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AUTHOR PROOF
Approval for publication Signed Date Number of amended pages returned
Sports Med 2006; 36 (4): 1
R
EVIEW
A
RTICLE
0112-1642/06/0004-0001/$39.95/0
2006 Adis Data Information BV. All rights reserved.
Physical Activity Levels of Children
During School Playtime
Nicola D. Ridgers,1,2 Gareth Stratton1,2 and Stuart J. Fairclough3,2
1 Research Institute for Sport and Exercise Sciences, Liverpool John Moores University,
Liverpool, UK
2 REACH (Research into Exercise, Activity and Children’s Health) Group, Liverpool John
Moores University, Liverpool, UK
3 School of Physical Education, Sport and Dance, , Liverpool John Moores University,
Liverpool, UK
Contents
Abstract ..................................................................................... 1
1. Definitions ................................................................................ 3
2. Physical Activity Recommendations......................................................... 3
3. Method .................................................................................. 3
4. Studies Investigating Physical Activity Levels During Playtime .................................. 3
5. Playtime-Based School Interventions Promoting Physical Activity ............................... 8
6. Future Research Directions .................................................................10
7. Conclusion ...............................................................................11
School represents a suitable setting for intervention programmes aiming to
Abstract promote physical activity to benefit health. During the school day, physical
education and school playtime offer children regular opportunities to engage in
physical activity. However, there is growing concern that, internationally, curricu-
lar time allocated to physical education is not meeting statutory guidelines. The
effectiveness of the playground environment to promote physical activity has
been considered as a complementary setting to physical education.
Physical activity guidelines state that children should engage in at least 1 hour
of moderate intensity physical activity a day. Currently no empirically tested
guidelines exist for physical activity levels during playtime. However, studies
cited in this article indicate that playtime can contribute between 5–40% of
recommended daily physical activity levels when no interventions have been
utilised.
The limited school-based investigations that have been reported in the litera-
ture suggest that boys engage in more physical activity during playtime than girls.
Studies that have implemented intervention strategies in order to promote physical
activity levels indicate that playtime can substantially contribute towards daily
optimal physical activity guidelines. Energy expenditure and physical activity
levels have increased during playtime following the implementation of play-
time-based interventions. In order to advance knowledge of children’s physical
activity during playtime, a number of key issues for consideration in future
AUTHOR PROOF
2Ridgers et al.
research are detailed. Research on children’s use of playtime to be physically
active and the extent of the contribution of playtime to daily physical activity
guidelines is warranted.
((Author: please note that the abstract has been modified to provide a
discrete synopsis of the article))
The benefits of a physically active lifestyle have tion whilst allowing children to choose their
been extensively documented in adults, with inverse leisure-time activities freely. Consequently, the im-
relationships between physical activity and diseases portance of the school environment warrants atten-
including obesity, coronary heart disease, hyperten- tion.
sion, diabetes mellitus, certain cancers and osteo- During the school day, physical education (PE)
porosis.[1-3] Additionally, a physically active lifes- and playtime enable children to engage in regular
tyle has been linked to psychological well-being.[4] physical activity.[16,17] Interventions that have
In recent years, considerable interest has been sought to increase physical activity levels in PE
directed towards determining physical activity lessons, such as SPARK (Sports, Play and Active
levels amongst paediatric populations. Research Recreation for Kids), CATCH (Coordinated Ap-
suggests that an active lifestyle during childhood proach to Child Health) and M-SPAN (Middle-S-
reduces the risk of health problems in later years,[5] chool Physical Activity and Nutrition) ((Author:
and that levels of physical activity during childhood please confirm that added definitions are cor-
track into adulthood, although this tracking evidence rect)) have generally been successful in raising the
is weak.[3,6] Whilst the relationship between child short- and long-term physical activity levels of ele-
physical activity and health is weak compared with mentary children.[18-20] Whilst these large-scale
stronger relationships found between adult health projects have been well funded, they have been
and physical activity,[3] health promoters consistent- implemented in the US and the costs of the interven-
ly endorse regular moderate intensity physical activ- tion programmes are unknown.[21] These studies
ity for children with the objective of benefiting have significantly increased physical activity in fo-
current and future health.[1] However, research has cused settings such as PE, although these increases
indicated that substantial numbers of children in the have made a small contribution to total daily physi-
UK,[7,8] Europe[9,10] and the US[11,12] do not engage in cal activity.
