The Mind-Body

Connection

How Physical Activity

and Physical Fitness

Affect Academic Performance

Vedrana Sember

Shawnda A. Morrison

The Mind-Body Connection

The Mind-Body

Connection

How Physical Activity

and Physical Fitness

Affect Academic Performance

Vedrana Sember

Shawnda A. Morrison

The Mind-Body Connection:

How Physical Activity and Physical Fitness

Affect Academic Performance

Vedrana Sember

Shawnda A. Morrison

Reviewers · Jose Carlos Ribeiro and Janko Strel

Photographs · Shutterstock

Published by · University of Primorska Press

Titov trg 4, 6000 Koper

www.hippocampus.si

Editor in Chief · Jonatan Vinkler

Managing Editor · Alen Ježovnik

Koper · 2018

© 2018 Vedrana Sember and Shawnda A. Morrison

http://www.hippocampus.si/ISBN/978-961-7055-30-6.pdf

http://www.hippocampus.si/ISBN/978-961-7055-31-3/index.html

https://doi.org/10.26493/978-961-7055-30-6

Kataložni zapis o publikaciji (CIP) pripravili

v Narodni in univerzitetni knjižnici v Ljubljani

COBISS.SI-ID=298153728

ISBN 978-961-7055-30-6 (pdf )

ISBN 978-961-7055-31-3 (html)





Contents

Seznam preglednic · 7

Preface · 9

1 Physical Activity · 11

Health-Mind Connection · 13

Health Effects · 13

Cognition Effects · 20

2 Physical Activity Recommendations · 23

Europe · 23

United States of America · 25

Canada · 28

Slovenia · 28

Adult Physical Activity Guidelines Comparisons · 31

3 Physical Activity: Growth, Maturation and Development · 33

4 Physical Education · 35

Education System · 35

Physical Education · 36

Europe · 37

Slovenia · 38

United States of America · 40

5 Physical Activity Research · 43

Quantifying Physical Activity · 43

Physical Activity in Numbers · 52

5

Contents

6 Physical Fitness · 67

Quantifying Physical Fitness · 68

Physical Fitness in Numbers · 71

7 Body-Mind Connection · 73

Summary · 79

References · 81

Reviews · 109

6





List of Tables

2.1 Comparison of National Physical Activity Recommendations from

European Countries for Children (5–18 Years Old) and Younger People · 26

2.2 Selected Objectives for Increasing Physical Activity for Children

and Adolescents, Healthy People 2010 · 27

2.3 Comparison between the US (2013), EU (2008), Canadian (2011),

and Slovenian (2007) Recommendations on Physical Activity for Adults · 30

4.1 Recommended minimum annual taught time for physical education

as compulsory subject, 2011/2012 · 38

4.2 Number of Hours of Physical Education (Year) and Physical Activity

in Slovenian Primary School Curriculum · 40

6.1 Chosen Fitness Test and Associated Physical Fitness Indicator, Test

Label and Units in Which Physical Fitness Indicator is Expressed · 70

7





Preface

In modern thinking, there is quite a sharp distinction between men-

tal and physical activities. In addition to separating between mental

and physical activities, thinking of the superiority of the language,

logic, mathematics, and academics compared to physical activity is

also present. Physical activity is any activity that raises heart rate

and can be implemented in the form of sports, playing with friends,

family, walking to school, dancing or other daily physical activities

(Roberts, Tynjälä, & Komkov, 2004). From the physiological point of

view each event produced by contraction of skeletal muscles, which

requires consumption of energy (Bouchard et al., 1990) is physical

activity.

Physical activity has a positive impact on child’s development,

but only if it is frequent, of sufficient quality, intensity and dura-

tion. Several studies examined the relationship between physical

activities, motor and physical development of a child. Since phys-

ical activity is an integrative part of every child’s development (Gris-

som, 2005), which combines physical and mental processes, it can

be considered an important but not the only factor influencing chil-

dren’s academic performance.

Academic performance is one of the most critical areas in the de-

velopment of a child, especially in late childhood (Papalia, Olds, &

Feldman 2003). Despite continued dramatic increases in children’s

health risks, physical education programs are being cut more than

ever to make room for more academic time (Shannonhouse, 2012).

This negative trend continues despite the evident positive influence

9

Preface

of physical activity on academic performance. The widest research

question of the doctoral dissertation is whether physical activity af-

fects the intellectual development or academic performance of the

child and how academic performance of elementary schoolchildren

changes through a different quantity of physical activity and time.

The following sections review the benefits of physical education and

related physical activity on physical fitness and academic perform-

ance. A detailed examination of physical activity is discussed next.

10





1

Physical Activity

Physical activity is a behavior influenced by many factors. These

factors work on four levels: physiological, psychological, sociocul-

tural, and ecological (Lindquist, Reynolds, & Goran, 1999). Physiolo-

gical level of physical activity in children is determined by age,

gender, and ethnicity (Reynolds et al., 1990; Hudson, 2008). It has

been found that girls are less active than boys, older children less

active than younger and black girls less active than white girls (Og-

den et al., 2006; Robinson & Killen, 1995; Zakarian, Hovell, Hof-

stetter, Sallis, & Keating, 1994; Centers for Disease Control, 1997).

Psychological determinants of physical activity are self-efficacy

(Dishman et al., 2004), a perception of physical competence (Sal-

lis, Prochaska, & Taylor, 2000), positive attitude (Trost et al., 1997), enjoyment of physical activity (Dishman et al., 2005) and perceiv-ing benefits from engaging in physical activity (Zakarian et al.,

1994). Sociocultural factor includes support for participation in

activity from peers and siblings, parental level of physical activity

(Sallis, Pattersen, Buono, Atkins, & Nader, 1988; Adkins, Sherwood,

Story, & Davis, 2004), parental support (Sallis & Saelens, 2000) and parental income. Ecological determinants include facilities, availability of equipment and transportation to activities (Sallis et al.,

1992).

Quantity, intensity, frequency and types of physical activity differ

by gender and age (Telford, Salmon, Timperio, & Crawford, 2005).

After the second year of life, children begin experimenting with their

bodies and various other movements. By the age of 4 are children

11



Physical Activity

usually proficient in patterns of natural movements, such as run-

ning, jumping, throwing and catching and standing or moving on

one leg (Škof, 2007). After the age of 7, movement and physical activ-

ity becomes more accurate, easy, efficient and useful in different

situations. Younger children move more than older, and boys are

moving more than girls (Riddoch et al., 2007), and children are phys-

ically less active than a decade before (Strel et al., 2003).

Physical activity is any bodily movement, produced by skeletal

muscles and resulting in energy expenditure. It can be measured

in kilocalories and can be classified into occupational, sports, con-

ditioning, household and other activities. It is a complex behavi-

or, including sports and non-sports activities (Caspersen, Powell, &

Christenson, 1985; Gabriel, Morrow, & Woolsey, 2012), so also meas-

uring it is complicated. Sports and movement are often planned,

structured and repetitive, whereas non-sport activities are occu-

pational and not planned. The difficult nature of physical activity

makes it challenging to precisely measure (Plasqui & Westerterp,

2006) all of its aspects and outcome parameters, such as energy ex-

penditure. Different measuring techniques can be grouped into five

categories: behavioral observation, self-report, physiological mark-

12





Health-Mind Connection

ers, motion sensors and indirect calorimetry (Plasqui & Westerterp,

2007).

Health-Mind Connection

Physical activity has positive effects on physical, psychological/so-

cial, and cognitive health on school-aged children and youth (Jans-

sen & LeBlanc, 2010). Evidence showed that physical activity im-

proved body composition and the prevention of overweight and

obesity, improved skeletal (Gunter, Almstedt, & Janz, 2012), meta-

bolic (Janssen & LeBlanc, 2010) and cardiovascular health (Fernhall

& Agiovlasitis, 2008). Despite biological benefits on biological health, physical activity also affects psychosocial health, such as reduction

of symptoms of depression, stress, anxiety and improvements in

self-confidence and self-esteem (Biddle & Asate, 2011).

Health Effects

It is widely known that physical activity has benefits on psycho-

social health, functional ability and overall quality of life (Powell

& Pratt, 1996). The prevalence of childhood obesity and health-

concerned factors is increasing and is anticipated to increase (Zani-

notto, Wardle, Stamatakis, Mindell, & Head, 2006). Promotion of

physical activity in children and adolescents has become a key focus

to promote health (Lobstein, Baur, & Uauy, 2004). It has been shown

that physical activity reduces blood pressure and certain types of

cancer (Batty & Thune, 2000). Physical activity reduces the risk of

coronary heart disease (Batty & Lee, 2004) and raises cardio respir-

atory function (Strauss, Rodzilsky, Burack & Collin, 2001), improves

muscular fitness and reduces the risk of falls (World Health Organ-

isation, 1997). Physical activity engages directly on weight reduction

and allows better control of fat in blood (Leon & Sanchez, 2001),

reduces the amount of body fat (Kromhout, Bloember, Seidell,

Nissinen, & Menotti, 2011), raises the level of protective cholester-

ol (HDL), reduces the level of harmful cholesterol (LDL) (Sasaki,

Shindo, Tanaka, Ando, & Arakawa, 1987) and increases bone dens-

ity (Centres for Disease Control and Prevention, 1997). Low physical

activity has been identified as major risk factor for cardiovascular

13

Physical Activity

disease (Sandvik et al., 1993; Yusuf et al., 2004), which is the leading

cause of death for men and women (World Health Organisation,

2010). Elevated body mass index (BMI) represents a greater risk for

cardiovascular disease (CVS) as adults (Haque et al., 2008). Physical

activity in childhood significantly affects healthy lifestyle and health

status in adulthood (Gillander & Hammarstrom, 2002), since pos-

itive linear connections have been established between increased

physical activity and positive health outcomes (Pate, 1993).

It has been reported that relations between physical activity of

children and benefits on health are hard to find in children (Rid-

doch, 1998). Following a systematic review of the health benefits

of physical activity and fitness in school-aged children (Janssen &

LeBlanc, 2010), authors limited their research on seven health as-

sociated indicators. These indicators are high blood cholesterol, hy-

pertension, the metabolic syndrome, obesity, low bone density, de-

pression, and injuries.

It has been reported that relations between physical activity of

children and benefits on health are hard to find in children (Rid-

doch, 1998). Following a systematic review of the health benefits

of physical activity and fitness in school-aged children (Janssen &

LeBlanc, 2010), authors limited their research on seven health as-

sociated indicators. These indicators are high blood cholesterol, hy-

pertension, the metabolic syndrome, obesity, low bone density, de-

pression, and injuries.

Cardiovascular Disease

Development of cardiovascular disease becomes evident in middle-

age, but the beginning of development of cardiovascular disease

starts in childhood and adolescence (McGill et al., 2002), especially

elevated blood cholesterol and blood pressure. It has been demon-

strated that physical activity has a beneficial effect on lipids, lipo-

proteins (Kraus et al., 2002) and blood pressure (Whelton, Chin,

Xin, & He, 2002) in adults. Armstrong and Simons-Morton (1994)

reported minimal, but beneficial effect of physical activity on lip-

ids and lipoproteins in children and adolescents. Aerobic training

had only weak relationship with blood pressure, but that kind of

14

Health Effects

exercise reduced systolic and diastolic blood pressure in adoles-

cents. After a thorough review of literature, Riddoch (1998) reported

that six studies found no beneficial associations (Al-Hazzaa, Sulai-

man, Al-Matar, & Al-Mobaireek, 1994; de Visser et al., 1994; Dwyer & Gibbons, 1994; Harrell et al., 1996; Rowland, Mattel, Vanderburgh,

Manos, & Charkoudium, 1996) between physical activity and lipids

and lipoproteins, whereas another six showed a limited association

(Suter & Hawes, 1993; Bistritzer et al., 1995; Craig, Bandini, Licht-

enstein, Schaefer, & Dietz, 1996; Gutin, Cucuzzo, Islam, Smith, &

Stachura, 1996; Twisk, Kemper, Mellenbergh, Van Mechelen, & Post,

1996; Boreham, Twisk, Savage, Cran, & Strain, 1997). 12-year old

boys ( n = 1005) from two Moscow districts were divided into ref-

erence group and intervention group participated for three years

in a 3-year intervention study. The intervention group received

counseling for children and their parents on a diet, physical activ-

ity and smoking hazards. Follow up were carried out after 1 and

three years, following baseline measures. Examinations at 1-year

showed greater reduction cholesterol level, triglycerides, systolic

blood pressure in the intervention group (Alexandrov, Maslenikova,

Kulikov, Propirnu, & Perova, 1992). DuBose, McKune, Brophy, Gey-

er, and Hickner (2015) reported lower systolic blood pressure values

related to higher physical activity levels in children ( n = 72), aged 9.5 + 1.2 years. Despite the strong links between physical activity

and cardiovascular fitness and coronary heart disease risk in chil-

dren and adolescents, it appears to be mostly mediated by fatness

(Boreham & Riddoch, 2001).

Metabolic syndrome

Metabolic syndrome is characterized by hyperinsulinemia, low gluc-

ose tolerance, hyperlipidemia, hypertension, and obesity (Brage et

al., 2004). Metabolic syndrome has been present in adults (34.4%),

adolescents (8.6%), and children (5%) (DuBose, Addy, Ainsworth,

Hand, & Durstine, 2005; Ford, Li, & Zhao, 2010; Johnson et al., 2009).

Obese children and adolescents have higher prevalence of meta-

bolic syndrome compared to non-obese peers (Cook, Weitzman,

Auinger, Nguyen, & Dietz, 2003) and obesity may be a primary risk

15

Physical Activity

factor for development of metabolic syndrome in youth (Goodman,

Dolan, Morrison, & Daniels, 2005). Physical activity has been negat-

ively associated with development of metabolic syndrome in adults

and adolescents and total physical participation seems not to be

associated with metabolic syndrome in children (Brage et al., 2004;

Ekelund et al., 2007). DuBose et al.(2015) examined the relation-

ship between physical activity and the metabolic syndrome Score

in 72 children, aged 9.5 + 1.2 years. Metabolic syndrome score was

created from blood pressure, waist circumference, high-density-

lipoprotein, triglyceride, and glucose values; physical activity was

assessed with an accelerometer. Time spent in different levels of

physical activity were not related to metabolic syndrome after con-

trolling for confounders. Jiménez-Pavón et al. (2013) report that

odds for having metabolic syndrome were higher for boys (6–9-

year-olds) in the lowest physical activity quartile, compared to chil-

dren in highest physical activity quantile. Several studies suggest

negative associations between metabolic syndrome, physical activ-

ity intensity and metabolic syndrome Score (Martínez-Gómez et al.,

2009; Ekelund et al., 2007). Martínez-Gómez et al. (2009) reported

an interaction between metabolic syndrome score, cardiorespirat-

ory fitness metabolic syndrome score. Children with high physical

activity levels and physical fitness had lower metabolic syndrome

score than those with low physical activity levels and physical fit-

ness levels. Vigorous physical activity may be substantial for de-

termination the metabolic syndrome score (DuBose et al., 2015).

