- Richard Krajicek Foundation
This project is funded through The Netherlands Organisation for Health Research and Development (ZonMw); project number 200120009. ZonMw funds health research and stimulates use of the knowledge developed to help improve health and healthcare in the Netherlands.
The health benefits of an active and fit lifestyle are well established. Thereby, sedentary lifestyle habits are a major international and national Public Health (PH) problem. A recent study in the Netherlands revealed that less than 10% of the children in primary schools (ages 4 through 11 years) meet 30 minutes of physical activities (PA) per day, while the guidelines state a minimum of 60 minutes of PA per day for children in this age range. Although between the ages 12 and 17 this percentage triples to 27% according to 'Statistics Netherlands', the number of adolescents meeting the minimal required dose of daily PA remains unacceptably low. Looking at the current low PA rate in children, the PA rate in adolescents may only decrease in the near future. Based on these percentages it has been estimated that in 2015 one out of five adolescents is overweight. In addition, this increase is not linear, but exponential. It has become quite clear from the seriousness and extent of the current problem of overweight and insufficient PA, its rapid and exponential proliferation and its far-reaching consequences that action must be taken in stimulating adolescents are to be more physically active. Obesity is difficult to treat, which is why the preference lies with prevention of overweight and obesity. Although overweight and obesity are health problems that are ‘hot’, low levels of PA during adolescence have additional serious health consequences at later ages as well, e.g. coronary heart disease, osteoporosis, diabetes, cancer and mental illness. With the current low levels of PA in adolescents, the presently seen health problems associated with a lack of PA will only increase in the near future. This compromises the current and future health and well-being of the population, and makes promotion of PA in adolescents a major PH priority.
Previous ‘pilot’ research in the United Kingdom in children aged 4-11 years, suggested that the physical alteration of a school’s playground significantly increased children’s participation in moderate and vigorous physical activities on both the short-term and long-term. In addition it was found that children who were less active at baseline benefited more from this intervention than their more active peers. This strongly indicates that altering a school’s physical environment, based on the needs and demands of the school-going population, indeed affects PA levels in a positive way. Therefore, more research is warranted to validate these previous important findings into other (Dutch) school settings as well.
In general, schools have been recognized as key settings in promoting PA. Next to the home, the school is the environment where adolescents spent most of their time. Within the school, physical education lessons represents the main context in which adolescents have the opportunity to be physically active. Next to such structured and frequent PA opportunities, schools can cater irregularly for sporting days and other extracurricular activities. For the promotion of PA in the secondary school setting, interventions targeted at structural environmental changes have an important advantage over other interventions. Most PA provided by the school is on an irregular and/or non-daily basis. By altering the physical environment of a school’s grounds the adolescent is continuously exposed to PA possibilities. These changes then, of course, need to provide a continuous, appealing, challenging and socially safe PA environment. If this can be achieved all adolescents have the opportunity to be physically active each single day.
In the Dutch setting, as in general, overweight and obesity, it’s associated negative consequences on health, as well as a lack of sufficient PA is mostly being reported in neighborhoods in which the population of immigrants is relatively high and/or socio-economic status of the population is low. Amongst others, this is suggested to be mostly due to the little PA possibilities imposed by the infrastructural lay-out of these urban neighborhoods. In addition, low levels of participation in organized sports are suggested to be related to membership costs which may provide an important barrier for the inhabitants of deprived neighborhoods. Even so, a large group of girls living in these neighborhoods may not participate in organized sports and PA due to their religious beliefs. The ability to give adolescents in such neighborhoods the opportunity to be physically active on a daily basis has a great potential PH gain. For that reason it is important to investigate the effect of changes in the physical environment of secondary VMBO schools situated in these neighborhoods. If effective, the alteration of the physical school environment may provide a relatively simple, continuous, and long lasting PA intervention that is openly available for the entire target population.