1 Recommendations

This is NICE's formal guidance on physical activity, active play and sport for pre-school and school-age children and young people in family, pre-school, school and community settings. When writing the recommendations, the PDG (see appendix A) considered the evidence of effectiveness (including cost effectiveness), fieldwork data and comments from stakeholders and experts. Full details are available online.

The evidence statements underpinning the recommendations are listed in appendix C.

A brief description of the definitions used is given below, immediately before the list of recommendations.

The evidence reviews, supporting evidence statements and economic analysis are available online.

Definitions

Physical activity is 'any force exerted by skeletal muscle that results in energy expenditure above resting level' (Caspersen et al. 1985).

The recommendations refer to opportunities for moderate to vigorous-intensity physical activity. Children and young people should undertake a range of activities at this level for at least 60 minutes over the course of a day. At least twice a week this should include weight-bearing activities that produce high physical stresses to improve bone health, muscle strength and flexibility. This amount of physical activity can be achieved in a number of short, 10-minute (minimum) bouts.

Moderate-intensity activity increases breathing and heart rates to a level where the pulse can be felt and the person feels warmer. It might make someone sweat on a hot or humid day (or when indoors). Vigorous activity results in being out of breath or sweating.

Opportunities for moderate to vigorous physical activity include everything from competitive sport and formal exercise to active play and other physically demanding activities (such as dancing, swimming or skateboarding). They also include some of the actions that can be involved in daily life (such as walking, cycling or using other modes of travel involving physical activity).

Groupings, themes and links

The recommendations are grouped as follows:

  • national policy

  • high level policy and strategy

  • local strategic planning

  • local organisations: planning, delivery and training

  • local practitioners: delivery.

There are a number of key themes:

  • Promoting the benefits of physical activity and encouraging participation (recommendations 1 and 15)

  • Ensuring high-level strategic policy planning for children and young people supports the physical activity agenda (recommendation 2)

  • Consultation with, and the active involvement of, children and young people (recommendations 3, 6,11 and 14)

  • The planning and provision of spaces, facilities and opportunities (recommendations 2, 4, 9, 10 and 13)

  • The need for a skilled workforce (recommendations 7 and 8)

  • Promoting physically active and sustainable travel (recommendations 5 and 12)

The diagram below shows the structure of, and the links between, the 15 recommendations.

How the recommendations link together

Who should take action

The recommendations are aimed at the following organisations and groups although each organisation and group should be aware of all the recommendations and the links between them:

  • Children's trusts and services: 2, 4, 6, 7, 10, 13

  • Community and voluntary groups (such as those running sports and other organised activities): 3, 6 to 11, 13 to 15

  • Early years providers: 4, 10, 12, 13, 15

  • Government departments: 1

  • Local authorities (leisure and related services): 2 to 4, 6 to 15

  • Local authorities (transport and planning, regeneration): 2 to 5, 12

  • Local strategic partnerships: 2, 3

  • Organisations offering practitioners education and training: 7, 8

  • Parents, families and carers: 13, 15

  • Police: 4, 5

  • Primary care trusts: 2 to 4, 6, 9, 15

  • Private sector providers: 4, 6 to 11, 13 to 15

  • Schools and colleges: 4 to 7, 9 to 15.

All the organisations, groups and people listed under 'Who should take action?' in each recommendation are equally responsible for ensuring the recommendation is put into practice.

The recommendations

National policy

Recommendation 1 National campaign

Who is the target population?

  • Children and young people aged 18 and under, their families and carers.

  • Planners and providers of services and facilities.

Who should take action?

  • Department of Health, Department for Children, Schools and Families and Department for Culture, Media and Sport working with:

    • Department for Business, Enterprise and Regulatory Reform

    • Department for Communities and Local Government

    • Department for Energy and Climate Change

    • Department for Environment, Food and Rural Affairs

    • Department for Innovation, Universities & Skills

    • Department for Transport

    • Cabinet Office

    • Home Office

    • Ministry of Justice.

What action should they take?

  • Deliver a long-term (minimum 5 years) national campaign to promote physical activity among children and young people. The campaign should be integrated with and support other national health campaigns and strategies to increase participation in play and sport and reduce obesity (such as 'Change4Life').

  • Use research, consult and actively involve children and young people and their parents to determine the best media to use, the most effective messages and the most appropriate language for different groups. (Examples of different groups that could be covered include families, parents and carers, and children of different ages, ethnicity and who have different levels of physical ability.)