Obesity

Obesity is a multifactorial disease which is dependent on many

factors and multiple interactions between genes and environment

(Maffeis, 2000). Obesity in youth is associated with conditions such

as dyslipidemia (Stensel, Lin, Ho, & Aw, 2001) and an increased risk

of type II diabetes mellitus (Sinha et al., 2002). Obesity is defined as

excess body fat, which is mostly defined by body mass index (BMI)

(Flodmark, Lissau, Moreno, Pietrobelli, & Wilham, 2004). BMI is a

value derived from weight and height of an individual (expressed

in units kg/m2). The overweight equivalent in children and adoles-

16

Health Effects

cents corresponds to the cut-off points of BMI at or above 25.0 and

obesity equivalent corresponds to the cut-off points of BMI at or

above 30.0. Children’s and adolescents’ obesity around the world

is a significant health problem and showed an increased preval-

ence of pediatric and adolescent obesity in Europe (Caroli, 2003),

USA (Ogden, Flegal, Carol, & Johnson, 2002) and in other less de-

veloped countries (Ebbeling, Pawlak, & Ludwik, 2002). Since 1980

the percentage of obese children in the United States aged from 6

to 11 has doubled and the proportion of obese adolescents aged

from 12 to 19 has tripled (Centers for Disease Control, 2013). The

highest prevalence of overweight children in Europe was found

in children and adolescents from Finland, Ireland and Greece (ex-

pressed as 85th centile BMI) (Flodmark et al., 2004). In the USA pre-

valence was higher than in Europe (expressed as 95th centile BMI)

(Lissau et al., 2004). More accurate comparisons between Americ-

an and European children and adolescents cannot be made, since

the same method and the same reference values for definition of

obesity were not available (Troiano & Flegal, 1998). The two coun-

tries with the highest prevalence of overweight and obese youth

participated in Health Behaviour in School-Aged Children Study,

were Malta (33.3%) and United States (31.9%). Countries with the

lowest prevalence of overweight youth were Lithuania (5.5%) and

Latvia (6.4%) (Janssen et al., 2005). Children of obese parents have

a higher risk of becoming obese compared to children of non-obese

parents (Garn & Clark, 1976). Obesity in childhood and adolescence

in 30% to 60% of cases continues to obesity in adulthood (Serdula et

al., 1993). The risk of obesity is reduced when children and adoles-

cents engage in recommended levels of physical activity daily (Pate

et al., 2015).

The rise of childhood obesity became the global trend and is in-

creasingly prominent; 21.4% of children, aged from 5 to 17 years

were considered overweight or obese (OECD, 2012), which repres-

ents a double proportion of the comparison in relation to the pre-

vious decades. In 1978 and 1979 in Canada 15% of youth, aged 5

to 17 years were overweight or obese; in 2009–2011 31.5% of Ca-

nadian youth were overweight or obese (Roberts, Shields, de Groh,

17

Physical Activity

Aziz, & Gilbert, 2012). To stop the negative trend of obesity among

adolescents and children, all children should follow physical activ-

ity guidelines within the school premises, since the schools have the

maximum control on children’s behavior.

Bone Density

The overall amount of bone during the development and grow-

ing years of children represents a major determinant of the risk of

fractures in later life. Childhood and adolescence have been identi-

fied as the most critical periods of mineralization (Slemenda et al.,

1994). The residual bone mass is under environmental influences,

which appear to be body mass, diet – calcium intake (Heaney et al.,

2000) and the amount and type of physical activity in child and ad-

olescent period (Bailey, Faulkner, & McKay, 1996). Slemenda et al.

(1994) reported 4–7% increase in bone mineral density for prepu-

bertal children in the highest physical activity quartile. Researchers

from the University of Saskatchewan were investigating the influ-

ence of physical activity on bone mineral accrual during adolescent

years. Children and adolescents in the highest activity quartile had

greater peak bone mineral accrual rate and a greater bone mineral

accumulation (Bailey, McKay, Mirwald, Crocker, & Faulkner, 1999).

In 10 months, high impact, strength-building exercise program ( n =

71) in 9–10 years old girls were investigating positive effects of phys-

ical activity on bone and lean mass. At the end of the intervention,

there were no differences in height and total body mass, puber-

tal development or external physical activity. More lean mass, less

body fat content, greater shoulder, knee and grip strength and great-

er total body (control 1.2%; exercise 3.5%), lumbar spine (control

1.2%; exercise 4.8%), proximal femur (control 1.3%; exercise 4.5%)

and femoral neck (control 1.7%; exercise 12.0%) and bone miner-

al density (Morris, Naughton, Gibbs, Carlson, & Wark, 1997) was

found. In research, if moderate exercise during growth in prepu-

bertal boys increase areal bone mineral density, twenty boys (mean

age 10.4 years) were participating in 8-months of 30-minute ses-

sions, three times per week of weight-bearing physical education.

The increase in areal bone mineral density in the exercise group was

18

Health Effects

twice as in the control group and volumetric bone mineral density

increased by 1.14 + 0.33% per month ( p < 0.05) (Bradney et al., 1998).

Physical activity, especially weight-bearing physical activity dur-

ing childhood is a significant predictor of bone mineral density,

while non-weight-bearing activity, such as swimming or cycling

is not (Grimston, Willows, & Hanley, 1993). Longitudinal and in-

terventional studies have shown that increased physical activity in

prepubertal children stimulates bone mineral accrual (Bailey et al.,

1999; McKay et al., 2000; Fuchs, Bauer, & Snow, 2001). Overall, phys-

ical activity is the stimulus for bone structure and has potential to

increase peak bone mass notwithstanding genetics, hormonal and

nutritional influences (Boreham & Riddoch, 2001).

Depression

Evidence from studies demonstrates that physical activity in adults

is inversely associated with depression (North, McCullagh, & Tran,

1990). Kanner (1990) compared the effects of two levels of exer-

cise in childhood and adolescence depression. Subjects were chil-

dren and adolescents ( n = 68) between age 8 and 18 from Psychi-

atric Treatment Center in California. Children were randomly di-

vided into two groups; high-level exercise treatment and low ex-

ercise treatment. Both groups demonstrated a better reduction in

depression compared to pre-test but no statistically significant dif-

ferences between groups in depression outcome score. McPhie and

Rawana (2015) examined the influence of physical activity on a tra-

jectory of depression from adolescence through adulthood. They

reported lower levels of depression during mid-adolescence in ad-

olescents with engaging in higher levels of physical activity. Biddle

and Asate (2011) synthesized reviews investigating physical activ-

ity and depression, anxiety, self-esteem and cognitive functioning

in children and adolescents.

Four review articles reported evidence concerning depression

(Craft & Landers, 1998; North et al., 1990), which summarized that

physical activity over no intervention seemed to be potentially be-

neficial for reduced depression in children and adolescents. All re-

viewed articles had certain limitations, such as inclusion in inter-

19





Physical Activity

ventions with mild depression over a short time frame and bad spe-

cification of frequency, duration, and type of activity; therefore all

interpretations of articles should be taken with vigilance. Authors

summarized that physical activity has positive psychosocial out-

comes in young people and higher levels of sedentary behavior are

associated with worse mental health.

Injuries

Despite all the positive features and benefits of physical activity

on health in children, every engagement in physical activity can

lead toward injuries. Among young elite athletes, 40 injuries per 100

children in 1year incidence rate occurred (Baxter-Jones, Maffulli, &

Helms, 1993). All activities carry an increased risk of acute injur-

ies, physical activity in any competitive form of sports can result in

the additional risk for fracture (Van Mechelen, 1997). Injuries sus-

tained during physical activity engagement have been established

as a leading cause of injuries in children and adolescents (Brud-

vik & Hove, 2003; Finch, Valuri, & Ozzane-Smith, 1998). Jespersen et al. (2015) described the epidemiology of diagnosed musculoskeletal

extremity injuries and incidence rates about different settings, body

regions and injury types in children, aged 6–12 years. Overall, the

total of 1259 injuries were diagnosed, with an overall rate of 1.59 in-

juries per 1000 physical activity units.

To ensure positive effects of physical activity on children’s health,

all activities need to be under the watchful eye of teachers and par-

ents, because injuries can lead to absenteeism in school, sport and

the occurrence of incipient depression. Injuries may result in lo-

comotors inactivity, weakening of the locomotors system, obesity,

high blood cholesterol and bad habits of children and adolescents

in the most critical period of development.

Cognition Effects

Physical inactivity influences not only the health of children but also

cognitive and brain health (Chaddox, Pontifex, Hillman, & Kramer

2011). Low levels of activity and aerobic fitness are associated with

declines in academic achievement (Chaddock, Pontifex, Hillman, &

20

Cognition Effects

Kramer, 2011), brain structure, cognitive abilities and brain function

(Sibley & Etnier, 2003; Castelli, Hillman, Buck, & Erwin, 2007; Chaddock et al., 2010).

Research findings in aging population studies showed that exer-

cise and physical activity are protective against cognitive decline,

especially working memory and executive planning (Kramer et al.,

1999; Van Boxtel et al., 1997). Physical activity may increase oxygen

saturation (Kramer et al., 1999) and angiogenesis (Kleim, Cooper, &

VandenBerg, 2002) in brain area responsible for task performance.

Several studies have demonstrated a positive relationship between

aerobic fitness and cognition (Colcombe & Kramer, 2003; Chaddock

et al., 2010). The prefrontal cortex and the hippocampus are the fo-

cus of many human studies of activity and neurocognition; molecu-

lar architecture and behavior of basal ganglia may be influenced by

physical activity (Chaddock et al., 2010). The prefrontal cortex is the

cerebral cortex in the front part of the lobe, containing Brodmann

areas 9, 10, 11, 12, 46 and 47 (Finger, 2001). The functions carried

out in prefrontal cortex are executive functions, such as planning

complex cognitive behavior, personality expression, decision mak-

ing, and moderating social behavior (Yang & Raine, 2009). The hip-

pocampus is located in the temporal lobe of each cerebral cortex.

Humans have two hippocampi, one in the left part of the temporal

lobe and the other in the right part of the temporal lobe. As part of

the limbic system, the hippocampus plays a major role in memory,

spatial memory, and navigation. Basal ganglia are situated at the

base of the forebrain. Principal components of the basal ganglia are

the dorsal striatum, ventral striatum, globus pallidus, ventral pal-

lidum, substantia nigra and subthalamic nucleus. The basal ganglia

are primarily responsible for motor control, motor learning, execut-

ive functions and emotion (Lanciego, Luquin, & Obeso, 2012).

Chaddock et al. (2010) reported that exercise influences the stri-

atum by increasing dopamine signaling and angiogenesis. Children

with higher aerobic fitness levels showed less behavioral interfer-

ence to misleading and irrelevant flanking cues (Chaddock et al.,

2010). Their results supported that dorsal striatum is involved in

cognitive control, motor integration and response resolution (Aron,

21

Physical Activity

Poldrack, & Wise, 2009). Welk, Morrow and Falls (2002) reported that

lower levels of aerobic fitness were associated with longer reaction

time in youth and decreased response accuracy; children in higher

levels of aerobic fitness were not behaviorally different. Chaddock-

Heyman et al. (2014) reported that children with higher aerobic fit-

ness levels had greater white matter integrity and subcortical struc-

tures than children in lower aerobic fitness levels. White matter and

subcortical structures are critical for learning and memory. They

were the first to demonstrate that aerobic fitness in children is pos-

itively associated with brain and cognitive health, using diffusion

tensor imaging. Researchers showed that higher fit children show

greater fractional anisotropy in sections of the corpus callosum,

corona radiata, and superior longitudinal fasciculus, compared to

lower fit children.

22





2

Physical Activity

Recommendations

Physical inactivity is identified as the fourth leading (6% of deaths

globally) risk factor for global mortality (World Health Organisa-

tion, 2010). Physical inactivity, non-communicable diseases (NCDs)

and general health problems of the population are rising world-

wide. Following recommendations from World Health Organization

(2010), all children aged 5–17 years should be participating in a vari-

ety of physical activities that support natural development, are en-

joyable and safe. Recommendations include play, games and sports,

active transportation, recreation, physical education, planned exer-

cise, school and community activities.

Children aged 5–17 years should accumulate at least 60 minutes

of moderate- to vigorous-intensity (MVPA) physical activity per day,

what is more than 60 minutes provides additional health benefits.

Most of the physical activities should be aerobic (World Health Or-

ganisation, 2010). Examples of MVPA include basketball, racquet

sports, soccer, dance, swimming laps, skating, brisk walking, jog-

ging, stair climbing, strength training, cross-country skiing and cyc-

ling.

Europe

The European recommendations are based primarily on the recom-

mendations of the World Health Organisation (World Health Organ-

isation, 2002), which are not completely adequate for the European

population since 40–60% of the people of Europe lead a sedentary

life (EUPAG, 2008). Many of State Members of the European Uni-

23



Physical Activity Recommendations

on have national guidelines for physical activity which help health

agencies and private institutions to promote the importance of

physical activity. The EU Working Group ‘Sport & Health’ (2008)

made recommendations that would promote increased physical

activity in the European Union. These recommendations are ad-

dressed primarily to policy makers as inspiration for a formula-

tion of national physical activity guidelines. The first guideline is

based on World Health Recommendation. European Union recom-

mended a minimum of 60 minutes of daily moderate-intensity for

children and youth and at least of 30 minutes of daily moderate-

intensity physical activity for adults and seniors (EUPAG, 2008).

European guidelines were divided into sections sport; health; edu-

cation; transport, environment, urban planning and public safety;

working environment and services for senior citizens.

Kahlmeier et al. (2015) reviewed and systematically analyzed

physical activity recommendations of the World Health Organisa-

tion for the European region. Review of the research article con-

tains information on national recommendations and guidelines

for physical activity. Information about national physical activity

recommendations were found only in 37 countries ( ∼ 70%). Only

24





United States of America

21 countries developed recommendations including frequency, in-

tensity, and duration of activity ( ∼ 40%). Recommendations for chil-

dren (Table 1) have been developed only in 14 European countries

( ∼ 26%) and for older adults only in 6 countries ( ∼ 11%). Countries with developed physical recommendations in Europe for all age

groups are Austria (Titze et al., 2010), Iceland (Public Health In-

stitute, 2008), Ireland (Department of Health and Children, 2009),

Netherlands (Ministry of Health, Welfare and Sport, 2005) and Unit-

ed Kingdom (Department of Health, 2011).

According to review article of Kahlmeier et al. (2015), physic-

al activity recommendations were available only for about one-

third of countries, mostly from central and eastern part of Europe.

