Theme and Aims

Definition - The Project team tentatively define “Healthy Living” as possessing healthy lifestyle including those daily habits of consuming balanced diet and healthy eating, taking adequate sleep and rest, performing regular physical exercise, managing effectively of stress and taking no substance abuse and smoking. Taking the 360° promotion carries the intention and determination of the project that students should be helped to develop healthy living by all means in and out of schools with the supports by all types of professions. It is similar to the meaning of “life-wide learning” stated in the KLA Curriculum document.

The Health problem-There is growing concern, both internationally and in Hong Kong, over the problems of health facing students in the past decades. The concern has probably resulted from an increase in students’ health problems resulted from problematic lifestyles or living.

“Hypokinetic diseases”- The association of many health problems with inactivity, sedentary lifestyles or living in student population has reached at an alarm stage. Studies (Pemberton & McSwegin, 1993) confirmed that physical inactivity, sedentary and problematic lifestyles have led to a rise in hypokinetic diseases such as coronary disorder, hypertention, obesity, and musculoskeletal disorder. Evident also indicates that such problems trouble the health condition of most adults and students in Hong Kong (Speak 1989; Chung, 1996).

The Audit Commission, Hong Kong (2009), has recently conducted a review titled healthy lifestyle for primary school children to examine the Government’s efforts in fostering a healthier lifestyle for primary school children. In its Report No. 52, the Director of Audit pinpointed that the Department of Health has recorded a rising trend of obesity among primary school children, from 16.4% in the school year 1997/98 to 21.3% in 2007/08. Childhood obesity has posed a growing threat to public health and creates significant socioeconomic burden to society.

Risk Factors-“'Risk factors are defined as those that medical research has shown to be associated with a significant increase in the risk of cardiovascular disease' (Nieman 1995, p304). Smoking, drinking, physical inactivity and obesity are classified as some of the risk factors detriment to health. Below is the list of risk factors identified by the American Heart Association (1994 in Nieman 1995, p307) in terms of whether they can be changed or not :

Chart 1: List of categories of risk factors identified by the American Heart Association

        The importance of physical activity-   The importance of physical fitness resulted from physical activity engagement is associated with improved health measurements (Malina, 1994) and reduces health risks induced by sedentary lifestyle (Blair et al 1987 in Pemberton & McSwegin 1993). Bouchard and Shephard (1993:78) describe their complex hierarchical relationships among their major elements of physical fitness, health and physical activity as follows: 

Chart 2: Relationship among Health, Physical Activity and Physical Fitness suggested by Bouchard and Shephard (1993)

Regular physical activities had been proved to be important means of not only maximizing human physical performance, but also productivity. As one's health habits and physical activity improve, one can move to a higher level of healthy state. Without physical exercise, further inactivity and unhealthy lifestyles can lead to poor fitness and sickness. (Haskell 1989 in Williams & Wallace).

It is generally supported that attaining a certain level of fitness reduce health risks (Blair et al 1987 in Pemberton & McSwegin 1993). Morris (1984) elaborates the relationship between health and physical fitness in a 'continuum' with a scale continues moving throughout life, ending with death at the extreme unhealthy state in the left and it moves to the right when health condition becomes better as physical fitness level improves because of physical conditioning.

Chart 2 : The concept of Health/Fitness Continuum illustrating the relationship between health and fitness (Morris 1984, p.7).

Studies in physical activity in initially sedentary life correlate well with subsequent reductions in mortality and possibly improve longevity (Blair 1993, Paffenbarger et al 1993). The benefits of physical activity for improving cardio-respiratory function, reducing coronary artery disease risk factors, decreasing mortality and morbidity, decreasing anxiety and depression etc. (Bouchard et al 1994, Whitehead 1989,  American College of Sports Medicine 2006) has long been well-established by research. ACSM (2006, p4) concludes that  “there is a clear inverse relationship between activity and mortality risk across activity categories, and the risk profile indicates that some exercise is better than none, and more exercise -up to a point- is better than less. Thus public health efforts should be directed towards getting more people more active of the time”. Increasing the physical activity level of students is one of the means to improve their physical fitness and health state.

