Twelve-month effects of a playground intervention on children's morning and lunchtime recess physical activity levels

Background: Recess is an opportunity for children to engage in daily physical activity. The aim of this study was to investigate the 12-month effects of a playground intervention on children’s moderate-to-vigorous (MVPA) and vigorous physical activity (VPA) during morning and lunchtime recess.

Methods: Four hundred and seventy children (232 boys, 238 girls) from 26 elementary schools participated in the study. Fifteen schools redesigned the playground environment using playground markings and physical structures. Eleven schools served as socioeconomic matched controls. Physical activity levels were quantified using heart rate and accelerometry at baseline, 6 months, and 12 months post-intervention. A 3-level (time, pupil, and school) multilevel analysis was used to determine the effects of the intervention across time on MVPA and VPA.

Results: Positive yet nonsignificant intervention effects were found for MVPA and VPA during morning and lunchtime recess. Intervention children were more active during recess than control children. Interactions revealed that the intervention effect was stronger at 6 months than 12 months post-intervention.

Conclusions: A playground markings and physical structures intervention had a positive effect on intervention children’s morning and lunchtime MVPA and VPA when assessed using heart rate and accelerometry, but this effect is strongest 6-months post-intervention and decreased between 6 months and 12 months.

Relationships between maturity status, physical activity and physical self-perceptions in primary school children

The aim of this study was to examine the influence of maturity status on primary school children's physical activity and physical self-perceptions. Altogether, 175 children (97 girls, 78 boys) aged 10.6 ± 0.3 years completed the Children and Youth Physical Self-Perception Profile and wore an ActiGraph accelerometer for five consecutive days to assess moderate-to-vigorous physical activity. Anthropometric measures were completed to estimate maturity status. A two-level, multi-level analysis was used to assess the influence of maturity status on moderate-to-vigorous physical activity and physical self-perceptions. Boys performed more moderate-to-vigorous physical activity than girls (P < 0.0001), but when the effect of maturity status was controlled the difference was reduced (P = 0.02). Significant differences between the sexes were also observed for physical self-perception sub-domains (boys > girls, P = 0.02 to 0.0001). When maturity status was added to the model, significant differences were no longer apparent for each sub-domain, with the exception of perceived strength. Significant interactions between gender and maturity status revealed that boys' physical self-perceptions improved with more advanced maturity status, whereas girls' self-perceptions decreased (P = 0.07 to 0.002). Significant differences between the sexes in moderate-to-vigorous physical activity and some domains of physical self-perceptions were reduced or no longer evident when the effect of maturity status was controlled. Maturity status may differentially influence boys' and girls' physical self-perceptions.

Physical activity levels of Hungarian children during school recess

Objective : The purpose of this study was to examine physical activity levels and patterns of physical activity across daily school recess periods, and the contribution of recess to daily physical activity.

Method : Ninety-eight children (61% boys) from three schools in Hungary had their physical activity quantified using uni-axial accelerometry every 5 s for three consecutive school days (Wednesday to Friday). The proportion of time spent in sedentary, light, moderate-to-vigorous, and vigorous physical activity during 5 daily school recess periods was determined using existing age-appropriate cut-points. The relative contribution of recess to daily moderate-to-vigorous physical activity was also determined. Data were collected between May and October 2008.

Results : Boys engaged in significantly more light (30.6 ± 5.2%; 27.7 ± 5.1%), moderate-to-vigorous (24.9 ± 8.9%; 17.5 ± 5.2%) and vigorous physical activity (7.6 ± 4.7%; 4.3 ± 2.9%) than girls during recess. Girls (54.8 ± 8.1%) engaged in more sedentary activity than boys (44.5 ± 10.2%). Physical activity levels were generally similar across multiple recess periods. Recess contributed more moderate-to-vigorous physical activity towards weekday physical activity for boys (13.1%) than girls (10.8%).

Conclusions : Since sedentary activity accounted for the largest proportion of recess, interventions may be needed across all recess periods to promote physical activity during the school day.

Long-term effects of a playground markings and physical structures on children's recess physical activity levels

Objective : The aim of the study was to investigate the impact of a playground redesign intervention across time on children's recess physical activity levels using combined physical activity measures and to evaluate the potential influence of covariates on the intervention effect.

