Pediatric Physical Activity and Fitness

Cardiopulmonary Physical Therapy Journal, Jun 2005 by Downs, Anne Mejia

ABSTRACT

The importance of physical activity in childhood and adolescence cannot be overstated. Since adequate amounts of physical activity provide multiple health benefits and will improve or maintain physical fitness, it should be an integral component of children's lives. However, children and adolescents are much less active than in previous decades. The causes of this phenomenon are numerous, including social and environmental factors, and practices in schools. Physical therapists should consider these factors and the unique response to exercise by the pediatric population when prescribing exercise. Physical therapists can intervene to increase regular physical activity in children and adolescents at a variety of levels. At the Individual Level, we can support physical activity in the treatment of children with disabilities and for wellness. At the School Level, we can become active volunteers or consultants to enhance physical activity in the school environment. At the Policy Level, we can support policies that increase opportunities for physical activity in the schools, communities, and society. We need to change the way physical activity is perceived as not only an individual behavior choice, but also the result of many choices made for us in our environment. As physical therapists, we are uniquely positioned to advocate and provide guidance for increased physical activity among children and adolescents, their families, and the society as a whole.

INTRODUCTION

Physical activity can be described as any bodily movement produced by skeletal muscles, while physical fitness is defined as the ability to perform physical activity.1,2 Physical activity can prevent disease-a sedentary lifestyle leads to increased morbidity and mortality, while physical activity confers many positive health benefits to children and adolescents.1,3-6 Physical activity decreases health care costs and improves quality of life and can be individualized to age and ability.7,8 Since adequate amounts of physical activity will improve or maintain physical fitness, a central component of health and wellness, physical activity should be an integral component of children's lives.7 As physical therapists, we are uniquely positioned to advocate and provide guidance for increased physical activity among children and adolescents, their families, and the society as a whole.

The importance of adequate physical activity in childhood and adolescence cannot be overstated. Physical activity provides specific health benefits, including weight management, blood pressure control, and improved musculoskeletal and cardiopulmonary function. The value of physical activity for improved mental health has also been demonstrated for children and adolescents. A connection has been reported between physical activity and the prevention and treatment of depression.9 A lifestyle that lacks physical activity as a child is likely to lead to sedentary adulthood, setting the stage for heart disease, diabetes, high blood pressure, obesity, and some forms of cancer.1 Because children spend an abundance of time in school, this is a prime area for changing the social and physical environment to support and promote a healthy lifestyle, including opportunities for regular physical activity. In addition, since many adults make decisions that impact the lifestyles of children, it is essential for parents, teachers, coaches, and health care professionals to support physical activity.

WHERE ARE WE NOW?

Not so long ago in the US, children had physical education (PE) every day in school. Those who lived close enough walked to and from school, and after school children had to be coaxed indoors from informal games of kickball or Capture the Flag to do homework (written longhand) or eat dinner. Summers were filled with unstructured play, mostly outdoors, and TV was for watching occasionally, since program choices were limited. Fast-forward to a new century where a child can spend an entire school day without PE or active play at recess, only to spend the remainder of the waking hours indoors because of safety concerns or a desire to partake in the myriad of entertainment on television and computers.3,4,10-14 The problem only worsens as cars replace bicycling and walking as the preferred method of transportation.6,9 At the same time, parents and other adults model decreasing amounts of physical activity and increase incidence of overweight and obesity.4,11 There are many sociocultural and environmental factors that affect the activity patterns of children and consequently, their fitness levels.

Children and adolescents are not as active as in previous generations, but what are the current rates of physical activity?3

The first Surgeon General's Report on the state of physical activity and health in Americans was released by the US Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) in 1996.4 The following conclusions concerning adolescents were reported. Nearly half of Americans aged 12 to 21 years are not vigorously active on a regular basis and one fourth report no vigorous activity. Physical activity declines dramatically during adolescence; 72% of 9th graders participate in vigorous physical activity on a regular basis, compared with only 55% of 12th graders. Daily participation in PE by high school students dropped from 42% in 1991 to 25% in 1995. In addition, only 19% of all high school students reported being physically active for 20 minutes or more in the physical education classes they did attend. Children walk or ride bicycles much less than in the past. In 1995, youth aged 5 to 15 walked or cycled 40% less than in 1977. In addition, children make only 31% of trips to or from school of 1 mile or less by walking, and only 2% ride a bicycle.6,9 Trends show an association between inactivity and certain demographic factors. Low socioeconomic status has been related to decreased physical activity, and inactivity is more common among females than males.3 White females are most likely to engage in physical activity while black and Hispanic females are least likely.15,16