HALO Director Mark Tremblay delivered an invited keynote presentation titled “Innovation, technology and childhood healthy active living: moving forward by looking back” at the 2017 German Association of Sports Science Conference: Innovation & Technology in Sport (Munich, Germany). The abstract of his presentation is below.
Innovation, Technology and Childhood Healthy Active Living: Moving Forward by Looking Back
Professor Mark Tremblay, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
There is compelling evidence of global temporal increases in childhood obesity and sedentary behaviour concurrent with decreases in physical activity, physical fitness and nocturnal sleep. Such trends have been labelled public health crises and forecast significant future health and economic challenges. Less discussed are the potential implications of these trends for childhood play, recreational pursuits and sport. With compelling statistics from the World Health Organization and other international agencies, there is general agreement that the lifestyle behaviours of contemporary society are conducive to accelerated non-communicable disease development.
Juxtaposed with these trends is a global infatuation with technology, a central theme of this conference, and most conferences around the world, regardless of discipline. The juxtaposition includes the almost universal movement-reducing nature of technology, the ubiquitous, unregulated marketing of unhealthy food opportunities available, the interruption of sleep by small screen devices and the artificial reliance on technology to queue and monitor biological processes previously intuitive or organically prompted. While the opportunities afforded by technology are incomprehensible, they are also not without adverse consequences. In the context of this presentation, the omnipresence of limitless entertainment opportunities through sedentary screen-based technologies could be considered an unintended consequence of technological advancement. While technology is here, advancing, and progressively dominating our lives, skeptical reflection can be useful, provocative and even paradigm-adjusting.
Primum non nocere (“First do no harm”) is a principal precept of bioethics, though quite often ignored in the quest for “progress”. In the context of first do no harm, a technological advancement in the area of healthy active living should be shown to be better and be associated with no more adverse risks that the progenitor (often authentic healthy living behaviours) that is being replaced. Examples of associational and circumstantial evidence suggest a back to the basics approach, counter to an embrace the latest technology approach, may have more ecological validity, sustainability, scalability, durability and efficacy.
Better quality and quantity of physical education delivery and more community sport programs are standard solutions offered to deal with low levels of childhood physical activity. Our research on Old Order Amish and Old Order Mennonite children living in Canada has shown that despite having no school-based physical education classes, no structured sport opportunities in their communities, and certainly no access to even basic technology, these children are fit and active. Is their naturally active lifestyle as effective as contemporary structured approaches? Is our fixation on organizational and structural approaches misguided? Could it even be harmful?
Active Healthy Kids Canada performed a systematic review of evidence examining the relationships between active video games (AVG) and a variety of health and behavioral indicators. Collectively the results show that AVG use was not associated with an increase in habitual physical activity behaviour, suggesting that indeed AVG use displaced more authentic activities, an outcome most would consider adverse if not harmful. The AVG evidence also shows that adherence drops off rapidly, suggesting little likelihood of sustained impact on lifestyle behaviours. The same was the fate of Pokemon Go.
The wearable technology industry in the area of health active living is exploding. The assumption is that with such devices behaviours can and will be changed in a positive direction. However, some of the strongest research evidence (e.g., RCT) is not only underwhelming, but even hints again at harm. The IDEA Randomized Clinical Trial showed that “the addition of a wearable technology device to a standard behavioral intervention resulted in less weight loss over 24 months”.
The Active Healthy Kids Global Alliance (www.activehealthykids.org) has orchestrated detailed comparisons of physical activity related behaviours and their respective sources of support from countries around the world through the development of a “Global Matrix” that compares grades assigned across a variety of indicators and across countries using a rigorous harmonized process. The results of both the Global Matrix 1.0 (released in Toronto, 2014) and Global Matrix 2.0 (released in Bangkok, 2016) showed the paradoxical finding that countries that had high grades for physical activity behaviours general had low grades for indicators of supports for those behaviours (e.g., through schools, communities, government investments), and the reverse was also observed. Collectively the findings suggest that habitual physical activity is achieved through a combination of routine lifestyle-embedded activities throughout the day – that healthy active living is a way of life, not an item to check off your list of things to do.
