PHYSICAL EDUCATION AND HEALTH IN PUBLIC SCHOOL: A SYSTEMATIC REVIEW OF THE LITERATURE

Abstract

This systematic review aimed to analyze how health has been approached in national academic articles that deal with Physical Education in public schools and to relate health concepts and Physical Education views present. The search was performed on the CAPES Periodicals Portal. The articles included (n = 18) were submitted to Thematic Content Analysis. Most of them (n = 13) articulate the Biomedical and Behavioral conceptions of health and a Technical-Instrumental view of Physical Education, two of them presenting a Normative-Behavioral approach to Health Education. A minority (n = five) has a Socio-environmental concept of Health, of which only two express a Pedagogical-Reflexive view of School Physical Education articulated the Critical-Reflexive approach to Health Education. The expanded health perspective and a Pedagogical-Reflective view of Physical Education are still not present in academic research.

Keywords:
Physical Education; Health; Public school; Systematic review.

Resumo

Esta revisão sistemática objetivou analisar como a saúde vem sendo abordada em artigos acadêmicos nacionais que tratam da Educação Física em escolas públicas e relacionar concepções de saúde e visões de Educação Física presentes. A busca foi realizada no Portal de Periódicos CAPES. Os artigos incluídos (n=18) foram submetidos à Análise Temática de Conteúdo. A maioria (n=13) articula as concepções Biomédica e Comportamental de saúde e uma visão Técnico-Instrumental da Educação Física, dois deles apresentando abordagem Normativo-Comportamental de Educação em Saúde. Uma minoria (n=cinco) apresenta uma concepção Socioambiental de Saúde, dos quais apenas dois, uma visão Pedagógico-Reflexiva da Educação Física Escolar articulada à abordagem Crítico-Reflexiva de Educação em Saúde. A perspectiva ampliada de saúde e uma visão Pedagógico-Reflexiva da Educação Física ainda são pouco presentes nas pesquisas acadêmicas.

Palavras-chave:
Educação Física; Saúde; Escola Pública; Revisão Sistemática.

Resumen

Esta revisión sistemática trató de analizar cómo se aborda la salud en artículos académicos nacionales de Educación Física en escuelas públicas y relacionar los conceptos de salud y las visiones de la Educación Física presentes. La búsqueda se realizó en el Portal de Periódicos CAPES. Los artículos incluidos (n = 18) fueron sometidos a un Análisis de Contenido Temático. La mayoría (n = 13) articula las concepciones Biomédica y Conductual de la salud y una visión Técnico-Instrumental de la Educación Física, dos de ellos presentan un enfoque Normativo-Conductual de Educación en Salud. Una minoría (n = cinco) tiene una concepción Socioambiental de Salud, de los cuales dos, tienen una visión Pedagógico-Reflexiva de Educación Física Escolar articulada al enfoque Crítico-Reflexivo de Educación en Salud. La perspectiva ampliada de salud y una mirada Pedagógico-Reflexiva de Educación Física son poco presentes en las investigaciones académicas.

Palabras clave:
Educación Física; Salud; Escuela pública; Revisión sistemática.

1 INTRODUCTION

In the mid-1980s, in the midst of a context of criticism of the Biological conception of school Physical Education, which has traditionally emphasized physical fitness for standardized sports performance (BRASIL, 1998), the Physical Fitness Related to Health movement emerges, anchored on the idea of physical fitness for life and the search for active lifestyles by students. Physical Education would contribute to the improvement of health and quality of life of the population (FERREIRA, 2001).

Although considered an advance, this movement is based on an essentially biological approach to the issue. It is a “bio-Physical Education”, which omits fundamental aspects related to adherence to physical exercise such as socioeconomic and educational ones. A critical approach must therefore be taken.

The “public” school aspect is understood here as an ethical-political option: the promotion of health in spaces of greater social vulnerability, therefore, of greater demand for areas such as school Physical Education, which can expand access to information on Health, fundamental to human development and quality of life of students who attend public schools.

Characterized as a systematic review of the literature (GOMES; CAMINHA, 2014), this article starts with some questions: How has health been addressed in national academic articles that deal with Physical Education in public schools? What would be the views of Physical Education present in these research? Is it possible to establish a relationship between the different conceptions of health and the views of school Physical Education identified in these studies?

