. Low physical activity levels and associated factors in Brazilian adolescents from public high schools. J Phys Activ Health. 2014;11(7):14381445. doi:10.1123/jpah.2012-0157

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 64.

    Tassitano RM, Barros MVG, Tenorio MC, Bezerra J, Florindo AA, Reis RS. Enrollment in physical education is associated with health-related behavior among high school students. J Sch Health. 2010;80(3):126133. doi:10.1111/j.1746-1561.2009.00476.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 65.

    Tenório MCM, Barros MVG, Tassitano RM, Bezerra J, Tenório JM, Hallal PC. Atividade física e comportamento sedentário em adolescentes estudantes do ensino médio. Rev Bras Epidemiol. 2010;13(1):105117. doi:10.1590/S1415-790X2010000100010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 66.

    Vale S, Santos R, Soares-Miranda L, Silva P, Mota J. The importance of physical education classes in pre-school children. J Paediatr Child Health. 2011;47(1–2):4853. doi:10.1111/j.1440-1754.2010.01890.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 67.

    Woods CB, Tannehill D, Walsh J. An examination of the relationship between enjoyment, physical education, physical activity and health in Irish adolescents. Irish Educ Stud. 2012;31(3):263280. doi:10.1080/03323315.2012.710068

    • Search Google Scholar
    • Export Citation
  • 68.

    Aguilar-Farias N, Martino-Fuentealba P, Chandia-Poblete D. Correlates of device-measured physical activity, sedentary behaviour and sleeping in children aged 9-11 years from Chile: ESPACIOS study. Retos. 2020;37:110.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 69.

    Aljuhani O, Sandercock G. Contribution of physical education to the daily physical activity of schoolchildren in Saudi Arabia. Int J Environ Res Public Health. 2019;16(13):2397. doi:10.3390/ijerph16132397

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 70.

    Al-Thani M, Al-Thani A, Alyafei S, et al. Prevalence of physical activity and sedentary-related behaviors among adolescents: data from the Qatar National School Survey. Publ Health. 2018;160:150155. doi:10.1016/j.puhe.2018.03.019

    • Search Google Scholar
    • Export Citation
  • 71.

    Cheah YK, Lim HK, Kee CC. Demographic and lifestyle determinants of time spent in physical activity among Malaysian adolescents. Int J Adolesc Med Health. 2018;5(2):4954. doi:10.1016/j.ijpam.2018.02.001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 72.

    Cheung P. School-based physical activity opportunities in PE lessons and after-school hours: are they associated with children’s daily physical activity? Eur Phy Educ Rev. 2017;25(1):6575. doi:10.1177/1356336X17705274

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 73.

    Groffik D, Mitas J, Jakubec L, Svozil Z, Fromel K. Adolescents’ physical activity in education systems varying in the number of weekly physical education lessons. Res Q Exerc Sport. 2020;91(4):551561. doi:10.1080/02701367.2019.1688754

    • Search Google Scholar
    • Export Citation
  • 74.

    Herazo-Beltran Y, Sanchez-Guette L, Vidarte-Claros J, et al. Influence of daily and weekly activities in the physical activity levels of school children: a cross-sectional study. Nutr Hosp. 2020;37(1):1420.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 75.

    Kerr C, Smith L, Charman S, et al. Physical education contributes to total physical activity levels and predominantly in higher intensity physical activity categories. Eur Phy Educ Rev. 2016;24(2):152164. doi:10.1177/1356336X16672127

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 76.

    Maatta S, Konttinen H, Lehto R, Haukkala A, Erkkola M, Roos E. Preschool environmental factors, parental socioeconomic status, and children’s sedentary time: an examination of cross-level interactions. Int J Environ Res Public Health. 2018;16(1):119. doi:10.3390/ijerph16010046

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 77.

    Sharma B, Chavez RC, Nam EW. Prevalence and correlates of insufficient physical activity in school adolescents in Peru. Rev Saude Publica. 2018;52(51):113.

    • Search Google Scholar
    • Export Citation
  • 78.

    Silva DAS, Chaput JP, Tremblay MS. Participation frequency in physical education classes and physical activity and sitting time in Brazilian adolescents. PLoS One. 2019;14(3):114. doi:10.1371/journal.pone.0213785

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 79.

