bmj open · assessed using the 20 m shuttle-run test (shuttle-run), an incremental running test to...

For peer review only

Is Olympic Inspiration Associated with Fitness and Physical Activity in English Schoolchildren? A Cross-Sectional

Comparison 18 months after London 2012.

Journal: BMJ Open

Manuscript ID bmjopen-2016-011670

Article Type: Research

Date Submitted by the Author: 31-Mar-2016

Complete List of Authors: Sandercock, Gavin; University of Essex, Biological Sciences Beedie, Chris; Canterbury Christ Church University Mann, Steve; UK Active, ukactive Research Institute; Coventry University,

Faculty of Health and Life Sciences

<b>Primary Subject Heading</b>:

Public health

Secondary Subject Heading: Sports and exercise medicine, Epidemiology

Keywords: EPIDEMIOLOGY, SPORTS MEDICINE, PUBLIC HEALTH

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml

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Is Olympic Inspiration Associated with Fitness and Physical Activity in English

Schoolchildren? A Cross-Sectional Comparison 18 months after London 2012.

*Gavin RH Sandercock, Chris Beedie3, Steve Mann

1, 2

*Centre for Sport and Exercise Science,

School of Biological Sciences

University of Essex,

Colchester, UK.

CO43SQ.

Email [email protected]

Tel: 01206872043

Fax: 01207872648

1 ukactive Research Institute, 26-28 Bedford Row, London WC1, United Kingdom

2 School of Human and Life Sciences, Canterbury Christchurch University, Canterbury,

United Kingdom.

3Centre for Applied Biological and Exercise Sciences, Faculty of Health and Life Sciences,

Coventry University, Coventry, United Kingdom

Word Count: 3042

Tables: 2

Keywords: Public health, Sports medicine, Epidemiology

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Schoolchildren? A Cross-Sectional Comparison 18 months after London 2012.

ABSTRACT

Objectives: To compare cardiovascular fitness and physical activity of schoolchildren 18-

months after London 2012 according to Olympic ‘inspiration’.

Design: A cross-sectional comparison between-groups of schoolchildren categorised

according to self-reported Olympic inspiration.

Setting: Schools within a 50 km radius of the Olympic Park, Stratford, London.

Participants: n=931 10.0-15.9 year olds attending six schools assessed in 2013 and 2014 (18

[range:14-20] months after London 2012).

Primary Outcome Measures: Self-reported Olympic inspiration; cardiorespiratory fitness

assessed using the 20 m shuttle-run test performance and expressed as �� O2peak (ml·kg-1

·min-1

)

and self-reported physical activity (Physical Activity Questionnaire for Children or

Adolescents).

Secondary Outcomes Measures: BMI expressed as an age- and sex-normalised z-score.

Results: 53% of children reported being inspired to try new sports or activities. Compared

with those not inspired by the Games, �� O2peak was higher in boys (Effect Size, d=0.43) and

girls (d=0.27), who continued to participate in activities at 18(14-20) months. This 45% of

sample were also more physically active (boys, d=0.23; Girls d=0. 38) than those not

inspired. The 8% of participants who no-longer participated in activities inspired by the

Olympics were less active (boys d=0.24, girls d=0.21) than those still participating.

Conclusions: It is impressive that more-than of children report being to inspired try, and 45%

continued to participate in, new activities 18-months after London 2012. This the first study

to provide potential evidence for a health-related legacy associated with hosting the

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Olympics. Observing higher levels of cardiorespiratory fitness and physical activity in

children inspired by the Games is encouraging. These cross-sectional data must, however, be

interpreted with caution and within the context of declining fitness in English youth.

Olympic host countries should employ longitudinal monitoring of fitness and physical

activity to provide stronger evidence for health-related legacies.

Article Summary

• This is paper describes the differences in measures of fitness, physical activity and

BMI of schoolchildren according to their self-reported level of inspiration by London

2012.

Strengths and limitations of this study.

• This is the first study to assess associations between Olympic inspiration and health-

related fitness; the use of objectively measured cardiorespiratory fitness is a strength

of the study.

• The sample was drawn from schools close to the Olympic Park (<50 km) that had

participated in previous studies allowing comparisons with values recorded before

2012.

• The cross-sectional design is a limitation as it did not allow the inference of causation.

• Sampling of participants at different times following London 2012 and the use of self-

reported physical activity are also limitations.

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INTRODUCTION

In 2005, the International Olympic Committee awarded Great Britain the 2012 Olympic

Games based on their bid which promised to: ‘inspire a generation’ and ‘create a legacy of

sport and healthy living’. Such promises were made despite no evidence of such effects from

previous multi-sport events 1 2

.

Prior to London 2012, Shipway 3 highlighted the need for evidence to justify the economic

costs of hosting sporting mega-events. McCartney et al.1 found no evidence of health benefits

in countries hosting previous mega-events and proposed; ‘robust, long-term evaluations’

should be put in place to assess the impact of London 2012. Beyond the extant 4 Active

People Survey (APS) none were commissioned.

The Active People Survey (APS) showed an initial increase of 530,000 adults participating in

1 x 30 min weekly sports from April 2012-April 2013. Subsequent data (October 2012-

October 2013)4 showed a decline in the number of 16-25 year-olds participating in 1 x 30 min

weekly sport, a trend which has continued5.

All of the above metrics are subjective in nature and none are indicative of health in the way

that objectively-assessed physical activity or cardiorespiratory fitness are. The validity of

even the most-detailed, subjective assessments of children’s habitual activity is increasingly

coming under scrutiny6. Self- or proxy-reporting remains the dominant assessment tool in

population-based surveys due to the financial cost, time constraints, participant burden and

methodological difficulties of objectively assessing physical activity6. Assessment of

cardiorespiratory fitness provides an objective, cost-effective means to assess the health of

adults and children. Cardiorespiratory fitness is more-strongly related to health status than

(particularly self-reported) measures of physical activity7 8

.

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Our objective was to assess the legacy of London-2012 by examining associations between

Olympic inspiration and children’s fitness and physical activity. We hypothesised that

inspiration from London-2012 would be associated with better cardiorespiratory fitness,

higher levels of physical activity and lower BMI values.

METHODS

Study Design

Ethical approval was granted by the University Ethics Committee. School, parental and pupil

informed consent were also secured ahead of data collection.

The primary outcome measure was cardiorespiratory fitness assessed using the 20m shuttle-

run test. Using previously reported mean (±SD) values9 converted to �� O2

10. Assuming

differences in �� O2 of 2 ml·kg-1

·min-1

(boys) and 1.5 ml·kg-1

·min-1

(girls) represent meaningful

between-group differences, we calculated that n=100 boys and n=120 girls per group were

needed to achieve statistical significance (α=0.05, β=0.80).

Written invitations were sent to nine schools located within 50 km of the Olympic park

(Stratford, London). From nine respondents we selected two secondary (one in a rural area)

and four primary (one rural) schools to approximate the population distribution of the study

area.

Participants For comparability with published data on children from this region we used the

same inclusion and exclusion criteria as previous studies9 11

. All consenting pupils aged

between 10.0 and 15.9 years were eligible for the study. Those with medical conditions,

illness or injuries that precluded participation in normal PE lessons were excluded.

Protocol

Participants’ date of birth was used to calculate decimal age on day of testing. Home

postcode was used to calculate area-level deprivation using the English Indices of

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Deprivation12

and land use (rural or urban) using Geoconvert to access data from the National

Statistics Postcode Directory13

.

Stature to nearest 0.1 cm and mass to nearest 0.1 kg were measured with participants dressed

in standard physical education clothing and without shoes. Body Mass Index (BMI) was

calculated (kg·m-2

) and converted to z-scores14

. Cardiorespiratory fitness (fitness) was

assessed using the 20 m shuttle-run test (shuttle-run), an incremental running test to volitional

exhaustion. Total shuttle count was recorded and converted first to maximal running speed

then to estimated �� O2peak (ml·kg-1

·min-1

)10

. Participants also reported their physical activity

over the past 7-days using an English language version of the Physical Activity Questionnaire

for Adolescents (PAQ-A)15

. The PAQ-A is scored from 1 (very low physical activity) to 5

(highly active). Normative data for English children are available and scores show moderate

association with objective measures and cardiorespiratory fitness.

Inspiration to try, and persistence with, new activities were measured using items adapted

from the Chance to Shine Survey16

using closed (Yes/No) responses.

