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16 may 2012

The Promotion of Healthy, Active Lifestyles through Physical Education: Challenges and Opportunities

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Physical activity is recognised as an important health behaviour that needs to be encouraged (Biddle, Gorely & Stensel, 2004).  Yet, the most recent World Health Organisation’s (WHO) Health-Behaviour in School-aged Children (HBSC) Survey (2005/06) (Currie et al, 2008) reported less than half of young people to participate in one hour or more of at least moderate activity each day in almost every country and region. 

Autor(es):Lorraine Cale
Entidades(es): Loughborough University
Congreso:  Congreso de la asociación internacional de escuelas superiores de educación física (AIESEP)
26 al 29 de Octubre 2010
ISBN:978-84-614-9946-5
Palabras claves: Actividad física, salud, capacidad aeróbica

The Promotion of Healthy, Active Lifestyles through Physical Education: Challenges and OpportunitiesResumen

Physical activity is recognised as an important health behaviour that needs to be encouraged (Biddle, Gorely & Stensel, 2004).  Yet, the most recent World Health Organisation’s (WHO) Health-Behaviour in School-aged Children (HBSC) Survey (2005/06) (Currie et al, 2008) reported less than half of young people to participate in one hour or more of at least moderate activity each day in almost every country and region. 

Introduction

Physical activity is recognised as an important health behaviour that needs to be encouraged (Biddle, Gorely & Stensel, 2004).  Yet, the most recent World Health Organisation’s (WHO) Health-Behaviour in School-aged Children (HBSC) Survey (2005/06) (Currie et al, 2008) reported less than half of young people to participate in one hour or more of at least moderate activity each day in almost every country and region.  Given this, the promotion of physical activity within schools and the physical education (PE) curriculum would seem to be warranted.  With regards to physical education specifically, it is argued that contributing to public health, health-enhancing lifestyles and increased physical activity should be one, if not the most, important objective of the subject (e.g. Fox, Cooper & Mckenna., 2004; Fairclough & Stratton, 2005).  Furthermore, the role of schools and PE in promoting health has increasingly been recognized by governments in the United Kingdom (UK) and beyond, and the encouragement of lifelong participation in sport and physical activity through schools is now a common theme in government policy.  Notable examples of such policies are highlighted below.   

Schools and PE provide a very suitable setting in which to promote physical activity for a number of reasons.  For example, they have a captive audience and provide access to all young people, provide a context for learning at a time of high receptiveness, and have a responsibility to promote the ‘physical’ development of pupils and teach about health and health issues (Cale & Harris, 2005).  In addition, school-based PE and physical activity programmes have been found to be effective.  Reviews of school-based physical activity intervention studies (e.g. Kahn et al., 2002; Cale & Harris, 2006) have noted meaningful improvements in activity during PE classes, in fitness levels, and in knowledge and attitudes following interventions.  However, it is noteworthy that, whilst school-based programmes appear to be successful in increasing activity during PE, there is less evidence that they are effective in improving out of school physical activity levels. 

The above finding raises questions as to why PE is not more effective and what issues the profession faces in promoting healthy, active lifestyles.  This paper considers the role of PE in the promotion of healthy, active lifestyles, and in so doing, highlights some of the key challenges as well as the opportunities for PE and PE teachers in promoting health and physical activity.  Where appropriate, recommendations for practice are also offered. 

Challenges

We are bombarded daily now with government, media and scientific reports and messages concerning children’s health and in particular the growing ‘problem’ of childhood obesity and the possible health consequences.  As already noted, government policies have highlighted schools and PE to be instrumental in addressing the issue.  With respect to obesity, for example, a Public Service Agreement target was established in England in 2004 to halt the increase in obesity among children under 11 by 2010.  Following on, ‘Healthy Weight, Healthy Lives’ (Department of Health and Department for Children, Schools and Families, 2008) set out the government’s ambition for addressing obesity and overweight, the initial focus of which was on children and schools, including PE, and more recently the new coalition government’s strategy for public health in England ‘Healthy Lives, Healthy People’ (Department of Health, 2010) continues to highlight the role of schools and PE in the promotion of health. 

