Unveiling the Global Matrix

Mark Tremblay, Ph.D., D.Litt. (hons), FACSM, CSEP-CEP
Director, Healthy Active Living and Obesity Research Group
Children’s Hospital of Eastern Ontario Research Institute
Chief Scientific Officer, Active Healthy Kids Canada
Professor, Department of Pediatrics, University of Ottawa
Unveiling the “Global Matrix”:
A comparison of childhood physical activity across 15 countries

Active Healthy Kids Canada Report Card

Objectives
•Describe, explain and unveil the Global Matrix
•Acknowledge and integrate country leaders into the
presentation
•Provide a foundation for the rest of the Summit with
international comparison evidence to stimulate new
ideas and partnerships

The Report Card serves as...
• A public awareness mechanism and call to action through a
nationwide media advocacy strategy
• An accountability index for all Canadians
• A surveillance synthesis mechanism
• An advocacy tool for physical activity leaders and organizations
• A policy driver
• A process for identifying research and surveillance needs
• A challenge to other countries and jurisdictions to implement similar
processes to allow comparisons and facilitate improvements

Common indicators determined
• Five behaviours
– Overall physical activity
– Organized sport participation
– Active play
– Active transportation
– Sedentary behaviours
• Four settings and sources of influence
– Family and peers
– School
– Community and the built environment
– Government strategies and investments

Grade Interpretation
A We are succeeding with a large majority of children and youth (≥ 80%).
B We are succeeding with well over half of children and youth (60-79%).
C We are succeeding with about half of children and youth (40-59%).
D We are succeeding with less than half but some children and youth (20-39%).
F We are succeeding with very few children and youth (< 20%).
Grading Framework
Common benchmarks used to guide grade assignments
Expert groups established in each country to assign grades

Limitations vs Opportunities
• Common benchmarks were established although countries were
limited by the availability of data
• The best available evidence, often from multiple sources, were used
by expert work groups to assign grades
• Despite variation in country data sources it is believed that the grades
across all indicators are comparable and informative of global
variation in important factors related to PA among children and youth.
• The focus was on the possibilities of learning from one another and
work of addressing the limitations going forward

Global Matrix
Who is leading and who is lagging?

Overall Physical
Activity
Organized Sport
Participation
Active Play
Active
Transportation
Sedentary
Behaviours
Family and
Peers
School
Community and
the Built
Environment
Government
Strategies and
Investments

“Perhaps the most notable finding from the global matrix is the
substantial variation in the grades assigned to the nine indicators
of PA. This is encouraging for at least three reasons. First, it
demonstrates that at least some countries are succeeding in each
of the important indicators examined in the global matrix. Second,
such international variation consolidated in this fashion presents
an opportunity for cross-fertilization of ideas for improving the
grades. Third, the global matrix provides a framework for research
aimed at understanding the differences between and within
different nations.”
Tremblay et al. JPAH, 2014

Overall Physical Activity
• Benchmark: % of children and youth who meet
physical activity guidelines
• All countries graded this indicator
• Grades ranged from F to B

video: overall physical activity

Organized Sport
Participation
Active Play
Active
Transportation
Sedentary
Behaviour
Family and Peers School
Community. & Built
Environment
Government Strat.
& Investments
Overall Physical
Activity
Scotland
F
United States D-
Ireland
D-
Canada
D-
Australia
D-
South Africa
D
Finland
D
Ghana
D
Colombia
D
England
D+
Nigeria
C
Kenya
C
Mexico
C+
New Zealand B
Mozambique B

Organized Sport Participation
• Benchmark: % of children and youth who participate
in organized sport and/or physical activity programs
• 13 of 15 countries graded this indicator

Video: Organized Sport Participation

Organized Sport
Participation
Active Play
Active
Transportation
Sedentary
Behaviour
Community. & Built
Environment
Government Strat.
& Investments
Scotland
INC
Nigeria
INC
Mozambique F
Mexico
D
Colombia
D
United States C-
Ireland
C-
England
C-
South Africa
C
Kenya
C
Ghana
C
Finland
C
Canada
C+
Australia
B-
New Zealand B
Overall Physical
Activity
Scotland
F
United States D-
Ireland
D-
Canada
D-
Australia
D-
South Africa
D
Finland
D
Ghana
D
Colombia
D
England
D+
Nigeria
C
Kenya
C
Mexico
C+
New Zealand B
Mozambique B

