Background
The concept of physical literacy
Physical literacy, physical activity, and health
Project aims and research questions
Methods
Design and project team
Search strategy and screening
Inclusion | Exclusion |
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(1) Articles that conceptualize or define physical literacy and are reported from a health context will be included. Studies must: a. Have some mention of physical literacy or a physical literacy lens; b. Be reported from or in a health context including tools used in the past in a health setting or applied in the health sector. (2) All peer reviewed academic publications that are conceptual, theoretical, reviews, or original research articles will be included. | (1) Studies that do not conceptualize or define physical literacy; (2) Case reports, conference abstracts, editorial and opinion pieces, book chapters, book reviews, and book synopses; (3) Non-English studies; (4) Articles where full text is not available through University of Northern British Columbia Library or Interlibrary Loans. |
Data extraction
Synthesis of findings
Results
Literature search and study characteristics
Author | Country of origin | Study design | Definition and citations | Aim or purpose | Sample | Health care providers engaged? | Intervention and characteristics | Key findings | Conclusions |
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Belanger et al. 2018 [40] | Canada | Quantitative – cross-sectional | Whiteheadian | To examine associations between physical literacy (PL) domain scores among children who meet or do not meet Canadian physical activity guidelines (PAG) or sedentary behaviour guidelines (SBG). | Children aged 8–12 (n = 2956) | No | CAPL scores were compared between children who did and did not meet the daily recommended PAG. | Only 20% of sample met PAG. Children meeting PAG had higher PL domain scores for physical competence and motivation and confidence. Children were more likely to meet PAG if they met the minimum recommended level of the physical competence and motivation and confidence domains. Boys had significantly higher PL scores overall, With the exception of the knowledge & understanding domain. Boys were more likely to meet PAG than girls. | Children were more likely to meet PAG and SBG if they achieved the minimum recommended level of PL domain scores, specifically in the physical competence and motivation and confidence domains. Findings suggest associations between PL and the degree to which children adhere to PAG and SBG. |
Choi et al. 2018 [41] | Other (China) | Quantitative – cross-sectional | Whiteheadian | To examine the relationship between perceived PL and physical activity (PA) levels in adolescents studying in various secondary schools in Hong Kong. | Adolescent secondary school students aged 12–18 (n = 1945) | No | Questionnaires measured perceived PL and time spent physically active in past 7 days. Questions assessed walking, school activities, house work, and active transport. Attributes measured: sense of self and self-confidence, self-expression and communication with others, and knowledge and understanding. Demographic info and socio-economic status (SES) collected. | All attributes (sense of self and self-confidence, self-expression and communication with others, and knowledge and understanding) of perceived PL were found to be significant predictors for recreational PA levels. SES was divided into three levels, with middle income group having highest correlation between perceived PL and PA levels. | Study concludes relationship exists between perceived PL and PA levels, and individual factors (age, gender, and SES) impact this relationship. Authors argue the concept of PL should be introduced to adolescents by assigning them the responsibility of designing their chosen PA and discussing the importance of PA for lifelong health. |
Comeau et al. 2017 [42] | Canada | Quantitative– cross-sectional | Fundamental movement skills | To evaluate the association between fundamental movement skills (FMS) and health indicators using the PLAYbasic and Passport for Life tools and to evaluate whether the associations between FMS and health indicators were different between the two tools. | Children aged 9–12 years old (grades 4–6) (n = 145) | No | FMS were evaluated using the Passport for Life and the PLAYbasic tools. Health metrics (BMI, waist circumference, weight, grip strength, and cardiorespiratory fitness) were compared between each test. | FMS is significantly and independently associated with health metrics regardless of age or sex (BMI, waist circumference, weight, grip strength, and cardiorespiratory fitness). The results when comparing the two FMS measurement tools showed no difference. | Children with a high level of FMS display a better health indicators profile when compared to children with poor FMS. Tools used to measure FMS (PLAYbasic or Passport for Life) do not impact the associations observed. |
