The purpose of this paper is to summarize the results of the 2018 United States (U.S.) Report Card on Physical Activity for Children and Youth (Figure 1), which provides a comprehensive evaluation of physical activity levels and factors influencing physical activity among children and youth. The grades were based on the best available evidence, which included data from nationally representative surveys, peer-reviewed articles, as well as government and nongovernment reports and online content.
A Report Card Research Advisory Committee was assembled under the auspices of the National Physical Activity Plan Alliance (www.physicalactivityplan.org). The Committee reviewed the evidence and assigned grades to 10 indicators using data from nationally representative studies and surveys. The indicators included: 1) overall physical activity, 2) sedentary behavior, 3) organized sport participation, 4) active play, 5) active transportation, 6) physical fitness, 7) family and peers, 8) school, 9) community and environment, and 10) government. The Committee synthesized data from multiple sources to inform the 10 indicator grades. The data sources relied upon most heavily were national surveys and included the 2017 Youth Risk Behavior Surveillance System (YRBSS), the 2016 National Survey of Children’s Health (NSCH), the 2005-06, 2011-2012 and 2015-16 National Health and Nutrition Examination Survey (NHANES), and the 2012 NHANES National Youth Fitness Survey. Additional information was obtained from the State of Play 2017 Report,1 the 2016 School Health Policies and Practices Study (SHPPS),2 the 2016 School Health Profiles,3 and the 2017 United States Report Card on Walking and Walkable Communities.4 The 2018 Report Card was developed over one year, and involved several teleconferences and frequent email communication among the Committee members. Individual committee members were tasked with writing and reviewing specific sections of the Report Card.
Results and Discussion
Sufficient data were available to assign grades for 7 of the 10 indicators. The assigned grades ranged from C to D- (see Table 1). Due to insufficient data being available, grades of incomplete (INC) were assigned to active play, family and peers, and government. The general pattern of grades in the 2018 Report Card is similar to those reported in 20145 and 2016.6
Grades and rationales for the United States 2018 Report Card
|Overall Physical Activity||D-||Approximately 24% of children 6 to 17 years of age participated in 60 minutes of physical activity every day (2016 NSCH). Approximately 26% of youth in high school participated in 60 minutes of physical activity every day, while 47% participated in 60 minutes of physical activity on at least 5 days of the week (2017 YRBSS). There is a significant drop in physical activity levels with increasing age in children and youth: 42.5%, 7.5% and 5.1% of 6-11 year olds, 12-15 year olds and 16-19 year olds met physical activity recommendations, respectively, using objective physical activity measurement by accelerometry (2005-06 NHANES).|
|Sedentary Behaviors||D||Approximately 33% of children and adolescents aged 6-19 years engaged in 2 hours or less of screen time per day (2015-16 NHANES). There are significant race/ethnicity differences in reported screen time: 35%, 32%, 30%, and 25% of White, Hispanic/Mexican American, Asian, and African American children aged 6-19 years met screen time guidelines, respectively (2015-16 NHANES). Younger children aged 6-11 years were more likely to meet screen time guidelines than adolescents aged 12-19 years: 35% and 31%, respectively (2015-16 NHANES). Approximately 43% of high school-aged students use a computer or other electronic device for more than 3 hours per day (2017 YRBSS).|
|Organized Sport Participation||C||Approximately 54% of high school students reported playing on at least one sports team in the previous year (2017 YRBSS). Approximately 56% and 50% of 6-12 year old children reported playing a team sport (organized or unorganized) or an individual sport, respectively, at least once a year (State of Play 2017 Report).1 Approximately 37% of 6-12 year old children reported playing a team sport (organized or unorganized) on a regular basis (State of Play 2017 Report).1 There is a significant socioeconomic disparity in sport participation: approximately 12% of children from high-income households (≥$100,000 per year) compared to 30% of children from low-income households (<$25,000 per year) engaged in no sport activity during the year (State of Play 2017 Report).1|
|Active Play||Incomplete||Approximately 65% of school districts require elementary schools to provide regularly scheduled recess, while 31% of districts recommend elementary schools provide recess (2016 SHPPS).2 Approximately 11%, 8%, and 2% of school districts require that elementary, middle, and high schools, respectively, provide regular classroom physical activity breaks during the school day (2016 SHPPS).2|
