Summary
The fitness and physical activity levels of children and youth are commonly questioned, but the evidence cited is both equivocal and methodologically diverse. The amount and type of physical activity undertaken during childhood that is appropriate for optimal health is unknown, although it has been suggested that, in the absence of such criteria, activity levels known to confer health benefits in adults are also appropriate for children. The measurement of activity in children is problematical, and there is currently no valid method of assessing activity levels that is feasible for use in large studies. Therefore, studies may lack either internal validity or wider applicability.
Studies using self-report methods indicate relatively high levels of activity with 60 to 70% of children taking sufficient ‘appropriate’ physical activity. However, a variety of activity thresholds have been used. Studies that use more objective methods report much lower levels of activity, especially when cardiovascular fitness criteria are applied. The use of less stringent health-related thresholds results in higher levels of ‘appropriate’ activity. Nearly all studies of teenagers report a decline in activity with age during this period. Data from the large population studies indicate that activity levels peak in children at around 13 to 14 years of age, and then markedly decline. Boys are normally reported to be more active than girls, but this difference is greatly reduced when moderate activity alone is compared, indicating that boys participate in more vigorous exercise than girls. The health effects of low levels of vigorous activity in children are unclear.
There is a need to identify more clearly the quantity and type of activity which is appropriate for children’s health and well-being, and to improve assessment techniques. There is a particular need to assess the value of, and measure the prevalence of, low to moderate intensity activity below the level normally considered appropriate for cardiorespiratory fitness improvement.
Similar content being viewed by others
References
Powell KE, Thompson PD, Caspersen CJ, et al. Physical activity and the incidence of coronary heart disease. Annu Rev Public Health 1987; 8: 281–7
Berlin JA, Colditz A. A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol 1990; 132: 612–27
Wannamethee G, Shaper AG. Physical activity and stroke in British middle-aged men. BMJ 1992; 304: 597–601
Paffenbarger RS, Wing AL, Hyde RT, et al. Chronic disease in former college students, XX: physical activity and incidence of hypertension of college alumni. Am J Epidemiol 1983; 117: 245–57
Helmrich SP, Ragland DR, Leung RW, et al. Physical activity and reduced occurence of non-insulin dependent diabetes mellitus. N Engl J Med 1991; 325: 147–52
Wickham CAC, Walsh K, Cooper C, et al. Dietary calcium, physical activity, and risk of hip fracture: a prospective study. BMJ 1989; 299: 889–92
Stephens T. Physical activity and mental health in the United States and Canada: evidence from four population surveys. Prev Med 1988; 17: 35–47
Lee I-M. Physical activity, fitness and cancer. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity, fitness and health: international proceedings and consensus statement. Champaign: Human Kinetics, 1994: 814–31
Casperson CJ, Christenson GM, Pollard RA. Status of the 1990 physical fitness and exercise objectives — evidence from NHIS 1985. Public Health Rep 1986 Nov–Dec; 101: 587–92
Cureton KJ. Commentary on ‘children and fitness: a public health perspective’. Res Q Exerc Sport 1987; 58(4): 315–20
Epstein LH, Wing RR, Koeske R, et al. A comparison of lifestyle exercise, aerobic exercise, and calisthenics on weight loss in obese children. Behav Ther 1985; 16: 345–56
