Exercise as it relates to Disease/Strategies for increasing recess-time physical activity for children
This is a critique of the research article: Efrat, Merav W. Exploring Effective Strategies for Increasing the Amount of Moderate‐to‐Vigorous Physical Activity Children Accumulate During Recess: A Quasi‐Experimental Intervention Study. Journal of School Health. 2013, Vol.83(4), p.265-272. 
The critique was written as an assignment in the unit; Health, Disease and Exercise at University of Canberra, August-September 2018.
Background to research
Only 42% of American children are thought to reach the recommended amount of physical activity each day.  In other words, that means that 58% of American children did less than 60 minutes of moderate to vigorous physical activity each day. 
Children are said to be more engaged in physical activity during recess at school rather than during activities outside of school. Children’s play is a smart move to improve children’s health since it’s the most effective way to increase physical activity for children. During a school year, it has been argued that the recess provide a good opportunity to promote physical activity among children, it’s during recess that you have the best chance to improve their health.  Although children have a great opportunity to be active during recess, moderate-to-vigorous physical activity (MVPA) during recess is quite low, only 32.9% for boys and 25.3% for girls. The purpose of the present study was to see if a teacher's social prompting of physical activity could influence the amount of MVPA children do during recess as well as to see if certain recess games, made up by a competent adult, could influence the MVPA. 
The research was a quasi-experimental intervention study which means that the comparison group and intervention groups were not randomly assigned, and therefore the groups might be manipulated.   The results from this experiment might therefore not tell the whole truth since there are variables that might influence the result that the author do not have control over.  The study were conducted in Los Angeles County at three demographically matched schools in the suburbs. The match and similarities between the schools included:
- 1 morning recess of around 20 minutes
- Socioeconomically and ethnically diverse population of students
- Lack of physical education instructions from a credentialed physical education teacher
From the elementary schools, there were 161 children who participated in the study, including nine fourth-grade classes. The 161 students were separated in three different categories/groups, depending on which school they studied at:
- 59 children included in “social prompting group”
- 51 children included in “comparison group”
- 51 children included in ”modeling group”
Each school got their own category, where social prompting intervention happened at one school, modeling interventions at another school and no intervention at the last school since that was a comparison group. One of the benefits to having both intervention groups as well as a comparison group is that it gets easier to know if the intervention made a difference or not.  Although, it is important to have as similar groups as possible, to be able to get a true result and to make sure it was the intervention that did the only difference. This means that the groups should have been randomly picked, which did not happen in this study. It is important to separate the interventions with the comparison group since other studies show that if they are done at the same school, the children might influence each other to become more active or inactive during recess.
Merav Efrat, who is the author of this study, is an Associate Professor in the Department of Health Sciences at Cal State University Northridge. She has conducted research in similar areas as this research article and mostly focus on children and their relationship to obesity and physical activity. 
Methods of study
The amount of MVPA during recess was measured in this study. The tool used to measure MVPA in this study was a unidirectional Actigraph AM7164 accelerometer to measure sedentary, light, moderate and vigorous physical activity within the children participating. Actigraph's research-grade accelerometry monitoring system is the most frequently used system around the world and are seen as a reliable and accurate device to monitor activity.  The data collection where conducted in a 12-week period during the 2009-2010 academic school year. The children wore their accelerometer during recess to get the data necessary to see if any of the interventions did any difference in their physical activity. It was necessary to use the accelerometer to get the results in this experiment, although it is important to remember that it could affect the results of the study  since the children became somewhat informed about the research since they wore something that they normally do not wear. The social prompting group were introduced to a social prompting protocol and script. The children were introduced to a specific topic each day before recess that promoted physical activity. The modeling intervention consisted of six fifty-minute sessions of playing different games during students normally scheduled psychomotor instruction.
The limitations in the study needs to be taken into consideration while looking at the results further down. It was only three different schools involved in the study which means that if there were more schools involved, the results might be different. One of reasons to have more schools involved would be to get a broader perspective of the MVPA at the different schools and in different areas of the United States. Although, it should be enough to only have one school in each category, as long as the comparison group is a part of the study, since the impact of the intervention is seen while comparing the results to the comparison group. 
In the social prompting group, the MVPA increased significantly at the same time as it decreased in the modeling group. The MVPA in the comparison group stayed the same during the experiment. You can see from the research that the modeling group actually spend less time in recess after the intervention, while the two other groups had less difference in the minutes of recess before and after the intervention. The result shows that a teachers social prompting can have an impact on the MVPA during recess. By social prompting, Efrat  means helping the students engage in discussion about the benefits of MVPA. The MVPA during recess for the social prompting group increased with 2.41 minutes compared to before the intervention. The MVPA during recess for the modeling group decreased with 3.88 minutes, which show that teaching children games to play at recess isn’t a good strategy to increase MVPA during recess.
