The Daily Physical Activity (DPA) policy in Ontario: Is it working? An examination using accelerometry-measured physical activity data.
Stone, Michelle R. ; Faulkner, Guy E.J. ; Zeglen-Hunt, Laura 等
On October 6, 2005, the Ontario Ministry of Education (OME)
announced a policy requiring that "all students in Grades 1 to 8,
including students with special needs, be provided with opportunities to
participate in a minimum of twenty minutes of sustained
moderate-to-vigorous physical activity (MVPA) each school day during
instructional time". (1) Daily Physical Activity (DPA) had to be
scheduled during instructional time and could occur in a variety of
locations (i.e., classrooms, outdoors, the gymnasium and multipurpose
rooms). Full implementation of policy No.138, "Daily Physical
Activity in Elementary Schools, Grades 1-8", was to occur by the
end of the 2005-06 school year; the goal of the policy was to enable all
elementary students to improve or maintain their overall health and
wellness. The policy is similar to one endorsed in Alberta
(http://education.alberta.ca/teachers/resources/dpa.aspx) and another in
British Columbia (http://www.bced.gov.bc.ca/dpa/ dpa_requirement.htm).
Ontario houses 4,020 publicly funded elementary schools, serving
over 1 million children and youth across the province. With the
potential to impact so many children and youth, Ontario's DPA
policy is indeed a significant public health intervention given the
importance of physical activity to health in children. (2) This policy
has now been in place for six years; however, to the authors'
knowledge, it has never been formally evaluated. More specifically,
there have been no investigations as to whether schools are successfully
structuring DPA into daily timetables, and whether children are in fact
acquiring a minimum of 20 minutes of sustained MVPA during these
sessions. Evidence-based policies must be designed, implemented and
evaluated on an ongoing basis. Evaluation helps ensure that these
policies are "optimally effective and maximally utilized". (3)
The effectiveness of DPA is critical to evidence-based health policy and
to justifying ongoing implementation of the policy.
From January 2010 to June 2011, a large-scale, multidisciplinary
and mixed-method study was conducted, examining how the built
environment influences school travel modes of elementary schoolchildren
in Toronto (Project BEAT; www.beat.utoronto.ca). The study was
cross-sectional in nature. A total of 16 Toronto District School Board
schools were involved and 1,027 parents/guardians gave consent for their
children to participate (boys, n=478; girls, n=549). Physical activity
was measured using accelerometry, and classroom schedules were collected
to identify sessions of DPA (including Physical Education (PE)) across
the school week. The collection of these data provided the opportunity
to explore within these schools the proportion of children who
participate in DPA, and the proportion who manage to achieve sustained
MVPA within these sessions; these are the objectives of this article.
METHODS
Participants
A total of 1,027 parents/guardians gave consent for their children
to participate in Project BEAT. Accelerometer-measured physical activity
data were collected on a total of 1001 children, and their height and
weight measurements were taken. Of these 1,001, 85.5% had at least 3
weekdays and 1 weekend of valid data (n=856; boys=389, girls=467). This
article is therefore based on 856 participants, aged 10 to 12 years
(11.1 [+ or -] 0.6 years), who met the inclusion parameters. Using age-
and sex-specific body mass index (BMI) cut-points provided by the
International Obesity Task Force, (4) participants were classified as:
normal weight, overweight or obese.
Measurement of physical activity
Children's physical activity was objectively measured for
seven days using accelerometry (ActiGraph GT1M; Pensacola, FL). (5) For
inclusion in data analysis, each child was required to wear the
accelerometer a minimum of 10 hours for at least three weekdays and one
weekend day. (6) Time spent at various levels of movement intensity was
classified according to published thresholds in children. (7) These were
used to determine levels of physical activity during school days and
during the school day period. The school day period was identified using
start and end times from classroom timetables, which were collected from
all participating teachers. Physical activity variables of interest
included total physical activity (counts x [day.sup.-1]), mean counts
(counts x [min.sup.-1]) and minutes of moderate-to-vigorous activity
(MVPA). Classroom schedules were used to identify scheduled times for
DPA and PE. Teachers were informed ahead of time of the importance of
providing accurate information with regard to when children were
participating in DPA and PE for the week that physical activity was
being measured. Classroom schedules were collected after the measurement
week, in case teachers needed to make any amendments to their typical
schedule. The number of days with scheduled DPA and PE were summed to
give an overall score ([DPA.sub.total]; maximum of 5 days per school
week *). Accelerometer data were used to compute the number (frequency)
and average length (duration) of sustained bouts of MVPA (i.e., those
lasting 5 or more minutes) during scheduled DPA sessions.
