Active Schools in Europe—A Review of Empirical Findings

Citation: Bailey, R.; Ries, F.; Scheuer, C. Active Schools in Europe—A Review of Empirical Findings. Sustainability 2023,15, 3806. https://doi.org/10.3390/ su15043806 Academic Editor: Giuseppe Battaglia Received: 13 November 2022 Revised: 19 January 2023 Accepted: 1 February 2023 Published: 20 February 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). sustainability Review Active Schools in Europe—A Review of Empirical Findings Richard Bailey 1,2 , Francis Ries 3and Claude Scheuer 4,* 1Faculty of Social Sciences and Liberal Arts, UCSI University, Jalan Menara Gading, Cheras, Kuala Lumpur 56000, Malaysia 2Centre of Research for Mental Health and Wellbeing, UCSI University, Jalan Menara Gading, Cheras, Kuala Lumpur 56000, Malaysia 3Physical Education and Sports, Faculty of Educational Sciences, University of Seville, 41013 Sevilla, Spain 4European Physical Education Association, 8551 Noerdange, Luxembourg *Correspondence: [email protected] Abstract: Physical activity is an important part of children’s and young people’s healthy functioning, but evidence suggests many students are inactive to the extent that they are compromising their well-being. Traditionally, schools have played a minor role in contributing to physical activity, but it has held relatively low prestige. Some commentators have called for Whole-School or Active School approaches. Physical activity, in these models, is integrated into all aspects of school life. This article reports on a review of the most-cited elements of school-based physical activity promotion, assesses evidence of actual and potential contributions, and provides a tentative weight of evidence judgement for each component. A rapid reviewing methodology was followed, and the searches used a range of specialist academic databases (PsycARTICLES, PsycINFO, SPORTdiscus, CINAHL Complete), Google Scholar, ResearchGate, and Academia.edu, restricted to 2010–2021. Six settings were found to have the potential to add physical activity time, although none suffices alone: Active Breaks; Active Homework; Active Learning; Active Recess; Active Transport; and School Sports. Active Schools offer a plausible solution to the problem of physical inactivity by adding moments of movement and integrating physical activity in all aspects of school life, underlining the need for school-level change, the consideration of stakeholder groups, and the social and physical environments of school. Keywords: active breaks; active classrooms; active homework; active recess; active travel; adolescents; children; physical activity; physical education; school sports 1. Introduction Schools are expected to fulfil many different roles, but most would probably agree that two ambitions are central: the development of students’ well-being and the knowledge, skills, attitudes, and values likely to encourage a happy and successful life [ 1 ]. Curriculum content has developed to support the constitutive elements of these ambitions. Among them, physical education (PE), sports, and other forms of physical activity (PA) have been recruited to play a role. Traditionally, however, these activities have held relatively low prestige, often justified as a break from the real business of schooling, namely academic work [ 2 ]. This situation changed significantly in recent years as falling levels of PA have led international agencies, national governments, and agencies to sound calls of alarm about rising incidents of non-communicable diseases, such as Type 2 diabetes, heart disease, and obesity [ 3 ]. Due to sitting behavior established at school, children and adolescents are also increasingly experiencing musculoskeletal disorders [4]. Despite the fact that regular PA is near-universally acknowledged to be an important part of children’s and young people’s healthy functioning, there is compelling and alarming evidence that large numbers of youth are inactive to the extent that they are compromising their well-being, both now and in later life [ 5 ]. Obese children and adolescents are around five times more likely to be obese in adulthood [ 6 ]. Globally, 50% of children do not meet the Sustainability 2023,15, 3806. https://doi.org/10.3390/su15043806 https://www.mdpi.com/journal/sustainability Sustainability 2023,15, 3806 2 of 22 internationally recognized target of 60 min moderate-to-vigorous physical activity (MVPA) per day [ 7 , 8 ]. This figure rises to 80% in higher-income countries [ 8 ] and persists into adolescence [ 9 ]. As the great majority of children have exposure to school, it is unsurprising that European policies promote whole-school approaches as one of the most promising investments for childhood and youth PA [ 4 ]. Indeed, for a growing number of children, schools provide the main opportunity for regular, structured sports and PA. A combination of economic pressures and parental safety concerns means fewer children can play games in non-school settings [ 10 ]. Therefore, schools’ unique societal position has led to calls that they engage with public health issues, for example PA, more fully. Clearly, the traditional framing of PA in school—primarily through PE lessons and, less often, school sports—will not suffice to meet this challenge. PE alone rarely occupies enough curriculum space to provide enough frequency, intensity, and duration of PA to accrue health benefits [ 11 , 12 ], and voluntary sports clubs often struggle to include precisely the students who need PA the most [ 13 ]. Many commentators have called for more comprehensive, whole-school, or Active School approaches [ 4 , 14 – 16 ]. In these approaches, PA is no longer isolated to PE or clubs, nor is it the sole responsibility of PE teachers [ 17 ]. It has also become clear that, along with increasing PA, schools’ learning and living environments must change. Active School concepts consider the whole system and are “cause oriented” [ 4 ]. Some commentators have conceptualized school environments as complex adaptive subsystem [ 18 ] characterized by dynamic networks of interactions that produce emergent effects greater than the sum of the components [ 19 ]. The development and application of knowledge in this emergent field have been slowed by its inherent theoretical complexity and the limited knowledge of the existing evidence related to its components. This paper can be understood as a contribution to this second concern. It presents an overarching review of the most-cited elements of school-based PA interventions and practices, assesses evidence of actual and potential contributions to students’ healthenhancing PA, and provides a tentative weight of evidence judgment for each component. This is the first holistic review of the outcomes associated with Active Schools. This approach seems appropriate as the Active Schools concept posits a synergistic effect in which discrete elements interact to create a school-wide impact. In other words, Active Schools inherently involve comprehensive oversight. This article concludes by evaluating the extent to which the notion of Active Schools might offer a practical, sustainable solution to the global challenges to children’s and young people’s well-being due to inactivity and sedentary lifestyles. 