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Literature Review- Capstone Part II

EXS 467 Senior Seminar III

Physical Activity and Sedentary Behaviors in Youth

University of Mary

Written By: Jordan Steen

4/18/17
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I. Introduction

Cases of childhood obesity is on the rise and has tripled since the 1970s. 1 Now,

31.8% of children in the United States are considered overweight or obese. 2 This

increase in obesity is directly related to an increase in sedentary behaviors and a

decrease in physical activity in U.S. youth.2 Obesity is related to many health

complications including diabetes, cardiovascular disease, hypertension, asthma,

sleep disturbances, and some cancers in both children and adults 1,2, all of which

ultimately lead to an increased risk of premature mortality.

This decrease in physical activity is a worldwide problem. According to World

Health Organization, 81% of children aged 2-19 do not get enough physical activity.3

In the United States, as children get older, they tend to be less active. 42% of 6-11

year olds obtain at least 60 min/day of moderate-to-vigorous physical activity.

However, by the age of 12, only 8% of children are getting the same amount of

activity.2

Some of the decrease in physical activity can be attributed to the decrease in

recess in schools around the world, with many schools around the United States

being forced to cut recess time by up to 20% and physical education by as much as

9%.4 Because of this decrease, many physical activity interventions are targeting

schools and incorporating physical activity into the daily classroom routine. 95% of

children spend most of their day at school2 so it is believed to be an important aspect

of increasing physical activity and physical education. Physical education is almost

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as important as physical activity itself. It is hypothesized the more children know

about the benefits and importance of physical activity, the more likely they are to

participate.5 Knowledge of physical activity and the benefits will also make most

older children more likely to remain active throughout their lifetimes. 5

Some of the decrease may also be associated with accessibility. The percentage

of students who walk or cycle to and from school has also decreased to 12% with

more children (39.4%) having to ride the bus. There is also only a 58% participation

rate of students in high school sports which is where many students in age group

accumulate their physical activity.6

The decrease in physical activity leads to an increase in sedentary behaviors. By

high school, most adolescents are spending more than 8 hours/day sedentary 6 with

most of being screen time. On any given weekday, many children are spending

more than 2 hours/day using technology for purposes other than education 6, such as

watching television or playing computer games.

Physical activity is important in preventing obesity and obesity-related illness, but

there are many other benefits to physical activity such as bone health and

development, improved mental health and well-being, improved cognition and

academic performance, and better motor control. 6

The purpose of this paper is to analyze the current data and to determine

patterns of physical activity in children and their parents, patterns of sedentary

behavior in children and adolescents, benefits of physical activity for school-aged

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children, physical activity recommendations in children, and physical activity

interventions.

II. Body of Evidence

Parent-Child Physical Activity Patterns

A study conducted in the Czech Republic showed the influence parents have on

the activity levels of their children.7 4-7 year olds and their parents were asked to

wear pedometers for at least 8 hours for 7 consecutive days and log the step count

each day. All the children had similar school and playground environments and the

same 30-60 min minimum physical activity routine with other exercise activities

included throughout the day.7 The parents were also asked to assess screen time for

themselves and the children. The study showed physical activity was higher on the

weekdays compared to the weekends for all participants, but more significant in the

mothers and screen time increased for everyone on the weekends. However, if the

mothers reached their step count goal (10,000 steps) their children were 10 times

more likely to reach their goal (11,500 steps).7 Similarly, during the week, the children

were 6 times more likely to reach their step goal when most of their steps were taken

while at kindergarten.7 This study highlights the influence parents and teachers have

on children when it comes to physical activity and the importance of incorporating

physical activity in the daily school routine. It can also help physical activity

interventions target parents and teachers to develop physical activity routines.

The way parents view physical activity and sedentary time may also contribute to

how much their children are getting of both. Children under the age of 12 look to

their parents more than adolescents do for indication of how to behave, but even
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adolescents rely on the support of their parents, especially when it comes to physical

activity.7 According to Pyper, Harrington, and Manson, certain parental support

behaviors can indicate whether their children will meet the physical activity and

screen time recommendations. They broke parental support behaviors into

motivational, instrumental, regulatory, and conditional. Based on their survey

administered in Canada, parents who stated they took their children to places where

they could be active (instrumental social support) such as parks, the children were

more likely to meet the recommendations. Parents who motivated children to be

active (motivational social support) and parents who were active with their children

(conditional support behavior) also had children who met the physical activity

recommendations. In addition, regulatory parents also had children who met the

screen time recommendation of less than 2 hours per day. However, parents who

watched television with their children or were involved with other screen time

activities, had children who did not meet the screen time recommendation. The

results of this survey support the last two studies and show parents are large

influences on their children, especially when they are young. 8

Patterns of Physical Activity and Sedentary Behaviors

There may be some patterns correlate with the increase in sedentary behaviors.

