Why Pediatricians Are Being Urged to Write ‘Physical Activity Prescriptions’ for Children
By Dan Gray
Pediatricians are being urged to start writing "exercise prescriptions" for the children they see in their office.
That's the recommendation of a report published Sunday by the American Academy of Pediatrics (AAP) titled Physical Activity Assessment and Counseling in Pediatric Clinical Settings.
In it, AAP officials encourage pediatricians to go beyond simply recommending that kids get exercise and take the step of actually issuing a prescription for physical activity.
"Currently, most pediatricians recommend that children get 60 minutes per day of physical activity, but this is not commonly elaborated upon or provided as a prescription," Dr. Natalie D. Muth, a co-author of the clinical report who's also a pediatrician and registered dietitian in California, told Healthline.
"Additionally, there is an important opportunity to consider physical activity as a routine part of the treatment plan for many conditions, such as ADHD," she added.
Another pediatrician interviewed by Healthline agrees with the recommendations.
"In reading through the clinical report, what they do is recommend the prescription in the first 2 years," Dr. David Fagan, vice chair of the department of pediatrics at Cohen Children's Medical Center in New Hyde Park, New York, told Healthline.
"I think the reason they are going to that extreme is to promote the idea of physical literacy to impart on a family, even at that early age, the importance of being physically active," he said.
Fagan also notes the report represents a shift toward more directly confronting the rising rates of childhood obesity.
"Previously, we've focused on healthy nutrition in combating obesity and then focusing on kind of eliminating the sedentary behaviors — gaming and things like that," he said. "But this report states that we need to be more proactive in promoting activity."
The AAP points to a few statistics in their report.
For starters, only 1 in 4 children reports getting the recommended 60 minutes of physical activity per day.
Additionally, in their 2017 Youth Risk Behavior SurveillanceTrusted Source, the Centers for Disease Control and Prevention (CDC) found that only slightly more than a quarter of teens in the U.S. are getting the recommended amount of activity per day.
In addition, 15 percent of teens said they hadn't been physically active for even a single hour of the previous week.
The AAP also reports that the average preschooler is sedentary for more than 6 hours a day, and more than 40 percent of schoolchildren spend 3 or more hours in front of a television per school day.
In 2016, the AAP rolled out new guidelines that recommended minimal screen time for young kids and zero screen time for the first 18 months of life.
"Some people may say that it's extreme or not realistic in this day and age, but the emphasis of the message there is that we want children — infants and toddlers — to be on the floor, playing with toys, and moving around from an early age," Fagan said.
"That's what we're really imparting on families: the importance of being physically literate and understanding how vital physical activity is to the development of children," he added.
Academic pressures can also prevent children from getting the physical activity they need, says Muth.
"Physical activity in the school day has been compromised by a push toward more 'academic' subjects, even though we know well that physical activity in the school day improves concentration and attention, improves academic performance, improves behavior, and helps children and adolescents adopt habits for lifelong health," she said.
How Can Families Help?
As a pediatrician, Fagan says he tries to motivate his young patients by asking them what activities they like.
Sedentary activities, such as video games and social media, are a nonstarter.
"I ask, 'Besides video games, what do you like to do?' and then offer some suggestions. You have to find something that they like," he said.
"If you tell a child or teen that they need to be on a treadmill 60 minutes a day, 3 days a week, and it's not something they like, they're not going to do it. So I think it's critical to find out what the child or teenager enjoys doing in terms of physical activity. Even going out for a walk for 15 or 20 minutes is a step in the right direction," Fagan said.
The AAP notes in their report the importance of role models when it comes to physical activity.
Muth points out that kids who grow up in active households are more likely to be active themselves. She offers some suggestions for parental role modeling.
"Parents can help kids build activity into their day, whether that's walking or biking to school when possible, taking family walks together after dinner, and helping kids get to sports or active hobbies. The key is to help kids find physical activities that they enjoy doing," she said.
With childhood obesity rates on the rise, it's more critical than ever to encourage kids to get active — and a formal prescription, rather than a recommendation, may help spur them into action.
