Transcript Physical Activity Background Paper

Policy Options for Physical Activity
in Schools Background Document
Claire LeBlanc MD, FRCPC
June 6, 2007
Outline
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Background
Methodology
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review of literature
Policy Options
Roles of Stakeholders
Evaluation
Next Steps
Global Obesity Epidemic1
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More than 400 million
adults were obese in
2005 worldwide
Chronic diseases 2° to
obesity account for
60% of the 58 million
deaths/year2
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cardiovascular disease,
diabetes, some cancers,
chronic respiratory
diseases
1http://www.who.int/mediacentre/factsheets/fs311/en/index.html;
2
Preventing Chronic Diseases: a Vital Investment: Geneva, World Health Organization 2005
Children not Immune3
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≥ 20 million children under
five years old were
overweight globally in 20051
Childhood obesity associated
with many co-morbidities
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type 2 diabetes, high blood
pressure, obstructive sleep
apnea, nonalcoholic fatty
liver disease, poor selfesteem, and lower healthrelated quality of life
Up to 80% of obese youth
continue this trend into
adulthood increasing their
risk for chronic disease and
premature mortality
3
LeBlanc CMA, Gomez J et al. Pediatrics ,2006;117:1834-1842
Why are Kids Overweight?
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Excessive caloric intake
Excessive sedentary activity4
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Inadequate physical activity
levels5
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4
6-11yo > 2hr TV/d: 2x as
likely obese
> 30 hr/wk screen time
35% youth overweight vs
23% if less screen time
Canadian 5-17 year olds
take an average of 11,356
steps/day (pedometer) =
insufficient activity for
optimal growth &
development (need 12,000 16,500 steps/day ~ 90 min
mod-vigorous PA/day)
Shields M. Statistics Canada 2005; 82-620-MWE;
5
CANPLAY: Physical Activity Monitor 2005. www.cflri.ca/eng/statistics/surveys/pam2005.php
Why Not Active Enough?
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 PA DAILY at home
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time pressures
TV, computer, video games
preferred
unsafe environments
inactive parents
 recreational facilities
 PA DAILY at school
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17% Canadian schools
(Elementary  High) have
daily PE by PE specialists6
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6
7
7% 4x/wk; 25% 3x/wk;
36% 2x/wk; 12% 1x/wk
PE optional in most
secondary schools7
Cameron C. Opportunities for PA in Canadian Schools: Trends from 2001-2006. www.cflri.ca
Janzen H. Physical and Health Education 2004;4-12 (CAHPERD Scholar Address)
One Solution: School Wellness Policies
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Quality health education
Promote healthy foods
Encourage physical activity
(PA) & PE
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quality daily PE
active lunch & recess
active transportation
activity in classroom
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energizers
CLASS
intramural sports
activities before & after school
interschool sports
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“making the team”
Methodology
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Review of literature to 2005
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A second review from 2005-2007
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MEDLINE, Pubmed, HealthSTAR, CINAHL, Eric & PsychInfo
Supplemental resources
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7
many effective school-based research programs that improved student PA
levels, fitness scores & obesity measures7
WHO Information Series on School Health (www.who.int/schoolyouthhealth)
2006 WHO Regional Office for Europe’s Health Evidence Network Report on
School Health Promotion (www.euro.wo.int/document/e88185.pdf)
Challenge of Obesity in the WHO European Region and the Strategies for
Response Summary (www.euro.who.int/pubrequest)
Healthy Child Manitoba (www.gov.mb.ca/healthychild/index.html)
Washington State Department of Health Report on Nutrition and Physical
Activity – A Policy Resource Guide
(www.doh.wa.gov/cfh/steps/publications/nutrition_activity_policy_guide_final.pdf pages 52-57
Action Schools! BC (www.actionschoolsbc.ca)
Annapolis Valley Health Promoting Schools Initiative
(www.hpclearinghouse.ca/features/AVHPSP.pdf)
Attachment 1: CMAJ 2007;176(8):chapter 22
(1) Effective & Promising Policy Options for School PA
Policy
Policy Option
Evidence
Effective (E) Promising (P)
Raise quantity PE to daily K12
Sallis: ↑ grade 6-8 PE daily + school PA
 lower BMI boys (E)
Ensure students active most of PE
class time
McKenzie: PE curriculum more vigorous
PA  students > active in PE class not
outside school (E)
Integrate benefits of PA into regular
curriculum
Gortmaker: Curriculum = healthy foods
and PA. Girls ⇩BMI (E)
Integrate PA into curriculum
Mahar: Daily 10 min energizers K
grade 4: ↑ PA and ↑on task behaviour (E)
Extracurricular PA
Provide a variety of PA opportunity
outside of PE
Ernst: “PLAY” ↑ PA outside of PE. ↑ PA
levels; girls > interest PA (E)
Training
Ensure adequate training for
teachers of PE classes
Sallis: “SPARK” Specialist PE > trained
teachers > control teachers  ↑ girls
fitness (E)
Active Transportation
Ensure safe walking & cycling to and Rosenberg: leaner students actively
commuted (P)
from school
Facilities
Ensure adequate facilities &
equipment for PA
Sallis: better facilities & adult supervision
 kids ↑PA ~ 4-5 x control (P)
Community Outreach
Develop partnerships with
community recreation
Moody: 50% community rec. centers
have elementary after school programs:
vs 11% middle ; 0% High school (P)
Daily quality PE
Daily PA
(2) Untested Promising Policy Options for Physical Activity in Schools
Policy Area
Untested Policy Option
Best Practice Example
Curricular and extracurricular activities
Make physical activity enjoyable, respectful of all children &
promote fair play and maximum participation
Action Schools! BC (Promising)
Nova Scotia Health Promoting Schools (Promising)
Safety
Ensure adequate safety precautions to prevent physical activity
injuries and illness.