The conclusions we can draw from the research article is that MVPA can be improved during recess if the teachers promote physical activity each day before recess. Other studies in the field also show that encouragement from parents as well as the school works as an effective strategy to increase physical activity during recess.  One study also says that professionals in health care, in coordination with schools, should be involved in physical activity prompting for young children so that they become less inactive.
To teach students how to play games that increases PA is not a successful strategy, at least not for the school who were a part if the intervention. Even though that strategy wasn't successful, it should be investigated at different schools to rule that strategy out of the equation, since it might depend on the students as well as on the types of games they were taught. Efrat  mentions that the children being a part of the active recess games intervention, needed to make an active choice to actually engage in MVPA during recess, which might have play a part in the results for that specific intervention.
It would be interesting to see if MVPA changes during a school year according to weather, playground environment and other factors that takes a huge part in the MVPA during recess. Therefore, in future studies, some of the mentioned factors could be included to get a broader perspective of the amount of MVPA children do during recess.
To increase physical activity during recess in school, social prompting from teachers is clearly a good strategy, as stated above. To promote physical activity to the children before their recess time works if you want them to be involved in more MVPA during recess. According to another study  , a good intervention or strategy to increase physical activity during recess could be change in equipment for PA at the school grounds. Change in environment that promote PA is according to that study a good strategy to promote MVPA. It also states that organized recess activities could be a good strategy to increase physical activity. 
For further reading about physical activity for children and recess-time physical activity, please click the links below:
- Physical activity in USA
- Medicine & Science in Sports & Exercise - Children's physical activity
- Physical Activity During School Recess
- Children's physical activity in recess
- Efrat, Merav W. Exploring Effective Strategies for Increasing the Amount of Moderate‐to‐Vigorous Physical Activity Children Accumulate During Recess: A Quasi‐Experimental Intervention Study. Journal of School Health. 2013, Vol.83(4), p.265-272.
- Berrigan, D., Dodd, K. W., Mâsse , L. C., McDowell , M., Tilert, T., & Troiano, R. P. (January 2018). Physical Activity in the United States Measured by Accelerometer. Medicine & Science in Sports & Exercise, 40(1), 181-188.
- Beighle, A., Le Masurier, G., Morgan, C., & Pangrazi , R. (December 2006). Children's physical activity during recess and outside of school. J. Sch. Health, 76(10), 516-520.
- Robert Wood Johnson Foundation. (2007). Recess Rules. Princeton: Robert Wood Johnson Foundation.
- Fairclough, S., Ridgers, N., & Stratton , G. (July 2005). Assessing physical activity during recess using accelerometry. Prey Med, 41(1), 102-107.
- Kowalczyk, D. (2018). Quasi-Experimental Designs: Definition, Characteristics, Types & Examples. Available from Study.com: https://study.com/academy/lesson/quasi-experimental-designs-definition-characteristics-types-examples.html 15 September 2018
- Psykologiguiden, Natur & Kultur. (2018). Psykologilexikon. Available from psykologiguiden.se: https://www.psykologiguiden.se/psykologilexikon/?Lookup=quasi-experiment 15 September 2018
- Brusseau, T., Cothran , D., Hodges Kullina, P., & Tudor-Locke, C. (2008). Increasing physical activity behaviours through a comprehensive school change effort. Comprehensive Change 1. Brisbane: Australian Association for Research in Education.
- California State University, Northridge. (2018). College of Health and Human Development. Available from www.csun.edu: https://www.csun.edu/health-human-development/health-sciences/merav-efrat 12 September 2018
- Actigraph, LCC. (2018). Solutions for health research. Available from actigraphcorp.com: https://actigraphcorp.com/health-research/ 15 September 2018
- Salkind, N. J. (2010). Encyclopedia of research design Thousand Oaks, CA: SAGE Publications Ltd doi: 10.4135/9781412961288
- Okely, A. D., Parrish, A.-M., Ridgers, N. D., Salmon, J., & Stanley, R. M. (September 2012). Physical Activity During School Recess: A Systematic Review. American Journal of Preventive Medicine, 43(3), 320-328.
- Baranowski, T., Dowda, M., Pate, R. R., & Trost, S. G. (January 1996). Tracking of physical activity in young children. Medicine & Science in Sports & Exercise, 28(1), 92-96.
- Haapala, H. L., Hakonen, H., Hirvensalo, M. H., Laakso, L., Laine, K., Lintunen, T., & Tammelin, T. H. (October 2014). Adolescents’ physical activity at recess and actions to promote a physically active school day in four Finnish schools. Health Educ Res. , 29(5), 840-852.