    To QG, Gallegos D, Do DV, et al. The level and pattern of physical activity among fifth-grade students in Ho Chi Minh City, Vietnam. Publ Health. 2018;160:1825. doi:10.1016/j.puhe.2018.03.021

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 80.

    Vancampfort D, Van Damme T, Firth J, et al. Correlates of physical activity among 142,118 adolescents aged 12-15 years from 48 low- and middle-income countries. Prev Med. 2019;127:105819. doi:10.1016/j.ypmed.2019.105819

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 81.

    Viciana J, Mayorga-Vega D, Parra-Saldias M. Adolescents’ physical activity levels on physical education and non-physical education days according to gender, age, and weight status. Eur Phy Educ Rev. 2018;25(1):143155. doi:10.1177/1356336X17706683

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 82.

    Telford RM, Olive LS, Cochrane T, Davey R, Telford RD. Outcomes of a four-year specialist-taught physical education program on physical activity: a cluster randomized controlled trial, the LOOK study. Int J Behav Nutr Phys Act. 2016;13(64):111. doi:10.1186/s12966-016-0388-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 83.

    Meyer U, Schindler C, Zahner L, et al. Long-term effect of a school-based physical activity program (KISS) on fitness and adiposity in children: a cluster-randomized controlled trial. PLoS One. 2014;9(2):e87929. doi:10.1371/journal.pone.0087929

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 84.

    Hollis JL, Sutherland R, Williams AJ, et al. A systematic review and meta-analysis of moderate-to-vigorous physical activity levels in secondary school physical education lessons. Int J Behav Nutr Phys Act. 2017;14(52):126. doi:10.1186/s12966-017-0504-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 85.

    Hollis JL, Williams AJ, Sutherland R, et al. A systematic review and meta-analysis of moderate-to-vigorous physical activity levels in elementary school physical education lessons. Prev Med. 2016;86:3454. doi:10.1016/j.ypmed.2015.11.018

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 86.

    Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):14511462. doi:10.1136/bjsports-2020-102955

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 87.

    Kaluski DN, Mazengia GD, Shimony T, Goldsmith R, Berry EM. Prevalence and determinants of physical activity and lifestyle in relation to obesity among schoolchildren in Israel. Public Health Nutr. 2009;12(6):774782. doi:10.1017/S1368980008002991

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 88.

    Silva KS, Nahas MV, Hoefelmann LP, Lopes AS, Oliveira ES. Associações entre atividade física, índice de massa corporal e comportamentos sedentários em adolescentes. Rev Bras Epidemiol. 2008;11(1):159168. doi:10.1590/S1415-790X2008000100015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 89.

    Pearson N, Braithwaite RE, Biddle SJ, van Sluijs EM, Atkin AJ. Associations between sedentary behaviour and physical activity in children and adolescents: a meta‐analysis. Obes Rev. 2014;15(8):666675. doi:10.1111/obr.12188

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 90.

    Fernandes RA, Christofaro D, Casonatto J, et al. Cross-sectional association between healthy and unhealthy food habits and leisure physical activity in adolescents. J Pediatr. 2011;87(3):252256. doi:10.2223/JPED.2093

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 91.

    Matias TS, Silva KS, Silva JA, Mello GT, Salmon J. Clustering of diet, physical activity and sedentary behavior among Brazilian adolescents in the national school-based health survey (PeNSE 2015). BMC Public Health. 2018;18(1):1283. doi:10.1186/s12889-018-6203-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 92.

    Miguel-Berges ML, Reilly JJ, Aznar LAM, Jiménez-Pavón D. Associations between pedometer-determined physical activity and adiposity in children and adolescents: systematic review. Clin J Sport Med. 2018;28(1):6475. doi:10.1097/JSM.0000000000000419

    • Search Google Scholar
    • Export Citation
  • 93.

    Howells K. The Future of Education and Skills: Education 2030: The Future We Want. Paris OECD; 2018.

  • 94.

    McDavid L, Cox AE, McDonough MH. Need fulfillment and motivation in physical education predict trajectories of change in leisure-time physical activity in early adolescence. Psychol Sport Exerc. 2014;15(5):471480. doi:10.1016/j.psychsport.2014.04.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 95.

