Physical Activity Basics

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Physical Activity Basics

• American Academy of Pediatrics National
  Conference
• San Francisco, October 2004
• Eric Small, MD, FAAP
• Assistant Clinical Professor of Pediatrics,
  Orthopedics, and Rehabilitation Medicine
• Mount Sinai School of Medicine
• New York

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Physical Activity Basics

• Eric Small, MD, FAAP
• Family Sports Medicine Fitness
• Mount Kisco, NY
• email sportsdr_at_yahoo.com
• website www.sportsdoc4kids.com

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Outline

• Exercise Background
• Research Studies
• Specific exercise
• Recommendations for the pediatrician

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Case Scenarios

• 12 yo who plays sports
• 8 year old loves tv, internet
• 15 year old morbidly obese

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Why kids exercise

• Its fun
• To be with friends
• To improve skills
• (NASPE/SGMA)

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Why adults exercise

• Lower blood pressure/cv risk
• To fit in bikini/bathing suit
• Better clothes
• Wedding Dress

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Why kids quit exercise

• It ceases to be fun
• It becomes too competitive
• Dont get enough playing time

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At Risk Population

• Inner City/Minority/Single Family
• Lower Socioeconomic
• Neuromuscular Disease (CP, spina bifida)
• Depression
• Divorce

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Physical Fitness

• AerobicCardiovascular Health, Endurance
• Flexibility
• Muscle Strength
• Anaerobic
• Body Composition
• Balance
• Agility

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PEER-REVIEWED ARTICLES 0BESITY CHILDREN
EXERCISE
104
100 - 80 - 60 - 40 - 20 - 0
ARTICLES PER YEAR
20

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65-69 70-74 75-79 80-84 85-89 90-94 95-99
00-02
Y E A R S
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TV VIEWING AND RESTING ENERGY EXPENDITURE
IN 8 - 12 yrs OLD CHILDREN
Energy Eexpenditure
(Klesges et al., Pediatrics, 1993)
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POSSIBLE CAUSES FOR HYPOACTIVITY IN THE
OBESE CHILD
PARENTS LESS ACTIVE
HIGH PERCEIVED EFFORT
SHAME (UGLY BODY)
TEASING
HYPOACTIVITY
LOW FITNESS
INCREASED OBESITY
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ENERGY COST OF LOCOMOTION IS EXCESSIVE IN
THE OBESE (Maffeis et al., 1993)
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RATING OF PERCEIVED EXERTON OBESE vs
NON-OBESE ADOLESCENTS (Ward et al., 1986)
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EFFECT OF AEROBIC TRAINING ON VISCERAL AND
SUBCUTANEOUS ABDOMINAL FAT IN 7- TO
11-YR-OLD CHILDREN (Gutin Owens, Med Sci
Spor Exer 1999)
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EFFECTS OTHER THAN ON BODY COMPOSITION
INCREASE DECREASE NONE
Arterial Pressure X Insulin
Sensitivity X Plasma Triglycerides X
X HDL Cholesterol X X LDL
Cholesterol X X Total
Cholesterol X X Physical
Fitness X Self Esteem X
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The Biggest Effect is changes in Lifestyle
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TO WHAT EXTENT DOESENHANCED PA
INCREASETOTAL ENERGY EXPENDITUREIN OBESE
CHILDREN ?
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THE INCREASE IN TOTAL EE (TEE) DURING
1-MONTH TRAINING IS GREATER THAN THE ADDED
EE BY TRAINING (EEtr) (Blaak et al., Am.
J. Clin. Nutr., 1992)
TEE EEtr
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EFFECT OF A SINGLE EXERCISE SESSIONON
SPONTANEOUS ACTIVITY OF OBESE
CHILDREN(Kriemler et al., Pediatr. Res.,
1999)

• QUESTION
• WILL LABORATORY - BASED EXERCISE AFFECT THE
  CHILDS ACTIVITY
• ON THE NEXT DAY ?