2 PHYSICAL EDUCATION, HEALTH, AND PHYSICAL FITNESS

In the context of criticism of physical fitness for standardized sports performance, the concept of Physical Fitness Related to Health emerges in the theoretical discussions in Physical Education, initially by authors Nahas and Guedes (FERREIRA, 2001), whose pedagogical approach became known as Renewed Health (DARIDO, 2003).

According to Zancha et al. (2013), such pedagogical approach aims to introduce health as a guiding axis in Physical Education classes, serving all students, especially those who need Physical Education programs the most: sedentary, obese, with low physical fitness and with disabilities. It proposes an option to work with physical fitness related to health, in order to inform, raise awareness, change habits and attitudes, and promote the systematic practice of physical exercises. It aims at the student’s autonomy to practice physical activities and to have healthy habits throughout life. It proposes that these school Physical Education programs use teaching strategies for health promotion and the adoption of a physically active lifestyle. Its main focus is to teach about Health in the school setting.

Nahas (2013) conceptualizes physical fitness as the ability to perform physical activities, distinguishing two forms of approach: Physical Fitness Related to Motor Performance, which includes components necessary for maximum performance (agility, balance, speed, and anaerobic endurance), and Physical Fitness Related to Health, which brings together characteristics that, at appropriate levels, provide lower risks of developing diseases or chronic degenerative conditions associated with low levels of regular activity: cardiorespiratory fitness, flexibility, strength, muscular endurance, and body composition.

Physical fitness related to health refers to the fitness “for life”, focusing on an active life that removes the risk factors of hypokinetic diseases, considering physical inactivity as one of the major causes of morbidity worldwide (NAHAS, 2013). School Physical Education is seen as fundamental to promoting a physically active and healthy lifestyle, presenting itself as one of the most important variables for improving the quality of life of students. It is concerned with conceptual, procedural and attitudinal dimensions (NAHAS, 2013; ZANCHA et al., 2013).

Guedes and Guedes (1996) and Nahas (1997) understand that school Physical Education should develop themes related to health and quality of life since the practice of physical activities experienced both in childhood and adolescence favor the adoption of habits and attitudes in adulthood.

3 PHYSICAL EDUCATION AND HEALTH VIEWS

However, we must understand that Physical Fitness Related to Health ends up being ideological and political (CRAWFORD, 1977) and this association between physical exercise and health, in a causal relationship, as a “naive optimism” (SOBRAL, 1990), because it does not always correspond to reality. The existence of structural inequalities hinders the adoption of these active lifestyles and diseases are not dissociated from these determining contexts for their occurrence (BAGRICHEVSKY; PALMA, 2005).

Considering the exclusive emphasis on physical fitness contributes to putting into practice a technical-instrumental view of Physical Education, valuing its activities in terms of effectiveness for fitness. Thus, valuable educational experiences, which students could experience through physical activities, as a result of a pedagogical view of these practices in the school environment, are neglected (FARINATTI, 1994; FERREIRA, 2001; KIRK, 1988; PINTO, 2015)

In contrast, in the critical, reflective and transforming logic (Pedagogical-Reflective view of Physical Education), the social role of the discipline appears, pointing out the need for the thematization of socio-environmental, ethical and diversity-related issues, to empower the subjects in the search for solutions to problems faced in their local realities, aiming at the transformation of the social conditions of existence (PINTO, 2015).

Concepts such as Health Education and Health Promotion are relevant to school Physical Education, which should be focused on teaching-learning processes involving themes related to body health. Health Promotion brings a broader focus than Health Education, which, with its primarily educational character, is an integral part of the actions of the former (MARINHO; SILVA, 2013).

The educational practice is understood as the main strategy to promote health (CALDAS, 2001), by mobilizing and sharing knowledge, and Health Education presents an intentional pedagogical character of subjects that involve health, which are not restricted to mere definitions of terms (CONCEIÇÃO, 1994; FONSECA, 1994; MOHR, 2002).

For Fraga, Carvalho, and Gomes (2013), by valuing the figure of “health experts”, i.e., “private advisors”, the Physical Fitness Related to Health movement ends up reproducing an “informational biopolitics” to the detriment of health care. Among the main criticisms are the idea of causality between exercise and health, as if “being physically active” meant, in fact, “being healthy”, and the eminently individual character of their proposals, both considered a reductionism and contributing to the “victim-blaming” (CRAWFORD, 1977; FARINATTI, 2002; FERREIRA, 2001).