2. Methods Evidence for these reviews was gathered using a rapid reviewing methodology. Rapid reviewing has become an increasingly popular form of evidence synthesis in which components of the systematic review process are simplified or omitted to produce information more quickly and/or for a more variegated response [ 20 ]. The multifaceted nature of the present study meant that a systematic review was not a viable option. However, the authors’ hope was to realize some of the virtues of systematic reviewing without becoming overcome by its inherent restrictions. Searches used a range of specialist academic databases (PsycARTICLES, PsycINFO, SPORTdiscus, CINAHL Complete), Google Scholar, ResearchGate, and Academia.edu. The rationale for including the more general sources (Scholar, etc.) was partly a hope that they might generate findings that have been missed by the academic databases (this turned out not to be the case) and partly because they contain relevant research-orientated materials produced outside of traditional scientific publishing (the so-called ‘grey literature’), which would be useful for informing the context of this study. Recommendations were made by members of the HEPAS (Healthy and Physically Active Schools in Europe) project team (see Acknowledgements for further details), who were sent a penultimate draft of the report and essentially acted as internal reviewers. The following criteria were used to keep searches focused: Sustainability 2023,15, 3806 3 of 22 •Published from 1 January 2010 to 30 May 2021; • Study sample is made up wholly or mainly of school-aged children within the range of European nations (4-years-old to 17-years-old); •Study conducted in either primary or secondary schools; •Study investigated PA outcomes either as the sole or substantial focus; •Empirical study or systematic review; •Empirical studies based substantially or wholly in Europe. These criteria were used to guide the recruitment of the most relevant studies. Following some earlier rapid reviews, we did not follow search strategies that rigorously excluded potential sources (such as PRISMA) but relied on the study’s aims and the exclusion criteria to inform judgments about relevance. Initial searches were conducted in English, followed by German, French, Spanish, and Czech. The search used broad MeSH terms (Medical Subject Headings) to capture the most current studies and reviews. For example, “recess” AND “physical activity” AND “children”. Data on each context of interest were extracted, and the findings were validated with reference to other gathered data and published reviews. These data-sets were then used as the sources for the creation of the narrative commentaries that appear later in this article. This approach was selected as most appropriate to reflect the variegated settings and the imperative to interpret findings in practically orientated ways. The reviews were limited by a focus on school-setting and school-aged children and young people. The general approach followed an earlier set of PA reviews by Public Health England [ 21 ]. As such, it involved a purposive search, integration, and translation of relevant literature related to contexts for Active Schools. Once the different reviews had been completed, a group of experts (see Acknowledgements) independently evaluated the weight of evidence pertaining to the findings of each activity setting. Discrepancies were discussed, and a consensus was agreed upon for each area. 3. Results 3.1. Physical Activity Settings at School As for the setting Physical Activity, 14 relevant systematic reviews were identified: five for Active Breaks, one for Active Learning, six for Active Recess and two for Active Transport (Table 1). Table 1. Physical Activity Settings at School—Systematic Reviews. Area Source Countries of Authors Type of Review Age Phase Sample Key Findings Active Breaks Daly-Smith, Zwolinsky, McKenna, et al. (2018) UK/US Systematic review 4–17 year olds Inclusion criteria were focused on school-based bouts of classroom movement breaks with 4–17 year olds. Searches of eight scientific databases (to July 2017) Three studies assessed PA. Interventions replaced sedentary time with either LPA or MVPA depending on design characteristics (mode, duration, intensity). Classroom movement break increased PA Sustainability 2023,15, 3806 4 of 22 Table 1. Cont. Area Source Countries of Authors Type of Review Age Phase Sample Key Findings Active Breaks Erwin, Fedewa, Beighle, et al. (2012) US Systematic review Searches of five scientific database, plus cascading using references in included studies. The range was Jan 1990–February 2010. six studies measured effects of Active Breaks on PA. Breaks increased amount of PA in each school day. Primary school students affected most by interventions. Intervention length did not significantly influence intervention effect. Active Breaks Masini, Marini, Gori, et al. (2020) Italy Systematic review Searches of six databases and grey literature, with no time restriction and up to April 2019. Twenty-two intervention studies were found. Active Breaks interventions had a significant effect in increasing both MVPA and step count in primary school children. Active Breaks Norris, van Steen, Direito, et al. (2019) UK, Netherlands, Singapore, Australia Metaanalysis Six searches of six databases and grey literature; no time restriction up to April 2019. Reference cascading in included studies. Forty-two studies (thirty-nine preschool or elementary) identified. Active lessons produced significant increases in lesson-time PA, small increases on overall PA. Active Breaks Watson, Timperio, Brown, et al. (2017) Australia Systematic review 5–12 years of age Searches of four databases and grey literature up to January 2017 were carried out. Thirty-nine studies met the inclusion criteria, and sixteen provided sufficient data and appropriate design for inclusion in the meta-analyses. Results of meta-analyses showed no effect for PA. Active Learning Norris, Shelton, Dunsmuir, et al. (2015) UK (England) and Australia Systematic review Any age group of school students Eleven studies were identified: five examined PA outcomes only; three examined educational outcomes only; and three examined both PA and educational outcomes. All studies found improved PA following active lessons: either in the whole intervention group or specific demographics. Educational outcomes either significantly improved or no different. Sustainability 2023,15, 3806 5 of 22 Table 1. Cont. Area Source Countries of Authors Type of Review Age Phase Sample Key Findings Active Recess Broekhuizen, Scholten and De Vries (2014) Netherlands Systematic review 2–18 years old Thirteen experimental and seventeen observational studies Experimental studies generated moderate effects after the provision of play equipment, inconclusive evidence for use of playground markings, allocating play space and multi-component interventions. No evidence of increasing recess duration on health. Observational studies showed positive associations between equipment and PA level. Significant associations found between PA and decreased playground density and increased recess duration. density, the promotion of PA by staff. Active Recess Escalante, GarcíaHermoso, Backx, et al. (2014) Spain and UK (Wales) Systematic review 2–12 years Eight articles met the inclusion criteria The strategies had potential to increase PA during recess. Cumulative evidence was (i) interventions based on playground markings, game equipment, or a combination of the two, do not increase children’s PA during recess; (ii) interventions based on playground markings plus physical structures increase the PA of schoolchildren during recess in the short to medium term. Active Recess Ickes, Erwin and Beighle (2013) US Systematic review Preschools and elementary/primary schools Thirteen interventions represented both settings within the U.S and internationally Strategies included: added equipment/materials, markings, zones, teacher involvement, active video games, activity of the week, and activity cards. Of included studies, 95% demonstrated positive outcomes as a result of the recess intervention. Sustainability 2023,15, 3806 6 of 22 Table 1. Cont. Area Source Countries of Authors Type of Review Age Phase Sample Key Findings Active Recess Parrish, Okely, Stanley, et al. (2013) Australia Systematic review 5–18 years Nine articles met the inclusion criteria Inconclusive findings for all intervention types. Five studies demonstrated positive intervention effects on PA levels, with four reporting statistically significant increases and two reporting significant decreases in recess PA. Active Recess Reilly, Johnston, McIntosh, et al. (2016) UK (Scotland) Systematic review Primary and high school children Twenty-four eligible studies of primary school students; two eligible studies of high school students. Recess made a small contribution to daily MVPA. Substantial policy effort is likely to be needed if recess is to make a more useful contribution to MVPA among children and adolescents. Active Recess Ridgers, Salmon, Parrish, et al. (2012) Australia Systematic review 5–18 years Fifty-three studies Positive associations were found between overall facility provision, unfixed equipment, and perceived encouragement and recess PA. Results revealed boys were more active than girls. Active Transport Larouche, Saunders, Faulkner, et al., 2014 Canada Systematic review 5.0 to 17.9 years old Sixty-eight studies Active Transport users were more active inactive peers and interventions lead to increases in PA. All studies with relevant measures found a positive association between cycling to/from school and fitness. Active Transport Martin, Kelly, Boyle, et al. (2016) UK (Scotland) Systematic review and metaanalysis Primary and Secondary aged students Twelve studies 17 min per day MVPA accumulated walking to/from school in primary pupils; 13 min in high school pupils. Walking to/from school contributed 23% and 36% of MVPA on schooldays in primary school age children and high school pupils, respectively. Sustainability 2023,15, 3806 7 of 22 3.1.1. Active Breaks Active Breaks are short duration (typically 5–15 min) sessions of PA, usually led by class teachers or other members of school personnel, during classroom-based lessons. Active Breaks can take various forms, and many curricula have been developed, tested, and disseminated, i.e., [ 22 ]. Teachers tend to combine pre-produced and self-developed activities. Some active break strategies involve stopping instruction for several minutes, asking students to stand or move elsewhere in the classroom, or having the teacher or a video lead a guided activity that involves movement. These activities’ duration, intensity, and structure can vary considerably [ 23 ]. Active Breaks are unusual within the PA opportunities discussed in this report, as their implementation depends on decisions made by classroom teachers. Many classroom teachers do not have experience implementing Active Breaks, and the limited evidence indicates they are not widely used in primary school classrooms and barely in secondary schools [23]. Five systematic reviews or meta-analyses of Active Breaks met the inclusion criteria [ 18 , 24 – 27 ]. These reviews support the claim that Active Breaks increase children’s PA levels. However, a relatively high number of studies reviewed were of low methodological quality. Except for the Irish program devised as part of Murtagh, Mulvihill, and Markey [ 28 ], existing programs have tended to have taken place in the US. Therefore, findings from these reviews should be interpreted with caution. Several PA interventions have identified factors that mediate successful Active Breaks interventions, such as time, resource availability, and a supportive school climate might affect implementation [ 29 ]. Schools are also under performance pressure to achieve academic objectives, which often reduces PE time and PA opportunities [ 30 ]. Therefore, a successful school-based PA scheme should be integrated into the curriculum and the school day. The Active Breaks discussed in the studies of this review varied in duration from 4 min to 20 min. Activities tended to focus on aerobic exercise (e.g., marching with arm movements, jogging, running, jumping, and hopping). There are numerous ways of applying Active Breaks in classrooms, such as using pre-packaged programs, video exercise guides, and/or creating and implementing their own strategies. Previously evaluated programs that have integrated Active Breaks found that they can promote PA, increase time on tasks and improve academic performance. Evidence suggests that well-designed active break programs can significantly impact children’s PA. For example, one case study showed the incorporation of structured Active Breaks increased MVPA for preschoolers, accounting for 60–90% of time spent in MVPA at school [ 31 ]. Another study provided strong evidence that the Take 10! Program increased PA levels in children from 5–10 years old, in various contexts, in different countries. The review of empirical research based on the scheme reported at least a 13% increase in PA levels [32]. As with PA, in general, girls tend to be less active during Active Breaks than boys [ 33 ]. Girls spend less time in light PA (LPA) and MVPA and are more inactive than boys. However, possibly due to their lower baseline scores, girls respond better to active break interventions [ 33 ]. In addition, gender differences have been reported in delivery methodologies, with girls responding better to educational components based on social learning theory, while boys may be more influenced by structural and environmental changes facilitating increased PA [34]. Teachers are critical in implementing successful programs by demonstrating, motivating, and monitoring PA sessions [ 33 ]. Active Breaks can address the lack of some teachers’ knowledge and support the positive role that activity plays in the learning environment. Empirical studies suggest Active Breaks are generally popular with both students and teachers. No evidence has been found that they necessarily interfered with classroom learning or affected student behavior detrimentally [ 32 , 35 ]. Teachers tend to prefer Active Breaks of relatively low intensity, seeing VPA Active Breaks as disruptive to their teaching [ 36 ], which is unfortunate as VPA is more beneficial in terms of both physical health and academic effects [ 37 ]. Some evidence suggests that frequent, short MVPA Active Breaks offer a feasible alternative to VPA breaks, leading to positive outcomes [38]. Sustainability 2023,15, 3806 8 of 22 Overall, the evidence demonstrates that Active Breaks increase students’ PA levels. Other reported benefits include healthier weight status, improved behavior, enhanced cognition, and greater enjoyment. As with other aspects of PA outcomes, the successful implementation of Active Breaks seems to depend on several contextual factors, including: •Availability of relevant resources; •Teacher and senior management support; •Positive teacher attitudes [39]. A word of caution should be sounded, too. Many of the published studies on Active Breaks are of relatively low quality, and there is high variability in important design features, intervention methods, duration and intensity, and outcome measures. Therefore, further work in this area is needed. Nevertheless, Active Breaks seem a potentially valuable source of PA that enhances, rather than interferes with, wider educational outcomes. 3.1.2. Active Homework Active Homework has been proposed as a possible way of promoting PA among students by extending the time available for schools to influence students’ health behaviors [ 40 ]. Homework activities can be designed for students to apply and practice the skills learned in PE lessons and might take place at home (with or without parents’ involvement) and in nearby sporting environments or facilities [ 41 ]. According to Kääpä, Palomäki, Vähä-Ypyä, et al. [ 40 ], students can find homework connected to PE lessons enjoyable and beneficial. For example, students reported positive responses to homework that included practicing with family members. In addition, it has been found that Finnish students enjoy participating in planning PE homework [ 40 ]. One part of the rationale of Active Homework is to encourage students to become familiar with their local environments and available facilities to help make PA part of their lifestyles [42]. The evidence base regarding Active Homework is limited. Only one short review of the literature has been carried out in this area [ 43 ], which included no relevant studies for this report. Three empirical studies were identified that examined the relationship between Active Homework and PA [ 44 , 45 ], but only one was based in Europe. The sole European study was concerned with Finnish adolescent girls in a journal of questionable quality and with neither controls nor pre–post measures [ 40 ]. Active Homework represented a small part of the students’ whole-day PA, averaging 34 min per week. In total, 38% of the girls met the recommended levels of PA, which, in light of the mean PA results, implies that a substantial number of girls engaged in minimal PA (although this is not mentioned in the text), so the evidence base related to Active Homework is currently weak. It does seem a plausible strategy, but without credible research findings, the case for Active Homework is unproven. 3.1.3. Active Learning The use of PA in a cross-curricular setting varies considerably. In some countries, PA stands relatively separate from other aspects of schooling, while in others, curriculum guidance makes the expectation of integration with other areas clear [ 46 ]. Many teachers report finding it difficult to win support for adding PA to the school day from colleagues and managers [ 36 ], and time constraints are often significant barriers to implementing new PA [ 47 ], often due to curriculum demands in key learning areas and associated academic accountability pressure [ 48 ]. Therefore, time-efficient PA promotion strategies that contribute to PA promotion without undermining academic achievement are valuable. Active Learning has been proposed as a plausible solution to this challenge. There has been only one systematic review of the impact of Active Learning to date [ 49 ]. The authors aimed to investigate the methods used in interventions to promote PA through physically active lessons while maintaining academic time. All eleven studies in the review found improved PA following classes with Active Learning, either in the whole intervention group or in specific demographics. Educational outcomes either significantly improved or were no different compared with sedentary teaching. Sustainability 2023,15, 3806 9 of 22 Mathematics is the most common focus of studies investigating the effects of integrated PA on academic learning. However, First Language, Foreign Languages, Science, Geography, and general academic performance have also been investigated [ 50 ]. For example, Mullender-Wijnsma, Hartman, de Greef, et al. [ 51 ] developed active academic classroom lessons, primarily focusing on the repetition and memorization of reinforced concepts in mathematics and language. Overall, assessments showed increased on-task behavior and significantly higher test results (e.g., [52]). These studies could be framed as a single hypothesis: children in Active Learning conditions outperform those in non-active conditions in both immediate and delayed tests. This hypothesis was supported by the literature, although it is unclear whether this is due to the integration of PA in classroom lessons or PA per se. Positive effects could simply be due to the wide variety in physical and cognitive development, which is typical with children. This was reflected in the high standard deviations in findings. Or perhaps results were affected by the different types, intensities, and levels of activity in which children in other conditions were involved and the relevance of those PAs to cognitive tasks. Considered as a whole, these findings suggest that Active Learning is a cost-effective, enjoyable, and motivating strategy to increase students’ daily PA at school without undermining other educational goals. On the contrary, the evidence suggests that effective Active Learning programs can enhance academic performance. The papers reviewed here reinforce the importance of acknowledging that positive outcomes from Active Learning do not happen automatically; they are most likely to be realized in association with a series of conducive ‘change mechanisms’. The successful implementation of Active Learning is associated with proactive leadership and teacher support, teacher efficacy regarding mastering the programs, the ease of organizing Active Learning sessions, the genuine inclusion of Active Learning into lesson curricula, and children’s positive reception of the intervention. Therefore, Active Learning will work most effectively when it is part of a whole-school approach to promoting PA in school. 3.1.4. Active Recess Since it presents an opportunity to engage almost all students in daily PA in an environment that often includes space and facilities, recess has been identified as a potentially valuable setting for promoting PA [ 53 ]. Recent years have seen increasing interest in promoting children’s PA during school recess using different strategies, including the introduction of playground markings and games equipment [54]. Six reviews were found related to the relationship between school recess and PA [ 54 – 59 ]. The reviews suggest that recess has the potential to contribute about 40% towards daily PA recommendations [ 54 ], and the school environment is a potentially valuable setting for PA initiatives, particularly schoolyards during recess [60]. Empirical studies suggest that Active Recess periods can contribute to improved fundamental movement skills, weight status, and cognitive performance (e.g., [ 61 ]). However, PA behavior during recess varies widely depending on the space in which recess takes place [ 62 ], facilities [ 63 ], gender [ 64 ], and social grouping [ 65 ]. Studies found that recess PA was associated with aspects of the school’s physical environment; for example, large play spaces [ 66 ], adequate equipment [ 67 ], playground markings [ 68 ], and a clear division by activity type have been reported to be effective in promoting PA during recess [57]. There is some evidence that the physical environment factors that affect PA during recess differ by the culture or lifestyle of countries [69]. The systematic observation literature shows that the amount of MVPA during recess varies between 44% and 66% (e.g., [ 70 , 71 ]). Boys are generally more active than girls during recess, with boys typically spending about 50% of the time in MVPA [ 71 ]. Boys tend to play in larger groups than girls and engage more in sports activities, whereas girls primarily engage in sedentary play [ 67 ]. Girls tend to engage in more prosocial behavior than boys, whereas boys engage in more antisocial behavior than girls [ 71 ]. However, it needs to be acknowledged that there are inconsistent findings, probably due to the issue of different Sustainability 2023,15, 3806 16 of 22 population, and often the involvement of qualified teachers. However, since they are voluntary, these activities tend to be less successful at reaching the hardest-to-reach groups of students. Specially designed interventions are effective with groups such as girls and the overweight/obese. The evidence discussed here, therefore, shows potentially important contributions, but none of these should be accepted as given; the choice of activities, the way they are presented and supervised, and the underlying ethos of the school sports clubs and programs are of fundamental importance in determining any effects they have on students. 4. Conclusions Due to the widespread problem of sedentarism and the sustained advance of obesity among children and adolescents, regular PA has become a public priority. Today’s generation of children is the least active in history. To effectively address such high levels of concern, schools have been identified as key settings for promoting MVPA and reducing sedentary time. However, for most European students, schools are still the settings of the most sedentary parts of their day. Data from longitudinal studies with objective measures of PA suggest that the standard model of a school is poorly suited for the promotion of PA as MVPA begins to decline and sedentary behavior begins to increase from around the time young children first enter schools [ 127 ]. Consequently, policymakers and practitioners should consider investing in Active School concepts such as promising resources and opportunities for school students to be engaged in PA. In addition to the self-evident value of improving children’s and young people’s well-being and combating factors associated with the reduced quality and length of their lives, embedding physical activity within all aspects of school life can positively support academic performance and achievement in a relatively low-cost and sustainable way [ 26 ]. It may also help to reduce transport’s major contribution to global CO 2 emissions [ 128 ]. Schools have several distinctive characteristics that mean they are well-placed to act as foundational settings for the promotion of “sustainable physical activity” [ 129 ], as well as wider sustainability goals: • Schools can reach almost all children, and have long-term, in-depth contact with them, creating a unique opportunity to reach a wide range of children across the population, regardless of social background [130]; • This contact happens during a crucial period of development, during which many health-related behaviors and interests are formed which can be carried forward into later life [131]; • Schools present a unique setting for integrating PA with other sustainability related messages [132]; • Schools, especially primary schools, often act as hubs of community activities, creating a focal point for sustainable PA opportunities, both directly (by organizing schoolbased learning experiences), and indirectly (by encouraging appropriate activities at home, in the neighborhood, and during commuting to and from school) [133]; • Integrating PA, health, and other sustainability related materials into school lessons is likely to a significantly lower economic cost to local and national agencies that introduce such content in extracurricular contexts. Each of the settings of Active Schools discussed in the present review have the potential to add time to PA, although it seems that none will be able to do this