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STUDY DESIGN
- THREE CONSECUTIVE WEEKS - THREE
OBSERVATION DAYS EACH WEEK - LAB VISIT ON
THE SECOND OBSERV. DAY
INTENSE
MILD
PLACEBO
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MODERATE EXERCISE INCREASES NEXT DAYS ENERGY
EXPENDITURE (Kriemler et al., Pediatr. Res.,
1999)
700 - - 600 - - 500 -
ENERGY EXPENDITURE, kJoule h-1
PRE- EXERC. POST- DAY DAY DAY
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TWO-YEAR CHANGES IN OVERWEIGHT COMPARING
THREE ACTIVITY PROGRAMS (Epstein et al.,
Behavior Ther. 1985)
Calisthenics Aerobic Lifestyle
calisthenics
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HOW TO DETERMINE ENOUGH PHYSICAL ACTIVITY ?

• IN ADULTS, ACTIVITY DOSAGES HAVE BEEN
  DETERMINED BASED ON END POINTS (e.g.,
  myocardial infarction, sudden death)
• IN CHILDREN, THERE ARE NO SUCH END POINTS
  

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COMMONLY QUOTED GUIDELINES FOR PHYSICAL
ACTIVITY
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Summary of Guidelines

• 30 or 60 minutes/day
• 3 to 5 days/week
• Various intensities
• The problem is that none of the above is evidence
  based!!!

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Motivation for losing weight

• To look better
• To fit into better clothes
• To be better in sports

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Motivation

• Rate 1 to 10 motivation to change lifestyle
• Rate 1 to 10 supportiveness of parent(s)
• Whose idea to come today

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Exercise Recommendations

• Choose activities that are fun
• Choose activities that use large muscle groups
• Emphasize the positives not negatives
• Family activities

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Specific exercise

• Water Activities
• Weighttraining
• Strength sports

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Water Activities

• Overweight are more buoyant
• Fat keeps heat in
• Easier movement
• Ugly body submerged

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Weighttraining

• Appropriate supervision
• No maximal lifts
• Low weights/high repetitions
• Link with other activities
• (AAP COMSF, Ped, 2001)

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Strength Sports

• Football
• Wrestling
• Rugby
• Field Sports (javelin, hammer, discus)

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How to do a work-out

• 5-10 minute warm-up
• 2-5 minutes of stretching
• The work-out
• Cool down and stretching

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Top Ten Exercises

• Wood Chops
• Pelvic Tilt/Bridging
• One legged Balance
• Obstacle Course
• Sit-ups with ball
• Side to side jumps
• Jumping in a box
• Running side to side
• Running back and forth

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Measurements in Office

• Baseline heart rate
• Heart rate at submaximal exercise
• Recovery heart rate

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How to measure success

• Weight loss
• Decrease in BMI
• Improvement in fitness parameters
• Positive Change in lifestyle

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Specific Sports

• Baseball
• Hockey
• Football
• Swimming

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12 year old who plays sports

• Jog forwards, backwards, sideways
• Box drill
• Obstacle course

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8 year old-totally sedentary

• Find activity that he/she likes (rollerblading,
  walking, biking, hiking)
• Family activity on weekend

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15 year old morbid obese

• Daily Exercise (walking, biking, treadmill,
  elliptical)
• In School (PE teacher, physical therapy,
  occupational therapy)
• Be creative (use of one to one aides)

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Common Sense Approach to Activity

• Assuming that current levels are insufficient use
  incremental approach
• Add so many minutes/day to what you are doing
• Reduce screen time
• Apply gradual progression to activity and screen
  time

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Being creative

• Physical/Occupational therapy
• College/Graduate students
• Physical therapy students
• Involve the school

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Thinking outside the box

• Family Exercise night
• Exercise night at doctors office
• Weekly/monthly/quarterly exercise planning
• Rewarding children with exercise not food or
  television (amusement park, minigolf, hike)

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Key points

• Reeevaluate reward system
• Education/Advocacy
• Family outing
• Winter/summer activities

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Summary

• Have Fun!!!
• Use common sense.
• Be flexible.

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• Thank you and good luck!!!