Active Play
• Benchmark: % of children and youth who engage in
unstructured/unorganized active play for several
hours a day
• Grades ranged from D to B

Organized Sport
Participation
Active Play
Active
Transportation
Sedentary
Behaviour
Community. & Built
Environment
Government Strat.
& Investments
Scotland
INC
United States INC
Nigeria
INC
South Africa
INC
Mozambique F
Scotland
INC
Mexico
D
Mexico
INC
Colombia
D
Ireland
INC
United States C-
Ghana
INC
Ireland
C-
England
INC
England
C-
Colombia
INC
South Africa
C
Canada
INC
Kenya
C
Australia
INC
Ghana
C
Finland
D
Finland
C
Nigeria
C-
Canada
C+
Mozambique C
Australia
B-
Kenya
C
New Zealand B New Zealand B
Overall Physical
Activity
Scotland
F
United States D-
Ireland
D-
Canada
D-
Australia
D-
South Africa
D
Finland
D
Ghana
D
Colombia
D
England
D+
Nigeria
C
Kenya
C
Mexico
C+
New Zealand B
Mozambique B

Active Transportation
• Benchmark: % of children and youth who use active
transportation to get to and from places (school,
park, mall, friend’s place)

Organized Sport
Participation
Active Play
Active
Transportation
Sedentary
Behaviour
Community. & Built
Environment
Government Strat.
& Investments
Scotland
INC
United States INC
Colombia
INC
Nigeria
INC
South Africa
INC
United States F
Mozambique F
Scotland
INC
Ireland
D
Mexico
D
Mexico
INC
Ghana
D
Colombia
D
Ireland
INC
Canada
D
United States C-
Ghana
INC
Australia
D
Ireland
C-
England
INC
New Zealand C-
England
C-
Colombia
INC
South Africa
C
South Africa
C
Canada
INC
Scotland
C
Kenya
C
Australia
INC
England
C
Ghana
C
Finland
D
Mexico
B-
Finland
C
Nigeria
C-
Nigeria
B
Canada
C+
Mozambique C Mozambique B
Australia
B-
Kenya
C
Kenya
B
Finland
B
Overall Physical
Activity
Scotland
F
United States D-
Ireland
D-
Canada
D-
Australia
D-
South Africa
D
Finland
D
Ghana
D
Colombia
D
England
D+
Nigeria
C
Kenya
C
Mexico
C+
New Zealand B
Mozambique B

Sedentary Behaviours
• Benchmark: % of children and youth who meet
sedentary behavior or screen-time guidelines

Insert video clip(s)Video: Sedentary Behaviour

Organized Sport
Participation
Active Play
Active
Transportation
Sedentary
Behaviour
Community. & Built
Environment
Government Strat.
& Investments
Scotland
INC
United States INC
Colombia
INC
Mozambique INC
Nigeria
INC
South Africa
INC
United States F
England
INC
Mozambique F
Scotland
INC
Ireland
D
South Africa
F
Mexico
D
Mexico
INC
Ghana
D
Scotland
F
Colombia
D
Ireland
INC
Canada
D
Nigeria
F
United States C-
Ghana
INC
Australia
D
Canada
F
Ireland
C-
England
INC
New Zealand C-
Australia
D-
England
C-
Colombia
INC
South Africa
C
United States D
South Africa
C
Canada
INC
Scotland
C
Mexico
D
Kenya
C
Australia
INC
England
C
Finland
D
Ghana
C
Finland
D
Mexico
B-
Colombia
D
Finland
C
Nigeria
C-
Nigeria
B
Ireland
C-
Canada
C+
Mozambique C Mozambique B New Zealand C
Australia
B-
Kenya
C
Kenya
B
Kenya
B
Finland
B
Ghana
B
Overall Physical
Activity
Scotland
F
United States D-
Ireland
D-
Canada
D-
Australia
D-
South Africa
D
Finland
D
Ghana
D
Colombia
D
England
D+
Nigeria
C
Kenya
C
Mexico
C+
New Zealand B
Mozambique B