Haskell WL, Montoye HJ, Orenstein D. Physical activity and exercise to achieve health-related physical fitness components. Public Health Rep 1985 Mar–Apr: 202–13
LaPorte RE, Montoye HJ, Caspersen CJ. Assessment of physical activity in epidemiological research: problems and prospects. Public Health Rep 1985; 100: 131–46
Blair SN. Physical activity, fitness and coronary heart disease. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity, fitness and health: international proceedings and consensus statement. Champaign: Human Kinetics, 1994: 579–90
Paffenbarger RS, Hyde RT, Wing AL, et al. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med 1986; 314: 605–13
Leon AS, Connett J, Jacobs DRJ, et al. Leisure-time physical activity levels and risk of coronary heart disease and death: Multiple Risk Factor Intervention Trial. JAMA 1987; 258: 2388–95
Reiff GG, Dixon WR, Jacoby D, et al. The President’s Council on Physical Fitness and Sports national school population fitness survey. Ann Arbor: University of Michigan, 1986
Armstrong N. Children are fit but not active! Educ Health 1989; 7(2): 28–32
Peters RK, Cady LDJ, Bischoff DP, et al. Physical fitness and subsequent myocardial infarction in healthy workers. JAMA 1983; 249(22): 3052–6
Sobolski J, Kornitzer M, De Backer G, et al. Protection against ischemic heart disease in the Belgian fitness study: physical fitness rather than physical activity? Am J Epidemiol 1987; 125(4): 601–10
Blair SN, Kohl HW, Paffenbarger RSJ, et al. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA 1989; 262: 2395–401
Sandvik L, Erikssen J, Thaulow E, et al. Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med 1993; 328(8): 533–7
Pate RR, Dowda M, Ross JG. Associations between physical activity and physical fitness in American children. Am J Dis Child 1990; 144(10): 1123–9
Shephard RJ. Aerobic fitness and health. Champaign: Human Kinetics, 1994
Brill PA, Burkhalter HE, Kohl HW, et al. The impact of previous athleticism on exercise habits, physical fitness, and coronary heart disease risk factors in middle-aged men. Res Q Exerc Sport 1989; 60: 209–15
Dishman RK. Supervised and free-living physical activity: no differences in former athletes and nonathletes. Am J Prev Med 1988; 4: 153–60
Kuh DJL, Cooper C. Physical activity at 36 years: patterns and childhood predictors in a longitudinal study. Int J Epidemiol 1992; 46: 114–9
Telama R, Laasko L, Yang X. Physical activity and participation in sports of young people in Finland. Scand J Med Sci Sports 1994; 4: 65–74
Engstrom L-M. Physical activity in children and youth. Acta Pediatr Scand Suppl. 1980; 283: 101–5
Paffenbarger RSJ, Hyde RT, Wing AL, et al. The association of changes in physical activity level and other lifestyle characteristics with mortality among men. N Engl J Med 1993; 328(8): 538–45
Berenson GS, McMahan CA, Voors AW, et al. Cardiovascular risk factors in children: the Bogalusa heart study. Oxford: Oxford University Press, 1980
Boreham C, Savage M, Primrose D, et al. Coronory risk factors in schoolchildren. Arch Dis Child 1993; 68: 182–6
Strong JP, McGill HC. The paediatric aspects of atherosclerosis. J Atherosclerosis Res 1969; 9: 251–65
Riddoch CJ, Savage JM, Murphy N, et al. Long term health implications of fitness and physical activity patterns. Arch Dis Child 1991; 66: 1426–33
Montoye HJ. Risk indicators for cardiovascular disease in relation to physical activity in youth. In: Binkhorst RJ, Kemper HCG, Saris WHM, editors. Children and exercise. Champaign: Human Kinetics, 1985: 3–25