Delisle Nyström et al. 2018 [43] | Canada | Quantitative – cross-sectional | Whiteheadian | To determine the associations among the four domains of PL stratified by weight status. | Children aged 8 to 12y (n = 8343) | No | BMI/waist circumference measured. Four domains measured along with overall PL using cardiorespiratory fitness (PACER), muscular strength (handgrip, abdominal plank test) and the sit-and-reach test (flexibility). Daily behaviour measured using pedometer and questionnaire items. Motivation and confidence and knowledge and understanding measured using a questionnaire. | In the healthy-weight group, positive associations were found among all PL domains. Results suggest that motivation and confidence are important correlates of modified physical competence and daily behaviour, irrespective of weight status. Healthy-weight children scored higher in all four domains and overall PL in comparison to overweight/obese children, although the differences were small to negligible. | Findings align with current research and future interventions aimed at improving PL do not need to be tailored based on weight status, although longitudinal studies are needed to confirm these conclusions. |
Gibson et al. 2019 [44] | United Kingdom | Qualitative – formative concept testing | Whiteheadian | The purpose of the research is to explore how health and well-being specialists engage with the concept of ‘food and physical literacy’ (FPL). | Professionals from teaching, community development, public health, health and well-being, mental health, social support, active travel, and recreation. (n = 36) | Assessed how professionals engage with the concept of FPL. | Participants attended a workshop on FPL and participated in a focus group discussion on the following themes: professionals’ initial opinions on the concept, its applicability to their practice, and the perceived barriers and facilitators to the advancement of the concept. A questionnaire followed to give participants the opportunity to provide feedback. | Participants’ reactions to the concept were mixed and identified possible barriers, including the name of the concept, its narrow scope, and the perceived intangibility as a substantial number of participants [12] struggled to see the practical application. Despite the barriers, some participants suggested that they were receptive to new concepts, and favoured the inclusive nature of FPL. | FPL is proposed as providing a novel and sensitive resource for thought and for future action. The authors recommend more research on the developing concept of FPL. |
Holler et al. 2019 [45] | Other (Austria) | Quantitative - non-randomized control trial | Whiteheadian | To assess the effects of a holistic physical exercise training intervention on PL in physically inactive adults and to identify sociodemographic parameters affecting changes in PL. | Physically inactive adults (n = 31) intervention group, (n = 30) control. | Physicians assisted with recruitment of participants using motivational interviewing. | Intervention group (IG) participated in a holistic physical exercise training intervention once weekly for 15 weeks, while matched control group (CG) did not. BMI collected at start and end of study. PL was evaluated by a questionnaire assessing PA behaviour, attitude towards a physically active lifestyle, exercise motivation as well as exercise knowledge and exercise self-confidence/self-efficacy. | Findings indicate participation in a holistic exercise training program increases total PL score and selective PL domains (physical activity behaviour and exercise self-confidence/self-efficacy) in physically inactive adults. Improvements in PL are positively correlated with BMI values at baseline. No changes were found concerning attitude towards a physically active lifestyle, exercise knowledge or motivation. | Validated measurement tools are not available for measuring adult PL and therefore this should be taken into account when interpreting these findings. Further research is necessary to determine the psychometric properties for this PL questionnaire. |
Kwan et al. 2019 [46] | Canada | Quantitative - quasi-experimental design | Whiteheadian | The purpose of this study was to evaluate the effectiveness of a pilot PL based intervention in emerging adults. | First-year university students (17+) transitioning directly from high school to living in residence. IG (n = 26), HAL-CG (n = 20) and CG (n = 23). | No | PL domains were measured for all participants at baseline and follow-up. The IG took part in a 12-week program (PLUS intervention) designed to facilitate novel movement skills in a fun and engaging group-based environment. Measures included: PLAYfun tool for movement competence and confidence, motivation, and knowledge and understanding were measured via questionnaire. | PL based interventions can be effective in enhancing overall PL in the emerging adult population. Findings suggest that there was no overall change with respect to movement competence, small-to-moderate effect sizes were evident in the time by condition interactions for motivation, confidence, and knowledge and understanding. While the intervention was successful in maintaining and improving the psychological domains of PL, there were no observable changes in motor competence. | Given the typical decline in PA with age, the PLUS intervention may be a promising approach in promoting the maintenance of lifelong engagement in PA. |
