Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin 1
Physical activity in childhood -Physical activity in childhood -the role of evidencethe role of evidence
Dr med. B. Martin, MD MPHSwiss Federal Institute of Sports MagglingenPhysical Activity and Health [email protected]
3Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
Cavill N, Foster C, Martin BW, Oja P. 2005
4 ‘Key Tasks’ of a Systematic Evidence-4 ‘Key Tasks’ of a Systematic Evidence-Based Approach to Promoting PhysicalBased Approach to Promoting PhysicalActivityActivity
z Using the evidence for the health benefits of physicalactivity to “make the case”What is the nature of the problem?
z Conducting surveillance to collect evidence on theprevalence of physical activityWhat is the problem’s extent?
z Reviewing evidence on ‘what works’ in increasing physicalactivityWhat is the most effective way to tackle this problem?
z Evaluating practiceHow can progress be monitored and evaluated?
4Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
BM, 28.05.98
Physical activity and health –Physical activity and health –effects in adults from internationaleffects in adults from internationalresearchresearch
z Life expectancyz Cardiovascular diseasez Diabetesz Obesityz Colon cancerz (Breast cancer)z (Prostate cancer)z Osteoporosisz Lower back painz Symptomatic gallstone diseasez Depressionz Stress tolerancez Independence in old age
5Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
Half an hour of moderate intensityphysical activity or sports daily
Cardio-respiratory
fitness training3 /week
20-60 min
Strength/Flexibilitytraining
2 /week
Furthersports activities
The SwissThe Swiss HEPA HEPA recommendations recommendations
0%
20%
40%
60%
80%
100%
15-24 25-34 35-44 45-54 55-64 65-74 75+
trained
insufficiently active
regularly active
age
Pro
port
ion
• Trained individuals report at least 3 days per week with vigorous intensity activities during leisure time
• Regularly active individuals report at least half an hour of moderate intensity activities on five days of the week
• Insufficiently active individuals report less or no physical activity Lam
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Swiss Health Survey 2002Swiss Health Survey 2002Physical activity according to age groupPhysical activity according to age group
0%10%20%30%40%50%60%70%80%90%
100%
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
SHS (leisure time sweat episodes, all year)
SHS (new moderate intensity items, all year)
Pro
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Lam
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. Z
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Monitoring of Physical ActivityMonitoring of Physical Activityin Switzerlandin Switzerland
8Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
Cavill N, Foster C, Martin BW, Oja P. 2005
Development of culturally adaptedDevelopment of culturally adaptedinterventions for adults with study ofinterventions for adults with study ofeffectiveness in Switzerlandeffectiveness in Switzerland
z Workplace <z Primary health care <z Conscript Swiss Army <z Tourist region =z Human powered mobility ongoing
9Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
Cavi
ll N
, Fo
ster
C, M
artin
BW
, O
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. 20
05
Evaluation of large scale projects andEvaluation of large scale projects andprogrammes for adults implemented inprogrammes for adults implemented inSwitzerlandSwitzerland
z Majority of infrastructure -(Swiss Hiking etc.)
z Majority of offers -(sport clubs, fitness industry etc.)
z Vita Parcours +z Cycling in Switzerland +z SlowUp +z Allez Hop ++z Active-online.ch ++
z Seed Money approach =
10Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
Cavi
ll N
, Fo
ster
C, M
artin
BW
, O
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. 20
05
Evidence-Based Approach toEvidence-Based Approach toPromoting PAPromoting PA
Adultsz Evidence for health benefits +++z Surveillance ++z Effectiveness +z Evaluating Practice (+)
11Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
Direct healtheffects
Tracking
Quality of life
Obesity
Osteoporosis
Psychological effects
Cardiovascular disease
Diabetes
Health effects in adults
Social effects
Developmental effects
Perceived risk
Physical activityin children
THE
PEP
– Ph
ysic
al A
ctiv
ity
Potential health effectsPotential health effects
12Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
Health Effects in international researchHealth Effects in international research
Direct healtheffects
Tracking
Quality of life
Obesity
Osteoporosis
Psychological effects
Cardiovascular disease
Diabetes
Social effects
Developmental effects
Perceived risk
Physical activityin children Physical activity
Inactivity
Obesity
TH
E P
EP
– P
hysi
cal A
ctiv
ity
13Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
Why is the evidence for health effects ofWhy is the evidence for health effects ofphysical activity in children (still)physical activity in children (still)weaker than in adults?weaker than in adults?
