1 Active Livig Research Buildig Evidece to Prevet Childhood Obesity ad Support Active Commuities RESEARCH BRIEF May 2012 Policies ad Stadards for Promotig Physical Activity i After-School Programs Itroductio Today, early oe i three youg people i the Uited States are overweight or obese ad lack of physical activity cotributes to the epidemic. 1 Regular physical activity promotes health, reduces risk for obesity ad has bee show to improve studets academic performace. 2, 3 Leadig public health officials recogize after-school programs as a importat settig for promotig physical activity ad prevetig obesity. 4 7 Natiowide, more tha 8 millio childre ad adolescets sped a average of eight hours per week i after-school programs. 8 I recet years, 14 states have adopted policies ad atioal stadards have bee developed to help icrease the amout of physical activity childre accumulate while attedig after-school programs. 9 I April 2011, the Natioal Afterschool Associatio released physical activity stadards for after-school programs ad summer camps, but may of the existig stadards ad policies lack clearly defied bechmarks. 10 Sice may of the policy goals are difficult to A atioal program of the Robert Wood Johso Foudatio, with directio ad techical assistace provided by the Uiversity of Califoria, Sa Diego.
2 Active Livig Research RESEARCH BRIEF May 2012 page 2 measure, leaders ad staff at after-school programs, as well as state ad atioal orgaizatios, are ot able to moitor compliace with the policies or evaluate their effectiveess. There also are substatial differeces i staffig ad resources, such as idoor ad outdoor play space, amog after-school programs, 6, 7 which should be cosidered as policies ad stadards are developed. This brief summarizes research o physical activity i after-school programs ad examies how policies ca help after-school programs more effectively promote physical activity ad prevet obesity amog childre. Key Research Results Childre who atted after-school programs get some physical activity, but ot eough. A study of 25 after-school programs i Omaha, NE, ad Columbia, SC, foud that the programs dedicated a average of 64 miutes of their daily schedule to opportuities for physical activity. 11 Amog the programs, the time dedicated to physical activity raged from 40 miutes to 120 miutes. Childre accumulate 13 miutes to 24 miutes of moderate-to-vigorous physical activity each day at after-school programs. 12, 13 This is less tha half of the miimum atioal recommedatio for physical activity. Two large-scale studies of 253 childre attedig three after-school programs 12 ad 934 childre attedig 25 after-school programs 11 foud, o average, childre accumulated 2,800 to 2,900 steps per day durig the after-school program. This is less tha oe-third of the daily recommedatio for childre, which is 10,000 to 13,000 steps per day. 14 A systematic observatio of 745 childre i 12 after-school programs idicated that oly half of the childre were physically active durig the observatio periods. 15 Based o curret practice, the total legth of a after-school program ad the amout of time allocated i the program s schedule for physical activity do ot appear to be related to the amout of time childre sped i physical activity durig the program. 11 However, whe after-school programs reduce the amout of time dedicated to physical activity, childre accumulate less physical activity. 16 Coversely, icorporatig physical activity ito a after-school program s daily routie ca lead to icreased physical activity amog childre. 17 A atioal program of the Robert Wood Johso Foudatio, with directio ad techical assistace provided by the Uiversity of Califoria, Sa Diego. activelivigresearch.org
3 Active Livig Research RESEARCH BRIEF May 2012 page 3 FIGURE 1. Time Spet i Moderate-to-Vigorous Physical Activity Durig After-School Programs i Nebraska ad South Carolia 18 Girls Boys 30 Califoria guidelie of 30 miutes of moderate-to-vigorous physical activity 25 Miutes per day Note: Data represet 771 childre attedig 18 after-school programs i Nebraska ad South Carolia. Childre had to atted the after-school program a miimum of 60 miutes to be icluded i the estimates. Childre wore ActiGraph accerlerometers up to four cosecutive days; estimates use the Eveso et al., 2008 cutpoits. 