Thinking Outside the Gym
RESEARCH INSTITUTE Thinking Outside the Gym: An Integrated Perspective for Healthy Movement Behaviours in Early Childhood Mark Tremblay, Ph.D., D.Litt. (hons), FACSM, CSEP-CEP Director, Healthy Active Living and Obesity Research Group Children’s Hospital of Eastern Ontario Research Institute Professor, Department of Pediatrics, University of Ottawa Chair, Active Healthy Kids Global Alliance RESEARCH INSTITUTE I have received consulting, speaking, travel and/or research support from: Canadian Institutes of Health Research Canadian Population Health Initiative Public Health Agency of Canada Statistics Canada Dairy Farmers of Canada Laval University University of British Columbia University of Victoria University of Alberta University of Calgary University of Saskatchewan University of Manitoba Lakehead University Laurentian University Nipissing University University of Toronto University of Western Ontario University of Moncton University of Guelph York University Queen’s University University of Ottawa McGill University UPEI University of New Brunswick University of Guadalajara University of South Australia Conference Board of Canada University of Maringa Shanghai Sports University The Moblees West Texas A&M University Dalhousie University University of Jyvaskyla The Lawson Foundation Alberta Centre for Active Living Heart and Stroke Foundation of Ontario Ontario Ministry of Health Promotion Active Healthy Kids Canada ParticipACTION Fundacion Mexicana para la Salud Canadian Obesity Network New Brunswick School District #2 City of London Manitoba Institute of Child Health Chronic Disease Prevention Alliance of Canada Canadian Federation of Biological Societies Heart and Stroke Foundation of Canada Heart and Stroke Foundation of Ontario StepsCount Chatham-Kent Public Health Unit Huron-Perth Public Health Unit Ontario School Boards Association Bruce-Grey Public Health Unit Kellogg Canada World Health Organization Ontario Ministry of Health Promotion Ontario Ministry of Health and Long-Term Care Strathclyde University American Society of Bariatric Physicians Fuzhou Normal University American College of Advanced Medicine Ophea Respironics, Inc. Physical and Health Education Canada Upper Canada District School Board Ottawa Catholic School Board Canadian Society for Exercise Physiology Australian Council for Health, PE and Rec Halton Health Region Peel Health Region Canadian Home Economics Foundation Recreation and Parks Association of Yukon Capital Health Authority Newfoundland and Labrador Parks & Rec Refreshments Canada NB Power New Brunswick Health and Wellness Alberta Health and Wellness Nova Scotia Recreation Commission PEI Health Canadian Fitness and Lifestyle Res Institute CAHPERD Health Canada Statistics Canada Macro International CHEO Research Institute Jalisco Ministry of Health World Obesity Federation Canada Foundation for Innovation Thunder Bay Public Health South West University (China) Glasgow Caledoinan University Champlain LHIN Champlain Cardiovascular Disease Network Medical Research Fund of New Brunswick North American Soc for Ped Exercise Med Interprovincial Sport and Recreation Council Pennington Biomedical Research Center Diabeaters Inc. CAMBIO Nanjing University Shangdong University Beijing Sport University Ontario Society for Health and Fitness World Health Organization England Department of Health Wellcome Trust McMaster University Cancer Prevention Alliance of Canada C-CHANGE TROPIC Alberta School Boards Association Canadian School Boards Association Cardel Place Coca-Cola Company International Life Sciences Institute Discovery Vitality (South Africa) ActionSante (Switzerland) Ontario College of Family Physicians University of South Australia Canada Foundation for Innovation South Africa Nutrition Society Da Lian Department of Education Public Heath Ontario RESEARCH INSTITUTE RESEARCH INSTITUTE Presentation Overview • Status of healthy active living in the early years • Canadian guidelines for the early years • An integrated perspective on healthy moving – International comparisons – Evidence along the movement continuum – More than just “be active” • Some thoughts about doing things differently RESEARCH INSTITUTE THE HEALTH CONTINUUM Optimum Wellness increased functional capacity increased health contingency Death morbidity detectable illness threshold RESEARCH INSTITUTE Are we mortgaging the health of our population? increased functional capacity increased health contingency morbidity detectable illness threshold Optimum Wellness increased functional capacity increased health contingency Role for you! morbidity Death RESEARCH INSTITUTE Designed to Move: A Physical Activity Action Agenda. 