REVIEW ARTICLE

How Elementary In-School Play

Opportunities Relate to Academic
Achievement and Social-Emotional
Well-Being: Systematic Review
SHERI L. BURSON, PhDa DARLA M. CASTELLI, PhDb

ABSTRACT
BACKGROUND: Play is essential for child growth and development, and may have academic and social-emotional implications.
To understand the relationship between in-school play opportunities and academic achievement (AA) and social-emotional
well-being among elementary school students, a systematic review of the current in-school play literature was conducted.
METHODS: Keywords were input across 7 search engines. After screening, 20 peer-reviewed publications related to play, AA,
and social-emotional well-being met the inclusion criteria for this review.
FINDINGS: Across the included publications, recess was the only in-school play opportunity assessed. Overall, student
behavior and social-emotional outcomes benefited from more recess while mixed results were found between recess
participation and academic outcomes. However, more recess was not detrimental to AA.
CONCLUSION: The findings from this review support the need for recess as part of a whole child approach to education that
may mitigate the negative outcomes of sitting through long periods of instruction. More research is needed on the AA and
social-emotional effects of other types of in-school play opportunities (ie, centers, play stations, and other breaks). Findings
from this review indicate that recess is a necessary part of the elementary school day.

Keywords: play; play opportunities; elementary school; academic achievement; social-emotional; whole child.
Citation: Burson SL, Castelli DM. How elementary in-school play opportunities relate to academic achievement and
social-emotional well-being: systematic review. J Sch Health. 2022; 92: 945-958. DOI: 10.1111/josh.13217

Received on June 16, 2022

Accepted on July 8, 2022

T he enactment of the 2001 No Child Left Behind

(NCLB) Act resulted in an unintended consequence
of reductions in opportunities for free-time and play
developmental benefits that is unlikely to be achieved
in the classroom. Children can challenge their
movement, learn about their bodies, develop social
and increases in instruction time and standardized skills, and practice creativity.6,7 For the purposes of
test preparation.1 Despite initiatives (eg, Whole this review, play includes activities that are not goal-
School, Whole Community, Whole Child [WSCC], focused. They can be structured or unstructured,
Comprehensive School Physical Activity Programs include high or low physical activity (PA), and
[CSPAP])2 and legislation (eg, Every Student Succeeds require large or small motor movements, and children
Act [ESSA])3 that were aimed toward the utilization participate for fun and enjoyment. In-school play
of a health-first, whole-child approach to education, opportunities are free-time periods where children
many US schools have not implemented policies can choose to play, such as recess, lunch breaks,
related to free-time and in-school play opportunities.4 classroom breaks, outdoor breaks, centers, and play
Children play in a variety of ways, including stations. Skills harnessed through in-school play help
physical, game/rule-based, imaginary, rough and develop the whole child, and may benefit academic
tumble, and creative play.5 Engaging in play has achievement (AA) and social-emotional well-being.

a
Assistant Professor of Instruction, (slb4975@utexas.edu), University of Texas at Austin, Austin, TX.
b
Professor, (dcastelli@utexas.edu), University of Texas at Austin, Austin, TX.
Address correspondence to: Sheri L. Burson, Assistant Professor of Instruction, (slb4975@utexas.edu), University of Texas at Austin, Austin, TX.
[Corrections added on 9 September 2022, after first online publication: the fourth sentence of the second paragraph has been corrected in this version.]

Journal of School Health • October 2022, Vol. 92, No. 10 • © 2022, American School Health Association • 945