19 Physical activity policies i after-school programs vary. A comprehesive review idetified atioal orgaizatios ad 14 states that have developed or adopted policies targetig physical activity withi the after-school program settig. 9 Some of these policies icluded geeral laguage, such as provide scheduled daily play time, while other policies were highly specific: 20 percet of daily program time for moderate-to-vigorous physical activity or accumulate 30 miutes to 60 miutes of moderate-to-vigorous physical activity daily withi the after-school program. The majority of existig policies regardig physical activity for after-school programs claim to be evidece-based, yet oe of the evidece cited was based o data collected withi the after-school program eviromet. 9 Noe of the policies regardig physical activity for after-school programs specified how compliace via state, atioal oversight orgaizatios, atioal licesig agecies, or selfevaluatio by after-school program leaders ad staff will be coducted. A study 12 of 253 childre ages 5 to 13 foud that, depedig o the policy, the percetage of childre who met policy goals each day they atteded a after-school program raged from 0.1 percet for a specific goal (e.g., accumulate 60 miutes of physical activity daily) to 93 percet for a weak goal (e.g., provide opportuity for 30 miutes of physical activity every three hours). The largest study 11 of physical activity withi after-school programs foud that oly 17 percet of childre accumulated at least 4,600 steps per day while attedig a after-school program. The study icluded daily observatios of 934 childre ages 4 to 14 at 25 after-school programs i South Carolia ad Nebraska. The guidelie for daily steps was developed to reflect Califoria s policy which states that childre should accumulate at least 30 miutes of moderate-to-vigorous physical activity each day while attedig a after-school program. 20 A atioal program of the Robert Wood Johso Foudatio, with directio ad techical assistace provided by the Uiversity of Califoria, Sa Diego. activelivigresearch.org
4 Active Livig Research RESEARCH BRIEF May 2012 page 4 Strategies to icrease physical activity amog childre i after-school programs vary ad evaluatios of the programs are eeded. There are more tha 52 physical activity programs that after-school programs ca purchase. 21 It is uclear how may of the physical activity programs have bee evaluated for effectiveess. Evaluatios of commercial programs, such as the Sports, Play, ad Active Recreatio for Kids (SPARK) Afterschool Program ad the Child ad Adolescet Trial for Cardiovascular Health (CATCH) Kids Club, suggest they have limited effectiveess at icreasig physical activity amog 15, 22, 23 childre compared with after-school programs that do ot have a commercial program. A comprehesive review 5 of 13 physical activity itervetios coducted across umerous afterschool programs foud that the amout of time childre spet i physical activity durig the afterschool program icreased by as much as 17 percet after the itervetios were implemeted. The effectiveess of programs desiged to icrease childre s physical activity withi after-school programs is mixed; some programs have decreased the amout of time childre sped i 13, 14, 22, 23 moderate-to-vigorous physical activity ad others have show modest icreases. Oe study 17 foud modest icreases (of up to 10 miutes per day) i the total daily amout of time childre spet i moderate-to-vigorous physical activity. This was achieved by allocatig time for physical activity, ivolvig staff i activities or makig other chages to better support physical activity i after-school programs. A review of some strategies suggests that after-school programs should ehace professioal developmet traiig for their staff ad offer such traiigs at multiple times throughout the year to help childre be more active durig after-school programs. 