Venturi and Mohr (2021) identify two distinct approaches in the field of research and practice of Health Education in the school context: one normative and behavioral, with a merely transmissive focus, and another reflective and critical, focused on the construction of knowledge and scientific literacy.

In the first one, the Normative-Behavioral, recommendations of habits, rules and conduct norms to be followed are transmitted to students to change behaviors, favoring the prevention of diseases and the achievement of a so-called healthy life through prescriptive and preventive measures (GAZZINELLI et al., 2005; MOHR, 2002; SILVA et al., 2010).

In her comprehensive conceptual framework, Westphal (2006) highlights three different approaches to Health. In the first, called Biomedical, health is seen as the absence of disease and disability resulting from individual biological and physiological conditions. The individual and his health problems are understood in isolation from his psychosocial environment. In the second, called Behavioral, health is understood as the physical-functional capacity and physical and mental well-being of individuals, determined by biological and behavioral aspects, by inadequate lifestyles. It implies stimulating actions and the creation of appropriate habits.

The Critical-Reflective Health Education approach is based on another understanding of Health. It presents characteristics such as: encouragement of debates; exchange of experiences; construction of knowledge, practices, and attitudes as drivers of change; development of critical sense and responsibility; autonomy of thought; sensitization to participate in changes; associated with collective actions, involving health and environment, in a context that fosters reflection, choices/decisions, and actions (MOHR, 2002; OLIVEIRA, 2017; VENTURI; MOHR, 2021).

In a broad conception of Health, called Socio-environmental or Socio-ecological (ANTUNES; FURTADO, 2021; CARVALHO, 2012; MALDONADO, 2022; MARTINS et al., 2015, 2016; PALMA, 2020; WESTPHAL, 2006), health is presented as a complex of factors that encompasses the biological, psychological, socioeconomic, educational, scientific, cultural, occupational, political, risk and environmental dimensions, covering different sectors of society. It involves political action, the development of skills, knowledge, and attitudes, and programs that involve the community in critical and participatory dialogue with professionals and institutions. The citizen sees himself as part of health promotion, which has collective and individual dimensions and responsibilities.

Physical Education cannot lose sight of the multifactorial or multidimensional nature of health and, therefore, quality of life (FERREIRA, 2001). Problems of instrumental order, such as learning the motor gesture and developing physical fitness, are not enough to solve complex issues involving health (PINTO, 2015).

4 METHODOLOGY

The present work is characterized as a systematic review of the literature. It aimed to analyze how health has been addressed - as well as the views of Physical Education present - in national academic articles that deal with Physical Education in public schools and establish a possible relationship between different conceptions of health and the views of school Physical Education identified.

Such reviews require clear questions and well-defined selection criteria, ensuring the quality of the synthesized studies and their reproduction by another researcher, as well as a conclusion that provides new information, starting from the researched content in a structured way (GOMES; CAMINHA, 2014; THOMAS; NELSON; SILVERMAN, 2012). Thus, the following Research Protocol was followed:

Chart 1 Research Protocol Steps

Steps
Objectives
Research Equation
Scope of Research
Exclusion Criteria
Inclusion Criteria
Methodological Validity Criteria
Data Processing
Results

Source: Ramos, Faria and Faria (2014) and Rodrigues and Almeida (2017)

The searches were performed in the CAPES Periodicals Portal (Scope of Research), a virtual library of scientific information, which brings together 49 thousand full-text journals and 455 databases (CAPES, 2022). Therefore, its choice as a data source in this study was due to its comprehensiveness. The accesses were made between April and July 2022 via CAFe/UFRJ, and the searches were updated at the end of this period. The checking of the results was performed by another researcher, as Methodological Validity Criteria (RODRIGUES; ALMEIDA, 2017).

From the search equation “Educação Física” AND (“escola pública” OR “escolas públicas” OR “colégio público” OR “colégios públicos”) AND NOT (“escola privada” OR “escolas privadas” OR “colégio privado” OR “colégios privados”) AND health, the following filters with their respective results were used: Articles (n= 905); Peer Reviewed (n=457); Date (n=297), corresponding to the scientific production on the topic in the last ten years (2012-2022); and Language, Portuguese (n=198).