Data analysis

We grouped children’s according to their self-reported ‘Inspiration as: ‘None’ if they had not

tried a new sport or activity; ‘Brief’, if they tried new activity but ceased participating 18

(14-20) months after London 2012.; ‘Continued’ if they continued to participate in an

Olympic-Inspired activity at the time of assessment.

We calculated the intraclass correlation coefficient (ICC = between-school

variance/(between-school variance+within-school variance)) to assess whether outcomes

clustered within schools (low ICC (close to 0) = no/little clustering; high ICC (close to 1) =

most/all variance is explained by clustering).

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We examined differences in fitness (�� O2peak ml·kg-1

·min-1

), Physical Activity (PAQ-A score)

and BMI (z-score), using ANCOVA with post hoc Bonferroni Comparisons and controlling

for area-level deprivation and time of testing. Expressing BMI as a z-score corrects for

skewness, kurtosis and age. We used age as a covariate only in the analyses of physical

activity and fitness. To examine the potential causative pathway by which differences in

physical activity may account for differences in fitness we used ANCOVA to examine

between-group differences in fitness while controlling for physical activity (PAQ-A/C score)

in addition to deprivation and age).

We set statistical significance at p<0.05 and reported mean differences (95%CI) and

standardized effect sizes (Cohen’s d) for between-group differences. We assumed a minimum

important effect size of d=0.2 (small), d=0.5 as medium and d=0.8 as large17

. All analyses

were performed using SPSS version 20 (SPSS Inc. An IBM Company, Chicago, Il.)

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RESULTS

Table. 1 Demographic characteristics, outcome measures, engagement and Olympic

inspiration in schoolchildren from the East of England measured 18±2 months following

London 2012.

Boys, n=513 Girls n=418 Boys

ICC

Girls

ICC

Mean SD Mean SD

Age 12.4 (1.46) 12.3 (1.50)

�� O2peak (ml·kg-1

·min-1

)a 44.2 (5.45) 40.1 (5.58) R =0.11 R =0.12

Physical Activity (PAQ-A)b 2.92 (0.72) 2.58 (0.61) R =0.10 R =0.09

BMI (kg·m-2

) 19.1 (4.06) 19.8 (4.39)

BMI (z-score) 0.32 (1.42) 0.39 (1.24) R=0.09 R =0.08

Deprivation (EID)d 11.65 (5.90) 11.73 (6.52) R =0.27 R =0.31

Urbane 27% (n=138) 25% (n=104)

Rurale 73% (n=375) 75% (n=314)

Followed 2012 Olympics

A lot 57.2% (n=293) 60.1% (n=251)

A little 42.8% (n=220) 39.9% (n=167)

Inspired to try new activity 54.3% (n=279) 49.3% (n=206)

Continued at 12-months 45.2% (n=232) 40.0% (n=167)

ICC: Intracluster Correlation Coefficients; BMI-Body mass index, z-score calculated using

the UK1990 Growth Reference (Cole et al., 1995). a-estimated from 20 m shuttle-run using

equation of Leger et al. (1988); bPAQ-A – physical activity questionnaire for adolescents;

c-

Defined using the International Obesity Task Force criteria, , dEID - English Indices of

Deprivation (Office for National Statistics, 2010); eUrban included urban, town and fringe,

Rural includes Villages and Isolated Dwellings (National Statistics Postcode Directory,

2010).

The sample comprised n=931 pupils (55% boys) from school years (grades) 6-11 drawn from

six schools Demographic characteristics and values for outcome measures are presented in

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Table 1 separately for boys and girls. There were no differences in age, deprivation,

rural/urban dwelling or BMI (z-score) according to sex. Boys had higher cardiorespiratory

fitness and reported higher levels of physical activity than girls. There was little evidence of

between-school clustering of BMI or physical activity, and the between-cluster ICCs for

�� O2peak were only marginally greater than R=0.10. There was strong evidence of clustering

for area-level deprivation and controlling for this variable reduced ICCs for all outcome

variables R<0.06. We chose, therefore not to correct for clustering but controlled for

deprivation in all analyses.

Overall, 54.3% of boys and 49.3% of girls reported London 2012 had inspired them to try a

new sport or activity (Supplementary Table 1 lists the activities reported). Of those inspired,

83.3% of boys and 81.3% of girls reported they continued to participate in this sport one year

later with only n=79 children confirming they no longer participated.

Table 2 shows mean values by group and results of ANCOVA adjusting for age and

deprivation. There were significant main effects for fitness and physical activity in both sexes

and a significant main effect for BMI in girls. In boys, post hoc analysis showed the

Continued group were fitter (d=0.43) and more active (d=0.38) than the None group.

Continued had higher fitness (d=0.43) and were more active (d=0.23) than the group. There

were no significant differences between boys in the None and Brief groups. Girls classified as

Continued were significantly fitter (d=0.27), more active (d=0.34) and also had a lower BMI

(d=0.32) than the None group. Girls in the Continued group were more active (d=0.24) than

those in the Brief group

Controlling for physical activity rendered the main effect for inspiration on fitness non-

significant in boys (F=2.6, p=0.075) and greatly attenuated the main effect in girls (F=0.74,

p=0.48). There were no significant between-group differences in fitness (all post hoc tests

p>0.1) when we controlled for physical activity.

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Table 2. Fitness, physical activity and body mass index in 10-15.9 year olds from the

East of England measured 18 months post-2012 according to self-reported Olympic

Inspiration.

Olympic Inspiration Categories:

None Brief Continued ANCOVA

Boys Mean (SD) Mean (SD) Mean (SD)

�� O2peaka

(ml·kg-1

·min-1

)

43.4 (4.93) 43.2 (4.12) **

45.4 (6.00) F=9.35† p<0.001

Physical Activityb

(PAQ-A)

2.78 (0.70) 2.88 (0.75) *3.04 (0.65) F=8.84

†† p<0.001

BMI

(z-score)

0.32 (1.42) 0.35 (0.97) 0.39 (1.21) F=0.23† p=0.798

Girls Mean (SD) Mean (SD) Mean (SD)

�� O2peak

(ml·kg-1

·min-1

)

39.5 (4.61) 39.9 (4.91) *40.9 (5.59) F=4.02

† p=0.019

Physical Activity

(PAQ-A)

2.51 (0.68) 2.58 (0.62) *2.72 (0.55) F=8.22

†† p<0.001

BMI

(z-score)

0.58 (1.15) 0.39 (1.14) *0.20 (1.24) F=5.94

† p=0.003

Legend: None –children who had not tried a new sport or activity; Brief-children who had

tried a new activity but discontinued participation at 18-months; Continued – children who

had both tried a new activity and who continued to participate at 18 months. aVO2peak (ml·kg

-1·min

-1) estimated from 20 m shuttle-run test (Leger et al., 1988).

bPhysical

Activity is 7-day self-reported value (1-5) from the Physical Activity Questionnaire for

Adolescents. BMI – Body mass index presented as age- and sex-normalised z-score based

UK1990 Growth Reference (Cole et al. 1995). †Controlling for time of testing and area level deprivation;

†† Controlling for time of testing,

area level deprivation and decimal age. *Indicates value is significantly (Bonferroni post hoc

test, p<0.05) different from ‘Uninspired’ group; *Indicates value is significantly (Bonferroni

post hoc test, p<0.05) different from all other groups.

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DISCUSSION

Repeat cross-sectional cohort comparisons have provided evidence of the declines in English

children’s fitness9 18-20

. the London Olympic committee’s vision when they promised to

‘inspire a generation’ The self-reported data regarding inspiration are broadly comparable

with those of the Chance to Shine Survey16

54% of parents reported that their children had

been inspired to try a new sport following London 2012.

Our cross-sectional data are encouraging as they indicate that boys and girls inspired by

London 2012 who continued to participate in new activities were fitter, more physically

active than tended to have lower BMI than those not inspired (None) by the games. Brief

inspiration, however was not associated with fitness, physical activity or BMI which may

suggest that legacy development activities should focus on supporting children to help them

maintain participation in any activities initially taken up due to Olympic inspiration, a

sentiment highlighted before the games3 and one noted following other mega-events

21.

Fitness is more-strongly correlated with current22

rather than historical physical activity

habits23

24

, this attenuating effect therefore suggests boys inspired by the Olympics were fitter

because they were more active at time of testing.

