A broad range of researchers and professionals acknowledge that optimal health during childhood and adolescence requires a high level of physical activity. The health benefits of physical activity during the first two decades of life are many and diverse. As summarized in the 2008 Physical Activity Guidelines for Americans (26), physical activity at recommended levels improves physiological risk factors for cardiometabolic disease, enhances bone health, improves cardiovascular fitness and muscular strength, reduces symptoms of anxiety and depression, and improves body composition (28). In addition, positive experiences with physical activity during childhood and adolescence increase the probability that young people will adopt a physically active lifestyle that continues into adulthood (24). So there are many good reasons for children and adolescents to be highly physically active.
Unfortunately, many American youths are not very physically active. Today's young people, as a group, are less active than their counterparts from earlier generations, and recent evidence shows that large percentages of young people do not meet current physical activity guidelines. The 2008 Physical Activity Guidelines for Americans (26) call for young people to engage in 60 minutes (1 hour) or more of physical activity daily (26). This should include 1) moderate or vigorous aerobic physical activity daily (with vigorous-intensity physical activity at least 3 days per week), 2) muscle-strengthening physical activity at least 3 days per week, and 3) bone-strengthening physical activity at least 3 days per week (26). As shown in the accompanying Figure, the most recent National Health and Nutrition Examination Survey (NHANES), which used an objective measure of physical activity, found that only the youngest children, aged 6 to 11 years, were likely to meet the guidelines. Most older youths, aged 12 to 19 years, did not meet the physical activity guidelines (25).
;)
FigureFigure: Prevalence of achieving 60 minutes of moderate to vigorous physical activity per day (NHANES) (
23).
Why do most American children fail to meet physical activity guidelines? During the past 15 years, many studies have attempted to answer this question. Although there is still much to learn about the factors that influence physical activity behavior in young people, the research has identified both factors that promote and factors that limit physical activity. The primary purpose of this article is to summarize the current knowledge of the factors that constitute barriers to physical activity in children and adolescents. In addition, we will provide recommendations for parents, school personnel, and fitness professionals who seek to help young people become more physically active.
BARRIERS TO UTILITARIAN PHYSICAL ACTIVITY
"Utilitarian physical activity" is the activity children and adults accrue while participating in activities of daily life. For children and youths, it includes active transport (e.g., walking or biking to school) and activity accrued while performing household chores or working at a part-time job. To date, most of the literature on barriers to utilitarian physical activity focuses on active transport. Several demographic factors are associated with active transport. Girls, younger children, children with higher socioeconomic status, and children in households with increased car ownership are less likely to walk or bicycle to and from school (7,21). Other barriers to active transport can be classified into four categories: intrapersonal, interpersonal, institutional (school related), and environmental. Studies that used both qualitative (e.g., focus groups with children and parents) and quantitative methods have investigated barriers to active transport, and the findings of the two types of studies sometimes differ.
Intrapersonal Barriers to Active Transport
Qualitative studies (2) have identified parent and child concerns for safety (e.g., fear of abductions, child walking alone) as barriers to active transport, but quantitative studies have not identified these concerns as barriers (7,11,18,21). Other intrapersonal barriers include lack of planning (for the additional time required to walk or bike to school), lack of motivation (for getting up earlier), and child scheduling and time constraints (e.g., after-school plans).
Interpersonal Barriers to Active Transport
A child's relationships and social environment can serve as a facilitator of or barrier to active transport. Barriers related to the social environment include nonsupportive social norms (e.g., the child doesn't see other children walking or bicycling to school), low peer and parent support for walking or bicycling, parent schedule and time constraints related to work, the convenience for parents of driving or having children ride the school bus, and greater support for sedentary transport (2,7,11,14,18). Although concern about harassment from bullies and strangers is cited in qualitative studies, it has not been identified as a barrier to active commuting in quantitative studies (2,11,21).
Institutional Factors
Schools can facilitate or create barriers to active transport. School barriers can include school policies related to equipment and storage (e.g., lack of accessible and secure storage for bicycles and scooters), the logistics of coordinating passive (car or bus) and active transport, early school start times, lack of crossing guards, and homework policies that result in children carrying many books home (2,6).