sufficient activity during childhood to gain health Internationally, there is growing concern that the
benefits. curricular time allocated for PE is not meeting statu-
Opportunities for children to engage in daily tory guidelines, with PE making way for supposedly
physical activity are dependent on a number of more valuable areas of the curriculum, such as
socio-economic, environmental and personal fac- numeracy and literacy.[22] In light of these concerns,
tors. Competition from sedentary leisure-time activ- the effectiveness of the playground environment and
ities, such as television viewing, on the time availa- playtime in physical activity promotion may com-
ble for children to be active has been acknowl- plement PE interventions. Playtime is a mandatory
edged,[13,14] although recent data suggest that part of the school day where children usually spend
sedentary behaviours not only compete but also the majority of their time outside on the play-
coexist with physical activity.[15] Marshall et al.[15] ground.[23,24] With children experiencing up to 600
noted that promoting physical activity whilst main- playtimes a year (based on 3 times a day, 5 days a
taining the behavioural preferences of children is an week, 39 weeks a year),[25] playtime offers a signifi-
important consideration. School-based interventions cant amount of time where children can be physical-
may provide the scope for physical activity promo- ly active. The purpose of this article is to appraise
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (4)
AUTHOR PROOF
Physical Activity of Children During School Playtime 3
the research that has investigated the physical activi- er, it has recently been suggested by Ridgers et al.[29]
ty levels of children during school playtime. Moreo- that in order for playtime to contribute meaningfully
ver, it considers interventions that have been used to towards the accumulation of daily physical activity,
increase physical activity levels during this part of children should engage in at least moderate-intensi-
the school day. Key issues that emerge from the ty physical activity for 40% of playtime. Ridgers et
extant literature on playtime may provide clues al.[29] found that 40% of playtime engaged in physi-
about the delivery of a successful and sustainable cal activity equated to 34 minutes of daily MVPA in
intervention for physical activity promotion. their study when playtime across the school day was
measured. This exceeded the minimum recommen-
1. Definitions dation of 30 minutes of at least moderate-intensity
physical activity for children who currently partici-
For the purpose of this article, the term ‘children’ pate in little or no daily physical activity.[28] This
includes the age range 4–12 years. ‘Physical activi- threshold value was considered a realistic target for
ty’ is a broad term, which is defined as ‘any bodily children to achieve during playtime, and it will be
movement produced by skeletal muscles that results utilised throughout this article.[29]
in energy expenditure’.[26] This article focuses on
children’s physical activity, which is characteristi- 3. Method
cally spontaneous and intermittent.[11,27] ‘Playtime’
is considered as the non-curriculum time allocated A literature search was conducted for studies that
by schools between lessons for children to engage in measured children’s physical activity levels during
leisure activities (known as ‘recess’ in the US). playtime and were published in the English lan-
‘School playgrounds’ are regarded as the outdoor guage between 1970 and 2004. The search used the
area of the school available for children to use key words ‘playtime’, ‘recess’ and ‘playgrounds’
during their playtimes. They can encompass both using the Web of Knowledge and SportDiscus on-
grass and tarmac areas, and may contain playground line databases, and a manual search of conference
markings and equipment for children to use. proceedings was also performed. Both cross-sec-
tional and intervention studies were included to es-
2. Physical Activity Recommendations tablish the physical activity levels of children in
different school playtime contexts. Additional inclu-
The following physical activity recommendation sion criteria for studies were: (i) physical activity
has generally been accepted for the maintenance of levels during school playtime evaluated using objec-
health among children and will be used in this tive measures; and (ii) participants were between
review: ‘all young people should participate in phys- 4–12 years of age.
ical activity of at least moderate intensity for 1 hour
per day’.[28] Moderate-intensity physical activity 4. Studies Investigating Physical Activity
here is defined as ‘[an] activity usually equivalent to Levels During Playtime
brisk walking, which might be expected to leave the
participant feeling warm and slightly out of Despite being popular with pupils[23] and ac-
breath’.[28] Vigorous physical activity (VPA) here is counting for a significant amount of school time,[30]
defined as ‘[an] activity usually equivalent to at least playtime has been referred to as ‘the forgotten part
slow jogging, which might be expected to leave the of the school day’.[23] Little empirical research has
participant out of breath and sweaty’.[28] This article focused on the physical activity levels of children
will discuss moderate-to-vigorous physical activity within the playground and the merit of playtime
(MVPA) where a child engages in at least moderate strategies in this context.
intensity activity that encompasses bouts of VPA. Children best accumulate physical activity in un-
No empirically tested guidelines currently exist structured environments where they are free to inter-
for physical activity levels during playtime. Howev- act with their peers.[31] Playtime offers children an
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (4)
AUTHOR PROOF
4Ridgers et al.
opportunity to be physically active during the school Table I summarises 13 studies that have investi-
gated the physical activity levels of children aged
day, as the unstructured environment lends itself to
4–12 years in the school playground, where six
the highly transitory activity patterns of chil-
studies have used the criterion measure of direct
dren.[11,32] It is only recently, however, that research
observation on individual children and two studies
has attempted to quantify both the physical activity
have used scanning procedures on school play-
levels of children during playtime, and their contri- grounds.
bution towards physical activity guidelines.
