Children and sport

Encouraging a healthy attitude to exercise should start in primary school

Links between exercise and health are well established,1 yet levels of activity among adults are at best moderate and in many cases low.2 3 4 Concerns about the decline in provision of physical activity for children at school have been raised at various times during the past decade.5 6 Against this background the British government's new policy statement on sport, “Raising the Game,” aims to help schools to re-establish sport as “one of the great pillars of education,” to achieve “the wider social and health benefits of sport,” and to assist children to make “informed decisions about adopting healthy and active lifestyles.”7 Although this comes at a time when schools have weathered a great deal of change, much of which has affected the teaching of sport,5 cynics might still observe that there is a lot of ground to be made up before all pupils play sport in the sunlit uplands described in the report. The main thrust of the publication is about raising standards and levels of participation, but medical interest will focus on its statements about the contribution of sport to health.

British children now take part in less physical activity at school than almost all of their European counterparts.8 In 1987, 38% of 14 year olds at state schools did less than two hours' physical education a week, and by 1990 the figure was 71% (although recently there has been a small improvement).9 In 1994, a survey of 4400 children aged 6 to 16 revealed that just under half of them spent two or more hours per week in physical education lessons.10 Even among primary school children, sustained periods of regular activity lasting for 20 minutes, which raise the heart rate above recommended thresholds, are not as common as they might be.11 Poorly maintained playing fields and shortages of qualified teachers of physical education at primary level also contribute to reduced activity levels in this age group.12 Although children remain the fittest section of the population, few experience regular levels of activity at school or at home sufficiently energetic to stress their heart and lungs appropriately.13 14 15

Sedentary children become sedentary adults,8 16 and activity declines in children as they grow up; boys and girls of 17 and 18 can be as much as 50% less active than those in early years of secondary schooling.17 Physical activity at school is an important determinant of children's exercise behaviour. Outside of school, less than half of children exercise more than three times a week, although the majority do so at least once.17 Interventions to change children's preferred activity levels need to start early, probably in primary schools,14 or better still at home.18 The problem is in getting the recipe right—get it wrong and you can put children off for life.17 18 19 20

Has the British government got it right with its strong emphasis on competitive sport and team games? The policy statement proposes a minimum of two hours of sport and physical education a week for all children aged up to 16. Within this, more time is to be given to team games. As a result of the report, schools may offer extra sport to those children who want more, but the particular need to encourage more activity in sedentary 16-18 year olds still at school is largely ignored. And what about the actual activities available at school? Surely, in addition to offering experience of the fun of playing as a member of a team, we should also be developing an understanding of how to acquire and maintain a reasonable level of fitness, cultivating in children skills sufficient to enable them to enjoy a range of indoor, outdoor, and dance activities, and most of all generating an enthusiasm sufficient for young people to want to continue some form of physical activity when schooling ends.

Giving more of the very modest two hours a week of physical education to team games leaves less time for the other areas, even if certain schools do manage to offer some of these activities as options outside the school day. The low training effect of lessons and lack of qualified teachers in some schools12 will be partly addressed by following the report's recommendation to improve professional and inservice training of physical education teachers and by encouraging non-specialist teachers to gain coaching awards. None of this is new—even the proposed discretionary awards to teachers for out of hours work have been in use for some time—but perhaps making these plans more explicit will in the longer term help to raise standards in some lessons.

Doctors of many specialties have an interest in this paper. Today's schoolchildren are tomorrow's middle aged local populations. Purchasers of health care expend efforts promoting the benefits of exercise while providers use scarce resources treating the results of inactivity. Encouraging middle aged people to take more exercise has its place, but social and educational policies designed to develop in children, from the beginning, positive attitudes to exercise are more likely to be effective. The policy statement is a start.