Loughborough University
`Institutional Repository
`
`Monitoring physical activity
`in children
`
`This item was submitted to Loughborough University's Institutional Repository
`by the/an author.
`
`Additional Information:
`
`• Doctoral Thesis. Submitted in partial fullment of the requirements for
`the award of Doctor of Philosophy of Loughborough University.
`
`Metadata Record: https://dspace.lboro.ac.uk/2134/7062
`Publisher: c(cid:13) Lorraine Cale
`
`Please cite the published version.
`
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`This item is held in Loughborough University’s Institutional Repository
`(https://dspace.lboro.ac.uk/) and was harvested from the British Library’s
`EThOS service (http://www.ethos.bl.uk/). It is made available under the
`following Creative Commons Licence conditions.
`
`
`
`
`
`
`
`
`
`For the full text of this licence, please go to:
`http://creativecommons.org/licenses/by-nc-nd/2.5/
`
`
`
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`Monitonng Physical Activity in Children
`
`by
`
`Lorraine Cale
`
`A Dissertation submitted in partial fulfilment of the requirements
`
`for the award of
`
`Doctor of Philosophy of the Loughborough University of Technology
`
`December, 1993
`
`c Lorraine Cale, 1993
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`ABSTRACT
`
`Two main research problems were addressed within this thesis. Firstly, the construction of a self-
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`report measure of physical activity (questionnaire) designed specifically for use with children and
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`secondly, the use of the measure to provide information on the activity levels of a sample of British
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`children.
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`Every effort was made in designing the self-report, to address as many of the problems associated
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`with the current measures as possible, and thereby to design an instrument which may improve
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`upon existing measures. The process involved a detailed review of the literature, implementation
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`of a number of recommendations from the literature, and a series of preliminary and pilot studies to
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`determine the content and feasibility of the questionnaire forms and the feasibility of the
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`administration procedures. Following the preliminary studies, the scoring procedure for the self-
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`report measure was developed and the final format of the questionnaire established. The final
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`version was an interviewer administered questionnaire comprising two forms, a school day and a
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`weekend form.
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`Once designed, the measure was evaluated. The evaluation of the questionnaire involved
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`studies of the validity and reliability of the measure as well as the reliability of interviewers trained to
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`administer the questionnaire. The results of these studies proved favourable throughout and it
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`was declared that the measure was a valid and reliable measure of physical activity. The use of the
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`self-report measure to gather the activity information on a sample of British children in part two of
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`the research was thus well justified.
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`Part two of the research involved the administration of the self-report measure to gather activity
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`information on a final sample of 199 pupils. The questionnaire was administered according to
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`the method and protocols established in part one of the study. The findings of the study
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`revealed the majority of the pupils to be inactive. Low activity levels were reflected in the pupils'
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`activity scores and in the amount of time they spent in hard/very hard activity in particular. It was
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`declared that the health of many pupils in this study may be at risk and if these findings reflect
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`the activity levels of British children generally, then we may expect there to be serious
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`consequences for the future health of our young population.
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`ACKNOWLEDGEMENTS
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`I would like to offer my sincere thanks to Len Almond for his continual support and
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`encouragement over the past three years. I would also like to thank Mike Waring, Sonia
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`McGeorge and Jimmy Kiristis for the endless hours they spent helping me to collect the data.
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`Finally, a special thank you must go to my husband Andy Cale, who gave me the confidence to
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`embark upon this research and who has never stopped believing in my ability to complete it.
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`PUBLICATIONS
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`Parts of this thesis have been reported in the following publications:
`
`Cale, L. (1991). Monitoring Physical activity in children. Proceedings of the Look After Your Heart.
`
`Beatin g Heart Disease in the 1990's International Conference. (pp. 161-165). London, England.
`
`Cale, L., & Almond, L. (1992). Physical activity levels of young children: a review of the evidence.
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`Health Education Journal. 51, (2): 94-99.
`
`Cale, L., & Almond, L. (1992). Physical activity levels of secondary-aged children: a review. Health
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`Education Journal, 51(4): 192-1 97.
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`Cale, L., & Almond, L. (1992). Children's activity levels: A Review of Studies conducted on British
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`Children. Ph ysical Education Review. 15(2): 111-118.
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`Cale, L., Waring, M., & Almond, L. (1992). The Problem of time perception in self report measures
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`of physical activity. Proceedings of the 6th Ichpher-European Congress. (Dp. 81-85). Prague,
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`Czechoslovakia.