Around 40% of countries in the European Union did not develop

national recommendations till 2015.

United States of America

Healthy People Organisation provides science-based objectives for

improving health in the United States of America. The organisation

developed new goals and objectives for health and disease preven-

tion in States every 10-years for the past 30 years (US Department

of Health and Human Services, 2014). Healthy People 2010 ranked

physical activity as leading health indicator and developed goals to

increase physical activity levels among adults, children, and adoles-

cents and to reduce sedentary behavior among adolescents (US De-

partment of Health and Human Services, 2000). Two most import-

ant objectives in Healthy People 2010 (US Department of Health

and Human Services, 2000) are to increase the amount of moderate-

to-vigorous physical activity among all population subgroups and

increase opportunities and facilities where people can be physically

active. Objectives for increasing physical activity for children and

adolescents are seen in Table 2.

Committee on Physical Activity and Physical Education in the

School Environment from Institute of Medicine of the National

Academies, Washington (2013) formulated recommendations for

physical activity and divided them into six areas: whole-of-school

approach, considering physical activity in all schools related policy

25





Physical Activity Recommendations

Table 2.1 Comparison of National Physical Activity Recommendations from European Countries for Children (5–18 Years Old) and Younger People

Country/Org.

Inactivity

Duration

Intensity

Frequency

World Health

At least 60

Moderate-to-

Every day.

Organisation

minutes.

vigorous.

Austria

Sitting more

60 minutes.

At least mod-

Every day.

than 60

erate.

minutes.

Belgium

60 minutes.

Moderate.

Every day.

Denmark

At least 60

Moderate.

Every day.

minutes.

Finland (for

Sitting more

60–120

All-round

Every day.

children 7–18

than 120

minutes.

activity.

years old).

minutes.

France

60 minutes.

Moderate-to-

Every day.

vigorous.

Iceland

More than 120

60 minutes.

Every day.

minutes.

Ireland

60 minutes.

Moderate-to-

Every day.

vigorous.

Luxembourg

60 minutes.

Moderate.

Every day.

Malta

30–60 minutes. Moderate-to-

Every day.

vigorous.

Netherlands

60 minutes.

Moderate

Every day.

Norway

60 minutes.

Moderate-to-

Every day.

vigorous.

Sweden

60 minutes.

Moderate-to-

Every day.

vigorous.

Switzerland

More than 120

60 minutes.

Equivalent to

Every day.

minutes.

brisk walking

or cycling.

United King-

At least 60

Moderate-to-

Every day.

dom

minutes.

vigorous.

decisions, designating physical education as a core subject, mon-

itoring physical education and opportunities for physical educa-

tion. Whole-of-school approach advocates for 60 minutes of phys-

ical activity daily and at least 30 minutes in moderate to vigorous

level of physical activity in the school time in elementary school.

26





United States of America

Table 2.2 Selected Objectives for Increasing Physical Activity for Children and Adolescents, Healthy People 2010

Objective

Population

Baseline 2010 objective

At least 30 minutes of moderate

adolescents

27%

Increase to 35%

physical activity >5 of previous 7

days

Vigorous physical activity that

Adolescents

65%

Increase to 85%

promotes the development and

maintenance of cardiorespirat-

ory fitness >3 days per week for 20

minutes

Daily school physical education

Adolescents

29%

Increase to 50%

Walking to school <1 mile

Children and ad-

31%

Increase to 50%

olescents

Bicycling to school < 2 miles

Children and ad-

2.4%

Increase to 5%

olescents

For easier understanding, this is equivalent to 150 minutes per

week. Students should engage in additional physical activities dur-

ing recess, dedicated physical activity time and other opportun-

ities (Committee on Physical Activity and Physical Education in

the School Environment, 2013). With recommendation Physical

Activity in All School-Related Policy Decisions scientists advocate

for regular access for physical activity in the school environment

as a contributing factor in children’s health, development and im-

proving academic performance. In implementation, this refers to

after-school programming, participation in sports, active transport

to and from school, agreements between schools and community

sports objects to share places to be physically active after school-

time. School Physical Education is the only opportunity for some

children to make something for their health, be physically active

and excess negative energy. Despite negative tendencies of daily

physical activity and growing concern about physical inactivity in

the United States, physical education is not treated as a core sub-

ject. United States Department of Education and health agencies

need to find innovative applications of physical education as a core

subject, to measure and highlight outcomes. In the fourth recom-

27





Physical Activity Recommendations

mendation the committee states that all education, health and gov-

ernment agencies should develop data systems to monitor policies

and behaviors to provide a foundation for planning, developing and

implementing physical activity in schools. Next recommendation,

Providing Preservice Training and Professional Development for

teachers, is based on educating physical education and classroom

teachers to be more professional from the field sport and physic-

al activity and to promote physical activity across the curriculum.

The last recommendation is Enduring Equity in access to Physical

Activity and Physical Education, which should pursue equal access

to facilities and opportunities for physical activity.

Canada

Canada’s first physical activity guidelines were introduced in 2002

(Health Canada, 2002). Two sets of guidelines were published, sep-

arately for children aged 6 to 9 years and youth aged 10 to 14

years (Health Canada, 2002). Canada launched new guidelines for

physical activity for children, youth, adults and older adults in

January 2011. The process of updating Canadian Physical Activity

Guidelines lasted from November 2006 till the launch day to Ca-

nadians in January 2011. Canadian guidelines are relevant to all

healthy children (aged 5–11 years) and youth (12–17 years). Chil-

dren and youth should be physically active as a part of play, games,

transportation, recreation, physical education or planned exercise.

For health benefits, they should accumulate at least 60 minutes of

moderate- to vigorous physical intensity per day and should include

vigorous-intensity and activities that strengthen muscles and bones

at least three times per week. Adults (18–64 years) should accumu-

late at least 150 minutes of moderate- to vigorous-intensity physical

activity per week, which can be in sessions of at least 10 minutes.

Physical activity should include activities that strengthen muscles

and bones at least two days per week (Tremblay et al., 2011).

Slovenia

Slovenia made directives and recommendations for physical activ-

ity, but only for adults. Recommendations for physical activity in

28



Slovenia

Slovenia are divided into four sectors: type, intensity, frequency

and duration of physical activity (Fras & Poličnik, 2007). Tradition-

al recommendations advise aerobic activities, which require the

use of large muscle groups and are continuous (brisk walking, jog-

ging, cycling, swimming, ice skating, cross-country skiing). Newer

guidelines recommend walking or any activities which can be car-

ried out daily with every-day intensity, such as moderately intense

housework (such as lifting or carrying devices), moderately heavy

gardening, ball games and other games with children, moderately

intense swimming, slow jogging (about 7 km/h). It is important that

the physical activity in relation to the type of activity is balanced.

Activity should be partitioned into 50% aerobic activities, 25% flex-

ibility exercises and 25% of exercises to strengthen the muscles.

Intensity of physical activity should range between 50–85% of

maximum aerobic capacity (oxygen consumption) or moderate

physical activity of energy consumption of 3 to 6 MET or 4 to 7 kc-

al/min. Daily or 5 times/week. Duration of physical activity should

range between 30 and 60 minutes; newer recommendations al-

low intermittent exercise in several daily sessions with shorter or

longer intervals if activity cannot be carried continuously. Dura-

tion of each session should not be shorter than 10 minutes, and all

29





Physical Activity Recommendations

Table 2.3 Comparison between the US (2013), EU (2008), Canadian (2011), and Slovenian (2007) Recommendations on Physical Activity for Adults

European Union

United States re-

Canadian

Slovenian recom-

recommendations

commendations

guidelines

mendations (Fras

(EUPAG, 2008).

(US Department of (Tremblay et al.,

& Poličnik, 2007).

Health and Human 2011).

Services (2008).

At least 150

At least 150

At least 150

At least 150–

minutes/week

minutes/week of

minutes/week

210 minutes of

of moderate-

moderate-intensity of moderate- to

moderate-intensity

intensity phys-

physical activity

vigorous-intensity

physical activ-

ical activity or at

or 75 minutes of

physical activity

ity/week

least 60 minutes of

vigorous-intensity

vigorous-intensity

aerobic activ-

physical activity

ity/week

Activity can be

Activity should

Activity can be

Activity could be

accumulated in

be in episodes

accumulated in

in sessions, which

blocks of at least 10 of at least 10

blocks of at least 10 could not be short-

minutes.

minutes and

minutes.

er than 10 minutes

spread throughout

and all sessions to-

the week.

gether at least 30

minutes.

Activities to in-

Adults should

Activities to in-

crease muscular

also do muscle-

crease muscular

strength and en-

strengthening

strength and en-

durance should be

activities of mod-

durance should be

added 2 to 3 days

erate or high in-

added 2 days per

per week.

tensity and involve

week.

all major muscle

groups on 2 or

more days.

Adults should in-

All physical activ-

crease their aer-

ity should be por-

obic activity to

tioned: 50% aer-

300 minutes per

obic activities, 25%

week of moder-

flexibility exercises

ate intensity or 150

and 25% of exer-

minutes of vigor-

cises to strengthen

ous intensity.

the muscles.

sessions should sum at least 30 minutes altogether. Bratina et al.

(2013) published a scientific review article in Slovenian language

30





Adult Physical Activity Guidelines Comparisons

with guidelines for physical activity for Slovenian children, aged

2–18 years. Authors concluded that children should accumulate at

least 60 minutes of moderate- to vigorous physical activity daily and

to heat before exercise and calm and relax after physical activity.

Adult Physical Activity Guidelines Comparisons

European recommendations are based on World Health Organisa-

tion recommendations (World Health Organisation, 2002) for phys-

ical activity. American recommendations are based primarily on

policy changes and actions to increase physical activity. This ap-

proach also includes sport, health, education, environment, safety,

work and services for the elderly and active transport (US Depart-

ment of Health and Human Services, 2008). Canadian guidelines

are based on observation and systematic process of forming new

guidelines for physical activity. Canadian and American recom-

mendations provided recommendations for all age groups but in

Europe only six countries of 53 (Kahlmeier et al., 2015). Irrespective

of different policy in countries, all recommendations are very simil-

ar, almost identical and follow recommendations of World Health

Organisation (2002). Many guidelines recommend that children

and youth spend minimum of 60 minutes of moderate- to vigorous-

intensity physical activity (MVPA). The importance of MVPA is cru-

cial and could not be overstated, all intensities of physical activity

may be substantial for health promotion and disease prevention

(Carson et al., 2013). There are currently no recommendations that

include light-intensity physical activity (LPA), which may be due to

the historical focus on MVPA (Marshall and Ramirez, 2011).

31





3

Physical Activity: Growth,

Maturation and Development

In physical activity research, pedagogy, pediatrics, human biology

and biological anthropology terms like growth and maturation are

often in the center of attention. Both processes are often men-

tioned in the same sentence. Nevertheless, each refers to particu-

lar biological activity. Natural growth and maturation of children

and adolescents have been studied for more than 150 years (Ma-

lina, Bouchard, & Bar-Or, 2004). Growth is linked to maturation

(Hermanussen, 2010). Processes growth and maturation are very

important to understand the children’s and adolescents’ biologic-

al variability in the phase of development. Growth and maturation

are often used in conjunction with term development (Bose, 2007).

Development is a widely used term, which refers to biological, psy-

chological and emotional changes between birth and the end of

adolescence.

Growth is an increase in size, cell number or hyperplasia, cell size

or hypertrophy and intercellular substance or accretion. As children

grow, they become taller, heavier; they increase in lean and fat mass

and their organs increase in size (Malina et al., 2004). Maturation

is often described as the process of becoming mature and refers to

the timing and tempo toward the mature biological state. Timing

refers to when some specific events occur, e.g. appearance of pubic

hair and tempo refers the rate at which maturation progress young-

ster is. Timing and tempo of maturation are different in children at

the same age and the same size. Since maturation and growth are

closely related, they must be viewed as dynamic.

33



Physical Activity

In the transition from childhood to adolescence children un-

dergo many changes. Puberty occurs in girls earlier than in boys.

Nowadays puberty occurs earlier than in previous years, especially

in overweight children (Cheng et al., 2012). There are various meth-

ods for determining the degree of maturity. The most accurate es-

timate is by the skeletal maturity but is not widely used because

of the risks associated with x-ray. The maturity of the child can

also be determined through the development of the teeth and on

the development of secondary sexual characteristics. Often used is

also the method for determining the maximum height increments,

where the maximum height increase determine the ratio between

the length of the legs and body (Mirawald, Baxter-Jones, Bailey, &

Beunen, 2002).

34





4

Physical Education

Education System

Education system in European Union is classified by International

Standard Classification of Education – ISCED 2011 (UNESCO In-

stitute for Statistics, 2012). ISCED provides framework for present-

ing national education data in comparable manner – internation-

ally agreed categories (Eurydice, 2014): Early Childhood Educa-

tion (ISCED 0), Primary education (ISCED 1), Lower secondary

education (ISCED 2), Upper secondary education (ISCED 3), Post-

secondary non-tertiary education (ISCED 4), Short-cycle tertiary

education (ISCED 5), Bachelors’ or equivalent level (ISCED 6) and

Master’s or equivalent level (ISCED 7). Fort-two education systems

are included covering 37 countries from Europe continent (28 Mem-

ber States, Bosnia and Herzegovina, Switzerland, Iceland, Liechten-

stein, Montenegro, former Yugoslav Republic of Macedonia, Nor-

way, Serbia and Turkey).

Main organisational models in Europe are divided into Early

childhood education and care (ECEC) and Compulsory education

(EURYDICE, 2015). In ECEC structure, two main forms can be dis-

tinguished (EURYDICE, 2015): unitary system (programmes and

settings are provided for whole pre-school range and services and

educational guidelines cover entire ECEC range) and split system

(children are divided in settings for younger and older pre-school

children, where educational guidelines are only provided for older

children). Compulsory education consists of three main models

of organisation in European countries (EURYDICE, 2015): Single

35





Physical Education

structure (general education is provided for all pupils from the be-

ginning till the end of compulsory schooling), Common core cur-

riculum provision (after finishing ISCED 1 all students progress to

ISCED 2, where they follow same general common curriculum)

and Differentiated lower secondary education (after completing

primary education students follow specific types of schooling at

the beginning or during lower secondary education).

ISCED 0 finishes at children’s age of 6 or 7 years. ISCED 0 normally

finishes at 6 or 7 years of age, where ISCED 1 begins and continues

till children’s age of 9.5 (FRYM, Turkey), 10 (Croatia, Germany, Hun-

gary, Austria, Slovakia, Bosnia and Herzegovina), 10.5 (Serbia), 11

(UK (except Scotland), France, Liechtenstein, Montenegro, Czech

Republic, Bulgaria, Romania, Slovenia, Italy, Lithuania, Malta), 11.5

(Cyprus), 12 (Switzerland, Spain, Greece, Ireland, Belgium, Lux-

embourg, Netherlands, Poland, Portugal, Scotland) and 13 years

old (Iceland, Estonia, Denmark, Latvia, Finland, Norway, Sweden)

(EURYDICE, 2015). Education system in Slovenia is mainly organ-

ised as public service, where public schools are secular and school

environment autonomous. Italian and Hungarian ethnic minor-

ities have the right to Study in Slovenian educational system in

their own language. Slovenian education system in organised in

several levels of education: Pre-school education (optional in Slov-

enia, funded and financed by municipalities), Compulsory basic

education (single structure nine-year basic school, funded and

financed by municipality and state), Upper secondary education

(takes 2-5 years, funded and financed by state) and Tertiary edu-

cation (short-cycle higher education and higher education; see ht-

tps://webgate.ec.europa.eu/fpfis/mwikis/eurydice/index.php).

Physical Education

Often there is a misunderstanding with terms physical activity and

physical education. Physical activity is behaviour and physical edu-

cation is curriculum area that educates about physical activity. Main

goal for quality physical education is to develop physically edu-

cated children who have the knowledge and confidence to enjoy

being physically active for a lifetime. Physical education as a school

36





Europe

subject is teaching school-aged children methods and science of

health, sport, physical fitness and gross motor skills (Robinson,

2011). Physical education uses comprehensive, but physically act-

ive approach, who involves teaching social, cognitive and physically

active approach. Physical education is education through the phys-

ical (Siedentop, 2009).

School physical education accounts for a large proportion of chil-

dren’s physical activity and has positive effect on the development

of motor abilities (EUPAG, 2008). When comparing the pupils at-

tending sports classes to those who do not have any extra hours

of physical education, there are significant and noticeable positive

changes, especially in terms of better physical fitness dimensions

from Slovenian’s sports classes (Jurak, Kovač, & Strel, 2007). Lon-

gitudinal data have shown that normal weight adolescents parti-

cipated in physical education, the odds of becoming overweight in

adulthood decreased by 5% (Menschik, 2008).

Europe

Physical education in Europe is not limited only to the training

in physical abilities and has more than just recreational charac-

ter. By participating in many physical activities come knowledge

and insights focused on the principles of the game, such as hon-

est, respect, tactical and physical consciousness and social aware-

ness related to personal interaction and teamwork in many sports.

Health, social integration and good personal development of chil-

dren give extra weight to its importance in the school curriculum.

All European countries recognize importance of physical education,

which is part of core curriculums and is compulsory in primary

and lower secondary education in Europe. Physical education in

European primary schools is taught by generalist or specialist teach-

ers, who need to have bachelor’s degree. At lower secondary edu-

cation, physical education is normally taught by specialist, with

bachelors or masters degree. Almost all European countries assess

formative and summative personal progress in the field of physic-

al education. Grading system at physical education is usually the

same as at the other compulsory subjects. National test of physical

37





Physical Education

Table 4.1 Recommended minimum annual taught time for physical education as compulsory subject, 2011/2012

Country

(1)

Country

(1)

Germany

56–85

Netherlands

Flexible timetable

Estonia

53–70

Austria

60–120 (90)

Ireland

37–45

Poland

73–113

Greece

45–68

Portugal

81

Spain

35–53

Romania

30–59

Belgium

61–91

Slovenia

67–98

Bulgaria

36–64

Slovakia

56

France

108–144

Finland

57

Czech

59

Sweden

500 hours (2)

Denmark

30–90

England and Wales Flexible timetable

Italy

66

Northern Ireland

Flexible timetable

Cyprus

46–81

Scotland

76

Latvia

45–49 (46)

Croatia

53–79

Lithuania

54–72

Iceland

72

Luxembourg

68–108

Turkey

24–48

Hungary

69–83

Liechenstein

59–117 (88)

Malta

22–64

Norway

68–76

O P O M B E

(1) Average number of hours per year, (2) in 9 years.

education was carried out only in Slovenia in 2009 (European Com-

mission, 2013). Recommended minimum taught time for physical

education as compulsory subject is different from country to coun-

try (Table 4).

Slovenia

School physical education in Slovenia is a continuous process of

enriching knowledge, developing skills and motor abilities and im-

portant tool for formatting personality and relationships between

individuals. Regular and quality physical education in Slovenia con-

tributes to the harmonious development of the bio psychosocial de-

velopment with neutralization of the negative effects of long hours

sitting and other unhealthy habits. Healthy lifestyle is also respons-

ible for welfare, health, vitality and life optimism (Ministrstvo za šol-

stvo in šport, 2011).

38



Slovenia

Physical activity classes are in Slovenia divided into: physical edu-

cation classes and extracurricular program, which is different from

school to school. Slovenia have also extracurricular program called

Healthy lifestyle, where approximately 150 schools are part of it.

Children who are part of Healthy Lifestyle program have 2 extra

physical activity hours per week. Physical education in Slovenia is

required for every school-aged child.

From 1st to 6th grade in Primary school, children have 105 school

hours of physical education per year (3 hours/week), 70 hours in

7th and 8th grade (2 hours/week) and 64 hours in 9th grade (2

hours/week). One school hour lasts 45 minutes (Kovač, Jurak, Starc,

& Strel, 2011). Pupils from 7th to 9th grade can also choose elect-

ive courses. Slovenia offers 6 courses from the field physical activity

and sport. These classes are: dance, folklore dances, old and social

dances, sport for health, sport for release and selected sports (vol-

leyball, soccer, basketball). Pupils have 1 additional physical educa-

tion hour per week and 35 hours per year. Students can select one

course only once in primary education and maximum 2 courses

from field physical activity (Zakon o osnovni šoli, 2006). Combin-

ing all physical education and physical activity hours in Slovenian

39





Physical Education

Table 4.2 Number of Hours of Physical Education (Year) and Physical Activity in Slovenian Primary School Curriculum

Grade

Teacher

(1)

(2)

(3)

1st

Classrom teacher

105

70

and physical educa-

2nd

tion teacher – special-

3rd

ist

4th

5th

6th

Classrom teacher

and physical educa-

7th

70

35

70

tion teacher – special-

8th

ist

9th

64

35

70

O P O M B E

(1) Hours (year), (2) elective, (3) extracurricular.

curriculum, pupils can achieve up to 6 school hours of physical

activity and physical education during school day. Physical edu-

cation, elective courses and extracurricular program is taught by

physical education specialist and classroom teacher (with coopera-

tion with PE teacher first 5 years in primary school). Table 5 shows

all the hours of physical education and physical activity, including

extracurricular sports activities (not obligatory) and elective sport

courses (not obligatory) in Slovenian primary school curriculum.

United States of America

Physical education became one of subjects in United States schools

at the beginning of 19th century, but was presented in forms of Ger-

man and Swedish gymnastics (Hackensmith, 1966). In early 20th

century, learning about personal hygiene and exercise became part

of school physical education. Educator Thomas Wood (1913) criti-

cized schools’ physical education as being to narrow towards health

and hygiene, so physical education was transformed to more holist-

ic approach in terms of physical skills and sport games. During last

two decades, physical education became more science, health and

body-movement directed subject in school curriculum with goals

that facilitate holistic development of children (National Associ-

ation for Sport and Physical Education, 2004). United States don’t

40

United States of America

operate with centralized curriculum; all curriculums are made loc-

ally by school districts or individually by schools, what gave physical

education in USA great diversity (National Association for Sport and

Physical Education, 2010). Physical education in United States is

taught in many different forms and structures. Different curriculum

models are present, including movement education, sport educa-

tion and fitness education. Main goal in fitness education curricula

is to increase class-physical activity, in sport education and move-

ment education is physical activity only a basis for students to learn

skills or knowledge. In sport education students are educated to

become sportpersons and they tried roles of coaches, players, cap-

tains, referees, statisticians, manager . . . Fitness education is teach-

ing children the science behind why they need to be physical active

in their lives. The main goal of fitness education curricula for chil-

dren is to understand fitness concepts, principles, and strategies,

to participate in a health-enhancing level of fitness (Kohl & Cook,

2013). Children in United States of America in primary school re-

ceive 150 minutes per week of physical education and 225 minutes

per week in secondary school. Physical education classes are taught

by classroom teacher (generalist) and physical education teacher

specialist; 68% of elementary schools allow classroom teacher and

82% and 90% of states (National Association for Sport and Physical

Education, 2010) requires physical education teacher specialist in

middle/junior high school and high school.

41





5

Physical Activity Research

Quantifying Physical Activity

Physical activity can be quantified according to frequency (how of-

ten?), intensity (how hard?), duration (how long?), and mode (what

type?) (Chen & Bassett, 2005). If the habitual physical activity is re-

quired, some variation should be taken into account, because a reg-

ular physical activity is a behavior which can occur only as a result

of skeletal muscle activity that is supported by energy expenditure

(Armstrong & Welsman, 2006).

Determining physical activity needs to be socially accepted, should

not burden the children with major equipment and should only

minimally interfere physical activity of the child (Armstrong & Wels-

man, 2006; Livingstone, Robson, Wallace, & McKinley, 2003). Re-

searchers in the last decade developed a series of methods for

identifying and measuring physical activity for children. Based on

the literature review the most commonly used scientific methods

for determining physical activity are: direct observation or object-

ively assessed physical activity and indirect or subjectively assessed

physical activity (Kohl, Fulton, & Caspersen, 2000; Welk, Corbin, &

Dale, 2000).

The subjective measure is less reliable than objective and is more

easily administered to a population of groups. Subjective methods

possess various limitations regarding their reliability and validity

and are most commonly used to increase validity and reliability of

individual instruments (Shephard, 2003). Direct measures are be-

lieved to remove many of the issues of recall and response bias

43



Physical Activity Research

(Prince et al., 2008), but they are time and cost intensive and dif-

ficult to apply to large epidemiologic settings. Objective measures

also require specialized training, the physical proximity of parti-

cipants and there is no ¨gold standard¨ for measuring physical activ-

ity (Dishman, Washburn, & Schoeller, 2001), since there is a lot of

measuring equipment in the market these days.

The appropriate method for measuring physical activity depends

on different aspects, such as the number of participants in the study,

commercial availability and period of needed measurement.

Objective Methods

Objective measures of physical activity rely on information presen-

ted by another person through direct observation, measuring the

temperature of the body or from measurement device like heart-

rate monitor, accelerometer or pedometer. Objective measures of

physical activity are used to predict energy expenditure, which is

crucial in terms of decreasing obesity and other diseases related to

44

Quantifying Physical Activity

physical activity. Objective measures remove disadvantages associ-

ated with subjective measures, are more reliable, involve quantitat-

ive analysis of numerical data.

Objective methods can be expensive and are suitable for indi-

viduals or smaller groups. With direct (systematic) observation we

directly monitor and record children’s physical activity at the same

time. We can use video and special software for automatic detec-

tion of movement patterns. In the past this method was widely

spread, however today it is somewhat neglected, although it has

many advantages. Observation procedures are flexible, accurate,

detailed and offer many descriptions of observed events (environ-

ment, equipment, conditions, behavioral . . .) (Trost, 2007). It was an

important tool in assessment of physical activity, because it uses an

objective method and provides rich data, especially in researches

studying children, cognitive-behavior and effects of physical and

social environments on physical activity (McKenzie, 2001).

Measuring of physical activity is nowadays increasingly direc-

ted towards measuring devices, which provide physiologically and

mechanically more accurate and reliable data, compared to oth-

er techniques (Westerterp, 2009). Measuring devices referred to as

‘activity trackers’ or ‘fitness trackers’ are nowadays very popular for

personal PA monitoring. Their popularity has risen as they became

affordable, unobtrusive and useful in their application (Evenson,

Goto, & Furberg, 2015). Activity trackers can provide feedback and

offer recommendations for individual’s physical activity, but they

are not reliable for scientific purpose to the same extent as acceler-

ometers, pedometers and multiple-sensor devices. Unfortunately,

there are no gold standards for measuring physical activity with

wearable monitors (Freedson, Bowles, Troiano, & Haskell, 2012).

The choice of measuring device is left to the researcher and depends

on several factors: interest, target population, cost and precision of

measurement (Ainsworh, Cahalin, Buman, & Ross, 2015).

Accelerometers are small wearable motion sensors which detect

body accelerations in gravitational units (Freedson et al., 2012). The

core of accelerometer is a sensor from piezoelectric material, which

45

Physical Activity Research

produces voltage as a function of geometric deformation (Chen &

Bassett, 2005). Accelerations are then transferred to a lower resolu-

tion called epoch. Epoch is calibrated to a known criterion measure

(e.g., oxygen consumption, doubly-labelled water). Most of existing

calibration studies are then presented in unitless intensity metric

called ‘counts’ (Freedson et al., 2012). When we have physical activ-

ity in counts, we can modify this unitless intensity to different levels

of physical activity and energy expenditure. Acceleration is change

in velocity over given period of time; therefore, intensity, frequency

and duration of measured physical activity can be assessed (Ridgers

& Fairclough, 2011). Compared to measures of oxygen consumption

and METs most of accelerometer show a wide range of correlations

( r = 0.45 to 0.93) (Trost, McLever, & Pate, 2005), which corresponds to a number of protocol-related variations such as accelerometer

placement (hip, wrist, wrinkle, trunk) and investigation activities

(ambulatory, non-ambulatory).

There are uni-, bi-, and triaxial accelerometers. Uniaxial accelero-

meter measure accelerations in one direction, biaxial in vertical and

horizontal directin and triaxial in three directions: anteroposterior,

mediolateral and vertical direction. Triaxial accelerometers provide

more information and show the best relationship to activity-related

energy expenditure (Bouten, Westerterp, Verduin, & Janssen, 1994).

In physical activity research the most commonly used acceleromet-

er is uniaxial. Researchers found comparable results between uni-

axial, biaxial and triaxial accelerometers, because physical activity

research prevails in vertical acceleration and this type of accelero-

meter is cheaper and easier for data processing (Kumahara, Tanaka,

& Schutz, 2004).

Accelerometers can be placed on different body parts: ankle,

thigh, chest, wrist, upper or lower back, hips or belly button. In

terms of reliability and validity of the data, literature encourages

wearing accelerometer on the hips or in the lower back because of

the proximity of the center of gravity of the body (Ekelund et al.,

2000).

Accelerometer collects and stores data in intervals called epochs,

which is usually possible to adjust on 5, 15, 30, 45 and 60s or cus-

46

Quantifying Physical Activity

tomized to one second or less. Shorter intervals, such as 15s epoch

is more suitable for shorter and more intensive movement, because

longer interval may not detect a short-lasting movement. Use of a

longer epoch does not give an accurate assessment of high intensity

activity, but longer epoch ensures longer data collection and stor-

age up to three weeks or more (Nilson, Ekelund, Yngve, & Sjostrom,

2002). The majority of the studies in children and adolescents used

a 60s epoch (66%) and 15s epoch in preschoolers (42.9%) (Cain, Sal-

lis, Conway, Van Dyck, & Calhoon, 2013).

A valid day is one of the conditions we need to take in considera-

tion when measuring with accelerometers. The valid day is defined

by a minimum number of wearing hours. Rule 70/80 provides that

70% of the sample subjects wear an accelerometer for at least 80%

of the daily observation time (Catellier et al., 2005). Minimum num-

ber of wearing accelerometer ranges from 3–10 days (Mattocks et

al., 2008), 7 days should be reasonable standard for all ages (Ward,

Evenson, Vaughn, Rodgers, & Troiano, 2005). One of these days

needs to be weekend day (Rowlands, 2007).

When measuring physical activity with accelerometers, we need

to define non-wear time within a day, which is normally identified

with summing consecutive zero counts per minute (cpm) and wear

time is computed by decreasing the non-wear time from cumulative

possible time. It is very important to differentiate between wearing

accelerometer but being sedentary and not wearing accelerometer

because of sleep time or swimming (Cain et al., 2013).

Pedometer is probably the oldest technique to assess physical activity and was designed by Leonardo da Vinci 500 years ago (Montoye,

Kemper, Saris, & Washburn, 1996). The pedometer records acceler-

ation and deceleration of movement in one direction (Saris & Bink-

horst, 1977). Pedometers provide measure of the number of steps

taken during a given period of time (Kohl et al., 2000). Pedomet-

ers have been used for measuring physical activity for the last two

decades. Advantage of pedometers is low-cost, effectiveness (Buck-

worth, Lee, Regan, Schneider, & DiClemente, 2007) and usefulness

particularly in the epidemiological studies (Volmut, 2014). Disad-

47

Physical Activity Research

vantage of pedometer is that we cannot assess intensity of move-

ment and identify how many steps have been done in the specified

intensity and the results assessed from pedometer are poorly asso-

ciated with accelerometer outcome in everyday living conditions

with children (Treuth et al., 2003). Pedometer step count is more

inaccurate at speed <60 m/min (Abel et al., 2011), therefore it is

not suitable for older people and if the subject is walking faster

than normally, pedometer may underestimate total distance, since

step count of pedometer is influenced by stride length and speed of

walking (Abel et al., 2009).

Heart-rate monitors. Heart rate is an indirect measurement of phys-

ical activity and it measures the physiological response of the body.

Physical activity rate assessed with heart-rate monitor is closely re-

lated to oxygen consumption (VO2), thus power consumption at

different intensities of physical activity (McArdle, Katch, & Katch,

2006). Heart-rate monitors record participant’s heart rate at given

intervals during the period of observation. They gather inform-

ation about responses of the heart during exercise and physical

activity, which could be interpreted as a proxy measure of acute

physical activity (Kohl et al., 2000). Minute by minute information

from heart-rate monitor gives us information about intensity, fre-

quency and duration of free-living physical activity (Schutz, Wein-

sier, & Hunter, 2001). Estimation of energy expenditure accessed

via heart-rate monitor is popular, inexpensive, non-invasive and

versatile; however, there are various sources in the assessment of

physical activity by heart rate because factors other than exercise

affect heart rate. Factors such as high ambient temperature, high

humidity, and emotional stress will cause an increase of heart rate

(Freedson & Miller, 2000). Beside pedometers and accelerometers

heart-rate monitors are major examples of objective measurement

(Sirard & Pate, 2001).

Doubly-Labelled Water (DLW) appears to be a gold standard for val-

idating other methods to measure daily physical activity in free-

living individuals (Starling, Matthews, Ades, & Poehlman, 1999) and

is one of the most accurate assessments of energy consumption in

48

Quantifying Physical Activity

the implementation of activities in daily living environment. The

method assesses the energy consumption with an accuracy of 1–3%

depending on the results of calorimetry (Speakman, Nair, & Goran,

1993) and variability of the measurement is between 4–10% (Speak-

man, 1998). DLW is noncalorimetric technique for measuring total

energy expenditure (TEE) using an oral dose of water which con-

tains nonradioactive isotopes of hydrogen (2H) and oxygen (18O).

Derived CO2, as a product of physical activity, and indirect calori-

metry formulas are used to calculate energy expenditure. Physical

activity energy expenditure can be calculated knowing total daily

energy expenditure (TEE) measured by DLW, resting energy ex-

penditure (REE) and thermic effect of consumed food (TEF), meas-

ured by indirect calorimetry (Starling et al., 1999; Plasqui & West-

erterp, 2007). Measurement period normally runs from 1–3 weeks.

Samples isotopes may be sampled from all body fluids, but is the

most commonly used urine (Volmut, 2014).

AEE (kcal/day) = TEE (kcal/day) – REE (kcal/day).

Disadvantage of DLW technique is high cost, because of the relat-

ively high price of the oxygen-18 water, mass spectrometer instru-

mentation and specific technical expertise in sample preparation

and measurement (Starling et al., 1999). Despite being the criterion

for gold standard, DLW does not provide specific information about

daily physical activity, such as activity type, intensity and duration.

Taken into consideration all these limitations, DLW is used in sci-

entific manner to validate other techniques and approaches for the

quantification of free-living energy expenditure (Westerterp, 2009).

Multi-Sensor Devices. Measuring all aspects of physical activity under free-living conditions is complex; the use of multiple methods

of assessing physical activity simultaneously is recommended. Ac-

celerometer and heart-rate monitor together make a powerful tool

for assessing energy expenditure. Accelerometer counts verify that

elevations in heart-rate are because of increased physical activity

or vice versa. Technology has moved on, so new wearable devices

are produced. Actiheart (CamNtech Ltd, Cambridge, UK) com-

bines heart-rate and accelerometry (Zakeri, Adolph, Puyau, Vohra,

49



Physical Activity Research

& Butte, 2008), Intelligent Device for Energy Expenditure and Activ-

ity MiniSun (LLC, Fresno, CA) combine five accelerometers which

are worn on chest, thighs and feet (Zhang, 2003) and SenseWear

Armband (Bodymedia, Inc., Pittsburg, PA) combines triaxial accel-

erometry, skin temperature, heat flux and galvanic skin response

in a single device, worn on the upper arm. These devices collect

data on physiological and mechanical variables (Hills, Mokhtar, &

Byrne, 2014). There is no gold standard for objective measurements

of physical activity, the choice is complex and it depends on many

factors such as time, expertise, desired outcomes and desired phys-

ical activity outcomes (Ainsworth, Cahalin, Buman, & Ross, 2015).

Subjective Methods

Subjective assessment of physical activity relies on a child remem-

bering activities they participated in or recalling their perception of

the intensity of the movement. Subjective assessment of physical

activity is useful for measuring the activity of large groups since sub-

jective methods are cheaper than objective. Subjective methods or

self-report of assessing physical activity involves qualitative or de-

scriptive recall of behaviours, logbooks, self-reports, proxy reports

50

Quantifying Physical Activity

and diaries (Armstrong & Welsman, 2006; Laggeros & Lagiou, 2007).

Subjective instruments are the most widely used type of physic-

al activity assessment. It is very important to identify strength and

limitations of their use before using them. The recognized benefit of

self-report is collected data from a large number of children at low

cost. Self-reports have been used in different age ranges and meas-

ures can be adapted to fit the need of particular research and popu-

lation (Sallis & Saelens, 2000).

Questionnaires are the most common used tools for measuring

physical activity with children and adolescents. There are gener-

ally two types of questionnaires, the self-report type where the

older children and adolescents report on their PA on their own,

and the proxy-report where physical activity of young children is

reported by parents or teachers (Sallis & Saelens, 2000). Self-reports

have been used in a range of ages, and can be either interviewer-

administered or self-administered. In self-report, participants are

normally asked to obtain activity participation during a recent peri-

od of time (1 hour, 1 day, 7 days, 1 month) (Kohl et al., 2000). Disad-

vantage of self-report is validity and reliability of results (Shephard,

2003) due to over-reporting of physical activity (Warnecke et al.,

1997), since recalling physical activity is very complex cognitive task

(Baranowski, 1988). Disadvantage of proxy-report is reporter’s abil-

ity to observe the physical activity of the subject (Sallis & Saelenes,

2000). Benefits of questionnaires are simple compilation of the res-

ults and addressing a wide range of parameters such as type, meth-

od, duration and frequency of exercise (Planinšec, 2003). It has been

suggested that children younger than 12 years are unable to reli-

ably estimate their activity and quantify the time of their activity

(Pate, 1993). The main advantage of the questionnaires is simpli-

city, but they most often provide only minimal information about

activity. Objectivity of the data collected with questionnaires is low,

but they can be a very useful tool when we need quick and essen-

tial information about children’s physical activity (Volmut, 2014).

Questionnaires are a very good supplement to objective methods

of measuring in order to assess the context and type of physical

activity.

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Physical Activity Research

Physical activity diaries contain detailed information about vari-

ous aspects of physical activity and may include information about

intensity, duration, type and body position during physical activity

(Ainsworth et al., 2013). Physical activity diaries are superior to ret-

rospective questionnaires (Baranowski et al., 1984), but their use is

unsuitable for children younger than 15 years of age (Saris, 1986).

Physical activity can be monitored through physical activity diar-

ies from one day to several weeks, depending on the purpose and

interest of the research. Most of diaries are monitored via tablets,

computers and smart-phones. Advantage of diaries is detailed in-

formation about specific activity, but on the other hand, disadvant-

age is that is does not contain all the activities that took place during

the day.

Physical activity logs have checklist with tasks of activity that are

completed in the end of the day, week, month or discrete period of

time. Logs can include intensity and duration of physical activity.

Physical activity can be monitored through activity logs from one

day to multiple weeks, depending on the purpose of the assessment.

Advantage of physical activity logs is simplicity of collecting the data

and the biggest disadvantage is missing details of physical activity in

the end of the day (Ainsworth et al., 2015).

Physical Activity in Numbers

World

David Kirk (2010) at National Conference of the INEFC represented

current status and future trends in research on physical education.

He reviewed current and future trends within Europe-authorised

research published between 2000 and 2009. Total number of pub-

lished papers from physical education and pedagogy was 665 in

4 most influenced European peer-reviewed journals (EPER, JTPE,

EJPE/PESP, SE&S). In last two decades, physical activity and their

effects on health, cognition, and academics has become hot top-

ic in research field. Current studies indicated that majority of chil-

dren and adolescents are not meeting the recommendation of 60

minutes of moderate- to vigorous physical activity per day (Gort-

maker et al., 2012) and that physical activity levels are decreasing

52

Physical Activity in Numbers

with age (Nader, Bradley, Houts, McRitchie, & O’Brien, 2008). Sev-

eral studies has been researching intensity of physical activity and

and rate of energy expenditure. It has been shown, that moderate-

to vigorous physical activity is important for normal growth, devel-

opment, body composition and decrease in acquiring risk factors

for development of chronic disease. Moderate- to vigorous physic-

al activity is associated with physical, social and mental health be-

nefits (Warburton, Nicol, & Bredin, 2006; Janssen & Leblanc, 2010;

Hallal, Victora, Azevedo, & Wells, 2006) and is positively related to

adult physical activity (Hallal et al., 2006; Telama et al., 2005) and

health (Hallal et al., 2006).

Valid and reliable measures of physical activity are required (Cas-

persen, Nixon, & DuRant, 1998; Trost, Loprinzi, Moore, & Pfeiffer,

2011), therefore several studies has been made determinating ob-

jectively (Rowlands, 2007; Reilly et al., 2008; Guinhouya et al., 2006;

Schneider, Crouter, Bassett, 2004; Trost et al., 2011) and subjectively

measures (Sirard & Pate, 2001; Corder, Ekelund, Steele, Wareham,

& Brage, 2008) of physical activity. Subjectively measured physical

activity is more appropriate for large samples because it is much

cheaper than objectively measured physical activity, although the

reliability of the measured data is better when measuring with ob-

jective assessments. In physical activity research very interesting

and hot topics are also (Kohl & Cook, 2013): recess, physical educa-

tion, active transport, sedentary or light- intensity physical activity,

state and local policies on school-based physical activity, vigorous-

or moderate-intensity physical activity.

It is known very well, that school-related physical activity must be

a large contributor to overall physical activity among youth (Kohl

& Cook, 2013). Overall contribution, including every segment of

school day – transportation to and from school (McDonald, 2007;

Bassett et al., 2013), physical education (Simons-Morton, Taylor,

Snider, & Huang, 1993; McKenzie et al., 2006), recess (Lee, Burgeon,

Fulton, & Spain, 2007; Bassett et al., 2013), classroom time – be-

fore and after school activities. Guidelines, recommendations and

policies from all national, supranational levels and from various

organizations, are known to influence children’s and adolescent’s

53

Physical Activity Research

school physical activity. Despite excellent research and good public

health surveillance systems, current monitoring of overall physic-

al activity and all behaviours and forms included in term physical

activity, are inadequate. Differences have arisen for several reasons

(Kohl & Cook, 2013). Physical activity has only recently been ac-

knowledged as a vital public health issue. It is a behavior difficult

to measure and it is not easy to understand types and quantities

of physical activity relevant to health and health outcomes (Kohl

& Cook, 2013). Recommendations for types and amounts of phys-

ical activity for children have changed for many times in the last

two decades and the schools – as the most suitable institution for

the maintenance of the recommended amount of physical activity,

vary considerably in size, resources, urbanization, traditions, and

policies.

Very detailed and reliable overview of physical activity for chil-

dren and youth, based mostly on nationally measured data is ‘Re-

port Card on Physical Activity for Children and Youth,’ which falls

under cover of Active Healthy Kids Global Alliance (Tremblay et

al., 2014; Tremblay, Barnes, & Cowie, 2014; Tremblay, Brownrigg, &

Deans, 2008) and Health Behavior in School-aged Children (HB-

SC), which is a cross-national study gaining insight into young

people’s well-being, health behaviours and their social context (see

http://www.hbsc.org).

Slovenia

Findings show that in 2003 in Slovenia, 18% of boys and 19% of girls

were overweight, and 6% of boys and 8% of girls were classified as

obese (Bučar Pajek, Strel, Kovač, & Pajek, 2004). This proportion is

still on the rise. Starc, Strel, and Kovač (2010) found that changes in

motor dimensions are gigantic, diverse and surprising. In this study,

they were comparing generations from school year 2007/2008 with

previous generations. They found negative changes in motor abil-

ities are on the average (for all eight movement skills measured in

for SLOFIT data), or boys 0, 43% and for girls 0, 22% lower mo-

tor abilities than the previous generation. With body weight meas-

urements, there is also a noticeable downward trend in primary

54



Physical Activity in Numbers

school children, when comparing to the previous generations. The

greatest negative trend was noticeable with pupils between 9 and

11 years old, which gain over 1% weight compared to the previous

generations. The largest increase in body weight is noticeable in 15

years old girls. Despite a sufficient number of physical education

hours (3 school hours/week), and extracurricular activities connec-

ted to physical activity, there is still a negative trend, particularly

when motor abilities are taken into concern. It is necessary to rad-

ically change this trend for the low-quality way of life, and promote

awareness that physical activity is important- not only because of its

positive effects on health but also with positive effects on academic

performance. According to the ACDSi data, 97% of boys and 95%

girls (ages: 6–11 years) from Ljubljana are meeting WHO recom-

mendations for daily physical activity (2010), 86% of boys and 76%

of girls aged 6–18 years) meet physical activity guidelines. On week-

ends, 81% boys and 72% girls meeting recommendation guidelines

(Sember et al., 2016).

There is no centralized registry of sports practice or participation

in organized clubs for children and youth outside of the school sys-

tem in Slovenia; although 60% boys and 47% of girls aged 6–19 years

55

Physical Activity Research

are engaged in extracurricular sport or clubs (Sember et al., 2016).

On school days only 16% of Slovenian boys and 19% of Slovenian

girls play actively more than 2 hours per day, on weekends 57% boys

and 59% of girls (Sember et al., 2016). Only 3% of Slovenian chil-

dren uses bike and 26% walk to the school. The ACDSi nationally-

representative data (Jurak, Kovač, & Starc, 2013; Starc et al., 2015)

indicates that active commuting to school remains relatively stable

with age with about 52% of boys and about 50% girls from age 5 to

18 y actively commuting to school (Sember et al., 2016). In Slove-

nia, 90% of boys and girls meet the recommendation of fewer than

2 hours of screen time per day. During weekends this percentage de-

creases to 37 and 45% of boys and girls, respectively. Weekend and

weekday combined, 74% of boys and 79% of girls aged 6–19 years

meet the recommendations for screen time (Sember et al., 2016). In

Slovenia 75% of parents encourage their children between 11 and 19

y to be physically active. Almost 90% of parents indicate they sup-

port opportunities for physical activity by buying sports equipment,

driving kids to practice, etc. When asked about their parent’s phys-

ical activity levels, children perceived their fathers to be ‘very active’

in ∼ 30% of cases and ‘moderately active’ in 35% of cases. In Slove-

nia, physical education (PE) is a compulsory subject in all primary

and secondary schools and they all follow the same PE curriculum.

PE minutes vary by grade such that primary school (grades 1–5) re-

ceive a minimum of 105 hours per year, grades 7–8 receive 70 hours,

and grade 9 students receive 62 hours per year. Grades 7–9 have op-

portunities to select an additional 35 hours of elective sport classes,

and 35 hours of elective dance class. Grades 4–6 may also select an

additional 35 hours of elective, health-oriented sport classes (Kovač

et al., 2015). In addition to regular PE classes, primary school chil-

dren have 5 sport days in each grade, each lasting 5 hours, together

25 hours of school-based physical activity in a school year. Some

primary schools in Slovenia organise enhanced PE curriculum, dur-

ing which children receive supplementary lessons (Jurak, Cooper,

Leskošek, & Kovač, 2013). Additionally, primary schools in Slovenia

are allowed to have more than the prescribed minimum of 2 or 3

PE lessons per week if the school board decides so, although less

56

Physical Activity in Numbers

than 10% of schools actually do. All primary schools are obliged

to offer extracurricular sport programs, which are free of charge

for all children. In the best case scenario, a 10-year old in Slovenia

can receive 131 hours (or 7875 minutes) of regular PE lessons, plus

25 hours in school sport days, 35 hours of elective sport courses,

and at least 35 hours of extracurricular school-based sport practice,

summing to a total of 226 hours of school-based PE. Thus, Sloveni-

an primary schools offer access to 77 min of daily in-school, pro-

fessionally guided PA. In the (worst-case) event that a 10-year-old

would participate in only the compulsory 3-weekly lessons of PE

and obligatory school days, this number would drop to ∼ 39 min per

school day, still more than half the 60 min of recommended daily

physical activity (Sember et al., 2016).

In the past two decades, the national government and municip-

alities have invested in the reconstruction of old, and the building

of new, school sports halls including other sport infrastructure. For

example, from 2001–2008 public funding of sport infrastructure ex-

ceeded €300 million euros (Jurak, 2012). The policy of the Ministry

of Education, Science and Sport also enforces rules related to the

professional competencies of teachers and trainers in PE and youth

sport, which require people to have a university degree in PE to work

with young athletes (Zakon o športu, 2017). In addition, the Ministry

currently develops strategies to implement compulsory, joint teach-

ing of regular classroom teachers and PE teachers within the first

5 years of primary school to raise the quality and effectiveness of

PE. Finally, more than 25 years ago, the government of Slovenia es-

tablished the Centre for School and Outdoor Education programme

which has 23 learning centres scattered throughout the country.

Each of these centres employs at least one PE specialist, and of-

fers various outdoor activities that are not available within regular

school settings (Sember et al., 2016).

A key reason for the past effectiveness of government policies

related to schools, sport infrastructure, PE, and its curriculum in

Slovenia is the evidence-based policy planning of the Ministry of

Education, Science and Sports (Kovač et al., 2015). The Ministry has

continuously supported the SLOfit monitoring system and has been

57

Physical Activity Research

using evidence on secular trends in physical and motor develop-

ment of children and youth to plan its future activities and interven-

tions, as well as evaluate their effectiveness. To wit, the Ministry in-

troduced a health-oriented physical activity intervention program

‘Healthy Lifestyle’ to combat growing childhood obesity and de-

clining physical fitness (Strel, 2013). Current evidence from SLOfit

data suggest that these state-wide interventions are effective at in-

fluencing population movements (Strel, 2013), since obesity trends

have been in decline since 2011, and the physical fitness of primary

school children has improved significantly (Strel, 2013). Govern-

ment strategies, policies and investments was graded B+ (Sember

et al., 2016).

School Settings

Physical activity is important for children and adolescents. Schools

and community settings are necessary for promoting physical activ-

ity (Stone, McKenzie, Welk, & Booth, 1998), since children and ad-

olescents are most of the day in the school environment. In public

health and biomedical research, study design plays a major role in

interpretation (Rothman, 2012). Research studies are nowadays di-

vided into interventional and observational studies.

Interventional Studies. The interventional study design is also called experimental study design. Interventional studies are studies where

investigator is acting on participants and changing their normal be-

havior. Interventional/experimental study designs are: randomized

controlled trial study design, crossover randomized controlled tri-

al study design, pre-post study design, non-randomised trial study

design (Thiese, 2014). Since schools have major influence on chil-

dren during their childhood and adolescent time, schools are the

best environment for physical activity interventions (Story, Nanney,

& Schwartz, 2009). Physical activity has been shown to be indirectly

associated with academic performance, including better classroom

behavior, self-esteem, engagement in school, on-task behavior and

lower drop rate (Trudeau & Shephard, 2008). Van Sluijs, McMinn,

and Griffin (2007) reviewed 57 studies on the effectiveness of inter-

58

Physical Activity in Numbers

ventions among children and adolescents. Thirty-eight studies re-

ported positive effect (67%) and statistical signification in 27 studies

(47%) of physical activity interventions. Significant result ranged up

to 42% increase in participation in regular physical activity and in-

crease of 83 minutes of moderate-to-vigorous physical activity per

week. Kahn et al. (2002) evaluated the effectiveness of various inter-

ventions to increasing physical activity; informational, behavioral,

social, environmental and policy approaches. Effective interven-

tions were: ‘point-of-decision’ prompts to use stairs intervention

and community-wide campaigns of informational interventions;

school-based physical education, social support in community set-

tings and individually-adapted health behaviour change from field

behavioural and social interventions; and creation of or enhanced

access to places for physical activity combined with informational

outreach activities from field environmental and policy interven-

tions.

Randomised Controlled Trial Study Design. Randomized controlled

trial study design is the most used type of interventional studies

(Machin & Fayers, 2010). This study design randomly divides a ho-

mogenous group of participants and implements intervention on

only one group. The only difference between groups should be

intervention (Thiese, 2014). Dwyer, Coonan, Leitch, Hetzel, and

Baghurst (1983) investigated effects of daily physical activity on

health in primary schools in South Australia, using randomized

control trial research design. Results for students after two years of

intervention in 1980 were compared against cross-sectional meas-

ures of 1978. Findings of South Australia research suggested benefi-

cial effects on health and no loss of academic performance in spite

of 45 to 60 minutes loss of teaching time every day. Metcalf, Hen-

ley, and Wilkin (2012) reviewed 30 peer-reviewed studies, wheth-

er physical activity interventions affect overall activity of children.

Studies had to meet the following inclusion criteria: children and

adolescents younger than 16 years, studies had to be randomized

controlled trials; physical activity had to be objectively measured,

expressed in mean accelerometer counts/minute and intervention

59

Physical Activity Research

must have incorporated a component that aimed to increase phys-

ical activity. Thereview provided strong evidence that randomized

controlled trial – physical activity interventions have had only a

small effect on overall physical activity level. Intervention children

had been only 4 minutes per day more active compared to con-

trol children, which may explain why such interventions have had a

limited effect on body mass index or body fat.

Crossover Randomised Controlled Trial Study Design. Crossover ran-

domized controlled trial study design at first phase divides parti-

cipants the same as in the randomized controlled trial study, but

at the end of first treatment intervention, participants are relocated

to another treatment arm. Between treatments are often wash-out

periods (Thiese, 2014). Thirty-five German adolescents between 13

and 14 years of age participated in crossover study design. They

were divided into higher-fit ( n = 17) and lower-fit ( n = 16) subgroups. Participants were assigned to the event-related potential

(ERP) study with two recording sessions, one following 20 minutes

of exercise and one following 20 minutes of rest. They participated

in both conditions in a random order within an exact seven days

interval at the same day of the week and same time of the day.

Results indicated that higher fit-individuals showed significantly

greater contingent negative variation of the event-related potential

amplitudes. The research team did not found the reliable effect of

acute exercise on inattention or impulsivity; however, higher-fit in-

dividuals did perform better (Stroth et al., 2009). Researchers from

Scotland used a crossover design trial and randomized 552 children

into two groups. One group received a classroom-based program

of physical exercise on week 1 and no physical exercise program in

week 2; other group received a classroom-based program of phys-

ical exercise in week 2 and no physical exercise program in week 1.

Each week all participants completed cognitive test battery. Bene-

fits occurred only for participants who exercised during the second

week. The research team interpreted that exercise intervention has

a positive effect on cognitive performance possibly by facilitating

practice effects, which are not moderated by sex, ADHD symptom

60

Physical Activity in Numbers

level or BMI (Hill, Williams, Aucott, Thomson, & Mon-Williams,

2011).

Non-Randomised Trial Study Design. The non-randomised trial

study design is not considered as strong study design and is often

subject to many types of bias and error. The non-randomised trial

study compares a group where intervention was performed and a

group where intervention was not performed (Thiese, 2014). Alex-

androv et al. (1992) performed the non-randomized trial study. The

three-year intervention consisted in primary prevention. All inter-

vention children received counseling and lectures on prevention,

and secondary prevention, where children with risk factors were in-

vited to a single counseling session. Follow-up examinations were

carried out at one and three years following baseline. After one-year

intervention children had attained a greater reduction in their levels

of total cholesterol, triglycerides, and systolic blood pressure.

Pre-Post Study Design. Pre-post study design measures outcome be-

fore and after intervention has been implemented. Pre-post study

has the strength to suggest that outcome is impacted by interven-

tion; however, pre-post studies do not have control over other ele-

ments which have changed during the intervention (Thiese, 2014).

Ridgers, Stratton, Fairclough, and Twisk (2007) selected 297 school-

children from 26 elementary schools to wear uni-axial accelero-

meters during recess. Research has investigated the effects of the

recess-based intervention on physical activity, investigating short-

term effects of playground markings and physical structures on re-

cess physical activity and effects of covariates on the intervention.

Following legalities of pre-post study design, data were collected at

baseline and 6-weeks following playground intervention. Schools

were visited twice, once before the playground redesign (pre-test),

and once six weeks after playground redesign (post-test). After in-

terventions, positive but non-significant effects had been found

for moderate-to-vigorous physical activity and vigorous physical

activity and boys were significantly more engaged in moderate-to-

vigorous and vigorous physical activity than girls.

61



Physical Activity Research

Observational Studies. Observational or epidemiological studies are those where the investigator is not acting on participants and changing their normal behavior but is observing the natural relationship

between factors and outcomes. Observational studies are often ret-

rospective (Thiese, 2014) and make decisions where the independ-

ent variable is not under investigator’s control because of ethical or

logistical concerns (Porta, 2008). Observational studies are ecolo-

gical study design, proportional mortality ratio study design, cross-

sectional study design, case-control study design, case-crossover

study design, retrospective and prospective cohort study design,

diagnostic testing and evaluation study designs.

Ecological Study. The most basic observational study is ecological

study, which compares clusters of people, mostly based on their

geographical location (Breslow, 2014). Ecological studies are usu-

ally retrospective, and the data is derived from big databases, which

is their weakness, since big databases are typically created for oth-

er purposes, not research (Friis & Sellers, 2013). The advantage of

ecological study is cost effectiveness and starting point for hypo-

theses generation (Thiese, 2014). Joens-Matre et al. (2008) looked

for for rural-urban differences in physical activity, physical fitness

62

Physical Activity in Numbers

and overweight prevalence of children. The sample included 3416

Iowa children from grades 4, 5 and 6 with main age 10.6 + 0.96.

Data were obtained from the Physical Activity and Nutrition Among

Rural Youth (PANARY) project and level of urbanization was de-

termined by 1993 Rural-Urban Continuum Codes (RUCC), which

distinguish metropolitan counties by size and degree of urbaniza-

tion and proximity to metro areas (Joens-Matre et al., 2008). Phys-

ical activity was assessed using the Physical Activity Questionnaire

for Children-PAQ-C (Joens-Matre et al., 2008) and body mass index

was measured by trained physical education teachers. Prevalence of

overweight was higher among rural children (25%; p < 0.001) than

children from urban areas (19%) and small cities (17%). Urban chil-

dren were the least active overall (Cohen’s d = 0.4).

Proportional Mortality Ratio Study Design. Proportional mortality

ratio studies design is used in occupational epidemiology (Delgado,

Sillero, & Gálvez, 1994) and equals the cause-specific standard-

ized mortality ratio divided by overall proportionate mortality ratio

(Hansen, 1990). These type of studies are limited to death (Stolley &

Lasky, 1995) as an outcome and give us cause-specific information

between exposure categories (Monson, 1974).