The BMI of girls in the Continued group was lower than those in the None and Brief

inspiration groups. We cannot infer causality or directionality for the associations between

Olympic inspiration BMI, physical activity or fitness, physical. It was not possible to recruit a

control group who were not exposed to London 2012 and we cannot infer causality based on

these cross sectional findings. Comparing our results with those reported for children from

this region between 2007 and 2008 provides some context however. A cross sectional

investigation based on 2007-8 data reported 22% of (n=6628) 10-16 year olds had estimated

�� O2peak below age- and sex-specific criterion values recommended for health25

. The present

study lacked the statistical power to analyse categorical data of this kind. However, using the

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same criteria25

, we can calculate that 34.8% (n=348) of the n=931 children tested had poor

cardiorespiratory fitness. There also seems to be a gradient in the prevalence of poor fitness

across the inspiration groups from 40.9% (None) and 35.1% (Brief ) to 27.5% (Continued);

all of which are higher than reported five years previously.

The high proportion of participants with poor cardiorespiratory fitness is in contrast with the

prevalence of obesity particularly in boys (4.8%) but also in girls (6.8%). The overall

prevalence (5.7%) is, however, identical to that reported in 2007-825

. We have previously

reported poorer shuttle-run performance accompanied by lower BMI in a repeat cross-

sectional study of younger children from this region26

. These divergent trends strongly

suggest falls in physical activity levels.

The present data represent the first attempt to objectively identify a health-related legacy

from the hosting of an Olympic Games1 2

. While cross-sectional, our findings suggest some

potential benefits to cardiorespiratory fitness, mediated by higher physical activity levels, in

those schoolchildren inspired to try new activities. The proportion of those sampled who

reported continued engagement in Olympics-inspired activities (45%) is impressive but in

any benefits must be evaluated in context, against falling levels of cardiorespiratory fitness

and physical9 18-20 25

.

Hopes for a health-related legacy were laid at the feet of the London 2012 organisers despite

a total lack of evidence for such an effect following previous Games1. London 2012 did not

happen in isolation and many other factors might be responsible for changes in physical

activity levels that may have off-set any benefits to children’s fitness arising from London

2012. The lack of strategy regarding children’s activity and health has been compared to

neglect27

. During the period of this study, and in the run up to London 2012, the government

rescinded on the five hour offer of PE at schools, cutting funding to the English school sports

partnerships scheme. The Government also withdrew the previous administration’s offer of

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free swimming for all children. Swimming remains England’s most popular sporting activity4

but participation is currently declining5. Reducing opportunities for regular physical activity

during PE and through free swimming may have offset potential benefits from hosting

London 2012. The lack of any health-related fitness monitoring either before or since the

Games demotes this hypothesis to the level of mere conjecture.

Study Limitations

The sample population is drawn from an area geographically proximal to the Olympic park

itself, mostly from commuter towns with direct transport links to Stratford. It is also a

predominantly affluent area and one that has benefited from legacy investment projects. We

hypothesise that any such impact of London 2012 would be smaller if assessed nationally.

Despite calls for the introduction of health-related fitness assessment28-30

, the continued lack

of any such national surveillance leaves such hypotheses untestable. The opportunity sample

of schools that volunteered to participate may have produced selection bias but this is

difficult to quantify due to the paucity of nationally representative cardiorespiratory fitness

data.

Our study design means we cannot infer causality or identify the directionality of any

associations found. It may well be that those individuals inspired by London 2012 were

already physically active and fitter prior to London 2012. Our findings suggest higher

physical activity as the common denominator observed in those children inspired by London

2012 who we found to be fitter and to have a lower BMI than their less-inspired peers.

Without longitudinal data regarding physical activity we cannot infer any cause-and-effect

relationship between inspiration, physical activity and fitness. A longitudinal study including

objective measures of children’s health may have been able to provide more tangible

evidence; yet no such data exist for London 2012 or for any other Games2 3

. This paucity of

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evidence exists despite recommendations that decision makers should; ‘include robust, long

term evaluations as part of their design and implementation of events’1.

CONCLUSIONS

We found evidence for higher cardiorespiratory fitness in the 45% of schoolchildren who

continued to participate in activities inspired by the Olympics 18 months after London 2012.

Inspiration alone is not sufficient and our findings reiterate the importance of continued

investment in support networks to capitalise on any impetus that hosting major sporting

events may provide in promoting health-related behaviour change3 21 31

.

The cost of hosting future mega-events cannot be justified based on the assumption they will

automatically produce health-related benefits. To justify such costs, decision makers must

work with key stakeholders to formulate sustainable legacy development plans that include

objective longitudinal evaluations of key health outcome measures.

These findings may indicate a health-related legacy from London 2012 but the true scale of

which will likely remain undetected due to the lack of appropriate health surveillance

measures to assess any impact that events like London 2012 may have.

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ACKNOWLEDGEMENTS: Thank you to all the schools who participated, to the

researchers who helped collect the data, to Mark Walker at Writtle College for logistical

arrangements and to Christine Voss for the initial data handling protocols.

FUNDING STATEMENT: This work was funded by Provide Public Health (Grant:

DB0800H1).

COMPETING INTERESTS: The author declares that there are no conflicts of interest.

CONTRIBUTORSHIP STATEMENT: Sandercock devised the study and performed the

statistical analysis. Beedie and Mann contributed to writing the manuscript. All authors were

involved in the final drafting and pre-submission revision of the manuscript.

DATA SHARING: No additional data available

REFERENCES.

1. McCartney G, Thomas S, Thomson H, et al. The health and socioeconomic impacts of

major multi-sport events: systematic review (1978-2008). BMJ 2010;340:c2369.

2. Campbell D. Republished editorial: London's Olympic public health legacy: will it turn to

dust? Br J Sport Med 2013;47(11):687-91.

3. Shipway R. Sustainable legacies for the 2012 Olympic Games. J Royal Soc Prom Health

2007;127(3):119-24.

4. England S. Active People Survey 7 Oct 2012 - Oct 2013. Active People Survey: DCMS,

2013.

5. England S. Active People Survey: Once a week participation (National) 14+ APS9 Q2.

Active People Survey. London, UK, 2015.

6. Helmerhorst HJ, Brage S, Warren J, et al. A systematic review of reliability and objective

criterion-related validity of physical activity questionnaires. Int J Behav Nutr Phys

Act 2012;9:103.

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7. Simons-Morton BG, Parcel GS, O'Hara NM, et al. Health-related physical fitness in

childhood: status and recommendations. Annu Rev Public Health 1988;9:403-25.

8. Schmidt MD, Cleland VJ, Thomson RJ, et al. A comparison of subjective and objective

measures of physical activity and fitness in identifying associations with

cardiometabolic risk factors. Ann Epidemiol 2008;18(5):378-86.

9. Sandercock G, Voss C, McConnell D, et al. Ten year secular declines in the

cardiorespiratory fitness of affluent English children are largely independent of

changes in body mass index. Arch Dis Child 2010;95(1):46-47.

10. Leger LA, Mercier D, Gadoury C, et al. The multistage 20 metre shuttle run test for

aerobic fitness. J Sport Sci 1988;6(2):93-101.

11. Voss C, Sandercock G. Aerobic fitness and mode of travel to school in English

schoolchildren. Med Sci Sports Exerc 2010;42(2):281-7.

12. Office.For.National.Statistics. The English Indices of Deprivation 2007 (revised).

London.: Office of The Deputy Prime Minister, 2007.

13. ONS. National Statistics Postcode Directory (NSPD). London: Office for National

Statistics, 2007.

14. Cole TJ, Bellizzi MC, Flegal KM, et al. Establishing a standard definition for child

overweight and obesity worldwide: international survey. BMJ 2000;320(1240):1-6.

15. Voss C, Ogunleye AA, Sandercock GR. Physical Activity Questionnaire for Children and

Adolescents: English norms and cut-points. Pediatr Int 2013;55(4):498–507.

16. Shine Ct. London 2012 Olympics: 100 days on. 2012.

17. Batterham AM, Atkinson G. How big does my sample need to be? A primer on the murky

world of sample size estimation. Phys Ther Sport 2005;6(3):153-63.

18. Tomkinson GR, Olds TS. Secular changes in pediatric aerobic fitness test performance:

the global picture. Med Sci Sports 2007;50:46-66.

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19. Boddy LM, Fairclough SJ, Atkinson G, et al. Changes in cardiorespiratory fitness in 9-

10.9year old children: SportsLinx 1998-2010. Med Sci Sports Exerc 2011.

