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Physical activity in children

Summary

Physical activity amongst children is an essential aspect of child development. Immediate health include reducing risk factors for obesity and cardiovascular disease; promoting musculoskeletal health; motor skill development; psychological, social and emotional health. Habits track from childhood to adulthood and long-term maintenance of physical activity levels into later life can also impact on health.

UK guidelines on physical activity include quantified recommendations for children 0-5 years old but the Health Survey for England (2013) indicates only 9% and 10% of boys and girls, aged 2-4 respectively, were classified as meeting the guidelines for children under 5, who can walk unaided, of at least 180 minutes of physical activity spread throughout the day. There is no local data on physical activity levels of children aged 0-5.

In children aged 2-15 years in England, 68% of boys and 76% of girls do not meet the Chief Medical Officers’ physical activity recommendations. In South Gloucestershire, the online pupil survey of 6000 pupils aged 8 to 18 found that 66% had at least 4 hours of physical activity per week, the level of activity higher in secondary schools (74%) compared to primary schools (63%). The proportion of girls engaged 4 or more hours of physical activity each week was 60%, lower than the average for boys of 72%.  Overall 58% of pupils felt they did no enough exercise to keep them healthy quite often or always. A further 23% felt they did enough sometimes and 19% felt they did not do enough exercise to keep them healthy. 25% of pupils cited getting fit as an area they wanted more knowledge in.

A range of services are provided that promote physical development in children 0-5 years old.  There are a number of key local issues and gaps. There is a limited amount of training on physical activity for early years practitioners and health professionals. The quantity and quality of opportunities for physical activity in early years settings varies. Play on Prescription is being reviewed and recommendations will be made.

Further work is ongoing in a number of settings used by children and young people including; provision of leisure centres, parks and open spaces and Smarter Travel projects. A draft South Gloucestershire Physical Activity Strategy 2015-20 has been developed aimed at working together to make South Gloucestershire more active every day. A specific aim of this strategy is to support children and young people to have an active start in life.

Recommendations for consideration

Further work is required to develop a range of training opportunities for early years practitioners and health professionals linked to physical activity; develop audit tools on physical activity for use by early years practitioners; and implement the review recommendations for Play on Prescription.  Also see Physical Activity Adults section for further recommendations.

Authors: Lesley Causon, Programme Lead, South Gloucestershire Council; Clare Fleming, Programme Lead, South Gloucestershire Council, Liz Oxford, Specialist Health Improvement Practitioner

Who is at risk and why?

This section focuses on the physical activity of children.  Various terms are used, often loosely, when discussing this issue although they mean different things including:

Physical activity: Any bodily movement produced by skeletal muscles that requires energy expenditure.

Physical development: Development of a child’s control over their body, including control over muscles and coordination of these movements.

Play: In free play or child initiated play a child leads their own play.

Physically active play: activities that tend to be spontaneous, unstructured and intrinsically motivated, consistent with a conventional definition of play but distinguished from passive activities, such as playing table-top games or drawing, which may be accurately defined as play but typically involve minimal movement or physical exertion.

Structured physical activity: activity that is adult led and planned.

Early years practitioners routinely use the terms physical development and physical activity The Early Years Foundation Stage (EYFS) (2014) states seven inter-connected areas of learning and development that must shape educational programmes in early years settings. The three prime areas are communication and language, physical development and personal, social and emotional development and these support learning in all other areas.  The EYFS states: ‘Physical development involves providing opportunities for young children to be active and interactive; and to develop their coordination, control and movement. Children must be helped to understand the importance of physical activity and to make healthy choices in relation to food’ (EYFS, 2014, p8).

The early years: impact of physical activity on health

Relatively little is known about the health impact of physical activity in the early years compared to other stages of childhood (Timmons et al, 2012).  Researching links is difficult because activity patterns at this life stage typically involve bouts of activity and intermittent rest and limited cognitive recall (Tucker, 2008).  Methodological limitations are also apparent making study comparisons challenging (Rowlands and Eston, 2007; Tucker 2008).  Evidence suggests, however, that regular physical activity in the early years is beneficial.

Immediate health benefits may be associated with reducing risk factors for obesity and cardiovascular disease; promoting musculoskeletal health; motor skill development; psychological, social and emotional health (DH, 2011).  Habits track from childhood to adulthood (Lake, 2012) and long-term maintenance of physical activity levels into later life can also impact on health.  A dose-response relationship exists between physical activity and chronic conditions such as cardiovascular disease, diabetes and osteoporosis (Warburton et al, 2010; DH, 2011).

