Transcript Guidelines on Physical Activity and Sedentary Behaviour

Physical Activity Recommendations for
Birth-18 Years in the UK
Prof. John J Reilly,
University of Glasgow,
on behalf of English
DHCGOU Team
[email protected]
Early Years
Birth-School Entry
Background – what was available
for early years
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No time or resource to begin from scratch
USA (2002; 2009; NASPE) - expert committee
Canada (2007) – expert committee; doesn’t cover
infants; not quantitative
Australia (2009/10 Dept. Health & Ageing; Okely et
al) – evidence-based; not yet published:
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Recent, based on systematic review & evidence appraisal
Generalisable to UK & based in part on UK research
Covers ages 0 – 5
Updated by Early Years group with recent systematic
reviews
Background: Concepts & Terms:
Intensities of Physical Activity
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SEDENTARY
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LIGHT
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MODERATEVIGOROUS (MVPA)
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Energy expenditure<1.5 times
resting; could include naps, TV
viewing, fidgeting, drawing,
reading
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Energy expenditure 1.5-2.9
times resting; ‘pottering’; ‘slow
translocation of the trunk’
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Energy expenditure >3.0 times
resting; ‘rapid translocation of
the trunk’
The evidence: benefits &
prevalence of PA in young
children
Rationale for the draft
recommendations
What does the empirical Early
Years evidence tell us ?
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Mostly observational
studies
Mostly in pre-school
children
More physical activity
is better
No clear evidence that
it has to be of a
particular intensity for
benefits
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‘Better’ for
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Body fatness
Cardiovascular risk
factors
Bone health
Movement skills
Social & emotional
development
Later physical activity
Probably many other
benefits
Rationale – how to recommend an
amount; prevalence of PA currently
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Using objective measures, most studies
report that
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pre-school children typically spend between 3%5% of their waking day in MVPA, about 15-30
minutes /day.
Light intensity PA typically about 100-120
mins/day
Current average levels of physical activity (any
activity, light plus MVPA)115-150 minutes/day
Okely, 2009
Rationale – prevalence of sedentary
behaviour & screen time
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Objective measures: pre-school children
spend approx. 10-11 hrs/day in sedentary
behaviour, TV ≈ 25% of this time
Subjective measures: 2 to 3 hrs/day watching
television or other screen
Conclusion: apparently great scope for
more physical activity during currently
sedentary time
Okely, 2009
The secret life of pre-school
children
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Subjective measures suggest high levels of physical
activity
Expectations of high levels of PA: ‘Supercharged
dynamos’ Rowland 1988
Objective measures suggest much lower levels of
physical activity
Objective truths revealed by objective methods-e.g.
absence of socio-economic differences in PA
What young Scots children do all day
Objectively measured physical activity (Reilly et al Lancet 2004)
Drafting & refining the draft
recommendations
What the Early Years
evidence does and
does not tell us
Recommendations by age categories
and types of movement ?
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Australian guidelines decided on two
developmental periods: infancy, toddler/preschool:
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No evidence yet to justify different scientific
recommendations for toddlers vs. pre-schoolers,
nor for separating structured and unstructured
activity
Insufficient evidence to recommend intensities or
types of movement
UK early years expert panel have followed
this
Draft Recommendations – additional
issues
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Reasons for initially selecting three hours:
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Upper end of ‘normal range’ has benefits
Account for likely PA decline into formal schooling and thereafter
Tracking of PA: children should start off more active
Consistency with other international physical activity guidance
(NASPE; Australian Dept. Health & Ageing 2009/2010)
Guidelines for practitioners to provide important
information to facilitate implementation of the
recommendations
Research Gaps
Three ‘Headline’ Draft UK
Recommendations, Dec. 2009
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Infants: should be encouraged from birth to be
physically active daily, particularly through floorbased play in safe environments
Children capable of walking unaided: should be
physically active daily for at least 3 hours
Infants and children should be discouraged from
being sedentary:no sedentary behaviour should
last for more than 1 hour at a time (except sleep);
this includes time spent ‘restrained’ .