    Calahorro-Canada F, Torres-Luque G, Lopez-Fernandez I. Is physical education an effective way to increase physical activity in children with lower cardiorespiratory fitness?. Scand J Med Sci Sports. 2017;27(11):14171422. doi:10.1111/sms.12740

    • Search Google Scholar
    • Export Citation
  • 96.

    Mayorga-Vega D, Martinez-Baena A. Does school physical education really contribute to accelerometer-measured daily physical activity and non sedentary behaviour in high school students?. J Sports Sci. 2018:110. doi:10.1080/02640414.2018.1425967

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 97.

    Lima TR, Silva DAS. Prevalence of physical activity among adolescents in southern Brazil. J Bodyw Mov Ther. 2018;22(1):5763. doi:10.1016/j.jbmt.2017.03.022

    • Search Google Scholar
    • Export Citation

Supplementary Materials

  • Collapse
  • Expand
  • View in gallery
    Figure 1

    —PRISMA flowchart of article identification and selection procedures. aEight articles stratified their analyzes by sex and were counted as independent samples. PRISMA indicates Reporting Items for Systematic Reviews and Meta-Analyses.

  • 1.

    Centers for Disease Control and Prevention. Make a Difference at Your School. University of North Texas Health Science Center, Centers of Disease Control and Prevention; 2013:9.

    • Search Google Scholar
    • Export Citation
  • 2.

    Hallal PC. Promoção da atividade física no Brasil: chegou a hora da escola. Rev Bras Ativ Fís Saúde. 2012;15(2):7677.

  • 3.

    WHO. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. OMS; 2013:103.

  • 4.

    UNESCO. Quality Physical Education (QPE) Guidelines for Policy-Makers. UNESCO; 2015:86.

  • 5.

    Batista MSA, Mondini L, Jaime PC. Ações do Programa Saúde na Escola e da alimentação escolar na prevenção do excesso de peso infantil: experiência no município de Itapevi, São Paulo, Brasil, 2014. Epidemiol Serv Saúde. 2017;26(3):569578. doi:10.5123/S1679-49742017000300014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Mayorga-Vega D, Martínez-Baena A, Viciana J. Does school physical education really contribute to accelerometer-measured daily physical activity and non sedentary behaviour in high school students? J Sports Sci. 2018;36(17):19131922. doi:10.1080/02640414.2018.1425967

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Erwin H, Beighle A, Carson RL, Castelli DM. Comprehensive school-based physical activity promotion: a review. Quest. 2013;65(4):412428. doi:10.1080/00336297.2013.791872

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Pate RR, O’Neill JR, McIver KL. Physical activity and health: does physical education matter? Quest. 2011;63(1):1935. doi:10.1080/00336297.2011.10483660

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Kjonniksen L, Fjortoft I, Wold B. Attitude to physical education and participation in organized youth sports during adolescence related to physical activity in young adulthood: a 10-year longitudinal study. Eur Phy Educ Rev. 2009;15(2):139154. doi:10.1177/1356336X0934

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Pate RR, Trilk JL, Byun W, Wang J. Policies to increase physical activity in children and youth. J Exerc Sci Fit. 2011;9(1):114. doi:10.1016/S1728-869X(11)60001-4

    • Search Google Scholar
    • Export Citation
  • 11.

    Hardman K, Murphy C, Routen A, March ST. World-Wide Survey of School Physical Education: Final Report. UNESCO; 2014.

  • 12.

    Osborne R, Belmont RS, Peixoto RP, Azevedo IOS, Carvalho AFP Jr. Obstacles for physical education teachers in public schools: an unsustainable situation. Motriz. 2016;22(4):310318.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Brusseau TA, Hannon J, Burns R. The effect of a comprehensive school physical activity program on physical activity and health-related fitness in children from low-income families. J Phys Activ Health. 2016;13(8):888894. doi:10.1123/jpah.2016-0028

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Bergmann GG, Bergmann MLD, Marques AC, Hallal PC. Prevalence of physical inactivity and associated factors among adolescents from public schools in Uruguaiana, Rio Grande do Sul State, Brazil. Cad de Saude Publica. 2013;29(11):22172229. doi:10.1590/0102-311x00077512

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Chen SL, Kim YW, Gao Z. The contributing role of physical education in youth’s daily physical activity and sedentary behavior. BMC Public Health. 2014;14(1):110117. doi:10.1186/1471-2458-14-110