We sought to identify the national academic production on the conceptions of health and Physical Education in the last decade, focusing on the Brazilian reality (ANDRIJAUSKAS, 2020), in a timeframe that would provide greater diversity of this production.

After the last search filter used (n = 198),¹ the first step of the analysis was performed: the search, in the titles, abstracts and keywords of each work, for articles that fit the inclusion and exclusion criteria, sometimes resorting to the Full Text using the CTRL-F app, which allows searching for words or expressions such as these in printed texts.

The following articles were excluded: duplicates (n = 72); review articles or essays (n = 57); articles that referred to public and private schools (n = 9); articles that did not develop some contextual relation² of Physical Education (n = 33) and Health (n = 9) in the public school where the research was carried out. Therefore, 18 articles remained, which formed the corpus of this study, as they dealt with some contextual relationship³ of Health and Physical Education at the public schools where the research had been conducted.

The Data Processing was done through the analysis and discussion of the results. The Thematic Content Analysis of the selected articles was used, involving its stages of pre-analysis, exploration of the material (or coding) and processing of the results obtained (interpretation), with the aid of the Atlas TI software, which allowed linking citations to codes that came from the theoretical basis, thus visualizing the established relationship and facilitating the process of inferences (MINAYO, 2013; FERREIRA et al., 2012).

Chart 2
Synthesis of the Analyzed Categories

Conceptions of Health	Views of School Physical Education	Renewed Health Approach	Health Education Approach
Biomedical Behavioral	Technical-Instrumental	Physical Fitness Related to Health Physical Fitness Related to Performance	Normative-Behavioral
Socio-environmental or Ecological	Pedagogical-Reflective	-	Critical-Reflective

Source: Prepared by the authors

Conceptions of health and school Physical Education present in the articles were identified in the search for nuclei of meaning, in order to classify them into specific themes, according to a previous theoretical framework, based on the Thematic Content Analysis proposed by Minayo (2013) - used by other authors in systematic reviews (SOUZA, 2022; SILVA et al., 2020) - and thus reaching a critical view of the content found. The Results stage occurred by describing the research steps and recording the findings.

5 DATA ANALYSIS

A large part of the published articles (BUBOLZ et al., 2018; CORRÊA NETO et al., 2014; COSTA et al., 2019; FERREIRA; JARDIM; PEIXOTO, 2013; JOAQUIM; SANTOS; ROSA, 2017; LIMA et al., 2016; MARQUES et al., 2018; MELLO et al., 2019; NAGORNY et al., 2018; SAES; SOARES, 2017; SANTOS et al., 2016; SANTOS et al., 2018; VOSER et al., 2017) brings articulated the Biomedical and Behavioral conceptions of health and a Technical-Instrumental view of school Physical Education.

In these works, health is determined not only by biological aspects but also by behavioral aspects, especially by inadequate lifestyles. The major concern is with sedentary lifestyles as a public health problem. For Costa et al. (2019, p. 2), “spending long periods in sedentary behaviors has been shown to be a risk factor for cardiometabolic diseases in this population”.

We can identify the strong presence of the pedagogical trend of Renewed Health in these works, with a focus on Physical Fitness Related to Health. Ferreira, Jarmim and Peixoto (2013, p. 264) emphasize “the importance of informing the population about risk factors for chronic non-communicable diseases and measures to prevent the onset of diseases”.

Lima et al. (2016) also bring concerns about the improvement of students’ flexibility levels. The goal of this physical valence, according to the authors, is to reduce risks of injuries, increasing functional capacity and preventing late muscle pain, playing a strong influence on the health of individuals. They suggest “that Physical Education professionals direct the development of flexibility”, included in the main assessments of physical fitness through sit and reach tests and also indicated as a facilitator of the performance of daily motor tasks (JOAQUIM; SANTOS; ROSA, 2017, p.1003).

In addition to flexibility and anthropometry, Joaquim, Santos and Rosa (2017) bring concerns with agility. Santos et al. (2018) are concerned with the latter and with speed, using, for this purpose, two fitness tests: the speed test (20 meters) and the agility test (Square), both extracted from the Projeto Esporte Brasil (PROESP-BR). “Studying the physical abilities of children assists professionals in identifying possible profiles for success in sport” (JOAQUIM; SANTOS; ROSA, 2017, p. 997).

