Healthy active living: Physical activity guidelines for children and adolescents

Question 1

What is the WHO definition of health?

Answer 1

a state of complete physical, mental and social well-being and not merely as the absence of disease or infirmity

Question 2

How does Health Canada describe “healthy living”?

Answer 2

making choices that enhance physical, mental, social and spiritual health

Question 3

What percentage of children 2-17yo are overweight or obese?

Answer 3

26%

41% of Aboriginals

Question 4

What are some health consequences of childhood obesity?

Answer 4

1. Insulin resistance
2. Type 2 diabetes
3. Dyslipidemia
4. Hypertension
5. OSA
6. NASH
7. Poor self-esteem
8. Lower health-related quality of life

Question 5

What are some causes of obesity?

Answer 5

1. Excessive caloric intake
2. Sedentary behavior patterns
3. Inadequate physical activity
4. Lack of exercise

Question 6

What is the definition of sedentary behavior?

Answer 6

Behaviours associated with low energy expenditure, such as prolonged sitting or lounging in transit or at work, home or leisure

Question 7

What is the definition of physical activity?

Answer 7

Any body movement that works muscles using more than resting energy

Question 8

What is the definition of exercise?

Answer 8

Planned, structured and repetitive PA to condition any part of the body

Question 9

What is aerobic exercise?

Answer 9

Moderate-to-vigorous activity which increases heart rate and sweat production and improves cardiovascular endurance.

Question 10

What is the benefit of flexibility?

Answer 10

Increases muscle/joint range of motion.

Question 11

What is the benefit of anaerobic exercise?

Answer 11

Weight training, improves muscle strength

Question 12

What is the benefit of high impact weight-bearing exercise?

Answer 12

Promotes bone health

Question 13

What factors can reduce physical activity?

Answer 13

1. Older children
2. Female
3. Aboriginal
4. “Over-scheduled”
5. Disability
6. Living in public housing
7. Extremes of climate
8. Heavy climate
9. Local crime rates
10. Lack of green space
11. Urban sprawl

Question 14

What percentage of young Canadians actively commute?

Answer 14

24%

Question 15

What are the benefits of aerobic physical activity?

Answer 15

1. Reduce weight
2. Reduce visceral/SC abdominal fat
3. Reduce systemic BP
4. Improved early markers of atherosclerosis
5. Improved insulin resistance
6. Improved type 2 diabetes
7. Improved NAFLD
8. Improved sleep disordered breathing
9. Improved cardiorespiratory breathing

Question 16

What are the recommendations regarding screen time?

Answer 16

None in children <2yo

<1h/day in children 2-4yo

<2h/day in children 5-17yo

Question 17

What are the recommendations for sedentary behaviors?

Answer 17

Caregivers should minimize the time children <4yo spend being sedentary during waking hours including prolonged sitting or being restrained for >1h at a time

Limit sedentary transport, extended sitting time, and time spent indoors during the day

Question 18

What are the recommendations re: physical activity?

Answer 18

1. Infants <1yo: physically active several times per day particularly through interactive floor-based play
2. Toddlers (1-2yo) & pre-schoolers (3-4yo): at least 180m of physical activity of any intensity spread throughout the day, including:
   a) a variety of activities
   b) activities that develop movement skills
   c) progression toward at least 60min of energetic play by 5yo
3. Children (5-11yo) and youth (12-17yo) at least 60min of mod-to-vigorous intensity physical activity daily, including:
   a) vigorous-intensity activities at least 3 days/week
   b) activities that strengthen muscle and bone at least 3 days/week

Question 19

What are recommendations regarding strength training?

Answer 19

1. > 9yo
2. Well-supervised
3. Use small free weights w/ high repetitions (15-20)
4. Demonstrate proper techniques
5. Avoid heavier weights
6. Avoid maximum lifts

Question 20

What are strategies to reduce sedentary activities?

Answer 20

1. Remove TV and computers from the bedroom
2. Avoid eating in front of the TV
3. Replace screen time with physical activity
4. Avoid sitting for prolonged periods of time
5. Increase active transportation
6. Families should engage in games promoting physical activity rather than computer games
7. Engage families to mentor young children so they can develop suitable physical activity skills

Question 21

What are strategies to increase physical activity?

Answer 21

1. Create individual physical activity Rx
2. Post photos or posters demonstrating families eating together without TV and children involved in active play/dancing during TV shows
3. Determine child/adolescent access to free play, sports, and high quality school PE. Provide current information about local activities for families, community events, or recreational programs
4. Increase incidental movement: take breaks from sedentary activities, avoid sitting for prolonged periods, walk throughout the day, take the stairs
5. Provide educational information in waiting rooms
6. Encourage inviting an older child to motivate a younger one to adopt recreational PA or sport

Question 22

What are strategies to overcome lack of time?

Answer 22

1. Build activity into each day – active transportation
2. Take the stairs
3. Get off bus a stop early
4. Take PE in school
5. Play active games with friends

Question 23

What are strategies for overcoming dislike of sports/lack of sport specific skills?