alone. The positive effects of many of the items characterizing an Active School concept are based on rigorous scientific evidence; others still require further research. PA settings at school, such as Active Breaks, seem to increase students’ PA levels but depend on numerous contextual factors. More reliable research findings are needed to support the influence of Active Homework on children’s PA. Positive outcomes from Active Learning will only work successfully as part of a whole-school concept. Inconsistent findings about Active Recess call for additional clarifications. Furthermore, Active Transport to and from school needs to be encouraged as current patterns are a cause for concern due to decreasing levels of walking and cycling, and a shift towards greater car use brings with it considerable harm Sustainability 2023,15, 3806 17 of 22 to the environment. In light of the considerable variation in Active Transport opportunities in different parts of Europe, further research might profitably narrow its focus on specific countries’ policies, infrastructure, and practices. Additionally, and in the context of PE, the present review reveals that most lessons need to increase the level of MVPA and enhance students’ engagement to strongly affect overall PA levels. Finally, School Sports can also positively impact PA depending on the activities and the underlying ethos of the school sports clubs and programs. The Active School concept is called on to maximize student benefits by combining two substantial effects related to the promotion of PA, and the participation and the interaction of all factors. By adding moments of engagement in PA throughout the school day, from relatively brief and LPA bursts from Active Learning to longer periods, including MVPA and VPA, in PE and school sports, Active Schools should contribute to the integration of PA in all aspects of school time and life beyond school. By combining positive early PA experiences, as well as the development of appropriate knowledge (e.g., of the rules of games), skills (e.g., basic movements), attitudes (e.g., positive feelings towards PA, importance of intrinsic motivation for sustained participation in PA), and values (e.g., believing PA is important), sustained participation in PA would be guaranteed. Active Schools aim to increase the quantities of PA, but this is most likely to happen when attention is also paid to the quality of those PA experiences. Thus, the multifactorial nature of an Active School concept offers a holistic presentation of these competencies such that, when done well, the whole is greater than the sum of its parts. The so-called ‘whole-school concept’ underlines the need to focus on school-level change, the role of each key stakeholder group (e.g., teachers and teacher educators, parents, school leaders, health specialists) and the social and physical environments (e.g., engagement and support among stakeholders, playground, green space), not only the interventions within the mentioned chances for promoting PA among youth. Author Contributions: Conceptualization, R.B. and C.S.; methodology, R.B.; formal analysis, R.B.; writing—original draft preparation, R.B.; writing—review and editing, F.R. and C.S.; project administration, C.S.; funding acquisition, C.S. All authors have read and agreed to the published version of the manuscript. Funding: This study was a part of the ‘Healthy and Physically Active Schools in Europe’ (HEPAS) project, funded by the European Union’s Erasmus+ scheme, grant number 2019-1-LU01-KA201-050112. Acknowledgments: We thank colleagues in the following organizations for their support: Université du Luxembourg, International Sport and Culture Association, Deporte para la Educacion y la Salud (Spain), European Physical Education Association, and Magyar Diaksport Szovetseg (Hungary). Conflicts of Interest: The authors declare no conflict of interest. References 1. Wolbert, L.; de Ruyter, D.; Schinkel, A. The flourishing child. J. Philos. Educ. 2021,55, 698–709. [CrossRef] 2. Bleazby, J. Why some school subjects have a higher status than others: The epistemology of the traditional curriculum hierarchy. Oxf. Rev. Educ. 2015,41, 671–689. [CrossRef] 3. González, K.; Fuentes, J.; Márquez, J.L. Physical inactivity, sedentary behavior and chronic diseases. Korean J. Fam. Med. 2017 ,38, 111. [CrossRef] [PubMed] 4. Leitner, M. The Austrian Moving School Model: School Quality Means Enabling the Children to Live out Their Natural Need for Exercise. Discussion Paper. EU-OSHA European Agency for Safety and Health at Work. 2020. Available online: https://healthy-workplaces.eu/en/tools-and-publications/publications/austrian-moving-school-model-school-qualitymeans-enabling#pk_campaign=sm_ (accessed on 1 August 2022). 5. Kohl, H.W., III; Craig, C.L.; Lambert, E.V.; Inoue, S.; Alkandari, J.R.; Leetongin, G.; Kahlmeier, S. Lancet Physical Activity Series Working Group. The pandemic of physical inactivity: Global action for public health. Lancet 2012,380, 294–305. [CrossRef] 6. Simmonds, M.; Llewellyn, A.; Owen, C.G.; Woolacott, N. Predicting adult obesity from childhood obesity: A systematic review and meta-analysis. Obes. Rev. Off. J. Int. Assoc. Study Obes. 2016,17, 95–107. [CrossRef] 7. Breda, J.; Jakovljevic, J.; Rathmes, G.; Mendes, R.; Fontaine, O.; Hollmann, S.; Rütten, A.; Galea, G. Promoting health-enhancing physical activity in Europe: Current state of surveillance, policy development and implementation. Health Policy 2018 ,122, 519–527. [CrossRef] Sustainability 2023,15, 3806 18 of 22 8. Tremblay, M.S.; Barnes, J.D.; González, S.A.; Katzmarzyk, P.T.; Onywera, V.O.; Reilly, J.J.; Tomkinson, G.R. Global matrix 2.0: Report card grades on the physical activity of children and youth comparing 38 countries. J. Phys. Act. Health 2016 ,13, S343–S366. [CrossRef] 9. Guthold, R.; Stevens, G.A.; Riley, L.M.; Bull, F.C. Worldwide trends in insufficient physical activity from 2001 to 2016: A pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet Glob. Health 2018,6, e1077–e1086. [CrossRef] 10. Cope, E.C.; Bailey, R.P. A Review of Research and Evidence on Factors That Impact on Children’s Sport and Physical Activity Behaviours and Attitudes; Sport England: London, UK, 2017. 11. Hollis, J.L.; Williams, A.J.; Sutherland, R.; Campbell, E.; Nathan, N.; Wolfenden, L.; Morgan, P.J.; Wiggers, J. A systematic review and meta-analysis of moderate-to-vigorous physical activity levels in elementary school physical education lessons. Prev. Med. 2016,86, 34–54. [CrossRef] 12. Hollis, J.L.; Sutherland, R.; Williams, A.J.; Campbell, E.; Nathan, N.; Wolfenden, L.; Morgan, P.J.; Wiggers, J. 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. [CrossRef] 13. Schaillée, H.; Haudenhuyse, R.; Bradt, L. Community sport and social inclusion: International perspectives. Sport Soc. 2019 ,3, 885–896. [CrossRef] 14. Böcker, P. Projektwoche—Bewegte Zeit in der Ganztagsschule. In Bewegung und Sport in der Ganztagsschule—StuBSS: Ergebnisse der qualitativen Studie: Studie zur Entwicklung von Bewegung, Spiel und Sport in der Ganztagsschule (StuBSS); Hildebrandt-Stramann, R., Laging, R., Teubner, J., Eds.; Schneider-Verlag Hohengehren: Baltmannsweiler, Germany, 2014; pp. 533–562. 15. Pavelka, J.; Sigmund, E.; Sigmundová, D. Analýza organizaˇcních a materiálních podmínek pro pohybovou aktivitu a tˇelesnou výchovu na školách v ˇ Ceskérepublice. TˇelesnáKult. 2014,37, 9–22. [CrossRef] 16. Volkmann, V. Gesundheit fördern: Bestandsaufnahme und Perspektiven für den Schulsport. Sportpädagogik 2015,39, 2–5. 17. Dinkel, D.; Schaffer, C.; Snyder, K.; Lee, J.M. They just need to move: Teachers’ perception of classroom physical activity breaks. Teach. Teach. Educ. 2017,63, 186–195. [CrossRef] 18. Daly-Smith, A.J.; Zwolinsky, S.; McKenna, J.; Tomporowski, P.D.; Defeyter, M.A.; Manley, A. Systematic review of acute physically active learning and classroom movement breaks on children’s physical activity, cognition, academic performance and classroom behaviour: Understanding critical design features. BMJ Open Sport Exerc. Med. 2018,4, e000341. [CrossRef] 19. Luke, D.A.; Stamatakis, K.A. Systems science methods in public health: Dynamics, networks, and agents. Annu. Rev. Public Health 2012,33, 357. [CrossRef] 20. Khangura, S.; Konnyu, K.; Cushman, R.; Grimshaw, J.; Moher, D. Evidence summaries: The evolution of a rapid review approach. Syst. Rev. 2012,1, 10. [CrossRef] 21. Chalkley, A.; Milton, K.; Foster, C. Change4Life Evidence Review: Rapid Evidence Review on the Effect of Physical Activity Participation among Children Aged 5–11 Years; Public Health England: London, UK, 2015. 