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`Cale, L., Waring, M., & Almond, L. (1992). A review of children's physical activity levels.
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`Proceedings of the 6th lchpher-European Congress. (pp. 86-89). Prague, Czechoslovakia.
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`Cale, L., & Almond, L. (in press). Physical Activity Levels in Children-The Implications for Physical
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`Education. proceedings of the FIEP World Congress. Israel.
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`TABLE OF CONTENTS
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`Page Number
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`Chapter 1
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`Introduction
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`1 .1
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`1 .2
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`1 .3
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`1 .4
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`1 .5
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`The Importance of Physical Activity
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`Monitoring Physical Activity
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`Physical Activity Levels of Children
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`Summary of Research Aims
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`The Structure of the Thesis
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`PART ONE
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`Chapter 2
`
`Review of Literature
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`2.1
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`Introduction
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`Section 1
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`Monitoring Physical Activity
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`2.2
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`2.3
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`2.4
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`2.5
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`2.6
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`Monitoring Physical Activity
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`Physiological Measures
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`Heart Rate
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`Caloric Intake
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`The Direct Measurement of Energy Expenditure
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`Doubly Labelled Water Technique
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`Observational Measures
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`Mechanical Measures
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`Self-Report Measures
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`Diaries
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`Section 2
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`A Review of Self-Report Measures
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`Self completion and Interviewer conducted forms
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`2.7
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`2.8
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`2.9
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`Self-Report Measures
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`Reliability and Validity of Self-Report
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`Adult Physical Activity Self-Reports
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`1
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`1
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`5
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`8
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`10
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`10
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`12
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`12
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`12
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`12
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`13
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`13
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`15
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`16
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`17
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`18
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`19
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`22
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`23
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`24
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`26
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`26
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`27
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`29
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`The Health Insurance Plan Questionnaire
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`The Tecumseh Questionnaire
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`The British Civil Servants Questionnaire
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`The Paffenbarger Physical Activity Questionnaire
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`The Minnesota Leisure-Time PA Questionnaire
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`The Framingham Physical Activity Questionnaire
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`The 7-Day Recall Physical Activity Questionnaire
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`The Baecke Questionnaire
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`The Godin & Shephard Leisure-Time Exercise
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`Questkrnnaires
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`Summary
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`2.10 Scoring Procedures
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`2.11
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`Children's Physical Activity Self-Reports
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`Summary and Discussion of Children's Self-Report
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`Findings
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`2.12
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`Sources of Error in Children's Self-Report
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`2.13 Recommendations and New Directions from the Literature
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`for the Future Methodological Study of Children's Self-Report
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`Chapter 3
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`Designing the Self-Report Measure and Preliminary Studies
`
`3.1
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`3.2
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`3.3
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`3.4
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`Introduction
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`Designing the Self-Report Measure
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`Preliminary Studies
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`Study One
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`Method
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`Results
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`3.5
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`Time Perception Studies
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`Background
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`Method
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`3.6
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`Study Two-The Verbal Production Lunch time Study
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`29
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`30
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`31
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`32
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`33
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`35
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`35
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`37
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`38
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`39
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`40
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`43
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`56
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`61
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`66
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`77
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`77
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`77
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`83
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`84
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`84
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`85
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`86
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`86
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`87
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`87
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`Method
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`Results
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`Discussion
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`3.7
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`Study Three-The Verbal Estimation P.E. Lesson Study
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`Method
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`Results
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`Discussion
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`Implications
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`3.8
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`Study Four-Piloting the Self-Report Measure
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`Chapter 4
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`Designing the Interview Questionnaire