More girls than boys are not meeting the recommended 60 minutes per day of

physical activity. Children who do not have to actively transport to school are more

likely to report more sedentary behaviors. A study done in Wales in 2016 has shown

only 16% of 11-16 year olds are meeting current physical activity recommendations.

Most of the participants reported being active 4 or less days per week. Boys were
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twice as likely to be active as girls. Participants who exceeded 2 hours per day of

screen time were less likely to be physically active. The participants of this study

averaged 7.5 hours of screen time per day which is consistent with data collected in

the United States and Canada.9

The previous study also indicated the children accrued most of their physical

activity during the school day. The Wales government suggests children should be

offered at least 2 hours of recess per day.10 The reason being, during a 15-minute

recess, students will probably only accumulate 7 minutes of moderate-to-vigorous

physical activity.6 in the UK, 90% of schools provide 2 hours of recess during the first

6 years of school. Then, only 59% of schools provide the same amount. As the

children get older, there is more push for academic performance, so they are less

likely to get frequent breaks. By high school, they are no longer getting recess

breaks and only receive a lunch break. Shorter lunch breaks are associated with an

increase in sedentary behaviors which shows schools need to offer more breaks for

the children to be active.10

Academic Performance

Most countries are pushing their children to perform academically which leads to

fewer breaks and fewer chances at being active. However, there is some evidence

suggesting physical activity may actually help academic performance. When

children enter school, physical activity may aid in their academic achievements.

Even minimal intensity physical activity could help students who tend to have lower

academic scores. However, physical activity may not be beneficial to students who

already have high scores.11 There is one study done suggests there may be a
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negative influence on academic performance because of physical activity, but the

hypothesis is based on the idea physically active children are spending less time

studying. The relationship was very weak 12 when compared to the statistics showing

the benefits of physical activity on academics. The most important result of this study

is there are differences between the genders when it comes to the effects of

physical activity, but most of the literature shows improvements without significant

difference between the two genders.

A group of 228 second and third graders in the Netherlands demonstrated the

potential relationship between physical activity and academic performance.

Approximately half of the students participated in lessons that were designed to

keep them active while learning and the other half made up the control group. The

intervention group spent about 64% of their class time doing moderate-to-vigorous

physical activity. The teachers reported on-task behavior for about 70% of the time.

The children also had higher mathematics and reading scores compared to the

control group. However, the improved scores were not statistically significant and the

other results were based on subjective assessments.13

Health Benefits

There are also health benefits to physical activity. Children who are more

physically active have lower C-peptide levels. C-peptide levels positively correlate to

the levels of insulin in the blood. Therefore, higher C-peptide level means higher

insulin resistance. The children who had higher C-peptide were not only less active,

but had a higher body mass index compared to the children who had lower C-
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peptide. This indicates physical activity is related to the development of diabetes in

children.14

Comparatively, children who tend to be more sedentary have a higher chance of

having dyslipidemia than children who are more physically active. 14 Children who are

more active also have lower BMI and higher aerobic fitness. 5

Interventions

Because of the literature showing the health and academic benefits of physical

activity, some schools have begun implementing physical activity interventions to try

to increase the amount of physical activity the children participate in. However, there

was a study conducted on sedentary behavior in schools showed most children only

receive about 2.2 minutes of physical activity per 45-minute lesson, and number

decreased as the children got older and went up grade levels. By the time the

children were in 7th-9th grades, they were spending 87% of their school day

sedentary. But even the children in the lower grade levels were spending more than

70% of their lessons sedentary.15

One intervention was implemented in a preschool program and it involved

prompting from the childcare provider to get the children to stay active throughout

the day. The children who were participating and received the prompts were more

active than those who were not, and the children also became more active on their

own, without prompting, by the end of the study.16 The general recommendation for

children of age is to get a total of 2 hours of structured and unstructured physical

