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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 l.jpg

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: [email protected]

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

  • It’s 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

  • Don’t 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

  • Aerobic=Cardiovascular 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

4

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 yrs OLD CHILDREN

IN THE OBESE CHILD

PARENTS LESS ACTIVE

HIGH PERCEIVEDEFFORT

  • SHAME (“UGLY” BODY)

TEASING

HYPOACTIVITY

LOW FITNESS

INCREASED OBESITY


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ENERGY COST OF LOCOMOTION yrs OLD CHILDREN

IS EXCESSIVE IN THE OBESE

(Maffeis et al., 1993)


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RATING OF PERCEIVED EXERTON: yrs OLD CHILDREN

OBESE vs NON-OBESE ADOLESCENTS

(Ward et al., 1986)


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EFFECT OF AEROBIC TRAINING yrs OLD CHILDREN

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 yrs OLD CHILDRENOTHER 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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TO WHAT EXTENT DOES yrs OLD CHILDRENENHANCED PA INCREASETOTAL ENERGY EXPENDITUREIN OBESE CHILDREN ?


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THE INCREASE IN TOTAL EE (TEE) yrs OLD CHILDREN

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 yrs OLD CHILDRENSINGLE 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 ?


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STUDY DESIGN yrs OLD CHILDREN

- 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 yrs OLD CHILDREN

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


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TWO-YEAR yrs OLD CHILDREN 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 ? yrs OLD CHILDREN

  • 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 yrs OLD CHILDREN

FOR PHYSICAL ACTIVITY


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Summary of Guidelines yrs OLD CHILDREN

  • 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 yrs OLD CHILDREN

  • To look better

  • To fit into better clothes

  • To be better in sports


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Motivation yrs OLD CHILDREN

  • 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 yrs OLD CHILDREN

  • 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 yrs OLD CHILDREN

  • Water Activities

  • Weighttraining

  • Strength sports


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Water Activities yrs OLD CHILDREN

  • Overweight are more buoyant

  • Fat keeps heat in

  • Easier movement

  • ‘Ugly’ body submerged


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Weighttraining yrs OLD CHILDREN

  • Appropriate supervision

  • No maximal lifts

  • Low weights/high repetitions

  • Link with other activities

  • (AAP COMSF, Ped, 2001)


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Strength Sports yrs OLD CHILDREN

  • Football

  • Wrestling

  • Rugby

  • Field Sports (javelin, hammer, discus)


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How to do a work-out yrs OLD CHILDREN

  • 5-10 minute warm-up

  • 2-5 minutes of stretching

  • The work-out

  • Cool down and stretching


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Top Ten Exercises yrs OLD CHILDREN

  • 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 yrs OLD CHILDREN

  • Baseline heart rate

  • Heart rate at submaximal exercise

  • Recovery heart rate


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How to measure success yrs OLD CHILDREN

  • Weight loss

  • Decrease in BMI

  • Improvement in fitness parameters

  • Positive Change in lifestyle


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Specific Sports yrs OLD CHILDREN

  • Baseball

  • Hockey

  • Football

  • Swimming


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12 year old who plays sports yrs OLD CHILDREN

  • Jog forwards, backwards, sideways

  • Box drill

  • Obstacle course


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8 year old-totally sedentary yrs OLD CHILDREN

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

  • Family activity on weekend


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15 year old morbid obese yrs OLD CHILDREN

  • 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 yrs OLD CHILDREN

  • 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 yrs OLD CHILDREN

  • Physical/Occupational therapy

  • College/Graduate students

  • Physical therapy students

  • Involve the school


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Thinking outside the box yrs OLD CHILDREN

  • 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)


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Key points yrs OLD CHILDREN

  • Reeevaluate reward system

  • Education/Advocacy

  • Family outing

  • Winter/summer activities


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Summary yrs OLD CHILDREN

  • Have Fun!!!

  • Use common sense.

  • Be flexible.


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Thank you and good luck!!! yrs OLD CHILDREN


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