Article Figures & Data
Figures
- FIGURE 1
Brief office-based assessments of physical activity. Adapted from Joy EA, Lobelo F. Promoting the athlete in every child: physical activity assessment and promotion in healthcare. Br J Sports Med. 2017;51(3):143–145. Adapted from Exercise is Medicine. Healthcare providers’ action guide. Available at: https://exerciseismedicine.org/assets/page_documents/Complete%20HCP%20Action%20Guide_2016_01_01.pdf. Accessed September 5, 2018. Adapted from Centers for Disease Control and Prevention. YRBS Questionnaire Content - 1991–2017. Available at: https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2017/YRBS_questionnaire_content_1991-2017.pdf. Accessed September 5, 2018. ACSM, American College of Sports Medicine.
Tables
Age Activity Amount Intensity 3–5 y 3+ h/d Light, moderate, vigorous 6–17 y ≥60 min/d Moderate or vigorous aerobic activity daily Vigorous at least 3 d/wk Muscle-strengthening activities at least 3 d/wk Bone-strengthening activities at least 3 d per wk Children not meeting guidelines Gradually increase activity in ways the child enjoys Moderate-vigorous; increase time per d and No. days per wk; use multiple, smaller time increments in activity that are additive throughout the day Adapted from US Department of Health and Human Services. Physical Activity Guidelines for Americans. 2nd ed. Washington, DC: US Department of Health and Human Services; 2018. Available at: https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf. Accessed December 10, 2018.
MET Physical Symptoms Examples of Activities Rest 1 — — Light <3 Easily able to converse Household chores Walking No sweating or shortness of breath Playing catch Fishing Moderate 3–6 Some difficulty talking Yardwork Feeling warm Jogging or fast walking Light sweating Tag Slight shortness of breath Movement portion of ball sports Vigorous >6 Unable to talk Manual labor Short of breath Run Face red Skipping rope Sweating Skiing, skating Wheelchair use or use of assistive devices (crutches or ankle-foot orthoses) Comparable METs expended for comparable examples noted above (eg, wheeling on a smooth surface = light; wheeling fast or up an incline or as part of ball sports = moderate; wheelchair racing or sit-skiing = vigorous) (use of crutches or ankle-foot orthoses involves higher METs but usually not enough to increase the level of PA, eg, from light to moderate) — — Muscle strengthening — Pushing and/or pulling one’s body or an object Climbing Pushups, curl-ups, or resistance training Wheeling a wheelchair Bone strengthening — Increased impact Jumping rope Tumbling Running Data are from references 78–82. MET, metabolic equivalent of task; PA, physical activity; —, not applicable.
Infant (0–1 y) Toddler (1–3 y) Preschool (3–5 y) Elementary (5–10 y) Middle School (11–14 y) Adolescence (15–18 y) Frequency Daily Daily Daily Daily Daily Daily Intensity Any Any Any, including some moderate to vigorous Moderate to vigorous Moderate to vigorous Moderate to vigorous Time Several times per day At least 180 min/d At least 180 min/d, of which at least 60 min are moderate-to-vigorous intensity At least 60 min/d At least 60 min/d At least 60 min/d Type Interactive floor-based play and at least 30 min of tummy time spread throughout the day while awake Activities that develop gross motor skills; examples include walking in the neighborhood, unorganized free play outdoors, walking through a park or zoo, or playing on a playground for toddlers Activities that develop gross motor skills; unorganized free play in a safe environment; activities include walking, running, swimming, tumbling, throwing, and catching Aerobic daily; vigorous activity, muscle, and bone- strengthening at least 3 d/wk; include free play with opportunities for fundamental movement skill development through walk, dance, jump rope. Introduce organized sports with flexible rules and short instruction time with a focus on enjoyment rather than competition Aerobic daily; vigorous activity, muscle, and bone- strengthening at least 3 d/wk; incorporate activities that are enjoyable and encourage socialization; avoid sports specialization Aerobic daily; vigorous activity, muscle, and bone- strengthening at least 3 d/wk; incorporate activities that are enjoyable and encourage socialization and competition, when appropriate Data are from references 9, 15, 73, 75, 83, and 84.