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play.17 The children who had received prompting were more likely to achieve each

day.16

There is another intervention is aimed at elementary students called born to

move. Born to move features class-based physical activity encourages children to

find fitness enjoyable. Each lesson teaches motor skill are meant to improve health

and skill related fitness for each age group. When studied on 10-11 year olds, the

children who participated in born to move participated in 4.5 more minutes of

moderate-to-vigorous physical activity compared to regular physical education

classes. They also accumulated in an average of 2.5 minutes of moderate-to-

vigorous physical activity outside of the born to move class. The born to move group

also improved their muscular strength and cardiorespiratory fitness and reported

their lessons being more enjoyable than standard physical education classes. 18

Another intervention was targeted toward adolescents and was conducted in the

Netherlands. Children 12-14 years old participated in a physical activity intervention

where the schools they attended pledged to offer 60 minutes of physical activity

during school and the students were asked to cycle to and from school and some of

their homework involved physical activity. The students in the study, compared to the

control group, did not experience any significant changes in mathematics or

cognitive performance, but there was a definite increase in cardiorespiratory

fitness.19

III. Discussion
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There is a strong body of evidence suggesting a decline in physical activity and

an increase in sedentary behaviors have contributed to the rise in childhood

overweight and obesity.1,3,5,6 This rise in obesity is dangerous for the health of youth

and can lead to an increase in hypertension, Type II diabetes, and other

cardiovascular and metabolic diseases.1,2

There are many hypotheses about the decrease in physical activity in youth

including shorter recesses,4 shorter lunch breaks,10 less active parents,7-8 and fewer

children walking or cycling to and from school.9-11 The evidence also links the

decrease in physical activity to an increase in screen time (watching television,

playing computer games, etc.).

The relationship between physical activity and academic performance was weak

and there may be evidence showing implicit learning is negatively affected by

physical activity11, However, implicit learning is the source of addictive behaviors.

Having a negative impact on implicit learning could show a positive association with

addictive behaviors. More research is needed to show the relationship.

There is strong evidence supporting interventions in school systems as an

effective way to get children moving again, however, more should be done to find the

benefits of these programs. There are studies currently taking place look at physical

activity and how it affects mental health, self-confidence, overall self-worth, social

skills, and academic performance.11

There is still a lot of contradictory evidence, especially when it comes to different

age groups and genders. Exercise appears to affect girls and boys differently as well
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as younger children compared to the older adolescents. While younger children tend

to have very positive results, especially academically, when they participate in

physical activity daily, older children may not see the same benefits. However, there

are still health benefits to physical activity from childhood to adulthood.

The strength of these studies is most of them had a very large sample size and

were able to objectively measure their outcomes. However, when doing research

with children, the researchers had to rely on parents to accurately record some of

the measurements and to accurately report information which can cause

discrepancies in data. These studies were also able to implement many

interventions in the school systems and were able to receive positive feedback from

the teachers who were participating.

These studies are limited because of the need to do the research on children.

There also isnt enough literature on the benefits, other than physical or health

related, of physical activity. Many assumptions were made about the improvements

of academic performance, mental health, cognitive development, and other

outcomes, but the relationship was either weak or inconclusive. There should be

more research done in these areas.

The current recommendation is for children to participate in at least 60 minutes of

moderate-to-vigorous physical activity with a combination of high and low impact

exercises. There is not much literature proving the best recommendation, but this

seems to be where many children begin to see the benefits of the physical activity.

Younger children are more likely to achieve than older children are and boys are

more likely than girls to get enough physical activity.

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IV. Conclusions/Summary

Children are influenced by the people around them, so it is important for parents

to be active and for teachers to provide opportunities for the children to be physically

active and to prompt them to participate. It is also important to start intervening at a

young age in order to see the greatest gains when it comes to physically activity and

sedentary behaviors. When children lead active lives, they are more likely to be

active as adults, so targeting the younger population is important for developing

lifelong health physical activity habits. Physical activity has many advantages and

very few proven disadvantages. It can help lower BMI, prevent cardiovascular and

metabolic diseases, promote bone health, and potentially improve mental health and

well-being, as well as improve academic performance. Making sure children are

getting an adequate amount of moderate-to-vigorous intensity physical activity (60

minutes per day for at least 3 days per week) is crucial to their health as children

and later when they reach adulthood. While there is quite a bit of positive evidence

when it comes to physical activity in youth, there is still a lot of research needs to be

done.
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V. References
1. How much physical activity do children need? Centers for Disease Control and

Prevention. http://www.cdc.gov/physicalactivity/basics/children/index.htm.

Published June 4, 2015.