Sex differences in children’s physical activity
The determination of children’s physical activity levels have been found, with boys generally partici-
during school playtime has been undertaken using pating in more MVPA during playtime than
direct observation, heart rate monitoring and ac- girls.[17,25,45-48] Whilst the reasons behind sex differ-
celerometry. Direct observation enables the assess- ences are not widely established, links have been
ment of the pattern, frequency and intensity of made to sex roles, with boys viewing playtime as an
behaviours as well as contextual information con- opportunity to engage in competitive games while
cerning the physical activity behaviour. Whilst this girls view it as an opportunity to socialise with
method is time consuming and can cause reactivity, friends.[24] Conversely, two studies of Portuguese
it is considered the most practical method for assess- children found that girls engaged in more MVPA
ing patterns of activity and their related be- than boys,[41,42] although the authors were concerned
haviours.[33,34] Heart rate monitoring provides an about children’s low levels of physical activity par-
indication of the relative stress placed on an individ- ticipation. These studies were limited by the small
ual’s cardiorespiratory system during movement.[35]
sample sizes and single day of monitoring of physi-
It is cost-effective for use in moderately sized sam- cal activity. Further studies are needed to examine
ples and is relatively unobtrusive.[33] However, whether the differences found in these studies could
maintaining contact between the monitor and the be, in part, explained by cultural differences be-
chest is a problem, particularly in smaller children tween different countries by using representative
because of the size of their ribcage and recordings sampling and monitoring larger numbers of chil-
can be affected by factors not associated with the dren.
children’s movement such as emotional state and Stratton[25] investigated sex and seasonal differ-
level of fitness.[35] Accelerometry detects the body ences in playtime physical activity in a sample of 27
movement connected with physical activity. It is children and found that whilst boys engaged in
increasingly popular for assessing physical activity higher levels of physical activity than the girls in the
in field settings, as the monitors are small, non- winter months, there was no difference in their
invasive, and can store large amounts of data, thus activity levels in the summer months. Boys’ and
detailing physical activity patterns over time.[36] The girls’ activity was higher in the winter months com-
ability to use adjustable recording settings to moni- pared with summer.[25] While a small sample was
tor activity is an advantage of accelerometry.[37] Tri- used, these data suggest that establishing the under-
axial accelerometers are thought to be better suited lying determinants for the girls’ higher MVPA and
for measuring children’s physical activity than uni- the reduction of the children’s activity in the sum-
axial accelerometers, as they may be more sensitive mer months could have important implications for
to children’s activities.[33] However, uni- and tri- the promotion of physical activity over the academic
axial accelerometer recordings are highly correlat- year. On this basis, studies that aim to determine the
ed,[38] supporting the use of uni-axial accelerometry seasonal influences on children’s physical activity
as one of the commonly used methods in paediatric using a larger sample of children are warranted.
populations.[39] These methods of assessment are
reliable and valid for use with children (see Sirard Playtime offers an opportunity for children to be
and Pate[33] for a review). physically active at a sufficient level to meet mini-
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (4)
AUTHOR PROOF
Physical Activity of Children During School Playtime 5
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (4)
Table I. Summary of studies investigating children’s physical activity (PA) during playtime. Table ordered by sample size (smallest to largest)
Study Participants Design and PA assessment Results Other comments
Stratton and Mota[40] 9 English and 9 Direct observation: CARS English girls PA: ‘slow/easy Only morning playtime monitored
Portuguese girls aged 10y HR telemetry: 15 sec intervals translocation’ and ‘stationary with Difficult to synchronise HR and
Playtime video recorded movement’ CARS
Correlations Portuguese girls PA: ‘stationary with Sensitivity of measures
movement’ and ‘fast/hard translocation’ Small sample size
Low correlation’s between HR and
CARS
Santos et al.[41] 10 boys and 12 girls aged HR telemetry: measured Girls MVPA > boys Children engaged in PA for small
8–10y (Portugal) morning and afternoon playtime Girls spent 38% and boys 30.8% of percentage of playtime
on 1 day play in MVPA Opportunities for PA to be
Girls PA contributed 19% to PA encouraged in schools
guidelines; boys 15.4% Small sample size
Stratton[25] 14 boys and 13 girls aged HR telemetry during morning Winter PA > summer PA Seasonal influences examined
7–11y from one primary playtime Boys winter PA > girls 30 playtimes observed (500+ min)
school (England) 1 boy and 1 girl per playtime Boys summer PA ↔ girls Only morning playtime measured
filmed HR winter > summer Other variables affecting HR
Summer: Jun–Jul Small sample size
Winter: Jan–Feb
Mota and Stratton[42] 16 boys, 23 girls aged HR telemetry: 15 sec intervals Boys HR < girls Children engaged in some light
8–9y (9.3 ± 0.4y) grade 4 HR measured during morning Boys MVPA < girls activity
(Portugal) playtime (20 min) – 4wk Boys spent 19% and girls 34% in Only morning break monitored
ANOVA MVPA Small sample size
Johns and Ha[43] 40 children aged 6–8y Direct observation: BEACHES 23.3% of time children were seated Inter-observed results not given
(Hong Kong) 4 × 1h and 6 × 20 min during playtime Cultural influences on PA
observations (mean 5.5h) per 40.5% of time children were standing considered
child 28.1% of time children were walking Sex differences on PA not indicated
Chi-squared tests VPA only 3.3% of time Small sample size
Dale et al.[16] 40 boys and 38 girls (M Accelerometry PA active day > non-active day Examined restriction effects on PA
age = 9.3 ± 0.68y) [US] 4 school days monitored: 2d 70 Playtime and PE PA active day > non- PA threshold values not used to
min of PE and playtime, 2d no active day quantify PA duration or intensity
school activity, dependent t- PA after school on non-active days < 1 min epoch used – pattern of
tests active school days activity not shown
Sarkin et al.[17] 49 boys and 61 girls Accelerometry: PA measured in Boys playtime PA > girls Assessed PE and playtime on same
grade 5 (boys M age = PE and playtime on 3 separate Boys PE PA ↔ girls days – controls for contextual
11.29 ± 0.53; girls M age days Girls PA PE > girls PA playtime variables
= 11.18 ± 0.51) [US] 2 × 2 mixed model ANOVA for School part of PE intervention
sex differences
Continued next pag
e
AUTHOR PROOF
6Ridgers et al.
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (4)
Table I. Contd
Study Participants Design and PA assessment Results Other comments
Sleap and Warburton[14] 93 boys and 86 girls aged Direct observation: CPA PE PA < playtimes PA Seasonal effects addressed
5–11y over 5y (UK) procedure MVPA as total observation time in Observations conducted by
School day, 1 weekday evening morning playtime (55.4%), afternoon undergraduate students
and 1 × 4h period during playtime (59.8%) and lunch (46.3%) Observed at school on 1d only
weekend observed ((Author: rewording ok?))
Hovell et al.[44] 133 boys and 141 girls, Direct observation: PA Grade 3 girls lower- and upper-body First study to look at PA in playtime
grades 3–6 (US) observed during morning PA > grade 4 and grade 6 girls Linked behaviour to PA levels
playtime or lunch (10–20 min in ↔ between boys on PA Based on 5 min of observation
length) Mar–Apr Boys lower-body PA > girls
50 × 5 sec interval Boys upper-body PA < girls
observations per child
McKenzie et al.[45] E-A: 65 boys, 50 girls; Direct observation: BEACHES IOA%: 94.3–99.9% Longitudinal study
M-A: 90 boys and 82 girls technique Boys PA > girls 16% attrition rate
Mean ((Author: M?)) age: 2 observations per child (min E-A PA > M-A PA Limited generalisability
baseline: 4.4y, follow-up ((Author: minimum?)) = 10 Elementary PA > preschool PA Playtime duration differed across
6.6y mins) at preschool and schools
elementary
Paired t-tests
Kraft[46] 201 boys, 168 girls Direct observation: active and IOA reliability: r = 0.91 Classified active behaviour and
grades K-3 (US) passive behaviour recorded Vigorous activity = 21% of time extent of social interactions
every 5 sec Physical play = 59% of playtime Descriptive: based on 5 min of
1 child observed for 5 min Boys PA > girls observation
McKenzie et al.[47] 24 schools, mean SOPLAY direct observation IOA%: 88–97% Large scale study focusing on
((Author: M?)) enrolment procedure ICC: 0.76–0.99 playtime behaviour
1081 pupils, grades 6–8 3d per school (72d total) Boys MVPA > girls MVPA SOPLAY focuses on PA of groups
(US) 2 × 5 ANCOVAs Boys EE > girls EE >20% students enrolled observed
More boys visit PA area than girls Scanning procedure used in school
playground
Zask et al.[48] 3912 children year K-6 Direct observation: CAST IOA reliability: activity level = 0.79, Effect of play duration on PA stated
18 rural Australian procedure (based on SOFIT) category ID ((Author: does ID = Schools viewed on 1d only
schools Correlation and paired t-tests identification?)) = 0.95. CAST not widely used in literature
Multi-level regression model ICC MVPA = 0.94, VPA = 0.77 Scanning procedure used in school
Lunch PA > playtime PA playground
Boys PA > girls PA Environmental effects on PA
considered
ANOVA = analysis of variance; BEACHES = Behaviors of Eating and Activity for Children’s Health Evaluation System; CARS = ((Author: please define)); CAST = ((Author:
please define)); CPA = ((Author: please define)); E-A = European American; EE = energy expenditure; HR = heart rate; ICC = intra-class correlation; IOA = inter-observer
agreement; M = ((Author: please define. Mean?)); M-A = Mexican American; MVPA = moderate-to-vigorous physical activity; PE = physical education; r = correlation coefficient;
SOFIT = System for Observing Fitness Instruction Time; SOPLAY = System for Observing Play and Leisure Activity in Youth; VPA = vigorous physical activity; ↔ indicates no
significant difference; > indicates significantly greater than; < indicates significantly less than ((Author: please confirm that all definitions added are correct and supply
missing ones as indicated)).
AUTHOR PROOF
Physical Activity of Children During School Playtime 7
mum daily physical activity recommendations.[29]
Table II demonstrates the extent to which playtime
can contribute to daily physical activity recommen-
dations. This has been possible for studies that re-
ported the mean length of time children spent in
playtime. Sleap and Warburton[14] provided a de-
tailed breakdown of time children spent engaged in
MVPA for each playtime. They found that the chil-
dren engaged in an average of 8.3 minutes of MVPA
during morning break, 8.5 minutes during the after-
noon break, and 18.9 minutes during the lunch
break. This equated to 55.4%, 59.8% and 46.3% of
the average observation period for the children dur-
ing each respective playtime, although the playtime
length and sex differences in physical activity were
not stated.[14] Encouragingly, children engaged in an
average of 35.7 minutes of MVPA during all play-
time, which is over half the recommended 60 min-
utes of MVPA a day.[28]
Table II highlights a number of key points that
warrant attention:
1. Playtime contributed 4.7–40% of the recommend-
ed MVPA a day for boys and 4.5–30.7% for girls,
suggesting that it can make a considerable contribu-
tion to the accumulation of daily MVPA.
2. The duration of playtime available for children to
be active is an important consideration. Zask et
al.[48] suggested that the increased physical activity
levels observed at lunchtime compared with morn-
ing playtime were influenced by the longer play
duration at lunchtime. Schools should therefore pro-
vide adequate time periods during the school day for
children to engage in physical activity, which could
contribute to activity guidelines.
3. Children in four studies achieved the threshold
value of at least moderate-intensity physical activity
for 40% of playtime.[29] However, further empirical
testing is needed to establish its applicability across
schools in differing geographical areas. Since these
studies also utilised different measures for quanti-
fying physical activity, verification of activity cut
points in relation to different physical activity mea-
sures are also needed.
4. The study of McKenzie et al.[45] suggests that
physical activity levels may vary in children from
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (4)
Table II. Mean playtime duration, percentage of moderate-to-vigorous physical activity (MVPA), time spent in MVPA and contribution to daily physical activity (PA) guidelines (60
min) for boys and girls
Study Mean playtime duration MVPA (%) MVPA time (min) Contribution to daily PA (%)
(min)
boys girls boys girls boys girls
Stratton[25] 17.6 (S) 15.8 15.4 2.8 2.7 4.7 4.5
17.6 (W) 29.1 22.5 5.1 3.9 8.5 6.5
Kraft[46] 28 45 38 12.6 10.6 21 17.7
McKenzie et al.[45] 25.9 (PS: E-A) 52.2 41 13.5 10.6 22.5 17.7
25.9 (PS: M-A) 41.1 40 10.6 10.4 17.7 17.3
14.1 (EL: E-A) 56.3 50.7 7.9 7.1 13.2 11.8
14.1 (EL: M-A) 47.1 44.5 6.6 6.3 11 10.5
McKenzie et al.[47] 35.5 (lunch) 67.7 51.7 24 18.4 40 30.7
Mota and Stratton[42] 20 19 34 4 6.5 6.7 10.8
Zask et al.[48]a 16 (morning) 46.2 36.7 7.4 5.8 12.3 9.7
30 (lunch) 51.4 41.6 15.4 12.5 25.7 20.8
a Based on a school size of 200 children.
E-A = European American; EL = elementary school; M-A = Mexican American; PS = pre-school; S = summer; W = winter.