2012 RESEARCH INSTITUTE Are we getting healthier? Previous generation (1924-48) vs baby boomers (1948-1964) Indicator Previous Boomers excellent health 32.0% 13.2% walking assistance 3.3% 6.9% work limitations 10.1% 13.8% functional limitations 8.8% 13.5% obesity 29.4% 38.7% regular exercise 49.9% 35.0% no regular PA 17.4% 52.2% hypertension 36.4% 43.0% hypercholesterolemia 33.8% 73.5% King et al. JAMA Int. Med. 173:385-6, 2013 RESEARCH INSTITUTE Trends in drug expenditures in Canada 30 25 20 15 10 5 11 20 09 20 07 20 05 20 03 20 01 20 99 19 97 19 95 19 93 19 91 19 89 19 87 19 85 0 19 $ in billions 35 CIHI, 2013 RESEARCH INSTITUTE 19% overweight 15% obese 34% total RESEARCH INSTITUTE 19% overweight 11% obese 30% total RESEARCH INSTITUTE Portrait of a typical Canadian 12 year old Tremblay et al. Health Reports, 2010 RESEARCH INSTITUTE CANADIAN PHYSICAL ACTIVITY GUIDELINES FOR THE EARLY YEARS Aged 0-4 years RESEARCH INSTITUTE RESEARCH INSTITUTE Research question What is the frequency, intensity, time and type of physical activity, as measured by direct and indirect methods, associated with improved health indicators in preschool aged children (0-4 years)? RESEARCH INSTITUTE Age groups • • • • Infants: 0 - 1.0 years Toddlers: 1.1 - 3.0 years Preschoolers: 3.1 - 4.99 years Defined collectively as “the early years” Canadian Society for Exercise Physiology, 2012 RESEARCH INSTITUTE Health Indicators Health Indicator Infant (<1 y) Toddler (1-2 y) Preschool (3-4 y) Critical Critical Critical Unimportant Important Critical Motor development Critical Critical Critical Psychosocial health Unimportant Critical Critical Cognitive development Important Important Critical Cardiometabolic health Unimportant Unimportant Important Critical Critical Critical Adiposity Bone Risks (injury) RESEARCH INSTITUTE 11,222 18 12,742 participants RESEARCH INSTITUTE What did we find • • • • • 5 studies in infants 2 studies in toddlers 11 studies in preschoolers 12,742 enrolled participants from 8 countries Articles from 1972 to 2011 RESEARCH INSTITUTE What is the evidence “In infants, there was low- to moderate-quality evidence to suggest that increased or higher physical activity is associated with improved measures of adiposity, motor skill development, and cognitive development.” “In toddlers, there was moderate-quality evidence to suggest increased or higher physical activity was positively associated with bone and skeletal health.” “In preschoolers, there was low- to high-quality evidence on the relationship between increased or higher physical activity and improved measures of adiposity, motor skill development, psychosocial health, and cardiometabolic health indicators.” RESEARCH INSTITUTE Physical Activity Guidelines Guidelines: Agreement 527 responses – 94% agree Guidelines: Clarity 524 responses – 92% agree 63.90% 63.2% 29.2% 29.54% 2.1% 2.12% 5.41% 5.3% 0.19% 0.2% 68.80% 67.4% 27.71% 27.1% 1.94% 1.9% 3.29% 3.2% 0.39% 0.4% 331 153 11 28 1 355 143 10 17 2 Completely Somewhat agree agree Neither agree nor disagree Somewhat Completely disagree disagree Completely Somewhat agree agree Neither agree nor disagree Somewhat Completely disagree disagree RESEARCH INSTITUTE Knowledge Translation: Tools and Resources published online: csep.ca/guidelines RESEARCH INSTITUTE Clinical Practice Guideline Development Report (AGREE Report)* Scientific Statements for professionals Backgrounder Q&A *available in English only Information Sheets for professionals and the public Glossary of Terms Media Release RESEARCH INSTITUTE RESEARCH INSTITUTE Messaging RESEARCH INSTITUTE Messaging RESEARCH INSTITUTE RESEARCH INSTITUTE RESEARCH INSTITUTE RESEARCH INSTITUTE RESEARCH INSTITUTE An Active Day? 6 hours 30 min 30 min 30 min YES! 45 min 15 min 3 hours 4 hours RESEARCH INSTITUTE Sitting Time Deaths per 10,000 person-years 180 Active 160 Inactive p<0.001 140 120 p=0.008 100 80 60 40 20 0 <25% 25% 50% 75% >75% Katzmarzyk et al. MSSE. 41(5): 998-1005, 2009 RESEARCH INSTITUTE Breaks In Sedentary Time Dunstan et al, 2010 (Touch Briefings) RESEARCH INSTITUTE Benefits of Breaks in Sedentary Time Independent of total sedentary time and moderateto-vigorous intensity activity time, increased breaks in sedentary time were beneficially associated with waist circumference, BMI, triglycerides, and 2-h plasma glucose. Healy et al. 2008 (Diabetes) RESEARCH INSTITUTE Katzmarzyk. Med Sci Sport Exerc. 