Students’ academic performance, on-task behavior,
cognitive skills, and attitudes are components of AA,
which may improve with in-school play opportunities.
Children’s brains are more susceptible to interference
and require more frequent breaks between instruc-
tion compared to adults.8,9 When recalling pictures,
preschool, first, and third-grade students’ memories
improved when provided with longer breaks between
repetitions.10 Wallace and Russ identified11 a rela-
tionship between early exposure to pretend play in
girls and creativity 4 years later, which then signif-
icantly predicted math computability. Additionally,
recess has been associated with classroom behavior
improvements.11,12
With more focus on the whole child in education,
social-emotional learning (SEL) has gained focus
in elementary schools. SEL curricula teaches skills
to manage emotions, set goals, and build positive
relationships.13 SEL in school can help children
improve their social-emotional well-being, which
refers to the ability to build and maintain positive
relationships and self-regulate emotions.14,15 It can
be difficult for children to verbally express emotions
and describe experiences; however, play is a natural
and developmentally appropriate outlet16,17 that may
enhance coping and social skills.18
Play is not goal-oriented, therefore, studies that
assessed PA and physical education programs were
beyond the scope of this review. Although strong
evidence on the benefits of PA on child education has
been established,19-22 this review focused on studies
that assessed in-school play opportunities rather than
those aimed toward improving PA only. Free-play
opportunities in school may lead to participation
in moderate to vigorous physical activity,23,24 but
those who choose to participate in sedentary or light
intensity play are also reaping health and learning
benefits6,7,16 (Figure 1). By including publications that
primarily focus on PA, the opportunity to discover
benefits of PA and nonphysical play may be missed.
Therefore, the purpose of this systematic review was
Figure 1. Play and Physical Activity Continuum
PA activities are from Butte et al.25 reported metabolic equivalent (MET) values for children.
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to gain an understanding of how in-school play
opportunities relate to AA and social-emotional well-
being among US elementary school children.
METHODS
The Preferred Reporting Items for Systematic
Reviews and Meta-Analysis (PRISMA) guidelines were
followed throughout this review.26 A keyword search
was conducted across 7 databases—EBSCO Host,
ERIC, MEDLINE, PsychINFO, Academic Search Com-
plete, PubMed, and Science Direct. Sample keywords
included (line 1) unstructured play, free play, recess,
playground, playtime, loose parts play, (line 2) aca-
demic performance, AA, school performance, emo-
tional health, emotional skill, behavioral health, psy-
chosocial development, attention, memory, (line 3)
K-5, elementary, and children.
Inclusion/Exclusion Criteria
Peer-reviewed publications that were original
investigations (not a review) conducted in the United
States were included in this review. By the half-
life of NCLB, policies and programs implemented
under the act were well established; therefore, we
included articles published from 2007 to 2022.
Additionally, studies of included publications took
place in elementary schools with healthy K-5 students
and teachers, with a focus on in-school play
opportunities, and primary outcomes of AA and social-
emotional well-being.
Included Publications
Keyword and supplemental searches extracted 4764
publications (Figure 2). After removing duplicates
and excluding publications based on the initial title
and abstract screening, 506 full-text articles were
screened. Of these, 486 did not meet the inclusion
criteria, and 20 publications were included in this
review.
• © 2022, American School Health Association
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Figure 2. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flowchart

Coding and Bias Risk of Included Publications
Included publications were coded by methodology,
grade level, in-school play opportunity, and outcome
variable(s). Experimental and quasi-experimental
studies were assessed for bias and scientific rigor using
the Downs and Black checklist.27 Study quality was
not part of the inclusion/exclusion criteria.
FINDINGS
The review findings and bias risk results can be
found in Table 1. Across all the included publications,
recess was the only in-school play opportunity
assessed, with 1 study exploring a before school play
program in addition to recess.28 Studies assessing
classroom breaks were excluded from this review
because increasing PA was the focus, rather than
play. Additionally, students did not have a choice to
participate in the PA driven classroom breaks, which
did not meet our definition of play or in-school play
opportunities.
Of the included publications, most were nonexper-
imental (n = 10), while 4 were experimental and 6
were quasi-experimental designs. Of the experimen-
tal and quasi-experimental studies, 7 were rated as
fair (15-19 points) and 3 were rated as good (20-25
points) on the Downs and Black checklist.27 All scored
at least a 7/10 in reporting and all but 3 scored the full
points in external validity, while scores ranged from
7 to 10 out of 13 possible points in internal validity,

Journal of School Health • October 2022, Vol. 92, No. 10 • © 2022, American School Health Association • 947
 Table 1. Data Extraction and Summary

Down and Key Findings Relevant to the Review

First Author, Year Study Design
Barros et al. (2009) Nonexperimental
(secondary data analysis)
Black Scores Data Source and/or Recess Theme and (PA = Physical activity; MVPA = Moderate to
(If Applicable) Participants Measured Outcome(s) vigorous physical activity; ToT = Time on Task)
Early Childhood High versus low/no academic • Some recess was better than none.
Longitudinal Study achievement • Third-graders who received 15- to 30-minutes or more of
(ECLS-K) 1998-1999 (AA)—Behavior daily recess were scored significantly higher in positive
cohort

948 • Journal of School Health

behavior compared to those who did not receive daily
Third grade recess and recess that was less than 15-minutes.