AUTHOR PROOF
8Ridgers et al.
different ethnic backgrounds. European-American playtime-based interventions have been investigated
children engaged in higher levels of physical activi- as a way of increasing physical activity through the
ty compared with their Mexican-American counter- use of playground markings[52] and structured fitness
parts. Possible reasons included Mexican-American playtimes (table III).[53]
children enjoying physical activity less, having low- In the UK, Stratton[52] investigated the short-term
er self-efficacy and a greater difficulty in overcom- effects of playground markings as a strategy for
ing barriers compared with European-American increasing the physical activity of primary-aged
children.[49] Research into ethnicity and school play- (4–11 years) school children. He found that play-
time physical activity is required to address this ground markings increased the amount of time that
issue further. children spent in MVPA by 18 minutes a day com-
5. The stage of the child’s schooling may influence pared with their pre-intervention activity levels.[52]
physical activity levels. The study of McKenzie et This equated to children spending 45% of their time
al.[45] showed that, although elementary children had in the playground participating in MVPA.[52] Levels
shorter playtime duration than pre-schoolers, they of VPA increased by 40% and 60% in infant and
engaged in higher levels of physical activity. It has junior schools, respectively, following the play-
been suggested that young children use playtime as ground marking intervention.[56] This is of note, as
an opportunity to practise physical skills, develop VPA promotes muscular strength and bone health
motor skills and to become confident in their move- over and above that expected from participating in
ment.[50] Conversely, older children use playtime to moderate-intensity physical activity.[28] Additional-
develop social skills and to play games with other ly, total energy expenditure and rate of energy ex-
children.[51] Determining the physical activity levels penditure was found to increase by 35% and 6%
of children of different ages during playtime would ((Author: respectively?)) following a playground
enable educators and health promoters alike to es- marking intervention.[55]
tablish whether interventions are needed at different Whilst the playground marking interventions in-
stages of schooling. creased physical activity levels, the studies were
In general, the findings from these studies sug- limited by their short-term follow-up periods where
gest that playtimes can contribute up to one-third of a novelty effect of the environment may have influ-
daily MVPA, although strategies for increasing enced children’s physical activity levels. The long-
physical activity levels are needed if playtime is to er-term effects of these interventions were not inves-
achieve its potential in promoting physical activity tigated. While playtime duration was used as a
to children. covariate in the analyses,[52,53,55] the impact of the
interventions on playtime supervisors’ encourage-
5. Playtime-Based School Interventions ment of playtime activity, management or organisa-
Promoting Physical Activity tion of the playground, and the individual school’s
playtime regulations were not detailed. These fac-
Blatchford[23] noted that whilst educational poli- tors could also have positively influenced physical
cies have focused on curricular areas such as literacy activity levels. Further research is needed to address
and numeracy, scant attention has been paid towards these issues to determine the longer-term effects of
the improvement of school playtimes. Individual playground marking interventions and to address the
schools have initiated many changes to school play, impact that the management of the playground envi-
with the provision of equipment being a common ronment has on physical activity during playtime.
strategy. However, the wider benefit of the play-
In the US, Scruggs et al.[53] utilised fitness breaks
ground for teaching physical skills and promoting
(FB) in an attempt to increase children’s physical
peer and other social interactions with school staff
activity. The use of FB was first suggested by Gab-
through informal and formal games is greatly under
bard[57] and aimed to increase children’s VPA. FB
researched.[24] Surprisingly, it is only recently that
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (4)
AUTHOR PROOF
Physical Activity of Children During School Playtime 9
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (4)
Table III. Summary of intervention studies investigating children’s physical activity (PA) during playtimes. Table ordered by sample size (smallest to largest)
Study Participants Design and PA assessment Intervention Results Other comments
Scruggs et al.[53] 10 boys, 17 girls –HR telemetry and pedometers FB FB MVPA > morning and lunch Intervention benefited both boys
grade 5 (boys M Morning playtime, lunch and FB playtime MVPA and girls PA
age = 11.03 ± 0.32; monitored for 3 consecutive days FB VPA > morning and lunch Girls lower enjoyment of FB
Girls M age = 10.91 Repeated measures ANOVAs playtime VPA Limited generalisability
± 0.27) [US] Boys FB enjoyment > girls Short-term intervention
Boys FB VPA > girls Possible novelty effects
Small sample size
Connolly and 56 elementary Self-report, accelerometry, direct Games Games PA > standard PA Benefited boys and girls
McKenzie[54] children (US) observation playtime Boys self-report PA ↔ girls Enjoyment similar for both
