Malcolm Sweeney is an 11-year-old male who is visiting his family physician, Dr. Taylor, with his father, Martin. Type 2 diabetes runs in the Sweeney family, and Martin is concerned about his son’s weight. Malcolm has, in fact, gained almost 25 pounds since his last visit to Dr. Taylor about 18 months ago. Martin Sweeney is very physically active himself and coached Malcolm’s Little League team until about a year ago, when Malcolm told him he wasn’t interested in baseball anymore.
Dr. Taylor: Malcolm, why did you quit your Little League team?
Malcolm: It was boring, and I wasn’t good at it. I was always stuck in the outfield.
Mr. Sweeney: You pitched sometimes.
Malcolm: Yeah, but I wasn’t a good pitcher either. I just got tired of it.
Mr. Sweeney: Well, you have to play something. But you don’t like basketball or soccer, either.
Dr. Taylor: Malcolm, what do you like to do?
Malcolm: I guess I just don’t like sports.
Dr. Taylor: Well, what do you do for fun?
Malcolm: Mostly I play video games.
Mr. Sweeney (sighing): An Xbox was the only thing he wanted for his birthday.
Dr. Taylor: OK, well, Malcolm, video games are fun, but they aren’t very active so it’s a good idea to limit your screen time to no more than two hours a day. Do you know what I mean by “screen time”?
Malcolm: I guess you mean TV, video games and my computer. But what about homework on the computer?
Dr. Taylor: Homework is OK, of course! Do you have any ideas for other ways you could be more active?
Malcolm: I don’t know. I can’t ride my bike because it’s too small for me.
Dr. Taylor: What about a skateboard?
Malcolm: Yeah, I have a skateboard, but I really don’t use it.
Mr. Sweeney: Skateboarding isn’t a sport!
Dr. Taylor: Well, it’s not a traditional sport, Mr. Sweeney, but it is a form of activity. I’d rather hear about Malcolm outside skateboarding than in his room playing a video game.
Malcolm: I’m pretty good at the Tony Hawk game.
Dr. Taylor: Great! Then you know that skateboarding isn’t as easy as it looks. But I’ll bet you’ll be good at it with some practice. Would you be willing to give it a try?
Malcolm: OK.
Dr. Taylor: Good. Remember that you need to wear a helmet, wrist guards and knee pads when you skate. Now, what about your bike? If your old one is too small, maybe you could take it to one of those used sporting goods stores and get credit for it. You can put the credit toward a new bike. What do you think, Dad?
Mr. Sweeney: Sounds good. I’d be willing to chip in for a new bike, too, Malcolm, if you keep up with your chores.
Dr. Taylor: What kinds of chores do you have, Malcolm?
Malcolm: Um, I have to clean my room and take out the trash. Oh, and I feed Charlie, our dog.
Dr. Taylor: Do you take Charlie out for walks? I take my dog for a walk almost every day, and he loves it!
Mr. Sweeney: We’re not very good about that, are we, Malcolm?
Malcolm: Nope.
Dr. Taylor: Well, since you’re going to have more free time when you cut back on your screen time, what do you think about taking Charlie out for a walk every day when you get home from school? Do you think you could try that for a month, Malcolm?
Malcolm: I guess. Charlie would like it.
Mr. Sweeney: You know, Mal, they just put some new trails in the park near your aunt’s house. If we got you a mountain bike, and I got my bike tuned up, we could check out some of the trails.
Dr. Taylor: Great idea, Mr. Sweeney. I would like to see you guys being active together again. It’s too bad Little League didn’t work out, but I know you can find other things to do as a family. Why don’t you schedule a follow-up visit on the way out—say, six weeks from now? That way I can hear how Malcolm’s goal of walking Charlie went, and maybe we can talk about how to make healthy eating choices, too. Sound good?
Mr. Sweeney: OK, we’ll see you in six weeks.
Be Active
Case #1: Malcolm Sweeney
Benefits of Physical Activity
Table 1. Kid-Friendly Activities
The National Association for Sport and Physical Education recommends that children and adolescents get 60 minutes of moderate to vigorous physical activity on all or most days.8 Suggesting some of the following activities conveys the message that not all physical activity needs to be sports-related.
- Run through the sprinkler.
- Wash and wax the car.
- Walk or run with the dog.
- Play tag.
- Shoot baskets.
- Ride bikes through the neighborhood or on a trail.
- Rake leaves, mow the lawn or do other yardwork.