46:940-946, 2014 RESEARCH INSTITUTE Systematic review of the relationship between sedentary behaviour and health indicators in school-aged children and youth (232 studies, 983,840 participants) This review found that being sedentary for more than 2 hours per day was associated with • unfavourable body composition • decreased fitness • lowered scores for self esteem and pro-social behaviour • decreased academic achievement Tremblay et al. IJBNPA 8:98, 2011 RESEARCH INSTITUTE RESEARCH INSTITUTE Associations of sedentary behavior, sedentary bouts and breaks in sedentary time with cardiometabolic risk in children with a family history of obesity Co-authors: Mark Tremblay, Marie-Ève Mathieu, Mélanie Henderson, Jennifer O’Loughlin, Angelo Tremblay and JP Chaput Acknowledgements: Participating families, Katherine Gray-Donald, Marie Lambert Saunders et al. PLOS ONE, 2013 RESEARCH INSTITUTE Physical Activity: 65 mins/day Sedentary time: 8 hours/day Sedentary Breaks: Frequent Physical Activity: 65 mins/day Sedentary time: 8 hours/day Sedentary Breaks: Infrequent RESEARCH INSTITUTE Physical Activity: 65 mins/day Sedentary time: 8 hours/day Screen Time: 1 hour/day Physical Activity: 65 mins/day Sedentary time: 8 hours/day Screen Time: 5 hours/day RESEARCH INSTITUTE Movement variability is associated with clustered cardiometabolic disease risk in American youth Co-authors: Val Carson and Mark Tremblay Acknowledgements: Participating families Saunders et al., in revision (IJBNPA) RESEARCH INSTITUTE Physical Activity: 65 mins/day Sedentary time: 8 hours/day High Movement Variability Physical Activity: 65 mins/day Sedentary time: 8 hours/day Low Movement Variability RESEARCH INSTITUTE Optimal levels of cardiometabolic disease risk are Thelikely Take-Home Message most to be seen in children who: 1. Limit their time engaging in screen-based sedentary behaviours. 2. Frequently interrupt their sedentary time. 3. Who have high levels of variability in their movement behaviours. RESEARCH INSTITUTE Sedentary Behaviour Research Network (SBRN) • >900 members since Summer 2011 • Members from around the world • Members include researchers, students, clinicians, public health professionals and private sector personnel • >35,000 visitors/month to the website www.sedentarybehaviour.org RESEARCH INSTITUTE CANADIAN SEDENTARY BEHAVIOUR GUIDELINES FOR THE EARLY YEARS Aged 0-4 years RESEARCH INSTITUTE What is sedentary behaviour RESEARCH INSTITUTE RESEARCH INSTITUTE Sleep is NOT a Sedentary Behaviour RESEARCH INSTITUTE Appl. Physiol. Nutr. Metab. 2012;37:753–772 RESEARCH INSTITUTE 6,365 22,417 21 participants RESEARCH INSTITUTE Conclusions of Systematic Review 1. Increased screen time is associated with unfavourable measures of adiposity, psychosocial health, and cognitive development. 2. Available research provides no specific information on the amount of total sedentary behaviour associated with health. 3. No evidence that there are risks associated with decreasing screen time and other sedentary behaviours. RESEARCH INSTITUTE Sedentary Behaviour Guidelines Guideline: Agreement 601 responses – 92% agree Guideline: Clarity 601 responses – 95% agree 76.38% 71.5% 24.87% 23.3% 2.49% 2.3% 2.66% 2.5% 0.36% 0.3% 73.23% 68.7% 25.18% 23.6% 3.19% 3.0% 4.26% 4.0% 0.71% 0.7% 430 140 14 15 2 413 142 18 24 4 Completely disagree Completely agree Completely agree Somewhat Neither agree Somewhat agree nor disagree disagree Somewhat Neither agree Somewhat agree nor disagree disagree Completely disagree RESEARCH INSTITUTE Appl. Physiol. Nutr. Metab. 