Scoring F for fitness - how can we help children in Wales?

Dr Nick Wilkinson, Officer for Wales, recently joined a workshop on physical activity in children and young people to learn why kids in Wales scored F for fitness, what this means for them and, when in clinic, what he should be assessing, saying and signposting. He shares his findings.
Dr Nick Wilkinson, Officer for Wales

I love the Swansea foreshore and my cycle to a clinic at Singleton - no matter the weather. More recently I had the fortune to pedal the other way, amid blue skies, to the University Bay Campus. This was to join a crowd of enthusiastic and skilled colleagues across the therapies, nursing, counsellors, charities and research all invested in encouraging our children and young people to increase their physical activity. But have we been saying the right thing, because “Kids in Wales score F for Fitness”?

This was one of a series of workshops run by a dedicated team at the Welsh Institute of Physical Activity Health and Sport (WIPAHS), who produced the Welsh report card as part of a study involving 60 other countries. They are intent on reversing a deteriorating trend in physical activity in children and young people. Please complete their survey which closes on 30 October [now closed].

A case study

A nine year old boy diagnosed three years previously with juvenile arthritis affecting a knee and ankle was seen in follow up complaining of leg pain. Even though there was a trace of disease activity this could not explain the pain but his deconditioning could.

Asking about his physical activity, his step count was just 4,000 and his mother was still concerned from when she was told - possibly by a GP, possibly a physio or hospital doc - he should avoid sports while awaiting assessment.

"Sit less, be active, play more"

This was the title of our workshop. Simple.

The health benefits of physical activity are manifold, often later in life - reductions in early mortality (by up to 30%) from coronary heart disease, stroke, and type 2 diabetes - with physical activity behaviours typically set in childhood.1  In the young physical activity more specifically boosts self-esteem, mood, sleep quality and academic performance, whilst countering the effects of anxiety, depression, pain and fatigue.

True to their work, WIPAHS integrated movement into the workshop, not as you might think with running on the spot or touching our toes between talks, but with a purpose that kept us moving and thinking. We don't have to think of physical activity as discrete points of exercise. The day took us, of course, out onto the beach and we walked and talked as we explored the exercise labs and other research facilities learning about the impact of the pandemic and how physical activity differs from sport and exercise. 

For instance, based on actigraph data, children are generally far more active at school break times than in organised sport or dance and missing school during the pandemic not only saw physical activity levels drop off a cliff but also saw a delay in the development of gross motor milestones such as the ability to catch. 

The definition of sedentary behaviour

Any waking behaviour using less than 1.5 energy (metabolic) equivalents of lying and sitting. It includes desk (or bed!) based work or studies, riding in a car or bus, and of course most forms of screen time. For some it will also include wheelchair use and is highly correlated with low (step) counts on an accelerometer.

Beware of the chair!

Chairs in all their manifestations might not have quite the negative impact as cigarettes, but sedentary behaviour is an independent risk factor for poor long-term outcomes from coronary vascular disease and cancer.2  It is also the principal reason why Wales scored F for Fitness and the deteriorating trend. 

In the 2021 study, of those aged 11-16y in Wales just 13-17% met international guidelines of 60 min physical activity per day.3  This increased to half of all CYP when including preschoolers and those at primary school. In comparison Slovenia, New Zealand and Zimbabwe, where physical activity is driven by pervasive cultural norms, scored A minus. 

So why so low, when Wales received a B plus for PE and sports in schools?  It’s the amount of sedentary time - watching TV, playing computer games, staring at phones and riding in cars as well as sitting for lessons and homework.

So what can we do in health?

  1. Avoid inadvertently stigmatising physical activity. Why do we say “oh you have earache or tummy pain - better rest up and not do PE”. It's a knee jerk response, with unclear assumptions. If the condition is more longstanding - a hole in the eardrum, IBS or arthritis - who is there actively promoting a return to all activity? So it's not surprising I meet many who still view physical activity as harmful, when the opposite is true - inactivity in adults with osteoarthritis is associated with faster deterioration in pain and joint damage.
  2. Ask about sedentary time. It is easier to nudge this than encourage those unused to activity to engage in regular defined sport, dance or other moderate-to-vigorous activity. 
  3. Encourage an increase in step count; a simple way to reduce sedentary behaviour. This is accessible on most young people’s phones and in the past week all but one in my clinic could tell me their step count. A target of 8000-10,000 is reasonable and lower levels correlate with increasing sedentary time. In addition make families aware of the major drop off in physical activity out of school term time. 
  4. Address perceived barriers to activity including lack of time, motivation and resources. Suggest the family tag regular times during the week to make it routine, and keep it fun, simple, achievable and often. Self image may also be a barrier - a young overweight lad feeling trapped by his arthritis responded well to the suggestion of joining a boxing gym, while suggestions of baking or cooking may be well received by others. Of course this allows for other healthier weight conversations too and suggestions of helping with household chores may at least raise a smile or groan, but remain a practical tip.
  5. Parents ideally should be a role model, whilst other social connection or contact with friends can be motivational too. This has been the success of parkrun. Other opportunities include drop off for school a distance away to walk in with friends and avoid car congestion and the list can go on. 
  6. Provide website details - lastly I would like to recommend some websites for more individualised ideas: