EXPERT REACTION: Global report shows about 9 in 10 Aussie and Kiwi teens are not doing enough physical activity

Physical activities are essential for children growth and health; thus, it is shocking that about 80 per cent of children aged 11-17 years old are insufficiently physically active globally, and 89 per cent of young Australians and Kiwis do not perform physical activities at least one hour a day.

If only 11 per cent of the children meet the recommendation, the first question is whether the recommendation is valid, and the second question is whether it is possible for every child to accumulate 60 minutes or more of moderate to vigorous physical activity per day.

Theoretically, children have a time to do physical activities at school and before and/or after school, thus having 60 minutes of physical activities in total every day does not appear to be very difficult, if their time is not occupied by other activities (e.g., computer games).

It is interesting to know more why many children are physically inactive. Instead of a 15 per cent relative reduction of global prevalence of insufficient physical activity by 2030 among adolescents and adults, we need to think how ALL children can meet the recommendation.

We need a strategy to increase physical activities in the school, and implement 'exercises' in their daily activities, since it is highly possible to have 5-10 minutes of exercise every one hour or so throughout a day.

The fact that the majority of Australian children do not achieve recommended guidelines and we rank so low globally shows there is a serious problem throughout our communities.

We know that physical activity is a modifiable risk factor for developing cardiovascular disease, metabolic and psychological conditions as well as many cancers. It is certainly a behaviour in our control to mitigate these risks.

We also know that inactive children are more likely to become inactive adults, so it is vital to develop these behaviours as early as possible. This is clearly a global issue with the rise in technology use (phones, apps, gaming consoles) and the reduction in incidental activity such as bike riding, walking to school and playing during school lunch-times are contributing to this trend.

Efforts are needed by governments and communities to promote healthy lifestyles in schools and homes from a young age. With the increased technological age we live in, the use of fitness trackers and apps may be useful in monitoring and self-motivating people to become more active to strive towards recommended guidelines and improve the health outlook of growing Australians.

Gathering and reporting data of 1.6 million teenagers across 146 countries is not an easy task. Even though the study was based on pre-existing self-reported surveys, the data should prompt discussion especially about long-term impacts of physical inactivity early in life. The low levels of physical activity in adolescents are a major concern for their current health.

However, we may be facing an even bigger problem. Physical activity exhibited during adolescence can track through to adulthood. There is strong evidence to support the association between low levels of physical activity and increased risk of health conditions such as cardiovascular diseases, type 2 diabetes mellitus, certain forms of cancer and depression in adulthood.

Alarmingly, increased risk of health complications in reproductive age may also affect possible pregnancies and babies in the future. One way to tackle this problem is by focusing on the development and implementation of health literacy programs for adolescents and their parents. Equipping people to use evidence in regards to physical activity will facilitate improved health not only for our generation but also for the next ones.

This research highlights the current levels of physical inactivity among teenagers globally, and for the first time shows how physical activity levels have changed over the last 15 years. It is well known that boys are generally more active than girls. However, this study shows that there have been no changes in the percentage of girls meeting physical activity guidelines of 60 minutes a day, while there was a 2 per cent decrease in the percentage of boys not meeting guidelines. 

A major concern of the findings was that out of 25 high income Western countries, Australia had the highest number of teenagers (9 out of 10) not meeting physical activity guidelines. Italy and France were rated second and third respectively behind Australia.

Against the global trends, teenage Australian boys had bigger increases in inactivity between 2011 and 2016 (84 per cent to 87 per cent respectively), whereas girls were stable over time at 91 per cent. However, there are still fewer girls than boys meeting activity guidelines.

In spite of significant Australian government funds spent on youth sport over the last 10 years ($100s of millions), this has made very little difference to overall physical activity levels. Now is the time for the Australian government to develop a National Physical Activity Action Plan or framework and invest in evidence-based solutions to increase the number of teenagers in this country engaging in enough physical activity for their current and future health.

The finding that 9 out of 10 Australian adolescents are not meeting physical activity guidelines is alarming but not surprising. Research and trends reported over many years in Australia have shown similar findings.

What is disappointing is that, although in most countries the percentage of insufficient physical activity in boys has decreased, in Australia it actually increased from 2001 to 2016 (from 83.5 per cent to 86.8 per cent). While at the same time the percentage of insufficient physical activity in girls has remained undesirably high (being 91.4 per cent in 2016).

With Australia being one of the worst performers in the report, ranking 140 out of 146 countries urgent action is needed.

Other reports (including the Global Matrix 3.0 developed by the Active Healthy Kids Global Alliance) have shown that Australia is good in measures of physical activity participation in organised sport and schools but showed less positive results in measures of overall physical activity, active transport, screen time, government strategies and investment and physical fitness for children and adolescents.

