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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


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    1. 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

    2. Physical Activity Basics Eric Small, MD, FAAP Family Sports Medicine & Fitness Mount Kisco, NY email: sportsdr@yahoo.com website: www.sportsdoc4kids.com

    3. Outline • Exercise Background • Research Studies • Specific exercise • Recommendations for the pediatrician

    4. Case Scenarios • 12 yo who plays sports • 8 year old loves tv, internet • 15 year old morbidly obese

    5. Why kids exercise • It’s fun • To be with friends • To improve skills (NASPE/SGMA)

    6. Why adults exercise • Lower blood pressure/cv risk • To fit in bikini/bathing suit • Better clothes • Wedding Dress

    7. Why kids quit exercise • It ceases to be fun • It becomes too competitive • Don’t get enough playing time

    8. At Risk Population • Inner City/Minority/Single Family • Lower Socioeconomic • Neuromuscular Disease (CP, spina bifida) • Depression • Divorce

    9. Physical Fitness • Aerobic=Cardiovascular Health, Endurance • Flexibility • Muscle Strength • Anaerobic • Body Composition • Balance • Agility

    10. 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

    11. TV VIEWING AND RESTING ENERGY EXPENDITURE IN 8 - 12 yrs OLD CHILDREN Energy Eexpenditure (Klesges et al., Pediatrics, 1993)

    12. POSSIBLE CAUSES FOR HYPOACTIVITY IN THE OBESE CHILD PARENTS LESS ACTIVE HIGH PERCEIVEDEFFORT • SHAME (“UGLY” BODY) TEASING HYPOACTIVITY LOW FITNESS INCREASED OBESITY

    13. ENERGY COST OF LOCOMOTION IS EXCESSIVE IN THE OBESE (Maffeis et al., 1993)

    14. RATING OF PERCEIVED EXERTON: OBESE vs NON-OBESE ADOLESCENTS (Ward et al., 1986)

    15. EFFECT OF AEROBIC TRAINING ON VISCERAL AND SUBCUTANEOUS ABDOMINAL FAT IN 7- TO 11-YR-OLD CHILDREN (Gutin & Owens, Med Sci Spor Exer 1999)

    16. 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

    17. The Biggest Effect is changes in Lifestyle

    18. TO WHAT EXTENT DOESENHANCED PA INCREASETOTAL ENERGY EXPENDITUREIN OBESE CHILDREN ?

    19. 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

    20. 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 ?

    21. STUDY DESIGN - THREE CONSECUTIVE WEEKS - THREE OBSERVATION DAYS EACH WEEK - LAB VISIT ON THE SECOND OBSERV. DAY INTENSE MILD PLACEBO

    22. 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

    23. TWO-YEAR CHANGES IN OVERWEIGHT: COMPARING THREE ACTIVITY PROGRAMS (Epstein et al., Behavior Ther. 1985) Calisthenics Aerobic “Lifestyle” calisthenics

    24. 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”

    25. COMMONLY QUOTED GUIDELINES FOR PHYSICAL ACTIVITY

    26. 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!!!

    27. Motivation for losing weight • To look better • To fit into better clothes • To be better in sports

    28. Motivation • Rate 1 to 10 motivation to change lifestyle • Rate 1 to 10 supportiveness of parent(s) • Whose idea to come today

    29. Exercise Recommendations • Choose activities that are fun • Choose activities that use large muscle groups • Emphasize the positives not negatives • Family activities

    30. Specific exercise • Water Activities • Weighttraining • Strength sports

    31. Water Activities • Overweight are more buoyant • Fat keeps heat in • Easier movement • ‘Ugly’ body submerged

    32. Weighttraining • Appropriate supervision • No maximal lifts • Low weights/high repetitions • Link with other activities • (AAP COMSF, Ped, 2001)

    33. Strength Sports • Football • Wrestling • Rugby • Field Sports (javelin, hammer, discus)

    34. How to do a work-out • 5-10 minute warm-up • 2-5 minutes of stretching • The work-out • Cool down and stretching

    35. 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

    36. Measurements in Office • Baseline heart rate • Heart rate at submaximal exercise • Recovery heart rate

    37. How to measure success • Weight loss • Decrease in BMI • Improvement in fitness parameters • Positive Change in lifestyle

    38. Specific Sports • Baseball • Hockey • Football • Swimming

    39. 12 year old who plays sports • Jog forwards, backwards, sideways • Box drill • Obstacle course

    40. 8 year old-totally sedentary • Find activity that he/she likes (rollerblading, walking, biking, hiking) • Family activity on weekend

    41. 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)

    42. 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

    43. Being creative • Physical/Occupational therapy • College/Graduate students • Physical therapy students • Involve the school

    44. 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)

    45. Key points • Reeevaluate reward system • Education/Advocacy • Family outing • Winter/summer activities

    46. Summary • Have Fun!!! • Use common sense. • Be flexible.

    47. Thank you and good luck!!!