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
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.
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
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
rtio
ns
Low
ActivityModerate
Activity
High
Activity
Odds ratio- significant variables
Wet
Girls MV
PA
Ballp
lay
Tim
e
Unshaded
Soft
fall
Hig
hT
em
pera
ture
s
Bark
, G
rass &
Sand
Access t
o n
on-f
ixed
Gro
und t
arg
ets
Teachers
observ
ing
Teachers
managin
g
Wall
targ
et
Short
bre
ak
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Environmental variables
Od
ds r
ati
o
MV
PA
HT
em
p
Ba
llp
lay
Tim
e
We
t
Gir
ls
U
ns
ha
de
d
B
ark
, g
ras
s
& s
an
d
Ac
ce
ss
no
nfi
xe
d
eq
uip
me
nt
Gro
un
d t
arg
ets
Te
ac
he
rs o
bs
erv
ing
Wa
ll t
arg
et
Te
ac
he
rs M
an
ag
ing
Sh
ort
bre
ak
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
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