We also know that compared to 30 years ago our children do not have the same level of fundamental movement skill competency, fitness and strength. If children are unable to perform skills well, such as catching, throwing, kicking, jumping and running, or do not have the required strength, then they are more likely to have low self-esteem and not want to participate in sport. This then leads to inactivity in adolescents and this inactivity continues through to adulthood. There are strong links between physical activity and physical health and mental health, so it is crucial that Australia works on this. 

Another important thing to note is that worldwide and within Australia girls are less active than boys. Therefore, Australia needs to focus on increasing physical activity in children and adolescents, particularly in girls. Social marketing campaigns and also community-based interventions have shown to be effective at doing this, but countries that are doing well have demonstrated that physical activity is driven by culture and society, where being active is not just a choice, but a way of life. More needs to be done in this area, to give children the skills, abilities and confidence when young and continue to develop physical activity in adolescents so we can have young people that are physically and mentally well and adults with less health problems in the future. 

Additionally, the research was based on survey data, mainly undertaken in schools and it represents a limited, representative number of adolescents for each country. It would be ideal to use data collected via wearable devices such as accelerometers or pedometers. However, the researchers do acknowledge this and the limitations of the research. There was no clear pattern of physical activity according to country income group.

This is a very important piece of work highlighting the issue around adolescents and physical activity. This large scale global research study using over 1.6 million students, has shown that trends of insufficient physical activity amongst 11-17 year-olds remains high and relatively stable over a 15 year period.

This is concerning because we know that the best predictors of level of physical activity in adulthood, is your activity in adolescents.

On a positive note, when a group identifies as insufficiently active, it means that they are participating in activity but just not enough to meet recommendations so the opportunity for intervention and improvement is there but we just need to find the right strategies and pathways to engage this group.

The disproportionate representation of females over males being insufficiently active is highlighted in this work and something that we are trying to better understand through the program of work that we have commenced at UWA.

Physical activity is important throughout the lifespan,  both for physical health, and mental health. Teens that are physically active have better cardiovascular fitness, stronger bones and muscles, better posture, and less depression and anxiety. As a society, we should be equipping kids and teens with good physical activity skills and habits, since it helps set the norms for their physical activity habits and attitudes that can track with them through the rest of their lives.

This extremely large study brings together data from 1.6 million adolescents aged 11-17 from 146 countries around the world. It is the best global estimate of physical activity levels of teens from around the globe ever produced. It allows us to compare physical activity levels between countries, between boys and girls, and across time (from 2001 – 2016).

The majority of teens around the world aren’t getting enough physical activity – 81 per cent were categorised as insufficiently active (based on them failing to meet the World Health Organization’s guideline of 60 minutes of physical activity on 5 days a week).

The study confirmed the pattern that we always tend to see – that boys are more active than girls.
Australia didn’t fare well – out of 146 countries in the study, we were ranked 140th for our adolescents’ activity levels. 89 per cent of our adolescents fail to meet physical activity guidelines (compared with 81 per cent of adolescents globally). We were the lowest ranked of all of the “western” countries that we would usually compare ourselves to, and consider ourselves similar to.

In contrast to the global data, Australian teens became slightly less physically active across the study period (the % meeting guidelines went from 13 per cent to 11 per cent from 2001 to 2016), whereas the global data showed a small improvement over time. 

Australians tend to have an image of being beach loving, fit and healthy, but these results show it’s not the reality. At first, I was shocked when I saw Australia’s position in the list. However, we also rate badly on a global scale when it comes to overweight and obesity rates. So, the overall pattern makes sense. This really needs to be a wake-up call to Australians and to our governments.

As parents, we want to set our kids up for a happy and health life, and an important part of this is making physical activity a part of every day. Screens and mobile devices are a major challenge. A lot of kids love their screen time, and will spend many hours a day on screens if unchecked. We really need to be limiting screen time to free up time to be active and do other things.

At a society level, we need to look at how we can get kids more active in schools – particular older kids and teens – who often start to opt out of sport and PE. In Australia, we have excellent footpaths and great weather which should be conducive to active transport like walking and cycling.

However, our culture has become increasingly car-centric. In particular, encouraging young people to cycle would be a great way to boost their independence and physical activity levels at the same time. Governments are working to create safe cycling routes but they are inconsistent and incomplete – more should be done to make cycling a safe and normal option.

This Lancet published summary of global findings showing Australian teenagers ranking close to last, i.e. 140 out of 146 in terms of meeting the recommended moderate physical activity level of an hour a day is highly concerning.

We have to believe this finding, because it is consistent with previous studies in Australian children, where the sedentary nature of our teenagers is becoming worldly infamous.

The alarming nature of this finding is enhanced by a very recently published carefully measured study in a typical cohort of Australian teenagers (Telford et al see below) which clearly identified physical inactivity as the most significant characteristic of the overweight and obese children.

The fatter children in general did not eat more than their lean counterparts but were decisively less active. So, with World Health Organization identifying physical inactivity as a major risk factor for physical and mental illness, we have a double whammy with the physical inactivity of our children in that it appears to play a vital role in balancing kilojoules in and out.