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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. Physical Activity Basics.

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physical activity basics

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

physical activity basics2

Physical Activity Basics

Eric Small, MD, FAAP

Family Sports Medicine & Fitness

Mount Kisco, NY

email: [email protected]

website: www.sportsdoc4kids.com

outline
Outline
  • Exercise Background
  • Research Studies
  • Specific exercise
  • Recommendations for the pediatrician
case scenarios
Case Scenarios
  • 12 yo who plays sports
  • 8 year old loves tv, internet
  • 15 year old morbidly obese
why kids exercise
Why kids exercise
  • It’s fun
  • To be with friends
  • To improve skills

(NASPE/SGMA)

why adults exercise
Why adults exercise
  • Lower blood pressure/cv risk
  • To fit in bikini/bathing suit
  • Better clothes
  • Wedding Dress
why kids quit exercise
Why kids quit exercise
  • It ceases to be fun
  • It becomes too competitive
  • Don’t get enough playing time
at risk population
At Risk Population
  • Inner City/Minority/Single Family
  • Lower Socioeconomic
  • Neuromuscular Disease (CP, spina bifida)
  • Depression
  • Divorce
physical fitness
Physical Fitness
  • Aerobic=Cardiovascular Health, Endurance
  • Flexibility
  • Muscle Strength
  • Anaerobic
  • Body Composition
  • Balance
  • Agility
slide10

PEER-REVIEWED ARTICLES

“0BESITY + CHILDREN + EXERCISE”

104

100 -

80 -

60 -

40 -

20 -

0

ARTICLES PER YEAR

20

4

65-69 70-74 75-79 80-84 85-89 90-94 95-99 00-02

Y E A R S

slide11

TV VIEWING AND RESTING ENERGY EXPENDITURE IN 8 - 12 yrs OLD CHILDREN

Energy Eexpenditure

(Klesges et al., Pediatrics, 1993)

slide12

POSSIBLE CAUSES FOR HYPOACTIVITY

IN THE OBESE CHILD

PARENTS LESS ACTIVE

HIGH PERCEIVEDEFFORT

  • SHAME (“UGLY” BODY)

TEASING

HYPOACTIVITY

LOW FITNESS

INCREASED OBESITY

slide13

ENERGY COST OF LOCOMOTION

IS EXCESSIVE IN THE OBESE

(Maffeis et al., 1993)

slide14

RATING OF PERCEIVED EXERTON:

OBESE vs NON-OBESE ADOLESCENTS

(Ward et al., 1986)

slide15

EFFECT OF AEROBIC TRAINING

ON VISCERAL AND SUBCUTANEOUS

ABDOMINAL FAT IN 7- TO 11-YR-OLD CHILDREN

(Gutin & Owens, Med Sci Spor Exer 1999)

effects other than on body composition
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

slide19

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

slide20

EFFECT OF A SINGLE EXERCISE SESSIONON SPONTANEOUS ACTIVITY OF OBESE CHILDREN(Kriemler et al., Pediatr. Res., 1999)

QUESTION:

WILL LABORATORY - BASED EXERCISE AFFECT THE CHILD’S ACTIVITY

ON THE NEXT DAY ?

slide21

STUDY DESIGN

- THREE CONSECUTIVE WEEKS

- THREE OBSERVATION DAYS EACH WEEK

- LAB VISIT ON THE SECOND OBSERV. DAY

INTENSE

MILD

PLACEBO

slide22

MODERATE EXERCISE INCREASES

NEXT DAY’S ENERGY EXPENDITURE

(Kriemler et al., Pediatr. Res., 1999)

700 -

-

600 -

-

500 -

ENERGY EXPENDITURE, kJoule h-1

PRE- EXERC. POST-

DAY DAY DAY

slide23

TWO-YEAR CHANGES IN OVERWEIGHT:

COMPARING THREE ACTIVITY PROGRAMS

(Epstein et al., Behavior Ther. 1985)

Calisthenics

Aerobic

“Lifestyle”

calisthenics

how to determine enough physical activity
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”
slide25

COMMONLY QUOTED GUIDELINES

FOR PHYSICAL ACTIVITY

summary of guidelines
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!!!

motivation for losing weight
Motivation for losing weight
  • To look better
  • To fit into better clothes
  • To be better in sports
motivation
Motivation
  • Rate 1 to 10 motivation to change lifestyle
  • Rate 1 to 10 supportiveness of parent(s)
  • Whose idea to come today
exercise recommendations
Exercise Recommendations
  • Choose activities that are fun
  • Choose activities that use large muscle groups
  • Emphasize the positives not negatives
  • Family activities
specific exercise
Specific exercise
  • Water Activities
  • Weighttraining
  • Strength sports
water activities
Water Activities
  • Overweight are more buoyant
  • Fat keeps heat in
  • Easier movement
  • ‘Ugly’ body submerged
weighttraining
Weighttraining
  • Appropriate supervision
  • No maximal lifts
  • Low weights/high repetitions
  • Link with other activities
  • (AAP COMSF, Ped, 2001)
strength sports
Strength Sports
  • Football
  • Wrestling
  • Rugby
  • Field Sports (javelin, hammer, discus)
how to do a work out
How to do a work-out
  • 5-10 minute warm-up
  • 2-5 minutes of stretching
  • The work-out
  • Cool down and stretching
top ten exercises
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
measurements in office
Measurements in Office
  • Baseline heart rate
  • Heart rate at submaximal exercise
  • Recovery heart rate
how to measure success
How to measure success
  • Weight loss
  • Decrease in BMI
  • Improvement in fitness parameters
  • Positive Change in lifestyle
specific sports
Specific Sports
  • Baseball
  • Hockey
  • Football
  • Swimming
12 year old who plays sports
12 year old who plays sports
  • Jog forwards, backwards, sideways
  • Box drill
  • Obstacle course
8 year old totally sedentary
8 year old-totally sedentary
  • Find activity that he/she likes (rollerblading, walking, biking, hiking)
  • Family activity on weekend
15 year old morbid obese
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)
common sense approach to activity
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
being creative
Being creative
  • Physical/Occupational therapy
  • College/Graduate students
  • Physical therapy students
  • Involve the school
thinking outside the box
Thinking outside the box
  • Family Exercise night
  • Exercise night at doctor’s office
  • Weekly/monthly/quarterly exercise planning
  • Rewarding children with exercise not food or television (amusement park, minigolf, hike)
key points
Key points
  • Reeevaluate reward system
  • Education/Advocacy
  • Family outing
  • Winter/summer activities
summary
Summary
  • Have Fun!!!
  • Use common sense.
  • Be flexible.
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