Y-PATHS: A Conceptual Framework for Classifying the Timing, How, and Setting of Youth Physical Activity

Abstract

Background:

Multiple models and frameworks exist for the measurement and classification of physical activity in adults that are applied broadly across populations but have limitations when applied to youth. The authors propose a conceptual framework specifically designed for classifying youth physical activity.

Methods:

The Youth Physical Activity Timing, How, and Setting (Y-PATHS) framework is a conceptualization of the when (timing), how, and where (setting) of children’s and adolescents’ physical activity patterns. The authors developed Y-PATHS using the design thinking process, which includes 3 stages: inspiration, ideation, and implementation.

Results:

The Y-PATHS includes 3 major components (timing, how, and setting) and 13 subcomponents. Timing subcomponents include (1) school days: in-school, (2) school days: out-of-school, and (3) nonschool days. How subcomponents include: (1) functional, (2) transportation, (3) organized, and (4) free play. Setting subcomponents include: (1) natural areas, (2) schools, (3) home, (4) recreational facilities, (5) shops and services, and (6) travel infrastructure.

Conclusions:

The Y-PATHS is a comprehensive classification framework that can help researchers, practitioners, and policymakers to better understand youth physical activity. Specifically, Y-PATHS can help to identify the domains of youth physical activity for surveillance and research and to inform the planning/evaluation of more comprehensive physical activity programming.

Physical activity is a complex behavior that, when neglected, is related to multiple health concerns in childhood and adolescence and can create additional health complications in adulthood.^1,2 Globally, only about 20% of youth meet the physical activity recommendation of participating in 60 minutes or more of moderate to vigorous physical activity each day.^3,4 This proportion is lower among adolescent girls, older youth, and racial and ethnic minority populations.^5,6

To promote physical activity, coordinated efforts that involve researchers, practitioners, and policymakers often rely on models and frameworks to guide research agendas, surveillance, and program planning/evaluation. Researchers have proposed 4 key domains of adult physical activity: leisure time, occupational time, transportation time, and household time.⁷ This 4-domain classification system, however, is not relevant for children and adolescents, because it excludes youth-specific contextual factors (eg, school setting). Accordingly, a new framework that identifies the timing, how, and setting of youth physical activity is needed in order to better inform physical activity surveillance, research, and program planning/evaluation.

Timing is a major contextual factor that affects youth participation in physical activity, and the actual timing, duration, and frequency of attendance at school can be key drivers of structured and unstructured physical activity for children and adolescents. Worldwide, over 90% of primary school children are enrolled in school, and, in some countries, youth spend an average of 6.5 hours at school each day.^8,9 Experts recommend that schools provide multiple opportunities for physical activity and that at least half of the required 60 minutes of youth physical activity is achieved during physical education (PE) classes,¹⁰ a goal that is rarely met. Although a focus on school physical activity is important, physical activity during other times of the day (ie, before or after school) and year (eg, summer and winter breaks) have received less attention,¹¹ leading to fewer evidence-based programs and youth physical activity opportunities outside of the school setting. A framework that considers the timing and context of youth physical activity (eg, school days, nonschool days) can guide efforts to develop new programs to address this gap.

Another important consideration is how youth participate in physical activity. Adult frameworks use the categories of leisure-, occupational-, transportation-, and household-related physical activity.⁷ Although these categories could be used for youth, understanding other features of the activity, such as whether the activity is structured (eg, free play), who structured the activity (eg, parents), and the role that schools play may be especially pertinent. For example, using the aforementioned categories, attending a martial arts class and playing tag could be considered leisure-time physical activities, but a martial arts class must be organized and facilitated by adults, whereas playing tag can occur during free play and requires limited parental supervision. Consequently, promotion of each activity may require different considerations (eg, transportation), and these may be facilitated by appropriate categorization in a more comprehensive conceptual framework.

Finally, youth also participate in physical activity opportunities within a variety of settings. Some of these are explicitly designed for them, such as community pools, playgrounds, religious institutions, and summer camps,^12,13 while others are equally used by other age groups (eg, roads, sidewalks, parks, beaches). Physical activity opportunities in these settings are understudied but important for surveillance purposes and provide important avenues for delivering evidence-based physical activity approaches. A conceptual framework that captures the breadth of locations in which children and adolescents tend to participate in physical activity can serve to highlight the importance of often-overlooked settings and, therefore, facilitate youth physical activity promotion.

