The effects of school based interventions during recess in attempting to improve children(TM)s health

It is widely acknowledged that physical activity (PA) is simultaneously an essential component, and has a significant impact on a healthy lifestyle (Verstraete, Cardon, De Clercq and De Bourdeaudhuij, 2006; Zask, van Beurden, Barnett, Brooks, Dietrich, 2001; Ridgers, Stratton, Fairclough, Twisk, 2007). Furthermore it is recognized that inactivity amongst children leads to a number of lifestyle related diseases such as coronary heart disease, osteoporosis, diabetes and also other mental health illnesses (Zask et al. 001; Stratton and Mullan, 2005; Hale and Raglin, 2002; Di Lorenzo, Bargman, Stuck-Ropp, Brassington, Frensch and LaFontaine, 1999). Zask et al (2001) explains that physical activity during childhood is beneficial for later adulthood and that by becoming and remaining active during childhood it contributes to a number of factors including bone development, prevention of lifestyle diseases and it improves your psychological state. This assignment will look at the effects of school based interventions during recess in attempting to improve children’s health.

The assignment will begin by discussing the guidelines recommended for children to continue a healthy lifestyle and the benefits of using recess to achieve these recommendations. Following this, the assignment will then proceed to identify a number of interventions which have been conducted in the area, with some strength and weakness of these studies acknowledged. Finally the essay will conclude by bringing the strengths and weaknesses together, discussing the effectiveness of the studies and concluding if recess can be used as a vehicle to achieve the recommended guidelines of PA in children.

It has been widely publicised by the media and health organisations that more children are becoming obese than ever before and that the obesity epidemic is spreading much faster than anticipated. A number of reasons exist for this including; children eating unhealthy food and not receiving a balanced diet and children not being as physically active as they should be due to the introduction of computer consoles and other electronic entertainment available to them.

Pangrazi (2000) cited in Zask et al (2001) suggests that the recommended minimum of physical activity for a child is 60 minutes of daily moderate intensity activity on five or more days per week. Verstraete, Cardon, De Clercq and De Bourdeaudhuij, (2006) state that despite these recommendations only 27% of girls and 40% of boys in developed countries in Europe and America adhere to these recommendations. Ridgers et al. (2007) identifies that one of the biggest opportunities for children to become active is at school during either physical education (PE) or through recess.

We Will Write a Custom Essay Specifically
For You For Only $13.90/page!

order now

Although PE is viewed as a great opportunity to achieve a daily recommended amount, the reality is that children do not receive PE every day. Another complication with this is that as most PE sessions are delivered on an hourly basis the children are not engaging in a full hour of moderate PA. So with this in mind, and the fact that British school children receive up to 600 recess periods per year, recess is viewed as the primary vehicle to achieve the recommendations in schools. (Verstraete et al, 2006; Zask et al, 2001). Interestingly, Pate et al. 1996) cited in Stratton and Mullan (2005) explains that recess is viewed as a great opportunity to reach the recommended amount of PA for children as the children are more likely to engage is moderate intensity activities with their peers in an unstructured environment. To assess the impact recess has on children’s PA levels; Ridgers, Stratton and Fairclough (2004) completed a study, ‘Accessing physical activity during recess using accelerometers’, which aimed to compare the PA levels of boys and girls and determine if the children take part in moderate PA for at least 50% of the recess period.

The study consisted of 116 boys and 112 girls who were randomly selected across 23 schools in the same geographical area. Fifty six of the children were from early primary school and 151 were from late primary school. PA levels were measured objectively using accelerometers. The children were only monitored once as part of the study, however during this one day PA was monitored during morning, lunch and afternoon recess which provided a daily mean time of 85 (i?? 16) minutes available for PA. All the subjects involved in the study were instructed to stick to their normal daily school routine.

The accelerometers were fitted in the morning when the children arrived at school and they were then removed before the kids left to go home. Out of the 228 subjects used 207 complete sets of data were returned. The results obtained from the study showed that light intensity accounted for the largest proportion of recess time. Boys spent more time being physically active during recess than girls, 28 min and 21 min respectively. Similarly 19. 3% of boys took part in a moderate or higher level of intensity for 30 minutes or more compared to 7. % of girls. Out of all the children in the study, only 2 boys reached the recommended amount of time spent moderately active in a day. There are a number of strengths and limitations to the study by Ridgers et al (2004). Firstly, there was no control group set up, on the other hand, the structure of the study meant there were no groups to compare against as the study was just measuring to see how active boys and girls were, and if they took part in moderate levels of PA at least 50% of the recess time.

Secondly the accelerometers were fitted to the children in the morning and taken off at the end of the day so the children with timetabled PE classes could have affected results. Additionally playground supervisors could also have had an affect on the results as there is the possibility that they could have influenced children to take part in games. On top of this, some of them may have been more influential than others so for results to be accurate they have to be removed from the study. Results were also gathered on one day so it is hard to predict that these results are common.