22. Watson, A.; Timperio, A.; Brown, H.; Hesketh, K. A primary school active break programme (ACTI-BREAK): Study protocol for a pilot cluster randomised controlled trial. Trials 2017,18, 433. [CrossRef] 23. Turner, L.; Calvert, H.G.; Carlson, J.A. Supporting Teachers’ Implementation of Classroom-Based Physical Activity. Transl. J. Am. Coll. Sport. Med. 2019,4, 165–172. [CrossRef] 24. Erwin, H.; Fedewa, A.; Beighle, A.; Ahn, S. A quantitative review of physical activity, health, and learning outcomes associated with classroom-based physical activity interventions. J. Appl. Sch. Psychol. 2012,28, 14–36. [CrossRef] 25. Masini, A.; Marini, S.; Gori, D.; Leoni, E.; Rochira, A.; Dallolio, L. Evaluation of school-based interventions of active breaks in primary schools: A systematic review and meta-analysis. J. Sci. Med. Sport 2020,23, 377–384. [CrossRef] [PubMed] 26. Norris, E.; van Steen, T.; Direito, A.; Stamatakis, E. Physically active lessons in schools: A systematic review and meta-analysis of effects on physical activity, educational, health and cognition outcomes. Br. J. Sport. Med. 2020 ,54, 826–838. [CrossRef] [PubMed] 27. Watson, A.; Timperio, A.; Brown, H.; Best, K.; Hesketh, K.D. Effect of classroom-based physical activity interventions on academic and physical activity outcomes: A systematic review and meta-analysis. Int. J. Behav. Nutr. Phys. Act. 2017,14, 114. [CrossRef] 28. Murtagh, E.; Mulvihill, M.; Markey, O. Bizzy Break! The effect of a classroom-based activity break on in-school physical activity levels of primary school children. Pediatr. Exerc. Sci. 2013,25, 300–307. [CrossRef] 29. Innerd, A.L.; Azevedo, L.B.; Batterham, A.M. The effect of a curriculum-based physical activity intervention on accelerometerassessed physical activity in schoolchildren: A non-randomised mixed methods controlled before-and-after study. PLoS ONE 2019,14, e0225997. [CrossRef] 30. Huberty, J.; Dinkel, D.; Coleman, J.; Beighle, A.; Apenteng, B. The role of schools in children’s physical activity participation: Staff perceptions. Health Educ. Res. 2012,27, 986–995. [CrossRef] 31. Wadsworth, D.D.; Robinson, L.E.; Beckham, K.; Webster, K. Break for physical activity: Incorporating classroom-based physical activity breaks into preschools. Early Child. Educ. J. 2012,39, 391–395. [CrossRef] 32. Kibbe, D.L.; Hackett, J.; Hurley, M.; McFarland, A.; Schubert, K.G.; Schultz, A.; Harris, S. Ten Years of TAKE 10! ® : Integrating physical activity with academic concepts in elementary school classrooms. Prev. Med. 2011,52, S43–S50. [CrossRef] 33. Calella, P.; Mancusi, C.; Pecoraro, P.; Sensi, S.; Sorrentino, C.; Imoletti, M.; Franzese, A.; Valerio, G. Classroom active breaks: A feasibility study in Southern Italy. Health Promot. Int. 2020,35, 373–380. [CrossRef] Sustainability 2023,15, 3806 19 of 22 34. Martínez-Vizcaíno, V.; Sánchez-López, M.; Notario-Pacheco, B.; Salcedo-Aguilar, F.; Solera-Martínez, M.; Franquelo-Morales, P.; López-Martínez, S.; Rodríguez-Artalejo, F. Gender differences on effectiveness of a school-based physical activity intervention for reducing cardiometabolic risk: A cluster randomized trial. Int. J. Behav. Nutr. Phys. Act. 2014,11, 154. [CrossRef] 35. Wilson, A.N.; Olds, T.; Lushington, K.; Parvazian, S.; Dollman, J. Active school lesson breaks increase daily vigorous physical activity, but not daily moderate to vigorous physical activity in elementary school boys. Pediatr. Exerc. Sci. 2017 ,29, 145–152. [CrossRef] [PubMed] 36. Watson, A.J.; Timperio, A.; Brown, H.; Hesketh, K.D. A pilot primary school active break program (ACTI-BREAK): Effects on academic and physical activity outcomes for students in Years 3 and 4. J. Sci. Med. Sport 2019 ,22, 438–443. [CrossRef] [PubMed] 37. Singh, A.S.; Saliasi, E.; Uijtdewilligen, L.; Jolles, J.; Andersen, L.B.; Bailey, R.; Chang, Y.-K.; Fedewa, A.L. Effects of physical activity interventions on cognitive and academic performance in children and adolescents: A novel combination of a systematic review and recommendations from an expert panel. Br. J. Sport. Med. 2019,53, 640–647. [CrossRef] 38. Altenburg, T.M.; Chinapaw, M.J.; Singh, A.S. Effects of one versus two bouts of moderate intensity physical activity on selective attention during a school morning in Dutch primary schoolchildren: A randomized controlled trial. J. Sci. Med. Sport 2016 ,19, 820–824. [CrossRef] 39. Carlson, J.A.; Engelberg, J.K.; Cain, K.L.; Conway, T.L.; Geremia, C.; Bonilla, E.; Kerner, J.; Sallis, J.F. Contextual factors related to implementation of classroom physical activity breaks. Transl. Behav. Med. 2017,7, 581–592. [CrossRef] 40. Kääpä, M.; Palomäki, S.; Vähä-Ypyä, H.; Vasankari, T.; Hirvensalo, M. The Role of Physical Education Homework to Adolescent Girls’ Physical Activity in Finland. Adv. Phys. Educ. 2017,9, 223–239. [CrossRef] 41. Vogel, P. Hausaufgaben in einer Bewegten Schule. In Bewegte Schule: Schule Bewegt Gestalten; Hildebrandt-Stramann, R., Ed.; Schneider-Verlag Hohengehren: Baltmannsweiler, Germany, 2007; pp. 246–259. 42. Williams, S.M.; Hannon, J.C. Physical education homework that involves the family. Strategies 2013,26, 3–8. [CrossRef] 43. Hill, K. Homework in physical education? A review of physical education homework literature. J. Phys. Educ. Recreat. Danc. 2018 , 89, 58–63. [CrossRef] 44. Duncan, S.; McPhee, J.C.; Schluter, P.J.; Zinn, C.; Smith, R.; Schofield, G. Efficacy of a compulsory homework programme for increasing physical activity and healthy eating in children: The healthy homework pilot study. Int. J. Behav. Nutr. Phys. Act. 2011 , 8, 127. [CrossRef] 45. Duncan, S.; Stewart, T.; McPhee, J.; Borotkanics, R.; Prendergast, K.; Zinn, C.; Meredith-Jones, V.; Schofield, G. Efficacy of a compulsory homework programme for increasing physical activity and improving nutrition in children: A cluster randomised controlled trial. Int. J. Behav. Nutr. Phys. Act. 2019,16, 80. [CrossRef] 46. North Western Counties Physical Education Association. World-Wide Survey of School Physical Education; UNESCO Publishing: Paris, France, 2014. 47. Naylor, P.J.; Nettlefold, L.; Race, D.; Hoy, C.; Ashe, M.C.; Higgins, J.W.; McKay, H.A. Implementation of school based physical activity interventions: A systematic review. Prev. Med. 2015,72, 95–115. [CrossRef] [PubMed] 48. McMullen, J.; Kulinna, P.; Cothran, D. Physical activity opportunities during the school day: Classroom teachers’ perceptions of using activity breaks in the classroom. J. Teach. Phys. Educ. 2014,33, 511–527. [CrossRef] 49. Norris, E.; Shelton, N.; Dunsmuir, S.; Duke-Williams, O.; Stamatakis, E. Physically active lessons as physical activity and educational interventions: A systematic review of methods and results. Prev. Med. 2015,72, 116–125. [CrossRef] [PubMed] 50. Riley, N.; Lubans, D.R.; Holmes, K.; Morgan, P.J. Findings from the EASY minds cluster randomized controlled trial: Evaluation of a physical activity integration program for mathematics in primary schools. J. Phys. Act. Health 2016,13, 198–206. [CrossRef] 51. Mullender-Wijnsma, M.J.; Hartman, E.; de Greeff, J.W.; Bosker, R.J.; Doolaard, S.; Visscher, C. Moderate-to-vigorous physically active academic lessons and academic engagement in children with and without a social disadvantage: A within subject experimental design. BMC Public Health 2015,15. [CrossRef] 52. Vazou, S.; Skrade, M.A. Intervention integrating physical activity with math: Math performance, perceived competence, and need satisfaction. Int. J. Sport Exerc. Psychol. 2017,15, 508–522. [CrossRef] 53. Hyndman, B. Contemporary School Playground Strategies for Healthy Students; Springer: Singapore, 2017. 54. Parrish, A.M.; Okely, A.D.; Stanley, R.M.; Ridgers, N.D. The effect of school recess interventions on physical activity. Sport. Med. 2013,43, 287–299. [CrossRef] 55. Broekhuizen, K.; Scholten, A.M.; De Vries, S.I. The value of (pre) school playgrounds for children’s physical activity level: A systematic review. Int. J. Behav. Nutr. Phys. Act. 2014,11, 59. [CrossRef] 56. Escalante, Y.; García-Hermoso, A.; Backx, K.; Saavedra, J.M. Playground designs to increase physical activity levels during school recess: A systematic review. Health Educ. Behav. 