The Pediatrician

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The Pediatrician Physical Activity Promotion

• Antronette K. Yancey, MD, MPH, FACPM
• Associate Professor,
• UCLA School of Public Health

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Health challenges have changed, but our health
care system has not

• Factors influencing gain in life expectancy
• 1900-19992

• National spending for population-based
  prevention21

• Since 1900, life expectancy has increased by 30
  years. According to the CDC, only 5 of those
  years can be attributed to curative medicine the
  remaining 25 years are due to advances in public
  health.2

• As a nation, we spend about 1.3 trillion each
  year on health care. Less than 2 of our health
  care expenditures are for population-based
  prevention activities.21

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Obesity rates are skyrocketing

• In 1991, only 4 states had obesity rates of
  15
• or greater and no states had rates of 20
  or
• greater. By 1999, 39 states had rates of
  at
• least 15, and 16 states had obesity rates
  of
• at least 20.6

• Almost two-thirds (61) of American adults are
  seriously overweight or obese.4 Obesity rates in
  children have doubled over the last two
  decadesone in seven children are obese.5

Percentage of young people who are obese,5
Prevalence of obesity among U.S. adults, BRFSS
1991-19987
Obese is defined by the 95th percentile of the
sex-specific 2000 CDC BMI-for-age-growth
charts. Data for 1966-70 is based on
adolescents ages 12-17.

• Approximately 30 pounds overweight.

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Childhood Overweight

• Approximately one-third of overweight preschool
  children and one-half of overweight school-age
  children become overweight adults.
• Type II Diabetes in Adolescents is now about 33
  of cases 10-19 years (ten-fold increase from
  1982-1994 3 prevalence).

5
Obesity-Associated Annual Hospital Costs for
Youths Aged 6 to 17 Years
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Prevalence of Overweight Among U.S. Children and
Adolescents Ages 6-19 Years
SOURCE CDC/NCHS, NHES and NHANES
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Very Promising Evidence-Based Overweight
Intervention Strategies
Physical Activity Patterns Increase PE
participation Increase recreational physical
activity Decrease television viewing Dietary
Factors Decrease sweetened beverages Familial
Psychosocial Influences Improve
limit-setting Avoid using food as
reward Parental modeling of healthy behaviors
Position Paper - Prevention of Childhood
Overweight What Should Be Done? Center for Weight
and Health - U.C. Berkeley 10/02
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Somewhat Promising Evidence-Based Overweight
Intervention Strategies
Physical Activity Patterns Decrease
video/computer game playing/use Dietary
Factors Decrease total calories Decrease dietary
fat promote a heart-healthy diet Decrease energy
density of foods Increase fruits and
vegetables Decrease fast food consumption Avoid
skipping meals Decrease snacking on unhealthy
foods Familial Psychosocial Influences Improve
family communication Improve self-esteem
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Relative Promise of Intervention Strategies
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Relative Promise of Intervention Strategies
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Spectrum of PreventionHealth behavior change
model

• Level 1 Strengthening individual knowledge and
  skills
• Level 2 Promoting community education
• Level 3 Educating service providers
• Level 4 Fostering coalitions and networks
• Level 5 Changing organizational practice
• Level 6 Influencing policy and legislation

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Spectrum of Prevention(1st level)
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(No Transcript)
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Activity Counseling Trial (ACT)

• Design
• Randomized controlled trial with recruitment in
  1995-97, f/u x 24 mos
• Setting
• 11 primary care facil. affiliated with 3
  clinical research ctrs Palo Alto, Memphis,
  Dallas
• Participants
• 395 female 479 male inactive, relatively
  affluent patients aged 35-75 yrs without clinical
  CVD

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Activity Counseling Trial (ACT)

• Interventions
• 3 gps advice incl. MD advice written educ.
  materials (recommended care) assistance incl.
  advice interactive mail behavioral counseling
  at MD visits counseling incl. Assistance
  telephone counseling behavioral classes
• Main Outcome Measures
• Cardiorespiratory fitness self-reported total
  physical activity

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Activity Counseling Trial (ACT)

• Results
• In women, but not men, fitness improvements (5
  net VO2max) in the assistance and counseling grps
  compared with the advice gp. Among women men,
  26-30 met Surgeon Generals PA recommendation at
  24 mos vs. 1-2 at baseline. No ethnic-specific
  analyses presented.
• ACT Writing Group. Effects of physical activity
  counseling in primary care the Activity
  Counseling Trial a randomized controlled trial.
  JAMA 2001286(6)677-87.

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Spectrum of Prevention(5th level)
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Childhood Overweight
The Role of Schools and Communities
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Childhood Overweight Behavioral Risk Factors

• Eighty percent of 5th, 7th and 9th graders in
  California fail to meet the fitness standard.
• More than 25 of children in CA reported
  averaging 4 or more hours of TV watching per day.
• In California, of 7th, 9th and 11th graders
  surveyed less than half reported eating fruits or
  vegetables at least once per day in the past
  week.
• The average consumption of soft drinks by 12-19
  year olds is over 20 ounces per day.

