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Pediatrics

The effect of increasing risk and challenge in the school playground on physical activity and weight in children: a cluster randomised controlled trial (PLAY)

Abstract

Background:

To investigate whether changing the play environment in primary schools to one that includes greater risk and challenge increases physical activity and reduces body mass index (BMI).

Subjects/Methods:

A 2-year cluster randomised controlled trial was undertaken in 16 New Zealand schools (years 1–8). Intervention schools (n=8) redesigned their play environments to encourage imaginative and independent free play by increasing opportunities for risk and challenge (for example, rough-and-tumble play), reducing rules and adding new playground components (for example, loose parts). Control schools (n=8) were asked to not change their play environment. A qualified playworker rated all school play environments at baseline and 1 year. Primary outcomes were moderate-to-vigorous physical activity (7-day accelerometry) and BMI z-score, collected in 840 children at baseline, 1 and 2 years. Data were analysed using generalised estimating equations.

Results:

Multiple changes were made to the school play environments resulting in a significant difference in overall play evaluation score between intervention and control schools of 4.50 (95% confidence interval: 1.82 to 7.18, P=0.005), which represents a substantial improvement from baseline values of 19.0 (s.d. 3.2). Overall, schools liked the intervention and reported many benefits, including increased physical activity. However, these beliefs did not translate into significant differences in objectively measured physical activity, either as counts per minute (for example, 35 (−51 to 120) during lunch break) or as minutes of moderate-to-vigorous physical activity (0.4, −1.1 to 2.0). Similarly, no significant differences were observed for BMI, BMI z-score or waist circumference at 1 or 2 years (all P>0.321).

Conclusions:

Altering the school play environment to one that promoted greater risk and challenge for children did not increase physical activity, nor subsequently alter body weight. Although schools embraced the concept of adding risk and challenge in the playground, our findings suggest that children may have been involved in different, rather than additional activities.

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Acknowledgements

We recognise and thank the many children, families, schools and teachers who participated in this research and the research assistants who helped with data collection. The PLAY study was funded by the Health Research Council of New Zealand and the Otago Diabetes Research Trust. VLF was in receipt of a Medicine Award and subsequently a Lottery Health Research New Zealand PhD Scholarship during her PhD study. RWT is partially funded by a Fellowship from the Karitane Products Society (KPS) Limited. This study was retrospectively registered with the Australia New Zealand Clinical Trial registry ID: ACTRN12612000675820.

Author contributions

VLF assisted with study design, was project manager and PhD student on the PLAY study. She completed all accelerometry analyses, assisted with statistical analyses, and wrote the first and subsequent drafts of the paper. SMW was a co-investigator, assisted with study design, was responsible for all statistical analyses and commented on the manuscript. JIM was a co-investigator, assisted with study design and commented on the manuscript. GS was a co-investigator, assisted with study design and oversaw data collection in Auckland, with JCM being the project co-ordinator in Auckland. RWT conceived the idea for the study, was the principal investigator of the project, responsible for overall study design and monitoring of data collection, and re-drafted the manuscript with VLF. All authors read and approved the final manuscript.

Disclaimer

The funders had no role in the design of the study; the collection, analysis and interpretation of the data; the writing of the manuscript; or the decision to submit the article for publication.

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Correspondence to R W Taylor.

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Supplementary Information accompanies this paper on International Journal of Obesity website

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Farmer, V., Williams, S., Mann, J. et al. The effect of increasing risk and challenge in the school playground on physical activity and weight in children: a cluster randomised controlled trial (PLAY). Int J Obes 41, 793–800 (2017). https://doi.org/10.1038/ijo.2017.41

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