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Original Investigation
April 6, 2020

Association of Physical Education With Improvement of Health-Related Physical Fitness Outcomes and Fundamental Motor Skills Among Youths: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Navarrabiomed, Complejo Hospitalario de Navarra, Universidad Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
  • 2Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile, Santiago, Chile
  • 3Department of Health Sciences, Public University of Navarra, CIBER of Frailty and Healthy Aging, Instituto de Salud Carlos III, Pamplona, Navarra, Spain
  • 4Faculty of Sport Sciences, University of Huelva, Huelva, Spain
  • 5Laboratory of Human Performance, Quality of Life and Wellness Research Group, Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno, Chile
JAMA Pediatr. 2020;174(6):e200223. doi:10.1001/jamapediatrics.2020.0223
Key Points

Question  Is there an association between quality- or quantity-based physical education interventions and improvement in health-related physical fitness and fundamental motor skills in youth?

Findings  In this systematic review and meta-analysis of 48 185 youths, quality-based physical education interventions were associated with small increases in fitness components and fundamental motor skills regardless of frequency or duration of physical education lessons. By contrast, quantity-based interventions were associated with small increases in only fitness components.

Meaning  The study suggests that quality-based physical education strategies are associated with improved class efficiency assuming typical school constraints (eg, reduced practice time per session).


Importance  Whether quality- or quantity-based physical education (PE) interventions are associated with improvement of health-related physical fitness outcomes and fundamental motor skills (FMSs) in children and adolescents is unknown.

Objective  To examine the association of interventions aimed at optimizing PE in terms of quality (teaching strategies or fitness infusion) or quantity (lessons per week) with health-related physical fitness and FMSs in children and adolescents.

Data Sources  For this systematic review and meta-analysis, studies were identified through a systematic search of Ovid MEDLINE, Embase, Cochrane Controlled Trials Registry, and SPORTDiscus databases (from inception to October 10, 2019) with the keywords physical education OR PE OR P.E. AND fitness AND motor ability OR skills. Manual examination of references in selected articles was also performed.

Study Selection  Studies that assessed the association of quality- or quantity-based PE interventions with improvement in physical fitness and/or FMSs in youths (aged 3-18 years) were included.

Data Extraction and Synthesis  Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Random-effects models were used to estimate the pooled effect size (Hedges g).

Main Outcomes and Measures  Health-related physical fitness outcomes and FMSs.

Results  Fifty-six trials composed of 48 185 youths (48% girls) were included in the meta-analysis. Quality-based PE interventions were associated with small increases in health-related physical fitness (cardiorespiratory fitness [Hedges g = 0.24; 95% CI, 0.16-0.32] and muscular strength [Hedges g = 0.19; 95% CI, 0.09-0.29]) and FMSs (Hedges g = 0.38; 95% CI, 0.27-0.49). Subgroup analyses found stronger associations for quality-based PE interventions on body mass index (Hedges g = −0.18; 95% CI, −0.26 to −0.09), body fat (Hedges g = −0.28; 95% CI, −0.37 to −0.18), cardiorespiratory fitness (Hedges g = 0.31; 95% CI, 0.23-0.39), and muscular strength (Hedges g = 0.29; 95% CI, 0.18-0.39). Quantity-based PE interventions were associated with small increases in only cardiorespiratory fitness (Hedges g = 0.42; 95% CI, 0.30-0.55), muscular strength (Hedges g = 0.20; 95% CI, 0.08-0.31), and speed agility (Hedges g = 0.29; 95% CI, 0.07-0.51).

Conclusions and Relevance  The findings suggest that quality-based PE interventions are associated with small increases in both student health-related physical fitness components and FMSs regardless of frequency or duration of PE lessons. Because PE aims to improve more than health, high levels of active learning time may need to be balanced with opportunities for instruction, feedback, and reflection.

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