Health Benefits of Outdoor Time

Risky outdoor play is observed not just in children of all cultures. It can be found also in many mammal species, and is considered as an adaptive function [1,2]. Risky play plays a role in the development of the offspring on many levels, and supports them to pick up cognitive, emotional, motor, functional and social abilities. Through play, they can gradually learn about ways to overcome fear, or anger by engaging in rough-and-tumble play. Free play has an important role in the neurophysiological maturation of the prefrontal cortex, known as influencing self-regulation of behaviour and impulsiveness, and encouraging self-reflection.

WHO recommendations on physical activity in children

Children 3–4 years of age should spend at least 180 minutes in a variety of types of physical activities at any intensity, of which at least 60 minutes is moderate- to vigorous-intensity physical activity (MVPA), spread throughout the day. Following these recommendations during the first 5 years of life is associated with better motor and cognitive development, psychosocial (emotional regulation) and cardio-metabolic health, bone and skeletal health and reduced risk of injuries. Over the course of a day, a combination of more physical activity, less sedentary screen time and longer sleep duration results in the greatest benefits [3].

Children and adolescents aged 5-17 years should do at least an average of 60 minutes per day of moderate-to-vigorous intensity, mostly aerobic, physical activity, across the week. They should incorporate vigorous-intensity aerobic activities, as well as those that strengthen muscle and bone, at least 3 days a week. Children and adolescents should limit the amount of time spent being sedentary, particularly the amount of recreational screen time. This applies as well for children living with disability! Following these recommendations during the first 5 years of life leads to better bone health, improved weight status and cardiorespiratory and muscular fitness, better cardio-metabolic health, improved cognition and reduced risk of depression [4]. The situation regarding the physical activity of children and youth is a universal concern worldwide, with an estimated 80% of children in the age of 5 to 17 years not meeting the WHO recommendation of 60 min physical activity a day [5].

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On a scale of 0 to 10, where sitting is a 0 and the highest level of activity is a 10, moderate-intensity activity is a 5 or 6. When children do moderate-intensity activity, their heart beats faster, and they breathe much harder than when they are at rest or sitting. Vigorous-intensity activity is a level 7 or 8. When children do vigorous-intensity activity, their heart beats much faster than normal, and they breathe much harder than normal [3].

Physical inactivity contributes to the rise of non-communicable diseases in children, such as childhood obesity or diabetes. Physical activity and sedentary behaviour habits primed during childhood tend to continue to persist into adulthood. Restricting opportunities for outdoor and risky play has been discussed as potentially negatively impacting physical activity behaviours of children [6]. Physical activity and related behaviours are recognized by the World Health Organization’s Global Strategy to combat non-communicable diseases [4,7]. Strategies to promote healthy child development through the prevention of obesity and inactivity are much needed. It is a worldwide priority to develop approaches to target these concerning issues that are accessible, acceptable, cost-effective, culturally adaptable and feasible [8].

Physical activity

Physical activity is clearly related to better health outcomes and recognized to be one of the most efficient ways to enhance a person’s health across their lifespan [9]. Estimated 80% of children in the age of 5 to 17 years are not meeting the WHO recommendation of 60 min physical activity a day [5,8]. Parallel to these developments, current generations of children play for shorter durations and also less frequently outside as their parents’ generations. There is a shift from children’s physical activity away from unsupervised and unstructured outdoor play toward structured and supervised activities that are primarily performed indoors [8,10]. However, research suggests that increased outdoor time/play limits sedentary behaviour and increases physical activity and fitness in children [8]. Children's’ physical activity (moderate and vigorous physical activity/abbreviated: MVPA) was observed to be higher outdoors than indoors. Some studies showed that in total, physical activity is 2.2 to 3.3 times higher when children are outdoors than indoors. The results were consistent across different age groups, sexes, and contexts (weekends, at school/preschool). Therefore, it has been recommended to increase the amount of time that children spend outdoors, which seems to be a promising strategy to increase their physical activity levels and to promote healthy active living [8].

Sedentary behaviour

Children who spend one hour or more outside are less sedentary than children who spend less than one hour outdoors. Also, sedentary time is lower when children are outdoors than when they are indoors. For example, when preschoolers are indoors, they spend up to twice as much time being sedentary than when they are outdoors [8]. Loose parts in the environment (to move, carry, combine, stack, line up, redesign, take apart and put back together, with no directions or specific way of playing) empower creativity. Children playing on playgrounds containing loose parts, which enhance creativity and support risky play, showed a significant decrease in sedentary time per day, after a 13-week intervention period, though small [2,6].

Motor skills and cardio-respiratory fitness

Outdoor playtime correlates with faster completion of a 10 meter-run [8]. A study including 25,782 students showed that fracture frequency and severity was not associated with the height of playground equipment (risky play category ‘great heights’). In this study ulnar-radius fractures (accounting for 42% of playground fractures, and therefore the most frequent type of fracture on playgrounds) were likely to occur below the height of 59’ or 180 cm, as well as tibia fractures. No fractures to the head or spine as a result of falling from playground equipment were reported [6].