Statistical analyses
Frequency of DPA
Relationships between the frequency of scheduled physical activity
([DPA.sub.total]) and accelerometer-measured characteristics of physical
activity (total physical activity, mean counts and minutes of
moderate-to-vigorous physical activity (MVPA) accumulated during
weekdays (WD) and during the school day (SD)) were examined using
Pearson product moment correlations, and a series of independent-samples
t-tests were used to determine whether there were differences according
to level of DPA participation: a) Less than 5 days per week and b) 5
days per week.
Bouts During DPA
A series of independent-samples t-tests were used to explore the
number of bouts accumulated and the average length of bouts accumulated
by gender. Weekday and school day levels of physical activity and the
proportion meeting current physical activity recommendations for health,
between those children who accumulated at least 1 bout of MVPA during
scheduled DPA and those failing to accumulate any bouts, were also
explored. Differences between estimates were tested for statistical
significance at p<0.05.
RESULTS
Frequency of DPA
Of the 856 participants with valid accelerometer data, just under
half (49%) engaged in DPA every day of the school week. A total of 16.6%
engaged in DPA on 2 days, 17.9% on 3 days, and 16.1% on 4 days. These
results are presented according to the OME School Implementation
Continuum for Daily Physical Activity (Table 1) which appears in the
resource guide for elementary school principals. (8)
Frequency of DPA was positively associated with total physical
activity, mean counts and accumulated minutes of MVPA during weekdays
(r=0.10 to 0.13, p<0.01), and accumulated minutes of MVPA during the
school day period (r=0.19, p<0.01). Those children who participated
in DPA every day had significantly higher total physical activity, the
overall intensity of their activity was greater, and they accumulated
significantly more minutes of moderate-to-vigorous activity across
school days (MVPAWD) and during the school day period (MVPASD)
(p<0.05, Table 2).
Bouts during DPA
Just 19.3% of participants (n=165) accumulated at least 1 sustained
([greater than or equal to] 5 min) bout of MVPA during scheduled DPA
across the school week. The proportion ranged across the 16
participating schools (0 to 45%). The majority of children (74.5%)
accumulated 1 bout across the school week, with 18.2% and 3.7%
accumulating 2 and 3 bouts, respectively; just 6 children (3.6% of
sample) accumulated 4 bouts across the school week. A similar proportion
of boys (n=88) and girls (n=77) accumulated at least 1 bout; the
proportion acquiring more than 1 bout did not differ by gender.
Bouts, on average, lasted 7.1 minutes; duration did not differ
according to gender (boys: 7.3 min, girls: 6.9 min; p>0.05, Table 3).
The majority of all bouts lasted between 5 and 10 minutes in duration
(85%; boys=85%, girls=86%); just 4% of bouts lasted 15 or more minutes
in duration (Figure 1). No bouts lasted 20 or more minutes in duration;
the longest recorded lasted 18 minutes. While no child sustained MVPA
for 20+ minutes during a scheduled session of DPA, 9 participants (1% of
total sample, n=856) were able to accumulate at least 15 minutes of MVPA
through multiple shorter bouts (2 or more lasting <20 minutes in
duration) on 1 day of scheduled DPA.
In comparison to children who did not achieve any sustained bouts
of MVPA during scheduled DPA, those who achieved at least 1 bout had
greater total physical activity, the intensity of their activity was
higher, and they accumulated significantly more minutes of MVPA across
the school week and within the school day period (p<0.05, Table 4).
Furthermore, a significantly greater proportion accumulated at least 60
minutes of MVPA on one or more days of the week, and more attained an
average of 60+ minutes of MVPA across the school week. Those achieving
at least one bout also had lower BMI scores, and fewer were classified
as overweight/obese (Table 4).
DISCUSSION
The objective of this paper was to evaluate whether the Ontario
Ministry of Education's Daily Physical Activity (DPA) policy is
being effectively implemented in elementary schools. The results are
based on a small convenience sample of schools (n=16) that engaged in a
larger study (Project BEAT) in the Greater Toronto Area (GTA). This
sampling limitation should be considered in the context that all schools
in Ontario should be fully implementing the DPA policy. It is one of the
only studies conducted to date that provides objectively measured
feedback to key stakeholders about DPA implementation.