Clearly then, schools are under pressure to assume greater and greater responsibility for young people’s health and health behaviours.  The concern, however, and the challenge, is that some of the reports, messages and measures being advocated by, and in response to, government policy are exaggerated, misleading, misguided and not at all conducive to the promotion of healthy, active lifestyles.  Indeed, a number of researchers question whether there is an obesity problem at all (e.g. Gard; 2004; Evans et al., 2008).  Yet, in recognition of the expectations being placed upon them, in the well-meaning desire to make a difference, and based on the information and guidance from government, media and others, it seems that individual schools and teachers are responding in varied and at times inappropriate ways (Cale & Harris, 2009a).  Examples of some inappropriate responses are outlined later.

This brings us to the next challenge, which is concerned with the increasing reliance on ‘public pedagogy’ to learn about and promote health.  Theorists and researchers such as Giroux (2004), Rich (2011) and others have begun to focus on ‘public pedagogy’ in recognition that learning extends well beyond the boundaries of formalised education sites and operates within a wide variety of social institutions and formats including sports and entertainment media, TV networks etc.  In recent years there has been a proliferation of reality based media focusing on health, the body, diet and exercise which not only entertain the public, but which operate as pedagogical sites through which to encourage people to change their lifestyles and themselves.  Examples in the UK include Jamie’s (Oliver) School Dinners, Fighting Fat Fighting Fit’, and ‘Honey, We’re Killing the Kids’.  The problem though, is the profession’s tendency to draw on and over rely on public pedagogy as a source of information.  Recent research on PE teachers’ engagement with health-related continuing professional development (Ward, Cale & Webb, 2007; in press) has found that many PE teachers often uncritically acquire their health knowledge through ‘popular’ means and depend on this to guide their teaching of health within the curriculum rather than on any formal training.  This is worrying because often such sources are sensationalised, promote a distorted or inaccurate picture, and advocate questionable practice.  We therefore need to be aware of the dangers of adopting an uncritical attitude to such information sources and rather be more questioning of them.  

Other challenges that are increasingly faced in the promotion of healthy, active lifestyles are those presented by societal, environmental and technological changes and advances.  The impact of the environment on our physical activity is now well accepted (Spence and Lee, 2003) and is also recognised as a contributing factor in the increased levels of overweight and obesity.  Indeed, the term ‘obesogenic’ has been coined to describe the current ‘obesity promoting’ environmental circumstances in which we find ourselves these days.  Active transport particularly to and from school has decreased in most countries in the last three decades, though there are signs that this trend may be starting to reverse (British Heart Foundation (BHF), 2009).  Due to ever increasing concerns over safety parents have also placed more and more restrictions on their off-spring and children’s opportunity to range and play independently has dropped considerably over the years (Hilman, 2006; Karsten & van Vliet, 2006).  In addition, technological advances have been blamed for the increased time young people are spending in sedentary activities, with TV viewing, computer and video games and social networking now taking up large amounts of their time.  The HBSC Survey (2005/06) revealed a significant number of children (and over 40% of all boys) to spend two or more hours per day on week days playing computer games or games console.  Thus, physical activity now has to compete against a multitude of other attractive leisure time activities.  Interestingly though, the relationship between these other activities and physical activity is not clear and certainly for TV, the relationship has been found to be small suggesting there is time for both (BHF, 2009). 

Related to the above is another important consideration, namely the young people themselves.  Young people are undoubtedly influenced by the changed society and environment in which they live and in essence, they as our ‘clients’, and as consumers of physical activity have changed.  If we are to be successful in our efforts to promote physical activity to this group, then our practice needs to change to reflect young people’s needs, interests and physical activity preferences.  In other words, we need to understand young people and their physical activity behaviour. 

