Active outdoor play statement from the Council of Chief Medical Officers of Health

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Position statement

The Council of Chief Medical Officers of Health (CCMOH) Statement supports and endorses the Position Statement on Active Outdoor PlayFootnote 1 developed by a coalition of organizations in 2015, which states:

"Access to active play in nature and outdoors-with its risks-is essential for healthy child development. We recommend increasing children's opportunities for self-directed play outdoors in all settings-at home, at school, in child care, the community and nature."

The position statement was informed by the best available evidence, interpreted by a group of Canadian experts representing 14 organizations, and reviewed and edited by more than 1,600 stakeholders.Footnote 2 The position statement applies to girls and boys (ages 3-12 years) regardless of ethnicity, race, or family socioeconomic status. Children who have a disability or a medical condition should also enjoy active play with guidance from a health professional.


Play is a universal, developmentally appropriate, culturally relevant expression of childhood, and occurs in many ways and settings. Unstructured and independent active play tests boundaries and includes things like exploring the woods, rough housing, moving fast or climbing.Footnote 3

Active outdoor play (being physically active during play) is associated with a number of benefits such as improved social skillsFootnote 4, motor skill development (e.g., climbing and jumping)Footnote 5, healthier body weightFootnote 6, and increased overall physical activity.Footnote 7,Footnote 8, Footnote 9 In the long-term, sedentary behaviour and inactivity elevate the odds of developing chronic disease, including heart disease, type 2 diabetes, some forms of cancer and mental health problems. Footnote 10,Footnote 11,Footnote 12,Footnote 13,Footnote 14,Footnote 15,Footnote 16,Footnote 17,Footnote 18,Footnote 19 When children are exposed to nature and the outdoors they are happier, have more energy and are less anxious.Footnote 20

ParticipACTION's Protection Paradox identifies that "children are overprotected in the name of safety, but trying to keep them safe by keeping them close and indoors may set them up to be less resilient and more likely to develop chronic diseases in the long run." Footnote 21 What many parents remember from their childhoods as thrilling and exciting active play is sometimes considered risky these days. Children need the freedom to be active and explore their physical limits.

The promotion of active play can still occur with efforts to prevent serious injury through appropriate levels of education, supervision and hazard reduction. The vast majority of injuries from all forms of physical activity are minor and the benefits of active play outweigh the risk of minor injuries.Footnote 1

The following recommendationsFootnote 1, Footnote 22,Footnote 23,Footnote 24 have been agreed upon by the CCMOH to support active play and can be considered along with efforts by all organizations and leaders to advance A Common Vision for Increasing Physical Activity and Reducing Sedentary Living in Canada: Let's Get MovingFootnote 25:

Parents and caregivers

Health, sport and recreation professionals and educators

Municipalities, communities and school divisions

Federal and provincial governments


Footnote 1

Position Statement on Active Outdoor Play (2015). Retrieved from: on August 16, 2016.

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Footnote 2

Tremblay, M. S., Gray, C., Babcock, S., Barnes, J., Bradstreet, C. C., Carr, D., Chabot, G., Choquette, L., Chorney, D., Collyer, C., Devane, S., Herrington, S., Janson, K., Janssen, I., Larouche, R., LeBlanc, C., Pickett, W., Power, M., Sandseter, E. B. H., Simon, B., & Brussoni, M. (2015). Position statement on active outdoor play. International Journal of Environmental Research and Public Health12(6), 6475-6505. DOI: 10.3390/ijerph120606475 (Available at:

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Footnote 3

ParticipACTION Report Card on Physical Activity for Children and Youth: The Biggest Risk is Keeping Kids Indoors (2015) Retrieved from: on August 17, 2016

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Footnote 4

Burdette, H.L. & Whitaker, R.C. Resurrecting Free Play in Young Children Looking Beyond Fitness and Fatness to Attention, Affiliation, and Affect Arch Pediatr Adolesc Med. 2005;159(1):46-50. doi:10.1001/archpedi.159.1.46

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Footnote 5

Little, H. & Wyver, S. Outdoor play: does avoiding the risks reduce the benefits? Australian Journal of Early Childhood 33, 33 (2008).

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Footnote 6

Cleland, V., Crawford, D., Baur, L. A., Hume, C., Timperio, A. & Salmon, J. A prospective examination of children's time spent outdoors, objectively measured physical activity and overweight. Int J Obes 32, 1685-1693 (2008).

