“Turn OFF, switch to play” background paper Kids-‘Go for your life’ proposes that all children aged 0-12 years need to “Turn OFF, switch to play” and therefore engage less in sedentary behaviour. Children need to be more physically active and occupied in more active play. Limit sedentary behaviour Sedentary behaviour, or inactivity, can be described as time spent in tasks requiring minimal energy expenditure. Many different types of sedentary behaviour exist. For example in older children, sedentary behaviour can be productive (e.g. homework, sensible sleeping hours) and non-productive (e.g. electronic games and long unnecessary sleep-ins) 1. Electronic media are the most scrutinised forms of sedentary behaviour and can include, but are not limited to, television, DVDs, console games, computers and hand-held electronic games. These sedentary activities can be associated with a number of different problems including: - unhealthy food intake and prompts to eat beyond satiety2 - inactivity taking priority over times to be active3,4 - insufficient energy expenditure3 - displaced time for creative play4, 5 - social isolation6 - compromised time in outdoor activity7 - decreased opportunities for development of emotional intelligence4 ( e.g. empathy, flexibility, decision making, self-awareness and self-regulation.) - compromised musculoskeletal posture8 Less screen time, more PLAY Frequently guidelines quantify the amount of physical activity that children should undertake and outline the limitations for sedentary behaviour.9,10 Australia’s recommendations for physical activity in children aged 5-12 years are: - Children need at least 60 minutes (and up to several hours) of moderate to vigorous physical activity every day9 - Children should not spend more than two hours each day using electronic media for entertainment (e.g. computer games, television, internet), particularly during daylight hours9 Currently no Australian guidelines exist for physical activity for children under the age of five years. However, North American guidelines from the National Association of Sport and Physical Education (NASPE) are gaining international prominence. The guidelines10, shown in Table 1, provide recommendations for toddlers’ and pre-schoolers’ everyday physical activity. Table 1: NASPE guidelines for physical activity for toddlers and pre-schoolers Structured Physical Activity Unstructured Physical Activity (daily) (daily) Toddlers At least 30 minutes 60 minutes up to several hours Pre-schoolers At least 60 minutes N.B: Structured activity is usually organised, it may have rules and outcomes. (E.g. play groups or swim lessons). Unstructured activity is less restricted and can include playing alone or with friends, going for a walk or playing at a park. In support of the NASPE guidelines, the American Academy of Pediatrics11 recommends no more than 1-2 hours of quality TV and videos per day for children older than two years and no screen time for children under the age of two years10. Choose sedentary time wisely Although controversial, homework can be part of sedentary behavior that parents and teachers may see as vital to children’s education. Recommendations exist for the amount of homework children can be expected to complete each night. For children in years Prep to Grade 4, time spent doing homework should not exceed 30 minutes per evening and should not be done on weekends, or during the holidays. For children in the middle years of schooling the time spent engaging in homework will generally range from 30 to 45 minutes per evening at year 5 to 45 to 90 minutes per evening in Year 912. A good balance of sedentary behaviour and activity is important Television viewing is the most frequently researched form of sedentary behaviour. Parents report the setting of limits to television viewing time can be a successful family-based strategy for reducing sedentary time13 but the concept of restricting television viewing is now more readily extended to all screen time14. A useful indicator of a child’s risk of poor diet and low physical activity level can be linked to responses of questions regarding hours of television viewing15. The “Turn OFF, switch to play” message has emerged from studies recommending decreased sedentary behaviour through limiting access to electronic devices during leisure time. While several projects have targeted limits to sedentary behaviour in the school setting13, parents are the recognised agents for change. Long-term interventions into weight management can be successful when parents are targeted exclusively rather than parents and children in a session together16 or children alone17. Empowering parents of overweight young people about setting limits to sedentary time through a health-centered program rather than a program focused solely on weight reduction may be beneficial for promoting the family’s healthy lifestyle. It is important for parents to be good role models by leading an active lifestyle. Parents and carers should share the responsibility of encouraging children to be physically active and engage in active play everyday. It should be noted that as children get older, the role of a parent or carer changes from being frequently active with very young children to supporting older children’s involvement with outside activity such as ensuring children get to swimming lessons or responsible support on the sidelines of a team sport. Play is a risk worth taking Given that decreasing sedentary time can be as successful as increasing