How can we get kids to be more active at school? New review highlights gaps

boy looking through hole in playground equipment

What do you remember about school break times? Did we fall into predictable groups, with boys playing football and girls walking round arm in arm, sharing gossip? It seems to me, looking back, that it was a time spent on the move, one way and another, and from a health perspective that was a Good Thing.

Mind you, let’s not overlook the less healthy aspects. Tuck shops (no fruit on sale in the 1970s), bullying, smoking…  Then there are those playtime pursuits we generally  survived which have been subject to bans, including conkers, yo-yos, marbles, tag, skipping, hide and seek  and even making daisy chains.

Plenty of smoking still, as a walk past the neighbouring secondary school revealed the other day (behind the bike shed – what a cliché!). What is clear is that school break times provide an opportunity for physical activity (PA) and that this needs to be encouraged in our sedentary times.

According to the most recently available UK figures (2011), almost 10% of children in reception classes at school (four and five year olds) are obese. The general consensus in developed countries is that children and teens should accumulate a minimum of 60 minutes of moderate-to-vigorous physical  activity (MVPA) every day. So what can be done to encourage physical activity at school break times?

A new systematic review on how to encourage physical activity

This question was the focus of a recent systematic review from a team in New South Wales, Australia, who looked at the effectiveness of interventions aiming to encourage school-aged children and teens to be active at recess/break.

The review team searched six appropriate databases published between 2000 and 2011, but restricted their searches to studies published in English, so may have missed some relevant studies in other languages. Eight randomized controlled trials (RCTs) and one controlled trial were included, six from the UK. There were no suitable studies involving adolescents. Numbers of children in each study ranged from 28 to 667. All but one looked at environmental approaches. Five studies assessed multi-component interventions which combined strategies such as organized activities, fixed and moveable equipment and playground markings. The studies used a range of objective measures of physical activity such as pedometers. The studies were not considered suitable for combining results in a meta-analysis.

Their findings

Here’s what they found:

  • Playground markings and games equipment significantly increased children’s breaktime moderate PA, vigorous PA and MVPA compared with controls
  • Studies that examined combined strategies had mixed findings. Strategies that combined playground markings, playground coding or court rotation (to rotate playground use) and non-fixed equipment increased recess PA significantly
  • A study that used a combination of playground markings, a walking club and organized activities found boys were significantly  less active than their control group peers after 12 months
  • Of the single-component strategies used, games equipment and playground markings significantly increased PA whilst active video games had a negative impact
  • Only 3 studies were judged to be of high methodological quality overall, 3 studies had a follow-up period of less than 6 weeks and poor reporting was a problem in all studies
vintage photo of teen girls exercising

How can we encourage teenagers to be more active at school breaktimes?

The reviewers were unable to come to any clear conclusions about what might work best to increase children’s physical activity in school, owing to the limitations of the evidence, and instead highlight what needs to be addressed in future, high quality research. They note, in particular, the need to understand what works with adolescents and with subgroups (by age or gender, for example) and which elements of multi-component interventions are most effective.

What have other reviews found?

A Cochrane review on school-based interventions to increase physical activity in school, updated earlier this year, draws on a much larger body of evidence; 44 studies with almost 37,000 children. Sadly, the reviewers warn that its results should be interpreted with caution due to an at least moderate risk of bias and a small magnitude of effect, but the evidence favours the continuation of school-based physical activity interventions. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity resulted in positive effects. You can read more about this review or listen to a podcast from the link below.

Links:

Parrish A-M, Okely AD, Stanley RM, Ridgers ND. The Effect of School Recess Interventions on Physical Activity. A Systematic Review. Sports Med (2013) 43:287–299. DOI 10.1007/s40279-013-0024-2

Dobbins M, Husson H, DeCorby K, LaRocca RL. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD007651. DOI: 10.1002/14651858.CD007651.pub2. Cochrane summary and podcast

NHS Choices Latest obesity stats are alarming.  February 21 2013