Cross-Sectional Study Design. Cross-sectional study design or trans-versal is a type of observational study that involves the analysis of

a representative data at one specific point in time. Cross-sectional

study is also called prevalence study because one of the main vari-

ables is population prevalence (Woodward, 2013). The advantage of

this study design is low cost and major disadvantage that investig-

ators cannot normally answer the causation of the effect. Robinson

et al. (1993) conducted a cohort study among female adolescents

( n = 971, sixth and seventh-grade) with follow-up assessments 7, 14

and 24 months after baseline, where 671 girls had sufficient data

for baseline cross-sectional analyses. Hours of television watch-

ing, physical activity and stage of sexual maturation were assessed

with self-report instruments; height, weight and triceps skinfold

were measured and body mass index was calculated. Among ad-

olescent girls, television viewing time had weak associations with

63

Physical Activity Research

adiposity and physical activity. Andersen et al. (2006) assessed the

associations of objectively measured physical activity (acceleromet-

er Actigraph) with clustering of cardiovascular disease risk factors

in children. Researchers did a cross-sectional study of 1732 ran-

domly selected 9-year old and 15-year old school children from

Denmark, Estonia and Portugal. The primary sampling units were

schools; secondary sampling units were children on the school re-

gister. Key findings of this study were graded with negative associ-

ation between clustering of risk factors and physical activity. The

first to the third quintile of physical activity has had a raised risk in

all analyses.

Case-Control Study Design was originally developed in epidemi-

ology and compares people with an outcome of interest (case) with

people without the specific outcome of interest (control). The out-

come is measured before exposure and controls are selected by not

having the outcome. The disadvantage of this study is increased

risk for bias due to known case study of participants. Advantages

of this type of study are low cost, fast execution of data compared

to cohort studies, collection of individual participants’ data, con-

trol for multiple confounders and access to multiple exposures of

interest (Thiese, 2014). This study design is the most efficient when

researching rare diseases. Case-control studies increased the risk

for bias, particularly recall bias (Rothman, Greenland, & Lash, 2008;

Wacholder, Silverman, McLaughlin, & Mandel, 1992). The strength

of case-control studies is that study is most efficient for rare dis-

eases, its low cost, fast execution compared to cohort studies and

ability to assess multiple exposures of interest (Mann, 2003; Thiese,

2014). Da Costa Ribeiro, Taddei, and Colugnatti (2003) researched

obesity among children attending elementary public schools in Sao

Paulo, Brazil. They measured 223 obese and 223 eutrophic school-

children, aged 7–10 years. Parents of 446 schoolchildren all togeth-

er were interviewed about children’s eating behaviors and habits.

They concluded that children with a birth weight of 3500 g or more

or whose parents are obese should receive special attention in the

prevention of obesity.

64

Physical Activity in Numbers

Case-Crossover Study Design. Case-crossover studies are retrospect-

ive and the case serves as his/her own control for some compar-

ison issues (Woodward, 2013). These studies are good where the

outcome is acute and well defined (Rothman et al., 2008). The dis-

advantage of case-crossover studies is risk for having recall bias.

Case-crossover studies require careful selection of period and care-

ful selection of timing and the length of the windows. Experience

has shown that case-crossover design applies best if the exposure

is intermittent (Maclure & Mittleman, 2000). Broderick et al. (2012)

searched associations between physical activity and risk of bleeding

in children with hemophilia. A case-crossover study nested within

prospective cohort study design was conducted on 104 schoolchil-

dren. Children with hemophilia were monitored for bleeds up to 1

year. Physical activity was assessed according to expected frequency

and severity of collisions. The risk of bleeds associated with phys-

ical activity was estimated 8 hours before the bleed and two times

for 8hour control window. Children with hemophilia were more ex-

posed to the risk of bleeding in vigorous physical activity.

Cohort Studies identify a group of people and follow them for some

time with a desire to see how their exposures affect their outcomes

and are normally used in cases that cannot be controlled experi-

mentally. Cohort studies are the only ones of observational stud-

ies that can calculate cumulative incidence and an incidence rate

(Rothman et al., 2008; Ahrens & Pigeot, 2005; Aschengrau & Seage,

2013) between prospective and retrospective studies. Prospective

study design watches for outcome during the period of study and

involves observation of subjects over a long period and is con-

sidered as a gold standard of observational research (Aschengrau

& Seage, 2013). Maffeis, Talamini, and Tato (1998) researched the

influence of diet, physical activity and parents’ obesity on children’s

adiposity. Anthropometric measures of 112 prepubertal children

were initiated in 1992 and follow-up measurements in 1996. Obesity

was defined as relative body mass index > 120%. Parents’ obesity

was the main risk factor for childrens’ obesity and sedentary be-

havior was independently associated with overweight at the age of

65

Physical Activity Research

8 years. Retrospective study watches for outcome backward and

examines exposures about an outcome that is established at the

beginning of the study (Mann, 2003; LaMorte, 2015). Retrospective

study or historic cohort study is a longitudinal cohort study that

researches a cohort of individuals with common exposure in de-

termining influence and is compared to another group, which was

not exposed to exposure factor (Doll, 1980). A retrospective study

looks backward and examines exposures to suspected risk about an

outcome, established at the beginning of the survey. In retrospective

studies there is a higher risk for obtaining bias than in prospective

studies, this is why retrospective studies are often criticized. Data

from the Cardiovascular Risk in Young Finns Study ( n = 2309); lon-

gitudinal research project from the beginning of 1980 (Telama et

al., 2005) were used for investigation of stability of physical activ-

ity from childhood and adolescence to adulthood and how physical

activity in adulthood could be predicted from variables measured in

childhood and adolescence. Physical activity was assessed with self-

report, and medical examinations were made. It was concluded that

high level of physical activity in childhood affects physical activity

in adulthood (Telama et al., 2005).

66





6

Physical Fitness

Physical fitness is a general state of health and well-being and ca-

pacity to perform in physical activity, daily activities and sports and

refers to a full range of physiological and psychological qualities. It is

defined as the quality or state of being fit (see https://www.merriam

-webster.com/dictionary/fitness). Physical fitness is set of attrib-

utes associated with the capacity to perform physical activities (Or-

tega, Ruiz, Castillo, & Sjostrom, 2008), which consisted of three

components: muscle strength, endurance and motor skills (Malina

& Katzmarzyk, 2006). Physical fitness could also be thought as an

integrated measure of almost all body functions (cardiorespiratory,

hemato- circulatory, psychoneurological and endocrine-metabolic)

involved in daily physical activity and exercise (Ortega et al., 2008).

The cardiorespiratory function is assessed using maximal oxygen

consumption (VO2max). Principal components of muscle strength

are maximum power (static and dynamic), explosive strength, dur-

ability, power and isokinetic strength. Most appropriate tests for

the assessment of muscle strength are shaking fists, Standing Long

Jump and Bent Arm Hang. Speed is the ability to move the body

or body parts as quickly as possible and agility is a combination

of speed, balance, strength and coordination (Ortega et al., 2008).

It has been shown that physical fitness is strongly correlated with

total adiposity (Ruiz et al., 2006; Ara, Vicente-Rodriguez, Jimenez-

Ramirez et al., 2004; Lee & Arslanian, 2007), abdominal adipos-

ity (Ortega et al., 2007; Hussey, Bell, Bennett, O’Dwyer, & Gorm-

ley, 2007), cardiovascular disease (Hurtig-Wennlof, Ruiz, Harro, &

67





Physical Fitness

Sjostrom, 2007; Chomistek, Chasman, Cook, Rimm, & Lee, 2013;

Berry et al., 2013), skeletal health (Ginty et al., 2005), and mental

health (DiLorenzo et al., 1999; Castelli et al., 2007). Ortega et al.

(2008) found out that physical efficiency during childhood and ad-

olescence is a good indicator of health. Several health benefits are

associated with physical fitness. Better physical fitness reduces the

risk of cardiovascular disease, colon cancer, diabetes, dying pre-

maturely and obesity (US Department of Health and Human Ser-

vices, 1996), improves bone function, musculoskeletal function and

psychological variables such as depression, anxiety, stress and self-

confidence (American College of Sports Medicine, 2006).

Quantifying Physical Fitness

The assessment of physical fitness has a longer history than of phys-

ical activity (Malina & Katzmarzyk, 2006). Over the past 50 to 60

years the concept of physical fitness has evolved from a primary

focus on motor and strength components to more emphasis on

health in the 1970s (AAHPERD, 1980) and morphological and meta-

bolic components have been added to the more traditional mus-

cular strength and endurance, motor, and cardiovascular compon-

ents (Bouchard & Shephard, 1994). Caspersen et al. (1985) identified

the differences between physical activity, exercise and physical fit-

ness and their importance in health research. Physical activity is any

bodily movement produced by skeletal muscles that result in energy

expenditure and could be measured in kilocalories. Components of

physical fitness include strength, endurance, speed, power, agility,

flexibility, coordination, morphological and metabolic components

(Malina & Katzmarzyk, 2006), overall physical fitness is set of attrib-

utes that people have or achieve (Caspersen et al., 1985). The ability

to carry out daily tasks with vigor and alertness, without undue fa-

tigue and with ample energy to enjoy in activity means being phys-

ically fit. Things such as vigor, alertness, fatigue and enjoyment are

hard to measure, on the other hand, health-related physical fitness

is easier to measure (Caspersen et al., 1985). Definition of exercise

is more restrictive than definitions physical activity and physical fit-

ness. An exercise intended to improve or maintain an established

68

Quantifying Physical Fitness

level of physical fitness (Caspersen et al., 1985). From 1980 several

physical fitness tests have been used (Table 6). Caspersen, Powell,

and Christenson (1985) divided physicalfitness on capabilities re-

lated to health and capacity related to skills. Health-related capab-

ilities are cardiorespiratory durability, muscle durability, muscular

strength, body composition and flexibility. Skills related capabilities

are agility, coordination, balance, reaction time, power and speed.

Bös (1994) made clear and transparent model of motor abilities,

which represents the links between different impairments and their

interdependence. Motor abilities are under different influences as

the features of energy and information components of movement

are intertwined. Model of motor abilities (Bös, 1994) distinguishes

between fitness (power, durability) and information capabilities

(speed, coordination). Physical abilities are organized at different

levels (Magill, 1998) and different categories (Fleishman, 1972). In

the first category are perceptive-motor abilities, while others are

skills that relate to the capacity of the body. The group of perceptive-

motor abilities includes: coordination of movement, control preci-

sion, choice of response, reaction time, coordination, hand move-

ment, control the speed and direction of movement, dexterity, fin-

ger dexterity, precision movements with your hands, wrists and fin-

gers speed and targeting. The group of abilities that define the ca-

pacity of the body includes static power, dynamic power (repetitive

power), explosive strength, and the strength of the hull, flexibility,

coordination of movement of the whole body, the whole body bal-

ance and endurance. Magill (1998) added the following capabilities:

static balance, dynamic balance, movement coordination of eye-

hand coordination and eye-foot movement.

Pišot and Planinšec (2005) investigated the physical structure of

the early childhood population on five-, five- and a half and six- year

old children. In the group of five-year children, using PB-criterion

(Štalec & Momirovič, 1971), four latent motor dimensions were isol-

ated and appointed: coordination of movement, the speed of the

reciprocating movement, static balance and coordination of move-

ments of the extremities. In the group of six- and a half-year-old

children and using GK-criterion, seven factorswere isolated: co-

69





Physical Fitness

Table 6.1 Chosen Fitness Test and Associated Physical Fitness Indicator, Test Label and Units in Which Physical Fitness Indicator is Expressed

Physical fit-

Physical fit-

Physical test

Test label

Units

ness indicator

ness type

Aerobic

Health-related

Shuttle run

SHUTTLE

Nr. of repeti-

strength

indicator

tions

Muscle

Health-related

Hand grip

GRIP

Kilograms

strength

indicator

Repetitive

Health-related

Situps

SITUP

Nr. of repeti-

strength

indicator

tions

Explosive

Physical per-

Standing long

SLJ

Centimeters

strength

formance in-

jump

dicator

Coordination

Physical per-

Polygon back-

POLYGON

Decisecond

formance in-

wards

dicator

Balance

Health-related

Flamingo test

FLAMINGO

Nr. of repeti-

indicator

tions

Flexibility

Health-related

Sit and reach

SAR

Centimeters

indicator

Rhythmic im-

Physical per-

Hand tapping

HAND_TAP

Nr. of repeti-

plementation

formance in-

tions

of movement

dicator

structures

ordination of movements, the realization of rhythmic structures,

static balance, explosive leg strength, and coordination of hand

movement, speed of simple movements, precision and balance. In

the group of five and a half children they found that the structure of

motor abilities identified eight factors. Comparison between sexes

shows that the factor structures are partially similar, as were the fe-

male and male sex equally defined balance, explosive power and

agility.

The area of motor abilities is organized hierarchically. It is pos-

sible to identify two regulatory dimensions that define the structure

of a wide area of motor abilities. The first dimension is related to the

mechanisms for receiving and processing information and is crucial

for motor tasks, where structuring movement, movement control

70





Physical Fitness in Numbers

and central control of movement is essential for their implementa-

tion. The second dimension is related to mechanisms that regulate

energy and is critical for tasks where physical experience is associ-

ated with control of intensity of excitation (Matejek, 2013).

Physical Fitness in Numbers

In Slovenia physical and motor development of children and youth

has been monitored (Strel, 1996) for more than 30 years (Sember et

al., 2016). Every April there are physical fitness benchmarks which

are evaluated together; this initiative is called ‘Športno-vzgojni kar-

ton’ – the SLOFIT card. SLOFIT or the National System for Monit-

oring Physical and Motor Development of children and youth in-

cludes all Slovenian primary and secondary schools. For more than

30 years, this system has given teachers, researchers, and policy-

makers access to high-quality, standardized data on physical fit-

ness, which in turn allows for relatively responsive evidence-based

policy adjustments when needed. For example, based on more re-

cent evidence of declining physical fitness from the SLOfit database,

Slovenia introduced a health-oriented physical activity intervention

program called Healthy Lifestyle in the school year 2010/2011, of-

fering children 2 optional, additional hours of physical activity per

week. Healthy Lifestyle is considered part of a school’s regular ex-

tracurricular health-oriented physical activity program. This project

currently includes more than 30% of the entire primary school pop-

ulation. Before this initiative, Slovenian children had been experi-

encing negative trends in motor and physical fitness for over two

decades, but since 2011, physical fitness in 6- to 14-year-olds has

been steadily improving (Sember et al., 2016). In 2015, Slovenia also

started new tests among the student population. Indeed, with such

a massive, state-sponsored program, Slovenian children have bet-

ter physical characteristics compared to most European countries

(see http://www.slofit.org). Nevertheless, the Slovenian youth pop-

ulation is not immune to changes in lifestyle, and with access to this

longitudinal data, Slovenian researchers are now also seeing neg-

ative trends in child motor development. SLOfit card provide chil-

dren, teachers, youth, and others with the following (Strel, 1996): in-

71

Physical Fitness

formation on their achievements in sports education, graphical rep-

resentation of physical and motor development of a child or a young

person for the entire period of schooling, advice on which sport

activity a child should take part and usefully spent his or her leis-

ure time, advice on problems on physical or motor development,

advice on what sport equipment to buy for schools and parents.