Hudson-Collins P: CDC funded coordinated school health
Collect medical information from students & parents to ensure
safe participation in physical activity
Scheier LM: School Health Report Cards
Ensure family & community members can take part in planning
and decision-making
Action Schools! BC
Nova Scotia Health Promoting Schools
Saskatoon in Motion (http://www.saskatchewaninmotion.ca/)
Provide opportunities for family & community members to
advocate for & participate in activities & services offered
through schools
Action Schools! BC
Nova Scotia Health Promoting Schools
Saskatoon in Motion
Promote health benefits of physical activity to school staff
Hudson-Collins P: CDC funded coordinated school health
School Staff
program
program
Provide school staff with opportunities to be physically active
with colleagues
Hudson-Collins P: CDC funded coordinated school health
program
Referral from health
care professionals
Make recommendations on physical activity for students with
disorders or disabilities
American Academy of Pediatrics (AAP)
Canadian Pediatric Society (CPS)
Recognition
Recognize schools, administrators, teachers, parents and
students who make significant advancement of physical activity
and physical education in schools
CAHPERD
Monitoring and
Evaluation
Monitor and assess policy implementation, as well as physical
activity levels and fitness
Action Schools! BC
Nova Scotia Health Promoting Schools
Stakeholders: Why Get Involved?
(3) Potential Roles for Stakeholders
Roles
Possible Action
Stakeholders
Examples
Advocacy
Advocate for school physical
education & activity policies
Health sector, professional
organizations, parents,
community, children/ youth
organizations, media, school
administrators & teachers
CAHPERD
Center for Disease Control & Prevention (CDC)
Active Healthy Kids Canada
Canadian Pediatric Society (CPS)
American Academy of Pediatrics (AAP)
Policy
Development
Adopt (sub) national policies for
physical education and physical
activity in schools
Ministry of Education (lead),
school administrators,
parents, professional
organizations
Healthy Child Manitoba
Ontario Healthy Schools
(http://www.edu.gov.on.ca/eng/teachers/dpa.html)
Alberta Ministry of Education DPA initiative
(http://www.education.gov.ab.ca/ipr/DailyPhysAct.asp)
Make physical activity part of
comprehensive school health and
Program
Development
and
Implementation
other health promotion initiatives
Ministries of Education and
Health, school administrators,
local public health agencies
WIC Reauthorization Act of 2004 – all participating
schools in the USA must establish school wellness
policy by start of 2006-2007 year
Develop and implement local
programs consistent with established
(sub) national policies
School administrators,
teachers, leaders, parents,
students, volunteers and
Healthy Child Manitoba
Implementation of Grades 11 and 12 Physical
Education/Health Education: A Policy Document
(2007)
partner organizations
Ensure optimal use of resources,
facilities and opportunities during
school and non-school hours
School administrators,
municipalities, community,
children/youth organizations
Living Schools from the
Ontario Physical & Health Education Association
Monitor, encourage &enable children
to participate in school-based & non-
Teachers, parents and
guardians, community, as well
as children and youth
organizations, the media
Action Schools! BC
Nova Scotia Health Promoting Schools
Active Healthy Kids Canada Report Card
Public health and education
institutions, evaluation experts
WHO Information Series on School Health
(www.who.int/schoolyouthhealth)
school PA opportunities
Evaluation
Monitor, evaluate & report on the
implementation/outcomes of policies
(OPHEA) (www.livingschool.ca)
Potential Barriers/Solutions for Stakeholders: Health Professionals
CPS: Are We Doing Enough?