z Physical inactivity -> chronic diseasez Positive and negative aspects of poor trackingz Measurement of physical activity still in
developmentz Methodological limitations for complex outcomes
(e.g. developmental effects)
14Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
At least one hour ofphysical activity daily
Sports(Endurance, Strength, weight-
bearing activities, otheraspects...)
Furtheractivities
PA recommendations for childrenPA recommendations for children(still under discussion...)(still under discussion...)
15Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
?
Physical Activity Behaviour in Swiss ChildrenPhysical Activity Behaviour in Swiss Children0-10 years0-10 years
0%
5%
10%
15%
20%
25%
1960-1965
1980-1990
2002
Boys, 6-12 years, overweight Boys, 6-12 years, obese
Girls, 6-12 years, overweight Girls, 6-12 years, obese
Zimmermann MB, Gubeli C, Puntener C, Molinari L. Overweight and obesity in 6-12 year old children inSwitzerland. Swiss Med Wkly. 2004 Sep 4;134(35-36):523-8
Overweight and obesity in Swiss childrenOverweight and obesity in Swiss childrenCDC references, n=232/205/2431CDC references, n=232/205/2431
Kuendig, H., Kuntsche, E.N., Delgrande Jordan, M. & Schmid, H. (2003). Befragung zum Gesundheitsverhalten von11- bis 16-jährigen Schülerinnen und Schüler. Deskriptive Statistik der 2002 erhobenen Gesamtschweizer Daten.Lausanne: SFA. .
0%
20%
40%
60%
80%
100%
10 11 12 13 14 15 16 17 18 19 20
SPS Boys, <3 days per week with 60 min activity
SPS Girls, <3 days per week with 60 min activity
Physical Activity Behaviour in Swiss ChildrenPhysical Activity Behaviour in Swiss ChildrenThe Swiss Pupils’ Study, 11-16 years, n=5103The Swiss Pupils’ Study, 11-16 years, n=5103
Narring F et al. SMASH 2002: Swiss Multicenter adolescent survey on health 2002. Lausanne: IUMSP, 2004.
0%
20%
40%
60%
80%
100%
10 11 12 13 14 15 16 17 18 19 20SMASH Boys, school, <3 daysper week with 20 min activitySMASH Boys, vocational training, <3 days with 20 min activitySMASH Girls, school, <3 days with 20 min activitySMASH Girls, vocational training, <3 days with 20 min activity
Physical Activity Behaviour in Swiss ChildrenPhysical Activity Behaviour in Swiss ChildrenThe SMASH Study, 16-20 years, n=7428The SMASH Study, 16-20 years, n=7428
8.1% 4.6% 6.3% 9.8%
21.5%
0%
20%
40%
60%
80%
100%
6-9 10-12 13-15 16-17 18-20
NTS Boys and Girls, precentage of trips to school with car
Physical Activity Behaviour in Swiss ChildrenPhysical Activity Behaviour in Swiss ChildrenNational Travel Survey 2000,National Travel Survey 2000,6-20 years, n=44686-20 years, n=4468
14.4% 13.8% 16.4%
56.3% 53.3% 55.8%
0%
20%
40%
60%
80%
100%
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
SHS Boys and Girls, 15-20 years, <1 sweat episode in leisure time per week
SHS Boys and Girls, 15-20 years, <3 sweat episodes in leisure time per week
Lamprecht M, Stamm HP. Observatorium Sport und Bewegung Schweiz. Bewegungsverhalten in derGesundheitsbefragung 2002. Zürich, L&S Sozialforschung und Beratung AG, 2004.