Method : Fifteen schools located in areas of high deprivation in one large city in England each received £20,000 through a national £10 million Sporting Playgrounds Initiative to redesign the playground environment based on a multicolored zonal design. Eleven schools served as matched socioeconomic controls. Physical activity levels during recess were quantified using heart rate telemetry and accelerometry at baseline, 6 weeks and 6 months following the playground redesign intervention. Data were collected between July 2003 and January 2005 and analyzed using multilevel modeling.

Results : Statistically significant intervention effects were found across time for moderate-to-vigorous and vigorous physical activity assessed using both heart rate and accelerometry.

Conclusions : The results suggest that a playground redesign, which utilizes multicolor playground markings and physical structures, is a suitable stimulus for increasing children's school recess physical activity levels.

Assessing physical activity during recess using accelerometry

Background : Physical activity guidelines recommend children should engage in 60 min of moderate-to-vigorous physical activity (MVPA) a day. School recess presents an opportunity for children to be physically active during the school day. Limited research has investigated children's activity levels during recess and its contribution to physical activity recommendations. Moreover, no target for physical activity during recess has been set.

Methods : One hundred sixteen boys and 112 girls (aged 5–10 years) from 23 schools had their physical activity during recess quantified using a uniaxial accelerometer during three recess breaks on one school day. The percentage of time spent engaged in moderate, high, and very high intensity activity was calculated using existing thresholds.

Results : Boys engaged in more moderate, high, and very high intensity activity than girls. On average, boys and girls spent 32.9% and 23% of recess engaged in physical activity, respectively.

Conclusions : Boys engaged in higher intensity activities than girls. The results suggest that recess can contribute 28 min for boys and 21.5 min for girls toward the accumulation of recommended daily physical activity. However, the physical activity intensities that children engaged in were low during recess. On average, children in this study did not achieve 50% of recess time in physical activity. Interventions for increasing the physical activity of children in the playground are warranted.

Relationships between measures of fitness, physical activity, body composition and vascular function in children

Background : The prevalence of obesity and physical inactivity in Western countries has increased rapidly. Both are modifiable risk factors for cardiovascular disease. Atherosclerosis begins in childhood and endothelial dysfunction is its earliest detectable manifestation.

Methods : We assessed flow-mediated dilation (FMD) in 129 children (75 female; 10.3 + 0.3 yrs; 54 male; 10.4; 0.3 yrs). FMD was normalised for differences in the eliciting shear rate stimulus between subjects (SR_AUC). Fitness was assessed as peak oxygen uptake during an incremental treadmill exercise test (VO₂peak). Body composition was measured using a dual-energy X-ray absorptiometry (DEXA) scan. Physical activity (PA) was assessed using Actigraph accelerometers. The cohort was split into tertiles according to FMD% and also FMD% corrected for SR_AUC to gain insight into the determinants of vascular function.

Results : Across the cohort, significant correlations were observed between FMD%/SR_AUC and DEXA percentage fat (r = −0.23, p = 0.009) and percentage lean mass (r = 0.21, p = 0.008), and also with PA performed at moderate-to-high intensity (r = 0.363, p = 0.001). For children in the lowest FMD%/SR_AUC tertile, a stronger relationship with all PA measures was observed, particularly with high intensity PA (r = 0.572, P = 0.003). Regression analysis revealed that high intensity PA was the only predictor of impaired FMD%/SR_AUC.

Conclusions : These data suggest that traditional risk factors for CHD in adult populations impact upon vascular function in young people. Furthermore, it appears that individuals with impaired FMD may benefit from performing high intensity PA, whereas no relationships exist between FMD and lower intensities of PA or between PA and FMD in those subjects who possess preserved vascular function a priori.

An exploratory study of the factors that influence physical activity for prostate cancer survivors

Purpose To gain an understanding of the factors that influence participation in physical activity for survivors of prostate cancer and to examine changes in participation in physical activity pre- and post-diagnosis.
Methods Eighteen men who had completed treatment for prostate cancer 6 months prior were interviewed for this study. Constant comparison was used to examine the main themes arising from the interviews.
Results Barriers to physical activity tended not to be related to the physical side effects of treatment, however lack of confidence following treatment, co-morbidities, older age physical decline and lack of time were barriers. Motivations for physical activity included psychological benefits, physical benefits, and the context of the activity. Participants did not recall receiving information about physical activity from clinicians and few were referred to exercise specialists. Physical activity 6 months post-treatment was similar to physical activity levels prior to diagnosis, although there was some decline in terms of the intensity of participation.
Conclusions Interventions to increase physical activity for this group will need to take into account co-morbidities and decline associated with older age, as well as treatment side effects and psychological issues associated with a cancer diagnosis. Encouragement from health care professionals
and referral to an exercise specialist is likely to give men more confidence to participate in physical activity.