Currently, multiple models and frameworks guide the conceptualization, measurement, and planning of physical activity programs; several of these provide ecological perspectives,^14,15 while others help to classify physical activity. Although existing models/frameworks have great utility, pivotal factors for youth, such as the school setting and the role it plays, are not well articulated within them. Consequently, researchers and practitioners often adapt existing frameworks for youth populations. Youth physical activity generally consists of varying patterns (eg, short, intense physical activity bouts), differing circumstances (eg, participation in free play vs structured exercise), and distinct timing (eg, school time vs out-of-school time) as compared with adult physical activity. As a result, when adult frameworks are used or adapted, not all of the important facets of youth physical activity may be adequately considered or captured. This key limitation will be addressed by a youth-specific framework.

Researchers and practitioners have begun to address research gaps in the surveillance and evaluation of youth physical activity through efforts to develop new youth-specific surveillance modules, evaluation measures, and consortiums.^16-18 Although the development of these resources represents progress, a comprehensive conceptual framework that addresses the breadth of possible youth physical activity patterns has not been proposed. Thus, the purpose of this study was to describe the timing, how, and setting of youth physical activity. In addition, we propose the Youth Physical Activity Time, How, and Setting (Y-PATHS) framework, a conceptual tool that takes a comprehensive and pragmatic approach to the categorization of youth physical activity.

Methods

The Y-PATHS is the product of a multidisciplinary workgroup of epidemiologists, behavioral scientists, and environmental scientists from or affiliated with the University of Texas Health Science Center at Houston, School of Public Health, who study physical activity and public health. The development of Y-PATHS spanned 1 year (spring 2019 to spring 2020) and used the design thinking process,¹⁹ which includes 3 iterative stages: inspiration, ideation, and implementation. Inspiration is the identification of an issue that motivates a project; ideation involves generating, developing, and testing ideas; and implementation is the movement from project stage to reality.

Inspiration occurred in spring 2019 when we attempted to apply an existing physical activity framework to a project in the school setting. As a result, we identified the current lack of a framework to operationalize the important components of youth physical activity. We determined that a framework for the identification of children’s and adolescents’ distinct physical activity patterns was an important knowledge gap that required a design solution (ie, a conceptual framework).

During the ideation phase, we completed multiple charrettes to begin to generate a conceptual framework for youth (aged 6–18 y) physical activity. Through a team brainstorming process, we set several constraints around the design solution, including the requirements that the framework should be (1) comprehensive, (2) simple, (3) adaptive, and (4) practical. We produced an initial prototype of the Y-PATHS framework, which included 3 components (ie, timing, how, and setting) of physical activity. Each component was adapted based on ecological models of physical activity,^15,20 the adult framework proposed by Gabriel et al,⁷ and the US Centers for Disease Control and Prevention’s social determinants of health framework.²¹

Next, the workgroup reorganized the framework and determined that additional literature reviews were needed in order to identify important subcomponents within each larger component. We continued to iteratively review the literature, discuss the framework’s organization, and make modifications until a consensus was reached on the form and function of the framework. The final framework consisted of 3 components—timing, how, and setting—with 13 subcomponents that were organized into 3 circles, forming a dynamic tool similar to the Behaviour Change Wheel.²²

Next, we iteratively pilot-tested implementation, using multiple concurrent methods. We reviewed the literature to create conceptual definitions for each subcomponent within each of the 3 major components. We sought expert input to assess the face validity of the framework. We generated an example physical activity intervention within each framework combination (eg, after school, home, functional) and created illustrative applications that provided guidance on using the framework. Refinements during this phase did not conceptually alter the framework but, rather, enhanced the framework’s readability, applicability, and practicality.

Results

Form and Function of the Y-PATHS Framework

The Y-PATHS framework is illustrated as a central triangle, with each side pointing to a proximal circle (Figure 1). The triangle represents physical activity of children and adolescents, and each circle represents one of the 3 components of youth physical activity: timing, how, and setting. The 3 components are independent of one another and are further divided into multiple subcomponents (Figure 1). The Y-PATHS framework has 72 unique combinations that can be used to classify youth physical activity, but some combinations likely have more relevance than others.

Figure 1 —

Youth Physical Activity Timing, How, and Setting framework.

Component 1: Timing

An important component of youth physical activity is the timing of physical activity. Based on our literature reviews, we classified timing into 3 subcomponents: (1) school days, in-school, (2) school days, out-of-school, and (3) nonschool days.

School Days, In-School.

In-school time was defined as the time within school hours on days when school is in session (ie, from the time youth reach school to the end of their last class).²³ Globally, 56% of countries have universal primary education, and 8 in 10 countries have > 80% of children enrolled in primary education.⁹ Schools play an important role in helping students achieve physical activity by providing opportunities, such as PE, recess, and classroom activity.³ Roughly 40% of youth physical activity volume takes place during school,¹⁰ and a typical PE class, recess, and classroom activity adds about 20, 9, and 19 minutes of physical activity per day, respectively.^24-26

School Days, Out-of-School.

Out-of-school time was defined as the time outside of school hours on days when school is in session. Some physical activity opportunities during this time occur at home (eg, playing basketball in a driveway), through after-school programs (eg, interscholastic/ intramural sports, physical activity clubs), and through active transportation.¹⁰ Involvement in after-school programs and active transportation programming (eg, safe routes to school, walking school bus) add an estimated 10 and 16 minutes of physical activity to a student’s day, respectively.^26,27

Nonschool Days.

Nonschool days were defined as any time on days on which school is not in session, such as weekends, holidays, bad weather days, and summertime. Most children spend more days outside of school than in school, and research suggests that activity levels among youth are lower on nonschool days, particularly in the summer.¹¹ In addition, some nonschool day opportunities for physical activity differ from those provided on school days and can involve neighborhood-level initiatives (eg, play streets²⁸) and summer camps.²⁹ More research is needed, however, to understand the amount of physical activity that nonschool-day programs can provide.²⁹

Component 2: How

A second important classification of physical activity is how youth are achieving it. We identified 4 different subcomponents of physical activity that capture the means by which youth are physically active: (1) functional, (2) transportation, (3) organized, and (4) free play.

Functional.

Functional activities were defined as goal-oriented movements related to managing basic needs, such as dressing, eating, grooming/personal hygiene, and movement within a location.³⁰ Researchers estimate that youth spend about 8 hours per week engaged in functional activities, which can range from light- to moderate-intensity physical activity.^17,30,31 There is limited research that examines how youth functional activity contributes to achieving physical activity recommendations, but all youth engage in daily functional activity. Thus, it is important to gain a better understanding of this subcomponent.

Transportation.

Transportation activities, specifically active transportation, were defined as human-powered movement from one location to another (eg, home to school) but not movement within a location (eg, walking around the house, which would typically correspond to functional activity).³² For adults, active transportation typically includes walking or bicycling, but for youth, activities such as skateboarding, riding a scooter, and rollerblading also are common.^17,32 Active transportation can provide light- to vigorous-intensity physical activity. Participation in active transportation varies greatly between countries,⁴ but in the United States, estimates suggest that about 38% of youth participate in active transportation for 10 minutes or more at least once a week, and 23% of youth do so 5 or more days per week.^17,33

Organized.

Organized (ie, structured) activities were defined as activities that are planned, facilitated, and/or led by adults that typically have a scheduled time and may involve skill-building and/or goal-oriented movements.³⁴ Examples of organized activities include PE, team or individual sports, classroom activities, after-school interscholastic and intermural sports, and other after-school programs.¹⁰ Youth participation in organized physical activities varies, but, in many cases, organized activities may involve large proportions of school-aged youth. For example, in 2018, approximately 72% of US youth (aged 6–12 y) reported participating in at least 1 day of sport, and 39% of boys and 31% of girls reported playing a sport on a regular basis.³⁵ In addition, 69% of elementary schools, 84% of middle schools, and 95% of high schools require students to participate in PE, which offers a variety of organized activities.³⁶

Free Play.

Free play (ie, unstructured activities) was defined as activities that are directed by youth, such as free play at a park or during recess. Adults may help initiate, facilitate, or supervise, but free-play activities are not organized or directed by adults. Youth free play has declined over the years—by approximately 25% from 1981 to 1997—due to increases in the length of the school day and the number of school-related activities (eg, homework).^35,37 In addition, current estimates of time spent in free play are scarce, which suggests that more research is needed in order to better understand and promote free-play physical activity, particularly among older youth.³⁵

Component 3: Setting

A final classification of physical activity is the setting in which it occurs. From the literature, we identified 6 distinct types of settings in which youth engage in physical activity: (1) natural areas, (2) school, (3) home, (4) recreational facilities, (5) shops and services, and (6) travel infrastructure.

