Increase Physical Activity Opportunities Research Articles

A critique of the English national policy from a social determinants of health perspective using a realist and problem representation approach: the \u2018Childhood Obesity: a plan for action\u2019 (2016, 2018, 2019)

BackgroundThe UK government released Chapter 1 of the ‘Childhood Obesity: a plan for action’ (2016), followed by Chapter 2 (2018) and preliminary Chapter 3 was published for consultation in 2019 (hereon collectively ‘The Policy’). The stated policy aims were to reduce the prevalence of childhood obesity in England, addressing disparities in health by reducing the gap (approximately two-fold) in childhood obesity between those from the most and least deprived areas.MethodsCombining a realist approach with an analysis of policy discourses, we analysed the policies using a social determinants of health (SDH) perspective (focusing on socio-economic inequalities). This novel approach reveals how the framing of policy ‘problems’ leads to particular approaches and interventions.ResultsWhile recognising a social gradient in relation to obesity measures, we critique obesity problem narratives. The Policy included some upstream, structural approaches (e.g. restrictions in food advertising and the soft-drinks industry levy). However, the focus on downstream individual-level behavioural approaches to reduce calorie intake and increase physical activity does not account for the SDH and the complexity and contestedness of ‘obesity’ and pays insufficient attention to how proposals will help to reduce inequalities. Our findings illustrate that individualising of responsibility to respond to what wider evidence shows is structural inequalities, can perpetuate damaging narratives and lead to ineffective interventions, providing caution to academics, practitioners and policy makers (local and national), of the power of problem representation. Our findings also show that the problem framing in The Policy risks reducing important public health aims to encourage healthy diets and increase opportunities for physical activity (and the physical and mental health benefits of both) for children to weight management with a focus on particular children.ConclusionsWe propose an alternative conceptualisation of the policy ‘problem’, that obesity rates are illustrative of inequality, arguing there needs to be policy focus on the structural and factors that maintain health inequalities, including poverty and food insecurity. We hope that our findings can be used to challenge and strengthen future policy development, leading to more effective action against health inequalities and intervention-generated inequalities in health.

Evidence-based Strategies for Socially, Emotionally and Physically Beneficial School Recess

Health and education disparities continue to persist in low-income communities, and in communities with a high proportion of racial and ethnic minorities. Despite recess being a main contributor to children's school-based physical activity (PA), children in the aforementioned communities have less access to recess opportunities. The purpose of this article is to present evidence-based strategies and underlying critical success factors for school-based recess implementation that can be used by health and education professionals to increase PA opportunities in urban elementary schools. A brief overview of recess programs is provided, with a specific focus on Playworks — a national non-profit organization focused on providing safe and engaging recess for children. A program evaluation of the Playworks program was conducted through 15 focus groups and 13 semi-structured interviews. Data from a content analysis was used to identify strategies and critical success factors for recess implementation. These strategies are discussed, with implications for health and education professionals.

The Childhood Obesity Declines Project: A Review of Enacted Policies.

State- and local-level policies can influence children's diet quality and physical activity (PA) behaviors. The goal of this article is to understand the enacted state and local policy landscape in four communities reporting declines in childhood obesity. State-level policies were searched within the CDC's online Chronic Disease State Policy Tracking System. Local level policies were captured during key informant interviews in each of the sites. Policies were coded by setting [i.e., early care and education (ECE) also known as child care, school, community], jurisdictional level (i.e., state or local) and policy type (i.e., legislation or regulation). The time period for each site was unique, capturing enacted policies 5 years before the reported declines in childhood obesity in each of the communities. A total of 39 policies were captured across the 4 sites. The majority originated at the state level. Two policies pertaining to ECE, documented during key informant interviews, were found to be adopted at the local level. Similarities were noted between the four communities in the types of polices enacted. All four communities had state- and/or local-level policies that aimed to improve the nutrition environment and increase opportunities for PA in both the ECE and K-12 school settings. This article is a step in the process of determining what may have contributed to obesity declines in the selected communities.

