Promoting physical activity amongst children outside of physical education classes: A systematic review integrating intervention studies and qualitative studies

Objective To assess what is known about the barriers to, and facilitators of, physical activity outside the physical education (PE) lesson amongst children aged four to ten years. Design Systematic review of intervention studies assessing impact on health outcomes and studies evaluating the 'views' of children and parents on what helps and hinders children in being physically active. Mcthods Studies were located by searching multiple sources. Those meeting the inclusion criteria were assessed for methodological quality. Intervention and views studies were analysed separately; then their results were brought together to examine matches, mismatches and gaps between children's and parents' views and intervention strategies. Results Of 90 identified studies, 26 met the inclusion criteria: 21 intervention studies (of which five were sound) and five 'views' studies. Education and equipment provision for monitoring TV/video/video game use and multi-component interventions are promising approaches. In the views studies, children and parents identified several barriers and facilitators, and made suggestions for improving participation levels. There were important matches and mismatches between what children say influences their physical activity participation and the barriers and facilitators addressed in five soundly evaluated interventions. A major gap was the lack of soundly evaluated interventions addressing the barriers in children's local environments. Conclusion Children's and parents' clear views on what helps and hinders children's participation in physical activity rarely informed the development of interventions. Few well-evaluated health promotion interventions address physical activity beyond the PE lesson. Gaps between children's views and soundly evaluated interventions were most noticeable in relation to issues of restricted access to opportunities for physical activity.