Physical Environment
Greater travel distance is clearly a barrier for active commuting to school (2,6,7,18,21). Other barriers include the road infrastructure (lack of sidewalks, bike lanes, and lighting and dangerous crossings) and hilly terrain (6,7,11,18,21). Qualitative studies have identified heavy traffic, traffic dangers (especially for younger children), crime danger, and weather as barriers to active transport, but these barriers have not been identified in quantitative studies (7,11,18,21).
BARRIERS TO STRUCTURED AND FREE-TIME PHYSICAL ACTIVITY
"Structured physical activity" is organized activity that usually is planned and occurs within a specific setting. For children and adolescents, this includes playing on a sports team and taking an activity class (e.g., dance, tennis, karate, aerobics). "Free-time physical activity" is the activity that is performed outside of a structured setting or performed as a leisure activity. Examples include shooting hoops, playing an active game with friends, and social dancing. Barriers to structured and free-time physical activity also can be classified into four categories: intrapersonal, interpersonal, institutional, and environmental. Specific barriers have been studied using both qualitative (focus groups) and quantitative (questionnaires) methods.
Intrapersonal Barriers
Barriers to structured and free-time physical activity sometimes differ between boys and girls. In several studies, girls have reported higher total barrier scores than boys (4). Girls are more likely to report barriers such as embarrassment (1,9,12), sweating (12), fear of injury (12,13), and weight criticism by peers and family members compared with boys (10). Girls also report an identity conflict (e.g., feminine and attractive vs. sweaty and muscular) (9). In one study, girls stated that some opportunities were not available to them (9). Both girls and their mothers mentioned concern about physical activity and the girls' menstrual cycles. Boys mentioned that keeping up with games and television was a barrier to physical activity (14).
Other demographic factors (e.g., age, socioeconomic status, race/ethnicity, weight status) are associated with barriers to structured and free-time physical activity. For example, older adolescents listed homework and lack of time because of part-time work as a barrier more often than younger adolescents. Youths from lower socioeconomic families reported higher barriers of cost, distance to facilities, safety, and condition of available facilities. Expense was the primary barrier reported by parents and was reported more frequently by Hispanics and African Americans (6). In addition, parents were concerned about crime, with minority parents about half as likely to report that their neighborhoods were safe compared with white parents (27). Language was a barrier for some parents, as it prevented them from knowing the programs that were available for their children (20). Overweight 11- to 19-year-olds perceived more barriers to physical activity than did lower weight youths (8).
Characteristics within the individual may prevent children and adolescents from participating in structured and free-time physical activity. The most common barriers include lack of interest (3,8,12,13,23), lack of time (12,14,23), lack of skill (13), lack of motivation (1,13,14), and the expense of activities (13). Other barriers include having other commitments or preferring to do other activities (9,12,13), being tired (13), being out of breath (12), having medical conditions (1,9,13), and lack of equipment (1).
Interpersonal Barriers
Barriers associated with the social environment include not having anyone with whom to do activities (9,13), having friends who are not active (1,9,13), and family obligations (15). Physical activity can be a low priority compared with social needs (e.g., talking on the phone with friends, spending time with boyfriend/girlfriend) (3,9). Negative experiences while being active with peers and being intimidated by the social environment also are barriers (13). Lack of peer (14) or parental support, parental restrictions (3,9,13), coaching problems (e.g., coach is a poor teacher, places an emphasis on winning, plays favorites) (13,23), and aggressive players (12) also discourage children and adolescents from participating in structured and free-time physical activity.
Institutional Barriers
Students have reported several school-related barriers. These include teachers discouraging sports participation (9) and heavy school workloads (9,13). Other barriers include emphasis on competition (9), unavailability of school facilities (including limited or inconvenient hours of operation) (13), job responsibilities/other competing interests (9,13), and activities that are not of interest to children and youths (1).