However, it has commonly reported that school children nowadays do not engage in sufficient physical activity for the benefit of health (Armstrong, 1990) and evidence is accumulating that heart disease begins in childhood and adolescence (Harries, 1989; Simons-Morton et al, 1987).

It should also be noted that adult behavior has been proven to be so resistant to change, efforts need to be directed at children for the promotion of health through physical activities and active lifestyles before heart disease risk factors start to build up (Sleap, 1990).

On the whole, students’ health problems may result from nutritional deficiencies and unhygienic living conditions. They may be confronted with problems related to lifestyle changes. Thus, a wide concept of healthy living should be incorporated instead of limit ourself with physical activity and fitness.

Health and fitness in the school PE curriculum 
Promoting health has long been an important goal of PE in Hong Kong. Previous curricular emphases of PE as stated in the Syllabi (CDC, 1964; 1975; 1980; 1985; 1995) mainly focus on developing students’ physical movement efficiency as well as bodily or organic improvements so that students can perform with their athletic ability optimally. The Curriculum Guide for Primary school PE (CDC, 1985) appears to place its emphasis on skill-related activities. In the preface, it states that “regular exercise in fitness activities leads to the improvement in physique and physical skills <should be promoted>” (p.8). In the PE Syllabus for primary school (Curriculum Council, 1995), it was stipulated that “through physical activities, PE teachers should ensure: “to improve the organic system, the neuro-muscular system and physical fitness” and “to stimulate pupils’ interest and desirable attitudes towards physical activities and to encourage them to take part in sports, physical training and recreational activities actively and regularly” (p.11).

Local education reform oriented from better preparing students for rapid globalization, technological, economic and social changes, has been launched early twentieth-first Century. “Healthy Lifestyle” has been identified as one of the seven learning goals. Accordingly, the Key Learning Area PE Curriculum Guide recommends that “motivate students to regularly participate in physical activities” and “help students to acquire a healthy lifestyle” (CDC, 2002, p.4) as rationale and direction of local school PE curriculum. The PE curriculum aims should help students to “develop motor skills and necessary knowledge through physical activities and cultivate positive values and attitudes for the development of an active and healthy lifestyle”; “acquire good health and physical fitness and body coordination through an active lifestyle” (CDC, 2002, p.13). Moreover, “health and fitness” have also been included as one of the 6 subject specific strands to be promoted through PE.

Concerning the curriculum framework, the following coherent and sequencing learning targets have also been recommended for use of the schools for promoting “health and fitness” (CDC, 2002, p.16):

In 2007, the Curriculum Development Council and Hong Kong Examination and Assessment Authority (CDC & HKEAA) published the Key Learning Area PE Curriculum Guide for Senior Secondary 4 to 6 students. In the Guide, students’ “active and healthy lifestyle” has been recommended as an important goal for building healthy communities. In the Guide, Sharkey’s (2002) definition of healthy and active lifestyle is adopted. It refers to “a way of living based on regular physical activity and a cluster of related healthy behaviours” which leads to health, vigour, vitality, self-respect and the control of one’s destiny” (Sharkey, 2002). “PE aims to help students to raise their self-regulation for leading an active and healthy lifestyle” (CDC & HKEAA, 2007, p.1) through the General PE curriculum in the Other Learning Experience Domain.

In the Curriculum Guide, the concept of healthy living is further elaborated as “it fosters the development of a lifelong interest in participating in sport and physical activity. To sustain the emerging sport culture developed in students in recent years. The PE Elective provides the knowledge and skills to enable students to participate in physical activity for fun and self-enhancement in a safe manner” (CDC & HKEAA, 2007, p.4). It has to be promoted through PE Elective Subject Curriculum. The Curriculum Guides (CDC, 2002; CDC & HKEAA, 2007) proved practical direction and guidelines for teachers for planning the PE curriculum to achieve the health and fitness. However, there is also relatively little opportunity for teachers to share and debate on concrete and practice teaching ideas on how the above objectives can be promoted fully. It is the timely initiative to revisit the current curricular practices so that students’ healthy living can be promoted through PE.