- Splash and swim at the community pool.
- Dance—just for dancing’s sake, or while watching TV or talking on the phone.
The health and quality-of-life benefits associated with regular moderate physical activity extend well beyond the prevention of obesity. Benefits include improved plasma lipid profiles; prevention of hypertension; increased peak bone mass and bone density; increased strength and endurance; decreased body-fat percentage, stress, and symptoms of depression and anxiety; improved self-esteem and body image; and improved overall health and adult health status.3-6
Children are born with a natural curiosity, a love of playtime, a will to overcome small challenges and a pride in mastering new skills. For babies and young children, physical activity is a natural and joyful part of playing and interacting with their environment, family and friends. Active playtime also helps them develop cognitive, motor and social skills.2
Unfortunately, in many cases, as children get older their environments do not encourage physical activity as a convenient or necessary part of day-to-day existence. Active play has to compete with television, computers and video games that easily meet a young person’s need for adventure, play and mastery. As children move through adolescence into adulthood, they generally become even less physically active.7
It is currently recommended that children and adolescents get a minimum of 60 minutes of moderate to vigorous physical activity on all or most days (Table 1).8 To assist patients in reaching this goal, family physicians, school nurses, coaches and other community members should encourage families to engage in regular physical activity that is fun, comfortable, practical and intrinsically rewarding. Increasing playtime, family and school activities, and participation in organized sports will decrease the amount of time a child spends on sedentary activities. Further, physical activity that is integrated into a child’s daily routine does not require a conscious decision to exercise. Physical activities should also be matched to the child’s innate tendencies so that he or she will be motivated to stick with them. For example, some children are naturally competitive and enjoy individual and team sports. Some prefer unstructured play like pool games or hide-and-go-seek. Other children are adventurous and will enjoy hiking, rock climbing or mountain biking.
Children are born with a natural curiosity, a love of playtime, a will to overcome small challenges and a pride in mastering new skills. For babies and young children, physical activity is a natural and joyful part of playing and interacting with their environment, family and friends. Active playtime also helps them develop cognitive, motor and social skills.2
Unfortunately, in many cases, as children get older their environments do not encourage physical activity as a convenient or necessary part of day-to-day existence. Active play has to compete with television, computers and video games that easily meet a young person’s need for adventure, play and mastery. As children move through adolescence into adulthood, they generally become even less physically active.7
It is currently recommended that children and adolescents get a minimum of 60 minutes of moderate to vigorous physical activity on all or most days (Table 1).8 To assist patients in reaching this goal, family physicians, school nurses, coaches and other community members should encourage families to engage in regular physical activity that is fun, comfortable, practical and intrinsically rewarding. Increasing playtime, family and school activities, and participation in organized sports will decrease the amount of time a child spends on sedentary activities. Further, physical activity that is integrated into a child’s daily routine does not require a conscious decision to exercise. Physical activities should also be matched to the child’s innate tendencies so that he or she will be motivated to stick with them. For example, some children are naturally competitive and enjoy individual and team sports. Some prefer unstructured play like pool games or hide-and-go-seek. Other children are adventurous and will enjoy hiking, rock climbing or mountain biking.
The Role of Media
Watching television, playing video games, surfing the Internet and other forms of “screen time” are sedentary and modifiable activities that require a significant amount of a child’s discretionary time. The Kaiser Family Foundation reviewed evidence on the role of media in the childhood obesity epidemic in the United States and found that children who spend the most time using electronic media are more likely to be overweight.9 Although most of the studies reviewed by the Kaiser report did not find a statistically significant relationship between hours of screen time and levels of physical activity, at least one study did find that decreasing sedentary behaviors resulted in a decrease in overweight and body fat percentages.10 This strategy has become an element of many successful childhood obesity prevention programs.11
In some cases, electronic media may be helpful for reinforcing the physical activity message. For example, Web sites such as Kidnetic, the VERB campaign and BAM Body and Mind encourage children to be active and make healthy choices. Video games such as Dance-Dance Revolution require vigorous physical participation.
Additional messages about the importance of physical activity to pass along to patients are available in the Tips for Healthy Families handout.
In some cases, electronic media may be helpful for reinforcing the physical activity message. For example, Web sites such as Kidnetic, the VERB campaign and BAM Body and Mind encourage children to be active and make healthy choices. Video games such as Dance-Dance Revolution require vigorous physical participation.
Additional messages about the importance of physical activity to pass along to patients are available in the Tips for Healthy Families handout.
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