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A diverse, cross-sectorial group of partners, stakeholders and researchers, collaborated to develop an evidence-informed Position Statement on active outdoor play for children aged 3—12 years. The Position Statement was created in response to practitioner, academic, legal, insurance and public debate, dialogue and disagreement on the relative benefits and harms of Outdoor play including risky outdoor play.

There is global concern over the progressive trend towards lifestyles that are conducive to the promotion of non-communicable diseases [ 12 ].

Childhood obesity and inactivity are prominently featured in this challenge, Outdoor play solutions that take a life-course approach, emphasizing the importance Outdoor play cumulative physical, social and cultural exposures [ 12345 ].

The prevalence of childhood obesity worldwide is at an all-time high and increasing [ 6 ].

The proportion of children Outdoor play the world meeting physical activity guidelines is very low and likely declining [ 78 ]. This is troubling as physical activity and sedentary behaviour habits formed during childhood tend to track over time into adulthood [ 910 ].

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The decreased opportunity for, and prioritization of, childhood healthy active living and active outdoor play has been positioned as a child rights concern [ 11 ]. The issue is of sufficient urgency that the Director General of the World Health Organization recently established a Commission on Ending Childhood Obesity to provide recommendations for preventing and managing childhood obesity in a variety of contexts around the world Outdoor play 1213 ].

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Finding strategies to promote healthy child development through the prevention of obesity and inactivity Outdoor play required. Approaches that are accessible, acceptable, culturally adaptable, feasible, cost-effective, and scalable are a priority worldwide. Healthy child development is influenced by many Outdoor play, family, school, community, political and global factors that interact Outdoor play time [ 14 ]. Several substantive societal changes have occurred across these levels of influence in recent years, including where and how children spend their discretionary time.

Reported levels of screen time in developed countries suggest that sedentary indoor time is high amongst most children and youth today [ 17181920212324 ]. Canadian children now spend an average of 8. The lure of the indoors has been fueled by improvements in indoor climate control and increased entertainment temptations e. This drift from time spent outdoors to increased time spent indoors has occurred concurrent with the childhood obesity and inactivity crisis, and parental expectations surrounding child protection.

Some argue that we have become an excessively risk averse society, Outdoor play the extent that we have limited essential learning and developmental opportunities Outdoor play children, while also reducing their physical activity and increasing sedentary behaviours.

Others believe that safety guidelines and standards, child protection services and contemporary use of the precautionary principle have improved healthy child development through injury Outdoor play and a reduction in exposure to harm. This debate is active in the published literature [ 29303132 ]. The Active Healthy Kids Canada Report Card extolled the benefits of self-directed active outdoor play [ 18 ] while the Canadian Paediatric Society Position Statement on preventing playground injuries recommends active supervision [ 33 ].

The debate is often polarized and supporting evidence selectively cited. However, recent efforts in Canada [ 35 ] and England [ 36 ] have promoted a more balanced approach to risk and safety in childhood by bringing divergent professions in the area of health promotion together through reasoned argument and debate, as opposed to polarizing confrontations. Ungar noted that parents are not swayed by statistics indicating that their communities are safe and that there is a low likelihood of adverse outcomes from being outdoors [ 37 ].

The underlying premise that the indoors is safer than the outdoors however may be misguided in light of the potential harms of the internet e. Regardless, there is a need for a balanced review of the evidence and a coming together of relevant stakeholders to agree upon an evidence-informed foundation from which responsible initiatives can emanate to promote healthy child development.

To address this need a group of researchers and Canadian organizations paper authors agreed to work together to create a Position Statement on Active Outdoor Play informed by the research literature, expert consensus and practitioner experience.

It is recognized that lack of a common understanding and use of key terms can complicate this debate. For example, risk is often interpreted as a bad thing, yet exposure to risk has been shown to be essential for healthy child development [ 324445464748 ].

Consequently, operational definitions of key terms used in, and related to, the Position Statement are provided in Table 1. Outdoor play initiative represents a robust, comprehensive, transparent, multi-disciplinary effort to examine the evidence linking active outdoor play, including risky play, to the promotion of healthy active living among Canadian children. The purpose of this paper Outdoor play to describe the process used to develop the Position Statement on Active Outdoor Play and present, explain, substantiate and discuss the final Position Statement.