Environmental Barriers
The environment influences children's and adolescents' structured and free-time physical activity, both positively and negatively. Community barriers include lack of transportation (6,9,13), the expense of activities (9), and inaccessibility/lack of local opportunities (6,13). With regard to the physical environment, concerns about safety were found in many studies (6,9,13,14,20). In addition, poor weather was listed as a barrier to structured and free-time physical activity (1,9).
BARRIERS TO SCHOOL-BASED PHYSICAL ACTIVITY
Because children and adolescents spend a large portion of their time in the school setting, schools are in an optimal position to provide opportunities for students to be physically active. Traditionally, school-based physical activity includes physical education and recess. School-based physical activity also can include lessons in which students engage in active learning in the classroom. However, schools also can create barriers to school-based physical activity, including intrapersonal and interpersonal barriers and institutional and policy barriers.
Intrapersonal and Interpersonal Barriers
Students reported negative perceptions of physical education, including the lack of choice of activities, lack of support from their physical education teacher during class, and concerns about their inability to demonstrate skills in front of peers (22). Girls reported that boys are disruptive and dominate and discourage girls in physical education (3).
Institutional Barriers
Several institutional factors may limit school-based physical activity, and these affect both students and physical education teachers. For instance, students reported many barriers to being physically active in physical education, including lack of interest in activities (3,22), uniforms (3,22), negative experiences in physical education (3), competitive sports (3), and not having adequate time for changing and showering (22). Physical education department heads reported several institutional barriers, including physical education is not a school or student priority; physical education class sizes are not appropriate; lack of funding, equipment, indoor facilities, and district support; and insufficient physical education staff development (29).
Policy Barriers
The availability of physical education as established by policy can facilitate school-based physical activity, or the lack of such policies can create barriers to school-based physical activity. High school girls report the lack of opportunity for physical education (9). From the School Health Policies and Programs Study 2006 (17), a majority of the nation's schools (78.3%) require students to participate in physical education. However, schools vary greatly in the amount of physical education students receive. For example, few schools provided daily physical education (e.g., 3.8% of elementary, 7.9% of middle schools, and 2.1% of high schools) for all students for the entire school year (17).
The lack of policies for recess at the state and district levels also limits school-based physical activity. Although 57% of school districts required elementary school students to receive regular recess, only 12% of states had that requirement (17). Thirty-three percent of school districts and 26% of states recommended regular recess for elementary school students (17). Even if states or school districts have policies for regular recess, there is the possibility of withholding recess as punishment for bad behavior. Few states (8%) and districts (20%) prohibit withholding recess as punishment, although a larger portion (49% of states and 24% of districts) actively discourages the practice (17). At the school level, 82% of schools permitted teachers to withhold recess as punishment, whereas only 17% of schools discouraged the practice (17).
The School Health Policies and Programs Study 2006 also assessed whether schools offer the use of school facilities for physical activity outside of regular school hours (17). Sixty percent of schools allowed youths to use their physical activity facilities in the evenings, 58% of schools made facilities available after school, and 52% of schools permitted the use of their facilities on the weekends (17).
OVERCOMING BARRIERS TO PHYSICAL ACTIVITY
Knowledge of the barriers that tend to reduce physical activity levels of children and youth is useful only if we can devise strategies for overcoming those barriers. In this section, we suggest specific actions that school personnel, fitness professionals, community-based organizations, and parents can take to promote physical activity in young people by eliminating, lowering, or navigating around the barriers to physical activity.
OVERCOMING BARRIERS TO UTILITARIAN PHYSICAL ACTIVITY
Schools and communities often present barriers to children's physical activity by exposing them to physical and social environments that discourage or prevent physical activity.
Specific strategies include
- New schools should be sited in settings that are conducive to children walking or riding bikes to school.
- For schools that are already located in settings that are poorly designed or unsafe for active transport, school personnel should implement programs to promote active transport within the limitations of the setting (16,19). Examples include providing crossing guards to increase safety and developing walking school bus programs with adult supervision.
- For schools that are situated in safe and accessible settings, school personnel should work with parents and community leaders to reestablish walking to school as the social norm (16,19). This could be accomplished by developing and promoting walking school bus programs, hiring crossing guards, and providing equipment on school grounds to store bicycles.