  • Ensure the campaign is consistent and sustained. It should convey that physical activity:

    • is healthy, fun and enjoyable, makes you feel good and can be sociable (that is, it can be undertaken with existing friends or can help develop new ones)

    • promotes children and young people's independence

    • helps develop children's movement skills

    • can involve a wide variety of formal and informal activities such as play, dance, swimming, the gym, sport (including street sport and games) and physically active travel (such as walking, cycling and wheelchair travel)

    • can (and should) become a regular part of daily life and that small lifestyle changes can be worthwhile (for example, active travel to school, the shops or the park, using the stairs and ramps instead of lifts and helping with housework)

    • can be maintained by trying new and challenging activities to keep children and young people interested and motivated

    • is something that adults, especially parents and carers, should incorporate into their lives to set an example.

  • Ensure the campaign addresses any concerns that parents and carers may have about their children's safety.

  • Encourage regional and local campaigns to use the same messages, as well as promoting examples of local opportunities to be physically active.

  • Develop resources for regional and local dissemination of the campaign (for example, promotional materials and support for those delivering it). (For more on training see recommendation 8.)

  • Use process, impact and outcome measures to ensure national, regional and local campaigns are delivered effectively. For recommendations on the principles of evaluation, see Behaviour change at population, community and individual level (NICE public health guidance 6).

High level policy and strategy

Recommendation 2 Raising awareness of the importance of physical activity

Who is the target population?

Children and young people aged 18 and under, their families and carers.

Who should take action?

  • Chairs of local strategic partnerships.

  • Directors of children's services.

  • Directors of public health.

What action should they take?

  • Ensure the following explicitly address the need for children and young people to be physically active:

    • children and young people's plans

    • joint strategic needs assessments

    • local development and planning frameworks

    • sustainable community plans and strategies.

  • Ensure there is a coordinated local strategy to increase physical activity among children and young people, their families and carers.

  • The strategy should ensure:

    • there are local indoor and outdoor opportunities for physical activity where children and young people feel safe

    • individuals responsible for increasing physical activity are aware of national and local government strategies as well as local plans for increasing physical activity

    • partnership working is developed and supported within local physical activity networks

    • physical activity partnerships establish and deliver multi-component interventions involving schools, families and communities. (Partners may include: schools, colleges, out-of-school[1] services, children's centres and play services, youth services, further education institutions, community clubs and groups and private sector providers)

    • local factors that help children and young people to be (or which prevent them from being) physically active are identified and acted upon

    • local transport and school travel plans are coordinated so that all local journeys can be carried out using a physically active mode of travel.

  • Ensure physical activity initiatives aimed at children and young people are regularly evaluated. Evaluations should measure uptake among different groups (for example, among those with disabilities or from different ethnic backgrounds). Any changes in physical activity, physical skills and health outcomes should be recorded. In addition, progress towards local area agreement targets should be monitored.

  • Identify a senior council member to be a champion for children and young people's physical activity. They should:

    • promote the importance of encouraging physical activity as part of all council portfolios

    • ensure physical activity is a key priority when developing local authority programmes and targets

    • promote partnership working with council member leads of relevant departments (for example, transport, leisure and health)

    • explain to the public the local authority's role in promoting physical activity.

Local strategic planning

Recommendation 3 Developing physical activity plans

Who is the target population?

Children and young people aged 18 and under, their families and carers.

Who should take action?

  • All local authority departments and other local strategic partnership agencies responsible for physical activity facilities and services for children and young people.

  • Policy makers and planners working in the public, voluntary, community and private sectors.

What action should they take?

  • Identify groups of local children and young people who are unlikely to participate in at least 1 hour of moderate to vigorous physical activity a day. Work with Public Health England Centres, schools and established community partnerships and voluntary organisations to achieve this.

  • Involve these children and young people in the design, planning and delivery of physical activity opportunities, using the information gathered.

  • Consult with different groups of children and young people and their families on a regular basis to understand the factors that help or prevent them from being physically active. Pay particular attention to those who are likely to be less physically active. Ensure children and young people from different socioeconomic and minority ethnic groups are actively involved in the provision of activities. Also ensure those with a disability (or who are living with a family member who has a disability) are actively involved.

  • Use the information gathered to increase opportunities for children and young people to be physically active and to plan dedicated programmes that tackle any inequalities in provision.

For further recommendations on community engagement, see the NICE guideline on community engagement: improving health and wellbeing and reducing health inequalities.

Recommendation 4 Planning the provision of spaces and facilities

Who is the target population?

Children and young people aged 18 and under, their families and carers.

Who should take action?

The following should take action in partnership with, or as part of, the local strategic partnership:

  • Directors of children's services.