"I think the importance of this clinical report is giving the pediatrician the tools to dive deeper, so we can offer more specific recommendations in terms of how much moderate to vigorous physical activity a child should achieve," Fagan said.
"This can be promoted through referral to community-based organizations and providing families with lists of resources in the community, whether it's parks or recreation centers," he added.
Reposted with permission from Healthline.
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Since even moderate-intensity workouts offer a slew of benefits, walking is a good choice for people looking to stay healthy.
How to Rock Your Walk<p>Walking isn't just fun and healthy. It's accessible.</p><p>"Walking is cheap," says Dr. John Paul H. Rue, a sports medicine doctor at <a href="https://mdmercy.com/" target="_blank">Mercy Medical Center in Baltimore</a>. "You can do it anywhere at any time; [it] requires little to no special equipment and has many of the same cardio benefits as running or other more intense workouts."</p><p>Want to up your walking game? Try the tips below.</p>
Use Hand Weights<p>Cardio and strength training can go hand-in-hand when you add weights to your walk.</p><p>A <a href="https://journals.lww.com/acsm-msse/Fulltext/2019/03000/Associations_of_Resistance_Exercise_with.14.aspx" target="_blank">2019 study</a> found that weight training is good for your heart, and <a href="https://www.mayoclinicproceedings.org/article/S0025-6196(17)30167-2/abstract" target="_blank">research</a> shows it reduces the risk of developing a <a href="https://www.healthline.com/health/nutrition-metabolism-disorders" target="_blank">metabolic disorder</a> by 17 percent. People with metabolic disorders have a higher chance of being diagnosed with high cholesterol, high blood pressure, and diabetes.</p><p>Rue suggests not carrying weights for your entire walk.</p><p>"Hand weights can give you an added level of energy burning, but you have to be careful with these because carrying [them] over a long period of time or while walking could actually lead to some overuse injuries," he says.</p>
Make It a Circuit<p>As another option, consider doing a circuit. First, put a pair of dumbbells on your lawn or somewhere in your home. Walk around the block once, then stop and do some bicep curls and tricep lifts before walking around the block again.</p><p>Rue recommends <a href="https://www.healthline.com/health/exercise-fitness/running-with-weights" target="_blank">avoiding ankle weights</a> during cardio workouts, as they force you to use your quadriceps rather than hamstrings. They can also cause muscle imbalance, according to the <a href="https://www.health.harvard.edu/staying-healthy/wearable-weights-how-they-can-help-or-hurt" target="_blank">Harvard Health Letter</a>.</p>
Find a Fitness Trail<p>Strength training isn't limited to weights. You can get stronger by <a href="https://www.healthline.com/health/bodyweight-workout" target="_blank">simply using your body</a>.</p><p>Often found at parks, fitness trails are obstacle courses with equipment for pullups, pushups, rowing, and stretches to build upper and lower body strength.</p><p>Try searching "fitness trails near me" online, checking out your local parks and recreation website, or calling the municipal office to <a href="https://calisthenics-parks.com/" target="_blank">find one</a>.</p>
Recruit a Friend<p>People who workout together stay healthy together.</p><p><a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-017-0584-3" target="_blank">One study</a> showed that older adults who exercised with a group improved or maintained their functional health and enjoyed their lives more.</p><p>Enlist the help of a walking buddy with a regimen you aspire to have. If you don't know anyone in your area, apps like <a href="https://www.strava.com/" target="_blank">Strava</a> have social networking features so you can get support from fellow exercisers.</p>
