A Before-School Exercise Program May Help Children Thrive

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A supervised exercise program that gets young children running and playing for an hour before school could make them happier and healthier, while also jibing with the needs and schedules of parents and school officials, according to a new study involving two dozen elementary and middle schools.

The results also caution, however, that the benefits may depend on how often children actually participate.

Physical activity among children in most of the developed world has been on a steep decline for decades. National exercise guidelines in the United States recommend that children and adolescents engage in at least an hour of exercise every day. But by most estimates, barely 20 percent of young people are that active, and many scarcely exercise at all. Meanwhile, rates of obesity among children as young as 2 hover at around 17 percent, according to the Centers for Disease Control and Prevention.

Understandably, many concerned experts have suggested a variety of physical-activity interventions, from more sports programs to the use of “active” video games that allow children to move without relinquishing their screens and joysticks.

But many of these initiatives are expensive, logistically complex, time consuming or otherwise impractical.

So in 2009, a group of mothers in Massachusetts organized a simple, before-school activity program in their local grade school. They opted for the before-school start because they hoped to add to the total amount of time their kids spent moving and not displace existing physical education classes or after-school sports. It also struck many of the working parents as convenient and, apparently, did not lead to bitter complaints from their children about early rising times.

The original one-hour sessions consisted of a warm-up, running, calisthenics and rousing group games like tag, led by parent volunteers. The workouts proved to be so popular that other parents began asking if they could start a similar program at their children’s schools

Today, the program has gained a formal curriculum, a name and acronym, Build Our Kids’ Success (BOKS), along with corporate underwriting from the shoe manufacturer Reebok. (The similarity of the nomenclature is intentional.) It also has become one of the world’s most widely disseminated, free, school-based exercise programs. According to a BOKS spokeswoman, it is used at more than 3,000 schools worldwide.

But popularity is no guarantee of efficacy. So researchers at Harvard University and Massachusetts General Hospital, some of whom have children enrolled in a BOKS program, began to wonder about the measurable impacts of the exercise.

They also were aware that a number of school districts in Massachusetts had plans to allow BOKS at their elementary and middle schools during the 2015 or 2016 school years and, for the new study, which was published this week in the American Journal of Preventive Medicine, asked if they could piggyback their research onto the start of those programs. Principals at 24 schools agreed. The schools included students from a broad spectrum of incomes.

The researchers then asked those families planning to participate in BOKS, which is always voluntary, if they and their children would join a study.

Several hundred students in kindergarten through eighth grade and their parents consented. Other children, who would not be joining the exercise program, agreed to serve as a control group.

The researchers measured everyone’s heights, weights, body mass indexes and, through brief psychological surveys, general happiness, vigor and other signs of well-being.

For 12 weeks, the students then played and ran during before-school exercise. At some schools, the program was offered three times a week, at others twice.

Afterward, the researchers returned and repeated the testing.

At this point, those students who had exercised before school three times per week had almost all improved their B.M.I.s and fewer qualified as obese. (Many had gained weight as children should while they are growing.) They also reported feeling deeper social connections to their friends and school and a greater happiness and satisfaction with life.

Those students who had exercised twice a week also said they felt happier and more energetic. But the researchers found no reductions in their body mass.

The students in the control group had the same B.M.I.s or higher and had no changes to their feelings of well-being.

The upshot is that a one-hour, before-school exercise program does seem likely to improve young people’s health and happiness, says Dr. Elsie Taveras, a professor at Harvard and head of general pediatrics at Massachusetts General Hospital, who oversaw the study and whose children have participated in BOKS. (The experiment was partially funded by the Reebok Foundation, as well as the National Institutes of Health and other sources. None of the funders had control of the design or results, Dr. Taveras says.)

But the benefits are most noticeable if children exercise “at least three times a week,” she says.

This study was short-term, though, and looked only at a few, narrow physical and emotional impacts. Dr. Taveras and her colleagues hope soon to track the program’s impacts, if any, on academics and on aerobic fitness.

Perhaps most important, the study was not randomized. It involved self-selected students and families who chose to join. The results, in theory, would apply only to the kinds of children who will get up early and run and hop and skip and squeal for an hour before school.

But, Dr. Taveras says, those should be all children.

“In my experience as a pediatrician and parent, kids naturally love to move,” she says. “They revel in it. We have socialized that love out of them.”

She believes that programs such as the one in this study might help to re-instill some of our children’s instinctual pleasure in motion, she says.

“I’ve watched” sessions, she says. “You can see the kids light up with joy.”