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Children's Physical Activity Levels During School Recess: a Quasi International Journal of Behavioral Nutrition and Physical Activity BioMed Central Research Open Access Children's physical activity levels during school recess: a quasi-experimental intervention study Nicola D Ridgers*1,3, Gareth Stratton1,3, Stuart J Fairclough2,3 and Jos WR Twisk4,5 Address: 1Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Henry Cotton Campus, 15-21 Webster Street, Liverpool L3 2ET, UK, 2Centre for Physical and Outdoor Education, Liverpool John Moores University, I.M. Marsh Campus, Barkhill Road, Liverpool, L17 6BD, UK, 3The REACH Group, Liverpool John Moores University, Liverpool, UK, 4Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands and 5Department of Methodology and Applied Biostatistics, Institute of Health Services, Vrije University, Amsterdam, The Netherlands Email: Nicola D Ridgers* - [email protected]; Gareth Stratton - [email protected]; Stuart J Fairclough - [email protected]; Jos WR Twisk - [email protected] * Corresponding author Published: 21 May 2007 Received: 2 August 2006 Accepted: 21 May 2007 International Journal of Behavioral Nutrition and Physical Activity 2007, 4:19 doi:10.1186/1479- 5868-4-19 This article is available from: http://www.ijbnpa.org/content/4/1/19 © 2007 Ridgers et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract 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. Page 1 of 9 (page number not for citation purposes) International Journal of Behavioral Nutrition and Physical Activity 2007, 4:19 http://www.ijbnpa.org/content/4/1/19 Background [15,16,19,20]. However, a number of moderating varia- Physical activity is an integral component of a healthy life- bles may influence the outcome of a recess physical activ- style. Engaging in regular physical activity during child- ity intervention [22]. For example, Verstraete et al [16] hood is hypothesized to reduce the health risks associated found that boys and girls' physical activity levels with inactivity and benefit health both during childhood decreased during morning recess 3 months after the inter- and adulthood [1,2]. In recent years considerable atten- vention was implemented in a short morning recess, tion has focused on determining habitual physical activity though activity increased during the lunch recess. This levels in children [3,4]. Activity guidelines have recom- suggests that intervention may be effective when the recess mended that children accumulate sixty minutes of at least is of sufficient duration. Few studies however have moderate intensity physical activity a day [5,6]. Whilst explored variables that may moderate any intervention there is some empirical data that indicate many children effects. Therefore, the purpose of this study was twofold: are achieving this target [3,4], concern remains that a large firstly, to investigate the impact of a playground redesign proportion of children are insufficiently active in order to intervention on children's MVPA and VPA using acceler- gain subsequent health benefits [7,8]. Since physical activ- ometry, and second, to determine the potential influence ity levels have been found to decrease across childhood of pupil-level and school-level moderating variables on and adolescence into adulthood [9], and that physical the intervention effect. inactivity tracks across time [10], the promotion of health enhancing physical activity to children has become a pub- Methods lic health priority. Participants and settings One hundred and fifty boys and 147 girls randomly The school has been identified as a key setting for the pro- selected from 26 elementary schools from one large urban motion of physical activity to young people [2,11]. School city in the North West of England returned signed parental attendance is a generic part of childhood; therefore informed consent to participate in the study. Eleven chil- schools provide a conceivable and logical setting for phys- dren per elementary school (stratified by gender) were ical activity promotion. Physical education (PE) has been recruited equally from Grades K-1 (age 5–7 years) and the traditional backdrop for promoting physical activity Grades 2–4 (age 7–10 years). All children who were ran- in school time, though there is concern that PE is unlikely domly selected from the schools participated in the to provide sufficient activity for notable health benefits to project. Fifteen schools (76 boys, 73 girls) took part the be accumulated [7]. A recent review indicated that if PE intervention, and 11 schools (74 boys, 74 girls) served as was offered on a daily basis, which in the United Kingdom socioeconomic matched controls. (UK) it is generally not, PE could contribute around one fifth towards daily activity guidelines [12]. An alternative All schools were located in one Local Authority which was but complementary setting to PE for providing daily phys- involved in a national £10 million Sporting Playgrounds' ical activity opportunities at school is recess [13]. In the initiative. Through the initiative, funding was allocated to UK, children experience up to 600 recess periods a year the Local Authority to improve the playground environ- (based on 3 times a day, 5 days a week, 39 weeks a year; ment of schools situated in areas of high social and eco- [14]), therefore offering a significant amount of time nomic deprivation. To be involved in the project, schools where children can engage in moderate-to-vigorous phys- had to meet two criteria that aimed to identify schools in ical activity (MVPA) and vigorous physical activity (VPA; deprived areas that lacked adequate playground facilities. [13]). In light of this, the efficacy of recess-based interven- First, schools had to be included within a School Sport tions in order to increase physical activity levels has been Partnership, which aim to develop PE and sport opportu- advocated [14-16]. nities for young people across groups of UK schools. This enabled the partnerships to identify schools that had no Little empirical research has investigated the effects of markings or physical structures, and to provide support to recess-based interventions on children's recess physical the schools for the use of the facilities beyond recess. Sec- activity levels [13]. Interventions conducted within this ond, schools had to be located within a Sport Action Zone context include playground markings [14,15,17], activity (SAZ). SAZs are located in areas of high deprivation across and fitness breaks [18-20] games [20] and games equip- the UK and aim to address sporting deprivation in these ment [16], which have all documented significant areas, and integrate sport in to local health, education and increases in recess physical activity [14-16,18-21] and social inclusion agendas. SAZs were created in areas of energy expenditure [17], albeit using generally small sam- high deprivation,
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