1. Physical Activity Recommendations for Birth-18 Years in the UK Prof. John J Reilly, University of Glasgow, on behalf of English DHCGOU Team jjr2y@clinmed.gla.ac.uk

2. Early Years Birth-School Entry

3. Background – what was available for early years No time or resource to begin from scratch USA (2002; 2009; NASPE) - expert committee Canada (2007) – expert committee; doesn’t cover infants; not quantitative Australia (2009/10 Dept. Health & Ageing; Okely et al) – evidence-based; not yet published: – Recent, based on systematic review & evidence appraisal – Generalisable to UK & based in part on UK research – Covers ages 0 – 5 – Updated by Early Years group with recent systematic reviews

4. Background: Concepts & Terms: Intensities of Physical Activity SEDENTARY LIGHT MODERATE- VIGOROUS (MVPA) Energy expenditure<1.5 times resting; could include naps, TV viewing, fidgeting, drawing, reading Energy expenditure 1.5-2.9 times resting; ‘pottering’; ‘slow translocation of the trunk’ Energy expenditure >3.0 times resting; ‘rapid translocation of the trunk’

5. The evidence: benefits & prevalence of PA in young children Rationale for the draft recommendations

6. What does the empirical Early Years evidence tell us ? Mostly observational studies Mostly in pre-school children More physical activity is better No clear evidence that it has to be of a particular intensity for benefits ‘Better’ for – Body fatness – Cardiovascular risk factors – Bone health – Movement skills – Social & emotional development – Later physical activity – Probably many other benefits

7. Rationale – how to recommend an amount; prevalence of PA currently Using objective measures, most studies report that – pre-school children typically spend between 3%- 5% of their waking day in MVPA, about 15-30 minutes /day. – Light intensity PA typically about 100-120 mins/day – Current average levels of physical activity (any activity, light plus MVPA)115-150 minutes/day Okely, 2009

8. Rationale – prevalence of sedentary behaviour & screen time Objective measures: pre-school children spend approx. 10-11 hrs/day in sedentary behaviour, TV ≈ 25% of this time Subjective measures: 2 to 3 hrs/day watching television or other screen Conclusion: apparently great scope for more physical activity during currently sedentary time Okely, 2009

9. The secret life of pre-school children Subjective measures suggest high levels of physical activity Expectations of high levels of PA: ‘Supercharged dynamos’ Rowland 1988 Objective measures suggest much lower levels of physical activity Objective truths revealed by objective methods-e.g. absence of socio-economic differences in PA

10. What young Scots children do all day Objectively measured physical activity (Reilly et al Lancet 2004)

11. Drafting & refining the draft recommendations What the Early Years evidence does and does not tell us

12. Recommendations by age categories and types of movement ? Australian guidelines decided on two developmental periods: infancy, toddler/pre- school: – No evidence yet to justify different scientific recommendations for toddlers vs. pre-schoolers, nor for separating structured and unstructured activity – Insufficient evidence to recommend intensities or types of movement UK early years expert panel have followed this

13. Draft Recommendations – additional issues Reasons for initially selecting three hours: – Upper end of ‘normal range’ has benefits – Account for likely PA decline into formal schooling and thereafter – Tracking of PA: children should start off more active – Consistency with other international physical activity guidance (NASPE; Australian Dept. Health & Ageing 2009/2010) Guidelines for practitioners to provide important information to facilitate implementation of the recommendations Research Gaps

14. Three ‘Headline’ Draft UK Recommendations, Dec. 2009 Infants: should be encouraged from birth to be physically active daily, particularly through floor- based play in safe environments Children capable of walking unaided: should be physically active daily for at least 3 hours Infants and children should be discouraged from being sedentary:no sedentary behaviour should last for more than 1 hour at a time (except sleep); this includes time spent ‘restrained’.