It is also argued that the PE profession itself represents another key challenge to the promotion of healthy, active lifestyles.  As a profession we are noted for being resistant to change (Kirk, 2010).  For example, sport techniques, competitive sport, and particularly team games which focus on performance and fitness have, and continue to dominate our subject and PE teachers’ philosophies and practices (Green, 2009; Kirk, 2010).  Perhaps not surprisingly therefore, such a focus is also applied to the area of health and researchers have highlighted how many teachers adopt a ‘sport’, ‘performance’ and ‘fitness’ oriented approach to the delivery of health within PE (Leggett, 2008; Ward, Cale & Webb, 2007; in press; Harris, 2010).  However, it is suggested that such a focus may limit learning in this context and may be dissuading many from participating.  The relevance and appeal of competitive sports and team games to many young people has been questioned for some time (Green 2002; Fox & Harris, 2003) in that continued emphasis on these fails to acknowledge participatory trends in young people, towards lifestyle activities and non-competitive, more recreational sports, and away from competitive performance-oriented ones.  These trends need to be reflected in the content of PE programmes and we need to strive towards a broader and more balanced curriculum that features a range of physical activity experiences for young people.

This leads on to another challenge, which is the extent to which PE is inclusive for all young people.  It is known that some children experience PE differentially according to the intersections of their social class, gender, religion, ethnicity and ability (Kirk, 2010).  Indeed PE has been seen as a site for the reproduction of social inequalities and injustices (Flintoff & Scraton, 2001; Evans & Davies, 2008) with PE teachers being accused of providing ‘more of the same for the more able’ (Penney & Harris, 1997).  In addition, evidence suggests that overweight or obese youngsters have restricted access or are often excluded from physical activity and consequently take part less frequently (O’Dea, 2005).

Further concerns relate to PE teachers’ knowledge of health and the extent to which they have engaged with professional development in the area (Cale, Harris and Leggett, 2002; Ward, Cale and Webb, 2007; in press).  A number of researchers have found PE teachers’ understanding of health and/or health promotion to be rather narrow, limited and even flawed (Castelli & Williams, 2007; Ward, Cale & Webb, 2007; in press; Armour & Harris, 2008).  This is perhaps not too surprising considering that the same researchers, as well as others (e.g. Armour & Yelling, 2004; Kulinna et al., 2008), have also reported health and lifelong physical activity to be absent from PE teachers’ professional development profiles.  In their study, Ward, Cale & Webb (2007; in press) revealed that approximately half of teachers had had no prior experience of health within PE whatsoever before teaching it, and 70% had not taken part in any related professional development in the previous three years.  These findings raise serious questions about the extent to which teachers are equipped to teach young people about health and healthy, active lifestyles in and through PE.

Moreover, some claim that PE teachers remain ambivalent about health (Kirk, 2006).  Indeed, the concerns over their knowledge of health and the extent to which they have engaged with professional development in the area may be a sign of this ambivalence.  Interestingly though,
PE teachers themselves have reported to value health and health promotion (Cale, 2000; Ward, Cale & Webb, 2007), often offering health justifications for PE (Green, 2002), and claiming it to be one of the key objectives of the subject. 

Despite the above, PE teachers have been reported to feel confident about teaching health.  Evidence from some studies, however, seems to refute this.  Castelli and Williams (2007) tested PE teachers’ health-related fitness knowledge and found that, whilst the teachers were very confident in their perceived knowledge, their test scores did not meet the standard of achievement expected of a ninth-grade student.  They therefore concluded that a large proportion of the teachers did not have the necessary knowledge to teach pupils about health-related PE.  Likewise, the study by Ward, Cale & Webb (2007; in press) found that most PE teachers (86%) were confident in their ability to teach the area.  Given though, so few had formally experienced health in any capacity, it was proposed that the teachers’ confidence was misguided and rooted, at least in part, in their philosophies and narrow understandings of the area.  Such findings present a challenge in that, if teachers feel confident and knowledgeable and fail to recognise the limitations of their knowledge, then they are unlikely to access the continuing professional development required to change their current practice.  Evidently, if we are to be successful in promoting healthy, active lifestyles then PE teachers need a clear understanding of PE’s role and of the health knowledge required to effectively do so, as well as a commitment to developing this knowledge through appropriate professional development.

