Authors
Mountjoy, M; Andersen, LB; Armstrong, N; Biddle, S;
Boreham, C; Bedenbeck, H-PB, Ekelund, U; Engebretsen, L; Hardman,
K; Hills, A; Kahlmeier, S; Kriemler, S; Lambert, E; Ljungqvist, A;
Matsudo, V; McKay, H; Micheli, L; Pate, R; Riddoch,C; Schamasch, P;
Sundberg, CJ; Tomkinson, G; van Sluijs, E and van Mechelen,
W
Date
2011
Keywords
Physical fitness and health; psychological well-being;
physical activity; bone health; obesity; mental health;
determinants.
Country of research
International collaboration
Summary of findings
This was produced by an expert group after a
critical evaluation of scientific evidence as a basis for decision
making (including a number of systematic reviews reported in this
paper). Its key purpose is to identify potential solutions
through collaboration between sport and existing programmes and to
review research gaps. The paper provides a broad introduction
stating that insufficient PA has been classified by the WHO as the
fourth leading risk factor for global mortality from
non-communicable diseases (NCDs) after hypertension, tobacco use
and high blood glucose. Insufficient PA is responsible for
5.5% of all deaths. In addition, evidence shows that
insufficient levels of PA are adversely affecting the health and
the health trajectory of young people and PA levels are declining
as they move through childhood into adolescence.
The paper admits the difficulties in measuring
and interpreting the levels of young people PA and the limitations
of self-report. The recent use of accelerometry has increased
knowledge of PA and how it is associated with health outcomes,
although significant issues of interpretation remain.
Self-reported PA suggests that 30-40% of young people satisfy
current health-related PA recommendations. However
accelerometry data indicate that they are achieved by less than 25%
of young people
There are no widely recognised recommendations
for health-related levels of aerobic fitness in youth and no
compelling evidence to suggest that young people have low levels of
peak VO2 or that they are less aerobically fit than young people of
the previous generations. There has been a very small decline
of about 0.1% per decade in mass-related peak VO2 between 1962 and
1994. In contrast, there has been a substantial deterioration
of about 4.0% per decade in maximal aerobic performance, since
1975. Declines in maximal aerobic performance are likely the
result of a network of social, behavioural, physical, psychological
and physiological factors. In this context the paper provides
a review of the evidence on the impact of this on cardiovascular
and metabolic health. It concludes that current scientific
literature suggests that low levels of PA in young people are
associated with higher levels of obesity, hypertension and
cardiovascular risk factors, including increased instances of
metabolic syndrome.
It reviews research evidence about PA and bone
health and concludes that, taken together, a wide range of
extra-curricular sports, other activities and targeted school-based
programmes provide a weight-bearing stimulus that promotes young
people’s bone health. With regard to obesity the paper states
that in recent decades active behaviours have been displaced by
more sedentary pursuits, which have contributed to reductions in PA
energy expenditure. While many reports suggest that young
people’s participation in organised sport and PA is high or has
increased, incidental PA and exercise, including active transport
such as walking to and from school, has declined. The
promotion of a healthy diet and of PA and exercise are equally
important factors.
In terms of mental health, review-level
evidence has shown small-to moderate beneficial effects for reduced
depression and anxiety from PA, but the evidence base is weak and
effects are small. Little research has specifically addressed
sports participation and mental health separate from PA more
broadly. The absence of adequate fitness levels can increase
the risk of sports injuries. The paper presents a review of
related research and states that an ideal system for preventing
sports injuries due to lower levels of fitness would entail a
pre-participation evaluation of each participant followed by a
training prescription to address individual deficits in fitness
levels.
The paper presents a review of research
evidence relating to correlates and determinants of PA and
sedentariness, categorised into biological, psychosocial,
behavioural, social and environmental factors. However, on the
basis of two systematic reviews undertaken for the consensus
statement, the paper concludes that there is little ‘true’
high-quality information about the determinants of PA in
youth. In terms of sedentary behaviour research indicates
that time spent in sedentary behaviour is higher in lower
socioeconomic groups, in older versus younger youth, in non-white
youth, in more mature youth, and in young people who live in homes
that present heavy exposure to electronic forms of
entertainment.
On the basis of systematic reviews of
intervention studies it is suggested that family-based
interventions set in the home and including self-monitoring and
goal setting may be a useful strategy to pursue. Also
creating safe environments in which young people can engage in free
play or that they can use for active travel may have the potential
to increase population levels of PA. School-based
interventions are thought to be the most universally applicable and
effective way to counteract low PA, although little is known about
their effect on out-of-school PA. While the results support
the effectiveness of school-based PA interventions there is a need
to look at long-term effects and implementation strategies.
The consensus statement outlines the broad
context for action:
The International Olympic Committee - The IOC
has developed programmes for prevention of injuries and diseases in
high level and recreational sports, including Periodic Health Exam,
protection of the child athlete, consensus meeting on training of
the elite athlete.
International Federations - Few have
programmes that address inactivity in young people and they can be
instrumental in supporting National Federation programmes that
address inactivity in youth.
National Olympic Committees - A few National
Olympic Committees (e.g. Canada) have developed programmes to
promote PA and sport in young people.
The World Health Organization - The WHO and
the IOC have agreed to cooperate to promote, physical activity and
sport. In 2010, the WHO published the Global Recommendations
on Physical Activity for Health, which includes recommendations for
5-17 year olds.
International PA networks - There are two
global and four regional PA promotion networks. Such networks can
promote the health and fitness of young people in several ways: by
providing exchange platforms and access to key experts; by
analysing practice-led evidence to identify good practice, develop
guidance and foster monitoring and evaluation by distributing
recommendations to expert communities and local implementers; and
by contributing to more effective dissemination of recommendations
and good practice regionally, nationally or locally.
Non-governmental organizations - Such
organisations use PA and sport as platforms to develop social
capital and social cohesion. There is, however, limited
central coordination to promote interagency cooperation and
inadequate evaluation of programme implementation.
Governments - Reviews of actions taken by
governments in many countries show mixed results in terms of
operationalised plans for sports and PA promotion. Lessons
learned from one programme, the Agita Galera Program, which deals
with 6000 schools, and about 6 million students, in the State of
Sao Paulo, Brazil, provided an opportunity for the government to
identify and promote PA and sports participation, a surveillance
system, and support for building partnerships; to build
infrastructures for sports participation; to facilitate the
development and implementation of an eActive-School Curriculum; to
promote active transport to school; and to incentivise the practice
of PA and sports inside and outside school.
Education - Health and fitness promotion via
PA represents a complex issue, which can only be resolved by
multisectoral interventions. The education sector and
physical education comprises a primacy setting for interventions
throughout formative development, which can influence positive
attitudes and behaviours of young people. Comprehensive
whole-of-school approaches represent an effective strategy to
address childhood physical inactivity.
Healthcare system - Through the provision of
adequate education of primary healthcare professionals on the
benefits and prescription of PA, the healthcare system can play an
important role in the promotion of PA and sport involvement in
young people.
The consensus statement ends with a series of detailed
sector-specific recommendations and a range of recommendations for
further research.
Methodology
Consensus process; expert review panel.
Source of reference
British Journal of Sports Medicine, 45, 839-848
Web reference
http://bjsm.bmj.com/content/45/11/839.full.pdf