Exercise and Children's Health

A Little Counseling Can Pay Lasting Dividends

Regular exercise is an important health maintenance strategy for children and adolescents. It facilitates weight control; helps strengthen bones, and can reduce cardiovascular risk factors. Mental health may also benefit. An active childhood may also lay the groundwork for a lifetime of fitness. Physicians are in an important position to assess children's weight status and activity levels during a routine physical exam. And, with some simple recommendations to children and parents, they can play a key role in helping young patients find and maintain activities they enjoy, while keeping the risk of injury to a minimum.

Every child and adolescent needs exercise. It is a sound and largely risk-free investment in their present and future health.

Fewer than half of US children engage in activity sufficient for cardiovascular benefit and long-term health promotion. According to the surgeon general's report on physical activity and health, activity levels decline as children enter adolescence. These trends have not been reversed with physical education as only one third of elementary and secondary schools offer daily physical education. This decline is not without cost: A sedentary lifestyle in young people can have negative health consequences both now and later.

Weight control.
According to a recent statistical analysis nearly one fourth of children were overweight in 1991, up 20% from 1981. The relationship between physical activity and adiposity in children is complex, especially at earlier ages. But increasing physical activity while restricting calorie intake has been documented as an effective weight loss strategy.

The need for obesity interventions is clear. Overweight children are at increased risk of many health problems, including hypertension, hyperlipidemia, type 2 diabetes, growth hormone dysregulation, and respiratory and orthopedic problems.

Self-esteem and socialization frequently suffer. And that is just the beginning. Not only does obesity follow children into adulthood (40% of overweight children and 70% of overweight adolescents become obese adults) obesity in adolescence is independently associated with chronic diseases that develop in adulthood.

Bone building.
Physical activity in childhood may have lasting effects on bone development. Exercise may lower osteoporosis risk by increasing bone mineral density. Though most attention has focused on exercise in later years to reduce or restore bone loss, the skeleton appears to be most responsive to the effects of activity during the early years.

Cardiovascular protection.
While cardiovascular disease is primarily manifested in adulthood, risk factors appear much earlier in life and typically persist. Evidence links lipid and lipoprotein profiles in childhood and adolescence with the development of atherosclerotic lesions and high-normal blood pressure in young people. These conditions significantly increase the risk of essential hypertension in adulthood.

Mental health benefits.
That exercise has a beneficial effect on mental health for children as well as adults is an attractive, intuitive, and widely held notion.

Some suggest that the positive effect of exercise is limited and that exercise improves children's physical self-image but not academic or general self-worth . Sports participation has not been shown to foster moral development, which appears to depend on the specific context and conditions such as role models and leadership. Exercise can also improve the ability of young people to cope with stress.

Does Activity Follow Into Adulthood?
It would be gratifying to report that early exercise patterns continue into adulthood. One recent study compared 174 men and women who had five PE sessions per week in the 6 years of elementary school (in the early 1970s) with a control group of 720 who had less frequent PE. When surveyed in the mid 1990s, women, but not men, in the high-frequency PE group reported more frequent physical activity than controls. Men who had more frequent PE as children, however, were significantly less likely to smoke than controls (11.3% vs 30.8%).

Minimizing Injury Risk
Safety is paramount. Though exercise-related mishaps are common most injuries are minor. A prudent approach will minimise overuse injuries and more serious trauma. For example, parents should assess whether organised sports are conducted with appropriate attention to safety and injury prevention.

Times of rapid growth often increase vulnerability to certain injuries, and a temporary switch to low-impact activities can prevent injury during these times.

Children should not play when in pain or take painkillers to participate. Coaches and parents should be alert to signs that an overuse injury may be developing, such as limping on the field or rubbing of the arm after throwing.

In general, sensible precautions will minimize risk. Children should use appropriate equipment for each sport, including footwear that provides appropriate support and traction. Stretching and warm-up to minimize hamstring pulls and similar injuries should become habitual preludes to strenuous exercise. Children's bones often grow at a faster rate than adjacent muscles and tendons.

Children, like adults, should wear sunscreen when exercising outside. To avoid dehydration, to which children's smaller size makes them more vulnerable, they should be taught to drink fluids before and after exercise and during activity that lasts longer than 20 to 30 minutes--without waiting until they are thirsty. Though carbohydrate-electrolyte sports drinks may have no special merit, they may enhance voluntary drinking because of their taste or ability to induce thirst.

In sum, the lesson for physicians seems to be: Promote exercise in young patients, but do it positively and realise that activities must be individualised for each child. In light of the prevalence of sedentary behavior and its potential health consequences, a discussion of physical activity should be part of every exam. The issue deserves the same kind of attention as counseling on smoking and other aspects of health maintenance.

Exercise promotion is particularly important when working with girls or minority or low-income youth, who, for many reasons, have been shown to have more sedentary lifestyles. Children who have disabilities are generally less fit than those who are able-bodied; ironically, they probably need higher fitness levels to improve their function later in life.

No single sport or exercise regimen is uniquely beneficial for the physical or emotional well-being of children. It is far more important to find, with the help of parents, activities that will be interesting and enjoyable for the child and are appropriate to his or her age and physical abilities.

Though it is not necessary to exercise at anything approaching maximum capacity, aerobic activities are ideal. A reasonable goal, as suggested by the recent surgeon general's report on health and physical activity is 30 minutes of moderate activity on most days of the week. Greater daily activity such as walking or climbing stairs also contributes to overall fitness and well-being.

The goal (safe, enjoyable exercise) is readily attainable by virtually all youngsters.

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