Lang et al. 2018 [47] | Canada | Quantitative – cross-sectional | Whiteheadian | The aim of this study was to assess the relationships between cardiorespiratory fitness and components of PL among Canadian children aged 8–12 years. | Children aged 8–12 years (n = 9393) | No | PL was measured using the CAPL, CSAPPA, and 20 m shuttle run. Component measures of each domain: physical competence (total domain score, handgrip, plank, sit-and-reach, BMI, wait circumference, CAMSA), daily behaviour (total domain score, avg. daily steps, self-reported screen time, avg. days/week meeting guidelines), motivation and confidence (total domain score, benefits and barriers, activity level compared to peers, skill level compared to peers, CSAPPA adequacy and predilection scores), knowledge and understanding (total domain score, CAPL questionnaire score). | Cardiorespiratory fitness (CRF) is strongly associated with all components of PL in school-aged Canadian children. Participants in high CRF groups demonstrated better scores across all domains of PL in comparison with peers in lower CRF groups, regardless of age and gender. The strongest associations were identified between CRF and physical competence, followed by motivation and confidence, daily behaviour, and knowledge and understanding. | Preliminary evidence supports CRF as a predictor of PL outcomes. Future studies should aim to replicate these results in different populations, and to identify the sensitivity and specificity of using CRF to screen for children with low PL levels. |
MacDonald et al. 2018 [48] | Canada | Quantitative – cross-sectional | Whiteheadian | The purpose of this study was to investigate the association of age, gender, and physical competence components of children’s PL levels, with perceived adequacy in and predilection for physical activity | Children aged 8–12 years (n = 8530) | Authors make recommendations for health care providers by suggesting physical fitness should remain the focus of practitioners targeting physical activity promotion in youth. | Measures of PL included: Progressive Aerobic Cardiovascular Endurance Run (PACER), Canadian Agility and Movement Skill Assessment (CAMSA), sit and reach, handgrip, plank, and body mass index) and children’s perceived adequacy and predilection toward physical activity as measured by subscales from the Children’s Self-Perceptions of Adequacy in and Predilection for Physical Activity scale (CSAPPA). | Results demonstrated CRF, as measured by the PACER, was moderately related to children’s perceived levels of adequacy and predilection. Findings align with literature stating both boys and girls tend to prefer non-physical activities as they age. | It is unclear whether high levels of physical competence in PL lead to higher affective states or vice versa. The findings support the assertion that effective teachers and coaches will consider both the physiological and psychological makeup of a child to promote optimal PA participation. |
Millington 2015 [49] | Canada | Qualitative – multiple methods approach | Whiteheadian | This study aims to understand how video games such as Wii Bowling are being used in retirement centres and the implications of fusing technology and PL . | Four retirement centres offering Nintendo Wii as part of their activity programming. Staff (n = 10) and residents (n = 8) | No | Methods used in this research included semi-structured interviews with retirement centre staff (n = 10), semi-structured interviews with older persons residing at retirement centres (n = 8), and observation of exergaming in action. | Interactive games such as Wii Bowling are perceived by staff and residents as useful in the pursuit of active aging. Some games present challenges for older persons, both in their physical demands and in the need for gamers to successfully blend media and physical literacies. Residents noted sore muscles, aches, and arthritis flare-ups. Technologies presented challenges for staff as they struggled to blend media and physical literacies. | Exergaming may prove to be a useful tool in promoting PL and active aging in older adults. |
Pohl et al. 2019 [50] | Canada | Quantitative – cross-sectional | Whiteheadian | The purpose of this study is to compare the PL of children with epilepsy with that of a reference population of Canadian children without known health conditions. | Epileptic children aged 8–12 years with at least one seizure in the last 12 months. IG (n = 35), and CG (n = 228) | Neurology clinic was location for recruitment | CAPL assessment was conducted (daily behaviour monitored with a pedometer), and self-reported PA and screen time was recorded in IG and CG. | Only 11% of children with epilepsy met recommended PL scores, significantly fewer than the control group. Daily behaviour was not significantly different, but epileptic children had significantly lower agility and movement skills. Epileptic children matched their peers in the knowledge and understanding domain, yet scored higher than their peers in the motivation and confidence domain. | Children with epilepsy had significantly lower PL levels than their peers without known health conditions. Increased PA in children with epilepsy may improve their general long-term health, decrease anxiety and depression, and improve self-esteem and social integration while boosting neurocognitive skills. |