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`4.1
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`4.2
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`4.3
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`4.4
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`4.5
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`Introduction
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`Scoring Procedure
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`Limitations of Scoring Procedure
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`The Format of the Interview Questionnaire
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`Piloting the Interviewer administered forms
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`Interviewer Training
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`Chapter 5
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`Evaluating the Self-Report Measure
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`5.1
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`5.2
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`Introduction
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`Choice of Validation Methods
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`Heart Rate Monitoring
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`Observation
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`5.3
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`The Validation Study
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`Initial Preparations
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`Method
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`5.4
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`Treatment of the Data
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`Interview Questionnaire and Heart Rate
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`Interview Questionnaire and Observation
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`5.5
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`Results
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`Interview Questionnaire and Heart Rate
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`87
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`88
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`89
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`90
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`90
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`91
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`93
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`93
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`94
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`96
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`96
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`96
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`102
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`103
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`104
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`105
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`107
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`107
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`108
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`108
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`109
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`110
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`110
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`111
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`112
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`112
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`113
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`114
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`114
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`Interview Questionnaire and Observation
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`5.6
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`Discussion
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`Interview Questionnaire and Heart Rate
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`Interview Questionnaire and Observation
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`Summary of the Validation Study
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`5.7
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`The Reliability of the Interview Questionnaire
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`Method
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`Results
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`Discussion
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`5.8
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`5.9
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`Reliability of the Interviewers
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`The Measure of Inter Interviewer Reliability
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`Method
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`Results
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`5.10
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`The Measure of Intra-Interviewer Reliability/Test-Retest
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`Reabirity
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`Method
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`Results
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`5.11
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`Discussion of Interviewer Reliability Studies
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`5.12 Conclusions and Chapter Summary
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`PART TWO
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`Chapter 6
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`The Assessment of Children's Physical Activity Levels
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`6.1
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`6.2
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`6.3
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`6.4
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`6.5
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`6.6
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`6.7
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`6.8
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`Introduction
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`Review of Children's Physical Activity Levels
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`International Studies of Childrens Physical Activity Levels
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`British Studies of Children's Physical Activity Levels
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`Summary and Discussion of Findings of the Studies
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`Hypotheses
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`Sampling Procedure
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`Data Collection
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`114
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`114
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`114
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`119
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`122
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`122
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`122
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`123
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`123
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`126
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`126
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`126
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`126
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`127
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`127
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`128
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`128
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`130
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`133
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`133
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`133
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`134
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`145
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`152
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`156
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`156
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`157
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`Chapter 7
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`Results of the Assessment of Children's Activity Levels
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`7.1
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`7.2
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`7.3
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`7.4
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`7.5
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`7.6
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`7.7
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`7.8
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`7.9
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`Introduction
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`Treatment of the Data
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`Data Analysis
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`The Final Sample
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`Activity Scores
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`Hypothesis 1
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`Hypothesis 2
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`Time Spent in Moderate Activity
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`Time Spent in HardNery Hard Activity
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`Time Spent in Sleep, Very Light and Light Activity
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`Bouts of "Huff and Puff" Activity
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`7.10 Was the Activity Information Typical?
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`7.11
