Keep on moving: new physical activity guidelines

06 December 2019

Journalist Jo Waters outlines the update on the physical activity guidelines, and explains the importance of keeping babies and toddlers active.

Lots of ‘tummy time’ for babies, as much active play for the under-fives as possible, specific advice on exercise for pregnant women and new mums, and a new weekly average of 60 minutes of activity per day for children aged five to 18. These are some of the new recommendations from the UK’s chief medical officers’ updated physical activity guidelines (Department of Health and Social Care, 2019).

Worrying new evidence has shown that, if anything, primary school children do less exercise as they get older. The new study by the University of Bristol has revealed a fall in children’s physical activity levels by the time they finish primary school. Between the ages of six and 11, children lost on average more than an hour of exercise a week, with an even greater fall at weekends (Jago et al, 2019).

Professor Craig Williams, director of the Children’s Health and Exercise Research Centre (CHERC) at the University of Exeter, says community practitioners can play an important role in spreading the recommendations to key groups.

‘For instance,’ he says, ‘180 minutes of activity a day for toddlers sounds a lot to some parents, but we need to explain that it’s not just about having allotted “exercise” periods in our days but building more activity habitually into our daily routines. For example, parents can break up their children’s screen time by taking them for a walk or encouraging them to play outdoors in a park or to help out with chores.’

He adds: ‘Finding ways to be more active as a family together is also important, whether it’s walking to school or nursery, going swimming or running around in the park. Short bursts of activity all count and add up. The new guidelines acknowledge that you don’t necessarily have to be active for a minimum of 10 minutes at a time, as the 2011 guidelines stated.’

Julia Haynes, project lead HV at Kent Community Health NHS Foundation Trust, says: ‘As a HV passionate about sharing the message that babies are #BorntoMove for the past 10 years, I am thrilled to see the new national guidelines promoting daily active play from birth. HVs are uniquely placed to encourage more physical activity and the crucial thing is to share the “why?” Families and carers are much more likely to be motivated to find time for daily tummy time when they hear that it will help vital brain connections to help babies develop conscious control of their bodies.’

Have a healthy conversation Professor

Craig Williams, director of CHERC, says: 

HVs can help spread the word about the new guidelines by getting activity and exercise into the conversation with new parents, talking about the opportunities for exercise such as going out for walks, maybe jogging with their buggy, going to the park or walking to the shops. They can suggest screen breaks for toddlers who are using iPads and point out that getting them outdoors will help them forget about using devices. They could also signpost parents to mother-and-baby and toddler groups where there are play opportunities, as well as swimming classes and other activity groups.

School nurses are ideally placed to encourage teenagers to be more active. Traditionally, teens are a hard-to-reach group but an important one – there’s evidence that cardiovascular disease and type 2 diabetes disease may already be starting to develop if they are inactive and obese. Adolescence is also an important time for building up bone density, important for preventing fractures in later life. This age group need fun, engaging activities that can ideally be done with their peer group.

Unfortunately, there are no signs yet that children are becoming more active; in fact, activity levels appear static. Our environment encourages us to be sedentary. There may also be a whole raft of social and economic barriers, such as affordability of clubs and access to green space that affect parents and children taking exercise.

I think CPs can help by encouraging parents, children and young people to establish healthy activity habits that will stand them in good stead for enjoying better health in later life.

Activity for under-fives

The new guidelines put more emphasis on starting activity as young as possible, saying infants should be physically active several times every day in a variety of ways, including interactive floor-based activity such as crawling. For infants not yet mobile, this includes at least 30 minutes of tummy time spread throughout the day while awake, and other movements such as reaching and grasping, pushing and pulling themselves independently, or rolling over. The more the better, say the guidelines.

Toddlers and pre-schoolers aged three to four should spend at least three hours a day in a variety of physical activities at any intensity, including active and outdoor play, spread throughout the day. For pre-schoolers, this should include at least 60 minutes of moderate to vigorous physical activity.

