In the United States, the goal of physical education is to "develop physically literate individuals who have the knowledge, skills and confidence to enjoy a lifetime of healthful physical activity. " The 2012 Shape Of The Nation Report by the National Association for Sport and Physical Education (part of SHAPE America) and the American Heart Association found that while nearly 75 percent of states require physical education in elementary through high school, over half of states permit students to substitute other activities for their required physical education credit, or otherwise fail to mandate a specific amount of instructional time. According to the report, only six states — Illinois, Hawaii, Massachusetts, Mississippi, New York and Vermont — require physical education at every grade level, from K-12. A majority of states in 2016 did not require a specific amount of instructional time and more than half allow exemptions or substitution. These loopholes can lead to reduced effectiveness of the physical education requirements.