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Chapter 8 Physical activity Gillian Prior SUMMARY Age 2-15
Age 16-24
8.1.1 Background Increasing physical activity among adults has long been the subject of public health promotion policies. The health benefits of a physically-active lifestyle are well documented. Physical activity is one of the major risk factors for coronary heart disease and stroke which has been targeted by government health strategies since the early 1990s.1,2 Lack of physical activity has been shown to contribute to a range of other health conditions such as non-insulin dependent diabetes and osteoporosis.3 In addition there have been for many years internationally-accepted recommendations of the amount and type of physical activity among adults that is beneficial for health.4 For children and young people, on the other hand, there is less evidence of the benefits and desirable amount and type of physical activity. In 1997 the Health Education Authority initiated a process of expert consultation and review of the evidence surrounding the promotion of health-enhancing physical activity among young people, with the aim of producing a policy framework and recommendations, and produced review papers on key aspects of physical activity among young people.5 Evidence of direct relationships between activity and health among children is generally weak. However, small but beneficial associations have been demonstrated between physical activity and reduced overweight, fatness and obesity; psychological well-being; self-esteem; biological CVD risk factors; skeletal health and growth; other health-related risk factors; and tracking characteristics of childhood physical activity (that is, the extent to which an active child becomes an active adult).5 On the other hand physical activity can increase the risk of musculo-skeletal injuries, although this is mostly associated with over-exercise.6 Overall, as Riddoch argues, although the evidence is weak, the 'conceptual, biological and behavioural plausibility that physical activity is a healthful pursuit for children is high'.7 The outcome of the Health Education Authority's review process was a set of recommendations for young people and physical activity, where 'young people' is taken as all people aged 5-18. The primary recommendations are:
8.1.2 Child physical activity questions Questions relating to the physical activity of adults (age 16 and over) have been included in the Health Survey since its inception (with a break in 1995 and 1996), but 1997 was the first year such questions were included for children. For this reason, data presented in this chapter relate to the 1997 survey only. The Health Survey questions for adults were originally based on a major national study of activity carried out in 1990 (The Allied Dunbar National Fitness Survey),8 which included objective measurements of health and fitness (including heart rate monitoring) which were used to validate the physical activity interview questions. No such study existed for children's activity, so the development of the questions for the Health Survey was based on other smaller studies, and two sets of guidelines then published, proposing the levels of physical activity required for a health benefit for children. Extensive piloting of the questions was carried out in 1996, and a further stage of analysis and cognitive interviewing was carried out in mid-1997 (in preparation for the 1998 Health Survey).9,10 An important limitation of the Health Survey child physical activity module is that no attempt has been made to validate the questions by comparison with objective measures of activity and fitness, such as heart rate monitoring, use of motion sensors or physiological analysis. The module is thus purely based on self-reported activity. In addition, for children aged under 13 the questions are directed at a parent rather than at the child him/herself, so that for the younger children a proxy report of behaviour was obtained. Children would have been present during the interview, so in most cases would have contributed to the answers, but this is not certain. The Health Survey module attempts to limit the effects of inadequate recall by confining questions to activity in the seven days before the interview; this is in contrast to the adult questions which ask about activity over the last four weeks. Another important limitation, which should be borne in mind in considering the results presented here, is social desirability. There may be a tendency among some children/parents to over-claim levels of activity in the last week, by quoting what they believe the child would usually do rather than what was actually done, and to avoid the child being seen as inactive. Alternatively among some children (for example perhaps teenage girls) the tendency may be to under-claim activity levels as participation in sports/exercise, or particularly 'active play', is not fashionable. For children under 13 in particular it is possible that parents' responses reflect other stereotypes; for example parents may be more likely to claim high levels of activity for boys than for girls.11 Despite these limitations, the development work carried out and the results presented here confirm that at the broad level, the results on participation by age, sex, social class and health status are consistent with what might be expected given other available evidence, including studies that have incorporated objective methodology. 12,13 Methodology Children's physical activity is far more diverse than adults' and therefore more difficult to quantify. Children's activity patterns have been shown to be characterised by short, rather than sustained, bouts of activity,14 and are less likely to involve clearly-defined periods of specific activities. This makes the collection of data by structured questionnaire a complex task. The Health Survey questions collected details about the activity of children aged 2-15 in four main categories: Walking, Sports and Exercise activities, 'heavy' Housework and Gardening, and Active Play. The reference period was taken as the seven days before the interview. The decision was taken to exclude activities participated in as part of the school curriculum (that is, 'during school lessons'). This was for three main reasons: first, it was assumed that generally speaking the amount of activity carried out by children as part of the school curriculum would be similar for all children (according to their age) and so would contribute a 'standard' additional amount of activity for each child; second, activities as part of the school curriculum would generally be compulsory and it was felt that the survey was concerned more with what children would do of their own choice; and third, since a significant proportion of our data would be collected by proxy from a parent, it was felt that information about activities during school lessons would be less accurate than about activities during leisure time. However any activities carried out on school premises but not as part of school lessons (for example after-school clubs) were to be included. Data for Sports and Exercise activities and Active Play were collected separately for weekend and weekdays. Data collected for all activities was limited to activities that had lasted for at least 15 minutes, with the exception of Walking where children were asked if they had done any walks of at least five minutes, before going on to more detailed questions. Further details relating to the duration of activities were collected for Sports and Exercise activities and Active Play only. Details of what was included in each activity category are as follows:
In addition, a question intending to measure intensity of activity was included: 'On how many days last week did any of these (activities) make you breathe hard, huff and puff or make you hot and sweaty, for at least 15 minutes a time'. A set of questions on inactivity was also included, to assess the time spent 'Sitting', which included time spent sitting down doing things like watching television, or reading (or being read to). For younger children it included drawing or playing quietly, and for older children it included homework, listening to music or talking to friends. Information collected on 'Sitting' included the number of days at the weekend that the child had done 'Sitting' for at least 15 minutes a time; duration at the weekend; number of weekdays; duration each weekday. A limitation overall, which is perhaps particularly important for the Active Play category, was that no information was collected about activities carried out for less than 15 minutes (with the exception of a 'yes/no' question about walks of five minutes). For the youngest children in particular this may be too long a period, given the sporadic nature of their activity patterns. 8.1.3 Adult physical activity questions The adult physical activity module was developed for the 1991 Health Survey, and was repeated in 1997 with minor changes. The original Health Survey questions were based on those used in the Allied Dunbar National Fitness Survey (ADNFS) in 1990.8 The level of physical activity among adults has been measured in the Health Survey by the time spent being active, the intensity of the activity undertaken (in terms of energy expenditure) and the frequency with which it is done. In 1991 when the Health Survey physical activity module was first developed the internationally-accepted recommendations15 were that adults should take part in at least three occasions a week of vigorous activity lasting 20 minutes or more. By the mid-1990s however the emphasis had shifted towards encouraging people to take part in regular activity at a moderate level, as described in the 1994 Health Survey report.16 Although regular vigorous activity has been shown to produce maximum cardiac benefit for an individual, for the majority of the population this may have been an unrealistic target. Moderate activity became more important for health promotion, as it offered greater health benefits in the population as a whole.17 Recently the emphasis has shifted further, towards encouraging the accumulation of shorter bouts of activity (of as little as 10 minutes) to reach the daily target of 30 minutes.18,19,20,21 The latest guidelines for adults are that they should take part in at least 30 minutes of moderate activity on a daily basis (at least five days a week). In order better to measure achievement of this guideline, and to address the issue of accumulation, the Health Survey questions were slightly modified for the 1997 survey. Questions on physical activity were included in the 1997 Health Survey for all adults aged 16 and over. This chapter reports only on young people aged 2-24. Further analysis of the full adult physical activity data will be carried out as part of the 1998 Health Survey report, as the questions are being included again in the 1998 survey. 8.1.4 Adult physical activity definitions Types of activity Four main types of physical activity were asked about in the questionnaire:
For each activity type informants were asked on how many days in the last four weeks they had participated in the activity for at least 15 minutes a time. They were then asked how long they usually spent participating in the activity. For walking, informants were also asked on how many days they had taken more than one walk of at least 15 minutes. If they had taken more than one walk a day, the total time spent walking on that day was calculated as twice the average time taken for a walk. Intensity level In order to create a summary classification for this chapter, activities have been classified into intensity levels, based on an estimate of the energy cost of the activities. The levels are:
For sports and exercise, activities were classified according to the nature of the activity, and on the informant's own assessment of the amount of effort involved in doing that activity. For example, 'swimming' was counted as 'vigorous' if the effort was usually enough to make the informant 'out of breath or sweaty', otherwise as 'moderate'.22 For walking, informants were asked to assess their usual walking pace. Walks of 15 minutes or more at a 'brisk' or 'fast' pace were classified as 'moderate'. Walks at a 'slow' or 'steady average' pace were classified as 'light'. For home activity, informants were given examples of types of housework and gardening/DIY that counted as 'heavy' and 'light'. Heavy housework and heavy gardening/DIY were classified as 'moderate', other gardening/DIY as 'light', and light housework only as 'inactive'.23 For activity at work, a combination of factors was used for classification. The level of activity was assigned by combining the Standard Occupational Classification (SOC) code with the answer to a question about how physically active informants felt themselves to be in their jobs (if in work). For example, informants who said that they were very physically active in their jobs were only classified as doing 'vigorous' activity at work if their job was one of a short list of occupations; otherwise they were classified as 'moderately active' at work.24 8.1.5 Structure of this chapter As a result of using a different set of questions for informants aged 2-15 than for informants aged 16 and over, data for the age groups 2-15 and 16-24 are not directly comparable. Section 8.2 reports on physical activity among children aged 2-15, and Section 8.3 on activity among young adults aged 16-24. 8.2 Physical activity among children aged 2-15 8.2.1 Information collected about children As mentioned above, the questions relating to physical activity among children were divided into four groups:
Information was collected about children's activities in the seven days before the interview. All these activities can be described as involving at least moderate intensity