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Duan J, Hu H, Wang G, Arao T. Study on current levels of physical activity and sedentary behavior among middle school students in Beijing, China. PLoS One. 2015;10(7):e0133544. doi:10.1371/journal.pone.0133544

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Hobin E, Leatherdale S, Manske S, Dubin J, Elliott S, Veugelers P. A multilevel examination of factors of the school environment and time spent in moderate to vigorous physical activity among a sample of secondary school students in grades 9-12 in Ontario, Canada. Int J Public Health. 2012;57(4):699709. doi:10.1007/s00038-012-0336-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Kirkham-King M, Brusseau TA, Hannon JC, Castelli DM, Hilton K, Burns RD. Elementary physical education: a focus on fitness activities and smaller class sizes are associated with higher levels of physical activity. Prev Med Rep. 2017;8:135139. doi:10.1016/j.pmedr.2017.09.007

    • Search Google Scholar
    • Export Citation
  • 19.

    Martins JS, Souza EA, Filho NT. Factors associated with screen time among high school students in Fortaleza, Northeastern Brazil. Sci Med. 2015;25(4):16.

    • Search Google Scholar
    • Export Citation
  • 20.

    Meyer U, Roth R, Zahner L, et al. Contribution of physical education to overall physical activity. Scand J Med Sci Sports. 2013;23(5):600606.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Telford RM, Telford RD, Olive LS, Cochrane T, Davey R. Why are girls less physically active than boys? Findings from the LOOK Longitudinal Study. PLoS One. 2016;11(3):e0150041. doi:10.1371/journal.pone.0150041

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Farias Júnior JC, Lopes AS, Mota J, Hallal PC. Prática de atividade física e fatores associados em adolescentes no Nordeste do Brasil. Rev Saude Publica. 2012;46(3):505515. doi:10.1590/S0034-89102012000300013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Dauenhauer BD, Keating XD. The influence of physical education on physical activity levels of urban elementary students. Res Q Exerc Sport. 2011;82(3):512520. doi:10.1080/02701367.2011.10599784

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Dudley D, Burden R. What effect on learning does increasing the proportion of curriculum time allocated to physical education have? A systematic review and meta-analysis. Eur Phys Educ Rev. 2020;26(1):85100. doi:10.1177/1356336X19830113

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Lonsdale C, Rosenkranz RR, Peralta LR, Bennie A, Fahey P, Lubans DR. A systematic review and meta-analysis of interventions designed to increase moderate-to-vigorous physical activity in school physical education lessons. Prev Med. 2013;56(2):152161. doi:10.1016/j.ypmed.2012.12.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Silva DAS, Chaput JP, Katzmarzyk PT, et al. Physical education classes, physical activity, and sedentary behavior in children. Med Sci Sports Exerc. 2017;50(5):9951004. doi:10.1249/MSS.0000000000001524

    • Search Google Scholar
    • Export Citation
  • 27.

    Yli-Piipari S, Barkoukis V, Jaakkola T, Liukkonen J. The effect of physical education goal orientations and enjoyment in adolescent physical activity: a parallel process latent growth analysis. Sport Exerc Perform Psychol. 2013;2(1):1531. doi:10.1037/a0029806

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Amornsriwatanakul A, Lester L, Bull FC, Rosenberg M. Are Thai children and youth sufficiently active? Prevalence and correlates of physical activity from a nationally representative cross-sectional study. Int J Behav Nutr Phys Act. 2017;14(1):72. doi:10.1186/s12966-017-0529-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1e34. doi:10.1371/journal.pmed.1000100

    • Search Google Scholar
    • Export Citation
  • 30.

    Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000. http://www.ohri.ca/programs/clinicalepidemiology/oxford.htm. Accessed on May 12, 2018.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296. doi:10.1371/journal.pmed.0040296

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377384. doi:10.1136/jech.52.6.377

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Barbosa Filho VC, Minatto G, Mota J, Silva KS, Campos W, Lopes AS. Promoting physical activity for children and adolescents in low- and middle-income countries: an umbrella systematic review. A review on promoting physical activity in LMIC. Prev Med. 2016;88:115126. doi:10.1016/j.ypmed.2016.03.025

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Craggs C, Corder K, van Sluijs EMF, Griffin SJ. Determinants of change in physical activity in children and adolescents: a systematic review. Am J Prev Med. 2011;40(6):645658. doi:10.1016/j.amepre.2011.02.025

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Mendonça G, Cheng LA, Mélo EN, Farias Júnior JC. Physical activity and social support in adolescents: a systematic review. Health Educ Res. 2014;29(5):822839. doi:10.1093/her/cyu017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Alderman BL, Benham-Deal T, Beighle A, Erwin HE, Olson RL. Physical education’s contribution to daily physical activity among middle school youth. Pediatr Exerc Sci. 2012;24(4):634648. doi:10.1123/pes.24.4.634

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37.