Gross motor functions such as running, jumping, throwing, climbing, crawling, rolling, swinging and sliding are predominant when children play in nature compared to traditional kindergarten areas [11]. Children that do not get the chance to swing, climb, run are more likely to have poor motor skills [2]. Landscape structures such as steep slopes, rough cliffs and trees facilitate activities such as climbing and sliding [11]. Children playing in wild nature areas showed improved motor skills and spatial skills. These children were also reported learning risk assessment and ways to master risk situations [11]. Outdoor activity in children is related to lower diastolic blood pressure. In children and youth, outdoor time can be related to greater aerobic fitness [8].

Mental health and social competence

Children with greater independent mobility were reported to meet more often to play with their peers, schoolmates and neighbours than children with less independent mobility (risky play category ‘disappear/get lost). For boys, rough and tumble play was associated with higher interpersonal cognitive problem-solving, but not with increased aggression [6]. Interactive play is mostly common on adventurous playgrounds, whereas on prebuilt playgrounds the use is focused on the equipment. Children were also reported becoming more social, creative and resilient after they were exposed to loose parts on playgrounds, than before [6].

Risky play may have an anti-phobic effect in a child’s normal development. Children are motivated to investigate their environment by conducting behavioural experiments, which reduce safety behaviour. In a normal developmental process, a child will first show normal adaptive fears which protect a child against ecological risk factors. Risky play is a stepwise fear-reducing behaviour. Outdoor risky play improves a child’s coping skills, and they learn to master such situations and stimuli, which, as a consequence, are no longer feared. Hindering children in taking part in age adequately risky play may result in increased neuroticism or psychopathology in society, as the fears may continue, despite no longer relevant due to a child’s physical and psychological maturation, probably even turning into anxiety disorders [1].

Mental health of children has been reported to be deteriorating in all Western countries: For example, 20% of the child population in the United States present mental health issues, such as depression and anxiety. Although many different factors are attributed as causes of this phenomenon, research has shown a clear correlation between a deprivation of free play and the growing emergence of mental health issues of adolescents and children [2]. Furthermore, it is important that children’s basic needs for well-being are met. Otherwise, it becomes difficult for them to concentrate to get really involved in experiences. Indicators of true involvement are deep concentration, focus and commitment [9].

1. Sandseter EBH, Kennair LEO. Children’s risky play from an evolutionary perspective: the anti-phobic effects of thrilling experiences. Evol Psychol Int J Evol Approaches Psychol Behav. 2011 Jun 21;9(2):257–84. 2. Caprino F. When the risk is worth it: the inclusion of children with disabilities in free risky play. 2018 Feb 20;40–7. 3. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age [Internet]. [cited 2022 Jun 13]. Available from: https://www.who.int/publications-detail-redirect/9789241550536 4. WHO. Physical activity [Internet]. 2020 [cited 2022 Jun 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/physical-activity 5. Aubert S, Barnes JD, Abdeta C, Nader PA, Adeniyi AF, Aguilar-Farias N, et al. Global Matrix 3.0 Physical Activity Report Card Grades for Children and Youth: Results and Analysis From 49 Countries. J Phys Act Health [Internet]. 2018 Jan 2 [cited 2022 Jun 9];15(s2):S251–73. Available from: https://journals.humankinetics.com/view/journals/jpah/15/s2/article-pS251.xml 6. Brussoni M, Gibbons R, Gray C, Ishikawa T, Sandseter EBH, Bienenstock A, et al. What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review. Int J Environ Res Public Health. 2015 Jun 9;12. 7. Waxman A, World Health Assembly. WHO global strategy on diet, physical activity and health. Food Nutr Bull. 2004 Sep;25(3):292–302. 8. Gray C, Gibbons R, Larouche R, Sandseter EBH, Bienenstock A, Brussoni M, et al. What Is the Relationship between Outdoor Time and Physical Activity, Sedentary Behaviour, and Physical Fitness in Children? A Systematic Review. Int J Environ Res Public Health [Internet]. 2015 Jun [cited 2022 Jun 24];12(6):6455–74. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4483711/ 9. Sando OJ, Kleppe R, Sandseter EBH. Risky Play and Children’s Well-Being, Involvement and Physical Activity. Child Indic Res. 2021 Aug 1;14. 10. Tremblay MS, Gray C, Babcock S, Barnes J, Bradstreet CC, Carr D, et al. Position Statement on Active Outdoor Play. Int J Environ Res Public Health. 2015 Jun 8;12(6):6475–505. 11. Sandseter EBH. Restrictive Safety or Unsafe Freedom? Norwegian ECEC Practitioners’ Perceptions and Practices Concerning Children’s Risky Play. Child Care Pract [Internet]. 2012 Jan 1 [cited 2022 Jun 25];18(1):83–101. Available from: https://doi.org/10.1080/13575279.2011.621889