•
Adherence
Bauml et al. (2020) Nonexperimental K-6th grade private and Increase recess periods • Schools increased the number of recess periods from 1 or
(qualitative; interviews) public school teachers AA—Attention, grades 2 (before LiiNK) to 4 15-minute daily recess periods (post
(n = 17) Social-emotional well-being LiiNK). Teacher reports:
(SEW) • 88%—student focus improved with more recess and less
brain breaks needed.
• Student grades were not negatively affected with more
recess
• 59%—students were more sympathetic and friendly
• 41%—students were resolving conflicts and 24% saw

October 2022, Vol. 92, No. 10

emotional regulation improvements.

•
Bleeker et al. (2012) Experimental (randomized Reporting (R): 7 Playworks (n = 14) and Program/quality (playworks) • Teacher and student interviews fromPlayworks and control
control trial [RCT]) External validity (EV): 3 control schools (n = 11) AA—Attention, behavior schools
Internal validity (IV): 8 Fourth and fifth grade SEW • Playworksteachersreportedlessbullying,butnodifferences
Power (P): 0 Other—school climate in aggressive behavior compared to those in the control
school
• Playworks teachers reported improved behavior during
recess, but no improvements were seen in Playworks or
Control schools during observations
• Playworksteachersreportedincreasesinclasspreparedness
and conflict resolution
• Compared to control students, more Playworks reported
better behavior and attention after participating in play.

Brez et al. (2017) Quasi-experimental R: 8 Third-fifth graders (n = 99) Where and how students • Student sustained attention and creativity were assessed
EV: 3 from 2 schools participate pre and post recess

© 2022, American School Health Association

IV: 7 AA—Attention • Creativity increased post recess (not statistically significant)
P: 1 Other—Creativity • Significant increases in attention post recess compared to
before

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 Table 1. Continued

Down and Key Findings Relevant to the Review

First Author, Year Study Design
Byrd et al. (2007) Nonexperimental
(secondary data analysis)
Black Scores Data Source and/or Recess Theme and (PA = Physical activity; MVPA = Moderate to
(If Applicable) Participants Measured Outcome(s) vigorous physical activity; ToT = Time on Task)
ECLS-K High versus low/no • Significant positive correlation between recess and reading
Third grade AA—Reading scores
• 1.034 times more likely to score higher in reading for every
additional day of recess.

Dagli (2012) Nonexperimental ECLS-K High versus low/no • Reading was measured at the beginning and end of the

Journal of School Health

(secondary data analysis) Grade K AA—Reading school year, and scores were compared with the amount of

•
recess (periods per day and minutes) received.
• Reading scores were higher among students who received
at least 31- to 45-minutes of recess 1 to 3 times per day
compared to those with less recess.
• Recess was no longer significantly associated with reading
scores when assessed with minutes in language arts
instruction.

Dills et al. (2011) Nonexperimental ECLS-K High versus low/no • Assessed whether weekly recess minutes impacted reading
(secondary data analysis) K, first, third, and fifth grade AA—Reading and Math and math scores across K, first, third, and fifth grade.
• Recess minutes did not affect math scores at any grade

October 2022, Vol. 92, No. 10

level; however, a significant relationship between recess

•
minutes and reading scores between first and third grade
was identified
• 63 more minutes led to reading t-score increase of 0.485
• Recess effects on reading were no longer significant when
controlling for student, teacher, and school characteristics.

Erwin et al. (2019) Quasi-experimental R: 8 K-6th graders (n = 728) Increase recess periods • Compared student disciplinary referrals and math and
EV: 3 AA—Behavior, math and reading scores 1year after increasing recess from one
IV: 8 reading scores 15-minute period to two 15-minute periods per day
P: 1 • Reading test scores did not change, but math scores
significantly improved 1 year after the recess increase
• Behavioral referrals significantly increased 1 year after the
recess increase.

