Promotion of Physical Activity for Obesity Prevention in Youth

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Promotion of Physical Activity forObesity
Prevention in Youth

• Russell Pate
• Arnold School of Public Health
• University of South Carolina

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• Societal Trends
• Influencing Physical Activity

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Childrens Transportation to School

• from school
• 1 bicycled to or from school
• 25 of children aged 5-15 years who lived within
  1 mile of school walked or bicycled at least once
  in previous month

National Household Travel Survey, 2001 Bureau
of Transportation Statistics, 2003 CDC, 2002
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Transportation to SchoolColumbia, SC
Sirard, 2004
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Observed Modes of TransportationElementary
Schools, Columbia, SC
Percentage of Students
Sirard et al. AJPH 200595236-237
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Transportation to School
Percent of children walking and bicycling to
school by country (CA Safe Routes to Schools
1996, Dept. of Transport 2001, Gilewe et al.
1998, Carlin et al. 1997)
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Television
1 TV in household
1 TV in household
Percentage
Percentage
1950
1999
1970
1999
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Childrens Access to Television

• 50 of children 6 years lived in a house with
  3 TVs
• 36 of children 6 years had a TV in their
  bedrooms

Rideout et al. 2003
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Childrens TV Viewing Habits
5 h/d 17
1 h/d 36
3 to 5 h/d 16
1 to 3 h/d 31
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• Increasing Prevalence of
• Childhood Obesity

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Overweight ( 95th percentile of BMI) children
and adolescents 6-19 years of age
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• Feasibility of
• Preventing Obesity
• by Promoting
• Physical Activity in Youth

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Hypothetical Example

• Pre-obesity
• Age 6 years
• BMI 16.5 (12 Fat)
• Weight 22.7 Kg
• Obesity
• Age 12 years
• BMI 28.7 (35 Fat)
• Weight 64.5 Kg

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Hypothetical Example

• Weight Gain- Age 6-12
• 41.8 Kg
• Fat Gain - Age 6-12
• 20.2 Kg
• Excess Fat Gain- Age 6-12
• 13.1 Kg

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Hypothetical Example

• 100,870 Total Kcal
• 16,812 Kcal/Yr
• 323 Kcal/Wk
• 46 Kcal/Day

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• How Physically Active Should Kids Be?

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Evidence Based Physical Activity for School-Aged
Youth

• School-age youth should participate every day
  in 60
• minutes of more of moderate to vigorous
  physical activity that is enjoyable and
  developmentally appropriate.
• 
  Strong et al. J Pediatr
  2005146732-737

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• How Active are American Kids?

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Youth Risk Behavior Survey - 2005
60-min/day
20-min VPA 3x/wk or 30-min MVPA/day
Percentage
Percentage
Boys
Girls
Boys
Girls
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CSA Monitor

• Computer Science and Applications, Inc.
• Model 7164
• Weighs 1.5 oz 5x5x1.5 cm
• Measures integrated accelerations in the vertical
  plane

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Objectively Measured Physical Activity in
Sixth-Grade Girls

• Pate RR, Stevens J, Pratt C, Sallis JF, Schmitz
  KH, Webber LS, Welk G, Young DR. Arch Ped Adolesc
  Med. 20061601262-1268.

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Purposes

• To describe baseline PA characteristics of a
  diverse sample of 6th grade girls using
  accelerometry
• To examine the relation of these variables to PA
• Race/ethnicity
• Socioeconomic status
• Geographic location

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Methods

• Cross-sectional study
• Six middle schools from each community
• Tucson, AZ
• San Diego, CA
• New Orleans, LA
• Washington DC Baltimore, MD
• Minneapolis, MN
• Columbia, SC
• Random sampling of eligible girls
• n 1578

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Measures

• Race/ethnicity
• Socioeconomic Status
• Free or reduced-price school lunch
• Weight and height
• Physical Activity
• Actigraph accelerometers
• 6 complete days of data
• 30-second intervals

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Data Reduction

• Count thresholds
• Sedentary (
• Light (51-1499)
• Moderate (1500-2600)
• Vigorous ( 2600)
• Primary analyses - MPA
• 1500 counts/ 30 seconds
• Corresponds to 4.6 MET cut point
• Additional cut points
• 3.0 MET cut point (579 counts/ 30 seconds)
• 3.8 MET cut point (1047 counts/ 30 seconds)

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Time spent in various intensities
Vigorous 5.6 min/day 0.7
Moderate 18.1 min/day 2.2
Sedentary 459.9 min/day 55.7
Light 341.6 min/day 41.1
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Results

• More minutes of MPA and VPA
• Girls in Arizona and California
• White girls
• More minutes of VPA
• Girls that did not receive subsidized school
  lunch
• Fewer sedentary minutes
• Girls in Arizona and California

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Conclusions

• Effect of different accelerometer scoring
  protocols on prevalence of PA
• Conceptual empirical work is needed to define
  appropriate PA for youth using objective measures

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Amherst Health and Activity Study

• Subjects were recruited from 7 elementary
  schools, 1 junior high, and 1 senior high school
• 38 of the 3648 students enrolled in PE returned
  consent forms (n1379)
• Subjects (n400) were randomly selected to wear a
  CSA monitor for 7 days.
• Subjects were divided into 4 grade groups, A1-3,
  B4-6, C7-9 and Dgrades 10-12.

