3 Considerations

The PDG took account of a number of factors and issues in making the recommendations.

Value of physical activity

3.1 Physical activity is important for children and young people's heath and wellbeing and contributes to their physical, social, emotional and psychological development.

3.2 Physical activity can help prevent long-term medical conditions and help manage existing conditions.

3.3 The Chief Medical Officer's recommendation is for children and young people to do a minimum of 60 minutes moderate to vigorous physical activity daily. This should include weight-bearing activities to improve bone health, muscle strength and flexibility at least twice a week. The PDG notes that there is likely to be a link between the amount and intensity of physical activity and its effect on health. Recent evidence suggests that children aged 9 may need 120 minutes per day and young people aged 15 may need 90 minutes per day, to reduce their risk of cardiovascular disease (Andersen et al. 2006).

3.4 All children and young people should have the opportunity to be involved in physical activity and should be encouraged and supported to participate. Provision and support should be available irrespective of disability, health status, religion, ethnicity, social, economic and other circumstances.

3.5 The PDG believes that only by fostering enjoyment and competence will children and young people be intrinsically motivated to increase and sustain their physical activity levels.

3.6 When encouraging younger children to be physically active the focus should be on fun, enjoyment and active participation, rather than on the need to understand and conform to rules or master complex skills.

3.7 The PDG recognised that the recommendations are more likely to be implemented if they complement current policies that advocate physical activity.

Children and young people's needs

3.8 Children and young people need to participate in a wide range of different physical activities.

3.9 Children and young people need opportunities, time, space, facilities and equipment, permission and encouragement to be sufficiently physically active. They can be physically active through play and other spontaneous activities, as well as by taking part in structured or organised programmes.

3.10 Children and young people need to take risks and challenge themselves when involved in physically active play, sports and other activities, so they can learn their own boundaries. It was not within the PDG's remit to consider what might constitute an acceptable level of risk for children and young people when undertaking physical activity in different settings.

3.11 The PDG recognises that activities need to be tailored to the individual's developmental stage and physical ability. Activities also need to be sensitive to culture and gender issues. While it is important to take individual needs and preferences into account, the PDG believes it is also important to raise aspirations and encourage children and young people to explore a variety of options.

Factors that encourage or hinder physical activity

3.12 Parents, carers and other family members have a crucial role in encouraging young children to be physically active and in developing their movement skills. They can do this by providing a range of opportunities for physically active play and by playing active games with them. They can also encourage them to walk or cycle (or use other modes of travel involving physical activity) to get to and from different destinations. In addition, they can offer positive feedback, generally show an interest and act as positive role models.

3.13 The influence of peers is important and can serve to encourage or discourage physical activity.

3.14 Helping children and young people to be involved in the design of activities or play spaces is an important way of encouraging them to be more physically active.

3.15 Children and young people's opportunities to be physically active can be affected by environmental, economic and social factors and perceptions about safety and accessibility. Weather conditions – and their perception of what type of conditions make it suitable to be outside – can also affect the opportunities they take.

3.16 The interests of the community as a whole need to be balanced with the interests of children and young people when promoting unsupervised activity in local neighbourhoods.

3.17 Contemporary society is generally perceived as risky. Media reporting and a private and public culture which emphasises health and safety, blame and rights have made risk aversion a dominant social value. Children and young people benefit from exposure to risks and challenges to help them develop skills and confidence. Many forms of physical activity and play (and the environments where they take place) have inherent risks. Unnecessary risk can be minimised through the use of risk-benefit assessment, safety precautions and safety equipment. Parents' and service providers' fears of injury and litigation can prevent children and young people from being physically active, even though the fear of risk may not necessarily correspond to reality. Paradoxically, in the long run, this can put children and young people at greater risk from the conditions associated with lack of activity – such as obesity, heart disease and cancer.

3.18 The PDG recognises the need for service providers to comply with health and safety legislation but cautions against an overly protective and risk-averse approach which may limit children and young people's physical activity. The physical and psychological benefits associated with physical activity and the health risks associated with a sedentary lifestyle should be considered when appraising risk.

3.19 Some children and young people need special consideration. They include:

  • Those who are 'not in education, employment or training' (NEET). PDG experience shows that physical activity has been used to get some of these young people back into education, training or employment. Physical activity programmes may also provide a positive diversion for children and young people who are at risk of offending.

  • Looked after children and young people, many of whom move between residential care, foster carers or their own family home. This lack of continuity in their home life reduces their opportunities to access leisure facilities or participate in organised activities on a regular basis. In addition, as social groups are hard to maintain this may limit peer interaction and play.

  • Children of asylum seekers, refugees and travellers, many of whom have limited access to regular leisure, sport and play activities due to their transient lifestyle.

  • Young carers – children and young people who are providing care for a family member. The 2001 census identified 175,000 – and many more go unreported. Their responsibilities in the home limit the time they have for socialising with peers and getting involved in play or other types of physical activity.

  • Those who are disabled or from a family where someone else is disabled.

  • Those who are being educated at home.

  • Children who do not attend early years services.

  • Young people in the criminal justice system.

3.20 Children with physical disabilities, even those with severe impairments, can take part in physical activities to benefit their physical and social development. Children with the same impairment may display a wide range of abilities and therefore should not be treated as a single group. Many children who are disabled highlight social issues, rather than their impairment, as a barrier to participation. If they are encouraged to communicate their preferences, changes can be made to the physical environment, activities and the attitudes of others to help them to participate. Practitioners can encourage and nurture positive peer interaction through play and other physical activity opportunities.

3.21 The transitions between education institutions – and from education to employment – are times when young people may have less opportunity for physical activities.

Other issues

3.22 Despite extensive searches, it was difficult to find many high quality controlled studies demonstrating the effectiveness of interventions. Where there was little evidence from controlled studies, the PDG considered observational data and evidence from practice. It also drew on the expertise and experience of its members to supplement the evidence

3.23 There was a lack of consistency in the way children and young people's physical activity was measured, making it difficult to assess the effectiveness of comparative studies. In addition, some studies focussed on increases in particular types of physical activity rather than overall levels of activity. As interventions may result in children and young people getting involved in one type of physical activity at the expense of another, overall, it might not lead to them being more physically active. In other words, the cumulative impact of implementing the recommendations may not be as great as indicated for particular interventions.

3.24 There is little published evidence on the costs or cost-effectiveness of interventions. The economic review team, working with members of the PDG, undertook some exploratory economic analysis to estimate potential costs and benefits.

3.25 Many physical activities involve volunteers (either parents, young people or members of the local community). Those who undertake this kind of work (young people in particular), can act as inspirational role models to others. It is important to ensure this base of volunteers is sustained by providing them with training and support. National volunteering schemes such as 'Vinvolved' and many traditional volunteering and interest groups offer this kind of support to young people and, increasingly, their parents and carers.

3.26 Practitioners' opinions about what children and young people would like to do may differ from the reality; it may be difficult for them to keep up-to-date with the activities that children and young people are interested in. The PDG also acknowledges that some children and young people may not be aware of the range of physical activities they could get involved in.

3.27 It was not possible to address all aspects of the original DH referral. The guidance focuses on children aged 11 and under and adolescent girls. However, many of the recommendations relate to all children and young people under 18, as it also focuses on physically active travel and physical activity for all children and young people aged under 18 in community and family settings. Physical activity as part of the national curriculum was not part of the scope of this guidance, however it does cover physical activity in extra-curricular and extended school settings.

  • National Institute for Health and Care Excellence (NICE)