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`Summary of Results
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`Activity Scores
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`Time Spent in Moderate Activity
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`Time Spent in HardNery Hard Activity
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`Bouts of "Huff and Puff" Activity
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`Chapter 8
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`Discussion of the Results of the Assessment of Children's Activity
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`Levels
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`8.1
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`8.2
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`8.3
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`8.4
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`8.5
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`8.6
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`8.7
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`Introduction
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`Activity Scores
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`Time Spent in Moderate Activity
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`Time Spent in HardNery Hard Activity
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`Bouts of "Huff and Puff" Activity
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`Other Points for Discussion
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`Conclusions
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`Chapter 9
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`Summary, Implications and Recommendations
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`9.1
`
`Introduction
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`164
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`164
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`164
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`165
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`166
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`166
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`167
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`167
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`187
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`197
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`211
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`215
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`222
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`229
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`229
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`230
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`230
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`231
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`233
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`233
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`234
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`243
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`247
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`251
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`257
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`259
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`261
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`261
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`9.2
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`9.3
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`9.4
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`9.5
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`9.6
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`9.7
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`The Research Problems
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`Overview of the Research-Part One
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`Overview of the Research-Part Two
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`Implications of the Research-Part One
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`Implications of the Research-Part Two
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`Recommendations
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`Part One
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`Part Two
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`References
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`Appendices
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`APPENDIX A-Short pilot Questionnaire
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`APPENDIX B-Results of Time Perception Studies
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`APPENDIX C-Activity Codes, School and Atypical Day Codes
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`APPENDIX 0-Questionnaire-School day Form
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`APPENDIX E-Questionnaire-Weekend Form
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`APPENDIX F-Questionnaire Summary Sheets
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`APPENDIX G-Interviewers Protocol for School day Form
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`APPENDIX H-Interviewers Protocol for Weekend Form
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`APPENDIX I-Information for Interviewers
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`APPENDIX J-Letter for Parents re: Validation Study
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`APPENDIX K-Instructions for Parents for Removal of Sport Tester
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`APPENDIX L-Observation Record Sheet
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`APPENDIX M-Raw Data for the Evaluation Studies
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`APPENDIX N-Letter to Schools re: Activity Study
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`APPENDIX 0-Letter for Parents re: Activity Study
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`APPENDIX P-Summary of Activity Data for Schools
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`261
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`262
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`268
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`269
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`272
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`276
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`277
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`278
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`280
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`303
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`306
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`316
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`320
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`330
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`337
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`343
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`352
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`360
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`365
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`366
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`368
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`369
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`380
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`LIST OF FIGURES
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`FIGURE
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`Page Number
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`7.1
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`7.2
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`7.3
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`7.4
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`7.5
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`7.6
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`7.7
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`7.8
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`7.9
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`Activity Status of the Total Sample
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`Mean Activity Scores-Total, Boys and Girls
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`Activity Status of the Boys
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`Activity Status of the Girls
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`Activity Status of the Boys and Girls
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`Mean Activity Scores-Total, Year 7 and Year 9 Pupils
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`Activity Status of the Year 7 Pupils
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`Activity Status of the Year 9 Pupils
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`Activity Status of the Year 7 and Year 9 Pupils
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`7.10 Mean Activity Scores-Age and Sex
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`7.11 Activity Status of the Year 7 Boys
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`7.12 Activity Status of the Year9 Boys
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`7.13
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`Activity Status of the Year 7 Girls
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`7.14 Activity Status of the Year 9 Girls
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`7.15 Activity Status of the Sample by Age and Sex
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`7.16 Mean Activity Scores by School
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`7.17 Activity Status of the Sample by School
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`7.18 Proportions of Time Spent in Moderate Activity (Daily)
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`7.19 Average Daily Time Spent in Moderate Activity-Total, Boys and Girls
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`7.20 Proportions of Time Spent by Boys and Girls in Moderate Activity (Daily)
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`7.21
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`Average Daily Time Spent in Moderate Activity-Total, Year 7 and 9 Pupils