Snacks, beverages, and physical activity during volunteer-led out-of-school-time programs: a cross-sectional analysis

BackgroundTens of millions of children regularly participate in out-of-school-time (OST) programs, providing an opportunity for child health promotion. Most research on OST has focused on structured, staff-led after-school programs, as opposed to volunteer-led programs such as enrichment programs and youth sports. The aim of this study was to describe snacks, beverages, and physical activity (PA) practices in volunteer-led OST programs across five organizations in three states.MethodsAn online survey including the Out-of-School-Time Snacks, Beverages, and Physical Activity Questionnaire was distributed to 1,695 adult leaders of enrichment and youth sports programs serving 5–12 year-old children in Maine, Massachusetts, and New Hampshire, USA. The response rate was 57.8%, with 980 leaders participating and 698 (136 youth sports, 562 enrichment) remaining after data cleaning procedures. Frequencies were calculated to describe snack, beverage, and PA offerings during typical meetings and whether healthy snack, beverage, and PA criteria were met. Criteria were developed a priori with the intent to capture co-occurring practices that together indicate healthy snack (fruits and vegetables or no snack over salty/sweet snacks); beverage (water over sugar-sweetened beverages); and PA environments (regular opportunities for >15 or 45 min of PA in enrichment and sports programs, respectively).ResultsAbout half of enrichment leaders reported that snacks and beverages were provided during typical meetings vs. one-fifth of sports leaders. In 28.4% of enrichment programs, PA was offered at every meeting vs. 98.5% of sports programs. Among enrichment programs, 50.4 and 25.8% met healthy snack and beverage criteria, respectively, and 29.4% met PA criteria, with 27.6% meeting criteria in two or more areas, and 5.0% in all three. Among sports programs, 72.8 and 78.7% met healthy snack and beverage criteria, respectively, and 71.3% met PA criteria. Eighty-two percent met criteria in two or more areas, and 46.3% met criteria in all three.ConclusionsMost programs did not meet criteria for healthier snacks and beverages and opportunities for PA during typical meetings, indicating room for improvement in encouraging widespread adoption of these practices. Efforts to improve the healthfulness of snacks and beverages and increase opportunities for PA during volunteer-led OST programs are warranted.

Adoption of Comprehensive School Physical Activity Programs: A Literature Review

P-12 physical education (PE) has evolved significantly over the last several decades, with one of the most important changes occurring recently with the inclusion of PE as a core academic subject (Society of Health and Educators [SHAPE America], 2015c). Well-designed PE programs have been acknowledged as having the unique potential to address student learning in all three of Bloom's domains (psychomotor, cognitive, and affective; National Association for Sport and Education [NASPE], 2011; SHAPE America, 2015a), but PE did not become a validated core subject until the recent 2015 revision of the federally legislated Elementary and Secondary Education Act (ESEA), a designation long since desired in the field (SHAPE America, 2015c).The advancement of a holistic approach emphasizing the education and health of students began in the late 1980s with the promotion of the Coordinated School Health Program model by the Centers for Disease Control and Prevention (CDC). The model identifies schools as essential agencies of change in youth health behaviors (Wechsler, McKenna, Lee, & Dietz, 2004) and includes eight components known to strongly influence student health, with PE serving as one of the components (Allensworth & Kolbe, 1987). In 1991, Sallis and McKenzie published the seminal paper Physical Education's Role in Public Health, highlighting the vital potential contribution of schools and PE in addressing the nationwide concerns related to childhood obesity and physical inactivity.In response to this critical national concern, the U.S. Department of Health and Human Services (USDHHS, 2008) introduced the first set of approved guidelines addressing physical activity (PA): the 2008 Activity Guidelines for Americans. The guidelines recommend that children and adolescents engage in at least 60 min of moderate to vigorous physical activity (MVPA) daily. To further convey the importance of increasing PA opportunities, NASPE (2008) released a position statement recommending that all P-12 schools implement a Comprehensive School Activity Program (CSPAP). A CSPAP should include (a) quality PE (QPE), (b) PA during school, (c) PA before and after school, (d) school employee wellness and involvement, and (e) family and community involvement.The National Activity Plan (NPAP Alliance, 2010) includes comprehensive strategies to promote PA by eight sectors of society. The education sector is responsible for outlining strategies and tactics that could be implemented in and around the school setting (NPAP, 2010), with the first of seven strategies specifically targeting the comprehensive approach of the CSPAP. The goal of Strategy 1 is to access to and opportunities for high-quality, comprehensive physical activity programs, anchored by physical education, in Pre-kindergarten through grade 12 educational (Education section, para. 4). In line with this strategy and the NASPE (2008) recommendation, schools have been identified as one of the most appropriate settings for increasing PA (Institute of Medicine [IOM], 2013; Kelder, Karp, Scruggs, & Brown, 2014; NPAP Alliance, 2010; USDHHS, 2008), and national initiatives such as Let's Move! Active Schools (n.d.) have been established to provide schools and teachers with the necessary resources and tools to increase PA opportunities for students.Most recently, in The Essential Components of Education, SHAPE America (2015a) outlines four components that establish a more direct path for attaining QPE programs: (a) policy and environment, (b) curriculum, (c) appropriate instruction, and (d) student assessment. SHAPE America (2015a) identifies these as foundational components designed to guide schools and physical educators in making PE a more validated subject area. In addition to emphasizing more rigorous policies and higher accountability in the field, SHAPE America (2015a) also strongly endorses the use of the CSPAP framework to increase overall PA opportunities for students. …