Each day: 1 games playtime, 1 Games playtime enjoyment ↔playtime types
standard playtime standard playtime Possible novelty effects
Paired t-tests Boys enjoyment ↔ girls enjoyment Short-term intervention
(both playtimes) Games played not detailed
Stratton[52] Exp: 18 boys, 18 3 children per school monitored Playground Play duration increased during PA increased after painting
girls each day markings intervention Play time duration increased
Con: 12 boys, 12 HR telemetry MVPA increased 18 min/d post- Short-term follow-up
girls 4wk follow-up intervention Possible novelty effects
Aged 5–7y ANCOVA Exp MVPA and VPA increased
(England) 11.1% and 4.7%
Stratton and 32 boys, 30 girls 1wk pre- and 1wk post-painting Playground Rate of EE increased 6.1% during Intervention benefited both
Leonard[55] aged 5–7y measures taken markings intervention sexes
(England) HR telemetry Total EE increased 35% during Short-term follow-up
RM ANCOVA (covariates: BM and intervention Most effective markings
play duration) Boys total EE 23% higher than girls unknown
Potential novelty effects
Stratton and Exp: 60 boys, 60 Baseline: 4wk pre-painting Playground Boys PA > girls Painting benefited both sexes
Mullan[56] girls (4 schools) Intervention: 4wk post-painting markings Exp MVPA > Con MVPA Possible seasonal effects on
Con: 60 boys, 60 HR telemetry Exp VPA > Con VPA control groups PA levels
girls (4 schools) 3 ANCOVAs (covariates: BM and Exp MVPA increased from 36.7% to Increases in MVPA may link to
Aged 4–11y (Wales, play duration) 50.3% novelty effects
England) Con MVPA decreased from 39.9% Short-term follow-up
to 33.4%
ANOVA = analysis of variance; ANCOVA = analysis of covariance; BM = body mass; Con = control group; EE = energy expenditure; Exp = experimental group; FB = fitness
breaks; HR = heart rate; M = ((Author: please define. Mean?)); MVPA = moderate-to-vigorous physical activity; RM = ((Author: please define)); VPA = vigorous physical activity;
↔ indicates no significant difference; > indicates significantly greater than; < indicates significantly less than. ((Author: please confirm that all definitions added are correct and
supply missing ones as indicated)).
AUTHOR PROOF
10 Ridgers et al.
were 15 minutes in duration and consisted of a 400m elty effects may explain some of the increases seen
in the children’s physical activity.
obstacle course that contained moderate-to-vigorous
In the limited studies conducted to date, play-
intensity activities such as running, crawling over
ground markings and FB intervention studies have
objects and fitness activities such as crunches and stimulated short-term increases in physical activity
push-up claps. Children’s enjoyment of the FB and levels of boys and girls. The main advantage of
playtime was also measured. Physical activity in- playground markings are that they give children of
creased in the FB for boys and girls, although higher all ages the opportunity to engage in the activity of
physical activity levels were observed in boys.[53]
their choice, and through selecting enjoyable activi-
Moreover, the FB encouraged the children to engage ties they are more likely to sustain their participa-
in MVPA for 50% of playtime. The authors con- tion.[5,52] Since markings are not sex specific, this
cluded that the use of FB in primary schools would may explain in part why both sexes benefited from
substantially contribute to the children’s daily phys- the markings. The main disadvantage is the cost
ical activity levels. involved, as schools consistently experience com-
Whilst the FB breaks increased children’s physi- peting budgetary demands.
cal activity, the duration of the programme was 3 The advantages of the FB intervention are the
days and the novelty of undertaking the FB may opportunities for children to engage in a variety of
account for some of the increases seen. Moreover, activities that promote physical exertion using dif-
due to the nature and structure of the FB, it is likely ferent parts of the body, and the development of
that such an intervention requires continuous organ- different physical skills.[53] However, girls did not
isation and supervision of school staff. This could enjoy the FB as much as the boys, as its structure
mean that it is less sustainable than environmental appealed more to the boys’ competitive nature.[53]
approaches such as playground markings, which Enjoyment is a central facet to participation
appear to warrant less supervision and instruction behaviours, and if girls do not experience a positive
for the children to use safely. Additionally, whilst affective response,[58] they may lack motivation and
there was no difference between the boys’ and girls’ avoid taking part in physical activity. Secondly, the
size of the obstacle course used in the FB study
enjoyment for playtime, girls’ enjoyment of the FB
would occupy a large proportion of available space
was significantly lower than boys’. Boys may re-
in smaller playgrounds. This could affect the physi-
ceive greater benefits from the FB, though further cal activity levels of other children on the play-
research is needed to address this. ground due to a lack of play space. The effects on
Connolly and McKenzie[54] investigated the ef- physical activity of reducing the scale of the obsta-
fects of a games intervention, implemented by play- cle course to suit smaller playground needs would
ground supervisors, on elementary school children’s need addressing in schools looking to use this ap-
physical activity levels. Children were more active proach as a playtime intervention.