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`7.22 Proportions of Time Spent by Year 7 and 9 Pupils in Moderate Activity (Daily)
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`7.23 Average daily Time Spent in Moderate Activity-Age and Sex
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`7.24 Proportions of Time Spent by Age and Sex in Moderate Activity
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`7.25 Proportions of Time Spent in HardNery Hard Activity (Daily)
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`7.26 Average Daily Time Spent in Hard/very Hard Activity-Total, Boys and Girls
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`1 69
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`170
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`171
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`171
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`172
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`173
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`177
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`177
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`178
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`180
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`181
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`181
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`181
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`181
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`182
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`184
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`186
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`191
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`192
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`193
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`194
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`195
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`198
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`199
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`7.27 Proportions of Time Spent by Boys and Girls in HardNery Hard Activity (Daily)
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`7.28 Average Daily Time Spent in Hard/very Hard Activity-Total, Year 7 and 9 Pupils
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`205
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`206
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`7.29 Proportions of Time Spent by Yr 7 and 9 Pupils in Hard/Very Hard Activity (Daily) 207
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`7.30 Average Daily Time Spent in Hard/Very Hard ActMty-Age and Sex
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`7.31 Proportions of Time Spent by Age and Sex in Hard/Very Hard Activity
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`7.32 Percentage of Daily Time Spent in Different Activity Types
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`7.33 Average Daily Time Spent in Different Types of ActMty-Total, Boys and Girls
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`209
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`210
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`212
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`213
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`7.34 Average Daily Time Spent in Different Types of Activity-Total, Yr 7 and 9 Pupils 213
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`7.35 Average Daily Time Spent in Different Types of Activity-Age and Sex
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`7.36 Mean Number of Bouts of "Huff and Puff" Activity-Total Sample
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`214
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`216
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`7.37 Number of Bouts of "Huff and Puff" Activity engaged in by the Total Sample 216
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`7.38 Number of Bouts of "Huff and Puff" Activity Lasting> 10 Minutes-Total Sample 217
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`7.39 Number of Bouts of "Huff and Puff" Activity Lasting> 20 Minutes-Total Sample 217
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`7.40 Mean Number of Bouts of "Huff and Puff" Activity-Boys and Girls
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`219
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`7.41 Number of Bouts of "Huff and Puff" Activity engaged in by Boys and Girls 219
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`7.42 Number of Bouts of "Huff and Puff" Activity Lasting> 10 Minutes-Boys and Girls 220
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`7.43 Number of Bouts of "Huff and Puff" Activity Lasting> 20 Minutes-Boys and Girls 220
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`7.44 Mean Number of Bouts of "Huff and Puff" Activity-Year 7 and Year 9 Pupils
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`223
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`7.45 Number of Bouts of "Huff and Puff" Activity engaged in by Year 7 and 9 Pupils 223
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`7.46 Number of Bouts of "Huff and Puff" Activity Lasting> 10 Mins-Yr 7 and 9 Pupils 224
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`7.47 Number of Bouts of "Huff and Puff" Activity Lasting > 20 Mins-Yr 7 and 9 Pupils 224
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`7.48 Mean Number of Bouts of "Huff and Puff" Activity-Age and Sex
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`225
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`7.49 Number of Bouts of "Huff and Puff" Activity engaged in by Yr 7 and 9 Boys and
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`Yr7and9rIs 225
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`7.50 Number of Bouts of "Huff and Puff" Activity Lasting> 10 Minutes-Age and Sex 226
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`7.51
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`Number of Bouts of "Huff and Puff" Activity Lasting > 20 Minutes-Age and Sex 226
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`7.52 Reasons Given by Pupils to Explain Why Days were NOT TYPICAL
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`228
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`LIST OF TABLES
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`TABLE
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`Page Number
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`The Health Benefits of Physical Activity
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`Characteristics, Reliability and Validity of
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`Self-Report Measures of Physical Activity for Children
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`A Summary of the Proposed Characteristics of the Self-Report
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`Summary of Verbal Production Results for Year 7 and Year 9 Pupils
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`Summary of Verbal Production Results for Year 7 Pupils
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`Summary of Verbal Production Results for Year 9 Pupils
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`Summary of Verbal Estimation Results for Year 7 and Year 9 Pupils
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`Summary of Verbal Estimation Results for Year 7 Pupils
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`Summary of Verbal Estimation Results for Year 9 Pupils
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`The Intensity Categories of Selected Activities
`
`Making the Energy Cost Calculations
`
`Correlation Matrix Illustrating the Inter Interviewer Reliability
`
`A Summary of the Major Findings of the International Studies
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`A Summary of the Major Findings of the British Studies
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`Definitions of "Appropriate" Physical Activity
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`t test for Independent Samples (Boys, Girls)
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`Activity Status of Boys and Girls in Relation to the Total Sample
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`Summary of Activity Status of Boys and Girls in Relation to the Total Sample
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`t test for Independent Samples (Year 7, Year 9)
`
`Activity Status of Year 7 and 9 Pupils in Relation to the Total Sample
`
`3
`
`71
`
`83
`
`89
`
`89
`
`89
`
`92
`
`92
`
`92
`
`98
`
`99
`
`127
`
`159
`
`1 61
`
`1 63
`
`168
`
`1 74
`
`174
`
`175
`
`176
`
`Summary of Activity Status of Year 7 and 9 Pupils in Relation to the Total Sample 176
`
`1.1
`
`2.1
`
`3.1
`
`3.2
`
`3.3
`
`3.4
`
`3.5
`
`3.6
`
`3.7
`
`4.1
`
`4.2
`
`5.1
`
`6.1
`
`6.2
`
`6.3
`
`7.1
`
`7.2
`
`7.3
`
`7.4
`
`7.5
`
`7.6
`
`7.7
`
`7.8
`
`7.9
`
`Activity Status of the Sample by Age and Sex
`
`Summary of Activity Status of the Sample by Age and Sex
`
`The Mean, Minimum and Maximum Activity Scores for each School
`
`7.1 Oa Activity Status of the Sample by Schools (%)
`
`1 79
`
`179
`
`183
`
`185
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`7.lOb Activity Status of the Sample by Schools (Number)
`
`7.11
`
`ttest for Paired Samples
`
`7.12 Mean Time Spent in Moderate Activity-Boys and Girls
`
`7.13 Mean Time Spent in Moderate Activity-Year 7 and 9 Pupils
`
`7.14 Mean Time Spent in Moderate Activity-Age and Sex
`
`7.15 Mean Time Spent in Hard/Very Hard Activity-Boys and Girls
`
`7.16 Mean Time Spent in HardNery Hard Activity-Year 7 and 9 Pupils
`
`7.17 Mean Time Spent in HardNery Hard Activity-Age and Sex
`
`7.18 Mean Number of Bouts of "Huff and Puff" Activity-Boys and Girls
`
`7.19 Mean Number of Bouts of "Huff and Puff" Activity-Year 7 and 9 Pupils
`
`7.20 Mean Number of Bouts of "Huff and Puff" Activity-Age and Sex
`
`7.21
`
`Reasons given by Pupils to explain why the day was NOT TYPICAL
`
`185
`
`188
`
`190
`
`196
`
`197
`
`202
`
`202
`
`208
`
`218
`
`221
`
`222
`
`227
`
`Please note that although this thesis has referred to
`British children throughout, the studies outlined were
`in fact conducted on English children only. The results
`may, therefore, be representative of English children
`only.