    Bezerra J, Silva Lopes A, Duca GF, Barbosa Filho VC, Barros MVG. Leisure-time physical activity and associated factors among adolescents of Pernambuco, Brazil: from 2006 to 2011. Rev Bras Cineantropom Desempenho Hum. 2016;18(1):114126. doi:10.5007/1980-0037.2016v18n1p114

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    Calahorro-Canada F, Torres-Luque G, Lopez-Fernandez I, Carnero EA. Is physical education an effective way to increase physical activity in children with lower cardiorespiratory fitness? Scand J Med Sci Sports. 2017;27(11):14171422. doi:10.1111/sms.12740

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39.

    Ceschini FL, Andrade DR, Oliveira LC, Araujo JF, Matsudo VKR. Prevalence of physical inactivity and associated factors among high school students from state’s public schools. J Pediatr. 2009;85(4):301306. doi:10.1590/S0021-75572009000400006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40.

    Cheah YK, Lim HK, Kee CC, Ghazali SM. Factors associated with participation in physical activity among adolescents in Malaysia. Int J Adolesc Med Health. 2016;28(4):419427. doi:10.1515/ijamh-2015-0030

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

    Chen SL, Sun HC, Zhu XH, Chen A. Relationship between motivation and learning in physical education and after-school physical activity. Res Q Exerc Sport. 2014;85(4):468477. doi:10.1080/02701367.2014.961054

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42.

    Costa BG, Silva KS, George AM, Assis MA. Sedentary behavior during school-time: sociodemographic, weight status, physical education class, and school performance correlates in Brazilian schoolchildren. J Sci Med Sport. 2017;20(1):7074. doi:10.1016/j.jsams.2016.06.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Dargavel M, Robertson-Wilson J, Bryden PJ. The relationship between secondary school physical education and postsecondary physical activity. Phys Educat. 2017;74(3):551569. doi:10.18666/TPE-2017-V74-I3-7213

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44.

    Duncan SC, Strycker LA, Chaumeton NR. School influences on the physical activity of African American, Latino, and White girls. J Sch Health. 2015;85(1):4352. doi:10.1111/josh.12218

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    El-ammari A, El Kazdouh H, Bouftini S, El Fakir S, El Achhab Y. Level and potential social-ecological factors associated with physical inactivity and sedentary behavior among Moroccan school-age adolescents: a cross-sectional study. Environ Health Prev Med. 2017;22(47):19. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46.

    Herman KM, Sabiston CM, Mathieu ME, Tremblay A, Paradis G. Correlates of sedentary behaviour in 8 to 10-year-old children at elevated risk for obesity. Appl Physiol Nutr Metab. 2015;40(1):1019. doi:10.1139/apnm-2014-0039

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47.

    Hobin EP, Leatherdale ST, Manske SR, Robertson-Wilson J. A multilevel examination of school and student characteristics associated with moderate and high levels of physical activity among elementary school students (Ontario, Canada). Can J Public Health. 2010;101(6):495499. doi:10.1007/BF03403971

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 48.

    Kantanista A, Osinski W, Bronikowski M, Tomczak M. Physical activity of underweight, normal weight and overweight Polish adolescents: the role of classmate and teacher support in physical education. Eur Phy Educ Rev. 2013;19(3):347359. doi:10.1177/1356336X13505188

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49.

    Kobel S, Kettner S, Lammle C, Steinacker JM. Physical activity of German children during different segments of the school day. J Public Health. 2017;25(1):2935. doi:10.1007/s10389-016-0755-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 50.

    Lima TR, Silva DAS. Prevalence of physical activity among adolescents in southern Brazil. J Bodyw Mov Ther. 2018;22(1):5763. doi:10.1016/j.jbmt.2017.03.022

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 51.

