Pediatric Physical Activity and Fitness

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

An exercise prescription for children and adolescents, as for adults, should include the components of mode, frequency and duration, and intensity. In addition to these components, physical therapists should consider other issues, such as maturation and skill level, the school environment, and safety. Arguably, the overall goal of an exercise program for the pediatric population is to establish a lifelong habit of regular physical activity. This program should change with the child's developmental stage, interests and abilities, and available resources. For young children, active play in place of an exercise program is recommended.

The most important aspect of selecting a mode for children and adolescents is to find an activity that is enjoyable, with the duration and frequency dependent on the chosen mode. The variety of possible activities is endless and may include group or individual activities (Table 1). Group activities provide socialization and may appeal to many children, but those who have less self-confidence or limited skills may not feel comfortable in a group setting.

Exercise intensity is an important component of any exercise prescription and it allows the tracking of the response to activity. Even though heart rate monitoring is a reliable measure of intensity, few children who are able are willing to track this regularly, with the exception of the student athlete in training. The Rating of Perceived Exertion (RPE) is an easy tool for children to learn and continue to use during various tasks involving physical activity and has been correlated with HR.30 There is also a reliable RPE scale for young children which includes faces depicting various amounts of effort.34 The OMNI rating scale of perceived exertion is another valid and reliable measure for use with children.35,36

Energy expenditure of daily physical activity in children with diabetes or obesity should be considered, so that caloric intake can be taken into account. One approach presented by Bar-Or37 is to assign 'exercise exchanges' equal to 100 kilocalories to various physical activities. The duration of the activity depends on the body mass of the child, with less time needed for children with greater body mass. Another tool for determining energy cost of particular activities is the Compendium of Physical Activities, published by the President's Council on Physical Fitness and Sports.38

Safety considerations are more important in children because children are physically and emotionally immature. Excessive exercise or sports trauma has the chance of causing overuse injuries or injury to the epiphyseal growth plate.30 The risk of injury can be decreased by the use of appropriate safety equipment, adequate skills preparation, and matching athletic opponents by size, skill, and maturation levels.25 Also, adequate training and supervision and appropriate clearance for sports by a pre-performance physical is recommended.

WIDER CIRCLES OF INFLUENCE

Physical therapists often think in terms of one-on-one interaction with a patient or client and are probably most comfortable with this level of interface. However, there are multiple levels of intervention in the Social Ecological Model, also known as the Multilevel Model that impact the physical fitness of children and adolescents (Figure 1).39 The many factors that influence physical activity necessitate a multileveled approach and physical therapists are uniquely positioned to intervene at a variety of levels.