Children and Adolescents - American College of Rheumatology

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Children and Adolescents - American College of Rheumatology

Getting & Keeping

Children Physically Active

in an Inactive World:

What Works?

Russell R. Pate, PhD

Arnold School of Public Health

University of South Carolina

June 2011

Kids Benefit from

High Levels of

Physical Activity

1


Physical Activity Guidelines

Advisory Committee Report

2008

• The report was

presented to the

Secretary of Health

and Human Services

and published in June

2008.

Health Benefits of Physical Activity

Children and Adolescents

• Strong Evidence:

• Improved

cardiorespiratory

endurance & muscular

fitness

• Favorable body

composition

• Improved bone health

• Improved cardiovascular

& metabolic health

biomarkers

• Moderate Evidence:

• Reduced symptoms of

anxiety & depression

2


Children and Adolescents

(6–17 years of age)

Children and adolescents should do 1 hour (60

minutes) or more of PA every day.

• Most of the 1 hour or more a day should be

either moderate- or vigorous-intensity aerobic

PA.

• As part of their daily PA, children and

adolescents should do vigorous-intensity activity

on at least 3 days per week. They also should

do muscle-strengthening and bonestrengthening

activity on at least 3 days per

week.

3


Kids Need More

Physical Activity

Prevalence of achieving 60 min/d

of MVPA on all 7 days - YRBS

2009

50

40

30

20

10

9th

10th

11th

12th

0

Males Females Total

CDC MMWR 2010;59(SS-5):1-146

4


Accelerometer Placement

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.

2006;160:1262-1268.

5


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

Pate et al. 2006

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

Pate et al. 2006

6


Time spent in various

intensities

Moderate

18.1 min/day

2.2%

Vigorous

5.6 min/day

0.7%

Light

341.6 min/day

41.1%

Sedentary

459.9 min/day

55.7%

Pate et al. 2006

National Trends of Overweight

in Youth

20

18

16

14

12

10

8

6

4

6-11 y

12-19 y

2

0

1971-

1974

1976-

1980

1988-

1994

1999-

2002

2003-

2006

2007-

2008

NHANES

7


Prospective associations

between objective measures of

PA & fat mass in 12-14 year old

children: ALSPAC

Riddoch CJ, Leary SD, Ness AR, Blair SN,

Deere K, Mattocks C, Griffiths A, Smith

GD, Tilling K. BMJ 2009;339:b4544

Methods

• 12-y olds followed for 2 years

• n = 4150

• Fat mass measured with DEXA

• PA measured with accelerometry

• 7 days

• Total PA = counts per minute

• MVPA > 3600 counts per minute

• Potential Confounders

• Age, sex, maternal education, maternal smoking

during pregnancy, mother’s pre-pregnancy BMI,

child’s pubertal status

Riddoch et al. 2009

8


Percent change in fat mass with

15 minutes of additional MVPA

per day - ALSPAC

Outcome Exposure % Change in Fat Mass (95% CI)

Boys

Fat mass at 14 MVPA at 12 -11.9 (-14.3 to -9.5)

Change in fat mass Change in MVPA -2.4 (-3.6 to -1.1)

Girls

Fat mass at 14 MVPA at 12 -9.8 (-12.8 to -6.7)

Change in fat mass Change in MVPA -2.3 (-3.5 to -1.2)

Riddoch et al. 2009

Policies to Promote

Physical Activity

in Youth

9


Preventing Childhood Obesity:

Health in the Balance

Institute of Medicine Committee on Prevention of Obesity in Children and Youth

Policy Recommendations

1. National Priority

2. Industry

3. Nutrition Labeling

4. Advertising & Marketing

5. Multimedia & Public Relations Campaign

6. Community Programs

7. Built Environment

8. Health Care

9. Schools

10. Home

10


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

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

11


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

Home

• Parents should promote regular PA for their

children

• Encourage & support regular PA

• Limit TV & recreational screen time to < 2

hours/day

• Serve as positive role models of PA behaviors

12


Promoting Physical Activity in

Children and Youth: A Leadership Role

for Schools

Scientific Statement from the American

Heart Association Council

Circulation, 2006;114:1214-1224

Physical Education

• 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

13


Active Transport

• Promote walking and bicycling to school

• Work with local governments to ensure safe

routes to school

Preschools

• Child development centers & elementary

schools

• Offer at least 30 minutes of recess each day

14


National Physical Activity Plan

www.physicalactivityplan.org

• Education

• Public Health

Sectors

• Volunteer and Non-Profit Organizations

• Transportation, Urban Design, and

Community Planning

15


Sectors

•Mass Media

•Healthcare

•Business and Industry

•Parks, Recreation, Fitness, and Sports

Education Strategies

• Provide access to & opportunities for high-quality,

comprehensive PA programs, anchored by PE, in prekindergarten

through grade 12 educational settings.

Ensure that the programs are physically active,

inclusive, safe, & developmentally & culturally

appropriate.

• Develop & implement state and school district policies

requiring school accountability for the quality and

quantity of PE & PA programs.

16


Actions we would take if

we were serious about

increasing children’s

physical activity

Demand high quality

physical education

17


CATCH

• A randomized, controlled field trial

• 4 field centers

• 56 Intervention schools, 40 Control schools

• 3rd to 5th grade, 5106 students

Luepker et al. JAMA 1996;275:768-76

CATCH - VPA-% of Lesson

25

20

Percent

15

10

Intervention

Control

5

0

Baseline 2 3 4 5 6

Semester

F=2.35, df=5, 1979, P=.04

Luepker et al. JAMA 1996;275:768-76

18


Shift the social norm so

that more children walk or

ride their bikes to school

Transportation to School

Percent

90

80

70

60

50

40

30

20

10

0

85

60

43

13

18

USA England Australia Denmark Germany

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)

19


Demand access to high

quality afterschool

programs

PA of youth attending

afterschool programs in

Columbia, SC

50

45

40

35

30

25

20

15

10

5

0

Total PA (min) MVPA (min) % MVPA

Boys

Girls

Beets et al. Prev Med 2010; 51:299-301

20


Eliminate disparities

across communities for PA

resources

Healthy Parks, Schools &

Communities – The City Project

Garcia & White. 2007.

www.cityprojectca.org

21


Launch a sustained

national social marketing

campaign aimed at

changing parenting

behavior around PA

Overall Effect of VERB

Weekly median free-time PA sessions

5

4

Sessions

3

2

No recall

All

1

0

9-10 y 11-13 y

Huhman et al. Pediatrics 2005; 116; e277-e284

22


Demand that every state adopt

policies to ensure young

children are active while in

child care and preschool

Policies & Characteristics of

the Preschool Environment &

PA

• 299 children wore accelerometers for 8.1

hours/day for 5.5 days

• Director Interviews about policies

• ECERS-R

• Preschools categorized as: 1) promoting PA or

2) not promoting PA

Dowda et al. Pediatrics 2009; 123:e261-6

23


MVPA min/hour during the

preschool day

Larger playgrounds

Lower use of electronic

media

More portable playground

equipment

Less fixed playground

equipment

Not promote

Promote

Quality

0 2 4 6 8

Dowda et al. 2009

Ensure that community-based

PA & sports programs are

accessible to children & provide

them with adequate amounts of

PA

24


Physical Activity During

Youth Sports Practices

35

30

25

20

15

Soccer

Baseball/ Softball

10

5

0

SED (min) LPA (min) MPA (min) VPA (min)

Leek et al. Arch Pediatr Adolesc Med 2011; 165:294-9

25

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