20. Stratton G, Canoy D, Boddy LM, et al. Cardiorespiratory fitness and body mass index of

9-11-year-old English children: a serial cross-sectional study from 1998 to 2004. Int J

Obes (Lond) 2007;31(7):1172-8.

21. Derom I, Lee D. Vancouver and the 2010 Olympic Games: physical activity for all? J

Phys Act Health 2014;11(8):1556-64.

22. Perusse L, Tremblay A, Leblanc C, et al. Genetic and environmental influences on level

of habitual physical activity and exercise participation. Am J Epidemiol

1989;129(5):1012-22.

23. Ceaser TG, Fitzhugh EC, Thompson DL, et al. Association of physical activity, fitness,

and race: NHANES 1999-2004. Med Sci Sports Exerc 2013;45(2):286-93.

24. Ridgers ND, Graves LE, Foweather L, et al. Examining influences on boy's and girls'

physical activity patterns: the A-CLASS project. Pediatr Exerc Sci 2010;22(4):638-

50.

25. Sandercock GRH, Ogunleye A, Voss C. Comparison of cardiorespiratory fitness and

body mass index between rural and urban youth: Findings from the East of England

Healthy Hearts Study. Pediatr Int 2011;53(5):718-24.

26. Sandercock GRH, Ogunleye A, Voss C. Six-year changes in body mass index and

cardiorespiratory fitness of English schoolchildren from an affluent area. Int J Obesity

2015;39(10):1504-07.

27. Weiler R, Allardyce S, Whyte GP, et al. Is the lack of physical activity strategy for

children complicit mass child neglect? Br J Sports Med 2013.

28. Chief Medical Officer. The 2009 Annual Report of the Cheif Medical Officer. London,

UK: Department of Heatlh. 2009.

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29. ukactive. Generation Inactive: An analysis of the UK's childhood inactivity epidemic and

tangible solutions to get children moving. London, UK: UK Active, 2015.

30. Cohen D, Voss C, Sandercock GRH. 'Fitness Testing' for Children: Let's Mount the

Zebra! J Phys Act Health 2015;12(5):597-603

31. Mahtani KR, Protheroe J, Slight SP, et al. Can the London 2012 Olympics 'inspire a

generation' to do more physical or sporting activities? An overview of systematic

reviews. BMJ open 2013;3(1).

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Supplementary Table 1. Detailed Listing of Sports and Activities Inspired by The Olympic Games in

a subsample of schoolchildren from the East of England measured 18±2 months following London

2012.

Sport or Activity

n= % Sport or Activity n= %

Summer Olympics Events

Running or Athletics 103 21.2 Hockey 3 .6

Swimming/Synchronized-

Swimming

61 12.6 Table tennis 3 .6

Football 36 7.4 Fencing 2 .4

Gymnastics 32 6.6 Kayaking 2 .4

Rugby 32 6.6 Rowing 2 .4

Basketball 28 5.8 Sailing 2 .4

Netball 25 5.2 Shooting 2 .4

Cycling 20 4.1 Squash 1 .2

Tennis 19 3.9 Volleyball 1 .2

Trampolining 17 3.5 Total n=485 95.4%

Handball 13 2.7 Non-Olympic Events n= %

Badminton 12 2.5 Cricket 8 1.6

Diving 8 1.6 Parkour 4 .8

Martial Arts 8 1.6 Rounders 4 .8

Boxing 7 1.4 Golf 3 .6

Canoeing 6 1.2 Cheerleading 2 .4

BMX 5 1.0 Ice skating 2 .4

Archery 4 .8 Total 23 4.6%

Equestrian 4 .8

Waterpolo 4 .8 Missing/Illegible 4

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STROBE Statement—Checklist of items that should be included in reports of cohort studies

page Item

No Recommendation

Title and abstract 2 1 (a) Indicate the study’s design with a commonly used term in the title or the

abstract

2 (b) Provide in the abstract an informative and balanced summary of what was

done and what was found

Introduction

Background/rationale 3 2 Explain the scientific background and rationale for the investigation being

reported

Objectives 4 3 State specific objectives, including any prespecified hypotheses

Methods

Study design 4 4 Present key elements of study design early in the paper

Setting 5 5 Describe the setting, locations, and relevant dates, including periods of

recruitment, exposure, follow-up, and data collection

Participants 5 6 (a) Give the eligibility criteria, and the sources and methods of selection of

participants. Describe methods of follow-up

- (b) For matched studies, give matching criteria and number of exposed and

unexposed

Variables 5/6 7 Clearly define all outcomes, exposures, predictors, potential confounders,

and effect modifiers. Give diagnostic criteria, if applicable

Data sources/

measurement

5/6 8* For each variable of interest, give sources of data and details of methods of

assessment (measurement). Describe comparability of assessment methods if

there is more than one group

Bias 11 9 Describe any efforts to address potential sources of bias

Study size 5 10 Explain how the study size was arrived at

Quantitative variables 5/6 11 Explain how quantitative variables were handled in the analyses. If

applicable, describe which groupings were chosen and why

Statistical methods 6 12 (a) Describe all statistical methods, including those used to control for

confounding

- (b) Describe any methods used to examine subgroups and interactions

- (c) Explain how missing data were addressed

- (d) If applicable, explain how loss to follow-up was addressed

- (e) Describe any sensitivity analyses

Results

Participants 7 13* (a) Report numbers of individuals at each stage of study—eg numbers

potentially eligible, examined for eligibility, confirmed eligible, included in

the study, completing follow-up, and analysed

(b) Give reasons for non-participation at each stage

(c) Consider use of a flow diagram

Descriptive data 5 14* (a) Give characteristics of study participants (eg demographic, clinical,

social) and information on exposures and potential confounders

(b) Indicate number of participants with missing data for each variable of

interest

(c) Summarise follow-up time (eg, average and total amount)

Outcome data 5 15* Report numbers of outcome events or summary measures over time

Main results 5 16 (a) Give unadjusted estimates and, if applicable, confounder-adjusted

estimates and their precision (eg, 95% confidence interval). Make clear

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which confounders were adjusted for and why they were included

(b) Report category boundaries when continuous variables were categorized

(c) If relevant, consider translating estimates of relative risk into absolute risk

for a meaningful time period

Other analyses 5 17 Report other analyses done—eg analyses of subgroups and interactions, and

sensitivity analyses

Discussion

Key results 6 18 Summarise key results with reference to study objectives

Limitations 7 19 Discuss limitations of the study, taking into account sources of potential bias

or imprecision. Discuss both direction and magnitude of any potential bias

Interpretation 6 20 Give a cautious overall interpretation of results considering objectives,

limitations, multiplicity of analyses, results from similar studies, and other

relevant evidence

Generalisability 7 21 Discuss the generalisability (external validity) of the study results

Other information

Funding -na- 22 Give the source of funding and the role of the funders for the present study

and, if applicable, for the original study on which the present article is based

*Give information separately for exposed and unexposed groups.

Note: An Explanation and Elaboration article discusses each checklist item and gives methodological background and

published examples of transparent reporting. The STROBE checklist is best used in conjunction with this article (freely

available on the Web sites of PLoS Medicine at http://www.plosmedicine.org/, Annals of Internal Medicine at

http://www.annals.org/, and Epidemiology at http://www.epidem.com/). Information on the STROBE Initiative is

available at http://www.strobe-statement.org.

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Is Olympic Inspiration Associated with Fitness and Physical Activity in English Schoolchildren? A Repeated Cross-

Sectional Comparison before and 18 months after London 2012.

Journal: BMJ Open

Manuscript ID bmjopen-2016-011670.R1

Article Type: Research

Date Submitted by the Author: 16-Jun-2016

Complete List of Authors: Sandercock, Gavin; University of Essex, Biological Sciences Beedie, Chris; Canterbury Christ Church University Mann, Steve; UK Active, ukactive Research Institute; Coventry University, Faculty of Health and Life Sciences

<b>Primary Subject Heading</b>:

Public health

Secondary Subject Heading: Sports and exercise medicine, Epidemiology

Keywords: EPIDEMIOLOGY, SPORTS MEDICINE, PUBLIC HEALTH


BMJ Open on D

ecember 7, 2020 by guest. P

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Schoolchildren? A Repeated Cross-Sectional Comparison Before and 18 months After

London 2012.