A final challenge is related broadly to the PE programmes and associated practices in some schools.  If PE is to positively influence young people’s participation both in and out of school, then it needs to provide them with relevant, meaningful and enjoyable physical activity experiences.  The continued dominance of sport, performance and fitness within the curriculum has already been highlighted as an issue, but in addition there are other aspects of practice which are likely to influence children’s experiences, enjoyment of, and attitudes towards PE and physical activity.   

Most PE teachers would agree that it is important to try to increase physical activity levels during lessons and concerns have been expressed over the low level of moderate to vigorous physical activity children often experience during PE (Fairclough & Stratton, 2005).  Guidelines suggest that pupils should participate in moderate to vigorous physical activity for at least 50% of PE lesson time (afPE, 2008; USDHHS, 2010).  However, this target needs to be approached sensibly otherwise it may prompt some inappropriate responses which may turn many young people off rather than on to PE and physical activity for life.  Appropriate responses to increasing activity levels in lessons include careful attention to planning and organization to maximize activity time.  Inappropriate responses on the other hand, include teachers adopting a hard line approach, using physical activity as a form of punishment, or forcing children into strenuous exercise such as cross-country running, fitness regimes involving dull, boring and repetitive drill type activities, or fitness testing (Cale & Harris, 2009a).

With regards the above point, the issue of fitness testing children has been widely debated by researchers (e.g. Keating, 2003; Garrett & Wrench, 2008; Cale & Harris, 2009b) in terms of its potential influence on young people’s physical activity.  There is not scope to discuss the pros and cons of fitness testing in detail here, but suffice is to say that there is little evidence to support the notion that fitness tests contribute to the promotion of healthy, active lifestyles.  To the contrary, there is evidence to suggest that testing may be counterproductive to this goal in that it can be demeaning, embarrassing and uncomfortable for some children, and often for those about whom there is most concern (Cale & Harris, 2009b).  Thus, it is argued that much of the fitness testing carried out in PE may well represent a misdirected effort and that curriculum time could be better spent.  That said, it is accepted that if appropriately employed, and provided the limitations of testing are taken into account, there is no reason why testing cannot play a role in supporting the promotion of physical activity and in educating young people about physical activity and fitness. 

Lastly, other and perhaps even more questionable practice appears to be prevalent within some schools and PE programmes, often  in efforts to address the issue of overweight and obesity.  One example is the routine measuring and weighing of children to calculate their Body Mass Index, a practice which often features within health-related fitness or fitness testing programmes.  This would seem to be a pointless exercise in that it is not necessary to weigh or measure any child to tell them something that they already know, and no child needs to be measured to be helped to enjoy being physically active (Cale & Harris, 2009a).  Other worrying practices include inspecting children’s lunch boxes, issuing health report cards, as well as organizing and delivering ‘fat’ clubs specifically aimed at overweight or obese students (Cale & Harris, 2009a).  The real concern with these practices is the potential damage they can do to a child’s self-esteem, body image, and potentially mental health.  According to the HBSC Survey (2005/06) many young people, and particularly girls, are unhappy about and attempt to control their weight which in turn can have negative physical and psychological effects.  Indeed, research has highlighted girls and young women with anorexia and bulimia who have been deeply affected by the way education policy and practice transmits what they refer to as ‘body perfection codes’ (Evans, Rich & Holroyd, 2004; Evans et al., 2008).  Such responses clearly represent an overly simplistic and narrow view of obesity and health and of the role schools and PE can and should play in addressing both.  In addition, they have the potential to further stigmatise overweight and obese children, an issue which is acknowledged to be growing (Latner & Stunkard, 2003).  The importance of addressing childhood obesity cannot be denied, but it is argued that this needs to be done appropriately, sensibly, and sensitively to avoid doing more harm than good. 