Santos et al. (2018) and Joaquim, Santos and Rosa (2017) bring concerns about the improvement of sports performance. This can also be observed in Santos et al. (2016), who bring as a research focus the motivation for sports practice in adolescents and the role of the Physical Education teacher as a motivator of this practice. It is up to these teachers to guide them to seek physical activities and/or sports to which they adapt successfully, reducing their dropout in classes and sports.

Mello et al. (2019), in turn, bring concerns about cardiorespiratory fitness, using the six-minute running test, pedometers, among others. For the authors, school Physical Education, which has the promotion of health among its wide range of actions, constitutes “an important space of intervention to reverse the low levels of cardiorespiratory fitness evidenced currently” (p. 368).

With these characteristics of Physical Education with biomedical and behavioral references, physical fitness corresponds only to a state of biological adaptation to external demands, bringing an individual approach to the problem (“victim blaming”): “The number of students who do not reach the daily recommendations of the number of steps is high” (NAGORNY et al., 2018, p. 70).

According to Mello et al. (2019), some studies with schoolchildren have shown effectiveness in promoting physical activity and physical fitness of children and adolescents. Such interventions have been based on the increase of school Physical Education classes per week, reaching up to five classes per week and obtaining good results in almost all variables of physical fitness evaluated.

A Technical-Instrumental view of Physical Education is perceived in these works. The discipline would be responsible for intervening, assuming a domain of technical aspects by the teacher - coming from disciplines such as Biomechanics and Physiology - to better conduct the physical exercises worked, in a recursive way, without problematizing these practices and without considering the production of knowledge among all, teachers and students, in this case, involving health as a human sociocultural production: “Table 2. Differences between the proportions of moderate to vigorous physical activity in total school time, recess and physical education classes of adolescents at baseline and after the ‘Move yourself’ intervention” (COSTA et al., 2019, p. 7).

The measurement or quantification is also another feature identified in these studies that bring a Technical-Instrumental view of Physical Education. Nagorny et al. (2018, p. 75) point out “that there are still few Brazilian studies that use the pedometer as a measuring instrument to objectively quantify physical activity”.

Two of these works (BUBOLZ et al., 2018; COSTA et al., 2019) presented a Normative-Behavioral approach to Health Education. Health is treated, in the school setting, only to inform, to raise awareness (conscientization - by the subjects themselves), aiming at the acquisition of knowledge (information and concepts) to change habits and attitudes. Costa et al. (2019) use “educational sessions in the format of classes and distribution of folders and posters with information about the outcomes of the intervention” (p. 1).

In the research of Bubolz et al. (2018, p. 2706), linked to the intervention “Physical Education +: Practicing Health at School”, characteristics that point to a merely transmissive approach to Health Education are also identified:

Handbooks were developed for each school year, from the 6th grade of elementary school to the 3rd grade of high school, structured in chapters and organized as follows: support text, lesson plans, supplementary information, and assessment suggestions [...].

The other articles (ALTMANN et al., 2018; BARBOSA FILHO et al., 2016; OLIVEIRA; MARTINS; BRACHT, 2015; REIS; PARAÍSO, 2014; SAMPAIO; NASCIMENTO, 2018) presented a Socio-environmental or Ecological conception of health. Concerns focused, also, on biological and behavioral issues are found. However, this restricted conception is overcome by considering other health actors involved.

Concerns about sedentary lifestyle and obesity are also found in Barbosa Filho et al. (2016), more particularly, with high anthropometric indicators in children (BMI; Waist Circumference; Waist-Stature Ratio⁴), associating them with sociodemographic factors, stating that both general and centralized obesity have been increasing in poorer child populations and in developing countries, drawing attention to children in rural areas and in the public network.

With this, the author also brings up issues of structure, transportation and access to health services for this target audience. This would involve different sectors of society, as well as political action in addressing them. “The promotion of a community and school favorable to healthy eating and active lifestyle in these families at risk can be a prominent action in promoting health and improving the nutritional status in this population”, argue Barbosa Filho et al. (2016, p. 222). Regional factors are also highlighted.

In Altmann et al. (2018) and in Reis and Paraíso (2014), some concerns turn to gender issues (equality and inequalities). The former investigates perceptions about experiences, frequency, interests, enjoyment, body competence, and social support, concluding that gender proved to be a statistically significant difference marker: “gender inequalities were favorable to boys in almost all aspects assessed, except for teacher support, which was perceived equally” (ALTMANN et al., 2018, p. 1).