Try Meditation<p>According to the <a href="https://www.nccih.nih.gov/research/statistics/nhis/2017" target="_blank">2017 National Health Interview Survey</a>, published by the National Institutes of Health, meditation is on the rise, and for good reason.</p><p>Researchers <a href="https://pubmed.ncbi.nlm.nih.gov/29616846/" target="_blank">found</a> that mind-body relaxation practices can regulate inflammation, <a href="https://www.healthline.com/health/biological-rhythms" target="_blank">circadian rhythms</a>, and <a href="https://www.healthline.com/health/glucose" target="_blank">glucose</a> metabolism, as well as lower <a href="https://www.healthline.com/health/high-blood-pressure-hypertension" target="_blank">blood pressure</a>.</p><p>"Any form of exercise can be turned into a meditation of some type, either by the surroundings you are walking in, like a park or trail, or by blocking out the outside world with music on your headphones," Rue says.</p><p>You can also play a podcast or download an app like <a href="https://www.headspace.com/headspace-meditation-app" target="_blank">Headspace</a> that has a library of guided meditations to practice while you walk.</p>
Do Fartlek Walks<p>Typically used in running, fartlek intervals alternate periods of increased and decreased speed. These are <a href="https://www.healthline.com/nutrition/benefits-of-hiit" target="_blank">high-intensity interval training (HIIT)</a> workouts, which allow exercisers to accomplish more in less time.</p><p><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0154075" target="_blank">One study</a> showed that 10-minute interval training improved <a href="https://www.healthline.com/health/metabolic-syndrome" target="_blank">cardiometabolic</a> health, or lowered the risk of heart disease, stroke, and diabetes, just as well as working out at a continuous pace for 50 minutes.</p><p><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0111489" target="_blank">Research</a> also shows that HIIT workouts increase muscle <a href="https://www.healthline.com/health/fast-twitch-muscles" target="_blank">oxidative</a> capacity, or the ability to use oxygen. To do a fartlek walk, try walking at an increased pace for 3 minutes, slow down for 2 minutes, and repeat.</p>
Gradually Increase Pace<p>A faster walking pace is associated with a lower risk of <a href="https://www.healthline.com/health/copd" target="_blank">chronic obstructive pulmonary disease (COPD)</a> and respiratory diseases, according to a <a href="https://pubmed.ncbi.nlm.nih.gov/30303933/" target="_blank">2019 study</a>.</p><p>Still, it's best not to go from a stroll to an Olympic-worthy power walk in a day. Instead, increase your pace gradually to prevent injury.</p><p>"Start by walking at a brisk pace for about 10 minutes per day, 3 to 5 days per week," Rue says. "Once you've done this for a few weeks, increase your time by 5 to 10 minutes per day until you get to 30 minutes."</p>
Add Stairs<p>You've likely heard that taking the stairs instead of an elevator is a way to add more movement into your daily routine. It's also a way to step up your walking. Stair climbing has been shown to <a href="https://www.sciencedirect.com/science/article/pii/S2211335519301123?via%3Dihub" target="_blank">decrease the risk of mortality</a> and can easily add a bit more challenge to your walk.</p><p>If you don't have stairs in your home, you can often find them outside a local municipal building, train station, or at a high school stadium.</p>
Is Your Walk a True Cardio Workout?<p>Not all walks are equal. A walk that's too leisurely may not provide enough burn to qualify as cardio. To see if you're getting a good workout, try to <a href="https://www.healthline.com/health/how-to-check-heart-rate" target="_blank">measure your heart rate</a> using a monitor.</p><p>"A target goal for a good walking workout heart rate is about 50 to 70 percent of your maximum heart rate," Rue says, adding that maximum heart rate is <a href="https://www.healthline.com/health/fitness-exercise/fat-burning-heart-rate" target="_blank">typically calculated</a> by 220 beats per minute minus your age.</p><p>You can also monitor how easily you can carry on a conversation while you walk to gauge your heart rate.</p><p>"If you can walk and carry on a normal conversation, that's probably a lower intensity walk," says Rue. "If you are slightly breathless but can still have a conversation, that's probably a moderate workout. If you are out of breath and can't talk normally, that's a vigorous workout."</p>
Takeaway<p>By shaking up your routine, you can add excitement to your workout and reap even more rewards than a basic walk provides. Increasing the pace and intensity of a workout will make it more effective.</p><p>Simply pick your favorite variation to add some spice to your next walk.</p>
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