Physical Activities For Improving Child Part 1

Physical Activities for Improving Child.

Billye Ann Cheatum.

AND YOUTH.

Canadians are gaining awareness of the health benefits of physical activity. Behaviour change must follow awareness, however, if patients are to counter the health risks a.s.sociated with sedentary living.

Physicians are continually challenged to identify effective and practical strategies to encourage ongoing partic.i.p.ation in physically active pursuits- particularly when sedentary choices for recreation and leisure options are so popular.

To help family physicians facilitate positive changes in physical activity levels, this module will explore the factors that influence physical activity partic.i.p.ation, and will provide a set of practical tools for interacting with children and parents.

CASES.

Case 1: Jamie B., age 4, male Jamie is a healthy youngster who is in for a checkup and immunization update prior to starting school.

[The following questions also could apply at earlier well-child visits anytime from 2 years on.]

How could you incorporate physical activity into the antic.i.p.atory guidance provided at a well-care visit?

How could you counsel Jamie's parents about enhancing their child's recommended amount of physical activity?

Case 2: Farah W., age 8, female Farah's mother has brought her in today, requesting a note that her daughter be allowed to take the bus to school for "medical reasons." Farah is a healthy youngster who is doing well academically.

EDUCATIONAL MODULE.

Volume 11(6), June 2003 Her mother is concerned because she has to walk one a decrease in resting blood pressure in adults. 5,6,9 kilometre to school each way and is "exhausted" by the time she gets home from school. The school board 3. Because "physical activity is correlated with lower provides a bus for children who live more than one fasting insulin and greater insulin sensitivity in kilometre away, but will not provide it for Farah because childhood" (Level 4 evidence), increasing physical she lives within that boundary. Farah's mother also activity levels may also reduce the risk of type 2 expresses concern about her child's safety while walking diabetes in children.6,10 to and from school.

At this time, there are a limited number of large, high- How could you determine if Farah is getting the quality studies by which to more definitively evaluate recommended amount of activity for her age?

other effects of physical activity. 11 What strategies could help Farah become more physically active?

Role of Family Physicians How could you address the mother's concerns about Farah's walking to school?

4. Family physicians are in a position to significantly influence the physical activity levels of their young patients, and they will see more than 90% of youths Case 3: Rob S., age 13, male aged 5-17 years in their practice at least once in a two-year period.12,13 Rob presents with a mild cold and complains about feeling tired a lot of the time. As part of the exam, you 5. The optimal time for broaching the subject of notice that he is at the 95th percentile in height and 15 physical activity is during "routine checkups or well kg above the 95th percentile in weight. On further visits." Secondary opportunities occur during enquiry, he appears to be sensitive about his size. His "follow-up appointments for injuries or illnesses, main form of physical activity is "gym", which occurs visits for chronic diseases (e.g. asthma), and twice a week at school. Each "gym" period is 40 minutes physical examinations before partic.i.p.ation in sports long and includes time for changing clothes, taking or camp programs." 13 attendance, and setting out/striking equipment. Rob is also having some problems in school performance.

6. Younger children rely heavily on parental support and direction in becoming more physically active.

How could you use this opportunity to initiate a Although physicians may have concerns about discussion with Rob about physical activity?

actively promoting physical activity with parents, a How could you a.s.sist Rob in getting the considerable majority of Canadian adults are either recommended amount of activity for his age?

already active, taking steps to become active, or in How could you counter Rob's reluctance to a period of relapse from activity.14 They are, becoming more active?

therefore, likely to support initiatives to increase the physical activity of their children.

INFORMATION SECTION.

Current Recommendations

Benefits of Physical Activity 7. Adult guidelines for physical activity are not necessarily appropriate for children and 1. In children and adolescents, daily physical activity adolescents.15 Adults frequently choose physical has many benefits. A variety of studies (Level 4 activity that is "structured, highly organized, and evidence) have shown that it can: often continuous in nature." In contrast, children's * positively affect lean muscle ma.s.s and bone activity is characterized by short bursts of activity, density1,2 alternating with frequent short periods of rest.

* help decrease excess body fat3 and/or maintain Given sufficient free time, children tend to a healthy body weight4,5 acc.u.mulate a greater volume volume of physical movement of physical movement * improve self-esteem and decrease anxiety, through active, unstructured play.15 depression, and moodiness6,7 * enhance academic performance8 8. Canada's Physical Activity Guides (Appendix 4) have tried to de-emphasize "absolute values" in 2. Physical activity helps reduce resting blood pressure time spent in physical activity and have taken the in children and adolescents with hypertension (Level approach of increasing acc.u.mulated time spent in 4 evidence) and has been positively correlated with physical activity and decreasing acc.u.mulated

2.