A status report on Canadian public policy and child and youth health
Advocacy: Government
CASM, AAP & CPS
position papers; CPS tool kit
Measures of obesity + co-morbid conditions;
No time for preventive counseling; Remuneration
AAP (POSH study)
CDC Funded
Advocacy: media
Unaware school health role
CPS/AAP media training
Student Pediatricians lack training
Hospital environment
not healthy “role model”
CPS HAL Residency Module
CPS & CAPHC: HAL Hospital
Barrier
Solution
AAP = American Academy of Pediatrics; CPS = Canadian Pediatric Society; HAL = Healthy Active Living
CASM = Canadian Academy of Sport Medicine; CAPHC = Canadian Association Pediatric Hospital Centers
How do We know the Policy is Working?
Process Indicators
Expert Advisory Committee
Output Indicators
Safe Cycling Routes
Outcome Indicators
↑ Student PA Levels
↓ Student BMI
WHO Framework: Monitoring and Evaluation of Policies
8 Global
Strategy on Diet, Physical Activity and Health. A Framework to Monitor and Evaluate Implementation. World Health Organization Geneva, 2006
8
(4) Process and Output Indicators for Effective & Promising Policy
Options for Physical Activity in Schools
Policy
Policy Option
Possible Process & Output
Indicators
Daily quality PE
Raise quantity PE to daily K12
% Schools providing daily PE using minimum
time set in (sub) national policies
Ensure students active most of PE
class time
% PE lessons meeting predetermined standards
% Students 'excused' from PE each school year
Integrate benefits of PA into regular
curriculum
% Schools meeting (sub) national health
curriculum standards
Daily PA
Integrate PA into curriculum
% Schools using in class energizer breaks
Extracurricular PA
Provide a variety of PA opportunity
outside of PE for all students
% Schools providing daily active recess
% Schools with enhanced programs to
accommodate special needs students
Training
Ensure adequate training for
teachers of PE classes
% Schools with qualified PE teachers
Active Transportation
Ensure safe walking & cycling to and
from school
Proportion & profile of children bussed to school
Facilities
Ensure adequate facilities &
equipment for PA
% Schools meeting national safety standards for
Develop partnerships with
community recreation
% Schools open after hours for community
recreation
% Schools using community recreation facilities
during school hours
Community Outreach
PA facilities and equipment
(5) Outcome Indicators (children) for Effective & Promising Policy
Options for Physical Activity in Schools
Policy
Policy Option
Possible Outcome
Indicators
Daily quality PE
Raise quantity & quality of PE to
daily K12
Survey students on PE curriculum satisfaction
Ensure students active most of PE
class time
% students reaching moderate-vigorous PA
levels in PE class
Integrate benefits of PA into regular
curriculum
- % Students meeting (sub) national health
education academic requirements
Integrate PA into curriculum
Student satisfaction, fitness, measures of
wellness, academic test scores in energizer
classes vs regular classroom setting
Daily PA
Focus testing students on preferred PE content
Extracurricular PA
Provide a variety of PA opportunity
outside of PE for all students
Student satisfaction survey
Training
Ensure adequate training for
teachers of PE classes
Teacher focus group testing
Active Transportation
Ensure safe walking & cycling to and
from school
Student satisfaction, fitness, and measures of
wellness, in schools with active transportation
policy vs control schools
Facilities
Ensure adequate facilities &
equipment for PA
% Students using schools bike racks
Community Outreach
Develop partnerships with
community recreation
focus testing on satisfaction of community
recreation leaders and teachers in Health
Promoting Schools
Conclusion
• Physical inactivity is an important
determinant of obesity and associated
chronic disease in children and youth
• Health Promoting Schools are a key
strategy to improve the health and
wellness of children
Next Steps
• Francois Lagarde & Claire LeBlanc
– finalize background paper based on feedback
gathered from Satellite Expert Roundtable on WHO
Global Strategy on Diet, Physical Activity & Health: A
School Policy Framework
• Satellite Expert Roundtable
– draft outline for DPAS School Policy Framework
• World Health Organization
– develop DPAS School Policy Framework
– organize consultation process
– launch School Policy Framework once finalized
Health Promoting Schools
Let’s Make it Happen!