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REP 18: PRESCRIBING PHYSICAL ACTIVITY AMIDST THE TIDE OF PAEDIATRIC OBESITY

Sarah Oosman

 

In 2014, Canada scored a D- for overall physical activity levels, an F for sedentary behaviours, and a D for active transportation among children. Interestingly, however, we scored B+ in the Community and Built Environment and C+ in Schools and Organized Sport Participation (Active Healthy Kids Report Card). The latter are still not great scores, but do show promise and suggest that infrastructure may not be the main challenge in addressing ‘exercise deficit disorder’.

The Big Idea

The Canadian Society for Exercise Physiology (CSEP) offers detailed physical activity and sedentary behavior guidelines for children and youth of all ages, recommending the accumulation of various amounts, intensities, and types of physical activity for different age categories. This is above and beyond the physical activity associated with activities of daily living. The Canadian Pediatric Society (CPS) also offers a position statement entitled Healthy Active Living: Physical activity guidelines for children and adolescents. Our own CPA position statement on Physical Activity for Youth and Children supports the notion that “removing barriers to physical activity in our social, physical and cultural environments…” are critical in order to nurture health promotion and healthy lifestyles among all Canadian children.

As the pediatric obesity tide rises, physical therapists must recognize these documents as a call to action and accept the challenge of committing even more time and energy to developing age-appropriate and ability-appropriate exercise programs for able-bodied children and for children living with obesity.

My Take on Things…

Obesity rates have almost tripled among young populations (age 2-17 years) in Canada since the 1980’s. The amount of time children spend being sedentary is growing while time spent engaged in physical activity is shrinking. The 2014 Physical Activity Report Card for Canada indicates only 7% of children are meeting physical activity guidelines (Healthy Active Living and Obesity Research). Canada is experiencing a childhood obesity crisis and although we have tremendous understanding of exercise, physical activity and promotion of healthy behaviours, our population continues to be challenged by our contemporary lifestyle.

What can physiotherapists do about it?

Here are some details obtained from the 2012 CSEP guidelines and CPS position statement:

Infants (<1 yr of age) should be physically active several times daily, focusing on floor-based activities and interactive play. Examples include tummy time, reaching/grasping for balls, crawling.

Toddlers (1-2 yrs) & Preschoolers (3-4 yrs) should accumulate a minimum of 180 minutesof physical activity at any intensity spread across the day. Examples include climbing stairs, moving around the home or outside, exploring their environment, dancing to music.

Children (5-11 yrs) should accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity (MVPA) daily. Activities that strengthen muscle should be encouraged at least 3 times per week. Examples include bike riding, playground activities, skating, running, swimming. Sedentary time should be limited and children should be supported to swap sedentary time with active time, and screen time should be limited to no more than 2 hours per day.

What else do we know?

We know that children do not generally engage in prolonged and sustained bouts of physical activity but rather accumulate many short, high intensity bursts of activity throughout the day. We know that free play, active transportation, and structured, organized sport all contribute to the accumulation of MVPA in a child’s day. We also know that for children who are less active or less fit to start with, we should gradually increase their frequency, intensity, time andtype of activity, just as we would with many populations living with chronic conditions. And we know that we must ensure that the ‘fun factor’ plays an integral role in prescribing physical activity to ensure prolonged interest and sustainability among our young ones.

As physical therapists, we have unique perspectives and skills for supporting and facilitating change in how we prescribe therapeutic exercise, as well as practical methods for measuring patient improvements.

We see a variety of populations and have strengths in translating our knowledge of exercise prescription from one unique population to another. So, what are our opportunities for applying this knowledge in order to support health promotion interventions for both able-bodied children and children living with obesity?

Some PTs may assess children in private practice for sports injuries, and other PTs may be part of health care teams supporting children living with conditions such as cerebral palsy, cystic fibrosis, asthma or downs syndrome. All of these provide ample opportunity for physiotherapists to engage in dialogue with children and families, and prescribe appropriate exercise based on national guidelines. There was a time when physical therapists were highly involved in managing programs like ‘Asthma Camp’, where children living with asthma would spend one week in the summer learning about their condition and how to mange it and remain as physically active as possible.

There was a time when physical therapists were highly involved in managing programs like ‘Asthma Camp’

What are we missing?

What about those other children who may not be directed to a physical therapist for a particular injury or condition? Do we have adequate reach to able-bodied or obese children for prescribing physical activity?

Many of us can likely think of physical therapists who have been involved in community-driven physical activity initiatives, but who have done this on a volunteer basis. I have a colleague who has been instrumental in developing and implementing a lifeguard program in a northern remote community. She volunteered her time (outside of her regular work responsibilities) to develop, fundraise, and implement a program that positively influenced physical activity levels among the lifeguards and the younger children in the community. Are these not the types of roles we should be advocating for as paid PT positions in health regions or community departments? Perhaps there is precedent for such positions. And if so, I would love to hear about them.

How do we bring our vast knowledge, and understanding of physical activity and sedentary behavior guidelines, behavior change models, and the sociocultural context of Canadian children and their families together to address these issues/concerns?

Should physiotherapists be in the business of setting the stage for building a healthy aging trajectory for our future populations? It just so happens that I know a retired physical therapist who is volunteering in a local elementary school to teach young children how to ride bikes – children who would not likely be learning how to ride a bike otherwise. (Look out community, we have a whole new group of active transporters ready to roll once the snow melts!) And in giving back to the community, this recently-retired-physical-therapist-grandparent is nurturing her personal mental and physical health in the process. Are these school environments another example of where we, as physical therapists, could be engaged on a larger scale?

What about having parent activities run on the sidelines of our children’s sports games? Is this another way to enhance adult involvement in physical activity while mentoring an active lifestyle for our children? Is this something that physical therapists could or should take on in the community?

Discuss

Surf’s up… where do you stand in the rising tide? I would love to hear from other physical therapists on their ideas on whether we should be championing community-driven and sport-based programs on a larger scale and how we might do so in ways that are ‘outside the box’.

Are we ready to accept the challenge of committing even more time and energy to developing age-appropriate and ability-appropriate exercise programs for able-bodied children and for children living with obesity?

Dive in using the comments box below, or via the CPA Facebook page or on Twitter (hashtag  #30Reps).

About Sarah Oosman

Sarah Oosman is a physical therapist, an assistant professor and researcher at the School of Physical Therapy, University of Saskatchewan. Sarah teaches MPT students in the areas of professional practice, health promotion and cultural competence. She is passionate about promoting health across generations and building evidence to address health inequities among Indigenous populations in culture-based ways.

@snopaddlista