Woodland Health for Youth (WHY): an evaluation of physical health benefits derived from outdoor learning in natural environments (LINE) for school-age children Picture courtesy of SS2N 1 Plymouth University Jennie Aronsson Maria Tighe Sue Waite

Today’s presentation Jennie Aronsson Alumni clinical-researcher, School of Nursing and Midwifery Institute of Education Naomi Wright, Freelance Researcher Woodland Health for Youth (WHY) - a multi-agency cross-disciplinary project Well-being and physical activity in Ham Woods – extended research project exploring children’s experiences of outdoor learning 2

Being a child in Plymouth… The health and well-being of children in Plymouth is generally worse than the England average. Deprivation in Plymouth is 26.2% - significantly higher than the England average and about 10,200 children under 16 live in poverty. Obesity prevalence is strongly correlated with deprivation. 3

Prevalence of overweight among children National Child Measurement Programme 2011/12 4 Child overweight (including obesity)/ excess weight: BMI ≥ 85 th centile of the UK90 growth reference One in five children in Reception is overweight or obese (boys 23.5%, girls 21.6%) One in three children in Year 6 is overweight or obese (boys 35.4%, girls 32.4%)

Health and greenspace Children who live close to green spaces have higher levels of physical activity and are less likely to experience an increase in BMI over time. Children in poverty are nine times less likely to have access to green space, places to play and to live in environments with better air quality Growing medical evidence shows that access to the natural environment improves child development, health and wellbeing, prevents disease and helps people recover from illness. 5

WHY – Woodland Health For Youth Small-scale research project aiming to improve children’s physical activity and utilisation of natural greenspace Action research methodology examines the relationship between children’s outdoor learning, levels of physical activity, healthy weight and use of greenspace. 6

Partnership projects Learning from and capitalising upon earlier and linked projects: Natural Connections Demonstration Project LINE (Learning In Natural Environments) connections Stepping Stones to Nature Good from Woods 7

Education, Health and Greenspace Public Health & NCMP School Nursing, LINE, SS2N Healthy Schools (LINE) Outdoor Learning Physical Activity Children Learning LTCs -Obesity Multi-agency cross-disciplinary partnership 8

Research aims Evaluate the physical health benefits of LINE In order to: – Identify barriers to outdoor health promotion in greenspace – Create healthier school environments – Improve parental and child involvement in healthy weight management strategies 9

Research elements Audit of school grounds and local woodland with SS2N 1 Natural connections school; year 2 class (age 6-7) 10 children selected: gender & attainment mix National Child Measurement Programme data from Reception Interim measurement Accelerometer data of moderate to vigorous physical activity Observational/reflective fieldnotes Feedback to partners, parents and school

Key accelerometry findings Higher MVPA during outdoor lessons than indoor ( especially boys 20.6% ± 6.5 SD in MVPA compared to 14.7% ± 7.1 SD for girls, p=0.009 ) Higher MVPA in woodland compared to school grounds ( 19.0% ± 7.2 SD in woodland LINE, 13.7% ± 4.8 SD in school ground LINE, p=0.001 ) Highest MVPA at break time & lunchtime ( 33.2% ) - but big individual differences between children ( ± 17.3 SD ) Outdoor curricular activities may offer more equal way of increasing overall physical activity levels

Comparison between BMI in Reception year and year 2 Child noBMI classification (Reception) BMI classification (year 2) BMI lower or higher 1Healthy weight Lower 2Healthy weight Lower 3Healthy weight Lower 4Healthy weight Lower 5Healthy weight Same 6Healthy weight Higher 7Healthy weightOverweightHigher 8OverweightHealthy weightLower 9Overweight Lower 10Not measuredHealthy weightUnable to compare

Identifying barriers to outdoor health promotion in greenspace Accessibility - vastly improved by SS2N through capital works Socioeconomic barriers - offer all children regardless of background LINE as part of the curriculum Risk-averse culture in the UK - children influencing the attitudes and behaviour of their parents Frequency of childhood visits predicts frequency of adult visits to woodlands and green places 13

Creating healthier school environments Range of different activities developing a multitude of skills Happy active children: 'This is fun!’ (girl looking for insects on a tree) 'I love nature' (boy in the woodland) 'I can feel the sun in my face and the fresh air' (girl in the woodland) 'I feel tired now from all that running around' (boy on way back from woodland) 14

Creating healthier school environments (cont’d) Green school grounds promote physical activity However; children were more active in the woodlands than in the school ground Woodland LINE offers greater freedom, wilder and more natural space, child-led learning, negotiated boundaries, created activities and managed risk 15

Improving parental and child involvement in healthy weight management strategies Parents are invited to one LINE session/term to participate and provide feedback Children’s feedback at the end of LINE session informs future lesson planning Well-being and physical activity in Ham Woods - extended research project that will further explore children's, parents'/carers' and staff/volunteers' views and experiences of woodland LINE. 16

Well-being and physical activity in Ham Woods 17

Interviews and games 18

Observations 19

‘The health and well-being of today’s children depend on us having the courage and imagination to rise to the challenge of doing things differently, to put sustainability and well-being before economic growth and bring about a more equal and fair society.’ Professor Sir Michael Marmot (2010): The Marmot Review Thank you! 20