Can after-school dance increase physical activity levels in adolescent girls?

Russ Jago, Professor of Paediatric Physical Activity & Public Health, reports some surprising findings from research conducted at the Centre for Exercise, Nutrition, and Health.


Adolescent girls who attend after-school dance classes are no more likely to be physically active than those who don’t. This is one of the key findings from Active 7, a research project that aims to find out whether after-school dance sessions can help adolescent girls to engage in moderate levels of exercise.

Physical activity is associated with improved physical and mental health, but many adolescents – and particularly adolescent girls – do not engage in recommended levels of physical activity.  A team, led by staff in the Centre for Exercise, Health and Nutrition at the School for Policy Studies aimed to address this issue by examining whether providing dance programmes at secondary schools led to increases in girls’ physical activity. The study took place in 18 secondary schools. In half of the schools, Year 7 girls were provided with a new after-school dance programme for 20 weeks. Girls in the other “control” schools carried on as normal.

The results were surprising.  Much academic research suggests dance is an appealing form of physical activity amongst teenage girls, that extra-curricular periods are better suited to delivering physical activity interventions, and that interventions based on psychological theory (as Active7 was) have more success than non-theory based interventions. However, we found no difference between the physical activity levels of the intervention and control group girls at the end of the programme, or 6-months later. We also found that only a third of girls attended at least two thirds of the sessions provided in their school.

Our earlier work had suggested that girls enjoy dance and as such the lack of a difference in the physical activity levels of the girls was surprising. This could be due to the intensity of the dance sessions. The goal of the project was to increase ‘moderate to vigorous physical activity’ (MVPA), which gets you sweaty and slightly out of breath. The results found that girls who attended Active7 only took part in 4.7 more minutes of MVPA on session days, and therefore the sessions may not have been intensive enough to impact on MVPA.  Only one-third of the girls met the attendance criteria of attending two-thirds of the sessions, suggesting there may be a need to consider alternative forms of physical activity. A final and third explanation is methodological; accelerometers may not be able to capture the nuanced movements inherent in dance, especially when preparing for performances. Thus, levels of MVPA in sessions may have been underrepresented.

The results have implications for how we think about delivering after-school physical activity interventions. We might need to move beyond delivering standardised forms of extra-curricular physical activity and instead find more novel forms of exercise that offer lots of different types of physical activity. Fortunately, the findings from Active7 provide us with new ways of thinking about designing interventions. Offering participants with sufficient ‘choice’ in the design of the intervention is one potential method uncovered in our analysis, whilst delivering tailored interventions that meet a diversity of schools was also suggested as a future recommendation from girls and school contacts. Thus, future research which examines how to engage girls in activity and focusses on the types of activities that they would like to attend, when they would like to attend and how to maximise physical activity during those sessions, is needed.

The project was funded by the National Institute for Health Research Public Health Research (NIHR PHR) Programme (project number 11/3050/01). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR PHR Programme or the Department of Health.

This blog post is based on Jago et al 2015: Effect and cost of an after-school dance programme on the physical activity of Year 7 girls: The Bristol Girls Dance Project, a school-based cluster randomised controlled trial, International Journal of Behavioral Nutrition & Physical Activity, 12:128, 2015


Capturing the benefits of ‘playing out’

School for Policy Studies academics work with a range of local interests. Playing out is a non-for-profit Bristol based organisation that encourages street play in the UK. Naomi Fuller, from playing out, has written this blog about how their work with the School is helping them to capture the benefits of such activity. 

I stood turning the skipping rope for ages at our last playing out session. Tall ten-year-olds and sturdy toddlers queued to have a go at jumping in as I chanted “Mickey Mouse Built a House” on request. I watched them – some skipping deftly, others stopping and starting with the rope getting tangled, some squatting down to do some chalking close by while they waited and I wondered whether it was possible to unpick what was going on. Of course they were having fun, giggling and trying to hold hands and skip together, then running out of the turning rope to add chalked horns to the rainbow-coloured cow they had drawn together in the middle of the street. But is there any way to measure this activity. And is there any need?PORTRAIT-grandma-skipping-rope.jpg

A conference hosted recently by University of Bristol gave some clear answers to these questions. The event was called “Outdoors and Active: Delivering public health outcomes by increasing children’s active travel and outdoor play”. It gathered people working in local authority public health teams, education and play services to share new research showing beyond doubt that children at playing out sessions are getting more exercise and activity than they would if they were indoors during that same period. Dr Angie Page and Professor Ashley Cooper are lead researchers for the PEACH project, a long term study examining the links between the different physical environments children spend time in and how active they are in them. They and their team have already measured children’s activity levels on their school journeys – whether in cars, on foot or by bike, during the school day and in the after-school period, examining the length of time they spend outdoors and indoors and exactly how much physical exercise they do.

