An article in the BMC Public Health journal broadens the analysis of physical activity of adolescents in Australia. The article notes that "24-hour movement guidelines recommend a healthy balance of high levels of physical activity, low levels of sedentary behaviour and appropriate sleep duration each day." The methods of the study were "A repeated national cross-sectional survey of students in grades 8 to 11 (ages 12-17 years) was conducted in 2009-2010 (n=13,790), 2012-2013 (n=10,309) and 2018 (n=9,102). Students’ self-reported physical activity, screen time and sleep behaviours were assessed using validated instruments administered in schools via a web-based questionnaire".  The results were "In 2018, around one in four students (26%) did not meet any of the 24-hour movement guidelines, while only 2% of students met all three. Adherence to the sleep duration recommendation was highest (67%), with substantially smaller proportions of students meeting the physical activity (16%) and screen time (10%) recommendations. Differences in adherence by sex, grade level and socio-economic area were apparent. Students’ compliance with the screen time recommendation has declined over time, from 19% in 2009-2010 to 10% in 2018. However, there has been no significant change in the proportion meeting the physical activity (15% in 2009-2010 cf. 16% in 2018) and sleep duration (69% in 2009-2010 cf. 67% in 2018) recommendations. Compliance with all three guidelines has remained very low (<3%) across each survey round."

ISHN Comment: Although the broader analysis is useful to measure the overall daily PA among young people, the continuing focus on the quantity of PS rather than the quality is troubling. It has been refreshing to see the shift in PA sector back towards fundamental movement skills rather than counting minutes of activity during the school day. (This article continues that quantity-based thinking by suggesting more walking to school.) while more PA is always health promoting, schools should be focused more on knowledge, skills and attitudes that can be carried into life rather than counting steps or minutes. Further, much of the quantity-based thinking suggests light PA activities (such as walking to school), which actually do not mean the guideline of 60 minutes of moderate to vigorous activity. Measuring acquired skills is a better measure. What might be even better for schools to address is attitudes. Do school-based activities and PE classes actually increase or decrease student enjoyment of PA? 

Read more in the journal article.

An July 2019 article in BMC Public Health underlines the need for greater clarity when we discuss scaling up programs as opposed to more effective ways to implement an effective program. "The implementation of interventions at-scale is required to maximise population health benefits. ‘Physical Activity 4 Everyone (PA4E1)’ was a multi-component school-based program targeting adolescents attending secondary schools in low socio-economic areas.An efficacy trial of the intervention demonstrated an increase in students’ mean minutes of moderate-to-vigorous physical activity (MVPA) per day and lower weight gain at low incremental cost.This study aims to assess the effectiveness and cost effectiveness of a multi-component implementation support intervention to improve implementation, at-scale, of the evidence based school physical activity (PA) practices of the PA4E1 program. Impact on student PA levels and adiposity will also be assessed, in addition to the cost of implementation." A cluster randomised controlled trial, utilising an effectiveness-implementation hybrid design, will be conducted in up to 76 secondary schools located in lower socio-economic areas across four health districts in New South Wales (NSW), Australia.Schools will be randomly allocated to a usual practice control arm or a multi-component implementation support intervention to embed the seven school PA practices of the PA4E1 program. The implementation support intervention incorporates seven strategies including executive support, in-School Champion, teacher training, resources, prompts, audit and feedback and access to an external Support Officer. The primary trial outcome will be the proportion of schools meeting at least four of the seven physical activity practices of the program, assessed via surveys with Head Physical Education teachers at 12 and 24-months. Secondary outcomes will be assessed via a nested evaluation of student PA and adiposity at 12-months (Grade 8 students) and 24 months (Grade 9 students) undertaken in 30 schools (15 per group)" . ISHN Commentary: This promises to be an excellent study but will it measure the effect and cost effect of an implementation strategy as opposed to different methods for scaling up the multi-intervention program to other schools or other regions? Read more....

A review of data from the Health Behaviours of School-Age Children (HBSC) surveys between 2002 and 2014 hase been published by the WHO Regional Office. "This report presents the latest trends in obesity, eating behaviours, physical activity and sedentary behaviour from the HBSC study and highlights gender and socioeconomic inequalities across the WHO European Region. Trends have previously been reported separately, but this report brings together for the first time HBSC data on obesity and obesity-related behaviours." The report notes that "Obesity continues to increase in all but a very few countries and regions, with disparities within and between them being marked. Trend data on dietary and physical activity behaviours are more mixed, but show some improvements for some age groups in some countries. Overall, however, the indicators show that adolescents’ dietary behaviours remain far from optimal, with too many sugary products and not enough fruit and vegetables consumed. At the same time, physical activity as part of daily life has been reduced to the bare minimum: adolescents spend most of their time sedentary. This paints a rather bleak picture that requires ambitious policy action." The report shows that some mixed progress has been made in eating habits, physical activity and sedentary time.

