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Health education through football (soccer): the ‘11 for health’ programme as a success story on implementation: learn, play and have fun!
  1. Jane S Thornton1,
  2. Jiri Dvorak2,
  3. Irfan Asif3
  1. 1 Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada
  2. 2 Department of Neurology, Schulthess Klinik and Swiss Golf Medical Center, Zurich, Switzerland
  3. 3 Department of Family and Community Medicine, UAB, Birmingham, Alabama, USA
  1. Correspondence to Dr Jane S Thornton, Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, ON N6G 2M1, Canada; jane.s.thornton{at}

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Physical Activity is a ‘best buy’ for public health: especially for our youth

Physical inactivity is one of the biggest public health threats of this century and greatly increases the risk of non-communicable diseases. This is especially true for our children and youth, where fallout from current pandemic lockdowns has disrupted access to physical activity and sport. Virtual classrooms translated into forfeited recess and free play while kids were thrown in front of computer screens and confined to a sedentary lifestyle. In large urban centres with many living in high rises, lockdowns on playgrounds and parks removed options for running or playing. Prior to the pandemic, physical inactivity was already a critical issue—a WHO survey of 1.6 million participants in 146 countries revealed that 81% of children and adolescents aged 11–17 were not active enough for optimal health.1

In response, WHO created the global action plan on physical activity, a call to action for policy change and effective implementation, where school-based policy initiatives are an essential component to create a more active society.2

Big challenges demand innovative solutions

In a recent large-scale cluster-randomised controlled trial, Danish researcher, Larsen aimed to investigate the effects on health knowledge and enjoyment of the 11-week ‘health education through football’ programme for 10–12 years old, with 3127 Danish schoolchildren (49% girls) taking part.3 This adaptation of the original FIFA ‘11 for Health’ programme aims to increase physical activity and enhance health knowledge at the same time, by coupling health education with football drills and small-sided games. Larsen found an increase in health knowledge related to hygiene, nutrition, physical activity and well-being within the intervention group. Even more compelling was that the children found the programme to be extremely enjoyable.

Originally developed in 2009 for children aged 10–13 years oldin Africa, the ‘11 for Health’ programme was launched prior to the FIFA World Cup South Africa and disseminated within 5 years among 52 countries around the world.4 5 Eleven football stars–among others Lionel Messi, Cristiano Ronaldo, Neymar and Marta–supported the programme by presenting the health messages. More than one million children have now completed the ‘11 for Health’. programme.

Since its European expansion, Danish researchers, led by Krustrup and Krustrup, have discovered wide-ranging positive benefits on health,6 7 health knowledge,8 cognitive function9 and well-being, the latter with even greater effects for girls than for boys10—important as 85% of adolescent girls are inactive vs 78% of boys.1

A springboard for broader implementation

To successfully tie in health education with physical activity on a large scale is a major step forward. The ‘11 for Health’ programme is currently running in 89 of 98 municipalities in Denmark with over 30 000 schoolchildren involved. The Denmark Football Association and the Government should be applauded for their continuous support—they understood the value and long-term benefits for their future generation.

Where do we as sport and exercise medicine clinicians and researchers fit in? As advocates for physical activity investments that work, we can promote programmes that play an important role in the prevention of communicable and non-communicable diseases, critical in the era during and after a pandemic. Larsen notes that for programmes such as the ‘11 for Health in Denmark’, future studies on objective physical activity measurements before, during and after the intervention, and of the children’s health in relation to the intervention, would be helpful.3

The ‘11 for Health in Denmark’ programme offers a framework for educating children about lifelong health habits. Reinforcement of messages by elite athletes through videos or other tele and social platforms can increase enthusiasm among youth while also offering a mechanism for countries to share resources. Those countries can also tailor education topics to critical public health issues in their parts of the world. The building blocks are here for others to use, so let’s share and learn from each other!

‘11 for Health’ for all: the time is now!

The evidence is clear that the ‘11 for Health’ programme is both low cost and effective in improving health outcomes for the children involved. We, therefore, challenge other Football associations and governments in low-income and middle-income countries around the globe, and in more resourced associations in Europe, North America and UEFA, to implement an ‘11 for Health’ initiative in their country. Enhancing health education, improving health knowledge and increasing physical activity in youth through the joys of sport is a model proven successful. Spreading this important message to more children around the world will be key in addressing WHO’s global action plan on physical activity and ensuring kids learn, play and have fun while pursuing optimal health.

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  • Twitter @janesthornton, @ProfJiriDvorak

  • Correction notice This article has been corrected since it published Online First. Reference 3 has been updated.

  • Contributors JST and IA composed the initial draft. All authors contributed to further content development, writing and final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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