Day-to-day and seasonal variability of physical activity during school recess

Objective : Children's physical activity levels are difficult to establish on a day-to-day or season-to-season basis. Most studies have attempted to measure reliability in habitual settings. This study investigated the variability in children's physical activity during recess.

Methods : Fifteen boys and 19 girls (aged 6 to 11 years) from 2 schools in North West England wore heart rate monitors for 5 consecutive days in summer and winter terms to assess day-to-day and seasonal variability during school recess. Data were collected in 2004. Repeated measures ANOVA's and intraclass correlations (ICC) analysed the day-to-day and seasonal variability in children's moderate-to-vigorous (MVPA) and vigorous physical activity (VPA) data.

Results : There were no significant differences in children's MVPA and VPA across days and seasons. ICCs for MVPA across 2 days ranged from 0.75 to 0.85 in summer, and from 0.53 to 0.81 in winter. Three-day MVPA ICCs were 0.83 in summer and 0.71 in winter.

Conclusions : The results revealed no significant variation in children's recess physical activity levels across days and seasons. Whilst children were free to choose their recess activities in school, the results suggested that children were relatively consistent in their choices, limiting physical activity variability.

Children's physical activity levels during school recess : a quasi-experimental intervention study

Background : Recess provides a daily opportunity for children to engage in moderate-to-vigorous (MVPA) and vigorous physical activity (VPA). Limited research has investigated the effects of recess-based interventions on physical activity using large sample sizes whilst investigating variables that may influence the intervention effect. The aim of the study was to investigate the short-term effects of a playground markings and physical structures intervention on recess physical activity. A secondary aim was to investigate the effects of covariates on the intervention.

Methods : 150 boys and 147 girls were randomly selected from 26 elementary schools to wear uni-axial accelerometers that quantified physical activity every 5 seconds during recess. Fifteen schools located in deprived areas in one large urban city in England received funding through a national initiative to redesign the playground environment. Eleven schools served as matched socioeconomic controls. Data were collected at baseline and 6-weeks following playground intervention. Recess MVPA and VPA levels adjusted for pupil- and school-level covariates (baseline physical activity, age, gender, recess length, body mass index) were analysed using multilevel analyses.

Results : Positive but non-significant intervention effects were found for MVPA and VPA when confounding variables were added to the model. Gender was a significant predictor of recess physical activity, with boys engaging in more MVPA and VPA than girls. Significant interactions for MVPA revealed that the intervention effect was stronger for younger elementary aged school children compared to older children, and the intervention effect increased as daily recess duration increased.

Conclusion : The playground redesign intervention resulted in small but non-significant increases in children's recess physical activity when school and pupil level variables were added to the analyses. Changing the playground environment produced a stronger intervention effect for younger children, and longer daily recess duration enabled children to engage in more MVPA following the intervention. This study concludes that the process of increasing recess physical activity is complex when school and pupil-level covariates are considered, though they should be taken into account when investigating the effects of playground intervention studies on children's physical activity during recess.

Physical activity levels of normal-weight and overweight girls and boys during primary school recess

Objective: This study aimed to compare moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA) in normal-weight and overweight boys and girls during school recess.

Research Methods and Procedures: Four hundred twenty children, age 6 to 10 years, were randomly selected from 25 schools in England. Three hundred seventy-seven children completed the study. BMI was calculated from height and weight measurements, and heart rate reserve thresholds of 50% and 75% reflected children's engagement in MVPA and VPA, respectively.

Results: There was a significant main effect for sex and a significant interaction between BMI category and sex for the percent of recess time spent in MVPA and VPA. Normal-weight girls were the least active group, compared with overweight boys and girls who were equally active. Fifty-one boys and 24 girls of normal weight achieved the 40% threshold; of these, 30 boys and 10 girls exceeded 50% of recess time in MVPA. Eighteen overweight boys and 22 overweight girls exceeded the 40% threshold, whereas 8 boys and 8 girls exceeded the 50% threshold.

