Ecological study of playground space and physical activity among primary school children

Objectives To examine the relationship between school playground size and total physical activity (PA), fitness and fundamental movement skills (FMS) of primary school students. Design Cross-sectional ecological analysis. Setting 43 primary schools in New South Wales, Australia. Participants Data were from 5238 students, aged 5 to 12 years, participating in the Schools Physical Activity and Nutrition Survey. Outcome measures Self (for age >= 11 years) and parent (for age <11 years) report of PA (meeting PA recommendations and number of days meeting recommendations), objectively measured FMS and cardiorespiratory and muscular fitness. Results Associations between playground space and measures of PA and fitness were mostly non-linear and moderated by loose equipment. Students in schools with no loose equipment showed a weak association between space and meeting PA recommendations (self-report). In schools with equipment, students' predicted probability of meeting PA recommendations increased sharply between 15m(2) and 25m(2) per student from 0.04 (95% CI: 0.01 to 0.08) to 0.30 (95% CI: 0.14 to 0.46), but at 30m(2) returned to levels comparable to students in schools with no equipment (0.18, 95%CI: 0.07 to 0.28). For cardiorespiratory fitness, in schools with no loose equipment, probabilities for being in the healthy cardiovascular fitness zone varied between 0.66 and 0.77, showing no consistent trend. Students in schools with loose equipment had a predicted probability of being in the healthy fitness zone of 0.56 (95% CI: 0.41 to 0.71) at 15m(2) per student, which rose to 0.75 (95% CI: 0.63 to 0.86) at 20m(2) per student. There was no relationship between space and FMS. Conclusions School space guidelines need to incorporate sufficient playground space for students. Our study provides evidence supporting better PA outcomes with increasing space up to 25m(2) per student, and access to loose equipment, however further research is required to determine precise thresholds for minimum space. Intersectoral planning and cooperation is required to meet the needs of growing school populations.