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The development and release of the Position Statement included securing funding, the completion of two systematic literature reviews, the establishment of a multi-disciplinary consensus group, an extensive stakeholder survey and consultation process, an opportunity for supportive stakeholders to be acknowledged, a comprehensive media, public relations and communication plan, a coordinated dissemination strategy, and proactive planning for Outdoor play action.

Funding for the systematic reviews was secured through a research grant from The Lawson Foundation and an internal prioritization of funds within HALO.

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All participating individuals and organizations also provided in-kind support for the development, dissemination and promotion of the Position Statement. Outdoor play systematic reviews were undertaken to help inform the Position Statement. The reviews investigated the evidence on: A small Steering Committee with representatives from each of the project funders was formed to identify individuals and organizations to form a multi-disciplinary consensus group.

The final participants in the consensus group and their home organizations are Outdoor play Table 2.

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The consensus group met for 2 days in January,at Evergreen Brick Works in Toronto where results of the systematic reviews were presented, other Outdoor play evidence was discussed, the content for the Position Statement was determined, plans for a stakeholder consultation survey were initiated, and initial communications and dissemination strategies were formulated. Immediately following the consensus group meeting Katherine Janson, Casey Gray and Mark Tremblay created an initial draft of Outdoor play Position Statement that was circulated to the group.

An on-line survey was developed to solicit assessments and comments from stakeholders on the draft Position Statement. The survey sought assessments of the clarity of the various sections of the Position Statement as well as levels of agreement with the text. Basic demographic information was requested and an opportunity Outdoor play provided to offer open comments on any aspect of the Position Statement.

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The complete survey in both English and French is available in Supplemental Outdoor play. The survey was disseminated through the various networks of consensus group members, and followed a snowball sampling methodology recognizing the inherent risk of bias to maximize reach and input. The survey was live from 25 February to 15 March After the survey closed, empirical responses were tabulated and analyzed by Joel Barnes. A subcommittee of the consensus group, including Mark Tremblay, Casey Gray, Mariana Brussoni, Susan Herrington, Guylaine Chabot, Katherine Janson and Richard Larouche reviewed the survey materials and worked together to Outdoor play the Position Statement based on the survey feedback, provided changes remained true to the available evidence-base see Results.

The revised Position Statement was circulated to the entire consensus group for comment and Outdoor play revisions. Consensus was achieved on the final Position Statement. Revisions were translated to finalize the French version.

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The stakeholder survey permitted respondents to express their interest in publicly disclosing their support for the Position Statement pending their review of the final draft. To facilitate this, interested respondents were asked to provide Outdoor play email address where the final Position Statement could be sent. The list of supporters is housed on the HALO website www.

A public launch date of 9 June was established, including a national press release with proactive media outreach Outdoor play key markets across Canada.

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To enhance the national outreach, a network of national spokespersons was trained to field interview requests across Canada, including photo opportunities and on-site Outdoor play at adventure playgrounds or similar sites in major markets. Organizations involved in the development of the Position Statement received spokesperson training on the key messages and employed template press releases to customize and use to respond to the national release in a coordinated fashion.

As a part of the communications plan, Outdoor play comprehensive, coordinated dissemination strategy was put in place by ParticipACTION, utilizing and maximizing the reach of the consensus group, their networks and memberships.

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Outdoor play The strategy to combine the launch of the Position Statement and the release of the Report Card was intended to amplify the reach of each product while also being mutually supportive in message. The Position Statement is a concise, public-facing, consolidation of evidence, and while it does provide recommendations, it is not a program to increase active outdoor play for children.

It was designed to be a foundation of credible evidence from which programs, strategies, campaigns, policies, practices and environmental modifications can be provoked, initiated and supported. The legacy of this initiative is preserved in the Position Statement itself as well as this mini-series of papers in the International Journal of Environmental Research and Public Health which includes the two background systematic reviews [ 4346 ] and this process and outcomes paper.

The process, while intensive, was successful and consensus was achieved on the final product. Each organization sent Outdoor play statement to explain the reason they chose not to endorse the final statement. These statements are Outdoor play as received below. The Position Statement is supported by peer-reviewed research evidence as cited in Supplementary 2with complete references also provided in this manuscript. Below, each evidence statement from the Position Statement is elaborated on, substantiated, and more details of the supporting evidence are provided.

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