Early Years web consultation
responses (82: lay; practitioners;
academic; government; health service)
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Quantitative: ratings, 1-5
scale (strongly agreestrongly disagree)
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Overwhelmingly positive
For 7/10 evidence summary
statements 80/82 agreed
or strongly agreed
For 3/10 statements 6/82
disagreed; (180
minutes/day; ‘light intensity
or above’; 1h at a time
sedentary)
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Qualitative
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Overwhelmingly supportive
Greater clarity over 180
minutes and intensity
(terminology) requested
Research gaps
Inclusions-who are the
guidelines aimed at ?
Implementation of
recommendations &
stakeholders identified
Children & Young People
5-18 years
From school entry
Background: What was available
for children & young people
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UK Health Depts have had evidence based guidance
for some time
e.g. ‘Lets Make Scotland More Active’ 2003
Subsequent guidelines overseas
US evidence-based guidelines for CYP
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2005
2009
Canadian evidence-based guidelines in preparation
(Janssen, Tremblay)
Existing Scottish guidance for
children & young people
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Children should accumulate (build up) at
least one hour of moderate activity on most
days of the week
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Let’s Make Scotland More Active 2003
Typical MVPA in UK children &
adolescents (accelerometry)
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20-25mins/day in 4-6 y
olds in Glasgow
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Reilly et al Lancet 2004
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25-35 mins/day 9-10
year olds in Newcastle
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McClure et al CCHD
2009
20-25 mins/day in 6-7
year olds in Gateshead
Basterfield et al Arch Dis
Child 2008
25-35 minutes/day in
11 year olds in Bristol
(ALSPAC)
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Mattocks et al Arch Dis
Child 2007;
Ness et al PLOS Med
2007
Recent trends:PA
recommendations for children &
young people
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Evidence base has been expanding
Increasing evidence of benefits of vigorous intensity
physical activity, though limited evidence on ‘dose
response’
Increasing evidence of benefits beyond 60 mins/d
MVPA
Distinctions between MVPA and ‘incidental’ activities
of daily living
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60 minutes daily does not include ‘pottering’
Draft ‘headline’ recommendations
for children & young people 1
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Should accumulate at least 60 mins/d,
preferably more, MVPA on a daily basis
As part of the recommended activity CYP
should incorporate vigorous intensity
activities on at least 3 days/week
As part of the recommended activity CYP
should include activities that strengthen
muscle & bone, and promote flexibility on at
least 3 days/week
Draft ‘headline’ recommendations
for children & young people 2
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Aerobic type activities should make up the
majority of daily PA
Recommended 60 minutes or more of MVPA
is over and above light intensity routine
activities associated with daily living
Statements about inclusiveness and
risks/safety
Consultation & feedback for CYP,
Oct. 2009-Jan. 2010
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Marlow meeting Oct. 2009- scientific and
policy critique
Web feedback Dec 09-Jan 2010; 85
responses
Overwhelmingly positive and emphasis was
on ‘messaging’ , ‘translation’
Led to some rewriting, clarification, and
combination of draft recommendations
Steps in the process: Early Years
& Children and Young People
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Early draft reviewed and discussed by scientific and health
experts October 2009 Marlow
Web-based consultation from December 2009-Jan 2010
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Feedback from academics, practitioners, health; government, lay
Stakeholder event –Early Years- February 2010
Formal response to & consideration of all the above
feedback; rewrite draft recommendations as required; add
explanatory ‘companion statements’ in response to
feedback
Editorial /Writing Group & Communications produce ‘final’ draft
recommendations
Invite Chief Medical Officer(s) to make recommendations
Any questions?
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Early Years
Children & Young People
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Questions/comments on the science ?
Questions/comments on the draft guidelines ?
Useful international web resources
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EARLY YEARS: ‘Get up and Grow’ 2009, Australian
Department of Health and Ageing
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CYP: Canadian guidelines in 2010
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www.health.gov.au/internet/main/publishing.nsf/Content/phd
-gug-child-familybook
Systematic reviews in press with International Journal of
Behavioural Nutrition & Physical Activity
CYP: US guidelines
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www.cdc.gov/ncccdphp/dnpa/physical/health_professionals/
reports/index.htm