Kemper HCG, Snel J, Verschuur R, et al. Tracking of health and risk indicators of cardiovascular disease from teenager to adult: the Amsterdam growth and health study. Prev Med 1990; 19: 642–55
Blair SN, Clark DG, Cureton KJ, et al. Exercise and fitness in childhood: implications for a lifetime of health. In: Gisolfi CV, Lamb DR, editors. Perspectives in exercise science and sports medicine. Indianapolis: Benchmark, 1989: 401–30
Blair SN, Meredith MD. The exercise-health relationship: does it apply to children and youth? In: Pate RR, Hohn RC, editors. Health and fitness through physical education. Champaign: Human Kinetics, 1994: 11–9
Blum R. Contemporary threats to adolescent health in the United States. JAMA 1987; 257: 3390–5
Åstrand P-O. Physical activity and fitness: evolutionary perspective and trends for the future. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity, fitness, and health: international proceedings and consensus statement. Champaign: Human Kinetics, 1994: 98–105
Malina RM. Physical activity: relationship to growth, maturation, and physical fitness. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity, fitness, and health: international proceedings and consensus statement. Champaign: Human Kinetics, 1994: 918–30
Hubert HB, Eaker ED, Garrison RJ, et al. Life-style correlates of risk factor change in young adults: an eight year study of coronory heart disease risk factors in the Framingham offspring. Am J Epidemiol 1987; 125: 812–31
Young and unfit? [editorial]. Lancet 1992; 340: 19–20
Sallis JF, Patterson TL, Buono MJ, et al. Relation of cardiovascular fitness and physical activity to cardiovascular disease risk factors in children and adults. Am J Epidemiol 1988; 127(5): 933–41
Sallis JF, McKenzie TL. Physical education’s role in public health. Res Q Exerc Sport 1991; 62(2): 124–37
Rowland TW. Exercise and children’s health. Champaign: Human Kinetics, 1990
Blair SN. Are American children and youth fit? The need for better data. Res Q Exerc Sport 1992; 63(2): 120–3
Saris WHM, Emons HGJ, Groenenboom DC, et al. Discrepancy between FAO/WHO enrgy requirements and actual energy expenditure levels in healthy 7–11 year old children [abstract]. In: Beunen G, Ghesquiere J, Reybrouck T, et al., editors. Children and exercise. Stuttgart: Enke, 1990: 119
Davies PSW, Day JME, Lucas A. Early energy expenditure and later body fatness. Int J Obes 1991; 15: 727–31
Department of Health. Dietary reference values for food energy and nutrition for the United Kingdom. London: HMSO; 1991. Report on Health and Social Subjects No. 41
Rippe JM, Weissberg RP, Seefeldt V. The purpose of play: a framework for improving childhood health and psychological and physical development. Med Exerc Nutr Health 1993; 2: 225–31
Fagan R. Animal play behavior. Oxford: Oxford University Press, 1981
Corbin CB, Pangrazi RP. Are American children and youth fit? Res Q Exerc Sport 1992; 63(2): 96–106
American College of Sports Medicine. Guidelines for exercise testing and prescription. Philadelphia: Lea & Febiger, 1991
Paffenbarger RS, Hyde RT, Wing AL, et al. A natural history of athleticism and cardiovascular health. JAMA 1984; 252: 491–5
Pollock ML, Froelicher VF. Position stand of the American College of Sports Medicine: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. J Cardiopul Rehab 1990; 10: 235–45
Activity and Health Research. Allied Dunbar National Fitness Survey. London: Health Education Authority/Sports Council, 1992
Dishman RK, Dunn AL. Exercise adherence in children and youth: implications for adulthood. In: Dishman RK, editor. Exercise adherence: its impact on public health. Champaign: Human Kinetics Books, 1988: 155–200
Seefeldt V, Vogel P. Children and fitness: a public health perspective. Res Q Exerc Sport 1987; 58(4): 331–3