during the games programme than standard play-
time, and there were no significant sex differences 6. Future Research Directions
between the children’s self-reported physical activi-
ty. Additionally, there were no differences in the Even with the observed benefits of the play-
children’s enjoyment of the games playtime and ground-based interventions, there are a number of
standard playtime. This highlights that a games key issues that future research could concentrate on
playtime may have similar benefits for both boys to further knowledge of children’s activity levels
and girls in terms of physical activity levels and during playtime:
enjoyment, but further research is needed. This ap- •The research has currently focused on the short-
proach is mainly limited by the need for high levels term benefits of the interventions, with the long-
of child supervision by school staff. Moreover, nov- est follow-up reported in the literature being 6
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (4)
AUTHOR PROOF
Physical Activity of Children During School Playtime 11
weeks. The extent of possible novelty effects of ty and playground behaviour is currently under-
the playground markings and the FB on physical researched. Zask et al.[48] found that the ratio of balls
activity levels, and the medium- and long-term to pupils was significantly correlated with VPA,
benefits of the interventions, warrant further at- suggesting that supplying sufficient equipment dur-
tention. ing playtime can influence and encourage children’s
physical activity. Therefore, studies that supply
•The types of markings or activities that are most equipment such as bats, balls and skipping ropes, for
effective in promoting physical activity are cur- example, on one day and which restrict children’s
rently unknown. However, the school’s play- access to such equipment the following day could
ground culture or the area where they live might determine how beneficial such an intervention
affect children’s preferences for different activi- would be on children’s physical activity and their
ties. The size and design of the original play- behaviour.
ground would also have an impact on children’s The role that adults supervising playtime play in
physical activity levels. Future research may the promotion of physical activity has been largely
need to consider matching playground markings neglected. In one study that addressed this issue,
or activities to child and schools needs in order to children complied with and maintained their physi-
be effective in promoting physical activity. cal activity participation following adult encourage-
•The effect of seasonal influences on children’s ment to be physically active during playtime.[45]
physical activity has attracted some atten- However, since the confidence and the skills of
tion,[25,59] although further research is required. these adults to give prompts could vary, the training
•Current studies using playground interventions supervisors could develop these skills and serve to
have assessed small numbers of children in only a expand their knowledge of children’s games, which
couple of geographical areas in the UK and the may increase the activity levels of children across
US. This lack of evidence limits the ability to the playground environment. In the UK, playground
generalise the results across child populations as supervisors have undergone training programmes,
a whole. Larger population-based studies using although the extent to which the training benefits
similar interventions would increase the existing physical activity promotion has not been reported.
knowledge concerning the benefits of school- The influence that school size has on physical
based interventions. It is acknowledged, howev- activity requires investigation. Zask et al.[48] found
er, that the cost of implementing playtime strate- that physical activity was higher in small schools
gies might be a limiting factor. compared with large schools. Social inclusion may
The extent to which the monitoring of children’s be stronger in small schools due to smaller numbers
physical activity on 1 day is representative of their of children, so children who are less sporty than
daily school playtime physical activity requires fur- their peers are included in games, whilst in larger
ther investigation. This has been one of the main schools they may be excluded. This suggests that
caveats of studies investigating school playtime opportunities for social interaction may have an
physical activity levels. important influence on physical activity during
A number of studies that have reported children’s playtime, and studies should look at the playground
physical activity during playtime have focused on behaviour of children to further knowledge of un-
one playtime. Monitoring all the available playtimes derlying reasons for differences in children’s play-
across the school day would determine playtime’s time physical activity.
contribution to physical activity and enable more
direct comparisons of children’s playtime activity 7. Conclusion
across different studies.
The effect that the provision of equipment in the The limited school-based investigations that have
school playground has on children’s physical activi- been reported in the literature suggest that a number
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (4)
AUTHOR PROOF
12 Ridgers et al.
10. Riddoch CJ, Andersen LB, Wedderkopp N, et al. Physical
of factors affect children’s physical activity levels activity levels and patterns of 9- and 15-year-old European
during playtime. These factors include sex, age, children. Med Sci Sports Exerc 2004; 36 (1): 86-92
11. Bailey RC, Olson J, Pepper SL, et al. The level and tempo of
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434-47
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SPARK. Res Q Exerc Sport 1997; 68 (4): 280-91
Author: please provide information, for publication in 19. Kelder SH, Mitchell PD, McKenzie TL, et al. Long-term imple-
the acknowledgements section of the manuscript, on any mentation of the CATCH physical education program. Health
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