This study examined enabling conditions related to implementing and sustaining a high-quality physical education program at three elementary schools in Pennsylvania. Physical education is being reduced or removed from elementary curriculums because of reduced school budgets and a strong focus on academic standards. Furthermore, the lack of high-quality and sustainability comes from a stagnant focus on teaching from a traditional sports and games-based model, opposed to teaching from a lifelong fitness and wellness model. The study asked two questions: "What does a high-quality physical education program look like?" and "What are the enabling and constraining conditions?" Proceeding from a conceptual framework that included enabling program conditions, which was adopted from the 2006 School Health Policies and Programs Study (SHPPS) (Lee, Burgeson, Fulton & Spain, 2007), and four reform mechanisms, the study used a three-site, qualitative, comparative case study design (Yin, 1994). Qualitative data included interviews with 19 participants, the elementary physical education curriculums, school district websites, onsite observations, and researcher field notes and memos. Data analysis techniques were drawn from case study and grounded theory traditions. One set of findings described what high-quality programs look like using a lifelong fitness and wellness model. Another set of findings described what has made the programs sustainable. The third set of findings described how programs have been able to make the transition from a traditional sports and games based model to a lifelong fitness and wellness model. The study contributed findings to the research literature on elementary physical education program reform. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]