Wood PD, Stefanick ML. Exercise, fitness and atheriosclerosis. In: Bouchard C, Shephard RJ, Stephens T, et al., editors. Exercise, fitness and health: a consensus of current knowledge. Champaign: Human Kinetics, 1990: 409–24
Hagberg JM. Exercise, fitness and hypertension. In: Bouchard C, Shephard RJ, Stephens T, et al., editors. Exercise, fitness and health: a consensus of current knowledge. Champaign: Human Kinetics, 1990: 455–66
Vranic M, Wasserman D. Exercise, fitness and diabetes. In: Bouchard C, Shephard RJ, Stephens T, et al., editors. Exercise, fitness and health: a consensus of current knowledge. Champaign: Human Kinetics, 1990: 467–90
Davis RB, Boyd DG, McKinney ME, et al. Effects of exercise and exercise conditioning on blood platelet function. Med Sci Sports Exerc 1990; 22: 49–53
Smith EL, Raab DM, Zook SK, et al. Bone changes with aging and exercise. In: Harris R, Harris S, editors. Physical activity and sports. Albany, NY: Center for the Study of Aging, 1989: 287–94
Biddle SJH, Mutrie N. Psychology of physical activity and exercise. London: Springer-Verlag, 1991
Stephens T, Casperson CJ. The demography of physical activity. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity, fitness and health: international proceedings and consensus statement. Champaign: Human Kinetics, 1994: 204–13
Thirlaway K, Benton D. Physical activity in primary- and secondary-school children in West Glamorgan. Health Educ J 1993; 52(1): 37–41
Epstein LH, Wing RR, Koeske R, et al. A comparison of lifestyle change and programmed aerobic exercise on weight and fitness changes in obese children. Behav Ther 1982; 13: 651–65
Epstein LH, Smith JA, Vara LS, et al. Behavioral economic analysis of activity choice in obese children. Health Psychol 1991; 10(5): 311–6
DeBusk RF, Stenestrand U, Sheehan M, et al. Training effects of long versus short bouts of exercise in healthy subjects. Am J Cardiol 1990; 65: 1010–3
American Academy of Pediatrics. Physical fitness and schools. Pediatrics 1987; 80: 449–50
Pate RR, Blair SN. Exercise and the prevention of atherosclerosis. In: Strong WB, editor. Atherosclerosis: its pediatric aspects. New York: Grune and Stratton, 1978: 251–86
Simons-Morton B, O’Hara NM, Simons-Morton D, et al. Children and fitness: a public and health perspective, reaction to the reactions. Res Q Exerc Sport 1988; 59(2): 177–9
American College of Sports Medicine. Physical fitness in children and youth. Med Sci Sports Exerc. 1988; 20(4): 422–3
Cale L, Harris J. Exercise recommendations for children and young people. Phys Educ Rev 1993; 16(2): 89–98
Cureton KJ. Physical fitness and activity standards for youth. In: Pate RR, Hohn RC, editors. Health and fitness through physical education. Champaign: Human Kinetics, 1994: 129–36
Massicote DR, Macnab RBJ. Cardiorespiratory adaptations to training at specific intensities in children. Med Sci Sports Exerc 1974; 6(4): 242–6
Simons-Morton BG, O’Hara NM, Simons-Morton DG, et al. Children and fitness: a public health perspective. Res Q Exerc Sport 1987; 58: 295–302
Cale L, Almond L. Children’s activity levels: a review of studies conducted on british children. Phys Educ Rev 1992; 15(2): 111–8
Sallis JF. Epidemiology of physical activity and fitness in children and adolescents. Crit Rev Food Sci Nutr 1993; 33(4/5): 403–8
Karvonen J, Vuorimaa T. Heart rate and exercise intensity during sports activities: practical application. Sports Med 1988; 5: 303–12
Swain DP, Abernathy KS, Smith CA, et al. Target heart rates for the development of cardiorespiratory fitness. Med Sci Sports Exerc 1994; 26(1): 112–6