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Percentage of children meeting Strong et al.
recommendation
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• Interventions
• to Promote Physical Activity
• in Youth

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Intervention Settings

• School
• Home
• Community
• Healthcare
• Media

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LEAPMethods

• 8th grade girls from 24 high schools
• 1603 girls, 50 African-American
• School randomly assigned to control or
  intervention
• Physical activity 3DPAR
• In 8th grade at baseline
• In 9th grade during school based intervention

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Family and Community Environment
Physical Education
LEAP Team
Health Education
School Services
School Environment
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LEAP Intervention Components

• Physical Education
• Other Health Components
• Health Education
• Health Environment
• Health Services
• Faculty/Staff Wellness
• Family/Community Environment

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LEAP PE

• Specific Objectives
• Develop behavioral skills
• Enhance physical activity self-efficacy
• Develop motor skills
• Provide enjoyable participation in physical
  activity
• Implement a personal out-of-school physical
  activity program

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Prevalence of Participation1 30-min blk of VPA
. Group P.05
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Prevalence of Participation1 30-min blk of VPA
Group P0.05 Trend P.02
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Structural Model
PA Enjoyment Time 1
PA Time 1
Factors PE Enjoyment Time 1
Self-efficacy Time 1
PA Enjoyment Time 2
PA Time 2
Factors PE Enjoyment Time 2
Intervention
Self-efficacy Time 2
Moderate
Weak
Not sign.
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Preventing Childhood Obesity Health in the
BalanceInstitute of MedicineCommittee on
Prevention of Obesity in Children and Youth

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Policy Recommendations

• National Priority
• Industry
• Nutrition Labeling
• Advertising Marketing
• Multimedia Public Relations Campaign
• Community Programs
• Built Environment
• Health Care
• Schools
• Home

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National Priority

• Government - provide leadership for prevention of
  obesity in youth
• Federal Government
• Support PA grant programs
• Develop evaluate pilot projects to promote PA
• State Local Governments
• Provide leadership support for promoting
  opportunities for PA in communities,
  neighborhoods, and schools

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Industry

• Make obesity prevention a priority
• Leisure, entertainment, recreation industries
• Develop products opportunities that promote PA
  reduce sedentary behaviors

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Community Programs

• Local governments, public health agencies,
  schools, community organizations
• Develop programs that promote PA
• Form community coalitions

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Built Environment

• Local governments, private developers,
  community groups should expand PA opportunities
• Improve street, sidewalk, street-crossing
  safety
• Encourage walking bicycling to school
• Build schools within walking bicycling distance
  of neighborhoods

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Schools

• Provide consistent environment conducive to
  regular physical activity
• State and Local Education Authorities Schools
• All youth participate in at least 30 minutes of
  MVPA during school day
• Enhance health curricula to include PA
  behavioral skills focus
• Involve school health services

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Schools

• State Local Education Authorities Schools
• Expand PA opportunities
• Physical education
• Intramural interscholastic sports programs
• PA clubs, programs, lessons
• After-school use of facilities
• Use of schools as community centers
• Walking biking to school programs
• Conduct annual weight height assessments
• Perform periodic assessments of schools policies

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Home

• Parents should promote regular PA for their
  children
• Encourage support regular PA
• Limit TV recreational screen time to hours/day
• Serve as positive role models of PA behaviors

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Promoting Physical Activity in Children and
YouthA Leadership Role for SchoolsScientific
Statement from the American Heart Association
Council

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Recommendation 1

• All children youth participate in a minimum of
  30 minutes of MVPA during the school day
• Provide extracurricular school-linked community
  programs

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Recommendation 2

• Deliver health-related PE programs that meet
  national standards to students at all levels
• Provide substantial amounts of MVPA
• Teach motor behavioral skills

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Recommendation 3

• States and school districts
• Ensure PE is taught by certified and qualified PE
  teachers

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Recommendation 4

• States should hold schools accountable for PE
  programs that meet national standards
• Grades K 8
• 150 minutes per week
• Grades 9 12
• 225 minutes per week
• Include PE in its core accountability system

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Recommendation 5

• Expand PA opportunities
• Clubs
• Lessons
• Intramural sports
• Interscholastic sports
• Coaches and leaders should be qualified

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Recommendation 6

• Promote walking and bicycling to school
• Work with local governments to ensure safe routes
  to school

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Recommendation 7

• Child development centers elementary schools
• Offer at least 30 minutes of recess each day

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Recommendation 8

• Provide evidence-based health education programs
• Emphasize behavioral skills
• To increase PA
• To decrease sedentary behaviors

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Recommendation 9

• Colleges and universities
• Provide professional preparation programs to
  produce highly qualified teachers to deliver PE
  and health education programs