Saunders et al. 2018 [51] | Canada | Quantitative – cross-sectional | Whiteheadian | The purpose of this study was to identify the domains of PL associated with key modes of sedentary behaviour (SB) among Canadian children. | Children aged 8–12 years (n = 8307) | No | PL was assessed using the CAPL. SB was broken into screen-based s, non-screen, and total SB. All were assessed via self-report questionnaire. | SB is associated with total PL, as well as motivation and confidence, knowledge and understanding, and physical competence domains. Motivation and confidence demonstrated the strongest association with screen-based modes of SB, while knowledge and understanding showed positive associations with non-screen SB, and negative associations with screen-based SB. Girls were more likely to meet screen-time guidelines than boys. | Interventions should be tailored to participant gender and age, which are associated with multiple modes of SB in this age group. |
Author | Country of origin | Study design | Definition | Aim or purpose | Health care providers engaged? | Key findings | Conclusions |
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Cairney et al. 2019 [19] | Canada | Literature review | Whiteheadian | The purpose of this work is to present a conceptual model positioning physical literacy (PL) as a health determinant, and present evidence in support of PL as a health determinant, drawing on research largely from outside physical education. | No | PL is a gateway to increasing physical activity (PA), which means PL must also be a necessary determinant of health via its impact on PA. Authors are developing a conceptual model positioning PL as a health (and disease) determinant, based on how professional communities (public health) might think about PL in the context of health promotion and disease prevention. This connection lacks direct empirical connectivity between PL and health outcomes, but authors feel there is sufficient evidence to warrant further research into the relationship. | By providing an evidence-informed model, it will encourage further discussion and stimulate empirical research on PL and the relationship to health. |
Demetriou et al. 2015 [52] | Germany | Systematic Review | Whiteheadian | This review provides detailed information on the aims, the theoretical background, content, design, methodological quality, and effectiveness of school-based interventions aiming to influence students’ health-related fitness knowledge | No | The primary aim of intervention programmes was the prevention of chronic heart disease risk factors. This overall aim was split up in more specific targets: increase PA and fitness, reduction of risk factors for obesity, nutrition behaviour, and psychological variables such as motivation and attitudes towards PA. School-based PA interventions can change students’ health-related fitness knowledge levels. Intervention programmes addressing adolescents were more frequently able to change their health-related fitness knowledge in comparison to studies that aimed to enhance children’s health-related fitness knowledge levels. | Authors recommend a standardised, validated and reliable measurement instrument to assess students’ health-related fitness knowledge is needed in order to compare the studies’ effects and also changes between cohorts of students |
Dudley et al. 2017 [2] | Canada | Literature Review | Whiteheadian | To present a new model of PL policy considerations for decision makers in public health, recreation, sport, and education. Definitions of PL and the wider construct of literacy were reviewed in order to establish common pillars of PL in an applicable policy model. | No | Authors state there are problems with connecting fundamental movement skills (FMS) to PL in that some practitioners, and by default, policymakers think FMS can be taught in isolation. Most attempts to rationalize these skills into public health, sport, or education resources have met controversy in the PL context because they fail to capture the broader PL components of moving for play, enjoyment, or recreation. | PL is still far from having the empirical weight to be substantiated as best practice in reduction of non-communicable disease or the promotion of PA. Future research should focus on clearly articulating the definitions, philosophical assumptions, and expected outcomes prior to evaluating the effectiveness of this emerging concept. |