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 Table 1. Continued

950 •
Down and Key Findings Relevant to the Review
Black Scores Data Source and/or Recess Theme and (PA = Physical activity; MVPA = Moderate to
First Author, Year Study Design (If Applicable) Participants Measured Outcome(s) vigorous physical activity; ToT = Time on Task)
Fedewa et al. (2021) Quasi-experimental R: 9 K-6th graders (n = 607) Increase recess periods • Increase daily recess from one 15-minute period to two 15-
EV: 3 AA—Behavior minute periods and examined student disciplinary referrals
IV: 8 for 1 year.
P: 1 • A total of 342 disciplinary referrals for 140 students were

Journal of School Health

documented
• Fewer referrals were documented between recess periods,

•
with the majority of verbal incidences occurring before the
first recess (45%vs 30%after second recess), and the majority
of physical incidences occurring after the second recess (45%
vs 32% before first recess).

Fink et al. (2018) Nonexperimental (student Third-fifth graders (n = 17) Where and how students • Student interviews about recess activities and withholding
interviews) participate recess
AA—Behavior • Students reported participating in active games or activities,
and they enjoyed PA, socializing, and having autonomy
• Students understood why recess may be withheld, but

October 2022, Vol. 92, No. 10

they believed recess was important to release energy, and

•
withholding recess was ineffective and unfair.

London et al. (2015) Nonexperimental Playworks schools (n = 6) Program/quality (playworks) • InterviewswithteachersandstudentsfromPlayworksschools

(qualitative; interviews, Fourth and fifth grade AA—Behavior • Teachers reported improvements in inclusionary behavior,
focus groups, SEW less conflict, and improved recess and school climate after
observations) Other—School Climate participating in Playworks.
• Students also reported the recess and school climate
improved with Playworks.

Lund et al. (2017) Experimental (stratified
random sampling)
R: 7 K and first graders from Increase recess periods • Compared listening effort among students who receive four
EV: 3 treatment (n = 88) and AA—Listening Effort 15-minute recess periods per day (LiiNK Project) to those
IV: 7 control (75) schools receivingone15- to20-minuterecess periodper day(control)
P: 1 • Listening effort was assessed in the morning and afternoon
• Larger differences inreactiontimefrommorningtoafternoon
were seen among control students compared to LiiNK
students, which meant control students had to expend more

© 2022, American School Health Association

listening effort than LiiNK students in the afternoon.
• LiiNK students expended more listening effort in the morning
thanintheafternoon, whichshowedlisteningeffortimproved
with more recess periods.

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 Table 1. Continued

Down and Key Findings Relevant to the Review (PA = Physical

First Author, Black Scores Data Source and/or Recess Theme and activity; MVPA = Moderate to vigorous physical
Year Study Design (If Applicable) Participants Measured Outcome(s) activity; ToT = Time on Task)
Massey et al. (2017) Quasi-experimental R: 7 Fourth and fifth graders Program/quality (Playworks) • Recess observations and junior coach classroom observations
EV: 3 (n = 450) from 3 • AA—Behavior were conducted in control and Playworks schools
IV: 7 Playworks schools and 1 • SEW • Playworks recess observations showed more positive stu-
P: 1 control school Other—School Climate dent/teacher interactions compared to baseline
• Compared to the control school, significantly more positive
interactions and significantly less peer conflict was observed at
the Playworks school

Journal of School Health

• Class observations of junior coaches indicated improvements in

•
adaptive behavior.