2014,41, 138–144. [CrossRef] 57. Ickes, M.J.; Erwin, H.; Beighle, A. Systematic review of recess interventions to increase physical activity. J. Phys. Act. Health 2013 , 10, 910–926. [CrossRef] 58. Reilly, J.J.; Johnston, G.; McIntosh, S.; Martin, A. Contribution of school recess to daily physical activity: Systematic review and evidence appraisal. Health Behav. Policy Rev. 2016,3, 581–589. [CrossRef] 59. Ridgers, N.D.; Salmon, J.; Parrish, A.M.; Stanley, R.M.; Okely, A.D. Physical activity during school recess: A systematic review. Am. J. Prev. Med. 2012,43, 320–328. [CrossRef] 60. Dobbins, M.; Husson, H.; DeCorby, K.; LaRocca, R.L. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst. Rev. 2013, CD007651. [CrossRef] Sustainability 2023,15, 3806 20 of 22 61. Pesce, C.; Masci, I.; Marchetti, R.; Vazou, S.; Sääkslahti, A.; Tomporowski, P.D. Deliberate play and preparation jointly benefit motor and cognitive development: Mediated and moderated effects. Front. Psychol. 2016,7, 349. [CrossRef] 62. Pawlowski, C.S.; Tjørnhøj-Thomsen, T.; Schipperijn, J.; Troelsen, J. Barriers for recess physical activity: A gender specific qualitative focus group exploration. BMC Public Health 2014,14, 639. [CrossRef] [PubMed] 63. Nielsen, G.; Bugge, A.; Hermansen, B.; Svensson, J.; Andersen, L.B. School playground facilities as a determinant of children’s daily activity: A cross-sectional study of Danish primary school children. J. Phys. Act. Health 2012 ,9, 104–114. [CrossRef] [PubMed] 64. Andersen, H.B.; Klinker, C.D.; Toftager, M.; Pawlowski, C.S.; Schipperijn, J. Objectively measured differences in physical activity in five types of schoolyard area. Landsc. Urban Plan. 2015,134, 83–92. [CrossRef] 65. Pawlowski, C.S.; Ergler, C.; Tjørnhøj-Thomsen, T.; Schipperijn, J.; Troelsen, J. ‘Like a soccer camp for boys’ A qualitative exploration of gendered activity patterns in children’s self-organized play during school recess. Eur. Phys. Educ. Rev. 2015 ,21, 275–291. [CrossRef] 66. Ridgers, N.D.; Fairclough, S.J.; Stratton, G. Variables associated with children’s physical activity levels during recess: The A-CLASS project. Int. J. Behav. Nutr. Phys. Act. 2010,7, 74. [CrossRef] [PubMed] 67. McKenzie, T.L.; Crespo, N.C.; Baquero, B.; Elder, J.P. Leisure-time physical activity in elementary schools: Analysis of contextual conditions. J. Sch. Health 2010,80, 470–477. [CrossRef] [PubMed] 68. Baquet, G.; Aucouturier, J.; Gamelin, F.X.; Berthoin, S. Longitudinal follow-up of physical activity during school recess: Impact of playground markings. Front. Public Health 2018,6, 283. [CrossRef] [PubMed] 69. Haug, E.; Torsheim, T.; Sallis, J.F.; Samdal, O. The characteristics of the outdoor school environment associated with physical activity. Health Educ. Res. 2010,25, 248–256. [CrossRef] [PubMed] 70. Ridgers, N.D.; Carter, L.M.; Stratton, G.; McKenzie, T.L. Examining children’s physical activity and play behaviors during school playtime over time. Health Educ. Res. 2011,26, 586–595. [CrossRef] [PubMed] 71. Roberts, S.J.; Fairclough, S.J.; Ridgers, N.D.; Porteous, C. An observational assessment of physical activity levels and social behaviour during elementary school recess. Health Educ. J. 2013,72, 254–262. [CrossRef] 72. Coolkens, R.; Ward, P.; Seghers, J.; Iserbyt, P. The effect of organized versus supervised recess on elementary school children’s participation, physical activity, play, and social behavior: A cluster randomized controlled trial. J. Phys. Act. Health 2018 ,15, 747–754. [CrossRef] 73. Erwin, H.; Beighle, A.; Carson, R.L.; Castelli, D.M. Comprehensive school-based physical activity promotion: A review. Quest 2013,65, 412–428. [CrossRef] 74. Haug, E.; Torsheim, T.; Samdal, O. Local school policies increase physical activity in Norwegian secondary schools. Health Promot. Int. 2010,25, 63–72. [CrossRef] 75. Interreg Europe. Promoting Active Modes of Transport; Interreg Europe: Lille, France, 2019. 76. Villa-González, E.; Barranco-Ruiz, Y.; Evenson, K.R.; Chillón, P. Systematic review of interventions for promoting active school transport. Prev. Med. 2018,111, 115–134. [CrossRef] 77. Mammen, G.; Stone, M.R.; Buliung, R.; Faulkner, G. School travel planning in Canada: Identifying child, family, and school-level characteristics associated with travel mode shift from driving to active school travel. J. Transp. Health 2014 ,1, 288–294. [CrossRef] 78. Hopkins, D.; Mandic, S. Perceptions of cycling among high school students and their parents. Int. J. Sustain. Transp. 2017 ,11, 342–356. [CrossRef] 79. Schönbach, D.M.; Altenburg, T.M.; Chinapaw, M.J.; Marques, A.; Demetriou, Y. Strategies and effects of promising school-based interventions to promote active school transportation by bicycle among children and adolescents: Protocol for a systematic review. Syst. Rev. 2019,8, 296. [CrossRef] [PubMed] 80. Hollein, T.; Vašíˇcková, J.; Bucksch, J.; Kalman, M.; Sigmundová, D.; van Dijk, J.P. School physical activity policies and active transport to school among pupils in the Czech Republic. J. Transp. Health 2017,6, 306–312. [CrossRef] 81. Buttazzoni, A.N.; Van Kesteren, E.S.; Shah, T.I.; Gilliland, J.A. Active school travel intervention methodologies in North America: A systematic review. Am. J. Prev. Med. 2018,55, 115–124. [CrossRef] 82. De Meester, F.; Van Dyck, D.; De Bourdeaudhuij, I.; Deforche, B.; Cardon, G. Changes in physical activity during the transition from primary to secondary school in Belgian children: What is the role of the school environment? BMC Public Health 2014 ,14, 261. [CrossRef] [PubMed] 83. Curtis, C.; Babb, C.; Olaru, D. Built environment and children’s travel to school. Transp. Policy 2015,42, 21–33. [CrossRef] 84. Masoumi, H.E.; Zanoli, G.; Papageorgiou, A.; Smaga, S.; Miloš, A.; van Rooijen, M.; Luczak, M.; Ça˘gan, B. Patterns of children’s travel to school, their body weight, spatial factors, and perceptions: A survey on nine European cities. GeoScape 2017 ,11, 52–75. [CrossRef] 85. Ewing, R.; Cervero, R. Travel and the built environment: A meta-analysis. J. Am. Plan. Assoc. 2010,76, 265–294. [CrossRef] 86. Helbich, M.; van Emmichoven, M.J.Z.; Dijst, M.J.; Kwan, M.P.; Pierik, F.H.; de Vries, S.I. Natural and built environmental exposures on children’s active school travel: A Dutch global positioning system-based cross-sectional study. Health Place 2016 ,39, 101–109. [CrossRef] 87. Martínez-Martínez, J.; Aznar, S.; González-Víllora, S.; López-Sánchez, G.F. Physical activity and commuting to school in Spanish nine-year-old children: Differences by gender and by geographical environment. Sustainability 2019,11, 7104. [CrossRef] Sustainability 2023,15, 3806 21 of 22 88. Martin, A.; Kelly, P.; Boyle, J.; Corlett, F.; Reilly, J.J. Contribution of walking to school to individual and population moderatevigorous intensity physical activity: Systematic review and meta-analysis. Pediatr. Exerc. Sci. 2016,28, 353–363. [CrossRef] 89. Larouche, R.; Saunders, T.J.; Faulkner, G.E.J.; Colley, R.; Tremblay, M. Associations between active school transport and physical activity, body composition, and cardiovascular fitness: A systematic review of 68 studies. J. Phys. Act. Health 2014 ,11, 206–227. [CrossRef] 90. Roth, M.A.; Millett, C.J.; Mindell, J.S. The contribution of active travel (walking and cycling) in children to overall physical activity levels: A national cross sectional study. Prev. Med. 2012,54, 134–139. [CrossRef] [PubMed] 91. Chillón, P.; Ortega, F.B.; Ruiz, J.R.; De Bourdeaudhuij, I.; Martínez-Gómez, D.; Vicente-Rodriguez, G.; Sjöström, M.; Ward, D.S. Active commuting and physical activity in adolescents from Europe: Results from the HELENA study. Pediatr. Exerc. Sci. 2011 , 23, 207–217. [PubMed] 92. Masoumi, H.; Rooijen, M.V.; Sierpi´nski, G. Children’s Independent Mobility to School in Seven European Countries: A Multinomial Logit Model. Int. J. Environ. Res. Public Health 2020,17, 9149. [CrossRef] [PubMed] 93. European Parliamentary Research Service. Physical Education in EU Schools; European Union: Brussels, Belgium, 2015. 94. European Commission/EACEA/Eurydice. Physical Education and Sport at School in Europe. Eurydice Report; Publications Office of the European Union: Luxembourg, 2013. 95. Hardman, K. Global issues in the situation of physical education in schools. In Contemporary Issues in Physical Education; Hardman, K., Green, K., Eds.; Meyer & Meyer Sport: Maidenhead, UK, 2011; pp. 11–29. 96. Ptack, K.; Tittlbach, S.; Brandl-Bredenbeck, H.P.; Kölbl, C. Eine Interventionsstudie zum Thema Gesundheit im Sportunterricht: Evaluation Eines Kooperativen Planungsprozesses in der Health-Edu-Studie; Feldhaus, Edition Czwalina: Hamburg, Germany, 2019. 