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HEART Insight:
doi: 10.1097/01.HEARTI.0000359348.74485.d9
Features: Fit & Happy

School's Out For Fitness

Fuerst, Mark

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Abstract

Other Options Available To Keep Kids Active

Back in the day, kids would play outside until it got dark, and even then, their parents would have to repeatedly urge them to come inside. Being inside was boring — kids would much rather be outside running around, playing hopscotch, jumping rope, racing their bikes and improvising new games with their friends (even if they couldn't always remember the made-up rules).

But the definition of “fun” has changed, and there are lots of things to do indoors — watch TV (with 100 channels to choose from), “talk” to friends by exchanging IM messages and texting, surf the Web and play video games. There may be fewer skinned knees or broken arms for parents to contend with, but the health effects of sedentary play day in, day out can have far more serious health consequences for kids.

About 17 percent of American children between the ages of six and 19-years old are overweight or obese — that's three times as many as 30 years ago — in part, because they get less physical activity than they used to. As a result, heart disease risk factors that were once found in adults are now common in overweight kids. For instance, 45 percent of diabetes diagnoses among kids and adolescents is of the adult onset variety (type 2).

Compounding the problem, most schools don't provide enough opportunities for physical activity. A 2006 Centers for Disease Control study found that only four percent of elementary schools, eight percent of middle schools and two percent of high schools provide daily physical education all year long. The same study found only 12 percent of states provide elementary students with regularly scheduled recess.

The No Child Left Behind Act has forced some school districts to cut down on physical education time to allow more academic time,” explains Fran Cleland, PED, President of the National Association for Sport and Physical Education (NASPE). “In general, across the nation, students attend physical education class once a week, which is sorely deficient.” The NASPE says elementary students should receive 150 minutes of physical education per week, and middle school and high school students should get 225 minutes per week throughout the school year.

That's just in school. Overall, the American Heart Association recommends at least 60 minutes of moderate to vigorous physical activity every day for children and adolescents, but about one-in-three kids between the ages of 12 to 19 don't meet this guideline. The federal government's new Physical Activity Guidelines for Americans also calls for children and adolescents to get one hour or more of moderate or vigorous aerobic physical activity a day, including vigorous intensity physical activity at least three days a week.

“It is now well recognized that heart disease is a pediatric problem,” says Kevin Patrick, M.D., professor in the Department of Family and Preventive Medicine at the University of California at San Diego. He adds that autopsies on obese, inactive children who die in accidents show fatty streaks — atherosclerosis — in their coronary arteries.

But a trend towards risk-aversiveness also undermines the type and amount of activity kids get, contends Philip Howard, author of “Life Without Lawyers,” who says obesity is both a cultural and a legal problem.

“Kids no longer find it fun or feel peer pressure to lead active lives. Jungle gyms, merry-go-rounds, high slides, large swings, climbing ropes, even seesaws are history. The centrifugal forces that throw kids off the merry-go-round are also the forces that make it fun. And the sprinting required to get the contraption really moving is a lot of exercise,” says Howard.

Safety is the reason for many of these changes in children's play opportunities, he says. “Nothing in schools or camps or home activities occurs without people first asking themselves whether something might go wrong,” says Howard. “Learning to deal with challenges and risks in daily activities — running around in a playground, confronting classmates at recess, climbing trees, or exploring the nearby creek — is part of what children need, not only physically but socially and intellectually.”

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FILLING IN THE GAPS

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Some parents are fighting back against voluntary inactivity (such as video games) and forced inactivity (lack of school-based programs) by signing their kids up at the local YMCA or YWCA, Boys & Girls Clubs, community centers and health clubs with fitness programs tailored to their needs, or by hiring personal trainers.

A national survey of 36 middle schools found that linking up with community partners, such as the Y, local health clubs and community recreation centers, increased time spent in moderate-to-vigorous physical activity among 1,700 6th grade and 3,500 8th grade girls by about two minutes per day. Doesn't sound like much, but this small increase in activity was enough to prevent roughly two pounds of weight gain a year.

Children are the second-fastest growing market for health clubs, according to the International Health, Racquet & Sportsclub Association (IHRSA), a trade group with 5,000 member clubs. More than four million kids in the U.S. between the ages of 6 and 17 belong to health clubs, and more than a million of these kids work out with personal trainers, says Joe Moore, IHRSA's president.

The fitness industry has made some changes to serve this new clientele: Nearly a third of clubs belonging to the IHRSA offer a children's program, exercise equipment has been modified for use by children and trainers have developed workout DVDs for kids who want to lose weight or to enhance performance in a specific sport. Gyms offering programs for kids and adolescents charge an average of $60 per month in membership fees; personal trainers charge from $40 to $100 per hour.