Natural Areas.

To define natural areas, we adapted a greenspace definition: “publicly accessible areas with natural vegetation, such as grass, plants or trees [and may include] built environment features, such as urban parks, as well as less managed areas, including woodland and nature reserves.” In this definition, we included mountains, water bodies, beaches, and other places not created by humans.³⁸ Exposure to nature is positively associated with children’s physical activity.^39,40 However, not all natural areas provide equal activity benefits. For example, a study of children aged 11–12 years found that mean minutes of physical activity differed based on greenspace type (eg, parks, private gardens, cemeteries).⁴⁰

School.

School was defined as a public, private, or charter institution that educates youth and is physically separated from a youth’s home (ie, not a home school). A school includes the numerous locations on campuses (eg, classroom, cafeteria, gym, hallway, park, playground, sports field) that support and engage youth in the learning environment. Schools provide both indoor and outdoor opportunities for physical activity as well as opportunities for physical activity outside of the school day (eg, competitive sports practices/games). Some common indoor physical activity opportunities include PE and classroom-based activities (eg, active learning, activity breaks), whereas common outdoor physical activity opportunities include recess, after-school programs, and organized sports.^10,26,41

Home.

We defined the home environment as either a child’s own home (eg, single or multiparent home, foster home) or another person’s home (eg, grandparent’s or friend’s home). Home environments include some combination of indoor spaces (eg, bedroom, living room, kitchen, gym) and, potentially, outdoor spaces (eg, front yard, back yard, swimming pool, courtyard). In the home setting, youth typically engage in physical activity through daily living, chores, and play.⁴²

Recreational Facilities.

We defined recreational facilities as both publicly and privately owned spaces that are intentionally designed for engagement in physical activity, including gyms, pools, community recreation centers, sports fields, golf courses, laser tag, and trampoline parks.^43,44 In addition, recreational facilities are spaces that are physically separated from the school campus. Although many of these spaces are specifically designed for youth, outside of community recreation centers, few studies have examined how each of these spaces can affect youth physical activity.

Shops and Services.

In contrast to recreational facilities, shops and services locations were defined as places not intentionally designed for physical activity but, rather, as business locations in which physical activity can occur.⁴⁵ Shops and services span a wide array of business domains, but those that may be important for youth include grocery stores, daycare centers, and shopping malls.

Travel Infrastructure.

Travel infrastructure is any route meant for people to travel, including streets, sidewalks, bike lanes, paths, and trails. Youth use travel infrastructure for free-play physical activity (eg, skateboarding around their neighborhood) and for active transport (eg, bike commuting to and from school or other destinations).^46,47 Certain initiatives, such as Ciclovias and Play Streets, also utilize travel infrastructure as settings for physical activity promotion.^28,48

Discussion

Scope of the Y-PATHS Framework

To date, researchers and practitioners have used multiple frameworks to conceptualize physical activity broadly across all age groups. We contend that youth physical activity is a product of the unique circumstances, developmental stages, and environments in which children and adolescents operate, and, consequently, it should be characterized using a framework germane to youth. The Y-PATHS is a youth-specific classification framework that does not replace existing models and frameworks but, instead, can be used in coordination with them. For example, the Y-PATHS framework can help users to discern environmental conditions and multilevel linkages from the ecological model of physical activity¹⁵ that are pertinent for youth. Classification frameworks, such as Gabriel et al’s⁷ frameworks could guide the selection of important health outcome measures for Y-PATHS-defined physical activity outcomes; and planning processes, such as intervention mapping,⁴⁹ can help to guide users in the development and delivery of youth-specific physical activity programs.

