Promoting physical activity in children and adolescents

Abstract

Physical activity is an integral part of a healthy childhood and adolescence. For 5–17 year olds, WHO recommends 60 min per day of moderate-to-vigorous-intensity physical activity, which can involve walking, cycling, recreational sports, and active play. However, the new WHO Global status report on physical activity, published on Oct 18, found that 81% of adolescents aged 11–17 years do not meet these recommended levels of physical activity needed to sustain good health and wellbeing. This report is the first global assessment of implementation of the 2018 Global Action Plan on Physical Activity (GAPPA) recommendations. Progress towards a 15% relative reduction in physical inactivity by 2030 has been slow and uneven: less than a third of countries have national physical activity guidelines for all age groups, and just over 40% have road design standards for safer walking and cycling. The meagre progress was further set back by the COVID-19 pandemic, with closures of schools and community spaces reducing opportunities for young people to be active, particularly those from disadvantaged neighbourhoods and poor socioeconomic backgrounds. Many countries are missing opportunities to engage certain groups of children and adolescents in physical activity. According to the report, in 2021, national policies to promote physical activity in childcare settings were implemented in only 59 (30%) countries. More girls were inactive than boys (85% vs 78% overall) across income groups in nearly all countries and regions, and the slight improvement in 2010–16 in levels of physical activity was seen in boys only. Young people with disabilities and chronic conditions are likely to face additional barriers, but no data were available to assess the promotion of physical activity in this subpopulation. The scarcity of data is seriously hampering progress. The report found that, in 2021, only 57 (29%) countries, mostly from Europe, reported surveillance of physical activity in children younger than 5 years. Although 146 (75%) countries did so for the 5–19-year age group, most collected data only from school-attending adolescents aged 11–17 years, severely limiting representation of younger children and those not in formal education. Therefore, an important step towards realising the GAPPA goals is to strengthen global and national data systems, ensuring that levels of physical activity are measured across the life course, and in key subpopulations, such as children younger than 5 years and aged 6–9 years, young people not in schools, and those with disabilities. Additional indicators are also needed, especially for policy reach and enforcement, as the WHO report identified a substantial gap between countries having and implementing relevant policies on physical activity. The cost of inaction is huge: physical inactivity is estimated to result in almost 500 million new cases of preventable non-communicable diseases between 2020 and 2030 globally, costing health systems US$27 billion per year. Therefore, multiple government departments— including health, education, sport, transport, and urban planning—must prioritise promotion of physical activity across the life course, in accordance with WHO guidance for different age groups and subpopulations. Early childhood services and childcare facilities are key settings to promote healthy habits from an early age. Educational settings should be a supportive environment, offering high-quality sports and physical education programmes to help young people develop self-confidence and physical literacy, while having fun with their peers. Investment in community programmes, public open spaces, safer roads and urban environments, and mass participation events will also help to encourage participation. Importantly, these efforts must be inclusive and equitable to increase engagement of the least active and most marginalised groups. Barriers stemming from stigma, socioeconomic, and cultural factors must be dismantled to create an enabling environment for all children and young people. In clinical settings, paediatricians, primary-care providers, and other health professionals have important roles in empowering young people and their families to take part in physical activity, especially for those with disabilities and chronic conditions. The American Academy of Pediatrics recommends regular assessment of physical activity and literacy, incorporation of physical activity into treatment plans, and provision of specific guidance. As countries recover from the COVID-19 pandemic, with overstretched health systems and a tight fiscal budget, promotion of physical activity is a practical and cost-effective way to improve long-term population health and must be prioritised.