There was the consensus of views generated from PE teachers concerning physical activity and health. Recently, a study on the interface of PE curriculum in Hong Kong has been initiated after the Summer School for PE Teachers (Li, Cruz & Yeung 2008). By using the questionnaire technique for investigating 296 PE teachers participating in the workshops, “Building active and healthy lifestyle” and “Improving physical fitness and bodily co-ordination” had been rated as the 1st and 2nd priority of important aims of PE:

                                                                                                    1st priority           2nd priority

1. Building active and healthy lifestyle                                      45% n=131          18%  n=53
2. Improving physical fitness and bodily coordination              25% n=74             32%  n=94
3. Nurturing positive values and attitudes                                11% n=33             20%  n=57
4. Learning sports skills                                                          9% n=26              16%  n=46
5. Acquiring PE related knowledge                                         3%  n=8               5%   n=16
6. Cultivating desirable ethical behaviours                                2%  n=7               4%   n=12
7. Promoting generic skills                                                      1%  n=3                1%   n=2

Health is an important goal for students, new initiatives to promote the awareness of the health concepts like “heath-related fitness”, “healthy living”, “active lifestyles”, “lifetime sports” and “public health” have been initiated and promoted in the current revival as justification for PE in the school curriculum. Health and physical benefits had been recognized by PE teachers as important goals.  However, relatively little information concerning how health and physical fitness can be developed through PE curriculum is available.

Having said that, Sleap (1990) alerted us that there might be some PE teachers who would urge caution and reservation of promoting healthy living through PE. He quoted NcNamee’s terminology of “naturalistic fallacy” for explaining that although “there is empirical evidence regarding activity levels and hypokinetic disease, it does not necessary follow that PE should have to do anything about” (Sleap, 1990, p.18). There is also “conceptual confusion” about teaching health in PE as two disciplines may be regarded as totally different subject content. Moreover, PE teachers are not logically health educators. PE teachers have to be equipped with skills and knowledge to teach it.

As a matter of fact, it has been commonly promoted with the mode of cross curricular approach ending up less effective and efficient health promotion programmes in respective subjects. In the case of PE from observation, health has been commonly promoted through introducing and engaging students in health-related fitness activities and assessment. In some cases, the School Physical Fitness Award Scheme which has been established in 1988 to replace the ED-AAA 5tar Award Scheme has been introduced as co-curricular activity for promoting health. However, it has not been successfully implemented as expected (Li, 1994). In some cases, fitness exercises such as “push up” or “running laps” have been misused and employed as a means of punishing misbehaving students. There were also cases especially in primary schools that classes were punished by being deprived from PE lessons for misbehavior.

As a matter of fact as revealed in the survey on PE lesson time of Primary 4 students (2008-09) conducted by the Director of Audit’s Report No.52 titled “Healthier Lifestyles for Primary School Children”, it was found that 95 (23%) of 409 responding primary schools allocated less than 70 minutes lesson time for PE. “PE lesson time (only) ranged from 40-65 minutes.” While 77% (N=314) primary schools allocated 70 minutes or more to PE lesson (Director of Audit’s Report 52, P.42). All of the above practices may hinder PE teachers for initiating and providing sufficient physical activities practices for their students for health.

However, there are four major reasons for including health as an important objective of school PE. Hey include:

• the contribution of PE to sound growth and development;
• promotion of the value of habitual physical activity;
• The establishment of a physically active lifestyle; and
• prevention of cardiovascular disease rick factors.” (p.21). 

Harries (1989) urges schools to take a more positive role in formulating a whole -school exercise policy in fostering behavioural pattern in students towards active and healthy lifestyles.  Moreover, the PE curriculum should be restructured to provide more opportunities for enhancing necessary affective, cognitive, motor and social skills essential for lifetime involvement in physical activity.