EDUCATIONAL MODULE.

Volume 11(6), June 2003 "screen" time (e.g., television , computer, video).16 13. Physicians and their staff can demonstrate support It is recommended, however, that at least 30 of healthy living and physical activity through 13 23: minutes of active time each day be spent in exhibiting posters which advertise community vigorous activities (such as running, basketball, or events or recreation schedules soccer).17 For optimal health benefits, other studies leaving a supply of take-away copies of the suggest as much as 2 to 2.5 hours per day of active active various Health Canada Physical Activity various Health Canada Physical Activity incidental play (NOT continuous play) for pre-school resources for Children and for Youth (see (NOT continuous play) for pre-school resources for Children and for Youth (see or elementary school children.6,18 Appendix 3) in the waiting room leaving "help yourself" physical activity

Strategies for Promoting Physical Activity prescription pads (Appendices 5 and 6) in the waiting room

For Physicians arranging with community recreation sources to display their up-to-date brochures in the waiting 9. Systematically "Ask, Advise, a.s.sist" during routine room visits to raise the awareness of patients and parents conspicuously posting a list of local day care about physical activity limits and/or lifestyle choices centres, recreation centres, or fitness facilities (a strategy devised originally for smokers).19 Use that promote physical activity for children.6 the "Ask" phase to uncover what the patient displaying on office walls photographs of considers an important benefit, and use that physicians and staff engaged in physical activity information to drive the "Advise" and "a.s.sist"

or local community fundraising initiatives phases.

14. Consider wearing a pedometer as way to role model the importance of physical activity. It "Ask" "Ask" every patient about physical activity potentially provides a "bond" between patient and every patient about physical activity potentially provides a "bond" between patient and levels and the personal benefits.

physician, particularly if the physician can "Advise" "Advise" on simple solutions to reducing on simple solutions to reducing commiserate with the patient on challenges in inactivity.

meeting the recommended 10,000 steps per day.

"a.s.sist" "a.s.sist" with specific recommendations for with specific recommendations for (See Info point 26 and Patient Information Sheet physical activity when asked.

for more details on a pedometer). 24 15. Physicians can use their influence in communities 10. Encourage young patients, where appropriate, to to speak out strongly in favour of quality daily be active during recess, at lunch, and immediately physical education (QDPE)6, especially if parents after school hours and on weekends. This strategy feel that school is the one safe place for children has been shown to be valuable in setting good and youth to get some of the recommended daily physical activity patterns.20 physical activity.

11. Discuss with parents the time commitment

For Parents involved in a.s.sisting children to be more active and in providing transportation to appropriate sites for 16. Parents are "powerful physical activity role models"

physical activity such as a recreation centre; local for their children 20, with studies showing a 30% to park; dance, martial arts, or gymnastics studio; or 40% positive a.s.sociation with a child's being sports facility.21 active25, particularly during the first decade of life.16 12. Understand the influence of age, gender, and 17. Parents should consider being physically active cultural background to help identify at-risk with their children and families a top priority. 26 populations and "set the stage" for successful interventions that take into account different cohorts: 22 young girls who are characteristically less active than boys minority ethnic groups, where culturally- appropriate opportunities may be an issue pre-adolescence, when physical activity levels begin to drastically decline.

3.

EDUCATIONAL MODULE.

Volume 11(6), June 2003 playgrounds16, and the building of new Sample activities for parents to consider: playgrounds (per 20,000 people there are twice Take your older child to the fitness centre with as many golf courses as playgrounds) 29 you arrange for a trained professional to supervise Get involved in a program for Moms/Dads or monitor their child's exercise time either and Tots singly (if this is financially feasible) or as part Help coach a sport team where your child is of a group in a recreation centre.20 involved Go swimming or hiking as a family on the Table 1. Factors to consider in counseling about weekend

physical activity Walk to school with the children FACTORS a.s.sOCIATED WITH PHYSICAL ACTIVITY IN.

