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Healthy Active Living Where Do Our Children Stand?

Healthy Active Living Where Do Our Children Stand? . Claire LeBlanc MD, FRCP, Dip Sport Med. *Adult Canadian Perceptions of Children’s Physical Activity Levels. 80% believe PA as important as good nutrition 63 % believe children inactive (33% with children in home)

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Healthy Active Living Where Do Our Children Stand?

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  1. Healthy Active Living Where Do Our Children Stand? Claire LeBlanc MD, FRCP, Dip Sport Med

  2. *Adult Canadian Perceptions of Children’s Physical Activity Levels • 80% believe PA as important as good nutrition • 63 % believe children inactive (33% with children in home) • 63% agree too much sedentary activities • 54% believe girls = boys • 57% believe adequate opportunity at school *Physical activity and Canadian children. Environics research group. Mar 28, 2002

  3. Physical Inactivity Statistics * • Over 50% of 5-17 y.o. not active enough for optimal growth • Adolescents less active than children 2-12 years old (33% vs 43%) • Decline in activity with age and gender (girls at 14-15 yrs vs boys 16-17 yrs) • Girls less active than boys: 30% vs 50% at 5-12 yrs and 25% vs 40% at 13-17 yrs • Girls - less intense physical activities * Physical Activity Monitor 2000. CFLRI

  4. Why are Canadian Children Inactive? • Time pressures or competing priorities • Increased sedentary activities TV, computer, Nintendo • Inadequate role models - inactive parents

  5. Why are Canadian Children Inactive? • Lack funds • Unaware or lack of recreational facilities • Unsafe environments • Lack of motor skills • Seasonal (winter)

  6. Why are Canadian Children Inactive? • Inadequate access to quality daily physical education (< 4% Canadian schools offer QDPE) • 1/3 Canadian schools offer formal PE programs * • Most children do not receive 5 classes PE per week * • < 50% high school students take PE after grade 9 * * CAHPERD 1999

  7. Health Implications of Physical Inactivity • WHO definition of health: comprehensive state of physical, psychological, and social well being • Childhood obesity • Type 2 diabetes • Hypertension • Osteoporosis • Depression • Smoking/alcohol/drugs • Adolescent pregnancy

  8. Childhood Obesity Facts • 25% NA children overweight • Canadian prevalence obesity tripled 1981 –1996* • Genetics only 25-30% • 40% obese children and 70% obese teens  obese adults • 1/6 Canadian adults obese * Tremblay and Willms CMAJ 2000;163(11):1429-1433; CMAJ 2001;164(7):970

  9. Canadian Obesity Epidemic 1985-1998 Katzmarzyk, P. CMAJ 2002;166(8)

  10. Childhood Obesity – Dietary Factors * • 1970-1994 absolute grams fat 154  159 g/d (USA) • 200%  fast-food restaurant visits 1977-1995 • Fast-foods high in fat and energy (Big Mac + medium fries = 83% recommended daily fat intake) • Mega-meals * French et al. Ann Rev Public Health 2001;22:309-35

  11. Childhood Obesity – Sedentary Factors • TV watching strong link (sedentary + commercials + eating fatty snacks * • Despite  fat intake 1995 – 2001,  rate obese kids • Labor-saving devices * Dietz and Gortmaker. Pediatrics 1985;75:807-12

  12. High Blood Pressure • ~ 3 million USA youths affected • Associated with obesity • Tracking from adolescence into adulthood established* *Anderson and Haraldsdottir J Int Med 1993;234:309-315

  13. High Blood Pressure • Tracking adolescence into adulthood established : ~ 50% HT boys, ~40% HT girls remain HT 8 yrs later * * Anderson and Haraldsdottir J Int Med 1993;234:309-315

  14. Type 2 Diabetes * • 1.8 million adult Canadians • CVD, kidney failure, blindness, limb amputation • Up to 45% newly dx diabetic in childhood • Obesity hallmark • Onset puberty • Ethnicity, family history * Rosenbloom et al. Pediatrics 2000;105(3):671-80

