Commentaries on Physical Activity and Health
Is the U.S. Leading or Lagging? The 2018 Global Matrix of Report Cards for Physical Activity in Children and Youth
By Peter T. Katzmarzyk, PhD, FACSM
Children and youth are not immune to the global pandemic of physical inactivity.1 Given the negative health and social concerns associated with a physically inactive lifestyle, parents, teachers, researchers and health professionals should be personally invested in creating healthy, safe and active environments for our children. Although most of my time is devoted to research, I try to contribute as much as possible to advocacy efforts that can help get kids moving. One such initiative is the Active Healthy Kids Global Alliance, which is a not-for-profit organization of researchers, health professionals and stakeholders who are working together to advance physical activity in children and youth from around the world (www.activehealthykids.org). One of the primary activities of the Active Healthy Kids Global Alliance is the coordination and dissemination of national report cards on physical activity for children and youth. The harmonization and comparison of physical activity data from children and youth living in diverse countries and cultures around the world has the potential to identify novel strategies to help turn the tide on the global downward trend in children’s physical activity.
On November 27, 2018, the 2018 United States Physical Activity Report Card for Children and Youth was released in Adelaide, Australia alongside 48 other countries who participated in the Active Healthy Kids Global Alliance Global Matrix. Each of the participating countries produced a report card that graded 10 common indicators related to physical activity in children and youth. These indicators included 1) overall physical activity, 2) organized sport participation, 3) active play, 4) active transportation, 5) sedentary behavior, 6) physical fitness, 7) family and peers, 8) school, 9) community and environment, and 10) government. In total, the Global Matrix involved 517 experts who produced 49 country report cards. This international release followed the domestic release of the U.S. Report Card in early October in Washington, D.C. (available at www.physicalactivityplan.org).
The primary goal of the U.S. Report Card is to assess the levels of physical activity and sedentary behaviors in American children and youth, facilitators and barriers for physical activity, and health outcomes related to physical activity.2 A Report Card Research Advisory Committee was convened as a sub-committee of the National Physical Activity Plan Alliance, which included experts in diverse areas of physical activity and health behaviors from academic institutions and partner organizations across the U.S. The Committee was charged with the development of the U.S. Report Card, which included determining which indicators to include, identifying the best available data sources, and assigning a letter grade to each indicator based on the best available evidence.
The U.S. grade for overall physical activity was D-, which indicates that we are succeeding with only about 1 in 4 children and youth with respect to physical activity. Indeed, the prevalence of school-aged children and youth 6 to 17 years of age meeting the current physical activity guidelines (60 minutes per day of moderate-to-vigorous intensity physical activity3) is only about 24%.4 Further, there is a significant gender gap observed, where 28% of boys and 20% of girls are currently meeting the recommendations. While the U.S. scored quite low for overall physical activity (D-) and sedentary behavior (D), we scored better for organized sport participation (C) and the community and built environment (C). In general, infrastructure for physical activity and opportunities for organized physical activity are better in the U.S. compared to opportunities for free play and unstructured physical activity.
Although the U.S. results are a powerful reminder about the overall poor grade on physical activity in children and youth in our country, the contribution of our results to the collaborative Global Matrix helps provide unique insights. For example, analysis of global variation in report card grades has revealed the highest levels of physical activity are observed among countries with a low or medium human development index (HDI) (average grade of C-) whereas the lowest grades for physical activity are in countries with a high or very high HDI (average grade of D-).5 On the flip side, the grades for the community and environment in countries with a low or medium HDI are the lowest (average grade of D), while grades for community and built environment in countries with a high or very high HDI are the highest (average grade of B-).5 These trends are reflected in the correlations between HDI and the indicator grades, where the correlation between HDI and overall physical activity is -0.31 and the correlation between HDI and the community and built environment grade is r = 0.73.5 Taken together, the results suggest that while building infrastructure for physical activity may be important in some contexts, it may not be the primary driver of physical activity in children and youth around the world. Changes in broader socio-economic trends within the context of the epidemiological transition and related transitions in physical activity6 may be driving changes in physical activity, especially in countries undergoing rapid economic and social development.
