Physical activity in childhood - the role of evidence · Alimentazione equilibrata e movimento...

Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin 1

Physical activity in childhood -Physical activity in childhood -the role of evidencethe role of evidence

Dr med. B. Martin, MD MPHSwiss Federal Institute of Sports MagglingenPhysical Activity and Health [email protected]

3Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin

Cavill N, Foster C, Martin BW, Oja P. 2005

4 ‘Key Tasks’ of a Systematic Evidence-4 ‘Key Tasks’ of a Systematic Evidence-Based Approach to Promoting PhysicalBased Approach to Promoting PhysicalActivityActivity

z Using the evidence for the health benefits of physicalactivity to “make the case”What is the nature of the problem?

z Conducting surveillance to collect evidence on theprevalence of physical activityWhat is the problem’s extent?

z Reviewing evidence on ‘what works’ in increasing physicalactivityWhat is the most effective way to tackle this problem?

z Evaluating practiceHow can progress be monitored and evaluated?


BM, 28.05.98

Physical activity and health –Physical activity and health –effects in adults from internationaleffects in adults from internationalresearchresearch

z Life expectancyz Cardiovascular diseasez Diabetesz Obesityz Colon cancerz (Breast cancer)z (Prostate cancer)z Osteoporosisz Lower back painz Symptomatic gallstone diseasez Depressionz Stress tolerancez Independence in old age


Half an hour of moderate intensityphysical activity or sports daily

Cardio-respiratory

fitness training3 /week

20-60 min

Strength/Flexibilitytraining

2 /week

Furthersports activities

The SwissThe Swiss HEPA HEPA recommendations recommendations

0%

20%

40%

60%

80%

100%

15-24 25-34 35-44 45-54 55-64 65-74 75+

trained

insufficiently active

regularly active

age

Pro

port

ion

• Trained individuals report at least 3 days per week with vigorous intensity activities during leisure time

• Regularly active individuals report at least half an hour of moderate intensity activities on five days of the week

• Insufficiently active individuals report less or no physical activity Lam

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Swiss Health Survey 2002Swiss Health Survey 2002Physical activity according to age groupPhysical activity according to age group

0%10%20%30%40%50%60%70%80%90%

100%

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

SHS (leisure time sweat episodes, all year)

SHS (new moderate intensity items, all year)

Pro

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Monitoring of Physical ActivityMonitoring of Physical Activityin Switzerlandin Switzerland


Cavill N, Foster C, Martin BW, Oja P. 2005

Development of culturally adaptedDevelopment of culturally adaptedinterventions for adults with study ofinterventions for adults with study ofeffectiveness in Switzerlandeffectiveness in Switzerland

z Workplace <z Primary health care <z Conscript Swiss Army <z Tourist region =z Human powered mobility ongoing


Cavi

ll N

, Fo

ster

C, M

artin

BW

, O

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. 20

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Evaluation of large scale projects andEvaluation of large scale projects andprogrammes for adults implemented inprogrammes for adults implemented inSwitzerlandSwitzerland

z Majority of infrastructure -(Swiss Hiking etc.)

z Majority of offers -(sport clubs, fitness industry etc.)

z Vita Parcours +z Cycling in Switzerland +z SlowUp +z Allez Hop ++z Active-online.ch ++

z Seed Money approach =


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Evidence-Based Approach toEvidence-Based Approach toPromoting PAPromoting PA

Adultsz Evidence for health benefits +++z Surveillance ++z Effectiveness +z Evaluating Practice (+)


Direct healtheffects

Tracking

Quality of life

Obesity

Osteoporosis

Psychological effects

Cardiovascular disease

Diabetes

Health effects in adults

Social effects

Developmental effects

Perceived risk

Physical activityin children

THE

PEP

– Ph

ysic

al A

ctiv

ity

Potential health effectsPotential health effects


Health Effects in international researchHealth Effects in international research

Direct healtheffects

Tracking

Quality of life

Obesity

Osteoporosis

Psychological effects

Cardiovascular disease

Diabetes

Social effects

Developmental effects

Perceived risk

Physical activityin children Physical activity

Inactivity

Obesity

TH

E P

EP

– P

hysi

cal A

ctiv

ity


Why is the evidence for health effects ofWhy is the evidence for health effects ofphysical activity in children (still)physical activity in children (still)weaker than in adults?weaker than in adults?