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`CHAPTER 1
`
`INTRODUCTION
`
`1.1 The Importance of Physical Activity
`
`Evidence highlighting the importance of physical activity to health is now stronger than ever and
`
`the benefits of physical activity to health are an increasing source of public interest (Royal
`
`College of Physicians, 1991). Major organisations including The Royal College of Physicians,
`
`The British Heart Foundation, The American Heart Association and The Centre for Disease
`
`Control in Atlanta have made particularly strong pronouncements on the benefits of physical
`
`activity and the ill effects of physical inactivity on cardiovascular health. Perhaps the strongest
`
`yet have been made by The British Heart Foundation and The American Heart Association. A
`
`report by the British Heart Foundation Working Group (Hardman, 1991), has acknowledged how
`
`'The relative risk of physical inactivity may be greater than commonly accepted and may
`
`approach that attributable to smoking, hypertension and hypercholesterolaemia." Indeed, the
`
`report declares how "Physical activity is seldom regarded as an important risk factor for coronary
`
`heart disease". ..but how "there is now sufficient research evidence to suggest that this view
`
`should be reconsidered..." The American Heart Association (AHA), however, after reviewing
`
`the evidence, go beyond this. They recently declared inactivity as a risk factor for coronary
`
`artery disease, along with smoking, high blood pressure and high blood cholesterol levels. In a
`
`position statement made in 1992, the AHA stated:
`
`'There is a relation between physical inactivity and cardiovascular mortality and inactivity
`
`is a major risk factor for the development of coronary heart disease."
`
`Such conclusions have been drawn following substantial evidence from over 40 studies which
`
`have been conducted over some 40 years of research.
`
`Studies conducted with adults have shown a relationship between regular participation in
`
`physical activity and increased longevity (Paffenbarger, Hyde, Wing & Hsieh, 1986; Blair, Clark,
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`Cureton & Powell, 1989) and decreased risk of coronary heart disease (Paffenbarger & Hyde,
`
`1984; Powell, Thompson, Caspersen & Kendrick, 1987). According to Powell et al., (1987),
`
`physically inactive people have almost twice the risk of developing coronary heart disease than
`
`those who engage in regular physical activity. Pekkanen et al., (1987) report how physical
`
`activity has been shown to increase life expectancy by more than 2 years over the population
`
`average. Regular physical activity can also help to prevent and manage a number of other
`
`medical conditions including non insulin-dependent diabetes metlitus and osteoporosis
`
`(Siscovick, LaPorte & Newman, 1985), and has been associated with lower rates of stroke
`
`(Salonen, Puska & Tuomilehto, 1982). Beyond the effects on mortality, several studies have
`
`reported that regular physical activity is associated with improved lipid profiles (Wood et al.,
`
`1983; Haskell, 1984), reduced levels of diastolic blood pressure (Montoye, Metzer & Keller,
`
`1972; Hagberg ,1988; Reaven, Barrett-Connor & Edelstein, 1991), obesity (Leon, Conrad,
`
`Hunninghake & Serfrass,1979; Thompson et al., 1982) and back pain (Frymoyer, 1988).
`
`Physical activity can furthermore improve musculoskeletal strength and flexibility and weight
`
`bearing activity is thought to be useful in the prevention and treatment of osteoporosis (Aloia,
`
`Cohn, Ostuni, Cane, & Ellis, 1978; Aloia, 1981). In addition, physical activity has been shown to
`
`have a number of psychological benefits. An extensive literature has developed which links
`
`exercise with affective/emotional changes such as reductions in anxiety, tension and
`
`depression and increases in feelings of well-being, mood and improved self-concept (Folkins &
`
`Sime, 1981; Dishman, 1986; Morgan & Goldstein, 1987; Martinsen, 1990; Petruzzello,
`
`Landers, Hartfield, Kubitz & Salazar, 1991). The major health benefits of physical activity are
`
`summarised in table 1.1. The Allied Dunbar National Fitness Survey report (1992) also includes
`
`a good summary of the health benefits conferred by an active lifestyle.
