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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By Jacob L. Steenwyk and Antonis Rokas
From the mythical minotaur to the mule, creatures created from merging two or more distinct organisms – hybrids – have played defining roles in human history and culture. However, not all hybrids are as fantastic as the minotaur or as dependable as the mule; in fact, some of them cause human diseases.
When Looking Through a Microscope Isn’t Close Enough.<p>For the last few years, <a href="http://www.rokaslab.org/" target="_blank">our team at Vanderbilt University</a>, <a href="https://www.researchgate.net/lab/Gustavo-Goldman-Lab" target="_blank">Gustavo Goldman's team at São Paulo University in Brazil</a> and many other collaborators around the world have been collecting samples of fungi from patients infected with different species of <em>Aspergillus</em> molds. One of the species we are particularly interested in is <a href="https://doi.org/10.1006/rwgn.2001.0082" target="_blank"><em>Aspergillus nidulans</em>, a relatively common and generally harmless fungus</a>. Clinical laboratories typically identify the species of <em>Aspergillus</em> causing the infection by examining cultures of the fungi under the microscope. The problem with this approach is that very closely related species of <em>Aspergillus</em> tend to look very similar in their broad morphology or physical appearance when viewing them through a microscope.</p><p>Interested in examining the varying abilities of different <em>A. nidulans</em> strains to cause disease, we decided to analyze their total genetic content, or genomes. What we saw came as a total surprise. We had not collected <em>A. nidulans</em> but <em>Aspergillus latus</em>, a close relative of <em>A. nidulans</em> and, as we were to soon find out, <a href="https://doi.org/10.1016/j.cub.2020.04.071" target="_blank">a hybrid species that evolved through the fusion of the genomes</a> of two other <em>Aspergillus</em> species: <em>Aspergillus spinulosporus</em> and an unknown close relative of <em>Aspergillus quadrilineatus</em>. Thus, we realized not only that these patients harbored infections from an entirely different species than we thought they were, but also that this species was the first ever <em>Aspergillus</em> hybrid known to cause human infections.</p>
Several Different Fungal Hybrids Cause Human Disease.<p>Hybrid fungi that can cause infections in humans are well known to occur in several different lineages of single-celled fungi known as yeasts. Notable examples include multiple different species of <a href="https://doi.org/10.1002/yea.3242" target="_blank">yeast hybrids</a> that cause the human diseases <a href="https://rarediseases.info.nih.gov/diseases/6218/cryptococcosis" target="_blank">cryptococcosis</a> and <a href="https://www.cdc.gov/fungal/diseases/candidiasis/index.html" target="_blank">candidiasis</a>. Although pathogenic yeast hybrids are well known, our discovery that the <em>A. latus</em> pathogen is a hybrid is a first for molds that cause disease in humans.</p>
(Left) Candida yeasts live on parts of the human body. Imbalance of microbes on the body can allow these yeasts, some of which are hybrids, to grow and cause infection. (Right) Cryptococcus yeasts, including ones that are hybrids, can cause life-threatening infections in primarily immunocompromised people. Centers for Disease Control and Prevention<p><a href="https://doi.org/10.1371/journal.ppat.1008315" target="_blank">Why certain <em>Aspergillus</em> species are so deadly</a> while others are harmless remains unknown. This may in part be because <a href="https://doi.org/10.1016/j.fbr.2007.02.007" target="_blank">combinations of traits, rather than individual traits</a>, underlie organisms' ability to cause disease. So why then are hybrids frequently associated with human disease? Hybrids inherit genetic material from both parents, which may result in new combinations of traits. This may make them more similar to one parent in some of their characteristics, reflect both parents in others or may differ from both in the rest. It is precisely this mix and match of traits that hybrids have inherited from their parental species that <a href="https://www.nytimes.com/2010/09/14/science/14creatures.html" target="_blank">facilitates their evolutionary success</a>, including their ability to cause disease.</p>
The Evolutionary Origin of an Aspergillus Hybrid.<p>Multiple evolutionary paths can lead to the emergence of hybrids. One path is through mating, just as the horse and donkey mate to create a mule. Another path is through the merging or fusion of genetic material from cells of different species.</p><p>It is this second path that appears to have been taken by our fungus. <em>A. latus</em> appears to have two of almost everything compared to its parental species: twice the genome size, twice the total number of genes and so on. But unlike other hybrids, which are often sterile like the mule, we found that <em>A. latus</em> is capable of reproducing both asexually and sexually.</p><p>But how distinct were the parents of <em>A. latus</em>? By comparing the parts contributed by each parent in the <em>A. latus</em> genome, we estimate that its parents are approximately 93% genetically similar, which is about as related as we humans are with lemurs. In other words, <em>A. latus</em>, an agent of infectious disease, is the fungal equivalent of a human-lemur hybrid.</p>
How A. Latus Differs From its Parents.<p>Elucidating the identity of closely related fungal pathogens and how they differ from each other in infection-relevant characteristics is a key step toward reducing the burden of fungal disease. For example, we found that <em>A. latus</em> was three times more resistant than <em>A. nidulans</em>, the species it was originally identified as using microscopy-based methods, to one of the most common antifungal drugs, <a href="https://www.drugbank.ca/drugs/DB00520" target="_blank">caspofungin</a>. This result provides a clear example of the potential importance of accurate identification of the <em>Aspergillus</em> pathogen causing an infection.</p><p>We also examined how <em>A. latus</em> and <em>A. nidulans</em> interact with cells from our immune system. We found that immune cells were less efficient at combating <em>A. latus</em> compared to <em>A. nidulans</em>, suggesting the hybrid fungus may be trickier for our immune systems to identify and destroy.</p><p>In the midst of the COVID-19 pandemic, our quest to understand <em>Aspergillus</em> pathogens is becoming more urgent. Growing evidence suggests that <a href="https://doi.org/10.1111/myc.13096" target="_blank">a fraction of COVID-19 patients are also infected with <em>Aspergillus</em>.</a> More worrying is that these <a href="https://doi.org/10.3201/eid2607.201603" target="_blank">secondary <em>Aspergillus</em> infections</a> can worsen the clinical outcomes for those infected with the novel coronavirus. That being said, we stress that little is known about <em>Aspergillus</em> infections in COVID-19 patients due to a lack of systematic testing, and none of the infections identified so far appear to have been caused by hybrids.</p><p>So, when it comes to hybrids, some are fantastic (the minotaur), some are helpful (the mule) and some are dangerous (<em>Aspergillus latus</em>). Understanding more about the biology of <em>Aspergillus latus</em> may help in our understanding of how microbial pathogens arise and how to best prevent and combat their infections.</p>
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