2012;37:370–380 Knowledge Translation: Tools and Resources published online: csep.ca/guidelines RESEARCH INSTITUTE Clinical Practice Guideline Development Report (AGREE Report)* Scientific Statements for professionals Backgrounder Q&A *available in English only Information Sheets for professionals and the public Glossary of Terms Media Release RESEARCH INSTITUTE RESEARCH INSTITUTE Messaging RESEARCH INSTITUTE Should we Consider Strategies for… • • • • • • Reducing auto-dependency – car time Reducing nature-deficit disorder Reducing indoor time Reducing screen time Reducing chair time Other indices for reducing sedentary behaviours RESEARCH INSTITUTE FITT vs SITT • • • • Frequency Intensity Time Type • • • • Sedentary Interruptions Time Type RESEARCH INSTITUTE M.S. Tremblay. Assessing the Level of Sedentarism. In C. Bouchard and P.T. Katzmarzyk (Eds.), Advances in Physical Activity and Obesity. Human Kinetics Publishers, 2010. RESEARCH INSTITUTE RESEARCH INSTITUTE RESEARCH INSTITUTE RESEARCH INSTITUTE RESEARCH INSTITUTE RESEARCH INSTITUTE RESEARCH INSTITUTE Global Findings • • • • • Wide global variation exists for most indicators, allowing potential for global learning transference Most countries are BOTH leading and lagging in some indicators In developed countries it seems we have built it but they are not coming When children are given the opportunity/freedom, they like to move A mix of physical activity opportunities are needed to reach desired levels: sport, play, chores, active transportation RESEARCH INSTITUTE Research and surveillance gaps • • • • • Global matrix is a start but many areas of the world not represented - we need to expand this process More global comparative research is needed on PA and SB correlates and determinants Better (especially more representative) and standardized measures of all indicators are required Data on young children (toddlers and preschoolers) needed Research on play and light activity particularly needed RESEARCH INSTITUTE Conclusion From Global Matrix 1.0 The global comparisons remind us of the importance of habitual physical activity, pervasive throughout the day – not simply planned and structured doses of movement. Physical activity is not an item to check off your list of things to do – it is a way of life – this is the message I glean from the global comparisons. Together, with our domestic stakeholders and our global partners, we have new and compelling evidence that can guide innovative and novel solutions to power the movement to get kids moving – and inform our work to improve the grades in the years ahead. RESEARCH INSTITUTE www.activehealthykids.org RESEARCH INSTITUTE RESEARCH INSTITUTE Can’t See the Forest for the Trees? • Recommendations for physical activity cluster around 30-60 min MVPA daily • Surely the other 23.0 – 23.5 hours (96-98%) of the day matter! • Why focus on the 2% and not the 98%? • Beware of behaviour compensation RESEARCH INSTITUTE The Movement Continuum Sedentary Physiology sleep sedentary behaviour - Exercise Physiology LPA moderate physical activity METS intense exercise + RESEARCH INSTITUTE RESEARCH INSTITUTE RESEARCH INSTITUTE RESEARCH INSTITUTE Engelen et al. J Phys Act Health 12:8-12, 2015 RESEARCH INSTITUTE RESEARCH INSTITUTE Updating the Guidelines We proposed a cyclical update of the guidelines as follows: Year Age group to be updated 2012 Young Children ages 0-4 (created) 2014 Children and Youth 2015 Adults 2016 Older Adults 2017 Young Children 2018 Children and Youth 2019 Adults 2020 Older Adults RESEARCH INSTITUTE Canadian Integrated 24-hour Movement Behaviour Guidelines: Guideline Development Meeting #1 Montebello, QC December 8-10, 2014 RESEARCH INSTITUTE RESEARCH INSTITUTE RESEARCH INSTITUTE RESEARCH INSTITUTE Key concepts • • • • Whole day thinking – compositional analyses Habitual Patterns may matter – movement variability Multiple intervention entry points – can be personalized • Back to basics thinking – – – – Eat well Move well Sleep well Avoid toxins RESEARCH INSTITUTE RESEARCH INSTITUTE “we spend the first two years of life teaching kids to walk and talk – and then the next 16 years telling them to sit down and shut up” anonymous “they have listened – now we need to fix it” common sense RESEARCH INSTITUTE “Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change we seek.” Barack Obama RESEARCH INSTITUTE
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