  15. Type 2 Diabetes • Onset puberty • Family history • Ethnicity: African-Americans, American Indians, Hispanics, Asians, Canadian Aboriginals

  16. Osteoporosis • 1 in 4 women > 50 y with osteoporosis • Annual cost hip fracture treatment $650 million * • Bone accretion in first 20 yrs major factor in final bone mass + bone health later years • Inadequate diet + weight bearing exercise contributory * Wiktorowicz et al. Osteoporos Int 2001;12(4):271-8

  17. Osteoporosis • Peak bone mass 3rd decade • Bone accretion in first 20 yrs major factor in final bone mass + bone health later yrs • Inadequate Ca, Vit D, weight bearing exercise contributory *Wiktorowicz et al. Osteoporos Int 2001;12(4):271-8

  18. Adolescent depression • 113,000 Canadian 12-17 year olds depressed * • Suicide 2nd leading cause of injury-related death in adolescence * • Juvenile obesity associated with poor self esteem and depression • Depression in non-obese adolescents assoc with 2x  risk obesity 1 year later** *Trends in Health of Canadian Youth. Health Canada 1999 **Goodman E, Whitaker R; Pediatrics 2002, 109 (3) 497

  19. Canadian Youth Mental Health - Smoking • Average age onset smoking  from 16 to 12 years over past 2 decades* • 1998grade 10 smokers – 28% boys, 34% girls** • Weekly smokers unlikely to quit thus become adult smokers*** *CPS position statement Ped & child health 2001;6(2):89-95 **Trends in Health of Canadian Youth. Health Canada, 1999 ***Kelder et al Am J Public Health 1994;84(7):1121-26

  20. Canadian Youth Mental Health – Drugs * • 1998 grade 10 students > 90% had tried alcohol • 43% grade 10’s “very drunk” > 2 x in 1998 • 1998 grade 10’s: 42% MJ, 13% LSD, 6% cocaine, 9% amphetamines * Trends in Health of Canadian Youth. Health Canada 1999

  21. Canadian Youth Mental Health - Delinquency • ~ 20% School drop out rate in 1999 •  Youth violence 106% vs  45% adults 1986-1991* • 75,000 youths/yr charged with crimes in Canadian courts * Smart et al J Psychoactive Drugs 1997;29(4):369-373

  22. Canadian Youth - Pregnancy * • Teen pregnancy dropped between 1975-1987 but has increased since 1990 • 2.7% incidence pregnancy 15-17 y.o. in 1990 • 52% 15-17 year olds continue pregnancy to term * CPS position statement Canadian J Ped 1994;1(2):58-60 reaffirmed Jan 2000

  23. Is Physical Activity the Answer?

  24. What Evidence Supports our Case?

  25. PA Reduces Obesity* • Healthy satisfying diet • Family lifestyle changes • Reduce TV/video games • Regular physical activity lifelong *Bar-Or ACSM Roundtable Discussion Paper 1996

  26. PA Reduces Hypertension * • Aerobic exercise reduces systolic and diastolic BP in adolescents with hypertension • Avoid resistance exercises (weight lifting) which increases BP * Hansen et al. BMJ 1991;303:682-5

  27. PA Prevents Type 2 Diabetes* • Avoid child obesity: healthy food + reduction sedentary activities • Regular PA important in weight reduction and  insulin resistance • Proper nutrition and regular PA foundation of all treatment programs; limited scientific evaluation of various drugs *American Diabetes Association. Pediatrics 2000;105(3):671-680

  28. PA Prevents Osteoporosis • Adequate vitamin D and calcium • Reduce sedentary activity • High impact exercises in puberty improves bone mineral content which may delay age osteoporotic fracture limit is reached* *Heinonen et al. Osteoporos Int 2000;11:1010-17

  29. PA Improves Mental Health • Regular PA may increase self esteem • Regular PA may decrease anxiety and depression* *K.J. Calfas, W.C. Taylor. Ped Exerc Sci 1994. 6:406-423

