Overall Physical Activity
The World Health Organization (WHO) defines physical activity as any bodily movement produced by skeletal muscles resulting in energy expenditure above resting. Physical activity therefore encompasses all activities (i.e., active transport, physical education, leisure time activities, exercise), irrespective of intensity (light, moderate or vigorous). Physical activity is associated with numerous positive health outcomes, such as preventing and managing non-communicable diseases (e.g., cardiovascular disease, cancer, and diabetes), improving physical (cardiorespiratory and muscular) fitness, reducing symptoms of anxiety and depression, enhancing bone strength and density, maintaining a healthy body mass, enhancing cognitive function, and improving overall well-being. Reducing physical inactivity for children and adolescents is a key priority: the Global Action Plan on Physical Activity 2018- 2030 seeks to reduce physical inactivity by 15%.
The WHO released guidelines on physical activity in 2020 strongly recommending that children aged 5-17 years should do at least 60 minutes, on average, of moderate-to-vigorous-intensity, mostly aerobic, physical activity, across the week. Moreover, vigorous-intensity aerobic activities, together with those that strengthen muscle and bone, should be incorporated at least three days a week. Given the availability of evidence, the latter component of international guidelines could not be considered, so the Research Working Group focused on the overall time spent being physically active as the benchmark to allocate a grade to this indicator.
The benchmark used by the Research Work Group to allocate a grade to this indicator was: the percentage of children and adolescents who meet the Global Recommendations on Physical Activity for Health, which recommend that children and youth accumulate at least 60 minutes of moderate-to-vigorous-intensity physical activity (MVPA) per day, on average.
- The School Health Research Network’s Student Health and Wellbeing survey (2019/2020), children aged 11 to 16 years (n=115,944)
- The HAPPEN survey (2018-2020), children aged 8 to 11 years (n=1,329)
Deciding on a grade
The School Health Research Network: Student Health and Wellbeing Survey (2019) collated self-report sedentary data on 110,877 children aged 11 to 16 years old. Distributed to 94% of schools (n=198) in Wales, young people were asked how many days, across a week, they were physically active for a total of at least 60 minutes. The survey found that 17.0% of young people (11- to 16-year-olds) were active for at least 60 minutes across all seven days of the week. However, this figure decreased to 14.4% when only considering moderate-to-vigorous-intensity to align with international government guidelines. More boys (18.4%) reported engaging in MVPA, in comparison to girls (10.3%) and those who identified as neither a boy nor a girl (17.7%). A decline in the proportion of young people was found in age, with the highest MVPA among Year 7 pupils (11 years; 20.0%) and the lowest among Year 11 pupils (16 years; 9.5%). A lower percentage (11.7%) of young people from less affluent families met the recommended daily physical activity guidelines, compared to 16.5% from more affluent families. The proportion of White (14.2%) and Black Minority Ethnic (14.9%) children reporting being active was similar.
The HAPPEN survey collected self-report data on 1,329 children aged 8 to 11 years old. The survey was distributed among 27 primary schools across three local authorities in Wales. Children were asked ‘in the last seven days, how many days did you do sports or exercise for at least one hour in total?.’ The survey showed that 22% of 8- to 11-year-old children did sport/exercise for at least 60 minutes across all seven days. Boys reported more engagement (27%) than girls (17%). There was little variation with age (21-24%) or socioeconomic status (20-24%).
The Research Working Group assigned an F to this category when taking the sample size and representation (i.e., sub-national population data for HAPPEN) into account. This grade has decreased from the 2018 AHK-Wales Report Card. However, it is important to note that the data utilised, and thus the questions used, for the 2018 overall physical activity indicator differed, with the current questions also capturing more specific MVPA, rather than total physical activity, in line with current guidelines and benchmarks. Furthermore, the data included refers to being physically active for 60 minutes ‘across all seven days’, rather than ‘at least four days’ or ‘60 minutes per day on average’, which were deemed inappropriate given our national physical activity guidelines, available data, and divergence from our previous national Report Card. The current grade also incorporates a new dataset, with HAPPEN data availability for 2020.
There continues to be no large-scale studies using device-based assessment of physical activity (e.g., accelerometery) of children and adolescents in Wales. This is particularly important given the evidence of over-reporting of physical activity levels via self-report when compared to accelerometer-measured physical activity. It could be proposed that the ongoing longitudinal device-based assessment of physical activity levels in 800 8- to 16-year-olds, stratified by age, sex, and socioeconomic status, across Wales, as part of the Welsh Institute of Physical Activity, Health and Sport (WIPAHS), should be expanded. Beyond the HAPPEN survey, there is currently limited research available in Wales for children under the age of 11 years and no data available for those under 8 years old. This needs to be addressed through robust, systematic, data collection methods. Greater attention needs to be given to socioeconomic patterning. Consideration should be given to 24- hour movements and behaviours. The effect of interventions to enhance physical activity levels need to be quantified.
How to improve
The best available evidence shows that the majority of children and young people in Wales need to increase their physical activity levels. This can be achieved through a range of behaviours including dance, sport, active transportation, and active play.
A significant effort needs to be made to address the very low physical activity levels among young people in Wales. High-quality evidence using device-based measures, while simultaneously capturing information on the duration (e.g., per day, per week), context (e.g., school time, leisure time) and type (e.g., sport, active transport, play) of physical activity, is needed to inform the design of effective strategies, interventions, and policy.