Factors affecting physical development

Physical activity behaviour of children 0-5 years old is influenced by a wide range of factors although the way they impact is unclear:

  • Gender: Differences in the activity patterns of boys and girls during the early years have been consistently observed, with boys generally being more active than girls.
  • Age: Findings are inconsistent with respect to changes in physical activity and increasing age
  • Ethnicity or socio-economic status: The influence of these is unclear.
  • Psychological: These influences have been little studied
  • TV viewing: Some studies have examined the association between physical activity and TV viewing in under 5s. Findings are generally mixed; some studies have reported TV viewing is associated with lower levels of activity but others have reported no association.
  • Parental behaviour: There is evidence that parental physical activity or parent-child interactions during activity are associated with higher levels of activity.
  • Time spent outdoors: Some studies have shown that time spent outdoors is linked with higher levels of physical activity during the early years (Hinkley et al, 2008; Tucker, 2008).

Recommended amount of physical activity

UK guidelines on physical activity include quantified recommendations for children 0-5 years old:

  • Infants who cannot yet walk unaided physical activity should be encouraged from birth, particularly through floor based play and water based activities in safe environments
  • Pre-school children who can walk unaided should be physically active daily for at least 180 minutes spread throughout the day (DH, 2011).
  • All under-fives should minimise the amount of time spent being sedentary (being restrained or sitting) for extended periods (except time spent sleeping)

Early years settings

Many children 0-5 years old, spend a significant part of the day attending an early years setting; nursery, pre-school or childminder.  Evidence suggests there is variation in the extent of physical activity in settings:

  • Median time spent in moderate to vigorous physical activity represented only 2% of monitored hours of three year old children (Reilly et al 2004).
  • The average time spent in moderate to vigorous activity per day in one study was under 25 minutes (Reilly et al 2006).

A range of factors have been found to influence physical activity levels in settings:

  • Boys were more likely to be active than girls and older boys were less active than younger boys (Pate et al 2008)
  • Where parents reported higher levels of physical activity away from the setting, their children chose independently to engage in more physical activity within the setting (Mollett and Francis 2004)
  • Nursery teachers have good perceptions of the amount of physical activity that children in their care are engaged in when compared to objectively collected data (Chen et al 2002).
  • There is evidence that activity levels may vary between childcare settings. Smaller numbers of children attending a childcare centre, shorter break times and more time between breaks have been associated with higher levels of activity (Cardon et al 2008). Pre-school settings with more policies and practices promoting physical activity have more children engaged in physical activity (Dowda et al 2004: Pate et al 2004)

Active travel

Developing active travel amongst children who travel to a ‘pre-school or early years facility’ is a target group identified by NICE in 2009.There is however, a dearth of literature on prevalence of active travel to early years settings although one study found an overall prevalence of 42%, with significantly fewer children walking to the setting if they lived over 800m away.

Which children are less likely to engage in physical activity

Children who are likely to be at greater risk of not engaging in sufficient physical activity are:

  • Children with additional needs
  • Children living in poverty

The level of need in the population

Current levels of physical activity amongst children 0-5 years old

The Health Survey for England identified:

  • a similar proportion of boys and girls aged 2-4 (9% and 10% respectively) were classified as meeting the current guidelines for children under 5 of at least three hours of physical activity per day
  • Patterns of activity varied by age. Younger children (aged 2-4) walked on more days in the last week than those in the middle age groups
  • The average time per day spent watching TV on weekdays increased steadily with age in boys starting with 1.5 hours for boys 2-4 years old and 1.5 hours for girls
  • For both boys and girls, the average number of hours spent watching TV on both
  • weekdays and weekend days increased as equivalised household income decreased
  • Boys and girls aged 2-4 spent a mean of 0.7 and 0.8 hours respectively walking to or from school. This lower average is likely to reflect the fact that they attended school on fewer days on average, rather than walking for a shorter time (HSCIC, 2013).

Elsewhere, Tucker (2008) found that children spend 2-4% of the day on moderate or vigorous intensity physical activity i.e. 20-30 minutes a day.

In South Gloucestershire, there is no systematically collected information available on the   physical activity levels of children 0-5 years old.

Current levels of physical activity amongst school aged children

In children aged 2-15 years in England, 68% of boys and 76% of girls do not meet the Chief Medical Officers’ physical activity recommendations.[1] The National Travel Survey (2012) revealed that children’s trips made to and from primary school on foot have declined by approximately 6%, to 47% compared to 1995/97 figure at 53%. School trips made by car have also increased by similar proportions. In secondary school children, similar patterns are observed, although only 36% of trips to school are made on foot.[2]

In South Gloucestershire, data on physical activity in children is available from the online pupil survey undertaken in 2015 of over 6000 pupils aged 8 to 18 in years 4, 5, 6 8, 10 and 12.

The survey found that 66% of pupils (n = 5,819) across all age groups had at least 4 hours of physical activity (including play) each week. 73% of pupils in secondary schools took part in physical activity for at least 4 hours a week, compared to 63% of primary pupils and 64% of Year 12’s.