    Loprinzi PD, Cardinal BJ, Cardinal MK, Corbin CB. Physical education and sport: does participation relate to physical activity patterns, observed fitness, and personal attitudes and beliefs? Am J Health Promot. 2018;32(3):613620. doi:10.1177/0890117117698088

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 52.

    Marttinen R, Fredrick RN, Silverman SS. Middle school students’ free-living physical activity on physical education days, non-physical education days, and weekends. Montenegrin J Sports Sci Med. 2018;7(1):512. doi:10.26773/mjssm.180301

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 53.

    Mooses K, Pihu M, Riso EM, Hannus A, Kaasik P, Kull M. Physical education increases daily moderate to vigorous physical activity and reduces sedentary time. J Sch Health. 2017;87(8):602607. doi:10.1111/josh.12530

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 54.

    Morgan CF, Beighle A, Pangrazi RP. What are the contributory and compensatory relationships between physical education and physical activity in children? Res Q Exerc Sport. 2007;78(5):407412. doi:10.1080/02701367.2007.10599440

    • Search Google Scholar
    • Export Citation
  • 55.

    Naiman DI, Leatherdale ST, Gotay C, Masse LC. School factors associated with the provision of physical education and levels of physical activity among elementary school students in Ontario. Can J Public Health. 2015;106(5):E290E296. doi:10.17269/cjph.106.4899

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 56.

    Nakamura PM, Teixeira IP, Papini CB, de Lemos N, Nazario MES, Kokubun E. Physical education in schools, sport activity and total physical activity in adolescents. Rev Bras Cineantropom Desempenho Hum. 2013;15(5):517526. doi:10.5007/1980-0037.2013v15n5p517

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 57.

    Pate RR, Ward DS, O’Neill JR, Dowda M. Enrollment in physical education is associated with overall physical activity in adolescent girls. Res Q Exerc Sport. 2007;78(4):265270. doi:10.1080/02701367.2007.10599424

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 58.

    Peltzer K, Pengpid S. Leisure time physical inactivity and sedentary behaviour and lifestyle correlates among students aged 13-15 in the Association of Southeast Asian Nations (ASEAN) Member States, 2007-2013. Int J Environ Res Public Health. 2016;13(2):217232. doi:10.3390/ijerph13020217

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 59.

    Rezende LFM, Azeredo CM, Canella DS, et al. Sociodemographic and behavioral factors associated with physical activity in Brazilian adolescents. BMC Public Health. 2014;14(485):111. doi:10.1186/1471-2458-14-485

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 60.

    Reznik M, Wylie-Rosett J, Kim M, Ozuah PO. Physical activity during school in urban minority kindergarten and first-grade students. Pediatrics. 2013;131(1):E81E87. doi:10.1542/peds.2012-1685

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 61.

    Sigmund E, Sigmundova D, Hamrik Z, Madarasova Geckova A. Does participation in physical education reduce sedentary behaviour in school and throughout the day among normal-weight and overweight-to-obese Czech children aged 9-11 years? Int J Environ Res Public Health. 2014;11(1):10761093. doi:10.3390/ijerph110101076

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 62.

    Silva KS, Nahas MV, Peres KG, Lopes AS. Fatores associados à atividade física, comportamento sedentário e participação na Educação Física em estudantes do Ensino Médio em Santa Catarina, Brasil. Cad de Saude Publica. 2009;25(10):21872200. doi:10.1590/S0102-311X2009001000010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 63.

    Silva RJS, Silva DAS, Oliveira AC. Low physical activity levels and associated factors in Brazilian adolescents from public high schools. J Phys Activ Health. 2014;11(7):14381445. doi:10.1123/jpah.2012-0157

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 64.

    Tassitano RM, Barros MVG, Tenorio MC, Bezerra J, Florindo AA, Reis RS. Enrollment in physical education is associated with health-related behavior among high school students. J Sch Health. 2010;80(3):126133. doi:10.1111/j.1746-1561.2009.00476.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 65.

    Tenório MCM, Barros MVG, Tassitano RM, Bezerra J, Tenório JM, Hallal PC. Atividade física e comportamento sedentário em adolescentes estudantes do ensino médio. Rev Bras Epidemiol. 2010;13(1):105