How does the U.S. fare in the global comparisons? The answer is not a straightforward one. Something we have learned from the Global Matrix is that there are no clear winners or losers across the board. As I described above, the U.S. fares poorly for overall physical activity and sedentary behavior, but scores better for organized sport participation and the community and built environment. Our overall average score across all 10 indicators was a D, which compares to an average grade of C- across all countries.5 For overall physical activity our grade of D- compares to a D grade across all countries, and our grade of C for the community and built environment is right at the average of C across all countries.5 So overall, I guess you could say that the U.S. falls into the middle of the pack with respect to the other 48 countries participating in the Global Matrix.
What does success look like? The highest average grade across the 10 indicators for a report card was a B in Slovenia.5 The Slovenia grade for overall physical activity was an A-, with grades of A for both the school and government indicators. These results highlight the importance of the school environment as one avenue for providing physical activity opportunities for children and youth, as well as the importance of governmental leadership on this issue. Achieving the highest grade in the Global Matrix makes Slovenia an interesting case study that deserves closer examination in order to learn from their successes and replicate them in other countries and regions of the world.
In summary, I believe that the 2018 United States Physical Activity Report Card for Children and Youth is a powerful tool for advocacy – a tool that can help power the movement to get kids moving. We will continue to work with the Active Health Kids Global Alliance and the U.S. National Physical Activity Plan Alliance to identify promising strategies that can be disseminated locally and nationally to help foster active, healthy environments for children to be active.
Peter Katzmarzyk is Professor and Associate Executive Director for Population and Public Health Sciences at Pennington Biomedical Research Center in Baton Rouge, LA. Dr. Katzmarzyk is an internationally recognized leader in the field of physical activity and obesity, with a special emphasis on pediatrics and ethnic health disparities. He has over two decades of experience in conducting large clinical and population-based studies in children and adults. Dr. Katzmarzyk has a special interest in global health, and has a record of building research capacity in physical activity and obesity research in developing countries. He has published his research in more than 500 scholarly journals and books, and has delivered over 195 invited lectures in 15 countries. He is an Associate Editor for Medicine and Science in Sports and Exercise and an editorial board member for Pediatric Obesity and Metabolic Syndrome and Related Disorders. In addition to his research, Dr. Katzmarzyk plays a leading role in national health advocacy initiatives. He chairs the Research Advisory Committee for the U.S. Report Card on Physical Activity for Children and Youth for the National Physical Activity Plan Alliance. He also recently served on the 2018 U.S. Physical Activity Guidelines Advisory Committee for the U.S. Department of Health and Human Services.
References
1 Hallal, P.C.; Andersen, L.B.; Bull, F.C.; Guthold, R.; Haskell, W.; Ekelund, U.; Lancet Physical Activity Series Working Group. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012;380(9838):247-57.
2US Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd Edition. Washington, DC: US Department of Health and Human Services, 2018.
3 National Physical Activity Plan Alliance. The 2018 United States Report Card on Physical Activity for Children and Youth. Washington, DC: National Physical Activity Plane Alliance, 2018.
1 Katzmarzyk, P.T.; Denstel, K.D.; Beals, K.; Carlson, J.; Crouter, S.E.; McKenzie, T.L.; Pate, R.R.; Sisson, S.B.; Staiano, A.E.; Stanish, H., et al. Results from the United States 2018 Report Card on Physical Activity for Children and Youth. J Phys Act Health 2018;15(S2):S422-S4.
1 Aubert, S.; Barnes, J.D.; Abdeta, C.; Abi Nader, P.; Adeniyi, A.F.; Aguilar-Farias, N.; Andrade Tenesaca, D.S.; Bhawra, J.; Brazo-Sayavera, J.; Cardon, G., et al. Global Matrix 3.0 physical activity report card grades for children and youth: Results and analysis from 49 countries. J Phys Act Health 2018;15(S2):S251-S73.
1 Katzmarzyk, P.T.; Mason, C. The physical activity transition. J Phys Act Health 2009;6(3):269-80.