The new paradigm-shifting Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep embrace these findings and recognize that the whole day matters for healthy active living. In many respects, a back to the basics approach, listening to your body, engaging with nature, and living actively is the approach that seems to work in many settings around the world. If our goal is to improve the healthy active living behaviours of our children and youth, a careful mix of nature and biology should be added to the technology shopping cart.
Selected Related References
- Barnes J, Tremblay MS. Changes in indicators of child and youth physical activity in Canada, 2005-2016. Canadian Journal of Public Health 107(6):e586-e589, 2016.
- Bassett et al. Physical activity and body mass index of children in an Old-Order Mennonite community. Medicine and Science in Sports and Exercise 39:410-415, 2007.
- Broyles et al. The epidemiological transition and the global childhood obesity epidemic. International Journal of Obesity 5:S3-S8, 2015.
- Chaput et al. Active Healthy Kids Canada’s Position on Active Video Games for Children and Youth. Paediatrics & Child Health 18(10):529-532, 2013.
- Craig et al. Trends in aerobic fitness among Canadian children and adults 1981 to 2007-2009: what can we conclude? Applied Physiology, Nutrition, and Metabolism 37:511-519, 2012.
- Esliger et al. Physical activity profile of Old Order Amish, Mennonite, and contemporary children. Medicine and Science in Sports and Exercise 42:296-303, 2010.
- Jakicic et al. Effect of wearable technology combined with a lifestyle intervention on long-term weight loss: The IDEA Randomized Clinical Trial. JAMA 316:1161-1171, 2016.
- Muthuri et al. Evidence of an overweight/obesity transition among school-aged children and youth in Sub-Saharan Africa: a systematic review. PLoS ONE 9(3):e92846, 2014.
- Muthuri et al. Temporal trends and correlates of physical activity, sedentary behaviour, and physical fitness among school-aged children in Sub-Saharan Africa: A systematic review. International Journal of Environmental Research and Public Health 11:3327-3359, 2014.
- Onywera et al. Emerging evidence of the physical activity transition in Kenya. Journal of Physical Activity and Health 9:554-562, 2012.
- Saunders et al. Sedentary behaviour as an emerging risk factor for cardiometabolic diseases in children and youth. Canadian Journal of Diabetes 38:53-61, 2014.
- Tremblay et al. Conquering childhood inactivity: Is the answer in the past? Medicine and Science in Sports and Exercise 37:1187-1194, 2005.
- Tremblay et al. Moving forward by looking back: Lessons learned from lost lifestyles. Applied Physiology, Nutrition, and Metabolism 33:836-842, 2008.
- Moving forward by looking back: Physical activity across the ages. Applied Physiology, Nutrition, and Metabolism 33:817-818, 2008.
- Tremblay et al. Physiological and health implications of a sedentary lifestyle. Applied Physiology, Nutrition, and Metabolism 35:725-740, 2010.
- Tremblay et al. Fitness of Canadian children and youth: Results from the 2007-2009 Canadian Health Measures Survey. Health Reports 21(1):7-20, 2010.
- Tremblay et al. Physical activity of children: A global matrix of grades comparing 15 countries related to the physical activity of children. Journal of Physical Activity and Health 11(suppl.1):S113-S125, 2014.
- Tremblay et al. Position Statement on Active Outdoor Play. International Journal of Environmental Research and Public Health 12:6475-6505, 2015.
- Tremblay et al. Canadian 24-hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. Applied Physiology, Nutrition, and Metabolism 41(6 suppl.3):S311-S327, 2016.
- Tremblay et al. Global Matrix 2.0: Report Card Grades on the Physical Activity of Children and Youth Comparing 38 Countries. Journal of Physical Activity and Health 13(Suppl 2):S343-S366, 2016.