# Exercise as it relates to Disease/Changing the school environment to increase physical activity in children

This page is a critique of the article: Lanningham-Foster L et.al (2008), Changing the School Environment to Increase Physical Activity in Children.

## What is the background to this research?

Obesity is a condition that is associated with having an excess amount of body fat, defined by genetic and environmental factors alike. Obesity in children is becoming ever more common in Australian children with 1 in 4 (aged 2-17) classified as overweight or obese. Sedentary behaviour is a common link to obesity and is associated with multiple damaging health outcomes, increasing the risk of type 2 diabetes and cardiovascular health along with many others. Children are on average spending 50-70% of their time at school in a sedentary state, further complimenting the constant rise in obesity.
Physical activity in early childhood is of high importance as it creates the foundation of behaviour in adulthood. In addition, exercise allows for development of muscular strength, endurance, balance and flexibility.
In order to reduce the amount of sedentary behaviour seen in school children today, a change in the traditional learning environment is of constant debate. With such debate Lanningham-Foster L, Foster R, et.al 2008 have suggested implementing an active-permissive learning environment to the everyday school curriculum as a strategy in preventing obesity in children.

## Where is the research from?

This research was conducted in the United States of America spread between two facilities within the State of Minnesota. The research was implemented at the Elton Hills Elementary School in Rochester, MN and the Rochester Athletic Club, MN.
All authors have conducted multiple studies in the area of obesity with Lorraine Lanningham-Foster an Associate Professor at the Iowa State University in the department of Food and Human Nutrition. It is important to note that six of the authors were affiliates of the Endocrine Research Unit Mayo Clinic Rochester, MN a clinic recognised as the best hospital in the nation (US) for 2018-19. It was disclosed that the authors declared no conflict of interest in this research.
This study is applicable to school children in Australia, as obesity is a major health concern that is rapidly increasing. School environments are similar to that of American schools, so therefore the results can be considered valid. However a similar study in Australia would provide evidence to validate this.

## What kind of research was this?

The research took the approach of a cohort longitudinal study, conducted in the Rochester Public school district. This method allowed Lanningham-Foster L, et.al 2008 to collect data whilst following their subjects over the course of the 12 week school period and summer vacation period. Conducting research in this manner allows the researchers the ability to analyse patterns of a variable over time. Longitudinal studies are highly accurate, however there is a risk of experiencing panel attrition, which refers to participants becoming unreliable or unavailable throughout the study.

## What did the research involve?

The research was conducted in three different school environments to evaluate the impact the school environment has on physical activity. The three differing environments implemented were:
1. Traditional school environment (individual seating and desks)
2. Active permissive environment “The Neighborhood” (encourage active learning)
3. The standing classroom (vertical standing desks)
One classroom of grade 4/5 students (14 girls, 10 boys) was selected from the Rochester Public School district to participate in all three differing school environments. A separate group of similarly aged children (6 girls, 10 boys) underwent the physical activity monitoring during the summer vacation period.
Data was collected 11 times over the course of a 12 week period. The classroom student’s were equipped with accelerometers 10 minutes prior to school commencing, and data was recorded at the end of the school day. Therefore indicating that any physical activity conducted outside of school hours is not accounted for, in the results.
Data collected on the summer vacation sample group was collected daily over a 10 day period at the Mayo Clinic General Clinical Research Centre. No specific time constraints were mentioned as to how long the accelerometer should be worn which could ultimately affect the results when compared to the classroom sample.

## What were the basic results?

* Physical Activity
Lanningham-Foster L, et.al 2008 results suggested that implementing “The Neighborhood” (active-permissive) environment in school is associated with a 50% increase in physical activity compared to that of the traditional classroom. Despite the intervention of implementing the standing classroom in schools the results found that this did not enhance physical activity in the children, displaying similar results to that of the traditional classroom environment.
The secondary study conducted on those children on summer vacation showed similar results to those in the active-permissive environment. This further emphasises the benefits an active-permissive style of education. The figure to the right highlights these results.
* Testing
All physical activity monitoring during the school period was analysed through a triaxial accelerometer worn on the thigh, however the summer vacation monitoring was analysed through a biaxial inclinometer worn on the thigh. Although comparison tests were performed to validate that the two accelerometers results were of similar values, it is important to take into consideration the use of two different accelerometers which provided data for the results.