Family & Peers
• Benchmarks:
– % of parents who facilitate physical activity and sport opportunities for their children
– % of parents who meet the physical activity guidelines for adults
– % of parents who are physically active with their kids
– % of children and youth with friends and peers who encourage and support them to be
physically active
– % of children and youth who encourage and support their friends and peers to be
physically active
• Grades ranged from D- to C

Organized Sport
Participation
Active Play
Active
Transportation
Sedentary
Behaviour
Community. & Built
Environment
Government Strat.
& Investments
Scotland
INC
United States INC
Colombia
INC
Mozambique INC United States INC
Nigeria
INC
South Africa
INC
United States F
England
INC
South Africa
INC
Mozambique F
Scotland
INC
Ireland
D
South Africa
F
Nigeria
INC
Mexico
D
Mexico
INC
Ghana
D
Scotland
F
Mozambique INC
Colombia
D
Ireland
INC
Canada
D
Nigeria
F
Mexico
INC
United States C-
Ghana
INC
Australia
D
Canada
F
Ireland
INC
Ireland
C-
England
INC
New Zealand C-
Australia
D-
Ghana
INC
England
C-
Colombia
INC
South Africa
C
United States D
England
INC
South Africa
C
Canada
INC
Scotland
C
Mexico
D
Colombia
INC
Kenya
C
Australia
INC
England
C
Finland
D
Scotland
D-
Ghana
C
Finland
D
Mexico
B-
Colombia
D
New Zealand C
Finland
C
Nigeria
C-
Nigeria
B
Ireland
C-
Kenya
C
Canada
C+
Finland
C
Australia
B-
Kenya
C
Kenya
B
Kenya
B
Canada
C
Finland
B
Ghana
B
Australia
C
Overall Physical
Activity
Scotland
F
United States D-
Ireland
D-
Canada
D-
Australia
D-
South Africa
D
Finland
D
Ghana
D
Colombia
D
England
D+
Nigeria
C
Kenya
C
Mexico
C+
New Zealand B
Mozambique B

• Benchmarks:
– % of schools with active school policies
– % of schools where the majority (≥ 80%) are taught by a PE specialist
– % of schools where the majority (≥ 80%) are offered at least 150 minutes of PE per week
– % of schools that offer physical activity opportunities (excluding PE) to the majority (≥ 80%)
of their students
– % of parents with children and youth who have access to physical activity opportunities at
school in addition to PE
– % of schools with students who have regular access to facilities and equipment that support
physical activity
• Grades ranged from F to A-
School

Organized Sport
Participation
Active Play
Active
Transportation
Sedentary
Behaviour
Community. & Built
Environment
Government Strat.
& Investments
Scotland
INC
United States INC
Colombia
INC
Scotland
INC
Nigeria
INC
South Africa
INC
United States F
England
INC
South Africa
INC
Nigeria
INC
Mozambique F
Scotland
INC
Ireland
D
South Africa
F
Nigeria
INC
Colombia
F
Mexico
D
Mexico
INC
Ghana
D
Scotland
F
Mozambique INC
South Africa
D
Colombia
D
Ireland
INC
Canada
D
Nigeria
F
Mexico
INC
Mexico
D
United States C-
Ghana
INC
Australia
D
Canada
F
Ireland
INC
Ghana
D
Ireland
C-
England
INC
New Zealand C-
Australia
D-
Ghana
INC
United States C-
England
C-
Colombia
INC
South Africa
C
United States D
England
INC
Ireland
C-
South Africa
C
Canada
INC
Scotland
C
Mexico
D
Colombia
INC
Mozambique C
Kenya
C
Australia
INC
England
C
Finland
D
Scotland
D-
Kenya
C
Ghana
C
Finland
D
Mexico
B-
Colombia
D
New Zealand C
Canada
C+
Finland
C
Nigeria
C-
Nigeria
B
Ireland
C-
Kenya
C
New Zealand B-
Canada
C+
Finland
C
Australia
B-
Australia
B-
Kenya
C
Kenya
B
Kenya
B
Canada
C
Finland
B
Finland
B
Ghana
B
Australia
C
England
A-
Overall Physical
Activity
Scotland
F
United States D-
Ireland
D-
Canada
D-
Australia
D-
South Africa
D
Finland
D
Ghana
D
Colombia
D
England
D+
Nigeria
C
Kenya
C
Mexico
C+
New Zealand B
Mozambique B