  30. Physical Activity Improves Mental Health • Regular PA may be associated with  smoking, alcohol and drug abuse* • Some studies show teen girls have lower rates of sexual activity and pregnancy when  PA** * Forman et al. Clin J Sport Med 1995;5(1):36-42 **Sabo et al. J Adolesc Health 1999;25:207-16

  31. Physical Activity Improves School Performance* • Positive associations with PA and academic performance • Some studies show maintain/improve good grades with regular  PA despite reduction in academic class time • Regular PA may improve attitudes, discipline and behavior** *R.J. Shephard. Pediatric Exercise Science 1997. 9:113-126 **Keays and Allison. Can J Public Health 1995;86(1):62-65

  32. High Academic Athletes • Ann Montminy (Olympic Diver) – Lawyer • Derek Porter (Olympic Rower) – Chiropractor • Tracey Ferguson (Para-Olympic wheelchair basketball) – masters exercise science • Russ Jackson (CFL Quarterback) – BSc, Bed, Rhode’s scholar, former high school principal • Frank Mahovlich (NHL) – Canadian Senator

  33. There are Many Other Benefits of Physical Activity • Enjoyment • Friends • Learning new skills • self confidence •  PA may track to adulthood to reduce heart disease/stroke

  34. How Much? How Often? • Canada’s Physical Activity Guide for Healthy Active Living for Children and Youth released April 2002: • Increase PA at least 30 min/day ( 10 minutes vigorous) then add 10 min moderate + 5 min vigorous monthly to minimum 90 minutes/day (60 moderate + 30 vigorous) • Reduce sedentary activities by 30 min/day and decrease by 15 min/month to minimum 90 min.

  35. Canada’s Physical Activity Guide to Healthy Active Living for Children and Youth • 2 guides • Children 6-9 years old • handbook, parent insert, tear sheet, interactive tool, teacher’s planning guide

  36. Canada’s Physical Activity Guide to Healthy Active Living for Children and Youth • Youth 10-14 years old • Handbook, family or friend insert, tear sheet, interactive tool, teacher’s planning guide

  37. Endurance • Activities that increase breathing rate, increase heart rate, make the body warm • Walk, run, hike • Skate • Swim • Bike ride

  38. Flexibility • Activities that promote good posture and balance • Bending • Stretching • Reaching • Yoga • Gymnastics

  39. Strength • Activities that build muscles and bones • Rake the leaves • Shovel snow • Carry groceries • Wall or rope climbing

  40. The Battle Against Physical Inactivity Is Not a Solo Fight

  41. Recommendations • Parents, children, youth, teachers, school boards, recreation leaders, medical and allied health personnel, public health and all levels of government need to work together to promote healthy active living • Healthy food choices • Limit sedentary behaviors • Regular daily PA: sport, recreation, transportation, chores, planned exercises and school phys ed classes • Parents to lead by example • School and community co-operative efforts • Policies to ensure safe recreational facilities, playgrounds, parks, roadways + use of appropriate protective equipment • Policies to mandate daily K-12 quality school phys-ed classes by trained specialists

  42. Canadian Pediatric Society (CPS) • CPS member of steering committee developing CSEP + Health Canada’s Physical Activity Guides for Children and Youth 1998-2002 • Endorsed Physical Activity Guides for Children and Youth 2002 • Media launch PA guides with Health Canada, CSEP, CFPC 2002 • Produced poster and brochure targeting families • Distributed guides and posters to all CPS members 2002 + feedback questionnaire

  43. Response from CPS members • “Finally some helpful information that can reinforce what we constantly talk about to young children.” • “An excellent start to addressing a very serious problem! Your next steps: lobby the fast-food industry to provide nutritious meals.” • “I have been distributing the physical activity guide of Health Canada, but the CPS brochure and the new one from Health Canada for kids has more impact.”

  44. CPS Future Plans • Grant 2002-2003 • Regular Ads in peds & child health on PA guides • Develop and distribute in-office counseling tools (Rx pad) • Slide presentation (education) to help MDs promote physical activity locally • Slide presentation (advocacy) for Government education and assistance

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