Fewer than half of children sampled were provided with a session of
structured physical activity in instructional time every day of the
school week. During these sessions, not a single child engaged in
sustained MVPA for 20 or more minutes in duration. Just 1% of all
children sampled were able to achieve 15+ minutes of MVPA through
multiple, shorter bouts, and only for one scheduled session of DPA. It
seems that even when multiple, shorter bouts of MVPA are allowed, the
majority of children (99%) fail to achieve the requirement. It is
possible that sessions of DPA might have occurred but were not recorded
on the classroom schedules. However, teachers were asked to specifically
record all sessions of PE/DPA for the same week that children's
physical activity behaviour was being measured. This should have
minimized error.
On average, bouts of MVPA lasted 6 or 7 minutes, with the vast
majority (nearly 90%) under 10 minutes. The habitual physical activity
patterns of children are very different from those of adults. Children
typically accumulate activity in short, sporadic bursts, whereas adult
patterns are less sporadic and more continuous. Early accounts based on
direct observation of children's physical activity behaviour
indicate that around 95% of all bouts are <10 seconds in duration; as
intensity increases, bout length decreases; in fact, very few bouts of
MVPA are sustained for 10+ minutes. (9) More recent evidence generated
from accelerometer data confirms these findings. (10,11) Asking schools
to create an environment in which children sustain moderate or greater
intensity activity for 20 or more continuous minutes does not reflect
children's typical physical activity patterns; it could also be
logistically challenging. Accordingly, the DPA policy may need to be
reviewed to move emphasis away from 'sustained' MVPA to the
accumulation of shorter bouts of MVPA as a means of attaining the
20-minute criteria.
On the more positive side, children who engaged in DPA every day of
the school week were significantly more active than their peers, both at
school and outside of school. Furthermore, those who accumulated at
least 1 bout of MVPA (sustained for at least 5 minutes) during DPA were
significantly more active and more likely to meet PA guidelines, and
fewer of them were overweight or obese. A potential consideration is the
hierarchical structure of the data. Our research was interested in the
occurrence of clustering (i.e., students who are exposed to regular DPA
in a given school are more likely to have higher physical activity
levels than those in schools that do not implement daily physical
activity). Our finding of a positive relationship between DPA and PA
during the school day independent of the entire day also strengthens the
case for providing opportunities for daily PA during school time.
It is encouraging that children who manage to accumulate some form
of sustained MVPA during sessions are more active over the course of the
school day and the whole day compared to those who do not. Given that a
greater proportion of these children also meet PA guidelines, and fewer
have unhealthy weights, the delivery of regular and effective DPA could
be quite promising as a physical activity-enhancing strategy for
children and youth. Our study is cross-sectional and therefore we can
only speculate that regular and effective DPA might lead to healthier
levels of physical activity and weight; it is a limitation that invites
future longitudinal work.
CONCLUSION
The results show that the majority of schools are not meeting the
required frequency (5 days) or intensity (sustaining
moderate-to-vigorous physical activity for at least 20 minutes) of the
DPA policy. A range of barriers to implementation have been addressed in
previous work. (12,13) However, our work demonstrates that the frequency
and intensity of DPA is positively related to health behaviours/outcomes
of students. While our design precludes us from determining cause and
effect, a positive relationship between DPA and physical activity/health
in children clearly exists. Longitudinal studies are needed to establish
whether the intended positive benefits for students can be achieved when
the policy is effectively implemented. Future investigations should also
focus on schools that are succeeding, and identify barriers and
facilitators to successful implementation.
Acknowledgements: This research was funded by the Built
Environment, Obesity and Health Strategic Initiative of the Heart and
Stroke Foundation and the Canadian Institutes of Health Research (CIHR).
Conflict of Interest: None to declare.
Received: November 24, 2011
Accepted: February 23, 2012
REFERENCES
(1.) Ontario Ministry of Education. Daily physical activity in
schools: Guide for school boards. Available at:
http://www.edu.gov.on.ca/eng/teachers/ dpa_boards.pdf (Accessed November
2, 2011).
