Raising an Active and Healthy Generation

A Comprehensive Public Health Initiative

Russell R. Pate; Marsha Dowda


Exerc Sport Sci Rev. 2019;47(1):3-14. 

In This Article


PA and Health in Children and Youth

An extensive body of knowledge documents the health benefits of PA during childhood and adolescence, and the report of the 2018 Physical Activity Guidelines Advisory Committee provides an important compilation of the relevant scientific literature.[8] Based on its review of studies using observational and experimental research designs, the U.S. federal advisory group concluded that maintaining higher levels of PA and increasing PA are associated with the following health benefits:

  • Improved cardiorespiratory endurance and muscular fitness

  • More favorable body weight and adiposity

  • Improved indicators of bone health

  • Improved cardiovascular and metabolic biomarkers

  • Positive effects on brain health, cognition, and academic outcomes

This foundation of scientific evidence has informed the development of public health guidelines on PA for children and youth. Multiple authoritative organizations around the world have developed such guidelines, and the consensus is that school-age children and adolescents should engage in moderate-to-vigorous intensity physical activity (MVPA) for at least 1 h·d−1. Within that hour of MVPA, guidelines recommend that youth regularly engage in resistance exercise, bone-loading activities, and vigorous intensity PA.[9] For children under 6 years of age, the prevailing consensus is that they should be physically active for 3 h·d−1, with the activity including intensities ranging from light to vigorous.[10] Unfortunately, population surveys have shown that most children and youth in the United States do not meet these targets.[4] Accordingly, there is a need to design and implement a public health initiative that will produce population-level increases in PA in children and youth.

Conceptual Basis for Promotion of PA in Children and Youth

Research studies aimed at understanding the factors that influence PA in young people have applied numerous theories of health behavior. Likewise, multiple conceptual frameworks have been developed to support planning and implementation of both research and programmatic efforts to increase PA in youth. While an in-depth discussion of these theories and frameworks is beyond the scope of this article, we provide an overview here as a means of establishing the theoretical underpinnings for the specific strategies and approaches we will recommend.

Many strategies for promoting PA in youth are designed to influence behavior of intact groups, such as students attending schools, participants in community-based recreational programs, or children living in specific communities. Nonetheless, to be successful, any PA promotion initiative must change the behavior of individual children. Accordingly, researchers have given much attention to investigating the factors that associate with or influence change in PA in studies in which the unit of randomization and analysis is the individual child. Several theories of health behavior have been particularly prominent in establishing this body of evidence, and they are summarized in the Table. Social cognitive theory[11] is perhaps the theory most widely applied in studies of PA in children and youth. This theory posits that a child's PA behavior is influenced by the interactive effects of personal characteristics, environmental factors, and attributes of specific forms of PA.[12]

In designing studies of interventions to increase PA in children, researchers frequently have applied certain conceptual frameworks. In addition, these frameworks often have been used to plan and evaluate public health interventions intended to promote children's PA. Several of these conceptual frameworks are summarized in the Table. In particular, one of these models, the Social Ecological Model,[13] has been used widely in conceptualizing public health research and practice on promoting PA in youth. Accordingly, we apply this model in organizing the recommendations presented in this article.