Massey et al. (2021) Nonexperimental Third and Fifth graders Program/quality • Assessed the relationship between recess quality, student
(cross-sectional; surveys, (n = 352) from n = 25 AA—Behavior behavior, andsocial-emotionalwell-beingthroughobservations
observations) schools and teacher reports
• Recess observations (n = 41) showed low to moderate quality
and recess was an average of 29.54-minutes per day
• Recess quality did not significantly predict externalizing or
internalizing behaviors; however, it did predict adaptive
classroom behaviors, resilience, and emotional self-control

October 2022, Vol. 92, No. 10

• More recess minutes also led to decreased externalizing
problems and bullying

•
Mayfield et al. (2017) Experimental (cluster RCT) R: 8 Recess observations in 2 Program/quality (Peaceful • Five recess observations were conducted at baseline and 5
EV: 3 Peaceful Playgrounds Playgrounds) more 1-year later in control and Peaceful Playgrounds (PP)
IV: 8 and 2 control schools SEW schools—Results were inconclusive.
P: 1 • No significant changes in MVPA, sedentary behavior, or social
behavior were observed in PP school 1 from baseline to follow-
up
• PP school 2 showed MVPA increases and decreases in verbal
conflicts at follow-up
• Increases in MVPA and decreases in physical conflict were
observed in control school 1, and only an increase in sedentary
behavior among boys was observed in control school 2 at
follow-up.

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 Table 1. Continued

Down and Key Findings Relevant to the Review

Black Scores Data Source and/or Actionable Criteria and (PA = Physical activity; MVPA = Moderate to
First Author, Year Study Design (If Applicable) Participants Emergent Theme(s) vigorous physical activity; ToT = Time on Task)

952 • Journal of School Health

Parrott and Cohen (2020) Quasi-experimental R: 8 K-fifth graders (n = 47), and Increase recess periods • Before school play club (PC) program and recess
EV: 1 AA—Behavior and Attention

•
teachers (n = 6) observations and interviews with students and teachers
IV: 10 SEW • Active play was observed the most (98.9%). Differences in
P: 0 game play were observed, as more invented games took
place in PC
• Studentsreportedtheyweremorefocused,inbettermoods,
and built friendships with PC and play participation.
• Teachers reported play participation improved their
students’ attention, social behaviors, problem solving skills

Powell et al. (2007) Nonexperimental Montessori school Where and how students • Recess observations and interviews with students who
(qualitative; interviews, observations participate chose to build forts rather than play on the playscape

October 2022, Vol. 92, No. 10

observations) K-sixth grade SEW • Students reported building forts because it was exciting,

•
Other—Creativity, Autonomy they felt a sense of ownership, andcouldsocialize withtheir
peers
• Observations and qualitative interpretations indicated fort
building outside encouraged socialization, negotiation,
conflict resolution, creativity, and spontaneity.

Rhea et al. (2016) Quasi-experimental R: 7 K and first grade (n = 126) Increase recess periods • LiiNK school increased daily recess from one to three 15-
EV: 2 private school students AA—Behavior, Attention, and minute periods, and provided students with 15-minute
IV: 7 Listening Comprehension positive action lessons 3 times a day. Observations and
P: 1 listening comprehension were compared from fall (pre) to
spring (post).
• Transition time significantly decreased, and significant
decreases in off-task behaviors were observed after LiiNK
implementation compared to before.
• Significant improvements inlisteningcomprehensionwere
found post LiiNK.

© 2022, American School Health Association

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 Table 1. Continued

Down and Key Findings Relevant to the Review

Black Scores (If Data Source Actionable Criteria and (PA = Physical activity; MVPA = Moderate to
First Author, Year Study Design Applicable) and/or Participants Emergent Theme(s) vigorous physical activity; ToT = Time on Task)
Stapp et al. (2018) Quasi-experimental R: 8 Fifth graders (n = 12) Where and how students • ToT was assessed 30-minutes before and 30-minutes after

Journal of School Health

EV: 1 participate recess

•
IV: 7 AA—Time on-Task • Increases in ToT were observed after recess compared to
P: 0 before recess among all participants
• More time was spent off task before recess versus after
recess where 83% of students were on-task. ToT increased
by 3 to 13minutes on average.

Woods et al. (2018) Nonexperimental (surveys and Fourth and fifth graders Where and how students • Students wore accelerometers during recess, completed
interviews) (n = 179) from 2 public and participate a survey assessing their activity preference, and were
2 private schools SEW interviewed
Other—Break, Autonomy • Themajorityof students weremoderately(n= 78) or highly
active (n = 61) at recess

October 2022, Vol. 92, No. 10

• Those who were less active participated in group and

•
individual activities, most boys participatedingroupand/or
sports, and most girls participated in individual, group, or
partner activities
• During interviews, students discussed the importance of
being with friends, being active, and needing a break from
school work.
• Fewer students (n = 8) reported sometimes needing alone
time and not feeling like socializing.