Features at school such as tuck shop days may have affected some of these results. On the other hand there are many strengths to the study. The study used random selection to obtain the subjects which is good as it means that the schools or the researchers could not hand pick the subjects to get the results they had hypothesised. Additionally the use of accelerometers are a valid and reliable method of measuring data as they can differentiate the difference between walking and running and can record the frequency and intensity of movement.

Ridgers et al (2004) illustrated that although differences between PA levels between boys and girls are unknown a reason behind boys being more active is the social set up of the playground. With Ridgers et al (2004) comments in mind Ridgers et al (2007) tested this theory and created an intervention which split playground into three clear sections using markings. The study consisted of 232 boys and 238 girls from 26 elementary schools in the same local authority which was described as ‘one of the most deprived areas in the country’ (Ridgers et al, 2007).

One hundred and thirty boys and 126 girls from 15 schools were given the intervention which consisted of their playground environment being re-designed into three different zones. The three colour coded areas consisted of a red sports area, a blue multi activity area and a yellow quiet area. The control group consisted of the 11 remaining elementary schools (102 boys, 112 girls). The control group did not receive any playground markings; instead they received sports equipment including soccer balls, jump ropes and tennis balls.

Physical activity levels were measured using both heart-rate monitors (HRM) and accelerometers. Every child was provided with a HRM and 298 children (149 boys, 149 girls) were randomly selected to wear both the HRM and the accelerometer. Baseline data was measured before the intervention was implemented. Data was collected at two follow up tests; one at 6 weeks and the second at 6 months. The results attained demonstrate that the intervention was highly successful in improving moderate to vigorous physical activity (MVPA) and also vigorous physical activity (VPA).

The HRM shows that on average the intervention school children engaged in 4% MVPA and 2. 4% VPA more than the control group. The accelerometers show similar results with intervention school children engaging in 4. 5% MVPA and 2. 3% VPA more than the control group. The use of accelerometers found a significant finding in both MVPA (P<0. 05) and VPA (P<0. 05) indicating that the invention was effective in increasing recess duration. The results also found that after 6 months boys had increased MVPA twice as much as girls had and this was also reflected in VPA.

For both MVPA VPA boys increased rapidly between baseline and 6 weeks, however from 6 weeks to 6 months they increased again but only slightly. For girls, similarly, they increased rapidly between baseline and 6 weeks, however between 6 weeks and 6 months duration of PA reduced by around one third for MVPA but for VPA it only reduced slightly. There are several strengths and limitations the intervention design by Ridgers et al (2007). A limitation acknowledged by Ridgers et al (2007) is that the combination of both HRM and accelerometers has produced contrasting results in both MVPA and VPA.

However Ridgers et al (2007) proceed to explain that this has become strength as it is now witnessed that playground activities put stress on the body in a number of different ways. A strength to using both HRM and accelerometers is that the results are made more accurate. It was expressed that the HRM had a lot of technical failures and without the data from the accelerometers the study may have been inaccurate. Additionally, the way the control group was used does not really help with the study as they gave them sports equipment such as soccer balls and jump ropes.

An effective control group in this instance would have been keeping everything the same as it was before. By providing the kids with equipment during recess this might encourage and motivate them to be more active during recess. Another strength of the study was that the study was implemented in the same local authority meaning weather would be similar across all schools and the social and economic factors amongst children will also be very similar. Finally the intervention was the recording of baseline data so that results can be compared and well evaluated.

A similar intervention to Ridgers et al (2007) which consists of a much more effective control group was a study conducted by Stratton and Mullan (2005). The study was designed to examine whether painting playgrounds with multicoloured markings would increase the percentage of recess time in MVPA or VPA in both boys and girls. Secondly the study would examine if recess contributes to the national recommendations for young peoples PA. The study consisted of 8 schools (4 early primary, 4 late primary). Thirty children were used in the study (15 girls, 15 boys) and they were all randomly selected.

Two early primary groups (4-7 years) and 2 late primary groups (7-11 years) were selected from the Northeast of Wales and they were chosen to be the control group. The study group similarly consisted of 2 early primary groups and 2 late primary groups however they were situated in the Northwest of England around 40 miles from the other schools. Baseline data was recorded before any of the study schools received the playground markings. All schools had playground supervisors who were not informed about the aim of the study and no additional equipment was supplied to the children before baseline tests and throughout the intervention.

HRM were used to record the data. Prior to recess the children’s resting heart rate was recorded every minute for 15 minutes and then the three lowest consecutive heart rates were used as baseline. After playgrounds were painted, data was collected for 4 continuous weeks in both the intervention and control group. The results gathered show that MVPA had increased by 13. 6% in the intervention group compared to a decrease of 6. 5% in the control group, which is described as significant by Stratton and Mullan (2005), p;0. 01.