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Footnote 7

Gray, C., Gibbons, R., Larouche, R., Sandseter, E. B. H., Bienenstock, A., Brussoni, M., Chabot, G., Herrington, S., Janssen, I., Pickett, W., Power, M., Stranger, N., Sampson, M. S., & Tremblay, M. (2015). What is the relationship between outdoor time and physical activity, sedentary behaviour, and physical fitness in children? A systematic review. International Journal of Environmental Research and Public Health12(6), 6455-6474. DOI: 10.3390/ijerph120606455 (Available at:

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Footnote 8

Schaefer, L., Plotnikoff, R. C., Majumdar, S. R., Mollard, R., Woo, M., Sadman, R., Rinaldi, R. L., Boulé, N., Torrance, B., Ball, G. D. C., Veugelers, P., Wozny, P., McCargar, L., Downs, S., Lewanczuk, R., Gleddie, D. & McGavock, J. Outdoor Time Is Associated with Physical Activity, Sedentary Time, and Cardiorespiratory Fitness in Youth. The Journal of Pediatrics 165, 516-521 (2014).

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Footnote 9

Remmers, T., Broeren, S. M., Renders, C. M., Hirasing, R. A., van Grieken, A. & Raat, H. A longitudinal study of children's outside play using family environment and perceived physical environment as predictors. International Journal of Behavioral Nutrition and Physical Activity 11, 76 (2014).

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Footnote 10

Lee, I.-M., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N. & Katzmarzyk, P. T. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. The Lancet 380, 219-229 (2012).

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Footnote 11

Pahkala, K., Heinonen, O. J., Simell, O., Viikari, J. S. A., Rönnemaa, T., Niinikoski, H. & Raitakari, O. T. Association of Physical Activity With Vascular Endothelial Function and Intima-Media ThicknessClinical Perspective. Circulation 124, 1956-1963 (2011).

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Footnote 12

Raitakan, O. T., Porkka, K. V. K., Taimela, S., Telama, R., Räsänen, L. & Vllkari, J. S. Effects of Persistent Physical Activity and Inactivity on Coronary Risk Factors in Children and Young Adults The Cardiovascular Risk in Young Finns Study. Am. J. Epidemiol. 140, 195-205 (1994).

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Footnote 13

Tuomilehto, J., Lindström, J., Eriksson, J. G., Valle, T. T., Hämäläinen, H., Ilanne-Parikka, P., Keinänen-Kiukaanniemi, S., Laakso, M., Louheranta, A., Rastas, M., Salminen, V., Aunola, S., Cepaitis, Z., Moltchanov, V., Hakumäki, M., Mannelin, M., Martikkala, V., Sundvall, J. & Uusitupa, M. Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance. New England Journal of Medicine 344, 1343-1350 (2001).

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Footnote 14

Diabetes Prevention Program Research Group. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. New England Journal of Medicine 346, 393-403 (2002).

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Footnote 15

Mammen, G. & Faulkner, G. Physical Activity and the Prevention of Depression: A Systematic Review of Prospective Studies. American Journal of Preventive Medicine 45, 649-657 (2013).

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Footnote 16

Paffenbarger, R. S., Hyde, R., Wing, A. L. & Hsieh, C. Physical Activity, All-Cause Mortality, and Longevity of College Alumni. New England Journal of Medicine 314, 605-613 (1986).

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Footnote 17

Paffenbarger, R. S., Hyde, R. T., Wing, A. L., Lee, I. M., Jung, D. L. & Kampert, J. B. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N. Engl. J. Med. 328, 538-545 (1993).

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Footnote 18

U.S. Department of Health and Human Services. Physical Activity Guidelines Advisory Committee Report, 2008. (U.S. Department of Health and Human Services, 2008).

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Footnote 19

Biswas, A., Oh, P. I., Faulkner, G. E., Bajaj, R. R., Silver, M. A., Mitchell, M. S. & Alter, D. A. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann. Intern. Med. 162, 123-132 (2015).

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Footnote 20

Canadian Fitness and Lifestyle Research Institute, Lifestyle Tips: Get Outside and Be Active! Retrieved from: on November 25, 2016.

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Footnote 21

ParticipACTION Report Card on Physical Activity for Children and Youth: The Biggest Risk is Keeping Kids Indoors (2015), pg. 7.Retrieved from: on August 17, 2016

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Footnote 22

ParticipACTION Report Card on Physical Activity for Children and Youth: Are Canadian Kids Too Tired to Move? (2016) Retrieved from on August 17, 2016.

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Footnote 23

ParticipACTION Report Card on Physical Activity for Children and Youth: The Biggest Risk is Keeping Kids Indoors (2015) Retrieved from: on August 17, 2016.

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Footnote 24

ParticipACTION Report Card Tips (2015) Retrieved from: on November 25, 2016.

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Footnote 25

Common Vision for Increasing Physical Activity and Reducing Sedentary Living in Canada: Let's Get Moving.

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Footnote 26

Convention on the Rights of the Child: Retrieved from: on November 26, 2016.

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