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and 7 received the full point for power. In-school play
opportunities were assessed more in upper grade lev-
els (4th-6th grade; n = 11) compared to lower (K-3rd
grade; n = 3) or a combination of both levels (n = 6).
Four themes were identified across the publications:
(a) increasing daily recess (n = 6),28-33 (b) high versus
low amounts of recess (n = 4),34-37 (c) programs and
quality (n = 5),38-42 and (d) where and how students
participate in recess (n = 5).43-47
Increasing Daily Recess
Six studies assessed the impact of increasing the
number of daily recess periods or minutes on compo-
nents of AA28-33 and social-emotional well-being.28-30
Three of the studies examined the effects of the Let
us Inspire Innovation ’N Kids (LiiNK) Project,29,32,33
in which daily recess increased from 1 to 3 or four
15-minute recess periods per week, and a 3 times
per week SEL curriculum was implemented. When
piloting LiiNK, classroom observations were con-
ducted and listening comprehension was measured
in grades K-2 prior to (fall semester) and during
implementation (spring semester) within the partic-
ipating school.33 Significant improvements in on-task
behavior—specifically, fidgeting decreases—and lis-
tening comprehension were recorded with 3 versus
1 daily recess period.33 Similarly, Lund et al.32 found
LiiNK students expended less listening effort following
4 recess breaks compared to effort expended in the
morning. LiiNK students also expended less cognitive
effort to listen in class compared to those in the control
school who received 1 daily recess break. K-6 LiiNK
Project teachers (n = 18) reported improvements in
students’ attention, creativity, and relationship build-
ing.29 Adding more recess periods required teachers to
make instruction time adjustments; however, teach-
ers reported students appeared to retain information
better, resulting in continued academic progress.
Two studies assessed the impact of increasing daily
recess from 1 to 2 daily periods on disciplinary referrals
and AA among K-6 students.30,31 Although math
scores significantly improved with more recess, reading
scores did not improve and disciplinary referrals
significantly increased 1 year after implementation.30
Fedewa et al.31 determined most referrals occurred
before the first recess break or after the second break,
with fewer occurring between recess periods. The
referrals were documented, on average, 100-minutes
after recess, indicating students may require play
breaks after no more than 100-minutes of instruction.
One study assessed the effects of implementing
a before school play club (PC; 60-minutes) in
addition to providing 40-minute recess periods on
student behavior and social-emotional well-being
through observations and interviews.28 Students
were typically observed participating in active play
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during PC and recess with more creative game
play observed during PC. Students believed they
were more focused after PC, and teachers reported
play participation led to improvements in students’
attention, social behaviors, and problem-solving skills.
Similarly, students reported improvements in mood
and relationships with play.28
High Versus Low Amounts of Recess
The effects of recess amounts on AA components
were examined in 4 secondary data analyses of
the Early Childhood Longitudinal Study, 1998-
1999 Kindergarten Cohort (ECLS-K)34-37 with mixed
results. Dagli36 compared Kindergarteners’ reading
scores, recess periods and minutes provided, and
reading and language arts instruction frequency, and
found that those receiving at least 31-minutes of recess
1 to 3 times per day scored higher in reading compared
to those with less recess. However, recess alone was not
a strong predictor of reading scores when accounting
for reading and language arts instruction. Such that
students who received at least 61-minutes of reading
and language arts instruction and participated in up
to 15-minutes of daily recess scored higher in reading
compared to those with 45-minutes of daily recess.36
Among third-graders, Byrd35 found for every
additional day of recess each week, students were
1.034 times more likely to achieve proficiency in
reading scores. Conversely, when assessing the impact
of weekly recess minutes on reading scores across K-5,
recess minutes only significantly positively impacted
reading scored between first and third graders.
Despite the lack of reading improvement with more
recess, increased recess minutes did not decrease
scores.37 While mixed reading score results were
identified across the studies, Barros et al.34 determined
third-grade teacher ratings of classroom behavior
were significantly more positive among those whose
students received 15- to 30-minutes of daily recess
versus those whose students received less than 15-
minutes of recess less than 5 days per week.
Recess Programs and Quality Recess
Five studies assessed the effects of recess quality41
and programs that may improve quality, such
as Playworks38-40 and Peaceful Playground.42 To
determine if levels of recess quality predicted student
behavior and social-emotional outcomes, researchers
conducted recess observations (n = 41) within
25 schools using the Great Recess Framework-
Observational Tool (GRF-OT), which assessed recess
characteristics including safety, adult supervision,
equipment access and availability, student play and
activity levels, conflict resolution, and play support.
Third- and fifth-grade teachers reported behavior of
352 randomly chosen students using the Behavioral
• © 2022, American School Health Association