18. A simple and effective way for parents to increase CHILDREN AND YOUTH22 CHILDREN AND YOUTH22 physical activity among their children is to ensure

Children Youth (Variables can be (Variables can be that they have time to play outdoors either during divided into two the day (for pre-school children) or after school.5,21 categories) 19. As many as 75% of children engage in inactive * time spent outdoors

Psychological and pursuits after school: doing homework, reading, * an inclination to be behavioural: watching television, or playing computer or video physically active * level of self-esteem games. These pursuits often add up to the * a healthy diet and perceived equivalent of a full-time desk job (i.e., 40 hours per * previous experience competence week)! It has been shown that children and youth with physical * "sensation seeking"

who are not active after school, or are not involved activity * previous experience in community sports programs, are generally * access to both with physical activity sedentary.21 facilities and * partic.i.p.ation in equipment community sports 20. While intrinsic motivation (e.g., having fun) is * intention to be Social/cultural and crucial to ongoing partic.i.p.ation, parents can use physically active

physical environment extrinsic motivators (such as calendars, daily logs, * parental support journals, or rewards) to nurture increased physical * support from activity or a more active lifestyle. 20 Nearly half of "significant others"

parents agree that being physically active for fun is * siblings who are preferable to "compet.i.tion and winning" for their physically active children.20 * opportunities to be physically active 21. Therefore, activities that are selected to foster confidence, competence, and, most of all, The following are a.s.sociated with a negative effect enjoyment are critical in enticing children to be enjoyment are critical in enticing children to be on physical activity levels more active.

* perceived barriers * depression 22. Parents can take the following actions to improve to physical activity * inactive pursuits after physical activity levels: school and on create "walking school buses" 27, cooperatives weekends to supervise physical activity, and/or car pools to share responsibility for transporting children

Children to or from activity programs.21 lobby with the school board for a greater 23. Children should naturally be more active than emphasis on daily quality physical education adults.18 One of the ways for children to maintain (QDPE) 28 and a greater access to facilities for a healthy balance of caloric intake and output healthy balance of caloric intake and output is to unstructured play during and after school is to unstructured play during and after school be physically active for at least 60 minutes per hours.20 28 16 day.15 approach city hall about sidewalk maintenance, the creation of safe cycling 24. Children age 4 years to 12 years respond positively routes 21, the installation of lighting in to activities that are "FUN". They are more willing

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EDUCATIONAL MODULE.

Volume 11(6), June 2003 to be involved in activities they enjoy and/or personally select, than in activities that their

THE BOTTOM LINE.

parents may favour or think beneficial.21 * Seize available opportunities to promote Making activity seem fun fun for children, for children, physical activity (at well-care visits, during therefore, is a key to promoting partic.i.p.ation.

visits for follow-up or for minor problems).

* Take advantage of the waiting room to actively 25. Regular positive feedback from parents as well as promote physical activity.

physicians help children stick with their physical * Encourage kids to be active outdoors after activity "prescription" or program.15 school and on weekends.

* Involve parents both as role models and 26. Pedometers are simple to use, inexpensive, and facilitators of physical activity for their children.

self-motivating devices to get older children involved in their own activity levels. 30 a. The following range of steps has been suggested in the literature based on a 5-day pedometer program.30:

CASE COMMENTARIES.

12,000 to 16,000 steps as a goal for children 8-10 years;3 Case 1: Jamie B., age 4, male 11,000 to 12,000 steps for adolescents 14 to 16 years old.30 How could you incorporate physical activity into b. The disadvantage is that they do not provide the antic.i.p.atory guidance provided at a well-care intensity levels of exercise. 30 visit?

27. Other self-monitoring tools that children could Antic.i.p.atory guidance has been a traditional part of well-create and/or use, include: baby and well-child care. Until recently, evidence was a personal log sheet for recording activity not necessary for physicians to encourage parents to levels, designed by children themselves using ensure play time for children as it was taken for granted their computer skills that children would play and be active. Sadly, this is no the poster-sized Health Canada longer the case.

Physical Activity Chart with colourful stickers available at no charge through Making a personal notation about physical activity under the Health Canada website the heading of Education and Advice on the Rourke (http://www.healthcanada.ca/paguide) or Baby Record, Guide III, (available at by calling 1-888-334-9769.

http://www.ctfphc.org) of young patients, can serve as a reminder to inquire about physical activity at well-care Youth/adolescents visits.

28. Adolescents might be enticed into being more In provinces where funding does not cover well-care active by experimenting with less traditional kinds visits up to the age 5 years, physicians will need to take of activities (e.g. rock climbing, "skateboarding", advantage of visits for other reasons in order to street or hip hop dancing, or kayaking) available in introduce the topic of physical activity (Info point 5).

the community, through school or munic.i.p.al The following "Talking Tips", modeled after "Ask, recreation departments.31 Advise, a.s.sist", could be helpful in a discussion with the child and parents (Info point 9). (See Appendix 1 for 29. Youth involved in organized sports, in contrast with other interview question samples) youth not so involved, expend more energy in moderate to vigorous activities and spend less time watching television than their less active peers.32 30. Physicians may be able to engage adolescents in setting goals and objectives for the 'Let's Get Active' prescription by acknowledging their growing desire for independent decision making.31