Altmann et al. (2018) establish an important relationship between the expression of these inequalities and the experiences (frequency and regularity) with physical activities and sports in these classes. It reinforces, however, that for both boys and girls, the frequency of practice was lower than that recommended by the WHO for the age group, a reason for warning. It also highlights the need for regular physical and sporting activities three or more days a week. Scientific aspects related to health are thus considered, in addition to the critical and participatory dialogue with professionals and institutions, by bringing the issue of inter-institutional partnership and the necessary questioning raised by the results about the obstacles to its realization. It also addresses pedagogical aspects involving health.

Reis and Paraíso (2014), in turn, mention that when there are doubts in the medical reading of a child’s body, exams or surgical and hormonal interventions are commonly prescribed in order to conform the “ambiguous body” to a single “sexed, coherent, and intelligible” body, but that, “however, beyond the scientific and health fields, the dichotomous constitution of bodies is massively produced in several other cultural fields” (p. 242), including being reiterated in the curricula through various practices. Normality is then questioned, beyond the issue of rights and its relation to social aspects.

Characteristics of a Pedagogical-Reflective view of school Physical Education were identified (OLIVEIRA; MARTINS; BRACHT, 2015; SAMPAIO; NASCIMENTO, 2018): new teacher’s attitude - critical, reflective and transformative of pedagogical practice; awareness of social, cultural and ideological issues of teaching action; pedagogical and political responsibilities with human emancipation, that is, with the overcoming of injustices and with the transformation of social conditions; subsidizing subjects in the search for solutions to problems faced; reflective and critical teaching ability to mobilize knowledge not available in textbooks.

Physical Exercise and Health is understood by Sampaio and Nascimento (2018) as a theme that can be studied, reinterpreted, and reflexively appropriated in order to contribute to the analysis of the senses and meanings of school Physical Education in the curriculum and its contribution to Education, which ends up revealing a corporal understanding (whole body present, without body/mind dissociations) about the knowledge of aspects of body culture of movement in connection with health. Moreover, competences are obtained, and elements of this body culture are added to the students’ experiences.

With this, there is a whole process of displacement of life projects and the discipline itself, practices and imaginary of most teachers from a restricted perspective - merely biological, to promote only the exercise of students (physical health) - to a broader conception of health. This happens through the re-signification of the biological sphere, the expansion of meanings, conceptions, and practices of Health Education. It is also taken into consideration the repercussions of this work in the students’ lives, specifically, the living of positive experiences in the field of movements, which would lead to the inclination towards these activities in the search for well-being and the enhancement of personal and collective life (OLIVEIRA; MARTINS; BRACHT, 2015; SAMPAIO; NASCIMENTO, 2018).

Oliveira, Martins and Bracht (2015) and Sampaio and Nascimento (2018) also brought a Critical-Reflective approach to Health Education. Concerns focused on dialogue - exchange of experiences and debates - in pedagogical practice are perceived through conversations and listening, in a context of reflection/questioning.

Sampaio and Nascimento (2018) investigate the didactic possibilities in school Physical Education classes with the thematization of the content Physical Exercise and Health. The objective of the study was to describe and analyze this didactic unit and its relationship with the teaching-learning process carried out. They conclude that it is possible to combine theory and practice, involving the student actively in this process. It also revealed the need for adaptations in relation to motor demands, linking the pedagogical intervention to the reading of reality, through collaboration, criticality and reflexivity, the inseparability between theory and practice, the sharing of experiences, based on notions of human movement beyond biomechanical aspects and the mere “exercising”.

Therefore, the authors (SAMPAIO; NASCIMENTO, 2018) address the expanded concept of health by also considering the development of skills, knowledge and attitudes in the didactic-pedagogical process carried out by school Physical Education. The theme of performance drugs, for example, was developed through problematizing the possible damage to health, with practical dynamics about body image, standards of beauty and health, aesthetics and quality of life. The dialogue about the proposed theme was also considered with reflective dynamics about “body and society” (SAMPAIO; NASCIMENTO, 2018). Knowledge is thus built, including scientific knowledge, with concern for the scientific literacy of students, considering also the construction of practices and attitudes as drivers of change.