Assessment System for Children-3. A large majority of
the schools’ recess quality was rated low or moderate.
Quality was not a predictor of externalizing nor
internalizing behaviors, but it significantly predicted
adaptive behaviors (ie, adaptability, social skills,
and communication), executive function problems,
resilience, and self-control.41 To improve recess
quality, some schools have adopted recess programs.
Playworks schools are provided with recess coaches
who facilitate inclusive games while teaching students
conflict resolution skills.48 Students may choose to
participate in the structured games or in other non
Playworks activities as long as they practice safe and
inclusive behaviors. Compared to the control school,
recess observations showed less peer-to-peer conflict
and more positive student-teacher interactions among
those in the Playworks school.40 Students reported
their behavior and attention during class improved
after participating in Playworks.38 Student reports
were supported by interviewed teachers who indicated
observing improved behavior, fewer conflicts,39 less
bullying, and an increased preparedness to learn
after Playworks participation.38 Conversely, results
from Peaceful Playground—a program that provided
schools with painted blacktop games, equipment, and a
recess supervisor—were unclear.42 Using the System
for Observing Children’s Activity and Relationships
During Play (SOCARP) tool, recess observations were
conducted before and after program implementation
in 2 intervention and 2 control schools to assess
students’ social interactions. No significant social
behavioral changes were observed among students
from intervention school 1, but significant decreases
in verbal conflicts were observed in school 2.
Observations from 1 control school showed significant
decreases in physical conflict. The results do not clearly
indicate the program positively impacted student
outcomes.42
Where and How Students Participate in Recess
Five publications assessed where and how students
participate in recess with 2 comparing AA outcomes
before and after recess,43,46 1 conducting recess obser-
vations,45 and 2 interviewing students.44,47 Measure-
ments of third through fifth-graders’ (n = 99) creativity
and sustained attention before and after recess indi-
cated that while nonsignificant increases in creativity
were found, students significantly increased their sus-
tained attention after recess compared to before.43 Brez
and Sheets also determined, students who played on
the playground saw greater improvements in creativity
and sustained attention compared to those who played
on the blacktop, near the benches, or in nature.43
Among fifth-graders (n = 12), all students increased
time on task on average by 3.125- to 13.125-minutes
after participating in 25-minutes of recess compared to
before recess.46
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While objectively measured creativity did not
significantly improve with recess,43 K-6 Montessori
students who chose to play in nature and build forts
during recess were observed being highly creative.45
Students also reported feeling a sense of pride in their
creations while also enjoying friendly competitions for
the best built fort and playing with friends.45 Playing
with friends was discussed as one of the most important
aspects of recess among interviewed students.44,47
Students reported choosing recess activities based on
their friends, and many looked forward to recess
because it provided a break from class,47 and they could
socialize freely without adult instruction.44 Discussions
regarding withholding recess for punishment showed
students understood why one might lose recess, but
they believed it did not effectively promote behavior
change and likely resulted in worse behavior.44
DISCUSSION
Publications included in this review examined in-
school opportunities that facilitated autonomous play,
which differentiated play opportunities from fun but
goal-focus PA opportunities (eg, recess vs physical
education). By excluding PA-focused publications,
the effects of in-school play opportunities on AA
and social-emotional well-being were more clearly
described and understood.
After recess participation, students showed greater
attention and time on task compared to before
recess. Higher amounts of recess minutes and
periods per day had mixed effects on academic
performance (reading and math scores), but teachers
reported seeing improvements in their students’
attention, focus, and classroom behavior with more
recess. Studies exploring recess quality and recess
programs determined recess quality significantly
predicted social skills, executive function, resilience,
and self-control. Further, teachers in schools with
programs that improved recess quality reported SEL
skills improvements, including inclusive behavior and
conflict resolution. Despite recess quality or frequency,
students valued recess as it was a period during the
school day they had autonomy, they could socialize,
and have a break from class.
The inclusion of publications utilizing a variety of
research methodologies was a strength of this review.
Objective effects of recess on student outcomes were
provided through quantitative studies, and student and
teacher interviews expanded upon those results. For
example, while objective measures indicate students
improve attention and time on task after recess, teacher
interviews expanded upon those results by sharing
their experiences in the classroom. Though this was a
unique review that separated play opportunities from
PA, it was not without its limitations. With only recess
studies included, there is a lack of understanding of
• © 2022, American School Health Association • 955