`
`Despite intense interest in and knowledge about adult physical activity, surprisingly little is
`
`known about children's participation in physical activity or the relationship between children's
`
`physical activity and health (Simons-Morton, O'Hara, Simons-Morton & Parcel, 1987). Sopko,
`
`Obarzanek & Stone (1992) claim that studies in youth have been limited and not sufficiently
`
`extensive to produce conclusive results. However, a number of researchers do acknowledge
`
`2
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`Table 1.1 Health Benefits of Physical Activity
`
`Physical Activity can:
`
`1) Increase Longevity
`
`2) Decrease the risk of Coronary Heart Disease
`3) Prevent and/or help in the management of non insulin-dependent diabetes mellitus.
`4) Prevent and/or help in the management of osteoporosis.
`
`5) Decrease rates of stroke
`6) improve lipid profiles.
`7) Reduce levels of diastolic blood pressure.
`
`8) Reduce levels of obesity
`
`9) Reduce back pain
`
`10) Prevent or be useful in the treatment of osteoporosis
`
`11) Reduce anxiety/tension
`
`12) Reduce depression
`
`13) Increase feelings of well-being
`
`14j Improve self-concept
`
`that physical activity has many physiological and possibly psychological effects that influence
`
`the health of children (Gilliam & MacConnie, 1984; Montoye, 1985; Pate & Blair, 1978;
`
`Shephard, 1984; Rowland, 1990). Regular physical activity has been shown to improve
`
`cardiovascular and other components of health-related fitness in children (Bar-Or, 1983) and
`
`there are an increasing number of studies which indicate that there is an inverse relationship
`
`between physical activity in children and coronary heart disease risk factors such as blood
`
`pressure (Fraser, Philips & Harris, 1983; Fripp et al., 1985, Strazullo et al., 1988) serum
`
`lipoproteins (Durant, Linder & Mahoney, 1983; Gilliam & Burke, 1978; Thorland & GlIliam, 1981)
`
`and obesity (Clark & Blair, 1988; Walberg & Ward, 1985). Indeed, the recognised associations
`
`between physical activity and such risk factors appear to be similar in both adults and children
`
`(Sallis, Patterson, Buono & Nader, 1988).
`
`These associations are considered to be particularly important in children because coronary
`
`heart disease (CHD) is known to have its origins in childhood (Lauer, Conner, Leaverton, Reiter
`
`& Clarke 1975; Newman et al., 1986) and because CHD nsk factors track overtime (Freedman,
`
`3
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`Shear, Shrinivasan, Webber & Berenson, 1985; Lauer, Lee & Clarke, 1989). The results of
`
`research support the notion that children display the same health risk factors and profiles as
`
`adults and that such factors appear to be relatively stable into early adulthood (Armstrong, 1992;
`
`Despres, Bouchard & Malina, 1990; Gilliam & MacConnie, 1984; Montoye, 1986). The
`
`Bogalusa heart study revealed how many children already possessed one or more of the clinical
`
`risk factors associated with heart disease: hypertension, obesity, or adverse lipoprotein
`
`changes (Berenson, 1986).
`
`Furthermore, physical activity during childhood is not only of such interest because of its
`
`concurrent relationships with risk factors, but also because of its possible influence on future
`
`adult participation in physical activity (Simons-Morton et al., 1990). Active children will develop
`
`skills, enjoyment and habits that will increase the likelihood that they will be active as adults (Blair
`
`et al., 1989; Ross & Gilbert, 1985; Simons-Morton et al., 1987; Simons-Morton, Parcel, O'Hara,
`
`Blair & Pate, 1988). Two major reports recently published in Britain, The Health of the Nation
`
`(1992) and the Allied Dunbar National Fitness Survey (1992) also strongly support this view and
`
`emphasise the need to establish active lifestyles at a young age. The Health of the Nation
`
`Document points out that "the maintenance of healthy lifestyles such as balanced diet and
`
`exercise in adulthood is more likely it established during childhood." The Allied Dunbar National
`
`Fitness Survey results showed that adult participation in physical activity in later years was
`
`strongly associated with behaviour at an earlier age. Twenty five percent of those who said they
`
`were very active aged 14-19 were very active now, compared with only 2% active now who were
`
`totally inactive at that early age. As a consequence of these findings, the survey report declares
`
`that "the exercise habit needs to start early, preferably in childhood as there is much more
`
`chance that people will continue or resume exercise in later years."