activity 8.2.2 Participation by children in different physical activities in the last week Table 8.1 summarises the proportion of children who participated in the different types of activity in the last week, by age and sex. For each activity type the proportions of children participating and not participating are shown, together with the mean number of days' participation. For Sports and Exercise and Active Play (for which details on durations of activities were collected), the mean number of hours' participation is also shown. Tables 8.2 and 8.3 give further details about the number of days' and number of hours' participation in the activities. Table 8.1 also includes a summary category: 'Any physical activities'. This adds together the number of days on which at least 15 minutes of Sports and Exercise, Active Play, Housework/Gardening and Walking was done. It should be noted that this summary probably over-estimates the actual number of days on which a child was active, as it assumes that each activity was done on a different day. So, for example, if a child had done Sports and Exercise and Active Play on the same day, this would get counted as two days of activity in the summary category. In considering these tables it should be remembered that no information was collected on activities carried out as part of the school curriculum, so any participation in school curriculum physical activity is excluded from these estimates. Figure 8A shows the proportions of boys and girls who had participated in each activity type asked about, by age. It can be seen that within the categories of activity there were marked differences by age and sex. Sports and Exercise 58% of boys and 51% of girls overall had participated in Sports and Exercise activities (of at least 15 minutes). Participation increased with age from age two (around three in ten children aged two doing some of these activities) to age 10 (76% of boys aged 10 had participated in Sports and Exercise activities, compared with 67% of girls aged 10). Participation then declined with age through to age 15, at which age 70% of boys had done Sports and Exercise, compared with 49% of girls (excluding any that had been done as part of school lessons). Above age 10, boys were far more likely than girls to have participated in these more organised sports activities. Active Play Levels of participation in Active Play tended to be higher among the younger children, although at nearly all ages boys were more likely to participate than girls. Around nine out of ten boys aged two (89%) participated in Active Play, compared with 80% of girls. The proportion of boys participating in this type of activity remained fairly level at between 84% and 89% through to age 10. Above age 10 the proportion of boys who participated in Active Play decreased, from 87% of those aged 10 to 75% of those aged 15. Among girls, the proportion who participated in Active Play initially increased, from 80% of those aged two to 85% of those aged five. From age 6-9 participation was fairly level at around eight in ten. From age 10 and above participation in Active Play declined steeply with age, from 71% of girls aged 10, to 35% of girls aged 15. Walking Participation in Walking increased fairly steadily with age among both boys and girls. Three-fifths of boys and girls aged two had done at least one walk of 15 minutes or more, increasing to around four-fifths of those aged 15. Housework/Gardening Participation in Housework/Gardening was asked about only for children
aged eight and over. Participation levels, although lower than for any
of the other types of activity, increased steadily with age. Among those
aged eight, 20% of boys and 26% of girls did some of this type of activity,
rising to 47% and 42% of boys and girls aged 15 respectively. 8.2.3 Number of days' participation by children in different physical activities Table 8.2 shows the number of days' participation in the different types of activity in the last week, together with the summary category 'All physical activities'. For the individual activity types the table shows the number of days in the reference week on which informants had carried out the activity type, for at least 15 minutes a time. Table 8.2 suggests that overall 78% of boys
and 70% of girls participated in some physical activity on five or more
days in the last week. The most common activity type overall was Active
Play; 53% of boys and 41% of girls had participated in Active Play for
at least 15 minutes on five or more days. 29% of boys and girls had
walked on five or more days. Levels of participation in Sports and Exercise
were lower, with 15% of boys and 7% of girls having participated on
five or more days. The least common activity type was Housework/Gardening,
which only 3% of boys and 4% of girls had done on at least five days. 8.2.4 Time children spent participating in physical activities Table 8.3 shows the total time spent participating in the different activity types in the last seven days, again on the basis of doing at least 15 minutes a day. As information on duration of Walking and Housework/Gardening was not collected, minimum estimates of these activities are counted (all occurrences of Walking and Housework/Gardening are counted as 15 minutes). For this reason, separate figures for total time spent Walking or Housework/Gardening are not shown. For all the activity groups shown, the mean time spent by boys was
higher than that spent by girls. Overall boys spent a mean of 10.41
hours in the last seven days doing any of the physical activities asked
about. The mean time spent by girls was significantly lower at 7.69
hours. Active Play was the most common type of activity, with a mean
of 7.14 hours among boys compared with 5.45 hours among girls. For Sports
and Exercise the mean time spent by boys was 2.55 hours, compared with
1.51 hours among girls. Figure 8B shows the mean time spent by boys and girls in all physical activities, by age. Among girls, the mean number of hours spent participating in physical activities declined steadily with age, from a mean of 10.27 hours among those aged two to 4.00 hours among those aged 15. The rate of decline in mean participation tended to accelerate after about age 10. Among boys, the mean time spent participating in physical activities was fairly level between age two (mean 12.00 hours) and age 10 (mean 12.29 hours). As with girls, the mean number of hours' participation decreased steadily after age 10, falling to 8.53 hours among boys aged 15. It is notable that up to about the age of seven, the mean number of
hours spent participating in physical activity did not differ significantly
between boys and girls. After age seven, however, boys' participation
increased slightly to age 10, while girls' participation levels began
to fall, so that by the age of 15 the mean number of hours spent by
boys in physical activity (8.53 hours) was more than twice that spent
by girls (4.00 hours). 8.2.5 Vigorous activity by children In addition to questions on different types of activity, a further question, aiming to get a measure of participation in vigorous exercise, asked on how many days in total the child did 'any vigorous activities that made (you/him/her) breathe hard, huff and puff or made (you/him/her) hot and sweaty', for at least 15 minutes a time. Participation in vigorous activity according to this definition was relatively low. Overall around six out of ten boys (59%) had done some activity of this kind in the last week, compared with around half of girls (47%). 32% of boys and 28% of girls had been vigorously active on only one or two days; only 17% of boys and 11% of girls had been vigorously active on five or more days. Among boys participation in this type of activity increased markedly with age. 37% of boys aged two had done some vigorous activities, rising to 71% among those aged 15. The mean number of days on which vigorous exercise was done also tended generally to increase with age, with a peak of 2.36 days at age 13, falling slightly to 2.02 days at age 15. Among girls the relationship with age was less clear. Participation
in this type of activity overall increased with age from age two (when
33% had done some vigorous activity) to age nine (when 57% had done
some vigorous activity). Above age nine, however, participation tended
to fall, so that by age 15, 46% of girls had been vigorously active.
