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Promoting Exercise and Activity in Children: Challenges and Solutions to Today's Digital Society

Wolverton, Andrew, PT, DPT

Journal of Pediatric Surgical Nursing: January/March 2018 - Volume 7 - Issue 1 - p 4–5
doi: 10.1097/JPS.0000000000000160
Pediatric Obesity Column

Andrew Wolverton, PT, DPT Senior Physical Therapist II, Support and Help In Nutrition and Exercise (SHINE) Clinic, Children's of Alabama, Birmingham.

The author declares no conflict of interest.

Technology has become an integral part of our daily lives. In many ways, it shapes the pace and flow of society. Unfortunately, it may shape our waistlines and steer many toward a more stagnant lifestyle. The overweight and obesity epidemic declared by the World Health Organization in 1997 continues to grow. According to the 2016 National Survey of Children's Health, the rates for pediatric obesity range from 19.2% up to 37.7% across the 50 states and the District of Columbia (National Survey of Children's Health, 2016). This growth is not only isolated to the United States. Worldwide, overweight and obesity is estimated to affect over 60 million children by 2020 (de Onis, Blössner, & Borghi, 2010). In addition, other studies indicate that there is a correlation between physical activity and screen time (but not other inactive activities) and BMI, BMI-for-age z score, % body fat, and waist circumference in children (Lee et al., 2015). Research repeatedly shows a positive relationship between regular exercise and the prevention of cardiovascular disease and its risk factors such as diabetes, hypertension, and obesity (Varghese et al., 2016).

Of course, technology is not all bad. There are many ways that the technology boom positively impacts our society. Schools are incorporating technology to promote inclusion and increased engagement into physical education classes (Faber, Kulinna, & Darst, 2007; Hill & Turner, 2007). Technology provides access for many to online resources and media that offer information designed to improve health and wellness at home and in the community (American Heart Association, 2017). These resources are now more portable and accessible than ever with the expanded use of smartphones and tablets giving rise to exergaming, a new division of the health promotion field (Witherspoon, 2013). Individuals are now able to utilize gaming systems that measure and assess effort and various mobility metrics. Examples of these systems are Nike + Kinect Training and exercise/health apps such as Sworkit, Sworkit Kids, and Charity Miles, in addition to YouTube exercise channels and/or videos to help improve fitness levels and eating habits (Chaddha, Jackson, Richardson, & Franklin, 2017). Several of these have become staples in the home as well as in the workplace. There is evidence to suggest that fitness trackers/wearables could help to improve activity in children as well (Ridgers, McNarry, & Mackintosh, 2016).

So, what do we do as healthcare providers? The American Academy of Pediatrics along with numerous other organizations state that the causes of decreased activity are multifactorial and have compiled guidelines for age-appropriate activity recommendations for children ranging from infancy through adolescence. Advocacy is key, and healthcare providers are encouraged to counsel patients/families not only in word but also in deed. In other words, be a good example and follow the recommendations yourself (Council on Sports Medicine and Fitness and Council on School Health, 2006). Another part of promotion is to educate and inform patients, coworkers, and others on settings that could bolster our children's activity level. Children typically spend nearly half of their waking day at school. Physical education classes may or may not be available in many schools; it will take consistent and determined efforts to implement, support, and improve policies affecting physical education (Cooper et al., 2016). In many ways, our children's initial encounter with physical education probably plays a more significant role in their long-term health and well-being than any of their academics. This exposure teaches them the “physical literacy” of exercise and its importance and incorporation into daily life (American Heart Association and American Stroke Association, 2015; Orlowski, Lorson, Lyon, & Minoughan, 2013). Additional resources exist with compiled recommendations and benefits for activity, both as structured and unstructured play, as well as what limitations to place on screen/sedentary time (Krakow, 2011; O'Malley & Thivel, 2015).

