How Australian school environments affect children's

playground physical activity and sedentary behaviour

Dr Anne-Maree Parrish

• Physical activity

• Sedentary behaviour

• Cognition & executive function

The impact of the Physical and Policy environment of schools on children’s:

The problem• Low physical activity 4th leading

cause of death non-communicable disease worldwide.

• Physical inactivity - main cause for approx: 21–25% breast & colon cancers, 27% diabetes 30% ischaemic heart disease burden.

• Physical inactivity - the 2nd greatest contributor to the cancer burden in Australia.

• In 2003, physical inactivity accounted for approx6.6% of the Australian disease burden.

(Begg et al 2007,WHO 2009)

Australia

• Only 1/3 of children & 1 in 10 youth did 60 mins of physical activity/day.

• 25% of children/youth are overweight or obese

• 60% of Australian adults did <30 mins of moderate intensity physical activity per day.

• Less than 1 in 3 children & youth (5-17 yr olds) met the “no more than 2hrs/day of screen time.

• Nearly 70% of Australian adults (almost 12 million) are sedentary or have low levels of physical activity.

(Australian Health survey 2011-12)

Children, young people & screen time • On average, children & youth (5–17 yrs) spent 136 mins/day

using screens.

• 44% of children & youth (2–17 years) had a screen in their bedroom.

• For 15–17 year olds, 3/4 had a screen causing an extra 2 hrs/week screen time.

• Children 5–11yrs 12,000 average 23% reached 12,000 steps/day only 7% 15–17 yr olds reached 12,000 steps.

(Australian Health survey 2011-12)

Physical activity: “is any bodily movement produced by the muscles that results in energy expenditure”

Sedentary behaviour: “ A distinct class of behaviours that involve sitting and low levels of energy expenditure, typically less than 1.5 metabolic equivalents (METs)”

Sedentary best described as sitting

(AIHW 2008, p135 Marshall & Ramirez 2011 p 2).

What does physical activity do???• reduces cardiovascular risk factors such as

overweight & high blood pressure

• improves the levels of HDL (the ‘good’ cholesterol)

• regular exercise-helps protect against Type 2 diabetes & some forms of cancer

• strengthens the musculoskeletal system-helping to reduce the likelihood of osteoporosis

& the risk of falls & fractures.

• improves mental wellbeing reducing feelings of stress, anxiety and depression

Sedentary behaviouris linked to:

• Increased cardiovascular events

• Obesity

• Metabolic syndrome

• Incident hypertension

• Type 2 diabetes

• Ovarian cancer

• Colon cancer and endometrial cancer

• Also associated with CVD markers in adolescents

Why is it a problem???

2 BIG take home messages:

Just because people meet the physical activity guidelines doesn’t mean that they meet the

sedentary guidelines.

Sedentary behaviour is linked to poor health outcomes independent of physical activity.

Lets stand up for health!!!

Most Australian children attend

school

Break time contributes 70-80 mins of a child’s day or 40% recommended MVPA

[Ridgers et al 2006]

Our studies

What we considered• Physical activity• Sedentary behaviour• Cognition and executive function

Where?

13 Illawarra public primary schools - 3 days at each

Fixed equipment

Painted ground targets

Sporting fields

Non-fixed equipment & access to it

Observed physical activity

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

0.5

Activity Categories

Pro

po

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ns

Low

ActivityModerate

Activity

High

Activity

Odds ratio- significant variables

Wet

Girls MV

PA

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Soft

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rass &

Sand

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ixed

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ets

Teachers

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Teachers

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0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Environmental variables

Od

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p<0.05

Schools can children’s PA by:

• longer breaks

• soft play surfaces

• ball games

• painted ground

targets

• non-fixed equipment

• Access to sporting fields

Parrish et al 2009 BJSN, Parrish et al 2009 JPAH, Parrish et al 2010 HER

Systematically reviewing the literature

• Of single component strategies games equipment & playground markings SIGNIFICANTLY increased recess PA

• 2 reported significant decreases in recess physical activity.

• NO studies examining interventions during recess/lunch for ADOLESCENTS

Parrish et al 2013 Sports Med

“There would be no playing equipment and there would be just cement and grass, nothing to play with, so you can’t really play games without

it. But kids like to play with fixed equipment and normal equipment” (student).

“If they are in a playground with lots of fantastic equipment and fixed equipment and sporting equipment then they’re more likely to use it to have a positive attitude towards it. I think it has a really huge effect” 1

(teacher)

Why

AIM: to assess the effect of an intervention that modified the school playground environment & policies addressing PA levels

among primary aged children during school recess/lunch.

