Painting lines on the playground - easiest physical activity intervention. EVER.

 
Image by Duchamp.

In most developed nations, kids get far less physical activity than they did just a few generations ago.  Given the strong links between physical inactivity and health risk (and given that we're now seeing "adult" diseases like heart disease and type 2 diabetes in children and teenagers), this has become a very real public health concern.  Unfortunately, when it comes to increasing childhood physical activity levels, people often want to reinvent the wheel.  For example, many people are enthralled with the Nintendo Wii as a means of increasing childhood physical activity - even though it is expensive, and the evidence supporting it is weak at best.  At the same time, evidence continues to accumulate in support of simple, inexpensive interventions for increasing childhood physical activity.  Today I'd like to briefly look at one of the simplest possible ways of increasing childhood physical activity levels - painting lines on a schoolyard playground.

The study

In a 2005 study from Preventive Medicine, Dr Gareth Sutton and Elaine Mullan examined the levels of objectively measured moderate and vigorous physical activity in a group of Welsh school children before and after their playgrounds

"were painted in bright fluorescent colors that varied according to school preference, although castles, dragons, clock faces, mazes, fun trails, dens, hopscotch, letter squares, snakes and ladders, and various animals were consistently popular in early primary schools. Late primary schools included markings for netball, football, and short tennis, and targets for games related skills."

Students attending nearby English schools which did not receive playground markings served as the control group.  Although the intervention and control schools were in different countries, they were separated by just 40 miles and had similar climates, playground dimensions and socio-economic status.  Baseline measurements were taken in June, immediately before the playgrounds at the Welsh schools were painted, while follow-up measurements were performed in September and October of the following school year.

What happened?

Not surprisingly, both moderate and vigorous physical activity levels increased by roughly 40% in the intervention schools, while activity levels slightly decreased in the control schools.  The graph below illustrates  the dramatic increase in the percentage of recess which was spent being moderately or vigorously physically as a result of the intervention.

The increases in activity levels were of a similar magnitude when the authors focused exclusively on vigorous activity, and there were no age or sex related interactions.  Taken together, these results suggest a clear and impressive increase in physical activity levels due to this extremely simple intervention.

Pros and Cons

It goes without saying that this study has some pros and cons.  Physical activity was objectively measured using heart rate monitors (as opposed to being assessed by self-report questionnaire), which is a definite strength.  The study also benefits from having a control group, which unfortunately has not always been the case with studies in this area.  However, the study was of a limited duration (essentially 1 month), and children were restricted to the paved portions of the playground during the study, which may have exaggerated the benefits of the markings (if they had been allowed to play soccer in the grassed portion of the playground, some of the markings may have held less appeal).  And finally, although the intervention and control groups were quite close geographically, they were in different countries.  I've never been to Britain, but this strikes me as being less than ideal.  None of these are huge problems, but things to keep in mind.

What does it all mean?

This study makes a lot of intuitive sense. Simply give kids the tools to be physically active, and many will do so of their own accord.  I really want to emphasize the magnitude of the increase in physical activity levels in the intervention group - they went from being active for just a third of their breaktime to being active for a a full 50% of their breaktime!  That's pretty impressive.  What's even more impressive is how ridiculously cheap an intervention like this could be.  How much could it cost for a school to paint designs on the playground every few years?  Or schools could make side-walk chalk available to their students, so that they could make their own designs!  And of course there is no reason that markings couldn't be extended to sidewalks and drive-ways as well. 

Many factors that influence childhood physical activity levels like socio-economic status and neighbourhood safety are both costly and complicated to address.  While governments work to address these more complex concerns, it's nice to know that simple and inexpensive tactics like giving the playground a coat of fresh paint can also have tangible benefits.   Similar studies have shown that providing children with inexpensive game equipment including jump ropes, balls, and hoops have a similarly impressive impact on moderate and vigorous physical activity levels.  These interventions are cheap, they are easy, and they should be among the first items addressed by any school attempting to increase overall physical activity levels. 

A big hat tip to my friend and colleague Meghann Lloyd for alerting me to Dr Stratton's work in this area. Have a great afternoon and Happy St Patrick's Day!

Travis Saunders

ResearchBlogging.orgSTRATTON, G., & MULLAN, E. (2005). The effect of multicolor playground markings on children's physical activity level during recess Preventive Medicine, 41 (5-6), 828-833 DOI: 10.1016/j.ypmed.2005.07.009

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I would suggest that the countries thing will have negligible effect on the outcome. The culture differs little between Wales and England, especially in area where Welsh isn't widely spoken.

I think that there may be some downsides to painting lines such as football areas on a playground. The people playing football then mentally own that area of the playground. So there are health benefits for up to 22 school children playing a game of football, but the rest of the school is then discouraged from using that area.

By Stephen Paulger (not verified) on 17 Mar 2010 #permalink

Difference between England and Wales is basically a slightly different accent and the school kids learn the Welsh language as well as English. There's not a lot of cultural or genetic difference, the Normans conquered Wales as well as England though the Welsh put up quite a fight and regained limited independence a few times but the last time was in 1283.