  • Directors of leisure and cultural services.

  • Directors of planning and regeneration.

  • Governors and heads of schools and colleges, office managers and other decision-makers involved with buildings and outdoor spaces within the public, voluntary, community and private sectors.

  • Planning and regeneration service managers and project managers and those involved in developing the 'Unitary development plan' (UDP) or other strategic planning documents.

  • Representatives from crime and disorder reduction partnerships.

What action should they take?

  • Ensure physical activity facilities are suitable for children and young people with different needs and their families, particularly those from lower socioeconomic groups, those from minority ethnic groups with specific cultural requirements and those who have a disability.

  • Provide children and young people with places and facilities (both indoors and outdoors) where they feel safe taking part in physical activities. These could be provided by the public, voluntary, community and private sectors (for example, in schools, youth clubs, local business premises and private leisure facilities). Local authorities should coordinate the availability of facilities, where appropriate. They should also ensure all groups have access to these facilities, including those with disabilities.

  • Make school facilities available to children and young people before, during and after the school day, at weekends and during school holidays. These facilities should also be available to public, voluntary, community and private sector groups and organisations offering physical activity programmes and opportunities for physically active play.

  • Actively promote public parks and facilities as well as more non-traditional spaces (for example, car parks outside working hours) as places where children and young people can be physically active.

  • Town planners should make provision for children, young people and their families to be physically active in an urban setting. They should ensure open spaces and outdoor facilities encourage physical activity (including activities which are appealing to children and young people, for example, in-line skating). They should also ensure physical activity facilities are located close to walking and cycling routes.

  • Ensure the spaces and facilities used for physical activity meet recommended safety standards for design, installation and maintenance. For example, outdoor play areas should have areas of shade from the sun and sheltered areas where children can play to reduce the impact of adverse weather.

  • Assess all proposals for signs restricting physical activity in public spaces and facilities (such as those banning ball games) to judge the effect on physical activity levels.

For further recommendations on the environment, see the NICE guidance on physical activity and the environment.

Recommendation 5 Local transport plans

Who is the target population?

Children and young people aged 18 and under, their families and carers.

Who should take action?

  • Governors and heads of schools and colleges.

  • Local transport authorities and executives.

  • Police casualty reduction officers.

  • Road safety officers.

  • School travel advisers.

  • Transport planners.

What action should they take?

  • Ensure local transport and school travel plans continue to be fully aligned with other local authority plans which may impact on children and young people's physical activity. This includes local area agreements, local area play strategies and healthy school plans. Liaise with the local strategic partnership to achieve this.

  • Ensure local transport plans continue to be developed in conjunction with local authority departments and other agencies that provide spaces and facilities for children and young people to be physically active.

  • Ensure local transport plans acknowledge any potential impact on opportunities for children and young people to be physically active. Transport plans should aim to increase the number of children and young people who regularly walk, cycle and use other modes of physically active travel. They should make provision for the additional needs of, or support required by, children, young people and their parents or carers with a disability or impaired mobility. For recommendations on local transport plans, see the NICE guidance on physical activity and the environment.

  • Continue working with schools to develop, implement and promote school travel plans (see recommendation 12). This may, for example, include: mapping safe routes to school; organising walk and bike to school days and walking buses; organising cycle and road safety training; and helping children to be 'streetwise'.

  • Organise training courses for school travel plan advisers.

  • Identify any aspect of transport policies which discourages children and young people from using modes of travel involving physical activity (such as walking or cycling). For example, policies that aim to keep traffic moving may make it difficult to cross the road. Consider how these policies can be improved to encourage physically active travel.

Local organisations: planning, delivery and training

Recommendation 6 Responding to children and young people

Who is the target population?

Children and young people aged 18 and under, their families and carers.

Who should take action?

  • Public, voluntary, community and private sector managers and decision-makers responsible for – or able to influence – opportunities for children and young people to be physically active.

  • Governors and heads of schools and colleges.

What action should they take?

  • Identify local factors that may affect whether or not children and young people are physically active by regularly consulting with them, their parents and carers.

  • Find out what type of physical activities children and young people enjoy, based on existing research or localconsultation (for example, some might prefer non-competitive or single-gender activities). Actively involve them in planning the resulting physical activities.

  • Remove locally identified barriers to participation, such as lack of privacy in changing facilities, inadequate lighting, poorly maintained facilities and lack of access for children and young people with a disability. Any dress policy should be practical, affordable and acceptable to participants without compromising their safety or restricting participation.