*Gavin RH Sandercock, Chris Beedie3, Steve Mann

1, 2

*Centre for Sport and Exercise Science,

School of Biological Sciences

University of Essex,

Colchester, UK.

CO43SQ.

Email [email protected]

Tel: 01206872043

Fax: 01207872648

1 ukactive Research Institute, 26-28 Bedford Row, London WC1, United Kingdom

2 School of Human and Life Sciences, Canterbury Christchurch University, Canterbury,

United Kingdom.

3Centre for Applied Biological and Exercise Sciences, Faculty of Health and Life Sciences,

Coventry University, Coventry, United Kingdom

Word Count: 3042

Tables: 2

Keywords: Public health, Sports medicine, Epidemiology

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Schoolchildren? A Repeated Cross-Sectional Comparison Before and 18-months After

London 2012.

ABSTRACT

Objectives: To compare cardiovascular fitness and physical activity of schoolchildren 18-

months after London 2012 according to Olympic ‘inspiration’.

Design: A cross-sectional comparison between-groups of schoolchildren categorised

according to self-reported Olympic inspiration and a repeated cross-sectional comparison

using data collected pre-2012.

Setting: Schools within a 50km radius of the Olympic Park, Stratford, London.

Participants: n=931 10.0-15.9 year-olds attending six schools assessed in 2013 and 2014 (18

[range:14-20] months after London 2012) and n=733 students from the same schools

assessed in 2008-2009, 42 (38-46) months before London 2012.

Primary Outcome Measures: Self-reported Olympic inspiration; cardiorespiratory fitness

(��O2peak ml·kg-1

·min-1

) assessed using the 20 m shuttle-run and self-reported physical activity.

Secondary Outcomes Measures: Differences in �� O2peak before and after London 2012.

Results: 53% of children reported being inspired to try new sports or activities. Compared

with those not inspired by the Games, �� O2peak was higher in boys (d=0.43) and girls

(d=0.27), who continued to participate in activities at 18(14-20) months. This 45% of sample

were also more physically active (boys, d=0.23; girls d=0.38) than those not or only briefly

inspired to participate in activities (boys, d=0.24; girls, d=0.21). Compared with pre-2012

values, �� O2peak was lower post-2012 in boys (d=0.37) and in girls (d=0.38).

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Conclusions: High levels of inspiration to participate in new activities reported following

London 2012 and positive associations with fitness are both encouraging. We cannot discount

the possibility that inspired participants may have already been fitter and more active pre-

2012. These associations must be interpreted in the context of the significant declines in

fitness shown by our repeated-cross sectional comparison. Olympic host countries should

employ longitudinal monitoring using objectively measured fitness and physical activity to

provide evidence of health-related legacy.

Article Summary

This is paper describes the differences in measures of fitness, physical activity and BMI of

schoolchildren according to self-reported inspiration from London 2012 and provides a

comparison of these measures made in children from the same schools five years previously.

Strengths and limitations of this study.

This is the first study to assess associations between Olympic inspiration and health-related

fitness; the use of objectively measured cardiorespiratory fitness is study strength.

The cross-sectional design is a limitation, as it did not allow the inference of causation.

Comparing data collected 18 months after London 2012 with those of children attending the

same schools five years earlier is a strength of the study.

Sampling of participants at different times following London 2012 and the use of self-

reported physical activity are also limitations.

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INTRODUCTION

In 2005, the International Olympic Committee awarded Great Britain the 2012 Olympic

Games based on their bid which promised to: ‘inspire a generation’ and ‘create a legacy of

sport and healthy living’. Such promises were made despite no evidence for such effects from

previous multi-sport events 1 2

.

Prior to London 2012, Shipway 3 highlighted the need for evidence to justify the economic

costs of hosting sporting mega-events. McCartney et al.1 found no evidence of health benefits

in countries hosting previous mega-events and proposed; ‘robust, long-term evaluations’

should be put in place to assess the impact of London 2012. Beyond the extant 4 Active

People Survey (APS) none were commissioned.

The Active People Survey (APS) showed an initial increase of 530,000 adults participating in

1 x 30 min weekly sports from April 2012-April 2013. Subsequent data (October 2012-

October 2013)4 showed a decline in the number of 16-25 year-olds participating in 1 x 30

min weekly sport, a trend which has continued5.

All of the above metrics are subjective and none are indicative of health as objective

measures of physical activity and cardiorespiratory fitness are known to be6. The validity of

even the most-detailed, subjective assessments of children’s habitual activity is increasingly

coming under scrutiny7. Self- or proxy-reporting remains the dominant assessment tool in

population-based surveys due to the financial cost, time constraints, participant burden and

methodological difficulties of objectively assessing physical activity7. Assessment of

cardiorespiratory fitness provides an objective, cost-effective means to assess the health of

adults and children. Cardiorespiratory fitness is more-strongly related to health status than

(particularly self-reported) measures of physical activity6.

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Our objective was to assess the legacy of London-2012 by examining whether uptake of

sports and activities inspired by the Olympics was associated with children’s fitness and

physical activity and BMI. As changes in all three measures have been reported in the last

decade8-10

, we compared post-London-2012 values with existing data collected in the same

schools (2008-2009) as part of the East of England Healthy Hearts Study (EoEHHS)8 11

.

METHODS

Study Design

Ethical approval was granted by the University Ethics Committee. School, parental and pupil

informed consent were also secured ahead of data collection.

The primary outcome measure was cardiorespiratory fitness assessed using the 20m shuttle-

run test performance converted to estimated �� O2peak12

. Assuming differences in �� O2peak of 2

ml·kg-1

·min-1

(boys) and 1.5 ml·kg-1

·min-1

(girls) represent meaningful differences, we

calculated that n=100 boys and n=120 girls per group were needed to achieve statistical

significance (α=0.05, β=0.80).

Written invitations were sent to nine schools located within 50 km of the Olympic park

(Stratford, London) all of which had participated in previous studies8 11

. From nine

respondents we selected two secondary (one in a rural area) and four primary (one rural)

schools to approximate the population distribution of the study area.

Participants

For comparability with historical data held on students from these schools we used the same

inclusion and exclusion criteria as previous studies8 11

. All consenting pupils aged between

10.0 and 15.9 years were eligible for the study. Those with medical conditions, illness or

injuries that precluded participation in normal PE lessons were excluded.

Protocol

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Participants’ date of birth was used to calculate decimal age on day of testing. Home

postcode was used to calculate area-level deprivation using the English Indices of

Deprivation13

and dwelling (rural or urban) using Geoconvert to access data from the

National Statistics Postcode Directory14

.

Stature to nearest 0.1 cm and mass to nearest 0.1 kg were measured with participants dressed

in standard physical education clothing and without shoes. Body Mass Index (BMI) was

calculated (kg·m-2

) and converted to z-scores15

. Cardiorespiratory fitness (fitness) was

assessed using the 20 m shuttle-run performed as the FITNESSGRAM PACER test16

. Total

shuttle count was recorded and converted to estimated �� O2peak (ml·kg-1

·min-1

)12

. Participants

also reported their physical activity over the past 7-days using an English-language version of

the Physical Activity Questionnaire for Older Children (PAQ)17

which is scored from 1 (very

low physical activity) to 5 (highly active).

Inspiration to try, and persistence with, new activities were measured using items adapted

from the Chance to Shine Survey18

a proxy report survey deployed after London 2012. To the

best of our knowledge, no direct assessments of inspiration were made in schoolchildren

before or after London 2012. No metric is reported in the London 2012 Meta-Evaluation

Documentation19

. Participants were asked a series of questions relating to their engagement

with and inspiration by London 2012 (see supplementary Materials). Responses to the

following items were used in the present study: ‘Have you been inspired to try a new

sport or activity since the 2012 Olympic Games?’ Participants were provided with a closed

(Yes/No) response and were asked not to include activities performed only as part of physical

education. Those responding ‘Yes’ were then asked: ‘Which sport ______ or activity

________?’ and ‘Are you still taking part in this sport or activity?’ again with a closed

(Yes/No) response.

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Data analysis

We grouped children’s according to their self-reported ‘Inspiration as: ‘None’ if they had not

tried a new sport or activity; ‘Brief’, if they tried new activity but ceased participating 18

(14-20) months after London 2012.; ‘Continued’ if they continued to participate in an

Olympic-Inspired activity at the time of assessment.