I'd be curious what the school schedules looked like before concluding that the different countries thing had no effect.

At the same time, even *without* the control group, the pre vs. post intervention aspect makes the results look promising.

By sciencelizard (not verified) on 17 Mar 2010 #permalink

As a Brit I agree the difference between England and Wales is insignificant in this context (though damned important in some others!)

The 16% fall in physical activity in the control schools is striking. All that happened there was that the kids went on summer holiday, then came back. Probably the weather was worse than at the June baseline, but it's still a big drop. But one can also hypothesise that kids take a while to settle and start playing normally at the start of the school year (in England, usually a week or so into September). In which case a bit of organised encouragement specifically at that time might also be beneficial, in addition to painting lines.

By Hilary PhD (not verified) on 17 Mar 2010 #permalink

Reminds me of the fitness version of the beverage intervention that simply added water fountains.

Yet another study impressing the importance of a focus on the environment rather than the individual.

Sadly, a lot of people seem to prefer complicated, expensive interactions because the adults who have to implement them find the simple cheap ones "simplistic" or "boring." They may bore the adults, but seemingly they don't bore the kids.

Also, adults who think these things up may get more ego strokes or praise for coming up with something that sounds esoteric or takes more money: importance is often falsely correlated with expense.

I'd think paint might be preferable to sidewalk chalk, especially since some kid will surely get the bright idea to use the chalk to write or draw things to shock their elders with. But I'd like to see the students have some input into what gets painted.

Hi couldn't get link to journal to work

By sean webster (not verified) on 18 Mar 2010 #permalink

England and Wales share the same National Curriculum and aim for the same examinations at the same time, so it would be surprising if there were significant systematic differences in the school schedules.

Of course, this intervention is only useful if schools allow children a significant amount of free play time in the first place, which I gather can be a problem in US schools. The schools in this study averaged 90 mins/day of recess (although that may include the time it takes children to eat lunch, it wasn't quite clear).

You make a good point. It sounds like football/netball/etc markings were mainly placed at the older schools in this study, where I'm guessing painting other types of lines (e.g. mazes, hopscotch) may have had less appeal (the individual schools chose which markings they wanted). I'm not sure exactly how large the playgrounds were, or how much of the playground was taken up by these lines, but hopefully there was still plenty of room for the other kids to play.

I checked and it should be working... unfortunately the journal itself is behind a pay-wall, but the abstract is free to access. Let me know if you're still having trouble with the link.

The major "intervention" when I was in grammar school was to paint the boxes for 4-square on some fo the wide sidewalks and issue 3 or 4 playground balls to each classroom.

It worked!

By Tsu Dho Nimh (not verified) on 18 Mar 2010 #permalink

... and children were restricted to the paved portions of the playground during the study ...

I was wondering why physical activity in the control group went down.

In the United States, recess and other physical activity is being phased out in the public schools, so that the children can spend more time being taught to pass standardized tests.

@#1, and thinking back to my high school days playing lunchtime football:

So there are health benefits for up to 22 school children playing a game of football

You mean 22 a side, right?

By Tristan Croll (not verified) on 19 Mar 2010 #permalink

I live in Brazil. Here, simply every school's playground floor has got the four lines painted on it. The playgrounds are used for many things besides playing football and children do not monopolize it with football games. The suspicion that it would make a group of kids "own" the place does not find evidence in real life.

Usually we didn't play football with 11 each side in these places because the "4 lines" don't limit a large enough square. We stick to 5 or 7 each side. With fewer people, we used to occupy only half the square. Two boys can still play using only one of the lines as the goal. One boy kicks the ball and the other defends the imaginary goal.

By Cássio (not verified) on 21 Mar 2010 #permalink

I'm pretty sure that the students was restricted to the paved portions both before and after the intervention, so I don't think that was what caused the decrease in physical activity levels in the control group. My first guess would be changes in weather as some others have suggested, although it's tough to tell for sure.

Changes in weather when the cities are only 40 miles apart seems unlikely assuming the sample set was large enough. I mean one week - yes there may be an impact weather wise, one month - unlikely.

It is quite possible that the spark of colors - gets the brain firing and induce a more active child. It is possible.

In a snowy climate, teachers can use spray bottles filled with water and food colouring to "paint" temporary lines on the playground. Or, you can get the kids into teams and see who can build the biggest snow pile.

Just don't touch the CHEESE!

WOW! All from painting lines in the playground.

The kids of today are not as active as they use to be... your right...
I think its wonderful how this activity increased the kids activity level on the playground.

I would suggest that the countries thing will have negligible effect on the outcome. The culture differs little between Wales and England, especially in area where Welsh isn't widely spoken.

I think that there may be some downsides to painting lines such as football areas on a playground. The people playing football then mentally own that area of the playground. So there are health benefits for up to 22 school children playing a game of football, but the rest of the school is then discouraged from using that area.