The survey found that the proportion of girls engaged in physical activity each week was lower than for boys overall; 60% of girls compared to 72% of boys do 4 or more hours of physical activity a week.

Fig.15

chart showing physical activity in primary phase gender differences

Fig.15

chart showing physical activity in secondary phase gender differences

58% of pupils overall felt they did enough exercise to keep them healthy quite often or always – a further 23% felt they did enough sometimes and 19% felt they did not do enough exercise to keep them healthy. There again was a difference in gender with 48% of girls reporting they felt they did enough exercise and 24% who did not do enough to keep them healthy compared to 67% of boys who felt they did enough and 15% who felt they did not do enough.

32% of girls said there was something that would help them do more exercise compared to 26% of boys. The overall total for all pupils was 29%. Later on in the survey 25% of pupils cited “getting fit” as an area they wanted more knowledge in.

[1] http://www.nice.org.uk/advice/lgb3/chapter/What-NICE-says

[2] https://www.gov.uk/government/statistics/national-travel-survey-2012

Current services and assets in relation to need

Promoting physical activity is an integral part of routine work for many people working with children 0-5 years such as early years practitioners, health professionals. Specific services that support those promoting physical activity amongst children 0-5 years old are summarised below:

Early years team

Since physical development is an integral component of the EYFS the South Gloucestershire Early Years team routinely work with early years settings in effectively meeting children’s needs

Training offered to early years settings

Public Health and Wellbeing Division, CAH: Training periodically offered includes Movement and Dance, Road safety, Yoga (commissioned), ATP level 3 training (commissioned).

Early Years Team, CAH: Training periodically offered on ‘Promoting physical development in babies and toddlers, Outdoor play, Forest skills.

Early years settings audit

Two physical activity/development audits were piloted in 2010 and 2011 with fifteen settings in Patchway and Kingswood.  Practitioners attended a training event and then completed an audit of opportunities for physical activity in their setting to help identify gaps and plan future development.  They reported on these at the second training event.  The pilot results suggest this approach had short term benefits in extending opportunities for physical development in the setting at relatively low cost, however longer term impacts were not assessed.

Play on Prescription (POP)

The aim of POP is to improve children’s health by providing free access to ‘soft play’ and ‘swimming’ at leisure centres, with vouchers usually issued by Health Visitors (HV’s).  To be eligible for a voucher the child must currently live in South Gloucestershire, be under 5 years old or aged 5-16 with a disability and have under developed play skills, behavioural problems, developmental delay or poor physical health.  Additionally, vouchers may be issued where children live in circumstances that hinder their progress such as a lack of quality time for child and parents, parent/guardian ill health, social/marital problems, or a lack of local play facilities.

The scheme is currently being reviewed and this covers the referral criteria and their application, the benefits gained by children/families using POP and administration.  Recommendations will be made and stakeholders will take part in a ‘task and finish’ group to agree how these will be implemented.

Details of other physical activity provision and schemes accessed by children and young people, and strategic initiatives for physical activity across South Gloucestershire are contained in the Physical Activity – Adults chapter of the JSNA.

Evidence of what works

It may be difficult to increase physical activity levels amongst children and a recent systematic review and meta-analysis of children under 16 years old found interventions aiming to increase children’s physical activity levels may simply replace other periods of activity (Metcalf et al, 2012).  There are few family and community-based interventions to increase physical activity in the early years and these have largely ineffective or methodologically weak (BHF 2011).

More studies have focussed on childcare settings with attention on three areas:

Motor skill development: A recent review found structured activity sessions delivered in childcare were effective in improving motor skills despite methodological limitations.  Successful interventions focused upon fundamental movement skills, body management, physical fitness or dance, delivered in discrete units of 30-45 minutes, 2-3 days per week for up to 20 weeks (Ward et al 2010).

Curriculum-based approaches: The effectiveness of curriculum-based approaches to increase physical activity in the early years is unclear, although examples of successful interventions have been identified (Ward et al 2010).  Higher dosage interventions, with more sessions per week or longer duration, may be needed to increase physical activity compared to that needed to improve motor-skills. Effective interventions comprised structured activity programmes delivered for 30-45 minutes, 5-6 days per week for up to 12 months.

Environment / Policy Approaches: A small number of studies have examined the influence of changes to the childcare environment or policy upon physical activity levels. Provision of additional playground equipment and training increased physical activity. Changes to childcare break times were likely to result in greater activity if additional shorter breaks were offered rather than extending the duration of a single break time (Ward et al 2010).

More research is needed to inform practice but the British Heart Foundation National Centre for Physical Activity and Health (BHFNC, 2015) provide guidance which provide a useful basis for developing work at local level:

  • Strategies for consideration when commissioning physical activity initiatives for the early years
  • Strategies for consideration by early years managers when seeking to promote physical activity with the under fives

User views (on need, services / assets and gaps)

While user views have been informally noted, there has been no opportunity to develop a mechanism for formal feedback on the quality of current service provision and gaps with respect to promoting physical activity in this age group.