The mean number of days' vigorous activity among girls peaked at 1.48
days at age nine, falling to 1.04 days at age 15. 8.2.6 Patterns of activity among children Table 8.5 shows the average time children spent participating in physical activities on each 'active' day (that is, each day on which they did some physical activity), by the total number of 'active' days in the last week. The table shows separate categories for those who were active on none, 1-4 and 5-7 days. The category for 1-4 days is broken down according to whether the average time spent per 'active' day was less than 30 minutes, or 30 minutes or more. For 5-7 days, the category is broken down according to whether the average time spent active was less than 30 minutes, 30-59 minutes, 60-119 minutes, or 120 minutes or more. This table is based for all activities on days of at least 15 minutes per activity. As before, time estimates for Walking and Housework/Gardening are included as 15 minutes, as detailed durations were not collected for these activities. Nearly all children had done some activity (of at least 15 minutes) in the last week - only 4% of boys and 6% of girls had no 'active' days. The proportion with no active days tended to be slightly higher among pre-school age children, for example among those aged two, 7% of boys and 10% of girls had no active days, compared with 4% for boys and 5% for girls aged five. This is probably an artefact caused by the imposition of a 15 minute minimum on activities discussed above (that is, the youngest children may have been active but not for as much as 15 minutes a time). At the opposite end of the scale, significant proportions of children reported very high levels of physical activity. 29% of boys and 19% of girls were active for at least two hours a day on most days (5 days or more). Among boys the proportion active at this level peaked at 36% of those aged 10, falling to 20% of those aged 15. However despite this decline with age, at all ages at least one fifth of boys were active at this high level. Among girls the pattern was quite different. The proportion active
for at least two hours on most days peaked at 30% of those aged four,
and then fell fairly steadily with age to only 6% of those aged 15. 8.2.7 Inactivity by children In addition to the questions on physical activities, a set of questions on inactivity was also included to assess the time spent 'Sitting', which included time spent sitting down doing things like watching television, or reading (or being read to). For younger children it included drawing or playing quietly, and for older children it included homework, listening to music or talking to friends. Information collected on 'Sitting' included the number of days at the weekend that the child had done 'Sitting' for at least 15 minutes a time; duration at the weekend; number of weekdays; duration each weekday. As for the physical activities reported above, time spent as part of school lessons was excluded. Tables 8.6 and 8.7 show the number of days 'sitting' for at least 60 minutes a day, and the total amount of time spent 'sitting' in the past week. Because the overall prevalence of 'sitting' was so high, data on number of days 'sitting' for shorter durations are not presented here. About three-quarters of both boys (73%) and girls (74%) had spent
at least 60 minutes 'sitting' on five days or more in the past week.
A significant minority of boys (17%) and girls (16%) reported no occurrences
of 'sitting' for an hour or more. The proportion of children 'sitting'
for an hour or more on most days increased steadily with age, from 56%
of boys and 48% of girls at age two, to 88% of boys and 90% of girls
at age 15. Figure 8C shows the mean total time spent
'sitting' over the last week, by age. Boys spent a mean of 12.52 hours,
and girls a mean of 13.26 hours 'sitting' in the last week. However
the mean time 'sitting' increased steadily with age, from 8.48 hours
among boys and 7.83 hours among girls at age two, to 16.99 hours among
boys and 17.93 hours among girls at age 15. Although the mean time spent
'sitting' was higher among girls in all ages from six upwards, the differences
between boys and girls were generally not large. Below age six the mean
time spent sitting by boys and girls was similar. 8.2.8 Summary measure of the activity levels of children In this section participation in the different types of activity has been summarised into a frequency-duration scale, by taking account of the average time spent participating in physical activities, and the number of active days in the last week. As before, there are some limitations as data was collected only about activities that lasted for at least 15 minutes a time, and duration of activities was not collected for Walking and Housework/Gardening. For these two activity types, therefore, any occurrence is counted as 15 minutes. For Sports and Exercise and Active Play, data on duration of activities was collected during the interview. It is assumed that all occurrences of these activity types are at least moderate intensity, which is probably accurate with the possible exception of Walking among older children, as noted above. The summary measure is as follows: Group 3 Active for 60 minutes or more on at least five days in the last week Group 2 Active for 30-59 minutes on at least five days in the last week Group 1 Active at a lower level or not active at all. This classification identifies those children achieving the recommended levels of activity of an average of one hour a day, or 30 minutes a day of physical activity of at least moderate intensity, counting '5 days or more' as equivalent to 'nearly every day'. It should be remembered that, as before, any physical activity carried out as part of the school curriculum would be additional to the estimates presented here. Table 8.8 and Figure 8D show the proportions of boys and girls in each of these activity groups, by age. The proportions of children in Groups 2 or 3 by age (that is, achieving at least the lower recommended activity level) are summarised below: Percentage of children doing at least 30 minutes activity on at
