Introduction: Children in the UK from South Asian backgrounds have increased risk of metabolic disease, increased body fat and engage in reduced physical activity (PA) compared to White children (Ehtisthan et al., 2000, 2004; Whincup et al., 2002). The mechanisms underlying the lower physical activity patterns are not fully understood in South Asian children. Ethnic groups cluster in deprived areas within the UK (Jayaweera et al., 2007; Williams et al., 2009) and thus the role of the physical environment and how children use this environment for PA, needs exploring in order to increase PA through interventions. The overall aim of the thesis was to assess the association between environmental factors and PA behaviour in deprived South Asian primary school children.
Methods: Following institutional ethical approval, children and their parents from two primary schools within deprived wards in Coventry were recruited. Objective assessments of PA (heart rate or pedometer, the physical environment (global positioning system))and body adiposity (body mass index, waist circumference and body fat%) were obtained from children. Perceptions about the physical and social environment were obtained from focus group discussions with children and parents. The findings obtained from quantitative and qualitative evidence were combined to apply a multi-dimensional intervention increase PA in SA children from low SES environments.
Results: Quantitative results identified that children are more active in outdoors environments (non-greenspace) (P<0.01), but that South Asian children spend more time indoors (P= 0.03) and are less active indoors (P= 0.04). Qualitative findings identified the importance of the supportive physical and social environment at school on children’s PA levels. Additionally, unsupportive physical (e.g. poor access, safety and quality) and social factors (e.g. anti-social behaviour) within the neighbourhood were identified as barriers to children’s outdoor play, resulting in sedentary behaviours indoors. The multi-dimensional intervention provides evidence that modifying the physical and social environment through school can increase PA. The results indicated that average daily steps were significantly higher in the intervention group at 6 weeks post compared to baseline and the control group (mean change ± SD of change = 8694 ± 7428 steps/day vs. -1121 ± 5592 steps/day, 95% CI of difference, 6726,7428 steps/day, P= 0.001, d= 1.76). No significant change from pre to post 6 weeks was found for the control group (mean change ± SD of change = -1121 ± 5592 steps/day,95% CI of difference = -1301, 3004 steps/day, P= 0.42). In addition, significant decreases in South Asian children’s body fat % (mean change ± SD of change = -4.46 ± 4.77% vs. -1.09 ± 2.77%, 95% CI of difference, -1.26,-0.34% , P= 0.001, d= 1.22)and WC (mean change = -1.73 ± 4.48cm vs. -0.21 ± 3.49cm vs. respectively, 95% CI of difference, -3.40,0.36cm,P= 0.001, d= 0.44) were observed in the intervention group post 6 weeks compared to the control group.
Conclusion: To conclude, the findings confirm the importance of social and physical environments on children’s PA patterns, which can be changed using an intervention to increase children’s PA. Further research needs to examine the long-term sustainability of an integrated school based curriculum intervention and the effects this has on metabolic risk.
|Date of Award||2014|
|Supervisor||Michael Duncan (Supervisor), Valerie Cox (Supervisor) & Samantha Birch (Supervisor)|