Based on the development process, we recommend that Y-PATHS be used for school-age youth (about 6–18 y old), because it may not be applicable for very young children (0–5 y old) or for adolescents who have completed their secondary education (approximately 18 y old). Early in life (0–3 y old), children’s physical activity comprises rudimentary movements that render several subcomponents within the Y-PATHS framework inapplicable (eg, travel infrastructure).^50,51 In addition, many children under 5 years old do not yet attend school. Furthermore, once youth have completed their secondary education, they may no longer have access to school facilities or interscholastic sports, and adult guardians/caretakers typically do not structure their physical activity opportunities. In addition, many older adolescents (aged 18 y or more) begin full-time jobs or attend college. These changes in adolescents’ physical activity environments suggest that their physical activity patterns may be increasingly similar to adults’ physical activity patterns, and transitioning to another physical activity framework may be more appropriate.

Y-PATHS Applications

The Y-PATHS framework has important surveillance applications.^4,52 Notably, many physical activity surveillance systems have a measurement scope limited to a single setting of physical activity (eg, school).⁵³ Inclusion of a single subcomponent does not allow for the monitoring of specific environmental (eg, presence/absence of a park) or policy-driven factors (eg, school wellness policies) that are known to influence youth physical activity. Consequently, existing surveillance practices may result in a limited understanding of potential differences in physical activity across locations.^52,54,55 The Y-PATHS framework provides structure for guiding physical activity surveillance development in order to ensure that a comprehensive approach is utilized.

Similarly, Y-PATHS has important applications for research and program planning/evaluation. The Y-PATHS helps researchers to select measures across components that drive youth physical activity and, in turn, can define more refined youth physical outcomes than overall moderate to vigorous physical activity. For program planners, Y-PATHS can inform decisions about which components to apply in physical activity promotion (ie, timing, how, and setting). For program evaluators, Y-PATHS can guide measurement decisions to reduce information bias. For example, a researcher may plan a physical activity intervention to improve transportation-related physical activity (ie, how) on nonschool days (ie, timing) within the travel infrastructure (ie, setting). To evaluate this intervention, we would use accelerometers to accurately and easily measure the timing of physical activity, but they would be less effective for measuring the setting in which the physical activity occurs. If both timing and setting are important, then evaluators can choose to use a measurement approach that includes both timing and setting, such as accelerometers combined with activity logs or diaries, which can provide information about where activity is occurring.

Y-PATHS User Considerations

Throughout our design thinking process,¹⁹ we identified additional considerations for use. First, when identifying settings in which physical activity occurs, we recognized that these settings are often embedded within one another. For example, zoos and restaurants, locations that would typically be considered shops and services locations, often have recreational spaces that are specifically designed for physical activity (eg, splash pads, fast food play places). When this type of embedded setting occurs, we suggest that Y-PATHS users consider the impetus for physical activity within that location. A user may determine, for example, that when a parent allows his or her child to use a splash pad, purposeful planning (ie, bringing a swimsuit) was required, and the parent likely considered it a recreational space. Conversely, physical activity that occurs at a fast food play place may be the byproduct of going out to eat. In this case, it would still be considered a shop or service location. Thus, there is some flexibility when using Y-PATHS to classify embedded settings.

Second, we recognize the omission of the workplace as a setting for youth physical activity. Although we acknowledge that child labor is, unfortunately, an important source of physical activity for many youth of the world, our framework reflects the contexts (timing, how, and setting) in which physical activity should occur to enhance physical and mental health. We believe that inclusion of a workplace in the Y-PATHS framework could have the unintended consequence of increasing the promotion of physical activity in this setting; thus, in order to preserve the rights of youth, it was intentionally omitted from the framework. Despite its omission, surveillance of youth physical activity in the workplace has important ethical implications that should be carefully considered by researchers who conduct work in this area.

A third consideration is the relationship between Y-PATHS and the quantification of physical activity. Based on the best available science, the World Health Organization and the US Physical Activity Guidelines for Americans recommend that youth achieve at least 60 minutes of moderate- to vigorous-intensity physical activity each day.³ The Y-PATHS was designed to help parse that recommendation into meaningful components and subcomponents as a strategy for identifying, evaluating, and improving the timing, how, and setting of youth physical activity. We recognize that the number of physical activity bouts, intensity thresholds (eg, light intensity physical activity), and duration recommendations for particular youth populations (eg, youth with physical and intellectual disabilities) are important areas of research and that quantitative recommendations (eg, 60 min) may change as more evidence becomes available. Accordingly, although Y-PATHS does not include quantification components in its structure, it should be used in conjunction with best practice physical activity recommendations.

