• Jenna L Hollis, Amanda J Williams, Rachel Sutherland, Elizabeth Campbell, Nicole Nathan, Luke Wolfenden, Philip J Morgan, David R Lubans, and John Wiggers.
• Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan 2308, Australia. Electronic address: jenna.hollis@abdn.ac.uk.
• Prev Med. 2016 May 1; 86: 34-54.

ObjectiveTo examine elementary school students' moderate-to-vigorous physical activity (MVPA) levels during physical education (PE) lessons.MethodsA systematic search of nine electronic databases was conducted (PROSPERO2014:CRD42014009649). Studies were eligible if they were in English; published between 2005-April 2014; assessed MVPA levels in PE lessons of elementary school children (aged four-12years); and used an objective MVPA measure. Two reviewers retrieved articles, assessed risk of bias, and performed data extraction. The findings were synthesised using a meta-analysis.ResultsThe search yielded 5132 articles. Thirteen studies from nine countries met the inclusion criteria. Eight studies measured MVPA through observational measures, five used accelerometry and one used heart rate monitoring. The percentage of PE lesson time spent in MVPA ranged between 11.4-88.5%. Meta-analysis of seven studies (4 direct observations; 4 accelerometers) found that children spent a mean (95% CI) 44.8 (28.2-61.4)% of PE lesson time in MVPA. When measured using direct observation and accelerometers, children spent 57.6 (47.3-68.2) and 32.6 (5.9-59.3)% of PE lesson time in MVPA, respectively. The review has limitations; the search strategy was restricted to studies in English; theses, dissertations and conference abstracts were excluded; and six studies that provided insufficient data were excluded from the meta-analysis.ConclusionMVPA levels during elementary school PE lessons do not meet the United States Centre for Disease Control and Prevention and the United Kingdom's Association of Physical Education recommendation (50% of lesson time), but is higher than estimated in the previous review (34.2%). Interventions to increase MVPA in PE lessons are needed.Copyright © 2015 Elsevier Inc. All rights reserved.

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