It was the later primary school group that found the markings more beneficial as their MVPA level increased by 6. 9% compared to the early primary group who only increased by 2. 4%. Girls and boys both increased their MVPA levels by similar amounts with girls improving slightly more by 0. 4%. However boys improved their VPA considerably more than girls. One of the outstanding strengths in this intervention was the use of the control group. The control group was located in a different country from the intervention group but they were still described as ‘geographically close’ Stratton and Mullan (2005).

Additionally the control group schools had the exact same size of playground to the intervention schools and they also had the same socio-economic status. What also make the control group convincing is that they were not given any new playing equipment, unlike in the study conducted by Ridgers et al (2007). A major weakness of the study however is the duration of the study. Four weeks is not a long enough time period to assess how effective the playground markings are. The fact that the markings are new may engage children for a short period of time but as time goes on the ‘novelty’ of the markings may wear off.

Furthermore the method used to collect the data may well be a poor choice. HRM are a good method of calculating if the kids are working at a moderate intensity or a vigorous intensity, however heart rate can be affected by anxiety and also caffeine can have an effect on heart. It could be suggested that during recess children may be drinking sugar drinks which contain caffeine and this would have had an effect on the results. As well as this Stratton and Mullan (2005) acknowledge that the HRM could be problematic and overestimate energy expenditure. Finally the small number of subjects used in the study does not produce effective findings.

Contrasting to the study carried out by Stratton and Mullan (2005) on a small study group was a study completed by Verstraete et al (2006) which was implemented on a much larger study group. Verstraete et al’s (2006) study ‘Increasing children’s’ physical activity levels during recess periods in elementary schools: the effects of providing game equipment’ consisted of a study group of 235 elementary school children randomly selected from 7 schools. Four schools (75 boys, 45 girls) were selected as the intervention group and the remaining 3 schools (45 boys, 67 girls) were chosen to be the control group.

All schools used had comparable playgrounds and before baseline tests were conducted no new equipment had been provided. Accelerometers were used to measure levels of PA in children. Accelerometers were put on in the morning and left on until after lunch when they were removed from the subjects. Children’s PA levels were measured before the games equipment was made available to the intervention group and then a follow up measurement was taken at 3 months. Both tests were organised on days with dry weather conditions so children could play out doors.

After baseline tests, the intervention group then received a range of games equipment and activity cards which provided examples of games that can be played with the equipment. However, children were only allowed to play with the equipment in their class groups. The equipment supplied to each class was very extensive and included jump ropes, juggling balls and rings, badminton rackets and beach paddles. The results obtained from the intervention found that during lunch break, children’s MVPA and VPA both significantly increased in the intervention group compared to the decrease of both MVPA and VPA in the control group.

What is also particularly significant is that at baseline 38% of the intervention group participated in MVPA however after the follow up test over 50% of the children in the intervention group participated in MVPA. Morning recess was also effective in improving MVPA, however MVPA levels only increased by 4%. A strength of the intervention is undoubtedly the fact that a large study group was used which provided more reliable results. Additionally what also assisted in this successful study was the use of accelerometers to record the data.

Verstraete et al (2006) state that “the accelerometer has been shown to be a valid, reliable and objective method for monitoring PA in children”. Another strength of the study is that after lunch time the accelerometers were removed from the children, unlike previous studies conducted by Ridgers (2004). By removing the accelerometer it means that any activity after lunch, for example physical education, will not affect the data. A limitation to the study is that it is unsure how influential teachers were in encouraging children to be active with the equipment.

A further limitation is the location of the schools. A range of environmental factors could have led to the results or also internal school factors such as tuck shop. In conclusion it has been shown that by providing games equipment and multi-colour markings in primary schools for or during recess, levels of physical activity will increase. It is evident that boys are more active during recess than girls (Ridgers et al, 2004; Ridgers et al, 2007; Startton and Mullen, 2005 ). Ridgers et al (2004) reported that for most of the period of recess children active at a light intensity.

The study reported that that with a total of 85 minutes of recess time available to children only 2 children in the study achieved the national recommendation of 60 minutes of moderate activity per day. Ridgers et al (2004) reported that boys are more likely to be involved in ball games so with this in mind, the set up of play grounds can have areas which allow boys to engage in a range of different ball games. To do this schools must install markings and appropriate equipment to encourage them, however, boys are not the primary concern as the results of the studies show.

Future research should look at what activities optimise PA levels in girls and also what the roles of the recess supervisor or teacher is in increasing PA levels. With around one hour a day for physical activity during recess available to children and an average increase of 15-20% of MVPA which corresponds to around 10-15 minutes more MVPA per day or 50-75 minutes more per week, more children will be within touching distance of reaching the national recommendation of 60 minutes of MVPA a day (Zask et al, 2001).

However the worrying fact is that none of the interventions discussed actually provided findings saying that playground marking will definitely get children attaining national health recommendations. What has to be established is a way of making playgrounds more effective in increasing PA levels over a longer period of time so children can begin to install activity patterns into their adolescent years and into adulthood.