91����

Another year and another illuminating report from the “Active Lives Children and Young People” survey for the last Academic year (running September 2020 to July 2021). It is accessible here:

First carried out in 2017-18 the report is a fascinating insight into the activity levels of our Nation’s children and now sheds light into how COVID-19 has impacted their activity levels and enjoyment of exercise. I am glad to say that not only COVID-19 is discussed – it puts in stark relief some of the upstream determinants affecting health and disease and the landscape of inequality many children and their families are facing.

The report is well laid out and informative as always. You can delve into their technical note to understand their methodology, statistics and the questionnaire if you would like as well. This report plus “The Big Answer” of September 2021 gives us an excellent basis of understanding to help support the children in our lives and regions more effectively so I highly recommend you read them if you have not already.

First, some definitions – the report states that children are “active” if they do an average of at least 60 minutes moderate intensity exercise every day. They are “fairly active” if they do between 30-59 and “less active” if they do less than 30 minutes a day. This links nicely with the UK Chief Medical Officer’s (CMO’s) Physical Activity Guidelines of 2019 that we know well. These recommend children and young people between 5 and 18 should aim for at least 60 minutes per day on average with “activities to develop movement skills, and muscle and bone strength” being done across the week.

The headline statistics – 44.6% of children are active, 23% are fairly active and 32.4% are less active. This means that 4 million children are not meeting the CMO’s recommendations and 3.2 million are. Quite simply, this is not enough, and we must make a significant effort to help support the activity levels of children and young people.

Physical Literacy, made up of four elements – competence, understanding and knowledge, enjoyment, and confidence – has taken a significant reduction in the last few years. Enjoyment and confidence have reduced dramatically. We know that the experiences children have mould their behaviours for the rest of their lives so these reductions are likely to impact our population for many years to come. Movement should first and foremost be fun – think bouncing a balloon between you and a friend, playing tag or other games – rather than a chore and how we frame physical activity to children should always take this in to account.

Austerity and lack of funding, as always, have had their inevitable impact on schools. With many schools having or choosing to sell off land previously used for sports fields and with targets generally being academic the priority is clearly not creating physical literacy. Looking more deeply into the environment in which many inner-city schools are based highlights a powerful lack of open and natural space – both powerful drivers promoting movement, enjoyment, exploration and learning of physical skills beyond the homogenous and unstimulating ‘concrete jungle’ many of us are unfortunately too accustomed to.

Physical activity levels continue to be intrinsically related to family affluence and ethnicity. Children from high affluence families are 50% likely to be active, compared to only 39% of those from low affluence families. 48% of White British children are active, compared to just 39% of Asian and 36% of Black children. Once again, the statistics are demonstrating convincingly what many of us know – there is significant health inequality in England. Changes must be made on an individual, organisational and societal level and I will suggest some areas we can make change or improve below.

Interestingly, gender and whether children have a disability or long-term condition did not significantly affect a child’s activity level this year. Looking more into the activity levels of girls and boys showed that boys’ activity levels have fallen during the pandemic by 2.4% but girls’ have increased by 2.7%. Is there a silver lining in there – can we learn a positive lesson here? Well, it seems that while boys generally participate more in organised sport girls preferred the pandemic’s restrictions allowing them to do more organised fitness activities or walking. Something to consider going forward.

Another concerning statistic is with swimming – the 91����is proud to be partnered with Swim England and we understand the benefits of aquatic exercise for all. Unfortunately, swimming was hard-hit by the pandemic with 850,000 fewer children and young people swimming during this academic year compared to 2019-2020. This has had the understandable consequence of negatively impacting swimming confidence, especially in the younger groups who have yet to spend much time in water. The national curriculum states that children should be able to swim 25m unaided by the time they leave primary school. In the last 3 years 79% of children met this target which can be counted as a moderate success, albeit still quite low. Concerningly, our current years 1-2 saw only 19% able to complete this (down from around 33% average in the few years prior). Years 3-4 were 46% (down from around 55% average in the few years prior). Swimming rates have improved post-lockdown but not to pre-pandemic levels and I am concerned we may not be able to reverse the above deficits.

We at the 91����are committed to increasing physical activity in our nation – it is one of the fundamental pillars of lifestyle medicine and so important for health and wellbeing through a variety of mechanisms. We use evidence-based techniques to break down individual’s barriers and empower them to engage with physical activity they enjoy and can keep consistent with. We also advocate for and influence factors that increase physical activity on a population level. From my experience as a lifestyle medic, social prescribing clinical director and school doctor, and from reading this report I have three areas I suggest we and those in power should focus on to improve the physical activity levels of our nation’s children:

1. Reprioritise movement in schools:
   • Activity snacks between and during lessons
   • Allow natural movement in class – to an extent!
   • PE or games every day looking to improve physical literacy with a focus on fun, not just performance.
   • Review current curriculum targets to prevent them undermining physical activity.
2. Significant funding to address ethnic and family affluence inequalities in physical activity:
   • A variety of excellent public health initiatives such as “This girl can” have had very positive impacts. A series of campaigns focused more on addressing the above inequalities could be powerful.
   • Funding Social prescribing and the voluntary sector as it is effective at combating social inequality and deprivation.
   • Funding community sport well – in July Boris Johnson pledged £50 million to grassroot football facilities. Much more is needed and with a return on investment of £3.91 for every £1 spent it will be well worth it.
3. Improve training of pertinent professional groups to better understand and promote physical activity
   • Healthcare workers – medical, nursing and allied students should have a more thorough education on the benefits of physical activity and how to promote physical activity to their patients.
   • Teachers – all teachers should have a good understanding of physical activity, how it impacts the children they are teaching and how it will help them learn more effectively. This can and should take precedence over attaining some targets that many teachers do not feel to be effective indicators of progress.

In a phrase that is prioritise, fund and educate.

Much of the above is being advocated, supported or implemented by the variety of excellent individuals and groups out there and for that the 91����are encouraged and very grateful. There is more that we can do. What do you suggest should be done? What should 91����do? If you would like to contribute to BSLM’s Physical Activity Special Interest Group please contact Dr Alex Maxwell or Dr Chris Lutterodt (emails below)

It was Socrates who said:

“No man has the right to be an amateur in the matter of physical training. It is a shame for a man to grow old without seeing the beauty and strength of which his body is capable”

Luckily, we now know that it is not just men but all people irrespective of sex, gender, ethnic background or affluence level who should all have the benefit of moving for fun, for life.

Thank-you,

Dr Alex Maxwell
91����London Director, Physical Activity SIG co-chair and Social Prescribing SIG chair.
Alex.maxwell@doctors.org.uk

Dr Chris Lutterodt
Physical Activity SIG co-chair.
chris.lutterodt@gmail.com