• Daily consumption of fruit and vegetables increased slightly between 2002 and 2014, but overall prevalence remains low.
• Daily consumption of sugary soft drinks and sweets decreased noticeably between 2002 and 2014, but consumption remains high: almost one in five adolescents drinks sugary soft drinks daily and one in four eats sweets every day.
• Overall, moderate-to-vigorous-intensity physical activity (MVPA) levels are low and decline with age during the adolescent years.MVPA levels have not changed substantially over time.
• Participation in vigorous-intensity physical activity (VPA) is reasonably high across Europe and appears to have remained stable between 2002 and 2014, with a slight positive trend in girls.
• TV-viewing is decreasing across Europe.Computer use for gaming and non-gaming purposes increased sharply between 2002 and 2014 and offset the TV-viewing decrease.

Despite this leveling off of mixed progress in child and youth behaviours, the report notes that "While levels of obesity have stabilized in some countries and regions,prevalence has increased in over half of those involved in HBSC surveys since 2002. The most marked increases have been observed in eastern European countries, where levels of obesity were relatively low in 2002. Only 13-year-old boys in Norway and 11-year-old girls in Spain experienced a significant decrease in obesity prevalence"
Although the HBSC survey reports only on behaviours and there is no mechanism to correlate or track the introduction of healthy school food policies and increases in physical activity time within the school day, we can safely assume that these HBSC data trends have coincided with increased efforts by schools to prevent obesity. Consequently, we need to question if these school-based efforts alone are sufficient to truly make a difference over the long term. A similar analysis of Canadian efforts (McCall, 2013), reported that similar little progress had been made after two decades of obesity prevention and heart healthy programs in that country.
In our view, this HBSC report requires us to ask some essential but possibly inconvenient questions:

1. If progress seems to be happening with young people in more affluent countries and communities but the overall averages are stagnant or deteriorating, should we shift our focus away from the middle class towards the working class students?
   
2. If schools are now doing their part, should we now focus on other environments such as the media, social media, recreation, sports and even families and introduce much stronger policies such as advertising limits, mandatory restrictions on sugars and other such measures?
3. Given that research and exposure of the activities of food companies has shown that physical activity, while beneficial in many ways, does not significantly affect obesity/overweight, should we focus more on other factors such as mental health, loneliness, boredom, stating at home after school without adult supervision, stressed parents with no time to prepare or even purchase healthy food?

Read more....
(This item is among the 5-10 highlights posted for ISHN members each week from the ISHN Member information service. Click on the web link to join this service and to support ISHN)

(An item from the ISHN Member information service)  A letter/article in Issue #11, 2015 of Public Health Nutrition makes a good point in response to an earlier article suggesting that BMI should be replaced as a measure of obesity by the time it takes a child to run 500 meters. The argument is made well by differentiating "fitness" from "fatness". The physical fitness to run that distance is quite a different construct than a simplistic height/weight ration such as BMI. Further, there are more sophisticated measures of body fat (waist circumference, waist to to height ratio and abdominal fat etc) that can replace BMI if needed. However it is this simple clarification of fitness and fatness that may be even more important to consider, especially in the light of increasing evidence that physical activity alone has little impact on body weight. Increasingly, researchers are turning to diet/healthy eating and accompanying mental states (boredom, loneliness,k stress) as the dominant factors. Read more>>

(An item from the ISHN Member information service)  Readers of this blog will know that we have been tracking the relationship (or lack thereof) between physical activity and overweight/obesity. Two Articles in July 2015 Issue of International Journal of Obesity continue the discussion. One article suggests that self-reporting of eating and activity behaviours are not sufficiently accurate and objective measurement is required. Another article reports on a study that "identified an unhealthy cluster of TV viewing with ED food/drink consumption, which predicted overweight/obesity in a small longitudinal sample of Australian children. Cluster stability was fair to moderate over 3 years and is a novel finding. A third behaviour examined in the study, physical activity was apparently not as significant as the eating/TV watching behaviours. This finding continues our growing realization that eating and activity may be independent factors/behaviours rather than linked and that it may be wiser to focus on eating, especially when combined with television viewing. Read more>>

(An item from the ISHN Member information service)  Three articles in June 2015 Issue of International Journal of Environmental Research and Public Health seek to make the case for "risky" outdoor play for all children. The first article reported on a "systematic review to examine the relationship between risky outdoor play and health in children, in order to inform the debate regarding its benefits and harms. We identified and evaluated 21 relevant papers for quality using the GRADE framework. Included articles addressed the effect on health indicators and behaviours from three types of risky play, as well as risky play supportive environments. The systematic review revealed overall positive effects of risky outdoor play on a variety of health indicators and behaviours, most commonly physical activity, but also social health and behaviours, injuries, and aggression". The second review article examined "the relationship between outdoor time and: (1) physical activity, (2) cardiorespiratory fitness, (3) musculoskeletal fitness, (4) sedentary behaviour; or (5) motor skill development in children aged 3–12 years. We identified 28 relevant studies that were assessed for quality using the GRADE framework. The systematic review revealed overall positive effects of outdoor time on physical activity, sedentary behaviour, and cardiorespiratory fitness, although causality could not be assumed due to a lack of RCTs". The third article was a position paper based on the two articles. Read More>>