(2.) Janssen I, LeBlanc AG. Systematic review of the health
benefits of physical activity and fitness in school-aged children and
youth. Int J Behav Nutr Phys Act 2010;7:40.
(3.) Patton IT, McDougall J. Canada's Active Schools: A review
of school-based physical activity interventions in Canada. Phys Health
Educ J2009;75:16-22.
(4.) Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a
standard definition for child overweight and obesity worldwide:
International survey. BMJ 2000;320:1240.
(5.) ActiGraph GT1M. ActiGraph LLC, Pensacola, FL, United States.
Available at: http://www.theactigraph.com (Accessed November 2, 2011).
(6.) Stone MR, Rowlands AV, Eston RG. Characteristics of the
activity pattern in normal weight and overweight boys. Prev Med
2009;49:205-8.
(7.) Stone MR, Rowlands AV, Eston RG. Relationships between
accelerometer-assessed physical activity and health in children: Impact
of the activity-intensity classification method. J Sports Sci Med
2009;8:136-43.
(8.) Ontario Ministry of Education. Daily physical activity in
schools: Guide for principals. Available at:
http://www.edu.gov.on.ca/eng/teachers/dpa_principals.pdf (Accessed
November 2, 2011).
(9.) Bailey RC, Olson J, Pepper SL, Porszasz J, Barstow TJ, Cooper
DM. The level and tempo of children's physical activities: An
observational study. Med Sci Sports Exerc 1995;27:1033-41.
(10.) Stone MR, Rowlands AV, Middlebrooke AR, Jawis MN, Eston RG.
The pattern of physical activity in relation to health outcomes in boys.
Int J Pediatr Obes 2009;4:306-15.
(11.) Stone MR, Rowlands AV, Eston RG. The use of high-frequency
accelerometry monitoring to assess and interpret children's
activity patterns. In: Jirimae T, Armstrong N, Jirimae J (Eds.),
Children and Exercise XXIV. London, UK: Routledge, 2008;150-53.
(12.) Chorney D. Daily physical activity initiatives across Canada:
A progress report. Phys Health Educ J 2009;75:12-13.
(13.) Robertson-Wilson JE, Levesque L. Ontario's daily
physical activity policy for elementary schools: Is everything in place
for success? Can J Public Health 2009;100:125-59.
Michelle R. Stone, PhD, [1] Guy E.J. Faulkner, PhD, [1] Laura
Zeglen-Hunt, bphe, [2] Jennifer Cowie Bonne, MSc [3]
Author Affiliations
[1.] Faculty of Kinesiology and Physical Education, University of
Toronto, Toronto, ON
[2.] Ontario Institute for Studies in Education (OISE), Theory and
Policy Studies, University of Toronto, Toronto, ON
[3.] Faculty of Applied Health and Community Studies, Exercise
Science and Health Promotion Program, Sheridan Institute of Technology
and Advanced Learning, Brampton, ON
* For the purpose of this article, sessions of DPA and PE are
combined and presented as simply DPA.
Correspondence: Michelle R. Stone, Faculty of Kinesiology and
Physical Education, University of Toronto, 55 Harbord Street, Toronto,
ON M5S 2W6, Tel: 416-978-2725, Fax: 416-971-2118, E-mail:
[email protected]
Table 1. Presenting Project BEAT Results (n=16 Toronto District School
Board schools) According to the School Implementation Continuum for
Daily Physical Activity (DPA) (1)
Indicators Stage 1 Stage 2 Stage 3
Schedule Students are Students are often Students are
occasionally given given always given
opportunities to opportunities to opportunities to
be physically be physically be physically
active during the active each day active each day
300 minutes of for 20 minutes for 20 minutes
instructional during the 300 during the 300
time. minutes of minutes of
instructional instructional
time. time.
16% of children 34% of children 49% of children
sampled were sampled were often sampled were given
occasionally given given an opportunity to
opportunities to opportunities to be physically
be physically be physically active each day
active (1-2 days active (3-4 days for 20 minutes
per week) during per week) for 20 during the 300
the 300 minutes of minutes during the minutes of
instructional 300 minutes of instructional
time. instructional time.
time.
Out of the 16
schools sampled, 3
provided this
opportunity in
every Grade 5 and
6 classroom.
Out of the 71
Grade 5 and 6
classrooms
sampled, 27 (38%)
provided this
opportunity.