physical activity for long- term weight management benefits in children3, parents need to consider offering alternative physical activity opportunities in place of non-productive inactive times. Safety concerns about injury from physical activity may persuade parents to permit excessive sedentary behaviour. Some parents may benefit from “risk reframing”. This involves an understanding that greater health risks are in fact associated with sedentary behaviour rather than being active. Young children’s perceptions of injury risk may be greater in girls than boys by six years of age, even though boys are routinely more injured than girls18.Greater encouragement for children to undertake physical activity in positive, successful environments may be necessary before parents can successfully limit sedentary time. Choose active transport as the choice of travel Opportunities for active transport such as walking or riding a bike to school may not be an option for a number of complex reasons (e.g. parents perception of importance of physical activity and also distance from home to school) 19. In some studies active transport may be another strategy to minimise sedentary behaviour in children20, but if transport to school cannot be an option, families should seek other opportunities for active transport. In pre-school children, guidelines warn about the consequences of the “strollerization” of young children in preference to active transport to and from everyday venues10. It is important to make active transport an everyday activity by walking or riding a bike. Encourage young children to walk a little further each day before using the stroller In summary, to prevent long periods of unnecessary sedentary time, healthy alternatives need to become the preferred choice of children. Parents need to be the agents for the “Turn OFF, switch to play” message, but their role can be facilitated by carers or agencies such as schools and preschools who can implement policies to optimise physical activity opportunities every day.  Feldman DE, Barnett T, Shrier I, Rossignol M, Abenhaim L. Is physical activity differentially associated with different types of sedentary pursuits? Archives of Pediatrics & Adolescent Medicine. 2003;157(8):797-802.  Temple JL, Giacomelli AM, Kent KM, Roemmich JN, Epstein LH. Television watching increases motivated responding for food and energy intake in children. American Journal of Clinical Nutrition. 2007;85(2):355-61.  Epstein LH, Paluch RA, Gordy CC, Dorn J. Decreasing sedentary behaviors in treating pediatric obesity. Archives of Pediatrics & Adolescent Medicine. 2000;154(3):220-6.  Burdette HL, Whitaker RC. Resurrecting free play in young children: looking beyond fitness and fatness to attention, affiliation, and affect. Archives of Pediatrics & Adolescent Medicine. 2005;159(1):46-50.  Vandewater EA, Bickham DS, Lee JH. Time well spent? Relating television use to children's free-time activities. Pediatrics. 2006;117(2):e181-91.  Strauss RS, Pollack HA. Social marginalization of overweight children. Archives of Pediatrics & Adolescent Medicine. 2003;157(8):746-52.  Klesges RC, Eck LH, Hanson CL, Haddock CK, Klesges LM. Effects of obesity, social interactions, and physical environment on physical activity in preschoolers. Health Psychology. 1990;9(4):435-49.  Kratěnová J, Žejglicová K, Malý M, Filipová V. Prevalence and Risk Factors of Poor Posture in School Children in the Czech Republic The Journal of School Health. 2007;77(3):131-7(7).  Australian Government, Department of Health and Ageing, Australia's Physical Activity Recommendations for 5-12 year olds, Commonwealth of Australia, 2004.  National Association for Sport and Physical Education (NASPE). Active Start: A Statement of Physical Activity Guidelines for Children Birth to Five Years. 2002: http://www.aahperd.org/naspe/template.cfm?template=ns_active.html  American Academy of Pediatrics. Internet and media use. (2005) http://www.aap.org/healthtopics/mediause.cfm  Department of Education, Victorian Government. Homework guidelines. 2002. http://www.education.vic.gov.au/referenceguide/curric/3_23.htm  Gortmaker SL, Peterson K, Wiecha J, Sobol AM, Dixit S, Fox MK, et al. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Archives of Pediatrics & Adolescent Medicine. 1999;153(4):409-18.  UniSA. Children and Sport: Full report. Australian Sports Commision. Australian Government. 2004.  Salmon J, Campbell KJ, Crawford DA. Television viewing habits associated with obesity risk factors: a survey of Melbourne schoolchildren. Medical Journal of Australia. 2006;184(2):64-7.  Golan M, Kaufman V, Shahar DR. Childhood obesity treatment: targeting parents exclusively v. parents and children. British Journal of Nutrition. 2006;95(5):1008-15.  Israel A, Stolmaker L, Andrian C. The effects of training parents in general child management skills on a behavioral weight loss program for children. Journal of Behavioural Therapy. 1985;16:169- 80.  Morrongiello BA, Midgett C, Stanton KL. Gender biases in children's appraisals of injury risk and other children's risk-taking behaviors. Journal of Experimental Child Psychology. 2000;77(4):317-36.  Ziviani J, Scott J, Wadley D. Walking to school: incidental physical activity in the daily occupations of Australian children. Occupational Therapy International. 2004;11(1):1-11.  Rosenberg DE, Sallis JF, Conway TL, Cain KL, McKenzie TL. Active transportation to school over 2 years in relation to weight status and physical activity. Obesity. 2006;14(10):1771-6.