Opportunities

So far a rather bleak picture concerning the role of PE in the promotion of healthy, active lifestyles has been painted.  However, as well as challenges, there are a number of opportunities for promoting health and physical activity.  Ironically, some of the challenges that have just been highlighted can equally be seen as opportunities.

Whilst government and media interest present a challenge on the one hand, it is suggested that they also present an opportunity, if carefully managed.  Because health and physical activity are so high on the political agenda and attract so much media interest, we have seen greater investment and support for a range of measures to improve young people’s health and physical activity levels in recent years.  Thus, such interest can be used to strengthen the rationale and status of PE and potentially the funding it receives. In England, for example, the former labour government invested £978 million in PE and school sport between 2003-08 through the Physical Education, School Sport and Club Links Strategy and then the Physical Education and Sport Strategy for Young People in an attempt to increase participation.  Whilst this level of funding is unlikely to be available ever again, any amount gained should be used wisely to develop sound, evidenced-based practices, and sustainable supportive infrastructures, on any scale. 

Similarly, whilst young people may be seen as a challenge, they can also be viewed as an opportunity.  Encouragingly, the Health Survey for England (Craig and Shelton, 2008) revealed that 61% of boys and 74% of girls would like to do more physical activity.  If this study is representative, then it would seem there is real potential to positively influence the physical activity of more young people.  However, we need to establish what it is that is preventing many youngsters from putting this desire into action.  As already mentioned, if we are to successfully promote physical activity to young people, then we need to understand them and their physical activity behaviour and we need to listen to, engage with, and empower them.  Young people are the experts on themselves and their behaviours, including their physical activity, and should be given a voice.  It is therefore important to work ‘with’ rather than work ‘at’ young people and avoid the ‘nannying’ approach apparent in some physical activity promotion efforts.  Previous research has suggested that ‘nannying’ is counterproductive and serves only as a barrier to young people’s participation (Mulvihil, Rivers & Aggleton, 2000).  Further, research suggests that when young people are given a voice they are able to provide some very good and practical suggestions.  For example, a systematic review which explored young people’s views of physical activity in terms of the barriers and facilitators to their participation revealed that their interest would be increased by offering more variety in the types of activity, emphasising and developing the fun and social side of physical activity, and providing both single and mixed-sex activities (Rees et al., 2006).  

Earlier technology was identified as a challenge for PE in that it effectively competes against physical activity for young people’s time.  Indeed, physical activity guidelines in some countries (e.g. Australia and Canada) now include a recommendation to reduce sedentary behaviour, and restricting young people’s use of technology has been proposed as a measure that may help to increase physical activity (BHF, 2009).  However, surely the two could not simply be more effectively integrated.  Technology is now an integral aspect of daily life and of every other school subject.  In England, there is a requirement for Information and Communications Technology (ICT) to be incorporated into every curriculum subject but despite this, its effective integration into PE is arguably limited in many schools, certainly when compared with other subjects.  Indoor rowing is just one activity which is gaining popularity as a PE curriculum activity in the UK and which provides real potential for the integration and development of young people’s ICT, as well as other skills. 

Similarly ‘Exergaming’, PE that combines video gaming and exercise, is a trend which is now influencing the curriculum (Vander Schee & Boyles, 2010) and Dance Mats and the Wii are becoming commonplace in many schools and PE departments.  Some of the advantages claimed for exergaming, and which could also be said to be true of other forms of technology, are that they are inclusive and appropriate for all abilities and sizes.  However, there are also critics of exergaming.  Some claim that exergaming may actually be exclusive, for example, if a child finds they do not enjoy technology-based PE and/or if they are not able to afford such systems at home (Vander Schee & Boyles, 2010).  Vander Schee & Boyles (2010) also argue that exergaming de-skills and de-professionalises teachers, represents a site for potential corporate exploitation of young people, and note how it has even been accused of ‘tricking’ young people into exercise.  Providing though that technology is used first and foremost to serve the needs and interests of young people, and that young people are learning from and being challenged and motivated by the experience, then this must be acceptable and seen as a potentially positive development.  Thus, rather than seeing technology as the ‘enemy’, perhaps we need to embrace it, capitalise on young people’s technological skills and interests, and up-skill PE teachers to consider the pedagogical possibilities it provides for promoting learning about health and a healthy, active lifestyle. 