15. Early Years web consultation responses (82: lay; practitioners; academic; government; health service) Quantitative: ratings, 1-5 scale (strongly agree- strongly disagree) – Overwhelmingly positive – For 7/10 evidence summary statements 80/82 agreed or strongly agreed – For 3/10 statements 6/82 disagreed; (180 minutes/day; ‘light intensity or above’; 1h at a time sedentary) Qualitative – Overwhelmingly supportive – Greater clarity over 180 minutes and intensity (terminology) requested – Research gaps – Inclusions-who are the guidelines aimed at ? – Implementation of recommendations & stakeholders identified

16. Children & Young People 5-18 years From school entry

17. Background: What was available for children & young people UK Health Depts have had evidence based guidance for some time e.g. ‘Lets Make Scotland More Active’ 2003 Subsequent guidelines overseas US evidence-based guidelines for CYP – 2005 – 2009 Canadian evidence-based guidelines in preparation (Janssen, Tremblay)

18. Existing Scottish guidance for children & young people Children should accumulate (build up) at least one hour of moderate activity on most days of the week Let’s Make Scotland More Active 2003

19. Typical MVPA in UK children & adolescents (accelerometry) 20-25mins/day in 4-6 y olds in Glasgow – Reilly et al Lancet 2004 25-35 mins/day 9-10 year olds in Newcastle – McClure et al CCHD 2009 20-25 mins/day in 6-7 year olds in Gateshead – Basterfield et al Arch Dis Child 2008 25-35 minutes/day in 11 year olds in Bristol (ALSPAC) – Mattocks et al Arch Dis Child 2007; – Ness et al PLOS Med 2007

20. Recent trends:PA recommendations for children & young people Evidence base has been expanding Increasing evidence of benefits of vigorous intensity physical activity, though limited evidence on ‘dose response’ Increasing evidence of benefits beyond 60 mins/d MVPA Distinctions between MVPA and ‘incidental’ activities of daily living – 60 minutes daily does not include ‘pottering’

21. Draft ‘headline’ recommendations for children & young people 1 Should accumulate at least 60 mins/d, preferably more, MVPA on a daily basis As part of the recommended activity CYP should incorporate vigorous intensity activities on at least 3 days/week As part of the recommended activity CYP should include activities that strengthen muscle & bone, and promote flexibility on at least 3 days/week

22. Draft ‘headline’ recommendations for children & young people 2 Aerobic type activities should make up the majority of daily PA Recommended 60 minutes or more of MVPA is over and above light intensity routine activities associated with daily living Statements about inclusiveness and risks/safety

23. Consultation & feedback for CYP, Oct. 2009-Jan. 2010 Marlow meeting Oct. 2009- scientific and policy critique Web feedback Dec 09-Jan 2010; 85 responses Overwhelmingly positive and emphasis was on ‘messaging’, ‘translation’ Led to some rewriting, clarification, and combination of draft recommendations

24. Steps in the process: Early Years & Children and Young People Early draft reviewed and discussed by scientific and health experts October 2009 Marlow Web-based consultation from December 2009-Jan 2010 – Feedback from academics, practitioners, health; government, lay Stakeholder event –Early Years- February 2010 Formal response to & consideration of all the above feedback; rewrite draft recommendations as required; add explanatory ‘companion statements’ in response to feedback Editorial /Writing Group & Communications produce ‘final’ draft recommendations Invite Chief Medical Officer(s) to make recommendations

25. Any questions? Early Years Children & Young People – Questions/comments on the science ? – Questions/comments on the draft guidelines ?

26. Useful international web resources EARLY YEARS: ‘Get up and Grow’ 2009, Australian Department of Health and Ageing – www.health.gov.au/internet/main/publishing.nsf/Content/phd -gug-child-familybook CYP: Canadian guidelines in 2010 – Systematic reviews in press with International Journal of Behavioural Nutrition & Physical Activity CYP: US guidelines – www.cdc.gov/ncccdphp/dnpa/physical/health_professionals/ reports/index.htm