To carry out these studies and gather the data they need, researchers have kitted children out with GPS tracking devices which show precisely their location at every stage of their journey. Children have also worn ‘accelerometers’ which measure the intensity of their exercise and activity. Recently Angie and her research team have turned their attention to street play – visiting playing out sessions to measure the intensity and type of physical activity children are doing. As well as equipping the children with the technical kit, her team interviewed parents and children about their activity patterns and habits.

It’s the levels of ‘moderate to vigorous physical activity’ (MVPA) that are a key focus. Government guidelines are clear: children between five and eighteen need to get at least an hour’s MPVA each day to ensure they are healthy. But very few are managing this and recent figures show just 14% of boys and 8% of girls are doing so. And these levels of inactivity are increasingly worrying for children’s long-term health and wellbeing. During a playing out session MVPA is the energetic play we often see; the skipping, scooting, hopscotch and playing tag as you would expect. But it’s brisk walking and similar types of activity as well and lots of imaginative games would include periods of MVPA as I’ve observed on my own street when make believe wizards and witches take to their broomsticks after huddling over a pretend cauldron for a while. The University of Bristol data shows;

  •  Children are three to five times more active outdoors than indoors
  • Time spent outdoors with friends is linked to an increase in children’s physical activity levels
  • During playing out sessions children spent 30% of their time in moderate to vigorous physical activity (MVPA) and another 15% in light activity.
  • This compares to 5% of time indoors usually spent in MVPA

Holding-one-end-skipping-ropeAngie Page introduced some important questions in presenting these findings. First was the notion of ‘subsitutional replacement’. Put in lay terms the issue is whether the children at the playing out session would have got their physical activity in another place such as their garden or local park if they hadn’t been playing in the street that day. The clear answer was no. The responses from parents and children showed that the playing out session was usually an alternative to a less active option – watching TV or another sedentary indoor activity.

And the other intriguing question was around the idea of ‘compensation’. This is the question of whether being active during a playing out session means children flop on the sofa for longer afterwards and are ironically less active than they would have been normally (as many adults often are after a gym session!). Again the data showed that this did not happen to the children playing out and that they did not have a pattern of doing less activity after playing out to ‘compensate’ for the more vigorous play they had done.

Professor Kevin Fenton, Director of Health and Wellbeing at Public Health England closed the conference by starkly stressing the urgency of improving children’s levels of physical activity and the need to make active play the norm once more. “It’s often said that the environment is an important health service,” said Professor Fenton. And he talked about both green spaces and urban spaces like streets, needing to be seen in this way – as potentially health-giving spaces for those spending time in them. The challenge both for the audience gathered at the conference, and for policy-makers and public health commissioners, is to support the idea of street environments as a ‘health service’ and to act on the growing body of research and data which clearly shows the benefits of street play. The evidence is there – not that anyone who has watched a playing out session has ever doubted it.

A few days after the conference my street played out again and this time as I watched the pink-cheeked skippers, legs blurred as they jumped faster and faster it felt inspiring to realise that what they were doing – so naturally and with so much fun – is part of something increasingly important to researchers and policy makers. You can read more about the University of Bristol’s research findings here. If you want to know how to support street play in your street, or work for an organisation interested in finding out more do get in touch.

This piece was originally posted on the playing out blog.

From Bristol City to Mexico City: New challenges for obesity research

In this blog, Simon Sebire from the Centre for Exercise, Nutrition & Health Sciences and three PhD students reflect on new avenues of research into childhood physical activity and obesity in Low and Middle Income Countries and the opportunities and challenges this work presents.