Discussion: Overweight boys were significantly less active than their normal-weight male counterparts; this difference did not hold true for girls. Even though nearly double the number of normal-weight children achieved the 40% of MVPA during recess compared with overweight children, physical activity promotion in school playgrounds needs to be targeted not only at overweight but at other health parameters, as 40 overweight children met the 40% MVPA target proposed for recess

Physical activity levels of children during school playtime

School represents a suitable setting for intervention programmes aiming to promote physical activity to benefit health. During the school day, physical education and school playtime offer children regular opportunities to engage in physical activity. However, there is growing concern that, internationally, curricular time allocated to physical education is not meeting statutory guidelines. The effectiveness of the playground environment to promote physical activity has been considered as a complementary setting to physical education.

Physical activity guidelines state that children should engage in at least 1 hour of moderate intensity physical activity a day. Currently no empirically tested guidelines exist for physical activity levels during playtime. However, studies cited in this article indicate that playtime can contribute between 5-40% of recommended daily physical activity levels when no interventions have been utilised.

The limited school-based investigations that have been reported in the literature suggest that boys engage in more physical activity during playtime than girls. Studies that have implemented intervention strategies in order to promote physical activity levels indicate that playtime can substantially contribute towards daily optimal physical activity guidelines. Energy expenditure and physical activity levels have increased during playtime following the implementation of playtimebased interventions. In order to advance knowledge of children's physical activity during playtime, a number of key issues for consideration in future research are detailed. Research on children's use of playtime to be physically active and the extent of the contribution of playtime to daily physical activity guidelines is warranted.

Habitual physical activity and the risk for depressive and anxiety disorders among older men and women

Background: Regular physical activity is generally associated with psychological well-being, although there are relatively few prospective studies in older adults. We investigated habitual physical activity as a risk factor for de novo depressive and anxiety disorders in older men and women from the general population.
Methods: In this nested case-control study, subjects aged 60 years or more were identified from randomly selected cohorts being followed prospectively in the Geelong Osteoporosis Study. Cases were individuals with incident depressive or anxiety disorders, diagnosed using the Structured Clinical Interview for DSM-IV-TR (SCID-I/NP); controls had no history of these disorders.Habitual physical activity,measured using a validated questionnaire, and other exposures were documented at baseline, approximately four years prior to psychiatric interviews. Those with depressive or anxiety disorders that pre-dated baseline were excluded.
Results: Of 547 eligible subjects, 14 developed de novo depressive or anxiety disorders and were classified as cases; 533 controls remained free of disease. Physical activity was protective against the likelihood of depressive and anxiety disorders; OR = 0.55 (95% CI 0.32–0.94), p = 0.03; each standard deviation increase in the transformed physical activity score was associated with an approximate halving in the likelihood of developing depressive or anxiety disorders. Leisure-time physical activity contributed substantially to the overall physical activity score. Age, gender, smoking, alcohol consumption, weight and socioeconomic status did not substantially confound the association.
Conclusion: This study provides evidence consistent with the notion that higher levels of habitual physical activity are protective against the subsequent risk of development of de novo depressive and anxiety disorders.

Variables associated with children's physical activity levels during recess : the A-CLASS project

Background
School recess provides a daily opportunity for children to engage in physically active behaviours. However, few studies have investigated what factors may influence children's physical activity levels in this context. Such information may be important in the development and implementation of recess interventions. The aim of this study was to investigate the association between a range of recess variables and children's sedentary, moderate and vigorous physical activity in this context.

Methods
One hundred and twenty-eight children (39% boys) aged 9-10 years old from 8 elementary schools had their physical activity levels observed during school recess using the System for Observing Children's Activity and Relationships during Play (SOCARP). Playground variables data were also collected at this time. Multilevel prediction models identified variables that were significantly associated with children's sedentary, moderate and vigorous physical activity during recess.

Results
Girls engaged in 13.8% more sedentary activity and 8.2% less vigorous activity than boys during recess. Children with no equipment provision during recess engaged in more sedentary activity and less moderate activity than children provided with equipment. In addition, as play space per child increased, sedentary activity decreased and vigorous activity increased. Temperature was a significant negatively associated with vigorous activity.

Conclusions
Modifiable and unmodifiable factors were associated with children's sedentary, moderate and vigorous physical activity during recess. Providing portable equipment and specifying areas for activities that dominate the elementary school playground during recess may be two approaches to increase recess physical activity levels, though further research is needed to evaluate the short and long-term impact of such strategies.