Overall, a higher proportion of boys than girls achieved the recommended levels - 55% of boys were in Group 3 (60 minutes or more), compared with 39% of girls. A further 16% of boys were in Group 2 (30-59 minutes), compared with 18% of girls. Overall 29% of boys did not meet either of the recommended levels, compared with 44% of girls. Among boys the proportion in Groups 2 and 3 increased from pre-school age to a peak at age 10, at which age 77% of boys met at least the lower activity recommendation. Above age 10 the proportion in Group 3 tended to decline with age, from 65% at age 10 to 48% at age 15. However this decline was matched by an increase in the proportion in Group 2, from 12% at age 10 to 23% at age 15, so that overall the proportion of boys in Groups 2 or 3 (ie. meeting at least the lower recommendation) decreased only a little, to 71% of boys aged 15. Among girls in contrast there was a marked fall from about age eight
or nine in the proportion meeting the recommended activity levels (ie
Groups 2 and 3). From age 12 the majority of girls were not meeting
either of the recommended levels. By age 15, only 36% of girls met at
least the lower target level of 30 minutes' activity per day. 8.2.9 Variations in participation in activity by children This section looks at variations in participation in activity overall (Groups 1, 2 and 3) and the different activity types (Sports and Exercise, Active Play, Walking and Housework/Gardening) by social class of head of household and equivalised household income. In addition, participation in activity overall is shown according to region, measures of self-reported health, and area and accommodation types. Tables for the different activity types are shown separately for boys and girls in two age groups - age 2-10, and age 11-15. These age groups were chosen, although they do not contain equal numbers of children, because above age 10, participation in some types of activity tended to decrease (as discussed above). Tables for activity overall (Groups 1, 2 and 3) are not shown split by age, as age did not tend affect the general relationships shown. Social class and equivalised income Tables 8.9 and 8.10 show proportions of boys and girls in Groups 1, 2 and 3 by social class and equivalised household income. There was no consistent relationship between overall activity and
social class or household income. However, there were differences in participation in the different activity types according to social class and equivalised household income, as shown in Tables 8.11 and 8.12. Table 8.11 shows a marked social class gradient in participation in Sports and Exercise among younger boys and all girls, with participation being lower among Social Classes IV and V. The proportions of children who had done some Sports and Exercise (of at least 15 minutes) in the last week, by age group, sex and social class, are summarised below: Percentage of children who had participated in Sports and Exercise
Among younger children, the proportion who participated in Sports and Exercise
decreased from 60% of boys and 63% of girls in Social Classes I and
II, to 45% of boys and 35% of girls in Social Classes IV and V. Among
older girls the trend by social class was less marked, while among older
boys (who were the group most likely to participate in Sports and Exercise)
there was no clear trend by social class. Table 8.12 shows participation in Sports
and Exercise by equivalised household income. The pattern is similar
to that for social class. In all the age/sex groups except older boys,
participation was related to household income. That is, children from
higher-income households were more likely to participate in Sports and
Exercise. For example, of girls aged 2-10, 34% in the lowest income
quintile households participated in Sports and Exercise in the last
week, rising to 64% in the highest income quintile. For Active Play, in contrast, the proportions of children who participated
in the last week did not vary by social class in either age group. However,
the proportion of older children who had done a lot of Active Play (that
is, participated on five days or more) tended to be higher among the
manual social classes (ie Social Classes IIIM, IV and V) than among
the non-manual classes (Social Classes I, II and IIINM). Similarly,
the proportion of children who had done Active Play on five days or
more tended to be higher among the lower income households. This tendency
was most marked among older boys: of boys aged 11-15, 52% in the lowest
income quintile households had done Active Play on five days or more,
falling to 34% in the highest income quintile households. The proportion of children who had done any Walking was similar across
the social classes. However, the proportion of children who had walked
very regularly (on five days or more) tended to be higher among the
manual social classes than among the non-manual classes. This relationship
held true among the four age/sex groups (ie. younger boys, older boys,
younger girls and older girls). This pattern was also apparent when
looking at equivalised household income. The proportion of children
Walking on five days or more decreased as household income increased.
