BACKGROUND Schools must play a central role in combating the prevalence of overweight and obesity among children and youths. This cannot be achieved without more robust policy and funding programs at both federal and state levels. METHODS Reviews of meta-analyses were used to assess the efficacy of improving PA/MVPA through interventions in school physical education programs. Individual research studies were reviewed to assess the efficacy of improving PA/MVPA in preschool settings, recess, and classroom activity breaks. Legislation at the federal and state levels was reviewed along with surveillance and accountability mechanisms at the state level. RESULTS Physical education interventions produce improvements in PA/MVPA if protocols relating to use of time are followed. PA/MVPA in recess can be increased through careful planning for attractive activity opportunities on carefully designed playgrounds. Classroom activity breaks provide important PA/MVPA daily and improve student on-task behavior. CONCLUSIONS Federal legislation is needed to provide guidelines and financial support for states to improve the quantity and quality of PA in school programs. States need to develop clear expectations for quantity and quality of PA programs in schools, surveillance systems to monitor district compliance in meeting those expectations, and an accountability system aimed at ensuring that state expectations are being met with assistance for districts that do not meet expectations.