There has been growing interest and support for ecological or environmental approaches to physical activity promotion in recent years (Spence and Lee, 2003) which also offer a real opportunity for the promotion of healthy, active lifestyles in schools.  Ecological approaches have at their core the notion that behaviour is influenced by many factors including intrapersonal (e.g. psychological and biological variables), interpersonal (e.g. family, peers), and physical and policy and legislative environments.  From this perspective, many aspects of the school can either promote or inhibit the adoption of an active lifestyle, and understanding gained through the ‘formal’ curriculum can either be reinforced and supported or completely undermined by other influences (Cale & Harris, 2005).  An ecological approach therefore addresses the multiple levels of influence on physical activity and explores the potential of the whole school to promote physical activity.  Yet, despite the merits and growing support for this approach, environmental and policy interventions are the least studied component of school health promotion (French, Story and Jeffrey, 2001). To date, school-based studies have primarily been limited to changes in the curriculum as opposed to whole school policies or to the environment.  We thus need to recognize the wider influences on physical activity, move beyond purely a PE curriculum focus, and draw on and enlist the support of the whole school in our efforts to promote healthy, active lifestyles. 

Alongside the challenges presented by the PE profession are also a number of opportunities.  On-going research will continue to provide direction for the promotion of healthy, active lifestyles through PE and research interest in this area continues to grow.  However, and as acknowledged by Armour & Harris (2008), there are still many gaps in our understanding and more research is clearly needed.  For example, concerning the nature and extent of PE’s role is in promoting healthy, active lifestyles, and how specifically it can influence health and physical activity and achieve health outcomes.  As a profession we need to scope what the major research priorities are and drive developments in the area, ensuring at the same time that our research is translated and disseminated to practitioners and thereby informs practice.  

Numerous opportunities are also available via PE teachers themselves who have great energy, passion and enthusiasm for their subject, physical activity and young people.  Research reveals that often the reasons individuals give for wanting to become a PE teacher centre around an enjoyment or love of sport, PE and/or physical activity, a desire to pass on their knowledge, enthusiasm and love to others, and a desire to work with young people (Evans and Williams, 1989; Mawer, 1995).  Whilst earlier some gaps and concerns over PE teachers’ health-related knowledge were highlighted, teachers nonetheless have some very valuable knowledge, skills and expertise, certainly in some physical activities and not least in working with young people.  Furthermore, PE teachers serve as important role models for young people and can have a positive influence on the participation of many youngsters (Cale & Harris, 2009a).

Lastly, while PE teachers’ lack of health-related continuing professional development was raised as an issue earlier, evidence from the study by Ward, Cale & Webb (2007; in press) suggests that PE teachers do access continuing professional development generally (nearly 90% had done so in the previous 12 months).  In trying to explain this disparity it was proposed that, in some cases, the lack of engagement in health-related professional development may have been due to a lack of unawareness of the opportunities available, rather than interest.  Thus, it is argued that continuing professional development still has potentially an important role to play in addressing some of the issues highlighted and in equipping teachers with the knowledge, skills and understanding needed to effectively promote healthy, active lifestyles.  Given what we know, however, it seems that the way any such professional development is ‘packaged’ and ‘sold’ needs some careful thought. 

Conclusion

In conclusion, PE has an important a role to play in the promotion of healthy, active lifestyles and there is evidence that it can make a difference to young people’s physical activity levels.  However, evidence also suggests that there is room for improvement.  Consequently, we need to recognise and address the challenges highlighted in this paper, and at the same time recognise and seize the opportunities available.  Only in this way, will PE be able to maximise its potential and truly and effectively engage young people in a healthy, active lifestyle both now and in the future.

 

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