Answer 23

1. Dance, swim, walk or hike with a friend or pet

2. Increase active hobbies/transportation

Question 24

What are strategies for overcoming an unsafe neighbourhood?

Answer 24

1. Dance to music or do a workout video at home
2. Join the community recreation centre
3. Participate in PE at school
4. Take an after-school activity

Question 25

What are strategies for overcoming being out of shape?

Answer 25

Start slow - 10 min

Question 26

What are advocacy strategies for healthy active living at the federal level?

Answer 26

1. Mandate socially responsible media to promote PA and reduce inactivity 2. Modify the 2007 Children’s Fitness Tax Credit to benefit families living in poverty 3. Continue to provide provincial and municipal funding for sport infrastructure 4. Continue to provide provincial and municipal funding for active transportation projects 5. Continue to provide 100% GST rebate for municipality infrastructure HAL-promoting projects 6. Fund robust PA monitoring and surveillance systems 7. Fund revisions of early years, child and youth PA guidelines and resources 8. Create new guidelines/guides for children with special health care needs 9. Support ParticipACTION free of commercial bias 10. Maintain Joint Consortium for School Health 11. Develop and fund suitable PA promotion strategies for First Nations, Inuit and Métis children and youth 12. Provide sufficient funding for population-based PA- and obesity prevention-related research

Question 27

What are advocacy strategies for healthy active living at the provincial level?

Answer 27

1. Enhance access to recreational facilities during school hours 2. Enhance access to school gyms after hours 3. Promote PA before, during and after school 4. Mandate quality daily PE led by qualified teachers in all schools (kindergarten-grade12) 5. Implement PE curriculums that emphasize developing knowledge, attitudes, motor and behavioural skills required for healthy active lifestyles 6. Offer PE classes for everyone, regardless of ability, illness, injury, and developmental disability 7. Plan adequate resources for program funding, trained PE personnel, safe equipment, and facilities 8. Ensure safe sport and recreational facilities 9. Promote active transportation

Question 28

How can physicians and HCP promote HAL?

Answer 28

1. Documenting the number of hours/day spent on sedentary activities by families. 2. Discouraging the use of screen-based activities for children under two years of age; limiting recreational screen time to <1 h/day for children two to four years of age, and to ≤2 h/day for older children. HCP should discuss these recommendations with families. 3. Counselling families to become more active by finding alternatives to sedentary (ie, motorized) transport, and by limiting time spent simply sitting or being indoors throughout the day. 4. Encouraging families to keep television sets, video games, cell phones and computers out of childrens bedrooms. 5. Identifying barriers to the adoption of PA as part of family routine. 6. Determining sources of PA for family members at regular health care visits, and promoting PA at every well-child or adolescent visit. 7. Advising parents and caregivers that preschoolers should have an accumulated 180 min/day of PA at varying intensities, and that older children and adolescents should be accumulating at least 60 min/day of moderate-to-vigorous-intensity PA. These goals should include vigorous-intensity activities at least three days/week and activities that strengthen muscle and bone at least three days/week. More information can be derived from the Canadian Physical Activity Guidelines. 8. Helping parents to become more active role models by building on PA that family members of all ages and abilities can do together as a family routine. 9. Using anticipatory guidance to ensure that children play outside safely, with appropriate protective equipment (eg, bicycle helmets, personal flotation devices). 10. Advising parents to support their child’s preferences in sport and recreational activities, provided that they are safe and appropriate to the child’s age and developmental stage. 11. Encouraging older students to become HAL role models and leaders for younger schoolmates. 12. Being active role models themselves. 13. Calculating and plotting BMI trajectories and identifying obesity-related co-morbidities at every well-child or adolescent visit.

Question 29

What should clinicians and their professional organizations advocate for?

Answer 29

1. Regular revisions of the Canadian Physical Activity Guidelines for children and youth, to reflect current, evidence-based recommendations. 2. Creating Canadian Physical Activity Guidelines for Aboriginal children and youth, and for young people with special health care needs. 3. Developing and funding strategies to promote PA specific to First Nations, Inuit and Métis children and youth – in collaboration with Aboriginal groups. 4. Social marketing to promote PA involvement and participation. 5. The elimination of television advertising that promotes fast food, unhealthy foods and sedentary behaviour during children’s programming. 6. Establishing a school wellness council, on which local physician representation is encouraged. 7. A school curriculum teaching students the health benefits of regular PA. 8. Compulsory, quality, daily PE classes in schools (kindergarten through grade 12) taught by qualified, trained teachers. Also, the provision of a variety of school-related PA in addition to PE, including the protection of childrens’ recess time and extracurricular PA programs and non-structured PA before, during and after school hours. 9. Accessible community sport/recreation programs where school gyms or local facilities are open before and after regular hours and PA opportunities are available to all children and youth at low or no cost. 10. Safe recreational facilities, parks, playgrounds, bicycle paths, sidewalks and crosswalks. 11. Funding quality research on the promotion of healthy active living.