Community & the Built Environment
• Benchmarks:
– % of children or parents who perceive their community is doing a good job at promoting physical
activity
– % of communities that report they have policies promoting PA
– % of communities that report infrastructure geared toward promoting PA
– % of children or parents with facilities, programs, parks and playgrounds available to them in their
community
– % of children living in a safe neighborhood where they can be active
– % of children or parents reporting well-maintained facilities, parks/playgrounds in their community
that are safe
– % of children and youth who report being outdoors for several hours a day
• Grades ranged from F to A-

(
Video: Community and the Built Environment

Organized Sport
Participation
Active Play
Active
Transportation
Sedentary
Behaviour
Community. & Built
Environment
Government Strat.
& Investments
Scotland
INC
United States INC
Colombia
INC
Scotland
INC
Nigeria
INC
Nigeria
INC
South Africa
INC
United States F
England
INC
South Africa
INC
Nigeria
INC
Kenya
INC
Mozambique F
Scotland
INC
Ireland
D
South Africa
F
Nigeria
INC
Colombia
F
Colombia
INC
Mexico
D
Mexico
INC
Ghana
D
Scotland
F
Mozambique INC
South Africa
D
Mozambique F
Colombia
D
Ireland
INC
Canada
D
Nigeria
F
Mexico
INC
Mexico
D
Mexico
F
United States C-
Ghana
INC
Australia
D
Canada
F
Ireland
INC
Ghana
D
South Africa
D
Ireland
C-
England
INC
New Zealand C-
Australia
D-
Ghana
INC
United States C-
Ghana
D
England
C-
Colombia
INC
South Africa
C
United States D
England
INC
Ireland
C-
New Zealand C
South Africa
C
Canada
INC
Scotland
C
Mexico
D
Colombia
INC
Mozambique C United States B-
Kenya
C
Australia
INC
England
C
Finland
D
Scotland
D-
Kenya
C
Scotland
B
Ghana
C
Finland
D
Mexico
B-
Colombia
D
New Zealand C
Canada
C+
Ireland
B
Finland
C
Nigeria
C-
Nigeria
B
Ireland
C-
Kenya
C
New Zealand B-
Finland
B
Canada
C+
Finland
C
Australia
B-
England
B
Australia
B-
Kenya
C
Kenya
B
Kenya
B
Canada
C
Finland
B
Canada
B+
Finland
B
Ghana
B
Australia
C
England
A-
Australia
A-
Overall Physical
Activity
Scotland
F
United States D-
Ireland
D-
Canada
D-
Australia
D-
South Africa
D
Finland
D
Ghana
D
Colombia
D
England
D+
Nigeria
C
Kenya
C
Mexico
C+
New Zealand B
Mozambique B

Government Strategies & Investments
• Benchmarks:
– Evidence of leadership and commitment in providing physical activity opportunities for all
children and youth
– Allocated funds and resources for the implementation of physical activity promotion
strategies and initiatives for all children and youth
– Demonstrated progress through the key stages of public policy making (i.e., policy agenda,
policy formation, policy implementation, policy evaluation and decisions about the future)
• Grades ranged from D to B

