Editorial

Children, Physical Activity, and Public Health: Another Call to Action



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Am Fam Physician. 2002 Mar 15;65(6):1033-1035.

Children living in the United States are less active and more obese than ever before.1 They are, therefore, at increased risk for negative health outcomes such as diabetes, hypertension, and cardiovascular disease, which are associated with sedentary lifestyles. Multiple social, cultural, and environmental factors have converged to promote sedentary behaviors in children. To date, targeted national public health efforts2 have done little to slow rising rates of obesity or promote increased physical activity in children. Currently, 40 percent of U.S. children five to eight years of age have at least one risk factor for heart disease3; one in eight is considered obese. While the health effects of this rise in obesity will not be known for years,4 the time to act is now because risk factors track from childhood to adolescence5 and adulthood.6 To overcome this pandemic of sedentary behavior and resultant obesity, multiple factors must be addressed to ensure that children obtain sufficient levels of physical activity.

Currently, the most popular activities among children are watching television and playing video games.7 Children watch an average of 25 to 27 hours of television a week.8 In contrast, children spend only 14 minutes a day engaged in physical activity.9 While schools have historically provided opportunities for physical activity, cutbacks in space and funding have drastically reduced the number of children who participate in daily physical education classes. Additionally, during physical education classes and recess, children actually spend very little time engaged in physical activity.10 Other important environmental barriers include lack of access to play space and concerns about physical safety. To overcome these issues it is important for adults to take the following measures:

  • Moderate the amount of time children spend in front of television, computers, and video terminals.11

  • Encourage spontaneous physical activity during recess and physical education classes.

  • Provide safe opportunities for children to play.

The role that childrens' families play in fostering longitudinal patterns of activity for children is somewhat ambiguous. For instance, a parent's level of physical activity does not directly correlate with a child's level of activity.12 Parents who are active do not necessarily raise children who are active. Many parents also incorrectly assume that because their children are involved in organized sports that they are physically fit.13 Finally, children who are forced to exercise are much less likely to be regularly active in adulthood.14 For children especially, exercise should be modeled as playful and fun rather than competitive and punitive.

Important cultural differences in physical activity also exist. Black and Hispanic children are more sedentary than white children,15 and they are more likely to be overweight or obese.16 Additionally, persons belonging to certain ethnic groups may not view a dedicated exercise program as a worthwhile use of time.17

Exercise need not be synonymous with “workout.” Cumulative small periods of physical activity throughout the day can easily provide children with the recommended 20 to 30 minutes of activity.18 To help promote regular physical activity, it is important to encourage parents and families to support children in the following ways:

  • Foster a child's self-efficacy (the sense that they are “good” at a particular activity).19

  • Support regular physical activity at home, at school, and within the community.

  • Promote activities that the child enjoys.

  • Promote physical activity within a cultural context that is appropriate for each child.

Ultimately, the benefits of regular physical activity are well established and irrefutable. Unfortunately, in the setting of primary prevention, health care professionals do a very poor job of counseling children and parents about the benefits of exercise.20 Promoting physical activity must be a routine part of well-child care.

To reverse the trend of increasing obesity and sedentary behaviors in children, they must be provided with regular opportunities for physical activity; physical activity must be supported in a way that is sensitive to their culture, environment, and family; children and their families must be routinely advised about the benefits of regular physical activity. As medicine shifts to an evidence-based approach that focuses on health-related outcomes, the time has come to challenge traditional modes of physical education and physical fitness as largely ineffective, and focus on new ways to promote and sustain healthy behaviors in children. A body at rest tends to stay at rest until acted on by an external force. Let's be that external force.

Mark Stephens, LCDR, MC, USN, is an assistant professor of family medicine with the Uniformed Services University of the Health Sciences at Bethesda, Maryland.

Address correspondence to Mark Stephens, LCDR, MC, USN, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814-4799.

The opinions and assertions contained herein are the views of the author and are not to be construed as official or reflecting the views of the Navy Medical Department or the U.S. Navy service at large.

REFERENCES

1. National Health Center for Health Statistics. Update: Prevalence of overweight among children, adolescents, and adults—United States, 1988– 1994. MMWR. 1997;46:198–202.

2. National Center for Health Statistics (U.S.). Healthy people 2000 review 1998–99. Hyattsville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, 1999; DHHS publication no. (PHS) 99–1256.

3. Faigenbaum A. Fundamental fitness in children: recommendations for keeping kids healthy and fit. ACSM Health & Fitness Journal. 1998;2:18–22.

4. Hill JO, Trowbridge FL. Childhood obesity: Future directions and research priorities. Pediatrics. 1998;101:570–4.

5. Marshall SJ, Sarkin JA, Sallis JF, McKenzie TL. Tracking of health-related fitness components in youth ages 9 to 12. Med Sci Sports Exerc. 1998;30:910–6.

6. Harsha DW. The benefits of physical activity in childhood. Am J Med Sci. 1995;310(suppl 1):S109–13.

7. Luepker RV. How physically active are American children and what can we do about it?. Int J Obes Relat Metab Disord. 1999;23(suppl 2):S12–7.

8. Dietz WH Jr, Gortmaker SL. Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics. 1985;75:807–12.

9. Fry PL. From fat to fit. World and I. 1999;14:330–5.

10. Simons-Morton BG, Taylor WC, Snider SA, et al. Observed levels of elementary and middle school children's physical activity during physical education classes. Prev Med. 1994;23:437–41.

11. American Academy of Pediatrics.. Committee on Pubic Education. Media education. Pediatrics. 1999;104(2 pt 1):341–3.

12. Sallis JF, Alcaraz JE, McKenzie TL, Hovell MF, Kolody B, Nader PR. Parental behavior in relation to physical activity and fitness in 9-year-old children. Am J Dis Child. 1992;146:1383–8.

13. Kuntzleman CT. Childhood fitness: what is happening? What needs to be done?. Prev Med. 1993;22:520–32.

14. Taylor WC, Blair SN, Cummings SS, Wun CC, Malina RM. Childhood and adolescent physical activity patterns and adult physical activity. Med Sci Sports Exerc. 1999;31:118–23.

15. Myers L, Stirkmiller PK, Webber LS, Berenson GS. Physical and sedentary activity in school children grades 5–8: the Bogalusa Heart Study. Med Sci Sports Exerc. 1996;28:852–9.

16. Wolf AM, Gortmaker SL, Cheung L, Gray HM, Herzog DB, Colditz GA. Activity, inactivity and obesity: racial, ethnic, and age differences among schoolgirls. Am J Public Health. 1993;83:1625–7.

17. Duelberg SI. Preventive health behavior among black and white women in urban and rural areas. Soc Sci Med. 1992;34:191–8.

18. Roberts SO. Exercise prescription recommendations for children. ACSM Certified News. 1997;7:1–5.

19. Stucky-Ropp RC, DiLorenzo TM. Determinants of exercise in children. Prev Med. 1993;22:880–9.

20. Wee CC, McCarthy EP, Davis RB, Phillips RS. Physician counseling about exercise. JAMA. 1999;282:1583–8.


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