Oliveira, Martins and Bracht (2015) state that young people need to be prepared to live critically with these demands posed by society, especially in relation to the consumer market. They consider that the developed projects presented indications of what it would be to educate in health, contributing to preparing students to “consume” bodily practices offered both inside and outside school, without unbridled consumption. “Here consumption is perceived as an axis that influences the construction of people’s identity, therefore a central element in contemporary analyses about education and its interfaces with health” (p. 252).

Creativity and learning together between educator and learner were identified in Oliveira, Martins and Bracht (2015), with school games built in collaboration with students in one of the implemented projects. Concerns about caring for oneself and the others, promoting encounters, and social issues such as interpersonal relationships were also considered in another reported project. This one was specifically about the inclusion of students with disabilities in the educational space with a view to inclusion, solidarity, and cooperation.

The attention to aspects such as meeting the real needs of the subjects and the sensitization to participate in the changes is identified as part of Health Education, relying on the experiences in putting oneself in the condition of the other - the one considered “stranger” - as a means to raise awareness for the acceptance of people with disabilities. Some reports point to the change in the way students began to behave in the project and their attitudes in terms of lived experiences, in the personal-individual, social or ecological spheres, especially in the way they organize themselves, in the greater care for each other, in building a sense of relationship, according to Oliveira, Martins and Bracht (2015).

In the reported projects, there are elements based on a broad conception of health. Oliveira, Martins and Bracht (2015) understand that health represents the process, relationships and adversities that permeate the daily lives of people, who relate to each other in search of their life goals, of a good life. Respect for the physical, emotional and moral integrity of others appears as a keynote of work with these health-related themes, with one of the projects providing a reflection to the group of students about the consequences generated by violence within the school and, consequently, society.

6 DISCUSSION OF THE RESULTS

The vast majority of articles (n=13) bring together the Biomedical and Behavioral conceptions of health, which coincides with a Technical-Instrumental view of Physical Education. As the very term “physical fitness” suggests, the emphasis is only on the physical aspect of the body, disregarding several issues and influences related to body health that would bring other perspectives of action to the area. Two of them presented a Normative-Behavioral approach to Health Education, with no concern for human emancipation and social transformation.

Chart 3 Results of the Thematic Content Analysis (n =13)

Thematic Content Found	Related Works
Conceptions of Health: Biomedical Behavioral Physical Education View: Technical-Instrumental	Bubolz et al. (2018); Corrêa Neto et al. (2014); Costa et al. (2019); Ferreira, Jarmim and Peixoto (2013); Joaquim, Santos and Rosa (2017); Lima et al. (2016); Marques et al. (2018); Mello et al. (2019); Nagorny et al. (2018); Saes and Soares (2017); Santos et al. (2016); Santos et al. (2018); Voser et al. (2017)
Renewed Health Approach: Physical Fitness Related to Health Physical Fitness Related to Health and Performance Physical Fitness Related to Performance	Corrêa Neto et al. (2014); Ferreira, Jarmim and Peixoto (2013); Lima et al. (2016); Marques et al. (2018); Mello et al. (2019); Nagorny et al. (2018); Saes and Soares (2017); Voser et al. (2017) Joaquim, Santos and Rosa (2017) Santos et al. (2016); Santos et al. (2018)
Health Education Approach: Normative-Behavioral	Bubolz et al. (2018); Costa et al. (2019)

Source: Prepared by the authors

In these studies, health is conceived as a product for quality of life, the result of traditional health education, leaving the subjects with only one alternative: to live or not to live healthily (FERREIRA; AYRES; CORREA, 2009; OLIVEIRA, 2005). Health is conceived as a product of individual behaviors and bio-physiological conditions, respectively, of lifestyles and efficiency of biological functions, which would also involve behavioral risks and would imply in the very guilt of individuals, the so-called “sick” or “healthy” (FERREIRA; AYRES; CORREA, 2009; ZANCHA et al. 2013). “Allocating physical education with the exclusive function of prevention, even seeing the multidimensional characteristic of the occurrence of diseases, is to remove from the area its essence, its possibility of educational intervention, beyond the recursive practice” (CAMARA et al., 2010, p. 107) of physical exercises.

Only five articles brought a Socio-environmental or Socio-ecological conception of health, of which only two, a Pedagogical-Reflective view of School Physical Education, with a Critical-Reflective approach to Health Education, but enough to reveal that a didactic-pedagogical transposition of an expanded concept of health is possible in these formal education environments.