The intraclass correlation coefficient (ICC = between-school variance/(between-school

variance+within-school variance)) was calculated to assess whether outcomes clustered

within schools). We examined differences in fitness (�� O2peak ml·kg-1

·min-1

) and physical

activity (PAQ-score) using ANCOVA adjusted for: age, area-level deprivation and time of

testing. BMI was not adjusted for age as z-scores correct for skewness, kurtosis and age. To

examine the potential causative association between physical activity and between-group

differences in fitness ANCOVA was adjusted for physical activity in addition to age,

deprivation and time of testing).

Mean differences (95%CI) and standardized effect sizes (Cohen’s d) were used to describe

between-group differences. We assumed a minimum important effect size of d=0.2 (small),

d=0.5 as medium and d=0.8 as large20

. All analyses were performed using SPSS version 20

(SPSS Inc. An IBM Company, Chicago, Il.)

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RESULTS

Table. 1 Demographic characteristics, outcome measures, engagement and Olympic

inspiration in schoolchildren from the East of England measured 18±2 months following

London 2012.

Boys, n=513 Girls n=418 Boys

ICC

Girls

ICC

Mean SD Mean SD

Age 12.4 (1.46) 12.3 (1.50)

�� O2peak (ml·kg-1

·min-1

)a 44.2 (5.4) 40.1 (5.6) R =0.11 R =0.12

Physical Activity (PAQ)b 2.92 (0.72) 2.58 (0.61) R =0.10 R =0.09

BMI (kg·m-2

) 19.1 (4.1) 19.8 (4.4)

BMI (z-score) 0.32 (1.42) 0.39 (1.24) R=0.09 R =0.08

Deprivation (EID)d 11.6 (5.0) 11.7 (6.5) R =0.27 R =0.31

Ethnicity (White British) 93% (n=477) 92.5% (n=387)

Urbane 73% (n=138) 75% (n=104)

Rurale 27% (n=375) 25% (n=314)

Followed 2012 Olympics

A lot 57.2% (n=293) 60.1% (n=251)

A little 42.8% (n=220) 39.9% (n=167)

Inspired to try new activity 54.3% (n=279) 49.3% (n=206)

Continued at 12-months 45.2% (n=232) 40.0% (n=167)

ICC: Intracluster Correlation Coefficients; BMI-Body mass index, z-score calculated using

the UK1990 Growth Reference (Cole et al., 1995). a-estimated from 20 m shuttle-run using

equation of Leger et al. (1988); bPAQ – physical activity questionnaire for adolescents;

c-

Defined using the International Obesity Task Force criteria, dEID - English Indices of

Deprivation (Office for National Statistics, 2010); eUrban included urban, town and fringe,

Rural includes Villages and Isolated Dwellings (National Statistics Postcode Directory,

2010).

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The sample comprised n=931 pupils (55% boys) from school years (grades) 6-11 drawn from

six schools Demographic characteristics and values for outcome measures are presented in

Table 1. The sample provided a good representation of the East of England where 93% of

people describe themselves White-British and 71% of the population lives in urban areas.

Area-level deprivation (EID=11.6) was lower than expected for this part of the region

(EID=15.6)13

. There was little evidence of between-school clustering of BMI or physical

activity, and the between-cluster ICCs for �� O2peak were only marginally greater than R=0.10.

There was evidence of clustering for area-level deprivation but adjusting for this variable

reduced ICCs for all outcome variables R<0.06. We chose, therefore not to correct for

clustering but did adjust all analyses for area-level deprivation.

Overall, 54.3% of boys and 49.3% of girls reported being inspired to try a new sport or

activity (activities reported are in Supplementary Table 1). Of those inspired, 83.3% of boys

and 81.3% of girls reported they continued to participate in this sport one year later with only

8.5% (n=79) of participants reporting that they no longer participated.

Table 2 shows mean values by group and results of ANCOVA adjusting for age and

deprivation. There were significant main effects for fitness and physical activity in both sexes

and a significant main effect for BMI in girls. In boys, post hoc analysis showed the

Continued group were fitter (d=0.43) and more active (d=0.38) than the None group.

Continued had higher fitness (d=0.43) and were more active (d=0.23) than the group. There

were no significant differences between boys in the None and Brief groups. Girls classified as

Continued were significantly fitter (d=0.27), more active (d=0.34) and also had a lower BMI

(d=0.32) than the None group. Girls in the Continued group were more active (d=0.24) than

those in the Brief group. Adjusting for physical activity attenuated the main effect for

inspiration on fitness in boys (F=2.6, p=0.075). This effect was much greater in girls, in girls

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(F=0.74, p=0.48) and no between-group differences in fitness remained significant (all post

hoc tests p>0.1)

Table 2. Fitness, physical activity and body mass index in 10-15.9 year olds from the

East of England measured 18 months after London-2012 according to self-reported

Olympic inspiration.

Olympic Inspiration Group:

None Brief Continued ANCOVA

Boys Mean (SD) Mean (SD) Mean (SD)

�� O2peaka

(ml·kg-1

·min-1

)

43.4 (4.9) 43.2 (4.1) **

45.4 (6.0) F=9.35† p<0.001

Physical Activity

(PAQ)

2.78 (0.70) 2.88 (0.75) *3.04 (0.65) F=8.84

†† p<0.001

BMI

(z-score)

0.32 (1.42) 0.35 (0.97) 0.39 (1.21) F=0.23† p=0.798

Girls Mean (SD) Mean (SD) Mean (SD)

�� O2peak

(ml·kg-1

·min-1

)

39.5 (4.6) 39.9 (4.9) *40.9 (5.6) F=4.02

† p=0.019

Physical Activity

(PAQ)

2.51 (0.68) 2.58 (0.62) *2.72 (0.55) F=8.22

†† p<0.001

BMI

(z-score)

0.58 (1.15) 0.39 (1.14) *0.20 (1.24) F=5.94

† p=0.003

Legend: None- participants who had not tried a new sport or activity; Brief – participants

who had tried a new activity but discontinued participation by 18-months; Continued –

participants who had both tried a new activity and who continued to participate at 18 months. aVO2peak (ml·kg

-1·min

-1) estimated from 20 m shuttle-run test (Leger et al., 1988).

bPhysical

Activity is 7-day self-reported value (1-5) from the Physical Activity Questionnaire for

Adolescents. BMI – Body mass index presented as age- and sex-normalised z-score based

UK1990 Growth Reference (Cole et al. 1995). †Controlling for time of testing and area level deprivation;

†† Controlling for time of testing,

area level deprivation and decimal age. *Indicates value is significantly (Bonferroni post hoc

test, p<0.05) different from ‘None’ group; **Indicates value is significantly (Bonferroni post

hoc test, p<0.05) different to both other groups.

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Table 3. Differences in Fitness, physical activity and body mass index in 10-15.9 year olds from the East of England measured in 2009

and values of students from the same schools assessed in 2013/4.

Mean (SD)

Mean Difference (95%CI) versus Pre-2012 ANCOVA

Boys Post-2012

(n=513)

Pre-2012

(n=407)

Effect

Size None Brief Continued (Main effect)

�� O2peaka

(ml·kg-1

·min-1

)

44.2

(5.4)

46.2

(5.4)

d=0.37

-2.7*

(-1.8 to -3.9)

-3.0*

(-5.0 to -1.0)

-0.7

(-1.7 to 0.3)

F=12.1

P<0.001

Physical

Activity

(PAQ)

2.92

(0.75)

3.02

(0.75)

d=0.14 -0.10

(-0.25 to 0.19)

0.05

(-0.11 to 0.26)

0.08

(-0.06 to 0.28

F=0.99

P<0.395

BMI

(z-score)

0.32

(1.24)

0.71

(1.18)

d=0.30 0.36*

(0.25 to 0.64)

0.39*

(0.06 to 0.83)

0.33*

(0.15 to 0.58)

F=7.6

P<0.001

Girls Post-2012

(n=418)

Pre-2012

(n=366)

None Brief Continued

�� O2peaka

(ml·kg-1

·min)

40.1

(5.6)

42.2

(6.6)

d=0.37

-2.9*

(-1.8 to -3.9)

-2.4*

(-4.5 to -0.4)

-1.3*

(-2.4 to -0.2)

F=10.4

P<0.001

Physical

Activity

(PAQ)

2.55

(0.65)

2.58

(0.65)

d=0.01 -0.09

(-0.21 to 0.12)

-0.01

(-0.30 to 0.29)

0.14

(-0.11 to 0.22)

F=0.93

P=0.613

BMI

(z-score)

0.39

(1.06)

0.52

(1.06)

d=0.12 -0.07

(-0.13 to 0.26)

-0.08

(-0.32 to 0.41)

-0.37*

(0.18 to 0.58)

F=5.6

P=0.001

Pre-2012 values are shown as unadjusted means (standard deviatin). All other Values shown are mean differences (Post-2012 minus Pre-2012) based on

estimated marginal means adjusted for decimal age and area level deprivation† . �� O2peaka (ml·kg-1·min-1) estimated from 20 m shuttle-run test (Leger et al.,

1988). b Physical Activity is 7-day self-reported value (1-5) from the Physical Activity Questionnaire for Adolescents. BMI body mass index presented as age-

and sex-normalised z-score based UK1990 Growth Reference (Cole et al. 1995). ANCOVA – analysis of covariance (covariates: decimal age, area-level

deprivation, Factors - groups (Pre-2012, None, Brief, Continued). *Indicates mean difference is significant (Bonferroni post hoc test of estimated marginal

means, p<0.05, Pre-2012 versus Post-2012 group).