Griffiths M, Payne PR. Energy expenditure in small children of obese and non obese parents. Nature 1976; 260: 698–700
Saris WHM, Binkhorst RA, Cramwinckel AB, et al. The relationship between working performance, daily physical activity, fatness, blood lipids, and nutrition in schoolchildren. In: Berg K, Eriksson BO, editors. Children and exercise. Baltimore: University Park Press, 1980: 166–74
Cunningham DA, Stapleton JJ, MacDonald IC, et al. Daily energy expenditure of young boys as related to maximal aerobic power. Can J Appl Sports Sci 1981; 6(4): 207–11
Gilliam TB, Freedson PS, Geenen DL, et al. Physical activity patterns determined by heart rate monitoring in 6–7 year-old children. Med Sci Sports Exerc 1981; 13(1): 65–7
MacConnie SE, Gilliam TB, Geenen DL, et al. Daily physical activity patterns of prepubertal children involved in a vigorous exercise program. Int J Sports Med 1982; 3: 202–7
Saris WHM, Noordeloos AM, Cramwinckel AB, et al. Aerobic power and daily physical activity in children [dissertation]. The Netherlands: Catholic University of Nijmegen, 1982
Verschuur R, Kemper HCG, Besseling CWM. Habitual physical activity and health in 13- and 14-year old teenagers. In: Ilmarinen J, Valimaki I, editors. Children and sport. Berlin: Springer-Verlag, 1984: 255–61
Verschuur R, Kemper HCG. Habitual physical activity in Dutch teenagers measured by heart rate. In: Binkhorst RA, Kemper HCG, Saris WHM, editors. Children and exercise. Champaign: Human Kinetics, 1985: 194–202
Pels A, Geenen DL. Physical activity pattern assessment of 2nd, 5th and 7th grade children. In: Dotson CO, Humphrey JH, editors. Exercise physiology. New York: AHS Press, 1985
Kucera M. Spontaneous physical activity in preschool children. In: Binkhorst RA, Kemper HCG, Saris WHM, editors. Children and exercise. Champaign: Human Kinetics, 1985: 175–82
Atomi Y, Iwaoka K, Hatta H, et al. Daily physical activity levels in preadolescent boys related to V̇O2max and lactate threshold. Eur J Appl Physiol 1986; 55: 156–61
Spurr GB, Reina JC. Daily pattern of %V̇O2max and heart rates in normal and undernourished school children. Med Sci Sports Exerc 1990; 22(5): 643–52
Armstrong N, Williams J, Balding J, et al. Cardiopulmonary fitness, physical activity patterns, and selected coronary risk factor variables in 11-to 16-year-olds. Pediatr Exerc Sci 1991; 3: 219–28
Armstrong N, Bray S. Physical activity patterns defined by continuous heart rate monitoring. Arch Dis Child 1991; 66: 245–7
Riddoch CJ, Mahoney C, Murphy N, et al. The physical activity patterns of Northern Irish schoolchildren ages 11–16 years. Pediatr Exerc Sci 1991; 3: 300–9
Durant RH, Baranowski T, Davis H, et al. Reliability and variability of heart rate monitoring in 3-, 4-, or 5-yr-old children. Med Sci Sports Exerc 1992; 24(2): 265–71
Al-Hazzaa HM, Sulaiman MA. Maximal oxygen uptake and daily physical activity in 7- to 12-year-old boys. Pediatr Exerc Sci 1993; 5: 357–66
Durant RH, Baranowski T, Davis H, et al. Reliability and variability of indicators of heart-rate monitoring in children. Med Sci Sports Exerc 1993; 25(3): 389–95
Sallis JF, Buono MJ, Roby JJ, et al. Seven-day recall and other physical activity self-reports in children and adolescents. Med Sci Sports Exerc 1993; 25(1): 99–108
Janz KF. Validation of the CS A accelerometer for assessing children’s physical activity. Med Sci Sports Exerc 1994; 26(3): 369–75
Slooten J, Kemper HCG, Post GB, et al. Habitual physical activity in 10- to 12- year old Bolivian boys: the relation between altitude and socioeconomic status. Int J Sports Med 1994; 15Suppl. 2: S106–S111
Bergren G, Christensen EH. Heart rate and body temperature as indices of metabolic rate during work. Arb Physiol 1950; 14: 255