- Community planning commissions and transportation authorities should implement policies that ensure that travel routes and neighborhoods are safe and conducive to physical activity (16,19). These include policies for the provision of sidewalks, crosswalks, and slower traffic patterns.
OVERCOMING BARRIERS TO STRUCTURED AND FREE-TIME PHYSICAL ACTIVITY
A broad range of community leaders, including those associated with both government and nongovernment organizations, should implement policies that overcome community-based barriers to children's structured and free-time physical activity. Specific strategies include:
- Community-level entities should create comprehensive integrated plans for ensuring that all children and youths residing in the community will have multiple opportunities to participate in safe, healthy, and enjoyable physical activities across the calendar year (16). This could be facilitated by forming coalitions and developing programs to promote physical activity.
- Youth service agencies and organizations should consistently provide physical activity programs that meet the needs and interests of all children and youths, regardless of their sex or ethnic and cultural backgrounds (16). Strategies could include making facilities more accessible for children and youths in terms of scheduling, transportation, and affordability (i.e., reduced fees).
- Local governments should ensure that recreation commissions and other publicly supported service agencies provide comprehensive youth physical activity programs (16). Examples include individual and team sports programs, activity lessons, and exercise classes that are appropriate for and of interest to children and youths of all ages and athletic abilities.
Children spend more time at or near their homes than any other location, and parents clearly exert a dominant influence on the home environment and on children's adoption of health behaviors, including physical activity. Although school and community organizations can and should make major contributions to lowering barriers to children's physical activity, overall success requires that parents address the barriers to structured and free-time physical activity that apply in the home setting. Specific strategies should include:
- Parents should control their children's access to sedentary forms of entertainment such as television watching, video game play, and Internet use. Cumulative participation should be limited to no more than 2 hours per day (5).
- Parents should ensure that their children spend as much time playing outdoors as possible, assuming that the setting is safe.
- The home environment should include equipment for physically active play (e.g., balls, bikes).
- Parents should provide children with multiple opportunities for physically active play through sports, lessons, recreation programs, and visits to parks (16). Examples include providing transportation and monetary support, as well as attending games, competitions, and/or performances.
- Parents should be physically active with their children as frequently as possible (16).
OVERCOMING BARRIERS TO SCHOOL-BASED PHYSICAL ACTIVITY
Schools can be very sedentary settings for children, but they don't have to be. School administrators, teachers, and parent-teacher organizations can promote physical activity in youths during the school day by lowering unnecessary barriers to physical activity. Specific strategies should include:
- School principals and teachers should ensure that students have adequate time for physical activity during the school day. This can be accomplished by establishing and enforcing policies regarding students' exposure to the national standards for physical education (i.e., 150 minutes per week for kindergarten through 8th grade and 225 minutes per week for 9th through 12th grades) and the provision of certified and qualified physical education instructors (19).
- School principals and teachers should ensure that students have numerous opportunities to obtain at least 30 minutes of moderate to vigorous physical activity during the school day, including recess, physically active classroom experiences, and extracurricular physical activity programs (16,19).
CONCLUSIONS
In conclusion, modern society presents multiple barriers that have the effect of reducing physical activity levels in children and youths. Some of these barriers are physical in nature and tend to prevent children from performing utilitarian forms of physical activity such as walking to school. Other barriers are institutional, for example, school policies may prevent children from being physically active during the school day. Still, other barriers operate in the social environment and act to draw children away from physical activity and into sedentary pursuits. Electronic entertainment is a prime example of a social barrier to physical activity. School personnel, community officials, and parents have a shared responsibility to help children in overcoming these barriers. The emerging scientific literature on promotion of physical activity in children provides a number of promising strategies for addressing the barriers that are collectively robbing young people of the physical activity they need to develop optimal health and fitness.
CONDENSED VERSION AND BOTTOM LINE
Modern society presents many barriers that tend to reduce the physical activity levels of our children and youth. These barriers are evident in our schools, communities, and homes. They include a wide range of physical and social environmental factors. These barriers can be overcome by implementation of policies and practices that impact the settings in which young persons spend most of their time.
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