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Center for Public Health Advocacy An Epidemic of
Unfit and Overweight Children http//www.publichea
lthadvocacy.org/
REGIONAL HEALTH EDUCATION
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Physical Fitness and Academic Performance

• The California Department of Education studied
  353,000 fifth graders, 322,000 seventh graders,
  and 279,000 ninth graders across the state to see
  whether 2001 SAT-9 performance was related to
  results of the state-mandated physical fitness
  test (the Fitness-gram), measuring
• Aerobic capacity
• Body fat composition
• Abdominal strength
• Trunk extension strength
• Upper body strength
• Flexibility.

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Physical Fitness and Academic Performance

• Key findings of the study
• Higher achievement was associated with higher
  levels of fitness at each of the three grade
  levels measured.
• The relationship between academic achievement and
  fitness was greater in mathematics than in
  reading, particularly at higher fitness levels.
• Students who met minimum fitness levels in three
  or more physical fitness areas showed the
  greatest differences in academic achievement at
  all three grade levels.
• Females demonstrated higher achievement than
  males, particularly at higher fitness levels.

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5th Grade SAT9 percentile and Fitness
Performance
SAT 9 Percentile
Number of Fitness Standards Achieved
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7th Grade SAT9 percentile and Fitness
Performance
SAT 9 Percentile
Number of Fitness Standards Achieved
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9th Grade SAT9 percentile and Fitness
Performance
SAT 9 Percentile
Number of Fitness Standards Achieved
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Recommendations - School Board Members

• Make quality physical education programs for all
  students a priority in the districts yearly and
  long term plans.
• Work with school administrators, teachers, and
  bargaining units to develop and implement
  policies that provide effective physical
  education instruction and physical activity
  opportunities during the school day for all
  students.
• Use physical fitness assessment data to determine
  needs and guide decision-making in instructional
  programs.

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Recommendations - Teachers

• Schedule time each day for your students to be
  physically active
• Inside the classroom
• During physical education instruction
• Recess/break periods when students can choose
  from a variety of activities in which to
  participate
• Plan instruction so that all students receive the
  mandated 200 minutes (elementary school) or 400
  minutes (middle and high school) of physical
  education instruction every 10 ten school days.
• Plan the physical education instructional program
  to provide students with opportunities to acquire
  knowledge, and develop skills and confidence in a
  variety of movement experiences. Include a
  fitness education component at each grade level.
• Motivate students to establish regular physical
  activity habits and assist students in setting
  goals that will improve or maintain their fitness
  levels.

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Recommendations - Families

• Encourage children of all ages to participate in
  a variety of physical activities that they enjoy.
• Plan family activities that include opportunities
  for all family members to be physically active
  together
• Use health related fitness assessment results
  provided by your school as a tool to help
  students understand, enjoy, improve and or
  maintain their physical health and well-being.
• Advocate for physical education classes and
  physical activity opportunities that are
  attractive to all students by encouraging school
  administrators and board members to support
  activities that promote lifelong physical
  fitness, not just competitive sports.

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Pediatric Prevention Strategies Rx

• Infancy Breastfeed for the 1st Year of Life
• Toddler
• Limit TV and Video Games to Less Than 1 Hour per
  Day
• Limit Juice and Soda to 4-6 Ounces per Day
• 30 - 60 Minutes of Structured Physical Activity
  per Day
• School Age
• Limit TV and Video Games to Less Than 1 Hour per
  Day
• No TV in the Bedroom
• Limit Juice and Soda to 4-6 Ounces per Day
• 30 - 60 Minutes of Structured Physical Activity
  per Day
• Offer 5 Helpings of Fruits Vegetables Every
  Day
• Limit Fast Food to No More Than Once a Week

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Pediatric Prevention Strategies Rx(cont.)

• Raising parental awareness of gender issues in PA
  promotion middle school girls report inequity
  in encouragement by PE teachers, exercising in
  mixed gender groups, and concerns about
  appearance (hair/make-up) as barriers to their
  school PA participation parents more likely to
  purchase equipment, provide transportation for
  boys

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Get More Energy!
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Get More Energy! Poster
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Parent Information
REGIONAL HEALTH EDUCATION
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Resources for Schools

• The Children and Weight What Schools and
  Communities Can Do About It Resource Kit
  http//www.cnr.berkeley.edu/cwh
• CDC School Health Index http//www.cdc.gov/nccdphp
  /dash/SHI/index.htm
• Bright Futures Physical Activity Nutrition
  Guides http//www.brightfutures.org/
• Kaiser Permanentes Educational Theatre
  Professor Bodywise 510-987-2223

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Recapturing RecessA model for fitness/wellness
promotion in communities of color

• Lessons from recess, applied to fitness/wellness
  promotion efforts
• Institutionalizedpart of the structure of the
  organization
• Social event/social support/peer modeling
  (pressure)
• Fun!
• Facilities provided convenient, accessible
• Carry-over to other venues
• Cultural congruence of activities
• Yancey, Am J Prev Med 199815(4)iv.