z Physical inactivity -> chronic diseasez Positive and negative aspects of poor trackingz Measurement of physical activity still in

developmentz Methodological limitations for complex outcomes

(e.g. developmental effects)


At least one hour ofphysical activity daily

Sports(Endurance, Strength, weight-

bearing activities, otheraspects...)

Furtheractivities

PA recommendations for childrenPA recommendations for children(still under discussion...)(still under discussion...)


?

Physical Activity Behaviour in Swiss ChildrenPhysical Activity Behaviour in Swiss Children0-10 years0-10 years

0%

5%

10%

15%

20%

25%

1960-1965

1980-1990

2002

Boys, 6-12 years, overweight Boys, 6-12 years, obese

Girls, 6-12 years, overweight Girls, 6-12 years, obese

Zimmermann MB, Gubeli C, Puntener C, Molinari L. Overweight and obesity in 6-12 year old children inSwitzerland. Swiss Med Wkly. 2004 Sep 4;134(35-36):523-8

Overweight and obesity in Swiss childrenOverweight and obesity in Swiss childrenCDC references, n=232/205/2431CDC references, n=232/205/2431

Kuendig, H., Kuntsche, E.N., Delgrande Jordan, M. & Schmid, H. (2003). Befragung zum Gesundheitsverhalten von11- bis 16-jährigen Schülerinnen und Schüler. Deskriptive Statistik der 2002 erhobenen Gesamtschweizer Daten.Lausanne: SFA. .

0%

20%

40%

60%

80%

100%

10 11 12 13 14 15 16 17 18 19 20

SPS Boys, <3 days per week with 60 min activity

SPS Girls, <3 days per week with 60 min activity

Physical Activity Behaviour in Swiss ChildrenPhysical Activity Behaviour in Swiss ChildrenThe Swiss Pupils’ Study, 11-16 years, n=5103The Swiss Pupils’ Study, 11-16 years, n=5103

Narring F et al. SMASH 2002: Swiss Multicenter adolescent survey on health 2002. Lausanne: IUMSP, 2004.

0%

20%

40%

60%

80%

100%

10 11 12 13 14 15 16 17 18 19 20SMASH Boys, school, <3 daysper week with 20 min activitySMASH Boys, vocational training, <3 days with 20 min activitySMASH Girls, school, <3 days with 20 min activitySMASH Girls, vocational training, <3 days with 20 min activity

Physical Activity Behaviour in Swiss ChildrenPhysical Activity Behaviour in Swiss ChildrenThe SMASH Study, 16-20 years, n=7428The SMASH Study, 16-20 years, n=7428

8.1% 4.6% 6.3% 9.8%

21.5%

0%

20%

40%

60%

80%

100%

6-9 10-12 13-15 16-17 18-20

NTS Boys and Girls, precentage of trips to school with car

Physical Activity Behaviour in Swiss ChildrenPhysical Activity Behaviour in Swiss ChildrenNational Travel Survey 2000,National Travel Survey 2000,6-20 years, n=44686-20 years, n=4468

14.4% 13.8% 16.4%

56.3% 53.3% 55.8%

0%

20%

40%

60%

80%

100%

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

SHS Boys and Girls, 15-20 years, <1 sweat episode in leisure time per week

SHS Boys and Girls, 15-20 years, <3 sweat episodes in leisure time per week

Lamprecht M, Stamm HP. Observatorium Sport und Bewegung Schweiz. Bewegungsverhalten in derGesundheitsbefragung 2002. Zürich, L&S Sozialforschung und Beratung AG, 2004.