Finally, when using Y-PATHS, it is important to identify who is classifying youth physical activity, because different reporters may be associated with various challenges or biases. The Y-PATHS helps users to carefully consider and acknowledge challenges/biases associated with various physical activity outcomes. For example, parents, teachers, or other caregivers often classify elementary school children’s physical activity; whereas middle and high school age children are capable of reporting on their own behaviors. When caregivers report on youth physical activity, they may be more apt to report on physical activity experiences that they have organized/attended (eg, sporting events) and less likely to report on experiences that they were unaware of, such as free play activities. In addition, parents have less knowledge of what occurs during the school day, and teachers cannot report on physical activity that occurs within the home. These types of reporting challenges are not specific to Y-PATHS, but, nonetheless, Y-PATHS can aid in the identification of reporting biases when classifying youth physical activity.

Limitations and Strengths of the Development Process

Our current development process had a few limitations. First, community partners were not part of the Y-PATHS design process. Although workgroup members involved in designing Y-PATHS had strong community connections, we did not get community partners’ feedback on the framework. Community partners can offer valuable insight into how academic solutions apply practically; thus, we recommend that individuals who use Y-PATHS work in conjunction with their community partners to determine how to apply Y-PATHS to their innovations. Second, we did not conduct a systematic review of the literature to inform the development of the framework. Given the scope of this project, such a sweeping review of the scientific literature was not tenable (eg, the Y-PATHS framework has 72 unique combinations of times, types, and settings of youth physical activity). We did, however, ground this research in the design thinking process and included existing systematic reviews when applicable. Finally, this framework was tested using conceptual exercises and illustrative applications but was not incorporated into an existing research project. Applying this framework to an existing research project will provide additional insights when used in practice.

Our development process also had several strengths. Our team included graduate students, postdoctoral researchers, and faculty with projects, expertise, and backgrounds that involved multiple types of youth physical activity promotion, measurement, and surveillance across multiple contexts in the design process. The authors’ youth physical activity research expertise and interests included school-based physical activity research, surveillance, physical activity policy, implementation science, the built environment, motor development, and physical activity-related injuries, among other items. Throughout the design thinking process, we drew on these relevant experiences and interests to inform the design of the final framework. Another strength of this work was the varied means that we used to develop this framework. We included practical experience, reviewed the literature, created illustrative applications, and completed classification exercises, which contributed to our understanding of the framework, helped to provide insight, and enabled the framework to have broad use for researchers, practitioners, and policymakers.

Future Directions

As a next step, researchers and practitioners can begin to use Y-PATHS across a broad range of physical activity innovations. Consistent with the design thinking process, implementation of Y-PATHS will likely result in the identification of new applications and additional user considerations. One consideration when applying Y-PATHS is the way in which the components and subcomponents translate across cultures. We are also interested in how physical activity at the population level is divided among different subcomponents and whether different pieces of each wheel should have different weights (ie, importances), as opposed to being identical in value. Because we know that children’s and adolescents’ physical activity patterns differ by age, gender, race/ethnicity, country of residence, and family socioeconomic status, among multiple other factors, it may be that the different subcomponents of each aspect need greater emphasis based on youth demographic characteristics. Researchers and practitioners who use Y-PATHS can help to guide these adjustments.

With the implementation of Y-PATHS, users also will begin to classify their physical activity innovations, which can serve as a useful organization system for helping other researchers to identify interventions or surveillance tools that fit within a particular component or subcomponent. Concurrently, literature reviews can begin to classify existing interventions and surveillance tools using Y-PATHS. By using Y-PATHS as a classification tool, evidence-based interventions and reliable/valid surveillance measures identified through these processes can then be compiled and built into an online Y-PATHS repository. Online repositories help researchers and practitioners to identify evidence-based innovations, which can ultimately accelerate the process of addressing the research to practice gap.

Conclusions

The Y-PATHS is a comprehensive conceptual framework for classifying the timing, how, and setting of youth physical activity, developed through the design thinking process. The Y-PATHS allows users to (1) characterize the complexities of physical activity germane to youth, (2) inform the coordination of more comprehensive physical activity programming for youth, and (3) identify the domains of youth physical activity for measurement and surveillance. Research, practitioners, and policymakers should use Y-PATHS as a guiding tool to help improve the quality and relevance of their youth-specific physical activity innovations.