Physical Activity Behaviour in Swiss ChildrenPhysical Activity Behaviour in Swiss ChildrenThe Swiss Health Survey, 15-20 years,The Swiss Health Survey, 15-20 years,n=808/703/1039n=808/703/1039
47.3% 47.8%
75.5% 71.7%
0%
20%
40%
60%
80%
100%
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
SPS Boys, 11-16 years, <4 sport sessions per week, equally weighted age groups
SPS Girls, 11-16 years, <4 sport sessions per week, equally weighted age groups
Kuendig, H., Kuntsche, E.N., Delgrande Jordan, M. & Schmid, H. (2003). Befragung zum Gesundheitsverhaltenvon 11- bis 16-jährigen Schülerinnen und Schüler. Deskriptive Statistik der 2002 erhobenen GesamtschweizerDaten. Lausanne: SFA.
Physical Activity Behaviour in Swiss ChildrenPhysical Activity Behaviour in Swiss ChildrenThe Swiss Pupils’ Study, 11-16 years, n=5103The Swiss Pupils’ Study, 11-16 years, n=5103
Narring F et al. SMASH 2002: Swiss Multicenter adolescent survey on health 2002. Lausanne: IUMSP, 2004.
13.7%20.4%18.1%
30.4%
0%
20%
40%
60%
80%
100%
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
SMASH Boys, 16-20 years, no sports outside school
SMASH Girls, 16-20 years, no sports outside school
Physical Activity Behaviour in Swiss ChildrenPhysical Activity Behaviour in Swiss ChildrenThe SMASH Study, 16-20 years, n=7428The SMASH Study, 16-20 years, n=7428
23Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
Physical activity time trends inPhysical activity time trends inSwiss ChildrenSwiss Childrenz (BMI éé)z (Fitness ê)z PA under 10 years ?z Swiss Health Study (15-20y) 1992-2002 èz PA Swiss Pupils Study (11-16y) 1998-2002 (ê)z SMASH (16-20y) 1993-2002 é
z Development of monitoring system under way(SCARPOL, recruitment, etc)
24Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
Development of culturally adaptedDevelopment of culturally adaptedinterventions for children with study ofinterventions for children with study ofeffectiveness in Switzerlandeffectiveness in Switzerland
z Kindergarten Evilard (<)
z KISS study (AG, BL) in development
z Feelok.ch in development
z Other projects (GE etc) in development
25Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, Stone EJ, Rajab MW,Corso P (2002). The effectiveness of interventions to increase physical activity. A systematicreview. Am J Prev Med 22: 73-107.
Effectiveness of interventions applicableEffectiveness of interventions applicableto children in international reviewto children in international review
z Prompts to encourage stair use <z Community-wide campaigns <z School-based physical education <z Social support in community settings <z Access to places combined with <
informational outreach
26Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, Stone EJ, Rajab MW,Corso P (2002). The effectiveness of interventions to increase physical activity. A systematicreview. Am J Prev Med 22: 73-107.
Effectiveness of interventions applicableEffectiveness of interventions applicableto children in international reviewto children in international review
z Classroom-based health education ?focused on information provision
z College-based health education ?and physical education
z Classroom-based health education ?focused on reducing televisionviewing and video game playing
27Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
Evaluation of large scale projects andEvaluation of large scale projects andprogrammes for children implementedprogrammes for children implementedin Switzerlandin Switzerland
z Majority of infrastructure -(Playgrounds, sports grounds etc.)
z Majority of offers -(sport clubs etc.)
z PE in school beginningz Youth + Sports beginning
28Alimentazione equilibrata e movimento nell'età scolastica" - 10 marzo 2005 Relatore: B. Martin
Evidence-Based Approach toEvidence-Based Approach toPromoting PAPromoting PA
Adults Childrenz Evidence for health benefits +++ ++z Surveillance ++ (+)z Effectiveness + (+)z Evaluating Practice (+) -
z Public awareness of problem ++ +++z Need for action +++ +++