New ideas emerge in the least likely places. As I listened to Professor Andy Gouldson present his research to the School for Policy Studies in spring 2014, I was inspired to sketch connections between some of Andy’s concepts (economic development and environmental issues) and my own (the psychology of motivating people to adopt healthy behaviours like being physically active). After the talk, I shared my scribbles with my colleague Prof. Russ Jago, only to find that he had an almost identical set.

Our thoughts had independently been transported from Bristol to Mexico and musings about the potential associations of urban development and rural-urban migration on the lifestyle behaviours of children and their families. This international perspective is not something either of us had previously pursued is but clearly had prompted some scribbling! The Mexico connection was inspired by three CONACyT-funded students, from Mexico, who at the time were studying our MSc in Nutrition, Physical Activity and Public Health and were considering PhDs.

Nearly 1 year on the three students (Ana Ortega Avila, Maria Hermosillo Gallardo and Nadia Rodriguez Ceron) are now PhD students in the School for Policy Studies Centre for Exercise, Nutrition and Health Sciences supervised by Prof. Russ Jago, Dr Angeliki Papadaki and I. They secured further funding from CONACyT to pursue their programme of research to study how various social, psychological and environmental factors might be related to physical activity and nutrition behaviours in children adolescents and their families in Mexico.

The causes of and response to increasing levels of obesity in low and middle income countries have been the focus of a recent Guardian Global Development Podcast. The podcast draws on the experiences of children, families, health practitioners and campaigners from South Africa and Mexico. In Mexico 73% of men, 69% of women and approximately 35% of adolescents are obese or overweight which is higher than in the USA. It is clear that there is much to be done to both treat those who are already overweight and prevent the development of obesity in young people. However, extrapolating our existing research and knowledge of what we think drives obesogenic behaviours in places like Bristol to the context of people’s lives in Mexico presents a number of challenges.

Ana, Maria and Nadia have a wealth of experience from previously working in Mexico as nutritionists or within the food industry, so I asked them to listen to the podcast and share their insider’s view of the challenges ahead:

Maria referred to the potentially damaging effects of families in Mexico aspiring to an American lifestyle dominated by unhealthy foods and sedentary behaviour:

The blog says that processed foods and junk food are one of the main causes of overweight and obesity increasing in Mexico, which is partially true, but I think it has to do a little bit more with what I call “junk behaviours”. For example, how mums from rural areas prefer to give their children processed foods instead of home-made meals because they heard somewhere that people from USA consumed them, and because Americans always choose right (at least that’s the belief in some parts of Mexico); junk food and processed foods are the way to go for feeding their children.

Ana suggested that this influence may be strongest in regions closest to America and highlighted the broader problems associated with researching an issue which is geographically diverse:

Mexico is among the largest countries in the world geographically and demographically (118 million people); where differences in dietary pattern exist between rural and urban areas or between north, central and south regions.I have always lived in the northwest and the influence of the U.S.A. is visible in a lot of aspects in our life compared to the centre or south of the country. Our dietary patterns are based on American food choices and less on the Mexican traditional diet.

Ana, Maria and Nadia all added that the potential mismatch between perceptions of wealth and health may be making being overweight an aspiration:

Ana: In my experience as a nutritionist there are a number of cultural misconceptions among population when it comes to healthy nutrition. For example, being a little overweight still means you are healthy and well-nourished whereas being thin means you are unhealthy or sick. People don’t see overweight as a problem, on the contrary, they see it as something normal.

Nadia suggested that such perceptions may prevent parents from identifying obesity as a potential health problem in their children:

I think the healthy body image is distorted as family, friends or in the streets, the most common thing is to see someone obese; and that is really concerning because how will they do something to improve their health if they don’t even think there’s a problem. 

Ana, Maria and Nadia reflected on the challenges of applying our physical activity and nutrition research findings which are largely based on evidence from developed countries such as the UK or USA to the context of middle income countries such as Mexico. A good example is parents’ perceptions of safety when letting their children play outside of the home. In UK research, including some in Bristol by my ENHS colleagues, we tend to focus attention on the presence of traffic or children’s risk of injury while unsupervised. In contrast, perceptions of safety in Mexico are measured nationally with questions including those related to the risk of kidnap, existence of violent gangs in the neighbourhood, armed robbery and frequency of firearms shootings. 73.3% of the participants in the 2014 National Survey on Victimization and Perception of Public Safety (ENVIPE) in Mexico reported not feeling safe in their local areas. In addition to the safety implications of conducting research in this context, it is clear that current measures of parents’ perceptions of their child’s safety to be active outside the home will not be sufficient and Nadia has plans to develop a new tool.