On the other hand, the Director of Audit Commission recommends that more schools in Hong Kong to participate in the “Schools’ participation in the School NutriAgent Project (SNAP)” aiming at empowering teachers and parents, through Department of Health training and support, with the self-efficacy in nurturing a healthy eating habit among school children. The Commission also suggests that the Education Bureau should advise primary schools to allocate at least 5% (which is about 70 minutes per week) lesson time for PE class. The Department of Health should advise primary schools to consider developing policy on physical activity alongside that on healthy eating and document the policy and disseminate it to stakeholders.

Rafei (Regional Director, WHO South-East Asia Region) also suggests that “health education in schools must become more comprehensive if children are to be empowered to pursue a healthy lifestyle and to work as agents of change”. Rafei also raised a number of questions which are worth to be considered by local schools and subject teachers like PE:

• Have these school health programmes equipped children with skills to practise healthy living?
• Have they motivated a child to value health, to seek and promote it?
• Have they empowered children to take decisions regarding their own health?
• Have they helped children to carry health beyond their classrooms - to their families and communities?

Sleap (1990) reviewed and suggests a number of health projects held successfully in primary schools in the USA and Australia for reference of PE teachers. They include the Body Owner’s Manual, Know your body, Go for health and Heart Smart”. Health promotion in and out of the schools should involve health and education sectors. Close partnerships between several players like health and education planners and implementers, environmentalists, NGOs, teachers, parents and community leaders are required.

It is always difficult to realize or substantiate fully in particular learning area like PE concerning the promotion of healthy living for the students. Achieving such a goal and translate it into our realistic and practical learning targets especially through PE are need to be thoroughly clarified and discussed.

Obviously, simply involving students in physical activities, games, sports and group activities may not be adequately enhance students’ healthy living. It needs purposeful planning and effective implementation. Sharing with good and relevant practices from and among PE researchers and practitioners are important if the concept promoting students’ healthy living through PE is to be successfully implemented. How PE can be treated as a means for promoting students’ healthy living needs further discussion, sharing and debate.

Teachers are key players in any educational activities as they directly involve in learning and teaching for the students. They are key players for promoting students’ healthy living. Their ability to create an optimal environment, structure learning goals, experiences, activities and select appropriate methods plays a vital role for nurturing students’ healthy living. Accordingly, they have to continuously improve the quality of their teaching and to be prepared to be reflective and innovative through professional development programmes. Opportunities and platform have to be provided so that PE teachers can be shared and nurtured for incorporating respective understanding and skills in their school PE curriculum for promoting students’ healthy living.

In return, opportunities for them to acquaint with professional skills and knowledge have to be provided. Nevertheless, developing students’ healthy living through PE is a valid educational endeavor. From theoretical and practical perspectives of helping students to develop healthy living through PE has merit, structuring learning experiences of these skills in the PE curriculum, teachers must be willing and be capable of planning, organising and evaluating relevant learning experiences for their students. It is an appropriate time to look into the issue and to see how the concept of healthy living can be promoted in the field of PE. Thus, through the initiation of this project, PE teachers can be acquainted with necessary skills and knowledge of structuring relevant learning experiences for nurturing healthy living for the students through a variety of professional development programmes namely symposium and workshops.

The annual Summer School for PE Teacher 2011 aims to help and familiarize PE teachers with knowledge and skills in nurturing students’ Healthy Living through PE and to build up knowledge-based sharing culture. The major purposes of the Summer School for PE Teachers 2011 are formulated as follows:

1. To familiarise PE teachers with the latest development in PE, in particular, healthy living;
2. To disseminate good practices and share the experiences among PE teachers with particular emphasis on how healthy living can be envisaged by the students through planned PE experiences; and
3. To enrich PE teachers’ professional knowledge of learning and teaching for promoting students’ healthy living.