Health Promotion Efforts as Predictors of Physical Activity in Schools: An Application of the Diffusion of Innovations Model.

Implementing a comprehensive school physical activity program (CSPAP) effectively addresses public health issues by providing opportunities for physical activity (PA). Grounded in the Diffusion of Innovations model, the purpose of this study was to identify how health promotion efforts facilitate opportunities for PA. Physical and health education teachers (N = 256) nationwide were surveyed using a CSPAP Index to identify teacher's efforts for providing opportunities for PA within a school setting. A hierarchical regression analysis revealed total number of PA opportunities was significantly predicted by teachers' health promotion efforts, p < .001. Sex and years of experience were not significant covariates, p = .35, in the final step of the model. Accounting for teaching environments, the model was significant, p < .001. The strongest predictors were the promotional efforts of PA for family and community, p < .001, PA for staff members, p < .01, PA during the school day, p < .05, and PA before school, p < .05. To increase PA opportunities for children in schools, emphasis should be placed on health promotion. This study confirms the importance of teachers involving family, community, and staff members as co-health promoters when trying to increase PA engagement surrounding schools.

Physical activity during the segmented school day in adolescents with and without autism spectrum disorders

The purpose of this study was to assess the intensity of physical activity (PA) that secondary school-aged students with autism spectrum disorders (ASD) and typically developing (TD) students exert during a school day, and to compare the percentages of students achieving the recommended guidelines between groups. The PA of 60 male students (ASD, n=30; TD, n=30) was recorded every 10s for up to 5 school days by performing uniaxial accelerometry. The main results are listed as follows: (a) daily PA was significantly lower among the students with ASD than among the TD students; (b) students with ASD spent significantly lower proportion of their time in moderate PA than TD students did during physical education (PE), recess, and lunchtime; and (c) fewer students with ASD than TD students achieved the PA guidelines during the school day and PE time. Schools should increase PA opportunities across the school day.

The challenge of low physical activity during the school day: at recess, lunch and in physical education

PurposeTo describe physical activity (PA) intensity across a school day and assess the percentage of girls and boys achieving recommended guidelines.MethodsThe authors measured PA via accelerometry in 380 children (8–11...