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OVERCOMING HURDLES

Even with all these options, getting your child to be more active isn't always easy, with each age group — young children (ages 4 to 9), tweens (ages 10 to 12) and teens (ages 13 to 19) — posing its own challenges:

1. Young Children: Television has always served as an “electronic babysitter” to allow busy Moms — and Dads — to get to what needs doing around the house, knowing their kids are safe and sound in the living room or den. But young children who watch too much television may suffer health consequences. “Young children who watch more than five hours of television per day are eight times more likely to be obese than those who watch two hours a day,” says Cedric Bryant, Ph.D., Chief Science Officer of the American Council on Exercise. He recommends setting a maximum daily limit of two hours of screen time (TV, computer and video games), citing a University of Buffalo study of 70 overweight children aged 4 to 7 that found keeping TV and computer time to less than two hours a day helped reduce caloric intake, sedentary behavior and body mass index over a two-year period.

He also recommends channeling your inner child and playing with your kids. “Take a trip back to your own childhood and play hopscotch, capture the flag or duck-duck-goose,” says Bryant. “Be active as a family — take nature hikes, walk the dog together or go cycling or swimming.”

Turn off the TV and participate in “Recess Rocks” and other community events for kids and families during September, which has been designated as Go Healthy Month by The Alliance for a Healthier Generation, a joint initiative of the AHA and the William J. Clinton Foundation (visit www.HealthierGeneration.org for details). And take a family hike as part of “Take A Child Outside Week” from September 24–30. Hundreds of organizations in the US and Canada now support this unique idea initiated by the North Carolina Museum of Natural Sciences to encourage parents to get outdoors with their children.

2. Tweens: Once children reach young adolescence, physical activity level plummets, especially among girls. Some girls don't like to sweat, feel self-conscious about their bodies or don't think they're good at volleyball or other school sports, says Patrick. But even small increases in a tween's daily activity level can yield dramatic results. A British study of 5,500 12-year-olds found that just 15 minutes of moderate physical activity a day nearly halved the incidence of obesity. The researchers also found higher levels of physical activity were associated with lower blood pressure.

One way to encourage physical activity in this age group is to organize group activities, such as a doubles tennis game, an ice-skating party or roller blading in the park. Parents can also enroll their kids in soccer leagues, dance classes and other extracurricular activities, so that free time after school and on weekends is not spent in front of the TV or computer. Studies show that tweens who have more opportunities to engage in physical activity when they're not in school are, indeed, more active.

James Sallis, Ph.D., professor in the Department of Psychology at San Diego State University, also notes that less than half of American children who live within a mile of school walk or bike, missing out on a built-in opportunity for physical activity. In fact, children at risk for obesity (at least one parent is obese) who live near parks or other green spaces are more likely to walk to school.

Ironically, “many families move to the suburbs because they are perceived as safer for kids. Many suburban schools are built on busy, high-speed roads to facilitate access by car, and those roads also make it unsafe to walk,” says Sallis. He suggests parents insist on sidewalks and well-lit streets and that schools provide plenty of bike racks. The National Center for Safe Routes to School (www.saferoutesinfo.org) offers tips on how to make your community conducive to walking or biking to school.

3. Teens: Studies show that kids who have their own TV in their bedrooms watch more TV, are less active, have more unhealthy eating and eat fewer meals with their families. The best way to combat this self-imposed isolation is to hold firm, and not outfit their bedroom with a TV, says Sallis.

You can also encourage your teen to get one or more friends together and take a group class at a local gym or community center, such as spinning, yoga or pilates. “If their friends do it, they want to do it as well,” says Moore.

And if your teen is hooked on video games, try those that simulate a sport, such as tennis or kickboxing — then transition him or her to the real thing with lessons. As an added bonus, a coach, personal trainer or dietitian can also provide advice on good nutrition, if overweight or body image is an issue.

One last thing to keep in mind: No matter how young your kids are, you have to be a good role model. “If they see you [exercising], they are more likely to do it, too,” says Bryant. Just as kids aren't born wanting to brush their teeth and have to be taught to incorporate it into their daily routine, it's the same with physical activity

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Children And Adolescents At Risk For Heart Disease, Too

Compared to active kids, those who are sedentary are heavier, have higher blood pressure and have lower levels of high-density lipoproteins (HDL, or “good” cholesterol). Researchers have been examining the consequences of childhood obesity on heart disease. Here are some eye-popping findings from several recent studies:

* Children who are overweight—being in the 85th and 95th percentile of body mass for other children in their age group — from the ages of 7 to 13 years old are at an increased risk of developing heart disease beginning at age 25.

* Children 6 to 11 years old who are obese—above the 95th percentile of body mass — are twice as likely to have diabetes as children who are normal weight.

* Children (average age 12) who watch two-to-four hours of TV daily have 2.5 times the risk of high blood pressure, as compared with those who watch less than two hours a day.

* Low levels of physical activity and aerobic fitness in childhood are associated with metabolic syndrome in adolescence.

© 2009 American Heart Association, Inc.

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