|Active Transportation||D-||Approximately 23% of adolescents 12-19 years of age walk or use a bicycle 5-7 days per week for at least 10 minutes continuously once or more in a typical week to get to and from places (2015-16 NHANES). Significant gender differences exist in reported active transportation: Approximately 45% of boys and 32% of girls aged 12-19 years reported any active transportation in a typical week (2015-16 NHANES). There are significant differences in reported active transportation by household income status in which children living in higher income households are less likely to report any active transportation compared to those from lower income households: 46%, 36%, and 34% of children ages 12-19 years living in households earning less than 130% of the federal poverty level, 130-349% of the federal poverty level, and 350% or more of the federal poverty level, respectively (2015-16 NHANES). There are differences in the number of days per week children walk or bike for travel in a typical week: 62%, 15%, and 23% of children ages 12-19 years walk or bike for travel on 0, 1-4, and 5-7 days per week, respectively (2015-16 NHANES).|
|Physical Fitness||C-||Approximately 42% of 12 to 15 year old youth had adequate cardiorespiratory fitness levels (2012 NHANES National Youth Fitness Survey).7 Approximately 5.3% of boys and 12.1% of girls aged 15 to 19 years were in the “excellent” Health Benefit Zone for grip strength. Further, more boys (37.2%) than girls (20.3%) were in the “needs improvement” category (2011-2012 NHANES).8 Approximately 52% of children aged 6 to 15 years had adequate muscular endurance, based on the number of pull-ups performed (2012 NHANES National Youth Fitness Survey).6|
|Family and Peers||Incomplete||No data.|
|School||D-||Approximately 33% of school districts support or promote walking or biking to and from school (2016 SHPPS).2 Approximately 71%, 74% and 81% of school districts have a policy that requires undergraduate or graduate training in physical education or a related field for newly hired staff who teach physical education in elementary, middle school and high school, respectively (2016 SHPPS).2 Approximately 30% of high school-aged students attended physical education classes 5 days a week, while 52% attended physical education classes 1 day a week (2017 YRBSS). The percentage of schools that taught a required physical education course in each grade decreases from 97% in 6th grade to 42% in 12th grade (2016 School Health Profiles).3 Approximately 3.0% of secondary schools have established and implemented a Comprehensive School Physical Activity Program (2016 School Health Profiles).3|
|Community and Environment||C||Approximately 77% of 6 to 17 year old children live in a neighborhood with a park or playground area (2016 NSCH). Approximately 75% of 6 to 17 year old children live in a neighborhood with sidewalks or walking paths (2016 NSCH). Approximately 64% of 6 to 17 year old children live in a safe neighborhood, and significant race/ethnicity differences exist: 72% of White, 53% of African American and 54% of Hispanic children live in safe environments (2016 NSCH). 32% of states have at least 30% of the population living in highly walkable neighborhoods. 42% of states earn at least 20/30 points on Complete Streets Policies (2017 Walking Report Card).4|
The poor grades on the 2018 U.S. Report Card indicate that children and youth in the U.S. are insufficiently active, and that additional work is required to provide opportunities for children to lead active lifestyles. Adult decision-makers, including parents, teachers, school administrators, health care providers, and policymakers are encouraged to make additional efforts to facilitate opportunities for physical activity for children and youth. There is also need for strategies to address disparities in physical activity participation across gender, race/ethnicity, age, and socioeconomic status.
Centers for Disease Control and Prevention. SHPPS: Results from the School Health Policies and Practices Study, 2016. Atlanta, GA: Centers for Disease Control and Prevention; 2017.
Brener ND, Demissie Z, McManus T, Shanklin SL, Queen B, Kann L. School Health Profiles 2016: Characteristics of Health Programs Among Secondary Schools. Atlanta, GA: Centers for Disease Control and Prevention; 2017.
National Physical Activity Plan Alliance. The 2017 United States Report Card on Walking and Walkable Communities. Columbia, SC: National Physical Activity Plan Alliance; 2017.
Dentro KN, Beals K, Crouter S, et al. Results from the United States’ 2014 report card on physical activity for children and youth. J Phys Act Health. 2014;11(suppl 1):S105–S112. doi:10.1123/jpah.2014-0184
Katzmarzyk PT, Denstel KN, Beals K, et al. Results from the United States of America’s 2016 report card on physical activity for children and youth. J Phys Act Health. 2016;13(suppl 2):S307–S313. doi:10.1123/jpah.2016-0321
Gahche J, Fakhouri T, Carroll DD, Burt VL, Wang CY, Fulton JE. Cardiorespiratory fitness levels among U.S. youth aged 12-15 years: United States, 1999-2004 and 2012. NCHS Data Brief. 2014;(153):1–8.
Perna FM, Coa K, Troiano RP, et al. Muscular grip strength estimates in the U.S. population from the National Health and Nutrition Survey 2011–2012. J Strength Cond Res. 2016;30:867–874. doi:10.1519/JSC.0000000000001104