Video: Government
Strategies and
Investments

Organized Sport
Participation
Active Play
Active
Transportation
Sedentary
Behaviour
Community. & Built
Environment
Government Strat.
& Investments
Scotland
INC
United States INC
Colombia
INC
Scotland
INC
Nigeria
INC
Nigeria
INC
Nigeria
INC
South Africa
INC
United States F
England
INC
South Africa
INC
Nigeria
INC
Kenya
INC
United States INC
Mozambique F
Scotland
INC
Ireland
D
South Africa
F
Nigeria
INC
Colombia
F
Colombia
INC
New Zealand INC
Mexico
D
Mexico
INC
Ghana
D
Scotland
F
Mozambique INC
South Africa
D
Mozambique F
Ireland
INC
Colombia
D
Ireland
INC
Canada
D
Nigeria
F
Mexico
INC
Mexico
D
Mexico
F
England
INC
United States C-
Ghana
INC
Australia
D
Canada
F
Ireland
INC
Ghana
D
South Africa
D
Ghana
D
Ireland
C-
England
INC
New Zealand C-
Australia
D-
Ghana
INC
United States C-
Ghana
D
Mozambique C
England
C-
Colombia
INC
South Africa
C
United States D
England
INC
Ireland
C-
New Zealand C
Mexico
C
South Africa
C
Canada
INC
Scotland
C
Mexico
D
Colombia
INC
Mozambique C United States B-
Kenya
C
Kenya
C
Australia
INC
England
C
Finland
D
Scotland
D-
Kenya
C
Scotland
B
Canada
C
Ghana
C
Finland
D
Mexico
B-
Colombia
D
New Zealand C
Canada
C+
Ireland
B
Australia
C+
Finland
C
Nigeria
C-
Nigeria
B
Ireland
C-
Kenya
C
New Zealand B-
Finland
B
South Africa
B
Canada
C+
Finland
C
Australia
B-
England
B
Scotland
B
Australia
B-
Kenya
C
Kenya
B
Kenya
B
Canada
C
Finland
B
Canada
B+
Finland
B
Finland
B
Ghana
B
Australia
C
England
A-
Australia
A-
Colombia
B
Overall Physical
Activity
Scotland
F
United States D-
Ireland
D-
Canada
D-
Australia
D-
South Africa
D
Finland
D
Ghana
D
Colombia
D
England
D+
Nigeria
C
Kenya
C
Mexico
C+
New Zealand B
Mozambique B

Global Findings
• Wide global variation exists for most indicators, allowing
potential for global learning transference
• Most countries are BOTH leading and lagging in some
indicators
• In developed countries it seems we have built it but they
are not coming
• when children are given the opportunity/freedom, they like
to move
• a mix of physical activity opportunities are need to reach
desired levels: sport, play, chores, active transportation

Disparities and inequities
• In all countries disparities and inequities exist for
physical activity opportunities, but the direction of the
gradient in some cases varies by country (e.g. urban
vs rural and SES)
• Around the world boys are more active than girls
• Very little evidence is available on physical activity
levels of children with a disability
• We need to both raise the and level the bar for PA

Research and surveillance gaps
• Global matrix is a start but many areas of the world not
represented - we need to expand this process
• More global comparative research is needed on PA and
SB correlates and determinants
• Better (especially more representative) and standardized
measures of all indicators are required
• Data on young children (toddlers and preschoolers)
needed
• Research on play and light activity particularly needed

Recommendations for improving the grade
• Expand international collaborations, cross-
fertilizations and capacity building
• developing countries should learn from developed
countries and vice versa
• The Global Matrix should be exploited to provoke
greater policy efforts aimed at improving the grade
• The Global Matrix findings should be used to
challenge, assist and inform future strategies and
solutions

Supplemental Issue of the
Journal of Physical Activity and Health

The global comparisons remind us of the importance of habitual
physical activity, pervasive throughout the day – not simply planned
and structured doses of movement. Physical activity is not an item to
check off your list of things to do – it is a way of life – this is the
message I glean from the global comparisons. Together, with our
domestic stakeholders and our global partners, we have new and
compelling evidence that can guide innovative and novel solutions to
power the movement to get kids moving – and inform our work to
improve the grades in the years ahead.
Conclusion

Unveiling the Global Matrix

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