Establishment, evaluation and monitoring of physical character-

istics and motor abilities are carries out by means of the follow-

ing measuring procedures (Strel, 1996): body height, body weight,

triceps skinfold, arm plate tapping, standing long jump, polygon

backwards, sit-ups, forward bend and touch on the bench, bent

arm hang, 60-m run, 600-m run. The SLOfit system measures phys-

ical development, motor development, and motor abilities. Phys-

ical development is measured through physical growth, defined by

body height, weight and skinfold of the upper arm. Body Mass In-

dex is calculated using height and weight and is used to assess nu-

tritional status. Triceps skinfold is the anthropometric indicator of

peripheral fat distribution. Motor development in system SLOfit

is monitored through the development of various motor abilities,

which are divided on health-related fitness indicators and physic-

al performance indicators. Indicators of health-related fitness are

aerobic power, muscular strength, muscular endurance and flexib-

ility. Highly developed aerobic abilities reduces the risk of heart dis-

ease, diabetes and stroke. Properly developed flexibility, muscular

strength and muscular endurance are important for injury preven-

tion, proper posture and overall functioning of the body. Indicators

of physical performance are speed, explosive strength and body

coordination. Measurement procedure from SLOfit are the same

throughout primary and secondary school period, what allows dir-

ect comparison of individual outcomes of physical and motor de-

velopment from 6 to 18 years of age. Selection of appropriate tests

based on several pilots and experimental studies. In last 30 years,

SLOfit system measured more than 1 million children and youth.

Slovenian children between 1995 and 2015 became higher for 0.8%,

heavier by 4.6% and their triceps skinfold increased for 14% (see

http://www.slofit.org).

72





7

Body-Mind Connection

Many experts note that additional hours of physical education have

a positive impact on the academic success (Shephard, 1997) since

learning of complex movements stimulates the frontal cortex in the

brain, which is also active in learning and problem solving (Jensen,

2005). The results of studies suggest a positive relationship between

physical and academic achievement (Singh, Uitjtdewilligen, Twisk,

Van Mechelen, & Chinapaw, 2012). More physically active children

are also more efficient at learning, compared to less active chil-

dren (Kirkendall, 1985). However, researchers are aware that the in-

creased volume of physical education in school alone cannot com-

pensate the lack of physical activity in daily life.

Educational experts intuitively believe that individuals who are

physically active perform better in school. Some studies have found

positive relationships between physical activity and academic per-

formance (Dwyer et al., 1983; Hollar et al., 2010; Donnelly, McK-

iel, & Hwang, 2009; Shephard, 1997), whereas other studies found

no difference, or even negative outcomes between physical activ-

ity and academic performance (Ahamed et al., 2006; Sallis et al.,

1997). Many experts from the field of physical activity and physic-

al education have found positive effects on health, musculoskelet-

al development, behavior and increased motivation to learn. In ad-

dition to adverse conditions correlated with physical inactivity (i.e.

high blood pressure, anxiety, depression, risk of certain type of can-

cer, coronary heart disease . . .); there are also positive outcomes of

physical movement in the school environment. Advocates of quality

73

Body-Mind Connection

daily physical education for prepubescent children frequently en-

counter the argument that such initiatives will harm academic pro-

gress (Shephard, 1997).

It was found that physical education affects some factors which

are predictors to raising academic performance in children. Some of

these factors are higher self-esteem, body image, concentration and

better behavior in the classroom. Caterino and Polak (1999) were

interested in the effects of physical activity on concentration. They

made a comparison between passive and directed physical educa-

tion activities. They used the Woodcock-Johnson Test of Concentra-

tion. Children from 4th grade were significantly more concentrated

in school after engaging in physical activity (Caterino & Polak, 1999).

Evans, Evans, Schmid, and Pennypacker (1985) reported a lower rate

of inappropriate behavior of children, who were a part of physically

active programs (football and jogging). Using a meta-analysis, they

came to the conclusion that the most physically active interventions

led to significantly reduced disruptive behavior (Allison, Faith, &

Franklin, 1985). Raising academic achievement can be as a result of

the better classroom climate, or better attitudes of teachers towards

students. For example, in an Australian quasi-experimental study,

and in a separate Trois-Rivieres study, academic achievement was

a result of a better classroom environment. Improved self-esteem

and body image (Nelson & Gordon-Larsen, 2006) are often associ-

ated with high levels of physical education. Investigators have found

links between school physical education and psychosocial factors

such as satisfaction, integration of students in the classroom and

self-esteem. These psychological factors should also prevent dro-

pout from school and help raise learning abilities (Libbey, 2004).

Additional physical activity in school curricula does not adversely

affect children’s academic achievement in the elementary school;

on the contrary, there is a positive trend between increased physical

activity and academic performance. There are some excellent stud-

ies which have investigated this connection, and some are sum-

marized herein. To begin, in the suburb of San Diego, California,

researchers looked at the effects of a 2-year Physical Education

Program (SPARK) in Elementary Schools. In the Spark study, there

74



Body-Mind Connection

were seven elementary schools which participated. Pupils who took

part in the SPARK program ( n = 759, 5th and grade-6rs), were di-

vided into three different groups which were assigned to one of

three conditions. In the first condition, kids were taught by a phys-

ical educator (80 min/week of PE), in the second condition, by a

classroom teacher (65 min/week), and in the third condition, by

an untrained classroom teacher (control group, 38 min/week). The

group taught by the physical educator achieved greater cardiovas-

cular and muscle endurance, slight declines in academic perform-

ance, but no negative effects on academic achievement. The de-

cline in academic performance and achievement was smaller in the

other two groups (Sallis et al., 1997). Similarly, in British Columbia,

experts made an intervention called Action Schools! BC (AS! BC)

with the desire to raise student physical activity levels, to determine

the gender differences in academic performance and to maintain

academic performance despite a corresponding decrease in overall

academic time, which was partially replaced with physical activity.

Finally, another Canadian study lasted 16 months and included 10

Canadian elementary schools. Two of the schools did not carry out

the research properly, so they were excluded. In the end, the inter-

75

Body-Mind Connection

vention study had a sample of 143 girls and 144 boys in the 4th and

5th grade. Physical activity in intervention schools was increased

by 47 minutes per week, and it was determined with the Physical

Activity Questionnaire for Children (PAQ-C). Academic perform-

ance, evaluated by Canadian Achievement Test (CAT-3), remained

unchanged.

Despite an overall reduction of academic time, the researchers

indicated a positive trend towards an enhanced academic perform-

ance (Ahamed et al., 2007). Similarly, in the Australian longitud-

inal study SHAPE (School Health; Academic Performance and Ex-

ercise), researchers came to the conclusion that school kids who

were given almost 60 minutes of physical activity/day, had after 14

weeks of study better ability to work and reduce body fat. Although

curriculum hours of Mathematics and Reading were transferred

to Physical Education, experts found positive trends in improv-

ing knowledge of mathematics and reading, body composition and

positive changes in behavior after two years (Dwyer et al., 1983). The

PASS & CATCH study examined 932 children from eight element-

ary schools from Texas. Experts were interested in the correlation

between increased school physical activity during the school day

and academic performance (Murray et al., 2008). Children from ex-

perimental group significantly improved math and reading scores.

From baseline to three years of study, classroom realized significant

improvements in academic performance (Donnelly et al., 2009),

measured with Wechsler Individual Achievement Test (Wechsler,

2001). Pupils from sports classes achieved statistically higher GPA

and higher scores in mathematics and foreign languages. Finally,

the HOPS (Healthier Options for Public Schoolchildren) project was

an obesity prevention intervention, conducted in Florida, USA. This

project examined the results of 1197 students, divided into experi-

mental and control group. The intervention components included:

integrated and replicable nutrition, physical activity and lifestyle

educational curricula, matched to the state curricula standard. Ex-

aminees took Florida Comprehensive Achievement Test (FCAT). In-

tervention children had significantly higher FCAT scores in math-

ematics than children from the control group (Hollar et al., 2010).

76

Body-Mind Connection

In many studies, it was found that physical education affects some

elements which are supposed to be the effects that raise academic

performance of children. These factors are higher self-esteem, body

image, concentration and better behavior in the classroom. Factors

that lead to better academic performance are reflected in Grade

point average (GPA).

Modern, fast lifestyle, unhealthy food choices and lack of exercise

are increasingly destroying the health of the younger population

worldwide. With increases in sedentary activities (watching televi-

sion, use of computer, learning), there is a corresponding decrease

in overall physical activity. Because of large academic breadth of

school curricula in many school environments, there remains less

time dedicated to children’s physical activity. A satisfactory amount

of physical activity does not only make a positive effect on children’s

health but also affects elements (self-esteem, body-image, concen-

tration and better behavior in the classroom) which lead to better

academic performance. Physical activity in elementary schools as

a part of physical education (Sallis et al., 1999), afternoon sports

related activities (Marsh, 1993), extracurricular activities (Eccles,

Barber, Stone, & Hunt, 2003), physical exertion in school curriculum

and recess periods (Verstraete, Greet, Dirk, Ilse & Bourdeaudhuij,

2006) have a significant impact on classroom behavior, self-esteem,

self-image, body image and cognitive function in elementary school

children. All these factors have an impact on learning outcomes,

which lead to better academic performance.

Parents are often concerned that increased physical activity and

participation in sport affect academic achievement negatively be-

cause not enough time is perceived to be devoted to the reading ma-

terial and homework. In addition to the negative effects of watching

TV, there is also a greater decline in academic performance (Sharif &

Sargent, 2006). In primary education, it should be imparted to chil-

dren that body movement is part of everyday life. A successful way

to achieve sufficient daily movement is by adding extracurricular

minutes to physical education in school, or by adding some extra-

curricular physical activities before or after school.

77





Summary

This monograph was hoping to investigate and explain the relation-

ship between physical activity and academic performance in ele-

mentary school children. It provides a summary of assessing phys-

ical activity using different methods; for example, objectively, us-

ing two types of physical activity monitors, and subjectively, using

school records of achieved physical activity and self-reported ques-

tionnaires.

Whether children live in urban or rural areas were found to be

sometimes different regarding the link between physical activity

and academic performance. There is also often not sufficient atten-

tion to rural and poorer areas of countries, including Slovenia, who

sometimes do not give attention devoted to older children finishing

elementary school.

When looking at Slovenia specifically, the country reportes the

highest grade for overall physical activity in comparison with 38

countries (Tremblay et al., 2016; Sember et al., 2016), since the ma-

jority of Slovenian schoolchildren meet the recommendation of at

least of 60 minutes of moderate-to-vigorous physical activity per

day (World Health Organisation, 2010). The Republic of Slovenia has

the most active schoolchildren and great school system (Tremblay

et al., 2016), compared to the other countries in the world. However,

the sobering fact is that despite these high levels of overall phys-

ical activity and a robust school system, Slovenia has room to im-

prove further, and give children more physically-narrated classes in

the school system, as it was in 2004. The situation elsewhere in the

79

Summary

world is more frightening compared to Slovenia, so it is necessary to

inform policy makers that physical activity programs in the school

system are beneficial to academic performance, and lead as an ex-

ample to ensure proper physical and psychological development of

the children around the world. Whereas there are links between aca-

demic performance and physical activity, we can not ignore the fact

that many cofactors are responsible for such positive links between

these two variables, such as parental education, place of residence

and children’s maturity levels.

Education will be ineffective unless children’s health is made a

priority and school may be the only place where health inequities

can be addressed (Basch, 2011). Children are nowadays extremely

sedentary (Tremblay et al., 2016) and unfit, what is related to an

earlier onset of several chronic diseases such as diabetes type II and

obesity. Not only health benefits of physical activity are important,

the academic performance which is affected by many factors such

as socioeconomic status, parental involvement, and participation is

also influenced by physical activity. Following literature review and

results of the thesis, academic performance is a mixture of interre-

lated factors, which are closely intertwined and interdependent one

of another.

80





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107





Reviews

This is the first monograph to systematically detail the state of phys-

ical activity in school children and relate these data to how well stu-

dents perform academically in school. The work in this monograph

provides an excellent overview of the methodologies used to col-

lect physical activity and physical fitness data in children, which

is of great importance for physical education university students,

teachers and practitioners alike. The document also includes some

of the first data complied on Slovenian school children in this area,

and as such, is an excellent communication tool for advocating for

child physical activity in Slovenia and particularly, highlighting the

Slovenian school- based physical activity and physical education

system. The work is written by dr. Sember and dr. Morrison, who

were each actively involved in creating the Active Healthy Kids Slov-

enia research group, with the purpose of systematically chronicling

the physical activity of children and youth in the country over the

past 4 years. This nation-wide initiative required Sember, Morrison,

and colleagues to assemble a national leadership group, compile all

available data related to the physical activity of children and youth,

and synthesize these data according to an international framework.

This monograph represents an excellent addition to the research

area and will certainly be used for pedagogical, research and out-

reach purposes both here in Slovenia and with International col-

leagues as well.

Jose Carlos Ribeiro

109

Reviews

Physical activity is one of the key determinants of health in life,

which can be expressed in sports, playing with friends, family,

physically-active transport, dancing, and others activities. Move-

ment and sport activity in a population is very difficult to evaluate,

especially when measuring physical activity directly. The Republic

of Slovenia has a lot of data on physical activity in children, but to

this day it has not been possible to read an overall view of the phys-

ical and sporting activities of children and adolescents in one place.

This book summarizes the best available, and most reliable data

and results from the field of physical activity in children and youth,

presenting a current picture of various aspects of this social phe-

nomenon. This book will be extremely welcome for all sports teach-

ers, researchers in the field of kinesiology, sport, public health, and

all those who have sports and movement in their heart. The content

of this book is also appropraite and recommended to the parents of

children who are involved in organized sport activities, and to the

general public, especially to policy makers in government, public

health, and education.

Janko Strel

110

University of Primorska Press

www.hippocampus.si





Document Outline


The Mind-Body Connection

Contents

List of Tables

Preface

Physical Activity Health-Mind Connection

Health Effects

Cognition Effects





Physical Activity Recommendations Europe

United States of America

Canada

Slovenia

Adult Physical Activity Guidelines Comparisons





Physical Activity: Growth, Maturation and Development

Physical Education Education System

Physical Education

Europe

Slovenia

United States of America





Physical Activity Research Quantifying Physical Activity

Physical Activity in Numbers





Physical Fitness Quantifying Physical Fitness

Physical Fitness in Numbers





Body-Mind Connection

Summary

References

Reviews