In addition, the political landscape challenges us to consider different ways in which our research may be best able to impact on health policy:

Ana: The political context in Mexico is complex, the government is dealing with high levels of insecurity and corruption, events that prevent the government from focusing on other matters such as the implementation of new health policies.

Maria believes that more is needed to be done to educate policy makers in addition to the public: There is a huge educational barrier, both governmental and individual, which makes difficult to take seriously the obesity and overweight problem.

Nadia: All those factors are completely different to high-income countries, and makes the context a complex matter to understand when almost all the research has developed in a completely different contexts with a wider range of opportunities to change or create policies that have a real impact in the population’s health. 

In summary, over the last year or so, I have been transported from Bristol city to Mexico City thanks to a fortuitous combination of research daydreaming and inspiring MSc (now PhD) students.  As a supervisor, my initial conversations with our new students has forced me out of my research comfort zone, an experience which has been echoed and reported by researchers in the International Physical Activity and the Environment Network in Latin America. Undoubtedly, our success in co-producing research which could have international impact will require us to work together to combine our collective knowledge to understand the context and key drivers of obesity-related behaviour change in Mexico.

Thanks to Ana Avila Ortega, Maria Hermosillo Gallardo and Nadia Rodriguez Ceron for their contributions.

  • Ana’s PhD focusses on the development of a social media intervention to reduce consumption of sugar-sweetened beverages in  Mexican older adolescents
  • Maria is studying the associations between urbanicity in Mexico and lifestyle behaviours and the influence of the rural urban transition on family health.
  • Nadia’s PhD focusses on the environmental and social correlates of physical activity in children in Mexico City.

Dr Simon Sebire is Lecturer in Physical Activity & Exercise Psychology in the Centre for Exercise, Nutrition & Health Sciences (ENHS) in the School for Policy Studies.The results of the 2014 Research Excellence Framework (REF) confirm the Centre’s international reputation for research excellence within the field of physical activity, nutrition and health. ENHS was rated 1st overall in the UK.


Patricia Lucas explains why the School for Policy Studies is researching dental decay


Data released by Public Health England on 30 September 2014 has shown what many interested in health in the early years know already.  Over 80,000 3-year-old children in England – about 12% – suffer from a completely preventable disease.  Dental decay is painful, the treatments are unpleasant, and decayed, missing and filled teeth affect appearance.  Oral disease can have very serious consequences: in Bristol alone 721 children aged 0-19 years (of whom 155 were under 5) were admitted hospital for extraction of decayed teeth in a one year period (2012/13).

Tooth decay is of importance for us in the School for Policy Studies because while rates have reduced dramatically since the 1970s, there remain important and significant inequalities.  Closer examination of

data suggests geographical and social disparities in oral health.  Children from more disadvantaged backgrounds are significantly more likely to have early tooth decay and to need teeth extracted under general anaesthetic.  In Bristol, while the rate of child dental decay was on a par with the UK average in 2008, the DMFT (decayed, missing, filled, in teeth) index for children in South Bristol, an area of high deprivation, is currently twice the city average.  Ashley and Lawrence Hill wards experience nearly three times as many dental fillings in under 5 years old, compared to neighbouring Bishopston and Redland wards.

The Public Health England (PHE) report points out that the most important cause of dental decay is sugar in diet, and the most important preventive action is fluoride (in toothpaste or water).  The response from PHE focuses on the former, but it is important not to ignore the latter, and to understand the policy context for this.  Despite clear evidence that very small amounts of fluoride in water supplies reduces dental decay, few water supplies are fluoridated in the UK.  Water supplies are a shared resource, and public and legislative barriers mean addition of fluoride seldom happens.  In the absence of this, use of fluoridated toothpaste and fluoride varnishes by dentists are the next line of defence.

One difficulty for local policy makers is that we don’t have good enough data on oral health in childhood.  The new PHE Survey is important, but sampled just 211 3 year olds in Bristol.  We need better local data to really understand what is happening to have a reliable estimate of the local rate, including how this varies between areas.