2. Robinson LE, Webster EK, Whitt-Glover MC, Ceaser TG, Alhassan S.

Effectiveness of pre-school- and school-based interventions to impact weight-

related behaviours in African American children and youth: a literature review.

Obesity Reviews. 2014;15:5-25. doi:10.1111/obr.12208.

3. 10 facts on physical activity. World Health Organization.

http://www.who.int/features/factfiles/physical_activity/en/. Published February

2017. Accessed February 1, 2017.

4. Time out: Is recess in danger? Time out: Is recess in danger?

http://www.centerforpubliceducation.org/Main-Menu/Organizing-a-school/Time-

out-Is-recess-in-danger. Published 2008.

5. Brusseau TA, Burns RD, Hannon JC. Effect of Body Composition, Physical

Activity, and Aerobic Fitness on the Physical Activity and Fitness Knowledge of

At-Risk Inner-City Children. The Physical Educator. 2016;73(4):745-756.

doi:10.18666/tpe-2016-v73-i4-6570.
6. Physical Activity for Children and Youth. Physical Activity for Children and Youth.

https://www.acsm.org/docs/default-source/other-

documents/nationalreportcard_longform_final-for-web(2).pdf?sfvrsn=0.
7. Sigmundov D, Sigmund E, Badura P, Vokov J, Trhlkov L, Bucksch J.

Weekday-weekend patterns of physical activity and screen time in parents and

their pre-schoolers. BMC Public Health [serial online]. August 30, 2016;16:1-9.
8. Pyper E, Harrington D, Manson H. The impact of different types of parental

support behaviours on child physical activity, healthy eating, and screen time: a
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cross-sectional study. BMC Public Health [serial online]. August 24, 2016;16:1-

15.
9. Morgan K, Hallingberg B, Moore G, et al. Predictors of physical activity and

sedentary behaviours among 11-16 year olds: Multilevel analysis of the 2013

Health Behaviour in School-aged Children (HBSC) study in Wales. BMC Public

Health [serial online]. July 15, 2016;16:1-10.

10. Atkin AJ, Foley L, Corder K, Ekelund U, Sluijs EMFV. Determinants of Three-Year

Change in Childrens Objectively Measured Sedentary Time. Plos One.

2016;11(12). doi:10.1371/journal.pone.0167826.
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Teacher-Reported Academic Performance among Fifth-Graders in Shanghai: A

Quantile Regression. Plos One. 2015;10(3). doi:10.1371/journal.pone.0115483.

12. Esteban-Cornejo I, Tejero-Gonzlez CM, Martinez-Gomez D, et al. Objectively

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13. Mullender-Wijnsma MJ, Hartman E, Greeff JWD, Bosker RJ, Doolaard S,

Visscher C. Improving Academic Performance of School-Age Children by

Physical Activity in the Classroom: 1-Year Program Evaluation. Journal of School

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14. Huus K, kerman L, Raustorp A, Ludvigsson J. Physical Activity, Blood Glucose

and C-Peptide in Healthy School-Children, a Longitudinal Study. Plos ONE [serial

online]. June 7, 2016;11(6):1-14.

15. Mooses K, Mgi K, Riso E-M, Kalma M, Kaasik P, Kull M. Objectively measured

sedentary behaviour and moderate and vigorous physical activity in different

school subjects: a cross-sectional study. BMC Public Health. 2017;17(1).

doi:10.1186/s12889-017-4046-9.
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16. Kahan D, Nicaise V, Reuben K. Effects of a Bug-in-the-Ear Intervention to

Increase Physical Activity Prompting and Level During Preschool

Recess. Physical Educator [serial online]. Fall2016 2016;73(3):555-577.

17. Active Start. Active Start.

http://www.shapeamerica.org/standards/guidelines/activestart.cfm.
18. Fairclough S, McGrane B, Sanders G, Taylor S, Owen M, Curry W. A non-

equivalent group pilot trial of a school-based physical activity and fitness

intervention for 10-11 year old english children: born to move. BMC Public

Health [serial online]. August 24, 2016;16:1-14.

19. Tarp J, Domazet SL, Froberg K, Hillman CH, Andersen LB, Bugge A.

Effectiveness of a School-Based Physical Activity Intervention on Cognitive

Performance in Danish Adolescents: LCoMotionLearning, Cognition and

Motion A Cluster Randomized Controlled Trial. Plos One. 2016;11(6).

doi:10.1371/journal.pone.0158087.