Quality of Very few students Some students are All students are
daily are physically physically active physically active
physical active for the for the full 20 for the full 20
activities full 20 minutes. minutes. minutes.
Just 19% of Not a single child N/A
children sampled sustained MVPA for
attained at least a minimum of 20
1 sustained bout minutes during
([greater than or scheduled DPA; the
equal to] 5 longest recorded
minutes) of MVPA bout lasted 18
during scheduled minutes.
DPA.
Table 2. Characteristics of Accelerometer-measured Physical
Activity According to Frequency of Daily Physical
Activity (DPA) per School Week
Frequency of DPA
Low High
(0-4 days/week) (5 days/week)
Total sample (number) 423 423
TPAwd 422,429 (124,245) 460,778 (135,477) *
mcwd 437.5 (140.9) 463.9 (166.4) *
MVPAwd 30.2 (13.8) 34.1 (16.1)*
MVPASD 15.1 (7.3) 18.0 (8.8) *
Mean (standard deviation) presented; significantly higher in those
getting 5 days/week, * p<0.05
WD=weekday; SD=school day
[TPA.sub.WD] = total physical activity (counts x [day.sup.-1];
weekdays); [MC.sub.WD] = mean counts (counts x [min.sup.-1];
weekdays); [MVPA.sub.WD] = minutes of moderate-to-vigorous physical
activity (weekdays); [MVPA.sub.SD] = minutes of moderate-to-vigorous
physical activity (school day)
Table 3. Percentage Attaining 1 or More [greater than or equal to]
5-minute Bouts of MVPA During Scheduled Daily Physical Activity (DPA)
per School Week, and Average Duration (min) of [greater than or equal
to] 5-minute Bouts of MVPA, by Gender
Number of [greater than or
equal to] 5-minute Bouts of MVPA Duration
(min)
1 2 3 4
% of Participants
Total (n=165) 74.5 18.2 3.7 3.6 7.1 (2.6)
Boys (n=88) 70.5 20.5 3.4 5.6 7.3 (2.5)
Girls (n=77) 79.2 15.6 3.9 1.3 6.9 (2.9)
Table 4. Characteristics of Accelerometer-measured Physical Activity
of Children Who Attain at Least One [greater than or equal to]
5-minute Bout of MVPA During Scheduled Daily Physical Activity (DPA)
(n=165) and of Those Who Do Not (n=691)
Characteristic Group
No Bouts At Least
One Bout
Total sample (number) 691 165
Age (years) 11.1 (0.6) 11.0 (0.6)
Height (cm) 147.4 (8.9) 147.2 (7.0)
Weight (kg) 42.2 (10.2) 38.7 (8.6) *
BMI (kg/[m.sup.2]) 19.2 (3.6) 17.7 (3.0) *
BMI category (%)
([dagger])
Normal weight 67.3 86.1 *
Overweight/Obese 32.7 13.9 *
Physical activity measure
[TPA.sub.WD] 423,386 (126,369) 516,735 (124,682) *
[MC.sub.WD] 434.4 (149.3) 518.3 (157.7) *
[MVPA.sub.WD] 29.6 (13.5) 42.5 (16.9) *
[MVPA.sub.SD] 14.9 (7.0) 23.3 (9.3) *
% attaining an average
of 60+ minutes of
MVPA across weekdays 2.6 17.0 *
% attaining 60+ minutes
of MVPA on at least
1 day 29.4 53.3 *
Mean (standard deviation) presented; significantly different from
reference group (no bouts), * p<0.01
([dagger]) International Obesity Task Force classification (4)
WD=weekday; SD=school day
[TPA.sub.WD] = total physical activity (counts x day-1; weekdays);
[MC.sub.WD] = mean counts (counts x [min.sup.-1]; weekdays);
[MVPA.sub.WD] = minutes of moderate-to-vigorous physical activity
(weekdays); [MVPA.sub.SD] = minutes of moderate-to-vigorous physical
activity (school day)
Figure 1. Proportion of bouts (%) lasting 5 to 10 minutes, 10 to
15 minutes, and [greater than or equal to] 15 minutes, by gender
Boys Girls
5 to min 10 minutes 85 86
10 to 15 minutes 12 10
[greater than or equal to] 15 minutes 3 4
Note: Table made from bar graph.