Physical Activity Behaviour in Swiss ChildrenPhysical Activity Behaviour in Swiss ChildrenThe Swiss Health Survey, 15-20 years,The Swiss Health Survey, 15-20 years,n=808/703/1039n=808/703/1039

47.3% 47.8%

75.5% 71.7%

0%

20%

40%

60%

80%

100%

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

SPS Boys, 11-16 years, <4 sport sessions per week, equally weighted age groups

SPS Girls, 11-16 years, <4 sport sessions per week, equally weighted age groups

Kuendig, H., Kuntsche, E.N., Delgrande Jordan, M. & Schmid, H. (2003). Befragung zum Gesundheitsverhaltenvon 11- bis 16-jährigen Schülerinnen und Schüler. Deskriptive Statistik der 2002 erhobenen GesamtschweizerDaten. Lausanne: SFA.

Physical Activity Behaviour in Swiss ChildrenPhysical Activity Behaviour in Swiss ChildrenThe Swiss Pupils’ Study, 11-16 years, n=5103The Swiss Pupils’ Study, 11-16 years, n=5103

Narring F et al. SMASH 2002: Swiss Multicenter adolescent survey on health 2002. Lausanne: IUMSP, 2004.

13.7%20.4%18.1%

30.4%

0%

20%

40%

60%

80%

100%

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

SMASH Boys, 16-20 years, no sports outside school

SMASH Girls, 16-20 years, no sports outside school

Physical Activity Behaviour in Swiss ChildrenPhysical Activity Behaviour in Swiss ChildrenThe SMASH Study, 16-20 years, n=7428The SMASH Study, 16-20 years, n=7428


Physical activity time trends inPhysical activity time trends inSwiss ChildrenSwiss Childrenz (BMI éé)z (Fitness ê)z PA under 10 years ?z Swiss Health Study (15-20y) 1992-2002 èz PA Swiss Pupils Study (11-16y) 1998-2002 (ê)z SMASH (16-20y) 1993-2002 é

z Development of monitoring system under way(SCARPOL, recruitment, etc)


Development of culturally adaptedDevelopment of culturally adaptedinterventions for children with study ofinterventions for children with study ofeffectiveness in Switzerlandeffectiveness in Switzerland

z Kindergarten Evilard (<)

z KISS study (AG, BL) in development

z Feelok.ch in development

z Other projects (GE etc) in development


Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, Stone EJ, Rajab MW,Corso P (2002). The effectiveness of interventions to increase physical activity. A systematicreview. Am J Prev Med 22: 73-107.

Effectiveness of interventions applicableEffectiveness of interventions applicableto children in international reviewto children in international review

z Prompts to encourage stair use <z Community-wide campaigns <z School-based physical education <z Social support in community settings <z Access to places combined with <

informational outreach


Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, Stone EJ, Rajab MW,Corso P (2002). The effectiveness of interventions to increase physical activity. A systematicreview. Am J Prev Med 22: 73-107.

Effectiveness of interventions applicableEffectiveness of interventions applicableto children in international reviewto children in international review

z Classroom-based health education ?focused on information provision

z College-based health education ?and physical education

z Classroom-based health education ?focused on reducing televisionviewing and video game playing


Evaluation of large scale projects andEvaluation of large scale projects andprogrammes for children implementedprogrammes for children implementedin Switzerlandin Switzerland

z Majority of infrastructure -(Playgrounds, sports grounds etc.)

z Majority of offers -(sport clubs etc.)

z PE in school beginningz Youth + Sports beginning


Evidence-Based Approach toEvidence-Based Approach toPromoting PAPromoting PA

Adults Childrenz Evidence for health benefits +++ ++z Surveillance ++ (+)z Effectiveness + (+)z Evaluating Practice (+) -

z Public awareness of problem ++ +++z Need for action +++ +++

Physical activity in childhood - the role of evidence · Alimentazione equilibrata e movimento...

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