how other in-school play opportunities may impact
students’ AA and social-emotional outcomes. Recess
and classroom breaks have been studied extensively
in elementary school, but few of those studies focus
only on play or play in addition to PA. This was a
vital exclusion to ensure only play opportunities in
school were assessed. Lastly, while 20 publications
were included in this review, the majority studied
the same programs or datasets (eg, LiiNK Project,
Playworks, and the ECLS-K). There are few in-school
play/recess programs to compare, which begs for future
in-school play studies.
Implications for School Health Policy, Practice, and Equity
Findings from this review support the need for daily
recess breaks in elementary schools. Children need
breaks from long instructional periods for cognitive
improvements,8,9 and recess provides a break and
allows children to choose activities they participate
in. The highly structured and scheduled school day
leaves little room for socialization and learning through
experience, but in recess, students can make and learn
from mistakes made in a safe environment that may
foster social and cognitive growth.
In-school play should be part of a whole child
approach to education, and recess and PA policies can
influence the provision of play opportunities. Schools
in states with recess policies were more likely to
provide 20-minutes of daily recess compared to those
in states without recess policies.49 However, few states
have implemented such policies.4 Further, strong
district-level policies prohibiting the withholding of
recess as a form of punishment decreased the
likelihood of teachers withholding recess.50 Recess
and play need to be treated as a right rather
than a privilege that can be taken away with poor
behavior. While providing daily recess is vital, recess
quality may also impact student engagement and basic
psychological needs attainment, as students attending
schools with higher quality recess scored higher in
autonomy, competence, and relatedness during recess
compared to those in schools with lower quality
recess.51 Similarly, high quality recess was associated
with greater engagement in play and recess activities
among students compared to lower quality recess.51
Inclusive recess is a component of high-quality recess,
and recess exclusion and enjoyment may have lasting
social-emotional effects. Adults’ retrospective reports
of recess memories were associated with current social-
emotional reports.52 Specifically, those who reported
being excluded during recess enjoyed PA less and
reported greater social isolation as an adult compared
to those who were not excluded. Additionally,
retrospective reports of recess enjoyment were related
to higher PA enjoyment, current PA participation, and
lower social isolation.52 Ensuring all K-5 children are
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given an opportunity for autonomous and inclusive
play during the school day may have immediate
and long-term academic, health, and social-emotional
implications.
Conclusion
The current review sought to better understand how
in-school play opportunities relate to K-5 students’
AA and social-emotional well-being. Studies utilizing
a variety of methodologies helped paint a broad picture
of the whole child implications of in-school play. While
students may understand why play opportunities may
be withheld, future studies are needed to understand
teacher perceptions of in-school play and factors
that may influence their decisions to provide and
utilize play opportunities in school. Additionally, direct
measures of in-school play and its impact on students
learning and social-emotional outcomes are needed.
Human Subjects Approval Statement
Preparation of this paper did not involve primary
research or data collection involving human subjects,
and therefore, no institutional review board examina-
tion or approval was required.
Conflict of Interest
The authors declare no conflict of interest.
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