As healthcare providers, our objective is to improve the health and quality of life of our patients. More specifically, as healthcare providers in pediatrics, we have the ideal window of time to impact, influence, and affect positive lifelong health. Our responsibility regarding activity and screen time is to continue to advocate and promote a holistic approach with a consistent message. We need to educate and empower our patients and families to seek, integrate, and employ activity into daily life, whether it is walking/riding bikes to school, participating in organized sports, or engaging in unstructured play (Centers for Disease Control and Prevention, 2011; National Physical Activity Plan Alliance, 2016). As a physical therapist, my profession continues to be tasked with promoting and restoring mobility in patients. However, the strain of the obesity epidemic on our healthcare system will continue to shift our focus toward treating the complications of obesity. We must engage and focus on proactive and aggressive lifestyle changes (Maibach, 2007) to both prevent and treat obesity complications. Our influence on the pediatric population we serve will inevitably shape the dynamics of the health of our world in the future.

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American Heart Association. (2017). Creating a physically active school year-round, play 60. Retrieved from
American Heart Association and American Stroke Association. (2015). Increasing and improving physical education and physical activity in schools: benefits for children's health and educational outcomes. Retrieved from
Centers for Disease Control and Prevention. (2011). Strategies to prevent obesity and other chronic diseases: The CDC guide to strategies to increase physical activity in the community. Atlanta, GA: U.S. Department of Health and Human Services.
Chaddha A., Jackson E. A., Richardson C. R., & Franklin B. A. (2017). Technology to help promote physical activity. American Journal of Cardiology, 119, 149–152.
Cooper K. H., Greenberg J. D., Castelli D. M., Barton M., Martin S. B., & Morrow J. R. Jr. (2016). Implementing policies to enhance physical education and physical activity in schools. Research Quarterly for Exercise and Sport, 87(2), 133–140.
Council on Sports Medicine and Fitness and Council on School Health. (2006). Active healthy living: Prevention of childhood obesity through increased physical activity. Pediatrics, 117, 1834–1842.
de Onis M., Blössner M., Borghi E. (2010). Global prevalence and trends of overweight and obesity among preschool children. American Journal of Clinical Nutrition, 92, 1257–1264.
Faber L., Kulinna P., & Darst P. (2007). Strategies for physical activity promotion beyond the physical education classroom. Journal of Physical Education, Recreation, and Dance, 78, 27–31.
Hill G., & Turner L. B. (2007). A checklist to promote physical activity and fitness in K-12 physical education programs. Journal of Physical Education, Recreation, and Dance, 78(14–16), 36–37.
Krakow E. (2011). Parenting series—Physical activity and play in early childhood; setting the stage for lifelong healthy habits. In Encyclopedia on early childhood development (pp. 1–4). Montreal, Canada: Centre of Excellence for Earl Childhood Development.
Lee S. T., Wong J. E., Shanita S. N., Ismail M. N., Deurenberg P., & Poh B. K. (2015). Daily physical activity and screen time, but not other sedentary activities, are associated with measures of obesity during childhood. International Journal of Environmental Research and Public Health, 12, 146–161.
Maibach E. (2007). The influence of the media environment on physical activity: Looking for the big picture. American Journal of Health Promotion, 21(4, Suppl.), 352–362.
National Physical Activity Plan Alliance. (2016). The 2016 United States report card on physical activity for children and youth. Retrieved from November 2017
National Survey of Children's Health. (2016). Child and adolescent health measurement initiated data resource center on child and adolescent health website. Retrieved from
O'Malley G., & Thivel D. (2015). Physical activity and play in children who are obese. In Frelut M. L. (Ed.), The ECOG's eBook on child and adolescent obesity. Retrieved from
Orlowski M., Lorson K., Lyon A., & Minoughan S. (2013). My classroom physical activity pyramid: A tool for integrating movement into the classroom. The Journal of Physical Education and Recreation, 84(9), 47–51.
Ridgers N. D., McNarry M. A., & Mackintosh K. A. (2016). Feasibility and effectiveness of using wearable activity trackers in youth: A systematic review. JMIR mHealth uHealth, 4(4), e129.
Varghese T., Schultz W. M., McCue A. A., Lambert C. T., Sandesara P. B., Eapen D. J., … Sperling L. S. (2016). Physical activity in the prevention of coronary heart disease: Implications for the clinician. Heart, 102, 904–909.
Witherspoon L. (2013). Exergaming. Retrieved from
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