For example, among boys aged 11-15, 48% in households in the lowest
income quintile had walked on five days or more in the last week, falling
to 24% in the lowest income quintile. Among girls, the proportion participating in Housework/Gardening tended
to be higher among the manual social classes. For example, of girls
aged 11-15, 34% in Social Classes I and II had done Housework/Gardening,
rising to 47% in Social Classes IV and V. Among boys there was no clear
trend according to social class. This pattern is again reflected when
looking at equivalised household income. Among girls, participation
in Housework/Gardening was highest in the lower income households. Among
boys there was no clear trend in participation by household income. Region Table 8.13 shows proportions of boys and
girls in activity Groups 1, 2 and 3 by region. Although there were some
differences in the proportions of children in each of the activity groups
by region, there was no consistent north/south relationship. The proportion
of boys and girls in Group 3 (high activity) was lowest in Trent (53%
of boys and 40% of girls in Group 3), and highest for boys in North
West (61%) and for girls in South and West (47%). Self-reported health Table 8.14 shows the proportions of boys and girls in activity Groups 1, 2, and 3 by self-assessed general health (very good, good or fair/bad/very bad), presence of longstanding illness, and number of days' acute sickness in the last two weeks (none, 1-3 days or four days or more). Overall activity participation varied markedly by self-assessed general health, with children with worse health (fair/bad/very bad) participating less in physical activities than children with good health. For example, 25% of boys and 40% of girls with 'very good' health were in Group 1 (ie not meeting the recommended level of activity), compared with 40% of boys and 53% of girls with 'fair, bad or very bad' health. There was no relationship between the presence of a longstanding illness and physical activity participation; the proportions of boys and girls in each of the activity groups were virtually identical, whether or not a longstanding illness was present. Not surprisingly, given that both sets of questions relate to the
period immediately before the interview, there was a clear relationship
between the number of days' acute sickness in the last two weeks and
physical activity participation (in the last week), with lower levels
of activity participation among children who had acute sickness. For
example the proportions in Group 3 (high activity) fell from 57% of
boys and 40% of girls who had no acute sickness, to 39% of boys and
28% of girls who had been sick for four days or more. Area and accommodation type Table 8.15 shows the proportions of children in each activity group by degree of urbanisation: urban, suburban or rural; and accommodation type: detached house, semi-detached house, terraced house or other (which includes flats or maisonettes in purpose-built blocks, converted houses or other types of building; caravans, mobile homes and houseboats; and other kinds of accommodation). Levels of physical activity participation were lower among children living in urban areas (44% of boys and 33% of girls in Group 3) than in suburban or rural areas (in rural areas 57% of boys and 41% of girls were in Group 3). There were no significant differences in participation between suburban and rural areas. Children living in terraced houses and 'other' accommodation (primarily
flats) had lower levels of participation in physical activity than those
living in detached or semi-detached houses. For example, the proportion
in Group 3 (high activity) fell from 59% of boys and 39% of girls living
in semi-detached houses to 46% of boys and 35% of girls living in 'other'
accommodation. 8.3 Physical activity among young adults aged 16-24 8.3.1 Measures used for young adults As explained above, information was collected about participation in Walking, Heavy Housework, Heavy Manual/DIY, Sports and Exercise and Occupational activity. For Heavy Housework and Heavy Manual/DIY, informants were asked the number of days on which they had done this in the last four weeks. They were then asked how long they usually spent doing the activity type on each day. For Walking, informants were asked the number of days on which they had taken a continuous walk of at least 15 minutes. They were also asked on how many days they had taken more than one of these walks, and the amount of time they usually spent walking each time. In calculating the total amount of time spent walking per day, days on which the informant took more than one walk have been counted as twice the average length per walk. In addition informants were asked to assess their usual walking pace (slow, steady average, fairly brisk or fast). Walking at a 'fairly brisk' or 'fast' pace is counted as moderate activity; a 'slow' or 'steady average' pace is counted as light activity. For Sports and Exercise, informants were asked if they had done any of a list of activities in the last four weeks, or any other sport or exercise not on the list.25 For each sport or exercise activity, informants were asked the number of days on which they had done the activity for at least 15 minutes a time; how much time they usually spent doing the activity on each day; and whether the effort of the activity was enough to make them out of breath or sweaty. For Occupational activity, the concept of an 'occasion' was not applicable, so no data on frequency or duration was collected. In previous Health Survey reports, adult physical activity questions have been analysed as 'frequency-intensity' scales, and by the proportions of adults reaching moderate level or above for the different activity types. In this report, in order to maximise comparability with the data for children, adult physical activity questions are analysed in terms of the number of days' participation in the different activity types, for at least 15 minutes a time. A summary classification of the number of days' participation in all physical activities of at least moderate intensity, for at least 30 minutes a day, is also presented. Since data for adults was collected about the four weeks before the interview, this involves averaging the number of occasions in the past four weeks to arrive at an average number of occasions per week. This means that data presented in this report are not directly comparable with those in previous Health Survey reports. The 1998 Health Survey report will present more data on adult physical activity, and will make comparisons with previous years. 8.3.2 Young adults' participation in different types of activity Table 8.16 shows the average number of days' participation per week in Heavy Housework, Heavy Manual/DIY, Walking and Sports and Exercise, for at least 15 minutes a time. In addition the table shows a summary classification of the number of days' participation in any physical activity for at least 15 minutes a time. In the summary classification, Occupational activity of at least moderate intensity is assumed to have been done for three days a week. For some informants in active jobs, this may under-estimate the number of days on which they were active. But overall the summary classification probably over-estimates the number of active days, as it assumes that each type of activity was done on a different day. So, for example, if an informant had done Walking and Heavy Housework on the same day, it would be counted as two days of activity in the summary classification. In calculating the (average) number of days per week of at least 15 minutes of each type of activity, the following conversion from the number of days in four weeks has been used:
The activity type most commonly reported by both males and females was Sports and Exercise. 80% of males reported at least one occurrence of Sports and Exercise (of at least 15 minutes a time). 29% of males had participated in Sports and Exercise on at least five days a week on average. Participation by females in Sports and Exercise was significantly lower than by males. 58% of females participated in Sports and Exercise at least once, and only 13% had done sports on at least five days a week. Among both males and females, participation in sports declined with age. Of males aged 16-18, only 86% had done some sport, falling to 74% at age 22-24. Of males aged 16-18, 39% had done sports on at least five days a week, falling to 22% of those aged 22-24. Among females, 61% of those aged 16-18 had done some sport, falling to 52% of those aged 22-24. Participation on five days a week or more similarly fell, from 18% of females aged 16-18, to 10% of females aged 22-24. The second most common activity among males was Walking. 53% of males had taken at least one walk of moderate intensity, decreasing with age from 60% of those aged 16-18 to 49% of those aged 19-21 and 51% of those aged 22-24. 27% of males had walked on at least five days a week. Again this proportion fell with age, from 31% of males aged 16-18 to 20% of those aged 22-24. Among females, 35% overall had taken at least one walk of moderate intensity, decreasing from 40% of those aged 16-18 to 30% of those aged 22-24. 15% of females had walked on at least five days. The proportion did not vary significantly by age. Among females the second most common activity type (after Sports and Exercise) was Heavy Housework. 48% of females had done some Heavy Housework. Participation in Heavy Housework increased with age; 31% of females aged 16-18 had done Heavy Housework, rising to 62% of those aged 22-24. Similarly the proportion who had done Heavy Housework on five days or more, although low overall, increased with age, from only 1% of those aged 16-18 to 8% of those aged 21-24. Fewer males (36%) than females (48%) had done Heavy Housework. As seen for females, participation among males increased with age: 29% of males aged 16-18 had done Heavy Housework, rising to 42% of those aged 22-24. Few males or females in this age range had done Heavy Manual /DIY, although participation was higher among males. 16% of males aged 16-24 had undertaken this type of activity, compared with 4% of females. Looking at the summary classification of participation in all of these types of activity (including activity at work), males aged 16-24 were more likely than females to have participated at all, and to have participated for a larger number of days. Only 6% of males had not done any moderate activities as defined here (for at least 15 minutes a time), compared with 15% of females. 61% of males had done some of these types of activity on at least five days a week on average, compared with 38% of females. Age trends in participation in activities overall were not marked. Younger
females tended to be less likely than older females to have participated
in activities of at least moderate intensity (81% of females aged 16-18
had done some of these activities, rising to 89% of those aged 21-24). Figure 8E shows the proportions of males and
females who had participated in each of the activity types, by age group. 8.3.3 Summary of young adults' overall participation in physical activity Tables 8.17-8.20 show a summary classification of participation by males and females in physical activity of at least 30 minutes' duration, by age, social class, equivalised household income and region. The summary classification shows the average number of days per week of participation in activities of at least moderate intensity, for at least 30 minutes a time. Occupational activities (moderate or vigorous) are counted as three occurrences a week of activity of at least 30 minutes. This classification shows the proportion meeting the current guidelines for adults, which are that they should carry out physical activities of at least 30 minutes' duration at least five times a week. Table 8.17 shows the summary classification by age group. 50% of males carried out physical activities for at least 30 minutes on five days or more, on average. This proportion was lower among those aged 22-24 (45%) than among the younger age groups (53% in those aged 16-18 and 19-21). Fewer than 10% of males in any age group had not done any of these activities for at least 30 minutes. Among females, the proportion achieving the recommended level of activity
was far lower, at 29% overall. This proportion did not differ significantly
according to age. However, it is interesting to note that the proportion
of females who had done at least some physical activity of at least
30 minutes' duration increased with age. Of females aged 16-18, 76%
had done some of these activities. This increased to 87% of those aged
22-24. This increase in overall participation with age seems largely
to be accounted for by the increase in the proportions of females doing
Heavy Housework, noted above. Tables 8.18 and 8.19
show the summary classification by social class of head of household
and equivalised household income. There were no clear trends in participation
in physical activity overall according to social class and income; however
base sizes for the different groups were small. Table 8.20 shows the summary classification
of physical activity by region. Although there appear to be some differences
between the regions in the proportions of males and females in each
of the summary categories, there are no consistent trends, and base
sizes for each region are small.
References and notes
1 See for example The Health of the Nation. A strategy for health in England, HMSO, London 1992; More
2 See for example Shaper A G and Wanamathee G. Physical activity and ischaemic heart disease in middle-
Powell KE, Thompson PD, Casperson CT et al. Physical activity and the incidence of coronary heart
3 See for example Helmrich SP et al. Physical activity and reduced occurrence of non-insulin-dependent
4 Killoran, A et al (eds). Moving on: international perspectives on promoting physical activity, Health
5 Biddle S, Sallis J and Cavill N (eds). Young and Active? Young people and health-enhancing physical
6 Riddoch C. Relationships between physical activity and physical health in young people in Biddle S, Sallis J 7 Riddoch C 1998 ibid, p.39 8Allied Dunbar National Fitness Survey, Health Education Authority and Sports Council, London, 1992.