  • Provide regular local programmes and other opportunities for children and young people to be physically active in a challenging environment where they feel safe (both indoors and outdoors). Ensure these programmes and opportunities are well-publicised.

  • Ensure physical activity programmes are run by people with the relevant training or experience.

Recommendation 7 Leadership and instruction

Who is the target population?

People who provide programmes or opportunities for children and young people aged 18 and under to be physically active.

Who should take action?

Employers or supervisors of the above.

What action should they take?

  • Ensure informal and formal physical activity sessions for children and young people (including play) are led by staff or volunteers who have achieved the relevant sector standards or qualifications for working with children. This includes the requirements for child protection, health and safety, equality and diversity.

  • Ensure staff and volunteers have the skills (including interpersonal skills) to design, plan and deliver physical activity sessions (including active play sessions) that meet children and young people's different needs and abilities. Those leading activities should make them enjoyable. The leaders should also be inspiring. They should raise children and young people's aspirations about what they can participate in – and the level of ability they can achieve. In addition, leaders should help foster children and young people's personal development.

  • Use community networks and partnerships to encourage, develop and support local communities and volunteers involved in providing physical activities for children and young people.For recommendations on the principles of networking and partnership working, see the NICE guidance on community engagement: improving health and wellbeing and reducing health inequalities.

  • Employers should provide regular and relevant development opportunities for employees and volunteers. The impact on practitioner performance and on children and young people's experiences should be monitored.

Recommendation 8 Training and continuing professional development

Who is the target population?

People who provide and deliver physical activity programmes (formal and informal) and other opportunities for children and young people aged 18 and under to be physically active.

Who should take action?

Education and training organisations.

What action should they take?

  • Establish continuing professional development (CPD) programmes for people involved in organising and running formal and informal physical activities. The education and training should enable them to:

    • give children and young people information and advice on physical activity, taking into account their needs (for example, their developmental age, physical ability and any medical conditions they may have)

    • give children and young people confidence in their own abilities and motivate them to be physically active (this includes encouraging them to set goals, where appropriate)

    • understand the practical issues and problems that may discourage families or groups of children and young people from getting involved. (This may include, for example, time constraints, access issues – including accessibility for those with a disability – and the cultural appropriateness of activities)

    • develop and foster partnership working and get the local community involved.

  • Monitor and evaluate the impact of training on practitioner performance.

  • Train people to deliver physical activity CPD programmes.

Recommendation 9 Multi-component school and community programmes

Who is the target population?

Children and young people aged 4 to 18 who attend school or other education institutions.

Who should take action?

  • Public, voluntary, community and private sector organisations involved in designing physical activity projects and programmes.

  • Governors and heads of schools and colleges.

What action should they take?

  • Identify education institutions willing to deliver multi-component physical activity programmes involving school, family and community-based activities. Identify families, community members, groups and organisations and private sector organisations willing to contribute.

  • Develop multi-component physical activity programmes. These should include:

    • education and advice to increase awareness of the benefits of physical activity and to give children and young people the confidence and motivation to get involved

    • policy and environmental changes, such as creating a more supportive school environment and new opportunities for physical activity during breaks and after school

    • the family: by providing homework activities which children and their parents or carers can do together, or advice on how to create a supportive home environment. (For example, advice on how they might help their child become involved in an activity.) It could also include school-based family activity days

    • the community: for example, by setting up family fun days and schemes such as 'Play in the park'.

Recommendation 10 Facilities and equipment

Who is the target population?

Children aged up to 11.

Who should take action?

Public, voluntary, community and private sector managers and decision-makers responsible for – or able to influence – opportunities for children to be physically active including:

  • early years providers and carers of young children, including those involved with nurseries, playgroups and creches

  • school governors, head teachers and teachers

  • those working in children's centres.

What action should they take?

  • Ensure opportunities, facilities and equipment are available to encourage children to develop movement skills, regardless of their ability or disability (for a definition of movement skills see glossary).

  • Provide children with access to environments that stimulate their need to explore and which safely challenge them. (Examples include adventure playgrounds, parks, woodland, common land or fun trails.) Also provide them with the necessary equipment. The aim is to develop their risk awareness and an understanding of their own abilities as necessary life skills.

  • Ensure children have the opportunity to explore a range of physical activities to help them identify those they can enjoy by themselves and those they can do with friends and family.

  • Provide daily opportunities for participation in physically active play by providing guidance and support, equipment and facilities. Keep children motivated to be physically active by updating and varying the way physical activities are delivered (including the resources and environments used).

  • Ensure opportunities are available after school, at weekends, during half-term breaks and during the longer school holidays. Activities should be led by appropriately trained and qualified staff (paid or voluntary) and take place in schools and other community settings.