Population Interventions for Obesity

To the Editor: In a recent letter in your journal, Walls et al write that “a population approach that de-skewed the population's body weight—reducing most the weight of the heaviest people and leaving largely unchanged the weight of the lightest people—would be particularly safe and effective, but it is not clear how to achieve such a change.”1 We beg to differ, and believe that it is not at all difficult to think of population-wide interventions that affect the obese more than those of normal weight. For example, a tax on energy-dense foods or sugared beverages2 would automatically target the overweight, because this group consumes most of these products. Indeed, it is one of the causes of their overweight. Numerous studies have shown an association between the consumption of sugared beverages and BMI, or between energy-dense foods and BMI.3 This would make a tax on such drinks exactly the kind of intervention Walls et al are looking for, ideally combined with subsidies on healthier foods to prevent decreases in purchasing power decreases among low-income earners. Other examples could be limiting the marketing of such foods, or banishing unhealthy foods from schools. An additional benefit is that, unlike explicitly targeted interventions, such changes to the “obesogenic” environment do not stigmatize obese persons. We would posit, therefore, that safe and effective interventions that reduce the weight of the heaviest, but not of the lightest people, do exist. In contrast, we cannot think of realistic examples of a population-wide intervention that reduces the BMI of heavy and light people to an equal degree (Walls' scenario 1). The example of the economic collapse in an already poor country (Cuba) hardly counts as a realistic intervention to improve health–though it does seem to have had that effect. Furthermore, as Walls et al show, BMI distributions in western countries historically changed by increasing skewness, not by shifting entire distributions up or down. It is unlikely that interventions that improve diet or increase opportunities for physical activity would do otherwise. The first scenario presented is therefore a bit of a red herring. In conclusion, unlike Walls et al, we believe it is well known what population-wide actions are likely to be effective. We do agree on the need for rigorous evaluation of the policy experiments that are undertaken, because the effectiveness of such interventions remains largely unknown.4 J. Lennert Veerman Jan J. Barendregt School of Population Health University of Queensland Brisbane, Queensland, Australia

The Association between Funding for Statewide Programs and Enactment of Obesity Legislation

Objective As part of a national effort to prevent and control obesity, the Centers for Disease Control and Prevention's (CDC's) Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases (NPAO) provides funding to states to improve access to healthful food and increase opportunities for physical activity. The CDC also provides funding to states to build Coordinated School Health (CSH) programs across agencies and within schools to help reduce chronic disease risk factors. This paper investigates the possible role of these programs in state policy change. Methods Descriptive study of state legislation targeting obesity prevention passed in 2005. Units of analysis were 135 pieces of obesity-related state legislation identified within 4 legislative databases. Legislation was coded into programmatic setting and obesity-prevention strategy categories. Results On average, states receiving NPAO or CSH program funding passed twice as many bills as states not yet funded. Conclusions and Implications The statewide obesity prevention and school health programs may have contributed to states enacting more obesity-related legislation. Further research into the process by which state programs influence the enactment and effective implementation of policies could help build the evidence base for policy changes that help prevent obesity.

Early Impact of the Federally Mandated Local Wellness Policy on Physical Activity in Rural, Low-Income Elementary Schools in Colorado

The What's Working project described the initial impact of the United States' federally mandated Local Wellness Policy in rural, low-income elementary schools located in Colorado. Before and after the Local Wellness Policy mandate went into effect, a survey about school features related to nutrition and physical activity was sent to a random sample of 45 rural elementary schools (i.e., schools located outside of urban areas), in which at least 40% of students qualified for free or reduced-cost lunch. Overall, opportunities for physical activity did not change after the policy went into effect: although time in physical education increased by 14 min per week (P=0.10), time for recess decreased by roughly 19 min per week (P=0.10). Policies supporting student participation in physical education and recess (an unstructured time during school hours when students are allowed to play outside) did not change. The researchers coded Local Wellness Policies and found them to have weak wording that produced minimal impact. Content analysis of key informant interviews suggested several barriers to the impact of the Local Wellness Policies: (1) competing pressures facing school districts, (2) lack of resources devoted to the Local Wellness Policy, (3) principals' lack of knowledge about the policy, and (4) lack of accountability mechanisms to ensure policy implementation. Financial resources and more effective communication about Local Wellness Policies among school districts and principals are needed to elevate the importance of and increase opportunities for physical activity in rural, low-income Colorado elementary schools.

National Nutrition Summit, May 30, 2000: Results of the Obesity Discussion Groups

National Nutrition Summit, May 30, 2000: Results of the Obesity Discussion Groups