Effective Policy Options for Promoting Physical Activity in Schools

1. Policy Options for Physical Activity in SchoolsBackground Document Claire LeBlanc MD, FRCPC June 6, 2007

2. Outline • Background • Methodology • review of literature • Policy Options • Roles of Stakeholders • Evaluation • Next Steps

3. Global Obesity Epidemic1 • More than 400 million adults were obese in 2005 worldwide • Chronic diseases 2° to obesity account for 60% of the 58 million deaths/year2 • cardiovascular disease, diabetes, some cancers, chronic respiratory diseases 1http://www.who.int/mediacentre/factsheets/fs311/en/index.html; 2 Preventing Chronic Diseases: a Vital Investment: Geneva, World Health Organization 2005

4. Children not Immune3 • ≥ 20 million children under five years old were overweight globally in 20051 • Childhood obesity associated with many co-morbidities • type 2 diabetes, high blood pressure, obstructive sleep apnea, nonalcoholic fatty liver disease, poor self-esteem, and lower health-related quality of life • Up to 80% of obese youth continue this trend into adulthood increasing their risk for chronic disease and premature mortality 3 LeBlanc CMA, Gomez J et al. Pediatrics ,2006;117:1834-1842

5. Why are Kids Overweight? • Excessive caloric intake • Excessive sedentary activity4 • 6-11yo > 2hr TV/d: 2x as likely obese • > 30 hr/wk screen time 35% youth overweight vs 23% if less screen time • Inadequate physical activity levels5 • Canadian 5-17 year olds take an average of 11,356 steps/day (pedometer) = insufficient activity for optimal growth & development (need 12,000 -16,500 steps/day ~ 90 min mod-vigorous PA/day) 4 Shields M. Statistics Canada 2005; 82-620-MWE; 5 CANPLAY: Physical Activity Monitor 2005. www.cflri.ca/eng/statistics/surveys/pam2005.php

6. Why Not Active Enough? •  PA DAILY at home • time pressures • TV, computer, video games preferred • unsafe environments • inactive parents •  recreational facilities •  PA DAILY at school • 17% Canadian schools (Elementary  High) have daily PE by PE specialists6 • 7% 4x/wk; 25% 3x/wk; 36% 2x/wk; 12% 1x/wk • PE optional in most secondary schools7 6 Cameron C. Opportunities for PA in Canadian Schools: Trends from 2001-2006. www.cflri.ca 7 Janzen H. Physical and Health Education 2004;4-12 (CAHPERD Scholar Address)

7. One Solution: School Wellness Policies • Quality health education • Promote healthy foods • Encourage physical activity (PA) & PE • quality daily PE • active lunch & recess • active transportation • activity in classroom • energizers • CLASS • intramural sports • activities before & after school • interschool sports • “making the team”

8. Methodology • Review of literature to 2005 • many effective school-based research programs that improved student PA levels, fitness scores & obesity measures7 • A second review from 2005-2007 • MEDLINE, Pubmed, HealthSTAR, CINAHL, Eric & PsychInfo • Supplemental resources • WHO Information Series on School Health (www.who.int/schoolyouthhealth) • 2006 WHO Regional Office for Europe’s Health Evidence Network Report on School Health Promotion (www.euro.wo.int/document/e88185.pdf) • Challenge of Obesity in the WHO European Region and the Strategies for Response Summary (www.euro.who.int/pubrequest) • Healthy Child Manitoba (www.gov.mb.ca/healthychild/index.html) • Washington State Department of Health Report on Nutrition and Physical Activity – A Policy Resource Guide (www.doh.wa.gov/cfh/steps/publications/nutrition_activity_policy_guide_final.pdf pages 52-57 • Action Schools! BC (www.actionschoolsbc.ca) • Annapolis Valley Health Promoting Schools Initiative (www.hpclearinghouse.ca/features/AVHPSP.pdf) 7Attachment 1: CMAJ 2007;176(8):chapter 22

9. (1) Effective & Promising Policy Options for School PA

10. (2) Untested Promising Policy Options for Physical Activity in Schools

11. Stakeholders: Why Get Involved?

12. (3) Potential Roles for Stakeholders

13. Potential Barriers/Solutions for Stakeholders: Health Professionals CPS: Are We Doing Enough?A status report on Canadian public policy and child and youth health CASM, AAP & CPS position papers; CPS tool kit Advocacy: Government Measures of obesity + co-morbid conditions; No time for preventive counseling; Remuneration AAP (POSH study) CDC Funded Advocacy: media Unaware school health role CPS/AAP media training Student Pediatricians lack training Hospital environment not healthy “role model” CPS HAL Residency Module CPS & CAPHC: HAL Hospital AAP = American Academy of Pediatrics; CPS = Canadian Pediatric Society; HAL = Healthy Active Living CASM = Canadian Academy of Sport Medicine; CAPHC = Canadian Association Pediatric Hospital Centers Barrier Solution

14. How do We know the Policy is Working? Process Indicators Expert Advisory Committee Output Indicators Safe Cycling Routes Outcome Indicators ↑ Student PA Levels ↓ Student BMI

15. WHO Framework: Monitoring and Evaluation of Policies 8 8 Global Strategy on Diet, Physical Activity and Health. A Framework to Monitor and Evaluate Implementation. World Health Organization Geneva, 2006

16. (4)Process and Output Indicators for Effective & Promising Policy Options for Physical Activity in Schools

17. (5) Outcome Indicators(children) for Effective & Promising Policy Options for Physical Activity in Schools

18. Conclusion • Physical inactivity is an important determinant of obesity and associated chronic disease in children and youth • Health Promoting Schools are a key strategy to improve the health and wellness of children

19. Next Steps • Francois Lagarde & Claire LeBlanc • finalize background paper based on feedback gathered from Satellite Expert Roundtable on WHO Global Strategy on Diet, Physical Activity & Health: A School Policy Framework • Satellite Expert Roundtable • draft outline for DPAS School Policy Framework • World Health Organization • develop DPAS School Policy Framework • organize consultation process • launch School Policy Framework once finalized

20. Health Promoting SchoolsLet’s Make it Happen!