6 No studies have evaluated whether itervetios that aim to icrease childre s physical activity i after-school programs effectively help meet goals for physical activity that are specified withi existig policies. Coclusios After-school programs have the potetial to help childre accumulate up to 30 miutes of moderate-to-vigorous physical activity each day, which would satisfy half of the atioal recommedatio for daily physical activity. Such a goal is a reasoable expectatio based o the amout of time after-school programs typically allocate for physical activity. Yet more efforts are eeded to better support physical activity i the after-school settig. Although 14 states have adopted physical activity policies for after-school programs ad recet atioal stadards for physical activity have bee developed, 10 there is little evidece showig that after-school programs facilitate sufficiet amouts of physical activity to meet policy goals. I additio, the majority of polices, icludig those recetly developed, fail to clearly defie how to measure progress toward meetig the goals. Fially, o studies have specifically evaluated strategies for icreasig physical activity i after-school programs to determie if they are helpig to meet oe or more of the established state-level policies. A atioal program of the Robert Wood Johso Foudatio, with directio ad techical assistace provided by the Uiversity of Califoria, Sa Diego. activelivigresearch.org
5 Active Livig Research RESEARCH BRIEF May 2012 page 5 Policy Implicatios The evidece suggests that after-school programs ca meaigfully cotribute to childre s overall daily physical activity, but their potetial impact is far from beig realized. Public health officials ad after-school program leaders should strive to icrease the amout of physical activity childre accumulate while attedig after-school programs. Policies for promotig physical activity i after-school programs eed to be S.M.A.R.T. The policies should specifically target a importat outcome (e.g., childre accumulate 30 miutes of moderate-to-vigorous physical activity). The outcome eeds to be measureable by oversight ad licesig agecies, as well as after-school program leaders ad staff. There should be a clearly defied accoutability system i place to reward those that attai policy goals (e.g., a star ratig system to idicate high levels of compliace) ad support those i eed of additioal assistace (e.g., techical support, professioal developmet traiig of after-school program staff). The outcome should be realistic ad able to be achieved withi a well-defied timeframe. Policies should state the amout of time scheduled for physical activity opportuities ad the amout of physical activity childre should accumulate each day they atted the program. Because childre are itermittetly active, scheduled time for physical activity eeds to be at least two or three times more tha the expected levels of physical activity. For example, if the goal is for childre to accumulate 30 miutes of moderate-to-vigorous physical activity, the after-school program should schedule 60 miutes to 90 miutes of time for physical activity. Several aspects of the after-school program eviromet should be cosidered as itervetios for supportig physical activity are developed. For example, promisig strategies iclude maximizig the amout of time childre sped i physical activity withi the period of time already allocated for activity; refiig existig evidece-based curricula to improve its effectiveess at icreasig physical activity; esurig that activities appeal to boys ad girls; improvig idoor ad/or outdoor play space ad the availability of play equipmet; ad creatig effective professioal developmet traiigs to help after-school program staff better promote physical activity. 24 Low-cost ad scalable strategies, such as those previously described, eed to be evaluated to determie if they cotribute to meetig physical activity policy goals. Feasible ad low-cost methods for assessig physical activity durig after-school programs should be validated i research, the used to moitor adherece to policy goals. 20 This brief was prepared by Michael W. Beets, Assistat Professor, Arold School of Public Health, Uiversity of South Carolia, with support from the Active Livig Research staff. Peer review was provided by David A. Dzewaltowski, PhD, Kasas State Uiversity ad Russell Pate, PhD, Arold School of Public Health, Uiversity of South Carolia. For updates ad a Web-based versio of this brief, visit Active Livig Research, a atioal program of the Robert Wood Johso Foudatio, stimulates ad supports research to idetify evirometal factors ad policies that ifluece physical activity for childre ad families to iform effective childhood obesity prevetio strategies, particularly i low-icome ad racial/ethic commuities at highest risk. Active Livig Research wats solid research to be part of the public debate about active livig. Active Livig Research Uiversity of Califoria, Sa Diego 3900 Fifth Aveue, Suite 310 Sa Diego, CA A atioal program of the Robert Wood Johso Foudatio, with directio ad techical assistace provided by the Uiversity of Califoria, Sa Diego. activelivigresearch.org