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Historical data were available for n=733 students (53% boys) from the n=6 participating

schools. Descriptive data are shown in Supplementry Table 2. Mean (SD) values for all

participants Pre- and Post-2012 and mean differences between Pre-2012 and all Post-2012

groups are shown in Table 3. To account for the small (d=0.13) differences in age (Boys,

12.2 ±1.4 years; Girls, 11.9 ±0.9 years) between cohorts all analyses were adjusted for age as

well as area-level deprivation.

Post-2012, boys’ �� O2peak was 2.0 (95%CI:0.9-3.2) ml·kg

-1·min

-1 lower than the Pre-2012

mean (d=0.38). Post hoc analysis for ANCOVA showed signifcantly �� O2peak in None and

Brief groups compared with boys assessed Pre-2012. Compared with Pre-2012 BMI (z-

scores) were lower overall (d=0.30) and across all Post-2012.

Compared with Pre-2012, girls �� O2peak was 2.1 (95%CI:1.3-3.0) ml·kg

-1·min

-1 lower Post-

2012 (d=0.37) . Post hoc analysis revealed �� O2peak was signficantly lower in all Post-2012

groups compared with Pre-2012 (Table 3). The difference in BMI between Pre- and Post-

2012 was trivial (d=0.12). There was, however, a signficant main effect (ANCOVA) and post

hoc analysis showed a significantly lower BMI in the Continued group compared with Pre-

2012. There were no significant differences in physical activity overall or by group in either

sex.

DISCUSSION

The self-reported data regarding inspiration are broadly comparable with those of the Chance

to Shine Survey18

54% of parents reported that their children had been inspired to try a new

sport or activity following London 2012. These cross-sectional findings are encouraging as

they indicate that schoolchildren who continued to participate in new activities inspired by

London-2012 were fitter, more active and had a lower BMI (girls only) than those not

inspired (None). Brief inspiration or short-term participation in new activities was not,

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however associated with higher fitness, physical activity or lower BMI. This might suggest

that legacy development activities should focus on supporting children to help them maintain

participation in any activities inspired by London-2012. This exact sentiment was highlighted

before London 20123 and following other mega-events

21. Fitness is more-strongly correlated

with current rather than historical physical activity habits22

. The attenuation of between-group

differences in boys’ fitness when adjusting for physical activity suggests the higher levels of

fitness observed in boys inspired by London 2012 were due to them being more physically

active at the time of testing.

These findings suggest higher physical activity as the common denominator observed in

those children inspired by London 2012 in whom we found better cardiorespiratory fitness

and lower BMI values than those of their less-inspired peers. It was not possible to recruit a

control group who were not exposed to London 2012 and our study design means we cannot

infer causality or directionality between associations. It may be that many of the Continued

group were already engaged in sport and fitter than schoolchildren not reporting take up of

new activities. In the most recent wave of Taking Part23

, 24.3% of respondents already

regularly physically active and participating in sport reported that London 2012 had

motivated them to increase participation. When assessed in 2011, 7% or active respondents

reported motivation to increase participation compared with only 1.5% of respondents not

who did not regular participate in sport. This figure rose to 5.9% following London 2012 but

has since then it has not been reported in the Taking Part survey.

The encouraging findings showing favourable fitness, physical activity and BMI values in

those still participating in Olympic-inspired activities are in stark contrast to those of our

comparison of these measures with those made 5-years previously. Compared with children

attending the same schools five years earlier, �� O2peak was 2 ml·kg-1

·min-1

lower in both boys

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and girls assessed in 2013-14 (Post-2012). This diffrence was both statistically and clinically

significant and is in agreement with reported declines in the cardiorespiratory fitness of

children from this region24

. Girl’s �� O2peak was lower across all Post-2012 groups. The only

group mean for �� O2peak not significantly lower than Pre-2012 was found in the 43% of boys

continuing to participate in new activities 18 months after London 2012. Low

cardiorespiratory fitness in childhood is associated with a greater risk metabolic ill-health in

adulthood25

and cross sectional investigation based on data collected in 2007-8 reported 22%

of (n=6628) 10-16 year olds had estimated �� O2peak below age- and sex-specific criterion

values recommended for health10

. The present study lacks the statistical power to analyse

categorical data. However, applying the same criteria10

to the present data reveals 34.8% of

participants assessed Post-2012 had low cardiorespiratory fitness compared with only 22.3%

Pre-2012. While the prevalence of low fitness varied from 40.9% (None) and 35.1% (Brief )

to 27.5% (Continued) across Post-2012 groups all values were higher than in 2008/9.

Prevalence of low cardiorespiratory fitness was also higher than reported previously in larger

studies10

of schoolchildren from this region.

Lower �� O2peak and the increased prevalence of low cardiorespiratory fitness are in contrast to

the lower BMI values of the post-2012 cohort as there is typically a negative association

between performance on weight-bearing tests of �� O2peak and BMI26

. We have previously

reported poorer shuttle-run performance accompanied by lower BMI in a repeat cross-

sectional study of younger children from this region24

. These divergent trends strongly

suggest falls in physical activity levels.

The present data represent the first attempt to objectively identify a health-related legacy

from hosting an Olympic Games1 2

. While cross-sectional, our findings suggest some

potential benefits to cardiorespiratory fitness, likely mediated by higher physical activity

levels, in those inspired to try new activities. The proportion of those sampled who reported

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continued participation in activities inspired by London 2012 (45%) is impressive but it is

likely these individuals are those who were already engaged in sport and physical activity.23

Our findings must also be interpreted within the context of reports of falling levels of both

cardiorespiratory fitness and physical activity8-10

in English youth. We also found lower

fitness overall and across all groups assessed post-2012, providing little that London-2012

has improved health through increased participation in sport. With the exception of the most-

active subgroup of boys there is scant evidence that hosting the 2012 Olympic Games has

attenuated ongoing24

declines in cardiorespiratory fitness8 26

.

Hopes for a health-related legacy were laid at the feet of the London 2012 organisers despite

a total lack of evidence for such an effect following previous Games1. London 2012 did not

happen in isolation and many other factors might be responsible for changes in physical

activity levels that may have off-set any benefits to children’s fitness arising from London

2012. The lack of strategy regarding children’s activity and health has been compared to

neglect27

. During the period of this study, and in the run up to London 2012, the government

rescinded on the five hour offer of PE at schools, cutting funding to the English school sports

partnerships scheme. The Government also withdrew the previous administration’s offer of

free swimming for all children. Swimming remains England’s most popular sporting activity4

but participation is currently declining5. Reducing opportunities for regular physical activity

during PE and through free swimming may have offset potential benefits from hosting

London 2012. The lack of any health-related fitness monitoring either before or since the

Games demotes this hypothesis to the level of mere conjecture.

The Governments own London-2012 Meta-Evaluation19

shows the majority of people

motivated to increase their participation in sport were already physically active. This

‘Matthew Effect’ may explain the differences in fitness reported in our cross-sectional

analysis. In school children this effect is likely driven by the focus on ‘competitive sport’ as

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outlined in Government’s plans for an Olympic legacy28

which outlined its commitment to

providing a sporting legacy for young people by: ‘bringing back a culture of competitive

sport in schools’. To do this, the School Games were introduced in 2011 along with increased

focus on competitive sports and intra-school competitions from an early age. Such an

approach appears paradoxical to the goal of ‘getting the whole population more active’ as

such opportunities are likely to appeal most to those already engaged in sport.

