Physical activity declines among children in their tweens and teens. To address physical inactivity as a health risk, national organizations are endorsing the implementation of comprehensive school physical activity programs (CSPAPs). The purpose of this article is to describe the history of school-coordinated approaches to addressing health issues and to provide steps for implementing CSPAPs in middle-school settings. The current need, theoretical-based rationale, how-to steps, and strategies for overcoming barriers are included. The article also includes sample artifacts from effective middle school CSPAPs and identifies multiple resources for CSPAP implementation.