Edwards et al. 2017 [53] | United Kingdom | Systematic review | Whiteheadian | The purpose of this systematic review was to conduct a systematic review of the PL construct as reflected in the contemporary research literature | No | Few of the proposed relationships and causal associations claimed for PL have been empirically tested to date, although such trials are currently underway. This paper is the first to provide a review of the core attributes of the PL construct, including the defining properties of PL, the philosophical foundations, and the theoretical associations of the construct. Seventy percent of articles that referred to the term PL adopted a Whiteheadian perspective. | Researchers need to operationalize PL and generate meaningful, measurable differences that will eventually be the arbiter of what PL is and how it works. |
Fortnum et al. 2018 [54] | Australia | Scoping review | Whiteheadian | To review the evidence relating to the individual components of PL (4 domains) in children with behavioural and emotional mental health disorders (MHDs). n = 68 studies included. | Physiotherapists should be included in the management of children with MHDs to increase the likelihood of children becoming physically literate and to help moderate the negative impacts of MHDs on physiological health. | Research is predominantly based around the physical competence domain, with 62 articles exploring the topic; other domains are not as well represented in the literature. Daily behaviour was assessed in 12 studies, motivation and confidence in 2 studies, and knowledge and understanding in 1 study. Children with MHDs appear to have lower PL levels than children without MHDs and can be observed across the daily behaviour domain, as well as the motor proficiency, aerobic fitness, muscular strength and muscular endurance components. | Children with MHDs are more likely to exhibit lower levels of PL than children without a MHD diagnosis, as such it is likely children with MHDs require additional support and tailored interventions to promote PL. A comprehensive PL assessment should be included in standard care for clinicians working with children with MHDs. |
Definition of physical literacy
Authors | Physical competence (physical) | Motivation and confidence (affective) | Knowledge and understanding (cognitive) | Engagement in physical activity for life (behavioural) |
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Belanger et al. 2018 [40] | CAPL, CAMSA | CAPL | CAPL | CAPL (pedometer step counts 7 days; self-reported activity) |
Choi et al. 2018 [41] | IPAQ-A | PPLI | PPLI | PPLI |
Comeau et al. 2017 [42] | Passport for Life and PLAYbasic | Not reported | Not reported | Not reported |
Delisle Nyström et al. 2018 [43] | CAPL, CAMSA | CAPL | CAPL | CAPL (pedometer step counts 7 days; self-reported activity) |
Gibson et al. 2019 [44] | Not reported | Not reported | Not reported | Not reported |
Holler et al. 2019 [45] | Questionnaire informed by ACSM/AHA, SMS28, SIMS, FKB-20, BREQ-2, IPAQ-SF, Stanford Five City Study. | Questionnaire informed by ACSM/AHA, SMS28, SIMS, FKB-20, BREQ-2, IPAQ-SF, Stanford Five City Study. | Questionnaire informed by ACSM/AHA, SMS28, SIMS, FKB-20, BREQ-2, IPAQ-SF, Stanford Five City Study. | Questionnaire informed by ACSM/AHA, SMS28, SIMS, FKB-20, BREQ-2, IPAQ-SF, Stanford Five City Study. |
Kwan et al. 2019 [46] | PLAYfun tool | BREQ-3, and two items based on recommendations from Bandura (1997, 2006). | BREQ-3 | Not reported |
Lang et al. 2018 [47] | CAPL, CAMSA | CAPL, CSAPPA | CAPL | SC-StepRx pedometer for 7 days |
MacDonald et al. 2018 [48] | CAPL, CAMSA | CAPL, CSAPPA | CAPL | CAPL |
Millington 2015 [49] | Semi-structured interviews with retirement centre staff (n = 10), and older persons residing at retirement centres (n = 8). Observations of exergaming. | Semi-structured interviews with retirement centre staff (n = 10), and older persons residing at retirement centres (n = 8). Observations of exergaming. | Semi-structured interviews with retirement centre staff (n = 10), and older persons residing at retirement centres (n = 8). Observations of exergaming. | Semi-structured interviews with retirement centre staff (n = 10), and older persons residing at retirement centres (n = 8). Observations of exergaming. |
Pohl et al. 2019 [50] | CAPL, CAMSA | CAPL | CAPL | CAPL (pedometer step counts 7 days; self-reported activity) |
Saunders et al. 2018 [51] | CAPL, CAMSA | CAPL | CAPL | CAPL (pedometer step counts 7 days; self-reported activity) |
Physical literacy in the health care setting
Relationship between physical literacy and health
Discussion
Concept and measurement of physical literacy
Physical literacy, physical activity, and health
Physical literacy in the health care setting
Recommendations for future work
Limitations
Summary of key themes and findings
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Health care practitioners are not engaged with the construct of physical literacy in practice;
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Greater emphasis is placed on the physical domain of physical literacy, leaving the remaining domains (affective, cognitive, and behavioural) underrepresented and understudied;
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There is evidence to support a relationship between the physical domain of physical literacy and improved health outcomes, although the directionality of this relationship is unknown.