Chart 4 Results of the Thematic Content Analysis (n = five)

Thematic Content Found	Related Works
Conceptions of Health: Socio-environmental or Ecological	Altmann et al. (2018); Barbosa Filho et al. (2016); Oliveira, Martins and Bracht (2015); Reis and Paraíso (2014); Sampaio and Nascimento (2018)
Physical Education View: Pedagogical-Reflective Health Education Approach: Critical-Reflective	Oliveira, Martins and Bracht (2015); Sampaio and Nascimento (2018)

Source: Prepared by the authors

Despite the efforts of some actors, it is concluded that an expanded perspective of health and a Pedagogical-Reflective view of Physical Education are still incipient in academic research. The displacement of practices anchored in a biological perspective, restricted to metabolic, anthropometric, and functional aspects, traditionally valued by the discipline, for the operationalization of a broad conception of health is necessary, widening the possibilities of working with Health.

Physical Education needs to review its paradigms in relation to the health of bodies, envisioning new perspectives of work with an emphasis on caring for oneself and the other, on social relations based on inclusion and respect among all, and on the promotion of a culture of peace. For this, the professionals in the area must get involved in scientific and social discussions about living conditions, without eliminating the biological dimension of this work, but moving towards another society project, especially when it comes to the less socioeconomically favored strata, who depend on public education. Health Promotion in these areas of greater social vulnerability becomes fundamental.

As a curricular component that deals with the body in movement in its various relational aspects and thus fulfills important educational functions, not only the personal-individual plan should be considered by Physical Education when working on Health, but also the social-ecological one. More attention must be paid to the human being who experiences his/her body beyond bio-physiological mechanisms.

7 FINAL CONSIDERATIONS

Conceptions of health and views of school Physical Education, once identified, showed the relationship between both in the very direction of the thematization of health by teachers in the school environment.

In a Critical-Reflective health education approach, a Pedagogical-Reflective view of Physical Education and a Socio-Environmental or Ecological conception of health were identified in the studies. In a Normative-Behavioral health education approach, the Biomedical and Behavioral conceptions of health and a Technical-Instrumental view of Physical Education were present in the analyzed works, with influences from the Renewed Health approach of school Physical Education.

The operationalization of a broad conception of health, although little worked out, points to a possible gap in the training of Physical Education teachers, calling for curricular changes in the undergraduate courses in the area.

Pathways and actions implemented by teachers, to address Health, can constitute a vast field of “school health knowledge” and potentially important research (OLIVEIRA, 2017) to direct other historical forms of action.

• 1
  On the left of the page, under “Collection”, one can see a list of the databases - 15 in total - with the respective number of related articles.
• 2
  Research that mentioned the words Physical Education and Health only in the footnotes or in the bibliographic references, not developing them conceptually.
• 3
  They developed both conceptually, in their relations with the school context, thus making it possible to search for the conceptions and thematic approaches present.
• 4
  An important indicator of childhood-centered obesity (abdominal fat accumulation), which, together with the measurement and classification of Waist Circumference and BMI, increases the prediction of cardiovascular risk - high blood pressure, hypertriglyceridemia and hypercholesterolemia (BARBOSA FILHO et al., 2016).
• FINANCING
  This work was carried out without the support of funding sources.

• HOW TO REFERENCE

  NARDUCHI, Fábio; STRUCHINER, Miriam. Physical Education and health in public school: a systematic review of the literature. Movimento, v. 29, p. e29020, Jan./Dec. 2023. DOI: https://doi.org/10.22456/1982-8918.128492

RESEARCH ETHICS

The research followed the current protocols in Resolutions 466/12 and 510/2016 of the National Health Council of Brazil.

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Edited by

EDITORIAL RESPONSIBILITY

Alex Branco Fraga*, Elisandro Schultz Wittizorecki*, Mauro Myskiw*, Raquel da Silveira*

* Universidade Federal do Rio Grande do Sul, Escola de Educação Física, Fisioterapia e Dança, Porto Alegre, RS, Brazil.

Publication Dates

• Publication in this collection
  25 Aug 2023
• Date of issue
  2023

History

• Received
  18 Jan 2023
• Accepted
  01 Mar 2023
• Published
  29 May 2023