6 Active Livig Research RESEARCH BRIEF May 2012 page 6 Edotes 1 Ogde CL, Carroll MD, Curti LR, Lamb MM, Flegal KM. Prevalece of high body mass idex i US childre ad adolescets, JAMA. Ja ; 303(3): The Surgeo Geeral s Call to Actio to Decrease Overweight ad Obesity Rockville, MD: Uited States Departmet of Health ad Huma Services, Public Health Service, Office of the Surgeo Geeral, Trost SG. Active Educatio: Physical Educatio, Physical Activity ad Academic Performace. A Research Brief. Priceto, NJ: Robert Wood Johso Foudatio, Pate RR, O Neill JR. After-school itervetios to icrease physical activity amog youth. Br J Sports Med. Ja 2009; 43(1): Beets MW, Beighle A, Erwi HE, Huberty J. Impact of After-School Programs to Icrease Physical Activity A meta-aalysis. Am J Prev Med. 2009; 36(6): Beets MW. Ehacig the traslatio of physical activity itervetios i afterschool programs. America Joural of Lifestyle Medicie epub; first published o Jauary 31, 2012 as doi: / Beets MW, Webster C, Sauders R, Huberty JL. Traslatig policies ito practice: A framework for addressig childhood obesity i afterschool programs. Health Promotio Practice. (Available from author upo request.) 8 America After 3 PM. America After 3 PM: A Household Survey o Afterschool i America. 2009; cfm. Accessed 2009, March 2d. 9 Beets MW, Waller M, Beighle A. Defiig stadards ad policies for promotig physical activity i afterschool programs. J Sch Health. 2010; 80(8): Wiecha JL, Gaett L, Hall G, Roth BA. Natioal Afterschool Associatio Stadards for Healthy Eatig ad Physical Activity i Out-Of-School Time Programs. 2011; Accessed August 8th, Beets MW, Huberty JL, Beighle A. Physical activity of childre attedig afterschool programs: Research- ad practice-based implicatios. Am J Prev Med. Feb 2012;42(2): Beets MW, Rooey L, Tilley F, Beighle A, Webster C. Evaluatio of policies to promote physical activity i afterschool programs: are we meetig curret bechmarks? Prev Med. Sep Oct 2010; 51(3-4): Tudor-Locke C, Craig CL, Beets MW, et al. How May Steps/Day are Eough? For Childre ad Adolescets. It J Behav Nutr Phys Act. Jul ; 8(1): Sharpe EK, Forrester S, Madigo J. Egagig Commuity Providers to Create More Active After-School Eviromets: Results From the Otario CATCH Kids Club Implemetatio Project. J Phys Act Health. Ja 2011; 8 Suppl 1: S Dzewaltowski DA, Rosekraz RR, Geller KS, et al. HOP N after-school project: a obesity prevetio radomized cotrolled trial. It J Behav Nutr Phys Act. Dec ; 7(1): Gortmaker SL, Lee RM, Mozaffaria RS, et al. Impact of a After-school Itervetio o Icreases i Childre s Physical Activity. Med Sci Sports Exerc. Aug epub. 18 Beets MW, Huberty J. upublished data. 19 Eveso KR, Catellier DJ, Gill K, Odrak KS, McMurray RG. Calibratio of two objective measures of physical activity for childre. J Sports Sci. Dec 2008; 26(14): Beets MW, Beighle A, Bottai M, Rooey L, Tilley F. Pedometerdetermied step cout guidelies for afterschool programs. Joural of Physical Activity ad Health. 2012; 9(1): Hall G, Gruber D. Healthy Choices Afterschool: Ivestigatio of the Aligmet of Physical Activity ad Nutritio Programs/Curricula ad the Natioal Afterschool Associatio Program Stadards. New York: Robert Wood Johso Foudatio, The After School Project; Nigg C, Battista J, Chag JA, Yamashita M, Chug R. Physical activity outcomes of a pilot itervetio usig SPARK active recreatio i elemetary after-school programs. Joural of Sport & Exercise Psychology. Ju 2004; 26: S144 S Kelder S, Hoelscher DM, Barroso CS, Walker JL, Cribb P, Hu S. The CATCH Kids Club: a pilot after-school study for improvig elemetary studets utritio ad physical activity. Public Health Nutritio. 2005; 8(2): Weaver RG, Beets MW, Webster C, Beighle A, Huberty JL. A coceptual model for traiig afterschool program staffers to promote physical activity ad utritio. J Sch Health. Apr 2012; 82(4): Trost SG, Rosekraz RR, Dzewaltowski D. Physical activity levels amog childre attedig after-school programs. Med Sci Sports Exerc. Apr 2008; 40(4): A atioal program of the Robert Wood Johso Foudatio, with directio ad techical assistace provided by the Uiversity of Califoria, Sa Diego. activelivigresearch.org