Julia says tummy time when awake also helps a baby develop its core strength in preparation for crawling. This can start from as little as a minute at a time. ‘Another important thing is that play also increases the one-to-one interaction and strengthens bonding. Many dads are very keen to get involved and when they hear that it also helps develop attention, balance and coordination in readiness for school, that is a real motivator.’

She says we should continue to promote ‘Back to sleep, tummy to play’ to parents. ‘Then babies will have the chance to move freely, out of containers such as seats. Once the babies realise how much fun daily movement play is, their physical development progresses amazingly.’

HVs should also talk to parents of toddlers about how to fit in more toddler walking, playing, rolling and pushing along toys to minimise sedentary screen time, says Julia. ‘After the introduction of the active play messages from HVs and children’s centre staff in Kent, subsequent audits of one-year reviews have shown that more children are again attaining their early developmental milestones, which are the building blocks for all later learning and school success. The new guidelines can now activate a national campaign as every child is ‘born to move’ and every family needs to know that.’

HVs should talk to parents about how to fit in more toddler walking, playing, rolling and pushing along toys

Exercise for pregnant women and new mums

Physical activity can safely be recommended to women during and after pregnancy and had no negative impact on breastfeeding postpartum, according to the guidelines. Physical activity choices should reflect activity levels before pregnancy and include strength training. Vigorous activity is not recommended for previously inactive women.

After the six- to eight-week postnatal check, and depending on how the woman feels, more intense activities can gradually resume, building up intensity from moderate to vigorous over a minimum period of three months.

The new advice has been welcomed by Clare Livingstone, professional policy adviser at the Royal College of Midwives (RCM). ‘The RCM really welcomes this guidance and the clarity it provides for pregnant women and newmothers. The new infographic advice will support midwives when discussing physical activity with women during pregnancy and after birth.’

Helping older people stay strong

Adults are advised to undertake strength-based exercise at least two days a week to help delay the decline in muscle mass and bone density that starts from around age 50.

Holly Holder, senior evidence manager at the Centre for Ageing Better, says: ‘It’s great to see these guidelines focusing on the importance of exercises which improve muscle strength and support good balance, which we know can have a huge impact on keeping us healthier for longer and reducing the risk of falls in later life. Many of us don’t realise the huge difference this kind of activity can make to our wellbeing, especially as we age.’ 

Exercise and mental health

An all-pervasive digital culture compelling children to stay indoors and stay still, and draconian reductions in opportunities for outdoor play are highlighted in a new report from the All-Party Parliamentary Group on a Fit and Healthy Childhood (APPGFHC).

Mental health through movement (APPGFHC, 2019) found that children are ‘pulled indoors’ by screens and ‘pushed away’ from outdoor play but cites examples of activity schemes that can change this such as Girls Active, the Outdoor Play and Learning Programme.

Group chair Steve McCabe MP says: ‘Nobody nowadays will deny that a crisis in children’s mental health exists. We’re saying that getting children moving is an obvious part of the solution.’

Lead author Helen Clark adds:‘The examples that we are proud to showcase in this report are proof that simply throwing money at the problem won’t do. Parents need help in learning how to dissuade their children from excessive screen use and to promote positive movement and activity.’



Department of Health and Social Care. (2019) Physical activity guidelines: UK chief medical officers’ report. See: gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report (accessed 13 November 2019).

Jago R, Salway R, Emm-Collison L, Sebire SJ, Thompson JL, Lawlo DA. (2019) Association of BMI category with change in children’s physical activity between ages 6 and 11 years: a longitudinal study (online only). International Journal of Obesity. See: https://www.nature.com/articles/s41366-019-0459-0 (accessed 13 November 2019). 

All-Party Parliamentary Group on a Fit and Healthy Childhood. (2019) Mental health through movement. See: https://royalpa.files.wordpress.com/2019/10/mentalhealththroughmovement_301019.pdf (accessed 13 November 2019).

Image credit | Alamy


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