Study Limitations

The sample population is drawn from an area geographically proximal to the Olympic park

itself, mostly from commuter towns with direct transport links to Stratford. It is also a

predominantly affluent area and one that has benefited from legacy investment projects. We

hypothesise that any such impact of London 2012 would be smaller if assessed nationally.

Despite calls for the introduction of health-related fitness assessment29 30

, the continued lack

of any such national surveillance leaves such hypotheses untestable. The opportunity sample

of schools that volunteered to participate may have produced selection bias but this is

difficult to quantify due to the paucity of nationally representative cardiorespiratory fitness

data.

Without longitudinal data regarding physical activity we cannot infer any cause-and-effect

relationship between inspiration, physical activity and fitness. A longitudinal study including

objective measures of children’s health may have been able to provide more tangible

evidence; yet no such data exist for London 2012 or for any other Games2 3

. This paucity of

evidence exists despite recommendations that decision makers should; ‘include robust, long

term evaluations as part of their design and implementation of events’1.

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CONCLUSIONS

We found evidence for higher cardiorespiratory fitness in the 45% of schoolchildren who

continued to participate in activities inspired by the Olympics 18 months after London 2012.

Inspiration alone is not sufficient and our findings reiterate the importance of continued

investment in support networks to capitalise on any impetus that hosting major sporting

events may provide in promoting health-related behaviour change3 21 31

.

The cost of hosting future mega-events cannot be justified based on the assumption they will

automatically produce health-related benefits. To justify such costs, decision makers must

work with key stakeholders to formulate sustainable legacy development plans that include

objective longitudinal evaluations of key health outcome measures.

These findings may indicate a health-related legacy from London 2012 but the true scale of

which will likely remain undetected due to the lack of appropriate health surveillance

measures to assess any impact that events like London 2012 may have.

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ACKNOWLEDGEMENTS: Thank you to all the schools who participated, to the

researchers who helped collect the data, to Mark Walker at Writtle College for logistical

arrangements and to Christine Voss for the initial data handling protocols.

FUNDING STATEMENT: This work was funded by Provide Public Health (Grant:

DB0800H1).

COMPETING INTERESTS: The author declares that there are no conflicts of interest.

CONTRIBUTORSHIP STATEMENT: Sandercock devised the study and performed the

statistical analysis. Beedie and Mann contributed to writing the manuscript. All authors were

involved in the final drafting and pre-submission revision of the manuscript.

DATA SHARING STATEMENT:

Data not shared.

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23. DCMS. Taking Part 2015/16 Quarter 3. Taking Part. London, UK.: Department for Culture, Media

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2007;31(7):1172-78.

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Supplementary Table 1. Detailed Listing of Sports and Activities Inspired by The Olympic Games in

a subsample of schoolchildren from the East of England measured 18±2 months following London

2012.

Sport or Activity

n= % Sport or Activity n= %

Summer Olympics Events

Running or Athletics 103 21.2 Hockey 3 .6

Swimming/Synchronized-

Swimming

61 12.6 Table tennis 3 .6

Football 36 7.4 Fencing 2 .4

Gymnastics 32 6.6 Kayaking 2 .4

Rugby 32 6.6 Rowing 2 .4

Basketball 28 5.8 Sailing 2 .4

Netball 25 5.2 Shooting 2 .4

Cycling 20 4.1 Squash 1 .2

Tennis 19 3.9 Volleyball 1 .2

Trampolining 17 3.5 Total n=485 95.4%

Handball 13 2.7 Non-Olympic Events n= %

Badminton 12 2.5 Cricket 8 1.6

Diving 8 1.6 Parkour 4 .8

Martial Arts 8 1.6 Rounders 4 .8

Boxing 7 1.4 Golf 3 .6

Canoeing 6 1.2 Cheerleading 2 .4

BMX 5 1.0 Ice skating 2 .4

Archery 4 .8 Total 23 4.6%

Equestrian 4 .8

Waterpolo 4 .8 Missing/Illegible 4

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Extract from Study Questionnaire.

1. Which best describes what you did during the London 2012 Olympics (Tick one)

I followed it very closely (watched daily)

I followed it quite closely (watched highlights and some events)

I followed it very little (watched occasionally)

I did not follow it at all

2. Did you go to see a live Olympic or Paralympic event?

3. Did you visit an Olympic venue?

4. Have you been inspired to try a new sport or activity since the 2012 Olympic Games? Please do not include activities you did during PE lessons.

a. If Yes, which sport _____________ or activity _______________

5. Are you still taking part in this sport or activity?

Yes No

Yes No

Yes No

Yes No

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STROBE Statement—Checklist of items that should be included in reports of cohort studies

page Item

No Recommendation

Title and abstract 2 1 (a) Indicate the study’s design with a commonly used term in the title or the

abstract

2 (b) Provide in the abstract an informative and balanced summary of what was

done and what was found

Introduction

Background/rationale 3 2 Explain the scientific background and rationale for the investigation being

reported

Objectives 4 3 State specific objectives, including any prespecified hypotheses

Methods

Study design 4 4 Present key elements of study design early in the paper

Setting 5 5 Describe the setting, locations, and relevant dates, including periods of

recruitment, exposure, follow-up, and data collection

Participants 5 6 (a) Give the eligibility criteria, and the sources and methods of selection of

participants. Describe methods of follow-up

- (b) For matched studies, give matching criteria and number of exposed and

unexposed

Variables 5/6 7 Clearly define all outcomes, exposures, predictors, potential confounders,

and effect modifiers. Give diagnostic criteria, if applicable

Data sources/

measurement

5/6 8* For each variable of interest, give sources of data and details of methods of

assessment (measurement). Describe comparability of assessment methods if

there is more than one group

Bias 11 9 Describe any efforts to address potential sources of bias

Study size 5 10 Explain how the study size was arrived at

Quantitative variables 5/6 11 Explain how quantitative variables were handled in the analyses. If

applicable, describe which groupings were chosen and why

Statistical methods 6 12 (a) Describe all statistical methods, including those used to control for

confounding

- (b) Describe any methods used to examine subgroups and interactions

- (c) Explain how missing data were addressed

- (d) If applicable, explain how loss to follow-up was addressed

- (e) Describe any sensitivity analyses

Results

Participants 7 13* (a) Report numbers of individuals at each stage of study—eg numbers

potentially eligible, examined for eligibility, confirmed eligible, included in

the study, completing follow-up, and analysed

(b) Give reasons for non-participation at each stage

(c) Consider use of a flow diagram

Descriptive data 5 14* (a) Give characteristics of study participants (eg demographic, clinical,

social) and information on exposures and potential confounders

(b) Indicate number of participants with missing data for each variable of

interest

(c) Summarise follow-up time (eg, average and total amount)

Outcome data 5 15* Report numbers of outcome events or summary measures over time

Main results 5 16 (a) Give unadjusted estimates and, if applicable, confounder-adjusted

estimates and their precision (eg, 95% confidence interval). Make clear

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which confounders were adjusted for and why they were included

(b) Report category boundaries when continuous variables were categorized

(c) If relevant, consider translating estimates of relative risk into absolute risk

for a meaningful time period

Other analyses 5 17 Report other analyses done—eg analyses of subgroups and interactions, and

sensitivity analyses

Discussion

Key results 6 18 Summarise key results with reference to study objectives

Limitations 7 19 Discuss limitations of the study, taking into account sources of potential bias

or imprecision. Discuss both direction and magnitude of any potential bias

Interpretation 6 20 Give a cautious overall interpretation of results considering objectives,

limitations, multiplicity of analyses, results from similar studies, and other

relevant evidence

Generalisability 7 21 Discuss the generalisability (external validity) of the study results

Other information

Funding -na- 22 Give the source of funding and the role of the funders for the present study

and, if applicable, for the original study on which the present article is based

*Give information separately for exposed and unexposed groups.

Note: An Explanation and Elaboration article discusses each checklist item and gives methodological background and

published examples of transparent reporting. The STROBE checklist is best used in conjunction with this article (freely

available on the Web sites of PLoS Medicine at http://www.plosmedicine.org/, Annals of Internal Medicine at

http://www.annals.org/, and Epidemiology at http://www.epidem.com/). Information on the STROBE Initiative is

available at http://www.strobe-statement.org.

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