1. Parrish et al 2011, HER 2. Parrish et al, 2009 BJSN 3.Parrish et al 2013 Sports Med,4.Ridgers et al 2012 Am J Prev Med.

Kid are more active: Soft-fall rubber surface, Bark, grass and sand, Access to non-fixed, Ground targets, Time, Ball play 2

What we did

• 2-arm parallel group RCT

• 4-13 yrs at 4 Illawarraprimary schools

• Intervention :

– policy changes

– donated quantity of portable

• SOPLAY5 inter-rater rel sig

• Linear mixed models adjusting for the clustering effect of schools.

• Effect sizes- Hedges5. McKenzie 2000 Prev Med

What we found• 1582 children (790 boys, 792

girls)

• Intervention changes

• Teachers acceptance of Intervention

• 50% of break-time in MVPA

• Pre Intervention schools MVPA increased by 13.5% & control by 1% at follow-up

(Mostly due to morning break)

• The results were greater for girls compared to boys.

• Medium beneficial effects at Int schools

0%

10%

20%

30%

40%

50%

60%

70%

Baseline Followup

Control

Intervention

%MVPA

Interventions effect on MVPA

Parrish et al 2015 JSAMS

What we found

0%

10%

20%

30%

40%

50%

60%

70%

80%

Baserecess

Postrecess

Baselunch

Postlunch

Cont boys

Cont girl

Int boys

Int girls

0%

10%

20%

30%

40%

50%

60%

70%

80%

Baserecess

Postrecess

Baselunch

Postlunch

Control

Int

%MVPA

%MVPA

Interventions effect at recess & lunch

Interventions effect for boys and girls

What it means

• Baseline 50% MVPA-room to improve

• Non-fixed

• Boys more active than girls

• MVPA stat sig for girls at recess (p=0.02)

http://www.mailtimes.com.au/story/1490855/horsham-haven-schools-receive-new-sports-gear/

What else?

Break time policies

• No hat no play

• Compulsory sitting

• Access to sporting fields

• Length of break time

http://www.ferryhillstationschool.co.uk/our-school/school-policies

Sedentary adolescents • Adolescents are sedentary for more than 50% of their waking

hours

• Older adolescents (16-19 years) the second most sedentary population group

• Among adolescent girls, more than 50% of their time in the first 2yrs of high school is spent in sedentary behaviour increasing to nearly 70% in the middle 2yrs

blogs.cdc.com

Calorimeter study This RCT aimed to examine the acute effects of a “modified” day at secondary school (25% of time sitting) on the energy expenditure (EE) and cognition of normal & overwt/obese 12-14 yr old adolescents compared to a typical day (50% sitting).

Preliminary findings

• The ‘reduced sitting’ school day (where adolescents sat for 50% less time, and had no bouts of sitting > 20 minutes), lowered the risk of poor cardiometabolic health outcomes compared with the ‘typical’ school day (65% of time spent sitting & two bouts of sitting > 20 minutes).

• The differences between the two conditions were also greater among the overweight/obese sample compared to the total sample.

• Significant impact on cognition

Heart Foundation Vanguard grant

The aim of this project was to test a pilot RCT intervention to reduce sitting time, increase light-intensity physical activity (LPA) and its impact on executive function and cognition during school hours among 12-14 yr old adolescents at 4 schools

Vanguard

Qualitative study- focus groups – students, teachers and executive

Quantitative study- intervention in 4 schools.

Summary Primary recess environment

• longer breaks

• soft play surfaces

• ball games

• painted ground targets

• non-fixed equipment

• Access to sporting fields

• Girls at recess

High school environment

• Use of stand up desks

• Policies to ensure students sit for no more than 30 mins per bout

• Education of staff and students regarding sedentary time.

Policies.

No hat no play, review compulsory sitting, ensure access to sporting fields

• Length of break time

Acknowledging

• The students, teachers, principals and parents who helped to make our research possible.

• The University of Wollongong and the National Heart Foundation for funding our research

And • Our fantastic research team Prof Tony Okely, Prof

Jo Salmon, Prof Stewart Trost, Assoc Prof MarijkaBatterham, Dr Dylan Cliff, Dr Steven Howard, Dr Bridget Kelly, Dr Chris Magee,

• Special thanks to our research assistants and Megan Hammersley and Anisse Penning

Questions??