Cost-effectiveness of a state policy requiring minimum levels of moderate and vigorous physical activity during elementary school physical education classes

Introduction: Children are not meeting physical activity recommendations; typical physical education (PE) classes engage children in moderate and vigorous physical activity (MVPA) only 34-37% of instruction time. U.S. states have considered active PE policies specifying minimum percent of PE time spent in MVPA. This study estimates the cost-effectiveness of a hypothetical state policy implemented nationally requiring at least 50% of elementary school PE time devoted to MVPA. Methods: We used the U.S. Assessing Cost Effectiveness model to estimate costs and health benefits of an active PE policy intervention on changes in energy expenditure for the lifetime of a simulated cohort of the 2005 U.S. population aged 5-11 years. Results: Implementation of an elementary school active PE policy would increase mean daily per capita physical activity levels by 0.58 minutes/day MVPA (95% Uncertainty Interval (UI): 0.05–2.23), corresponding to an increased energy expenditure of 1.53 kcal/day (95% UI: 0.13–5.84), among 12.1 million U.S. children (95% UI: 8.9–16.0 million) aged 5-11 years receiving the intervention. At an estimated annual cost of $54.6 million (95% UI: $35.7–$79.7 million), the intervention would cost $1.53 per MET-hour/day gained (95% UI: $0.14–$7.06), or $2.18 per 100 kcal/day (95% UI: $0.20–$10.08). Discussion: There is a lack of evidence for direct BMI impact due to increased physical activity expenditures via an active PE policy, even assuming no compensatory changes in diet and out of school physical activity levels. Additional modeling will estimate the impact of physical activity directly on specific health outcomes.