Recommendation 11 Supporting girls and young women

Who is the target population?

Girls and young women aged 11–18.

Who should take action?

Public, voluntary, community and private sector managers and decision-makers able to influence physical activity facilities, opportunities and programmes for girls and young women.

What action should they take?

  • Consult with girls and young women to find out what type of physical activities they prefer. Actively involve them in the provision of a range of options in response. This may include formal and informal, competitive and non-competitive activities such as football, wheelchair basketball, dance, aerobics and the gym. Activities may be delivered in single and mixed- gender groups.

  • Offer school-based physical activities, including extra-curricular ones. Provide advice on self-monitoring and individually tailored feedback and advice.

  • Address any psychological, social and environmental barriers to physical activity. For example, provide opportunities in easily accessible community settings with appropriate changing facilities offering privacy. Any dress policy should be practical, affordable and acceptable to participants without compromising their safety or restricting participation.

For further recommendations on community engagement, see the NICE guidance on community engagement: improving health and wellbeing and reducing health inequalities.

Recommendation 12 Active and sustainable school travel plans

This recommendation has been replaced by newer guidance. See recommendation 8 in the NICE guidance on physical activity: walking and cycling.

Recommendation 13 Helping children to be active

Who is the target population?

Children aged up to 11.

Who should take action?

  • Children's centre staff.

  • Early years providers such as playgroup (creche) leaders and child minders.

  • Parents and carers.

  • Teachers and school support staff.

  • Those providing local opportunities for physical activity in the voluntary, community and private sectors.

What action should they take?

  • Provide a range of indoor and outdoor physical activities for children on a daily basis, including opportunities for unstructured, spontaneous play.

  • Tailor activities according to the child's developmental age and physical ability. Ensure they are inclusive, progressive and enjoyable. The activities should develop the child's movement skills (such as crawling, running, hopping, skipping, climbing, throwing, catching and kicking a ball). Children should also experience more advanced activities such as swimming, cycling, playing football and dancing.

  • Provide opportunities at intervals throughout the day in pre-school establishments; during playtimes and lunch breaks at school; as part of extra-curricular and extended school provision; and during leisure time (including weekends and holidays) in wider community settings and the private sector.

  • Help children identify activities they can enjoy by themselves and those they can enjoy with their friends and families.

Recommendation 14 Helping girls and young women to be active

Who is the target population?

Girls and young women aged 11–18.

Who should take action?

Practitioners who lead physical activities including youth leaders, teachers, coaches and volunteers.

What action should they take?

  • Support participants of all abilities in a non-judgemental and inclusive way. Emphasise the opportunities for participation, enjoyment and personal development, rather than focusing on the evaluation of performance.

  • Encourage those who initially choose not to participate to be involved with physical activities in other ways. Help them move gradually towards full participation.

  • Encourage a dress code that minimises their concerns about body image. It should be practical, affordable and acceptable to them, without compromising their safety or restricting participation.

  • Provide appropriate role models.

Recommendation 15 Helping families to be active

Who is the target population?

Children and young people aged 18 and under, their families and carers.

Who should take action?

Groups and individuals who have regular contact with children, young people, their parents and carers including:

  • health practitioners

  • local authority personnel

  • physical activity professionals in the public and private sector

  • teachers and early years providers

  • volunteers and staff from community organisations.

What action should they take?

  • Ensure parents and carers are aware of government advice on how much physical activity children and young people should be doing.

  • Provide information and advice on the benefits of physical activity, emphasising how enjoyable it is. Provide examples of local opportunities.

  • Encourage parents and carers to get involved in physical activities with their children.

  • Encourage parents and carers to complete at least some local journeys (or some part of a local journey) with young children using a physically active mode of travel. This should take place on most days of the week. The aim is to establish physically active travel (such as walking or cycling) as a life-long habit from an early age. Parents and carers should also be encouraged to allow their children to become more independent, by gradually allowing them to walk, cycle or use another physically active mode of travel for short distances.

  • Act as a role model by incorporating physical activity into daily life. For example, opt for travel involving physical activity (such as walking or cycling), use the stairs and regularly participate in recreational activities or sport.

  • Promote physically active travel as an option for all the family. Raise awareness of how it can help children and young people achieve the recommended daily amount of physical activity.



[1] Out-of-school services are defined as those providing activities that take place outside the formal school day, possibly as part of extended school services. They could involve using school facilities during the evening, weekends and school holidays.

  • National Institute for Health and Care Excellence (NICE)