Equalities

The information presented within this chapter provides evidence of needs in respect of diverse groups. Consideration of these needs has resulted in the identification of priority issues to be addressed within South Gloucestershire as follows:

  • Supporting the physical development of children is stated as a key measure for success of initiatives to promote health and wellbeing in South Gloucestershire (SGC, 2012).
  • In children aged 2-15 years in England, 68% of boys and 76% of girls do not meet the Chief Medical Officers’ physical activity recommendations.

Unmet needs and service gaps

A range of services are provided that promote physical development in children 0-5 years old. The key local issues and gaps are:

  • There is a limited amount of training on physical activity for early years practitioners and health professionals.
  • The quantity and quality of opportunities for physical activity in early years settings vary.
  • Play on Prescription is being reviewed and recommendations will be made.

Recommendations for consideration by commissioners

Recommendations for commissioning activity are based on the key issues and gaps identified:

  • Further develop a range of training opportunities for early years practitioners and health professionals linked to physical activity.
  • Further develop audit tools on physical activity for use by early practitioners.
  • Implement the review recommendations for Play on Prescription

References

British Association for Early Childhood Education (2015) Development matters in the Early Years Foundation Stage (EYFS) (Accessed 03/11/15)

British Heart Foundation National Centre for Physical Activity and Health (2011) Early years evidence Briefing: Physical activity for early years. Evidence briefing. (online) Loughborough: BHF. (Accessed 04/11/2015)

British Heart Foundation National Centre for Physical Activity and Health (2015) Practice briefing – early years (online) (Accessed 04/11/15)

Department of Education (DE) (2014) Statutory Framework for the Early Years Foundation Stage Setting the standards for learning, development and care for children from birth to five (online). London: DoE. (Accessed 04/11/2015)

Department of Health (DH) (2010) Sedentary Behaviour and Obesity: Review of the Scientific Evidence Sedentary Behaviour and Obesity Expert Working Group (online).London DH. (Accessed 04/11/2015)

Department of Health (2011) Start Active Stay Active: A Report on physical activity from the four home countries’ Chief Medical Officers (online).  London: DH. (Accessed 04/11/2015)

Health and Social Care Information Centre (HSCIC), Lifestyles Statistics (2013) Health Survey for England. Statistics on Obesity, Physical Activity in Children, 2012. (online). London: Health and Social Care Information Centre. (Accessed 04/11/2015)

Hinkley, T., Crawford, D. and Salmon, J. (2008). Preschool children and physical activity: a review of correlates. American Journal of Preventive Medicine: 34(5), 435-441

Metcalf, B., Henley W., and Wilkin T. Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (Early Bird 54) British Medical Journal  345: e5888 doi: 10.1136/bmj.e5888

National Institute for Health and Clinical Excellence (NICE) (2009). Promoting physical activity, active play and sport for pre-school and school-age children and young people in family, pre-school, school and community settings.  Public Health Guidance 17 (online).  London: NICE (Accessed 04/11/2015)

National Obesity Observatory (NOO) (2011) BERTIE Babies and Early Years Risk – Trying to Implement the Evidence (online). London: NOO. (Accessed 15 August 2013) (Accessed 04/11/2015)

Reilly, J.J., Jackson, D.M., Montgomery, C., Kelly, L.A., Slater, C., Grant, S. and Paton, J.Y. (2004) Total energy expenditure and physical activity in young Scottish children: mixed longitudinal study. Lancet: 363 (9404), 211-2.

Rowlands, A.V. and Eston R. G. (2007) The measurement and interpretation of children’s physical activity. Journal of Sports Science and Medicine 6, 270-276 (Accessed 04/11/2015)

Rudolph, M. (2009) Tackling obesity through the Healthy Child Programme. A framework for action. (online) Leeds: University of Leeds and Leeds Community Healthcare (Accessed 04/11/2015)

Telama, R. (2009) Tracking of physical activity from childhood to adulthood: a review. Obesity Facts 2:187-95.

Timmons, B. W., Proudfoot, N.A., MacDonald, M.J., Bray, S.R. and Cairney, R. (2012) The health outcomes and physical activity in preschoolers (HOPP) study: rationale and design. BMC Public Health (online) 12: 284 (Accessed 04/11/2015)

Tucker, P. (2008) The physical activity levels of preschool-aged children: A systematic review. Early Childhood Research Quarterly (online) 23: 547-558 (Accessed 04/11/2015)

Warburton, D.E., Charlesworth, S., Ivey A., Nettlefold, L. and Bredin, S.S. (2010) A systematic review of the evidence for Canada’s Physical Activity Guidelines for Adults. International, 532 11,7:39.