`
`4
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`1.2 MonitorIng PhysIcal Activity
`
`The measurement of physical activity in children has become an important field of interest and
`
`challenging enterprise because of its influence on health and accurate measurement is
`
`required to adequately document health consequences (Sallis, Buono, Roby, Micale & Nelson,
`
`1993). However, historically, methodological problems have impeded research in physical
`
`activity epidemiology (Caspersen, 1987; LaPorte, Montoye & Caspersen, 1985). Physical
`
`activity is so complex a life element that its measurement and assessment tend to be as highly
`
`complicated and difficult as they are important (Paffenbarger, Blair, Lee & Hyde 1993). Its
`
`measurement is hampered considerably by the current state of measurement techniques and
`
`problems with definition, reliability and validity are widespread in existing measures (Williams,
`
`Klesges, Hanson & Eck, 1989). According to Saris (1986) obtaining activity information from
`
`children is even more difficult than it is for adults.
`
`Methods of assessing physical activity in adult and child populations have included
`
`physiological, mechanical, observational and self-report measures (Blair, 1984; Klesges &
`
`Klesges 1987; LaPorte et aL, 1985; Montoye & Taylor, 1984; Saris, 1985; Wilson,
`
`Paffenbarger, Moms & Haviik, 1986). All reviewers have concluded that there is a need to
`
`improve the assessment of physical activity, particularly among children. In epidemiological
`
`studies of physical activity, sell-report is the recommended method of assessment (Saris, 1985;
`
`Washburn & Montoye, 1986; Wilson et al., 1986) and will therefore be the concern in this
`
`research. Many researchers however, have expressed concerns about the accuracy of such
`
`measures (Baranowski, 1985; Bernard, Killworth, Kronenfeld & Sailer, 1984; McGowan, Bulik,
`
`Epstein, Kupter & Robertson, 1984; Powell et aL, 1987).
`
`Two major constraints on the accuracy of self-report are identified as the definition of the
`
`desired variables and the human cognitive processes (Baranowski, 1988). In terms of the
`
`problems with definition, Haskell (1985) states that the physical activity stimulus to achieve
`
`health related outcomes has not been clearly established. A main concern in studying and
`
`measuring activity levels has been to try to establish whether or not children are in tact doing
`
`5
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`sufficient exercise of an appropriate intensity to optimise their functional capacity and to attain
`
`health benefits. However, the exact nature, duration and intensity of activity required to
`
`produce health benefits is open to debate, especially for children. It is not known for example,
`
`what kind and how much physical activity will most clear'y prevent cardiovascular disease, or
`
`promote health. Paffenbarger et al., (1993) acknowledge how the health issues of appropriate
`
`physical activity are still being explored and debated by clinicians, physiologists, dieticians,
`
`exercise scientists, orthopaedists, epidemiologists and others. In 1988 the American College
`
`of Sports Medicine (A.C.S.M.) published an opinion statement on Physical Fitness in Children
`
`and Youth which acknowledged this problem and gave the following guidance:
`
`"The amount of exercise required for optimal functional capacity and health at various
`
`ages has not been precisely defined. Until more definitive evidence is available,
`
`current recommendations are that children and youth obtain 20-30 minutes of vigorous
`
`exercise each day."
`
`adapted from the A.C.S.M. Opinion Statement on Physical
`Fitness in Children and Youth, 1988.
`
`Simons-Morton et al., (1988), in a review of the published physical activity recommendations for
`
`children, concluded that appropriate physical activity for children should entail large muscle
`
`groups moving dynamically for periods of 20 minutes or longer, three or more limes a week, at
`
`an intensity that elicits heart rates equal to or in excess of 140 beats per minute. This
`
`recommendation is in keeping with the amount of physical activity suggested by Morris et al.,
`
`(1973) as being associated with a low incidence of coronary heart disease in adults. Armstrong
`
`& Bray (1991) have more recently questioned the applicability of such definitions of appropriate
`
`activity to children however, recognising that sustained periods of physical activity for such
`
`lengths of time are not features of children's habitual physical activity. In contrast, other
`
`researchers claim that it is the energy expenditure associated with physical activity which is
`
`important because it may reduce health risks, improve physical fitness, optimise growth and
`
`encourage future participation in physical activity (Bar-Or, 1983; Gilliam & MacConnie, 1984;
`
`Stiephard, 1984; Saris, 1985).
`
`6
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`The second major