97. Dudley, D.; Okely, A.; Pearson, P.; Cotton, W. A systematic review of the effectiveness of physical education and school sport interventions targeting physical activity, movement skills and enjoyment of physical activity. Eur. Phys. Educ. Rev. 2011 ,17, 353–378. [CrossRef] 98. Errisuriz, V.L.; Golaszewski, N.M.; Born, K.; Bartholomew, J.B. Systematic review of physical education-based physical activity interventions among elementary school children. J. Prim. Prev. 2018,39, 303–327. [CrossRef] 99. Lonsdale, C.; Rosenkranz, R.R.; Peralta, L.R.; Bennie, A.; Fahey, P.; Lubans, D.R. 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, 152–161. [CrossRef] 100. Zhou, Y.; Wang, L. Correlates of Physical Activity of Students in Secondary School Physical Education: A Systematic Review of Literature. BioMed Res. Int. 2019, 4563484. [CrossRef] 101. AfPE (Association for Physical Education). Health Position Paper—2015. 2015. Available online: http://www.afpe.org.uk/ physicaleducation/wp-content/uploads/afPE_Health_Position_Paper_Web_Version2015.pdf (accessed on 1 August 2022). 102. CDC (U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health). Strategies to improve the quality of physical education. 2010. Available online: www.cdc.gov/healthyschools/pecat/quality_pe.pdf (accessed on 1 August 2022). 103. Guijarro, E.; Rocamora, I.; González-Víllora, S.; Arias-Palencia, N.M. The role of physical education in the achievement of international recommendations: A study based on pedagogical models. J. Hum. Sport Exerc. 2019,15, 849–860. [CrossRef] 104. Lyyra, N.; Heikinaro-Johansson, P.; Lyyra, M. Exploring in-class physical activity levels during physical education lessons in Finland. J. Phys. Educ. Sport 2017,17, 815–820. 105. Fröberg, A.; Raustorp, A.; Pagels, P.; Larsson, C.; Boldemann, C. Levels of physical activity during physical education lessons in Sweden. Acta Paediatr. 2017,106, 135–141. [CrossRef] [PubMed] 106. Beets, M.W.; Weaver, R.G.; Turner-McGrievy, G.; Huberty, J.; Ward, D.S.; Pate, R.R.; Freedman, D.; Beighle, A. Making policy practice in afterschool programs: A randomized controlled trial on physical activity changes. Am. J. Prev. Med. 2015 ,48, 694–706. [CrossRef] [PubMed] 107. Demetriou, Y.; Gillison, F.; McKenzie, T.L. After-school physical activity interventions on child and adolescent physical activity and health: A review of reviews. Adv. Phys. Educ. 2017,7, 191–215. [CrossRef] 108. Verbestel, V.; De Henauw, S.; Barba, G.; Eiben, G.; Gallois, K.; Hadjigeorgiou, C. IDEFICS consortium. Effectiveness of the IDEFICS intervention on objectively measured physical activity and sedentary time in European children. Obes. Rev. 2015 ,16, 57–67. [CrossRef] [PubMed] 109. Metcalf, B.; Henley, W.; Wilkin, T. Effectiveness of intervention on physical activity of children: Systematic review and metaanalysis of controlled trials with objectively measured outcomes (EarlyBird 54). BMJ (Clin. Res. Ed.) 2012 ,345, e5888. [CrossRef] [PubMed] 110. Beets, M.W.; Okely, A.; Weaver, R.G.; Webster, C.; Lubans, D.; Brusseau, T.; Carson, R.; Cliff, D.P. The theory of expanded, extended, and enhanced opportunities for youth physical activity promotion. Int. J. Behav. Nutr. Phys. Act. 2016 ,13, 120. [CrossRef] 111. Ring-Dimitriou, S.; Krustrup, P.; Coelho-E-Silva, M.J.; Mota, J.; Seabra, A.; Rego, C. Could sport be part of pediatric obesity prevention and treatment. J. Sport Health Sci. 2019,8, 350–352. [CrossRef] 112. Bangsbo, J.; Krustrup, P.; Duda, J.; Hillman, C.; Andersen, L.B.; Weiss, M.; Williams, C.; Elbe, A.M. The Copenhagen Consensus Conference 2016: Children, youth, and physical activity in schools and during leisure time. Br. J. Sport. Med. 2016 ,50, 1177–1178. [CrossRef] Sustainability 2023,15, 3806 22 of 22 113. Larsen, S.; Dandanell, S.; Kristensen, K.B.; Jørgensen, S.D.; Dela, F.; Helge, J.W. Influence of exercise amount and intensity on long-term weight loss maintenance and skeletal muscle mitochondrial ROS production in humans. Appl. Physiol. Nutr. Metab. 2019,44, 958–964. [CrossRef] 114. Michelini, E.; Thiel, A. The acceptance of “sport” in the communication of the health system. A sociological analysis. Eur. J. Sport Soc. 2013,10, 325–344. 115. Nilsen, A.K.; Anderssen, S.A.; Loftesnes, J.M.; Johannessen, K.; Ylvisaaker, E.; Aadland, E. The multivariate physical activity signature associated with fundamental motor skills in preschoolers. J. Sport. Sci. 2020,38, 264–272. [CrossRef] [PubMed] 116. Grgic, J.; Dumuid, D.; Bengoechea, E.G.; Shrestha, N.; Bauman, A.; Olds, T.; Pedisic, Z. Health outcomes associated with reallocations of time between sleep, sedentary behaviour, and physical activity: A systematic scoping review of isotemporal substitution studies. Int. J. Behav. Nutr. Phys. Act. 2018,15, 69. [CrossRef] [PubMed] 117. Atkin, A.J.; Gorely, T.; Biddle, S.J.; Cavill, N.; Foster, C. Interventions to promote physical activity in young people conducted in the hours immediately after school: A systematic review. Int. J. Behav. Med. 2011,18, 176–187. [CrossRef] [PubMed] 118. Mears, R.; Jago, R. Effectiveness of after-school interventions at increasing moderate-to-vigorous physical activity levels in 5-to 18-year olds: A systematic review and meta-analysis. Br. J. Sport. Med. 2016,50, 1315–1324. [CrossRef] 119. Nielsen, G.; Bugge, A.; Andersen, L.B. The influence of club football on children’s daily physical activity. Soccer Soc. 2016 ,17, 246–258. [CrossRef] 120. Machado-Rodrigues, A.M.; e Silva, M.J.C.; Mota, J.; Santos, R.M.; Cumming, S.P.; Malina, R.M. Physical activity and energy expenditure in adolescent male sport participants and nonparticipants aged 13 to 16 years. J. Phys. Act. Health 2012 ,9, 626–633. [CrossRef] 121. Van Hoye, A.; Fenton, S.; Krommidas, C.; Heuzé, J.P.; Quested, E.; Papaioannou, A.; Duda, J.L. Physical activity and sedentary behaviours among grassroots football players: A comparison across three European countries. Int. J. Sport Exerc. Psychol. 2013 ,11, 341–350. [CrossRef] 122. Guagliano, J.M.; Rosenkranz, R.R.; Kolt, G.S. Girls’ physical activity levels during organized sports in Australia. Med. Sci. Sport. Exerc. 2013,45, 116–122. [CrossRef] 123. Bocarro, J.N.; Kanters, M.A.; Edwards, M.B.; Casper, J.M.; McKenzie, T.L. Prioritizing school intramural and interscholastic programs based on observed physical activity. Am. J. Health Promot. 2014,28, S65–S71. [CrossRef] 124. Sacheck, J.M.; Nelson, T.; Ficker, L.; Kafka, T.; Kuder, J.; Economos, C.D. Physical activity during soccer and its contribution to physical activity recommendations in normal weight and overweight children. Pediatr. Exerc. Sci. 2011,23, 281–292. [CrossRef] 125. Harwood, C.G.; Keegan, R.J.; Smith, J.M.; Raine, A.S. A systematic review of the intrapersonal correlates of motivational climate perceptions in sport and physical activity. Psychol. Sport Exerc. 2015,18, 9–25. [CrossRef] 126. Sasaki, J.E.; Howe, C.A.; John, D.; Hickey, A.; Steeves, J.; Conger, S.; Lyden, K.; Freedson, P.S. Energy expenditure for 70 activities in children and adolescents. J. Phys. Act. Health 2016,13, S24–S28. [CrossRef] [PubMed] 127. Cooper, A.R.; Goodman, A.; Page, A.S.; Sherar, L.B.; Esliger, D.W.; van Sluijs, E.M.; Bo Andersen, L.; Ekelund, U. Objectively measured physical activity and sedentary time in youth: The International children’s accelerometry database (ICAD). Int. J. Behav. Nutr. Phys. Act. 2015,12, 113. [CrossRef] [PubMed] 128. Lu, M.; Schmitz, O.; Vaartjes, I.; Karssenberg, D. Activity-based air pollution exposure assessment: Differences between homemakers and cycling commuters. Health Place 2019,1, 102233. [CrossRef] 129. Bjørnarå, H.B.; Torstveit, M.K.; Stea, T.H.; Bere, E. Is there such a thing as sustainable physical activity? Scand. J. Med. Sci. Sport 2017,27, 366–372. [CrossRef] 130. Martins, J.; Marques, A.; Gouveia, É.R.; Carvalho, F.; Sarmento, H.; Valeiro, M.G. Participation in Physical Education Classes and Health-Related Behaviours among Adolescents from 67 Countries. Int. J. Environ. Res. Public Health 2022,19, 955. [CrossRef] 131. Karnik, S.; Kanekar, A. Childhood obesity: A global public health crisis. Int. J. Prev. Med. 2012,1, 1–7. 132. Timm, J.M.; Barth, M. Making education for sustainable development happen in elementary schools: The role of teachers. Environ. Educ. Res. 2021,2, 50–66. [CrossRef] 133. Daly-Smith, A.; Quarmby, T.; Archbold, V.S.; Corrigan, N.; Wilson, D.; Resaland, G.K.; Bartholomew, J.B.; Chalkley, A. Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework. Int. J. Behav. Nutr. Phys. Act. 2020,17, 13. 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