9 Work on developing and amending the Health Survey questions on children's physical activity was carried
10 Prior G and Walker A. Children's physical activity: A report on development work carried out on a module
11 Limitations of the self-report approach are discussed in Sallis J. Self-report measures of children's physical
12 Armstrong N and Van Mechelen W. Are young people fit and active? in Biddle S, Sallis J and Cavill N 13 Armstrong N and Welsman J. Young people and physical activity, Oxford University Press, Oxford, 1997.
14 Armstrong N, Balding J, Gentle P and Kirby B. Patterns of physical activity among 11-16 year old British
15 American College of Sports Medicine. The recommended quantity and quality of exercise for developing
16 Gray R. Physical Activity in Colhoun H and Prescott-Clarke P (eds) Health Survey for England 1994,
17 Blair SN, Connelly JC. How much physical activity should we do? The case for moderate amounts and
18 Sallis JF and Patrick K. Physical activity guidelines for adolescents: consensus statement, Paediatric
19 Pate R R et al. Physical activity and public health: a recommendation from the Centres for Disease Control 20Strategy statement on physical activity, Department of Health, London, 1996.
21 US Department of Health and Human Services. Physical activity and health: a report of the Surgeon 22Sports and Exercise activities - Energy cost Vigorous: a) All occurrences of running/jogging, squash, boxing, kick boxing, skipping, trampolining.
b) Sports coded as vigorous intensity if they had made the informant breathe heavily or sweaty, but Moderate: a) See 'vigorous' category b).
b) All occasions of a large number of activities including: basketball, canoeing, fencing, field athletics, c) Sports coded as moderate intensity if they had made the informant breathe heavily or sweaty, but otherwise coded as light intensity, including: exercise (press-ups, sit-ups etc), dancing. Light: a) See 'moderate' category c).
b) All occasions of a large number of activities including: abseiling, baseball, bowls, cricket, croquet, darts, 23Home activities Examples of 'heavy' gardening or DIY work classified as moderate intensity: Digging, clearing rough ground, building in stone/bricklaying, mowing large areas with a hand mower, felling trees, chopping wood, mixing/laying concrete, moving heavy loads, refitting a kitchen or bathroom or any similar heavy manual work. Examples of 'heavy' housework classified as moderate intensity: Walking with heavy shopping for more than 5 minutes, moving heavy furniture, spring cleaning, scrubbing floors with a scrubbing brush, cleaning windows, or other similar heavy housework. Examples of 'light' gardening or DIY work classified as light intensity: Hoeing, weeding, pruning, mowing with a power mower, planting flowers/seeds, decorating, minor household repairs, car washing and polishing, car repairs and maintenance. 24Work activities Vigorous: Considers self very physically active in job and is in one of a small number of occupations defined as involving heavy work including: fishermen/women, furnace operators, rollerman, smiths and forge workers, faceworking coal-miners, other miners, construction workers and forestry workers. Moderate:
Considers self very physically active in job and is not in occupation groups listed above OR considers self any listed above OR fire service officers, metal plate workers, shipwrights, riveters, steel erectors, benders, fitters, galvanisers, tin platers, dip platers, plasterers, roofers, glaziers, general building workers, road surfacers, stevedores, dockers, goods porters, refuse collectors. Light: Considers self fairly physically active in job and is not in one of the occupation groups listed above. 25 The list of activities (presented on a card) was Swimming; Cycling; Workout at a gym/Exercise bike/Weight training; Aerobics/Keep fit/Gymnastics/Dance for fitness; Any other type of dancing;Running/jogging;Football/rugby; Badminton/tennis; Squash; and Exercises (eg press-ups, sit ups).
8.1 Summary of participation by children in different activities, by age and sex 8.2 Number of days' participation by children in different activities in the last week, by age and sex 8.3 Time children spent participating in physical activities in the last week, by age and sex 8.4 Number of days' vigorous activity by children in the last week, by age and sex 8.5 Average time spent by children per day inphysical activities and number of days active per week, by age and sex 8.6 Number of days children spent 'Sitting' in the last week, by age and sex 8.7 Time children spent 'Sitting' in the last week, by age and sex 8.8 Summary of children's activity levels, by age and sex 8.9 Summary of children's activity levels, by social class and sex 8.10 Summary of children's activity levels, by equivalised household income quintile and sex 8.11 Summary of children's activity types, by social class, age and sex 8.12 Summary of children's activity types, by equivalised household income quintile,age and sex 8.13 Summary of children's activity levels, by region and sex 8.14 Summary of children's activity levels, by self-reported health and sex 8.15 Summary of children's activity levels, by degree of urbanisation, accommodation type and sex 8.16 Young adults' average number of days participation per week in different activities, by age and sex 8.17 Summary of young adults' overall participation in physical activities, by age and sex 8.18 Summary of young adults' overall participation in physical activities, by social class and sex 8.19 Summary of young adults' overall participation in physical activities, by equivalised household income quintile and sex 8.20 Summary of young adults' overall participation in physical activities, by region and sex
Figure8A Proportions of children who had done each activity type in the last week Figure8B Average number of hours spent by children in physical activities in the last week, by sex Figure8C Average number of hours spent `sitting` in the last week, by sex Figure8D Proportions of children in Group 3 (high activity), Group 2 (medium) and Group 1 (low), by sex Figure8E Proporttions of those aged 16-24 who had done each activity type in the last four weeks (for at least 15 minutes)
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