Our study, which is part of the BoNEE project, will improve our understanding of oral health inequalities among children in Bristol.  We will do this by looking at dental hospital records of who is attending for dental extractions, by understanding better what happens when children do visit the dentist, and by gathering parents views and experiences of oral health services in Bristol.

This project is in collaboration with colleagues at University Hospitals Bristol NHS Foundation Trust, the University of Bristol’s School of Oral and Dental Sciences, and Bristol City Council.

Patricia is Head of the Centre for Research in Health and Social Care in the School for Policy Studies at the University of Bristol.


Progress on the FAB kids outreach project

FAB1Mark Edwards, Active7 Trial Manager in the School for Policy Studies, reflects on the first term of delivering the FAB Kids outreach workshop in schools. Mark previously blogged on this project here

It’s been a busy term. Aside from their full-time jobs, Exercise, Nutrition and Health Sciences (ENHS) staff and students have worked hard to get the FAB (Food, Activity, and Bodies) Kids project up and running in schools. Taking the workshop from drawing board to school hall has been an arduous task, but seeing the children (and teachers) learn from and enjoy the workshop activities makes the efforts worthwhile. It has been a rewarding process for FAB staff; going into schools and being in dialogue with small groups of children, learning from them and hearing their stories (sometimes fascinating, other times bizarre), and quickly(!) getting to grips with controlling groups of over-excited children.

Between May and early July, 13 staff and student volunteers have delivered the FAB workshop to 355 children. Workshops have been delivered in 8 mainstream primaries, one Special Educational Needs school, and one fee paying school. We’ve also taken FAB to the Big Bang (Cirencester) and Bridgwater Science Festivals.

What has been the impact?


So what have the children learnt? At the end of each workshop we ask them just this question. As you’d expect (or hope) from a health-focused workshop, lots of children came away with the message that they should ‘always keep healthy and fit and drink what’s right for you’.  Many took away messages they can use in their day-to-day lives, such as ‘some drinks that appear to be healthy have a lot of added sugar’ and the ‘more you exercise the less likely you are going to have heart problems’. Others memorised interesting snippets  such as ‘Diet Coke contains an ingredient that is in fireworks’, ‘there are over 600 muscles in your body’ and ‘the average heart rate for children is 70-100 beats per minute’. One child was simply speechless (or ironic beyond his years); ‘Absolutely epic! I can’t get any of it out of my head because I learnt so much!’ Whilst most were more conservative in their comments, we hope and think that all children have taken something – however little – from the workshop that may help them to improve their lifestyle.

What did the teachers think?

School staff provide more formal evaluation of the workshop. The three individual workshop activities and the workshop overall (separate questions) were rated ‘very good’ by all teachers. It was interesting to see how teachers engaged with the workshop, with some using it as a way to develop their own knowledge, and experimenting with props and asking questions as if they themselves were participants. The qualitative feedback they provided is testament to the enthusiasm of the staff delivering the workshop. Comments from teachers include:

‘A perfect morning’s learning where the children enjoyed themselves! They loved learning the new facts. All brilliant, staff energetic and formed great relationships with children.’

‘All interactivity was brilliant! Children really enjoy learning in a different way with various approaches.’

‘All the activities were interactive, stimulating and fun for the children. They were enthusiastic and engaged throughout and certainly enjoyed what they were doing.’


‘Really loved the jigsaw/children very engaged. Children liked the booklets and enjoyed all the activities.’

‘All members of the team had a lovely manner with children and quickly established a positive rapport. Not always easy! The resources were all well organised, interesting and engaging.’

Where next?

Although we are delighted with this term’s progress, we are not complacent and have identified several areas for improvement (which will be made over the summer). In September, MSc students will be invited to assist with the delivery of the workshop. As such, we will be designing training sessions and delivery manuals over the next few months. The plan is to allow trained MSc students to deliver the workshop, giving some supervisory roles, and gradually reducing the hands-on involvement of ENHS staff. In September we will begin to book in more schools to receive the workshop.