## What conclusions can we take from this research?

The research conducted by Lanningham-Foster L, et.al 2008 has provided a effective intervention which addresses the rapid incline of childhood obesity. Despite governments providing education on the risks associated with obesity, the chronic disease has not plateaued. Similarly to the implementation of school swimming programs, future considerations should be given towards adopting an active-permissive school environment.
The study has been able to identify a clear decrease in sedentary behaviour during school hours due to the active-permissive style of learning. The results of this study align with other studies conducted in this area, although further studies should take into consideration physical activity trends both in and out of school hours to further predict trends in childhood sedentary behaviour.

## Practical advice

Although the conclusions made by Lanningham-Foster L, et.al 2008, were made on the basis of increasing physical activity in children, real-world implications occur as the approach may not be a feasible option with implications that it may stunt the educational growth of the children through these environmental changes. Furthermore it was stated that the active permissive environment recognised increased implications in areas such as funding, space and safety concerns.
For more information on children's physical activity guidelines refer to:
Link to Australia's Physical Activity and Sedentary Behavior Guidelines
Tips for staying healthy

## Further information/resources

Further information surrounding physical activity in schools and its benefits are linked below:
Benefits of Physical Activity in Schools
Ideas to Increase Physical Activity in Schools

## References

* ↑ Lanningham-Foster, L., McCrady, S., Foster, R., Manohar, C., Hill, J. and James, L. (2008). Changing the School Environment to Increase Physical Activity in Children. Medicine & Science in Sports & Exercise, Vol 40, pp1849 - 1853.
* ↑ Wang Y, (2004) Epidemiology of childhood obesity—methodological aspects and guidelines: what is new? vol 28, pp 21-28
* ↑ Australian Institute of Health and Welfare. (2018). Overweight & obesity Overview - Australian Institute of Health and Welfare. [online] https://www.aihw.gov.au/reports-statistics/behaviours-risk-factors/overweight-obesity/overview [Accessed 19 Sep. 2018].
* ↑ Tremblay, M., LeBlanc, A., Kho, M., Saunders, T., Larouche, R., Colley, R., Goldfield, G. and Gorber, S. (2011). Systematic review of sedentary behaviour and health indicators in school-aged children and youth. International Journal of Behavioral Nutrition and Physical Activity, Vol 8, pp 98 - 110.
* ↑ Minges, K., Chao, A., Irwin, M., Owen, N., Park, C., Whittemore, R. and Salmon, J. (2016). Classroom Standing Desks and Sedentary Behavior: A Systematic Review, Vol 137, pp 2-10
* ↑ Marks, J., Barnett, L., Strugnell, C. and Allender, S. (2015). Changing from primary to secondary school highlights opportunities for school environment interventions aiming to increase physical activity and reduce sedentary behaviour: a longitudinal cohort study. International Journal of Behavioral Nutrition and Physical Activity, Vol 12, pp.5-23.
* ↑ Hs.iastate.edu. (2018). | College of Human Sciences | Iowa State University. [online] https://www.hs.iastate.edu/directory/profile.php?u=lmlf [Accessed 17 Sep. 2018].
* ↑ Mayo Clinic. (2018). About Us - Top Ranked More Often. [online]https://www.mayoclinic.org/about-mayo-clinic/quality/rankings[Accessed 17 Sep. 2018].
* ↑ Bmj.com. (2018). Chapter 7. Longitudinal studies | The BMJ.[online] Available at: https://www.bmj.com/about-bmj/resources-readers/publications/epidemiology-uninitiated/7-longitudinal-studies [Accessed 18 Sep. 2018].
* ↑ Pearson, N., Braithwaite, R., Biddle, S., van Sluijs, E. and Atkin, A. (2014). Associations between sedentary behaviour and physical activity in children and adolescents: a meta-analysis. Obesity Reviews, Vol 15, pp.666-675.
* ↑ Gråstén, A., Yli-Piipari, S., Watt, A., Jaakkola, T. and Liukkonen, J. (2015). Effectiveness of School-Initiated Physical Activity Program on Secondary School Students' Physical Activity Participation. Journal of School Health, Vol 85, pp.125-134.