Combining measurement tools to understand the context of children’s indoor and outdoor leisure-time physical activity
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This aim of this thesis evolved following a review of the literature investigating the factors which influence children’s participation in outdoor play. The review was conducted in light of theory recommending that when seeking to promote physical activity, considering context-specific behaviours and behaviour-specific determinants can enhance the effectiveness of interventions. An initial focus on outdoor play was warranted given the capacity for promotion of physical activity during leisure-time, concerns that children’s independent time outdoors is becoming increasingly restricted, and limited research focus on this domain of physical activity. The synthesised quantitative and qualitative evidence indicated that independent mobility, parental perceptions of safety and the availability of other children to play with were important factors related to outdoor play. However, the review also demonstrated that current understanding of how, where and with whom children spend their leisure-time is limited, and that traditional notions of children’s outdoor time may need to be re-evaluated. These deficiencies were in part due to the complexity of defining and measuring children’s outdoor play. The contributions of different indoor and outdoor leisure-time contexts towards total daily moderate to vigorous physical activity (MVPA) was identified as a particular knowledge gap. The aim of this thesis was therefore to develop greater understanding of the indoor and outdoor contexts of children’s leisure-time physical activity. A novel approach to context-specific physical activity research was devised. This method incorporated use of accelerometry to record physical activity intensity with high resolution, Global Positions System (GPS) receivers to automatically record indoor or outdoor location, and diary data to provide complementary contextual detail. Rather than utilise a domain label such as outdoor play, this method sought to combine measurement tools to not only objectively record physical activity intensity, but also build a picture of the context of this activity using combinations of contextual attributes. Children at the transition between primary and secondary school were the focus of the research due to the changes in independence which occur at approximately this age (10-13 years). The research consisted of three studies presented across three chapters. Chapter Five used data collected between 2006 and 2008 from children aged 10–11 years from Bristol involved in the Personal and Environmental Associations with Children's Health (PEACH) project. Given the association of outdoor play with independent mobility and the availability of other children, the chapter quantified who children spent their time with when indoors or outdoors after school, and measured associations with MVPA. Using a newer GPS receiver, Chapter Six aimed to assess the feasibility of using GPS data to differentiate indoor and outdoor location, and establish a cut-point for use in free-living individuals. Chapter Seven then used this GPS method in combination with accelerometry and diary data provided by children aged 11-13 years from Edinburgh. Owing to concerns that children’s unstructured outdoor time is restricted by parents in favour of adult organised sport and clubs, the chapter aimed to record the profile of children’s physical activity. This was achieved by recording whether indoor and outdoor leisure-time physical activity was structured or unstructured, and exploring relationships between periods spent in these contexts and total daily MVPA. Chapter Six demonstrated that using the signal-to-noise ratio from GPS data is an accurate tool for differentiating indoor and outdoor location, with 96.8% of all ten-second epochs correctly classified. Together the findings of Chapters Five and Seven suggest that children obtain their physical activity in multiple contexts and that no single context appears to fulfil the recommendation of 60 minutes of MVPA per day. Chapter Five showed that children spent most of the after school period with parents or alone, especially when indoors. However when participants were outdoors with other children, multivariate regression analyses indicated that these periods were most strongly associated with MVPA. Complementing these findings, Chapter Seven revealed that in a relatively active and affluent sample, participants accumulated most of their MVPA in school-time or unstructured leisure-time contexts (both indoors and outdoors). The results revealed that these active children spent more than one hour in unstructured outdoor leisure-time contexts each day. However, associations with MVPA were weaker than expected, and whilst being outdoors was favourable compared to being indoors, it was apparent that there is scope to maximise MVPA further when children are outdoors. The median contributions of structured leisure-time contexts to daily MVPA were minimal regardless of indoor or outdoor location. Deconstructing leisure-time according to contextual attributes recorded by a combination of measurement tools proved to be an informative approach for understanding variation in children’s MVPA. Taken together the findings of the thesis indicate potential for leisure-time to contribute greater volumes of MVPA. The results emphasise the importance of children being outdoors, the value of unstructured forms of physical activity and the necessity for children to spend time with their peers. It is clear from these studies that indoor time is also a vital source of MVPA. The work presented in this thesis makes a valuable contribution to our understanding of how children spend their leisure-time and how this relates to physical activity. Further research is required to explore the many other contextual attributes of children’s leisure-time, so that indoor and outdoor environments can be manipulated as part of multi-component interventions that promote physical activity as effectively as possible.