Saris WHM. The assessment and evaluation of daily physical activity in children. Acta Pediatr Scand 1985; 318 (Suppl.): 37–48
Canada Fitness Survey. Canadian youth and physical activity. Ottawa: Canada Fitness Survey, 1981
Ross JG, Gilbert GG. The National Children and Youth Fitness Study: a summary of findings. J Phys Educ Recreation Dance 1985; 56(1): 45–50
Riddoch CJ, Murphy N, Nicholls A, et al. Report of the Northern Ireland Health and Fitness Survey. Belfast: The Queen’s University of Belfast, 1990
Shephard RJ, Jequier J-C, Lavallee H, et al. Habitual physical activity: effects of sex, milieu, season and required activity. J Sports Med 1980; 20: 55–66
Silvennoinen M. Relations between different kinds of physical activity and motive types among Finnish comprehensive and upper secondary school pupils. Scand. J Sports Sci 1984; 6(2): 77–82
Dickenson B. The physical activity patterns of young people — the implications for PE. Bull Phys Educ 1986; 22: 36–9
Fuchs R, Powell KE, Semmer NK, et al. Patterns of physical activity among German adolescents: the Berlin-Bremen study. Prev Med 1988; 17: 746–63
Kemper HCG, Verschuur R, De May L. Longitudinal changes of aerobic fitness in youth ages 12 to 23. Pediatr Exerc Sci 1989; 1: 257–70
Gleeson N, Tancred W, Banks M. Psycho-biological factors influencing habitual activity in male and female adolescents. Phys Educ Rev 1989; 12(2): 110–24
Simons-Morton BG, O’Hara NM, Parcel GS, et al. Children’s frequency of participation in moderate to vigorous physical activities. Res Q Exerc Sport 1990; 61(4): 307–14
Aaron DJ, Kriska AM, Dearwater SR, et al. The epidemiology of leisure physical activity in an adolescent population. Med Sci Sports Exerc 1993; 25(7): 847–53
Suter E, Hawes MR. Relationship of physical activity, body fat, diet and blood lipid profile in youths 10-–15 years. Med Sci Sports Exerc 1993; 25(6): 748–54
Anderson LB, Schelin B. Physical activity and performance in a random sample of adolescents attending school in Denmark. Scand J Med Sci Sports 1994; 4: 13–8
Anderson LB. Changes in physical activity are not reflected in changes in fitness during late adolescence: a 2-year follow-up study. J Sports Med Phys Fitness. In press
Shephard RJ. Fitness of a nation: lessons from the Canada Fitness Survey. Med Sport Sci 1986; 22: 116–31
Arroll B, Beaglehole R. Potential misclassification in studies of physical activity. Med Sci Sports Exerc 1991; 23(10): 1176–8
Sallis JF, Buono MJ, Freedson PS. Bias in estimating caloric expenditure from physical activity in children. Sports Med 1991; 11(4): 203–9
Goodman RA, Baker DB, Powell KE, et al. Estimating the prevalence of leisure-time physical activity. J Sports Med 1988; 28: 360–6
Grimston SK, Willows ND, Hanley DA. Mechanical loading regime and its relationship to bone mineral density in children. Med Sci Sports Exerc 1993; 25(11): 1203–10
Stephens T, Jacobs DRJ, White CC. A descriptive epidemiology of leisure time physical activity. Public Health Rep 1985; 100: 147–58
Sallis JF. A commentary on children and fitness: a public health perspective. Res Q Exerc Sport 1987; 58(4): 326–30
Sallis JF, McKenzie TL, Alcaraz JE. Habitual physical activity and health-related physical fitness in fourth-grade children. Am J Dis Child 1993; 147: 890–6
Sallis JF, Patrick K. Physical activity guidelines for adolescents: consensus statement. Pediatr Exerc Sci 1994; 6: 302–14
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Riddoch, C.J., Boreham, C.A.G. The Health-Related Physical Activity of Children. Sports Med 19, 86–102 (1995). https://doi.org/10.2165/00007256-199519020-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00007256-199519020-00002