If you would like any further information on the FAB Kids workshop please visit or email

FAB team members: Bethan Baker Williams, Rachael Pound (MSc student), Mark Edwards, Laura Pool, Kate Banfield, Byron Tibbitts, Jo Kesten and Sarah Harding.

ENHS is a research centre in the School for Policy Studies. Staff work on a variety of projects focusing on physical activity and nutrition, and their associations with health across the life course. Much research in ENHS is conducted with children in local schools.

Children, parents and screen-viewing: New evidence from the School for Policy Studies


Russ Jago from the Centre for Exercise, Nutrition & Health Sciences discusses a recent paper in the International Journal of Behavioural Nutrition and Physical Activity on parent and child screen-viewing and its implications.

A body of evidence has shown that screen-viewing (watching TV, using the internet, playing games consoles) is associated with adverse health effects such as increased risk of heart disease, type 2 diabetes and obesity among adults. Recent research has also shown that screen-viewing is associated with adverse health effects among children and adolescents such as increased risk of obesity, higher cholesterol levels and poorer mental well-being. Collectively these findings indicate that there is a need to understand children and adolescent’s levels and patterns of screen-viewing among children and adolescents and identify ways in which the screen-viewing levels of children can be reduced. To date the bulk of this work has focussed on older-aged primary school aged children and adolescents with a lack of information about the screen-viewing patterns of younger children. This gap is important because previous work has shown that screen-viewing patterns are established in early life and then track through childhood into adulthood. Thus, there is a need to examine levels of screen-viewing among children at the start of primary school and the key factors that are associated with these patterns.

A relatively under-explored area of research is how patterns of screen-viewing may be shared between children and their parents. It seems logical that children who live in homes in which the parents engage in high levels of screen-viewing may be more likely to spend more time screen-viewing. Previous work has suggested that associations may exist between parent and child screen-viewing but again current research has been dominated by studies that have included older children and restricted to assessments of mothers’ TV viewing. These studies have not provided information on other forms of screen-viewing such as computer use or the roles of dads. These gaps are important as our previous work has shown that TV viewing is becoming a less dominant form of screen-viewing with other types of viewing such as tablet and smart-phones becoming more dominant.

In our current paper we attempted to look at these issues by examining the screen-viewing patterns of 1078 Year 1 (5-6 year old) children and their parents. These data are from the British Heart Foundation funded B-Proact1V project which was conducted in 63 primary schools in the greater Bristol area. We asked the parents to complete a survey reporting their own screen-viewing patterns and those of their child. In households in which there were 2 adults we asked the second parent to also report on his or her screen-viewing behaviour. We then examined levels of screen-viewing for the children and the parents and associations between parent and child screen-viewing. We found that 12 per cent of boys and eight per cent of girls in this age group watched more than two hours of TV on a weekday, with 30 per cent of parents exceeding this threshold. Figures were much higher at weekends, with 45 per cent of boys, 42 per cent of girls, 57 per cent of fathers and 53 per cent of mothers watching more than two hours of TV each day.

When we examined the associations between parent and child screen-viewing we found that children were at least 3.4 times more likely to spend more than two hours per day watching TV if their parents watched two or more hours of TV, compared to children whose parents watch less than two hours of TV. There were, however, different patterns for parents’ computer use in which daughters were 3.5 times more likely to use a computer at the weekends if their fathers spent more than 30 minutes a day doing so. There was, however, no evidence that sons were similarly influenced.

What do the results mean?

The results support our hypothesis that parents are strong influences on children’s screen-viewing behaviours and also show that it is not just mums but also dads who have important influences. These findings therefore imply that strategies which focus on reducing the screen-viewing habits of the entire family are likely to be important. Moreover, the results suggest that future behaviour change strategies need to focus on a broad range of screen-viewing behaviours and look at the factors that lead to screen-viewing and if they differ for weekdays versus weekend days. Over the next few months we will be analysing further data from this project to try and answer some of these more specific questions on how these behaviours are formed and how they might be changed.

Paper: ‘Cross-sectional associations between the screen-time of parents and young children: differences by parent and child gender and day of the week’ by R. Jago, J. Thompson, S. Sebire, L. Wood, L. Pool, J.Zahra and D. Lawlor in the International Journal of Behavioral Nutrition and Physical Activity, 2014, 11:54, doi:10.1186/1479-5868-11-54