# Exercise as it relates to Disease/"Switch-Play" in children: is it effective in reducing sedentary behaviour?

The following is an analysis of the article "Reducing sedentary behaviour and increasing physical activity among 10-year-old children: overview and process evaluation of the 'Switch-Play' intervention".

## What is the background?

Over the past 25 years the prevalence of childhood obesity has more than doubled, with an estimated 20% of Australian children categorised as overweight in 2012. With this rising prevalence comes a need for prevention of unhealthy weight gain, through strategies aimed at educating children on healthy lifestyles. A large proportion of education on sedentary behaviour and weight loss is aimed at the parents only and not the children directly - thus, the authors are focused on teaching children how to help improve their own health and limit their sedentary time. This particular research is aimed at decreasing screen time and increasing physical activity time, as the amount of television and computer time children partake in has increased dramatically in recent years. There is belief that television viewing is linked not only to decreased physical activity time but also child requests for unhealthy snacks (as advertised), making it even more important to decrease screen time and increase activity. Targeting this after-school period by trying to change the amount of screen time participation is very important, as research shows the time spent after school is where the most extra physical activity (or sedentary behaviour) is accumulated. Further to this, by using a school program rather than a home-based one, the authors are addressing the difficulties some parents face when it comes to creating a healthy, active environment for their child.

## Where is this research from?

This research was conducted by authors from both the Centre for Physical Activity and Nutrition Research (Deakin University) and the Centre for Research into Adolescents' Health (University of Sydney).

## What kind of research was this?

This study follows on from a controlled trial that allocated children to one of several different "play" groups - the aim here was to analyse which group produced the largest decrease in screen time and increase in physical activity participation.
In this paper the authors examine not just the intervention results, but also the levels of participation, enjoyment and understanding from both the child and parent perspectives across the different groups. The research was conducted using surveys of parents, children and instructors, as well as analysing participation data of all children involved.

## What did the research involve?

This research looked at children from three government primary schools in Melbourne, and it assessed whether changes implemented in class time were effective, fun and well thought out. This is a supplementary study to the original trial, analysing the impact of the study on the children and families. Children in the selected schools were allocated to the following groups:
* Behaviour modification (BM) - included lessons on decision making, active lifestyle and changing screen time patterns.
* Fundamental motor skills (FMS) - aimed to improve the motor skills involved in physical activity, such as kicking and throwing.
* BM and FMS - a combination of the above.
* Control group - regular class format.
This particular study assessed the following:
* Child participation.
* Enjoyment and participation as assessed by the instructor.
* Enjoyment as understood by parents.
* Enjoyment as told by children.
* Parent understanding of "Switch-Play".
* Child understanding of "Switch-Play".

## What were the basic results?

The authors looked at child enjoyment, child participation and both child and parental understanding of the "Switch-Play" regimen.
The results for child participation and enjoyment across both groups is addressed in the tables below. Overall participation in all BM, BM/FMS and FMS sessions was averaged at 88%. In terms of homework, 57% of BM and 62% of FMS completed their tasks, compared to 92% of in-class tasks across both groups.
Table 1. Comparison of BM and BM/FMS group results.
| | BM | BM/FMS |
| Overall enjoyment | 80% | 88% |
| Overall participation | 88% | 88% |
| Overall TV viewing change | 62% | 79% |
Table 2. Comparison of FMS and BM/FMS group results.
| | FMS | BM/FMS |
| Overall enjoyment | 77.5% | 88.5% |
| Change in activity participation | 44% | 40.5% |
| Improvement in motor skills | 34-51% | 34-51% |
Only 44% of parents with children involved in the study completed questionnaires, which leaves room for potential error in the following results. In terms of parental evaluation and understanding, most parents thought that "Switch-Play" related to physical activity and wearing accelerometers. Less than 1% of parents thought that "Switch-Play" was about watching less TV. Around 50% of parents reported a change in activity levels and a decrease in TV viewing, and 78% reported that their child enjoyed the new school program that they had participated in.

## What conclusions can we make?

Not only are the results from the intervention important, but so are the levels of enjoyment, participation and understanding of why the intervention is necessary and effective in reducing sedentary behaviour in children.
Enjoyment is especially important in children, as it is difficult to highlight concepts of health to children without also including some sort of enjoyable task to replace other enjoyed activities (exercise and games for screen time). The authors feel that more information on whether theory-based interventions can increase activity levels is an important future direction. Another important aspect is to further study the effect of family, school and community support on a child's activity levels.

## Practical advice

It is highly important to encourage increased activity among children, but also to create a supportive environment that allows them to continue on with their newfound activity levels and reduced screen time. Improving not only the behaviours surrounding exercise and screen time, but also the motor skills involved in exercise might give a child more enjoyment and understanding of how being active improves their health.

## Further reading

Helpful links on:
* Causes of obesity in children.
* Ways to limit screen time.
* How to switch to play.
Further research on interventions to increase physical activity and decrease screen time:
* Transform-Us!
* Active For Life Year 5

## References

* 1 2 3 4 Salmon J, Ball K, Crawford D, Booth M, Telford A, Hume C, Jolley D & Worsley A. Reducing sedentary behaviour and increasing physical activity among 10-year-old children: overview and process evaluation of the "Switch-Play" intervention. Health Promotion International, 2006;20(1):7-17
* ↑ Garnett SP, Baur LA, Jones AMD & Hardy LL. Trends in the prevalence of morbid and severe obesity in Australian children aged 7-15 years, 1985-2012. PLOS one, 2016;11(5):1-7
* 1 2 Salmon J, Hume C, Ball K, Booth M & Crawford D. Individual, social and home environment determinants of change in children's television viewing: the Switch-Play intervention. Journal of Science and Medicine in Sport, 2006;9(1):378-387
* ↑ Hager, RL. Television viewing and physical activity in children. Journal of Adolescent Health, 2006;39(1):656-661
* ↑ Harrison M, Burns CF, McGuinness M, Heslin J & Murphy NM. Influence of health education intervention on physical activity and screen time in primary school children: "Switch Off-Get Active". Journal of Science and Medicine in Sport, 2006;9(1):388-394
* ↑ Arundell L, Hinkley T, Veitch J & Salmon J. Contribution of the after-school period to children's daily participation in physical activity and sedentary behaviours. PLoS ONE, 2015;10(10):1-11
* ↑ Spurrier NJ, Bell L, Wilson A, Lowe E, Golley R & Magarey AA. Minimal change in children's lifestyle behaviours and adiposity following a home-based obesity intervention: results from a pilot study. BMC Research Note, 2016;9(26):1-10
* ↑ Salmon J, et al. A cluster-randomized controlled trial to reduce sedentary behaviour and promote physical activity and health of 8-9 year olds: The Transform-Us! Study. BMC Public Health, 2011;11(1):759.