Infancy: supporting rudimentary motor skill development Grasping (3–4 mo) Offer toys to support hand-eye coordination Roll over (4–6 mo) Tummy time to build core strength Sitting (6 mo) Tummy time to increase strength and coordination Crawling (7–10 mo) Place toys to help build strength and balance Cruising (9 mo) Offer a safe environment to explore which increases strength and balance Walking (12 mo) Create a safe environment to explore which improves balance and coordination Toddler or preschool age: support development of fundamental skills Encourage fun and socialization, incorporating activities preferred by the child, family walks, and chores (picking up, retrieving items, helping clean) Running (by 2 y) Play chase, visit parks, and offer a safe environment to practice Throwing (2 y) Play catch with easy-to-grasp foam or fabric balls Catching (2+ y) Create a “basket” with arms to catch Kicking (2 y) Play soccer with light, foam balls Swimming (1–4 y) Enroll in swimming lessons Skating (4 y) Elementary school age: improve fundamental skills and develop self-efficacy Encourage fun and socialization, incorporating fitness preferences (such as dance, yoga, running, hiking, sports), active transportation (walking, cycling to school and activities), and chores (walking the dog) Running Build fitness and skills with tag, introduce sports like soccer by age 6 Throwing and catching Falling and tumbling Helps decrease injury by learning to tuck head, knees, and arms Hopping and jumping Hopscotch and jump rope Cycling Teach a child to ride a bike Striking sports Practice at home with a plastic ball and bat, hockey stick, etc; introduce sports programs Dribbling sports Fine motor skills develop through practice and repetition Gymnastics One of the best activities for agility, balance, coordination, strength, and flexibility Skiing Low center of gravity makes it easier; it helps with balance Preadolescence and adolescence: honing physical literacy Encourage fun and socialization, incorporating fitness preferences (such as dance, yoga, running, hiking, sports), active transportation (walking, cycling to school and activities), and chores (walking the dog) Identify gaps in fundamental movement skills development, confidence, or desire to be active and devise a plan to remedy (eg, motivational interviewing, physical therapy, community program) Introduce skill development and strategy through coaching and camps Introduce more complex sports that incorporate multidirectional movement and attention (eg, sports with equipment and strategy and/or plays) Introduce resistance training with supervision and instruction on proper technique Avoid sports specialization until mid-to-late teenaged years Data are from references 16, 76, 83–85, 89, and 90.
- TABLE 5
Steps Toward Integrating Physical Activity Assessment and Counseling Into Clinical Practice
1. Ask about current physical activity frequency and duration and enjoyment of movement. 2. If it is an acute or subspecialty visit, connect benefit of physical activity to current health condition and advise on restrictions in physical activity (if applicable). 3. If it is a health supervision visit, assess physical literacy and any gap between current and recommended activity level. Assess the patient and family interest in discussing promotion of physical activity. a. If not interested, provide information on the benefit of physical activity to current health, if the patient has any chronic issues, and/or future health (including athletic performance). b. If interested, discuss the reason for interest and potential area of change and establish a specific, attainable incremental goal to progress toward physical activity guidelines. Connect patient and/or family to resources to support achievement of goal, such as a physical education teacher, exercise specialist, physical or occupational therapist, or coach. 4. Recommend scheduling an appointment to discuss achievement toward goal; identify obstacles to change and establish new goals. Institute for Healthy Childhood Weight: http://ihcw.aap.org Exercise is Medicine: www.exerciseismedicine.org National Physical Activity Plan: http://www.physicalactivityplan.org National Association of Physical Literacy: http://naplusa.org SHAPE America: 2016 Shape of the Nation: https://www.shapeamerica.org/advocacy/son/default.aspx Prescription for Activity: https://www.prescriptionforactivity.org/ Lifestyle Medicine Education Collaborative: http://lifestylemedicineeducation.org/ National Recreation and Park Association: “Prescribing Parks for Better Health Success Stories”: https://www.nrpa.org/contentassets/f768428a39aa4035ae55b2aaff372617/final-prescribing-parks-for-better-health-success-stories.pdf National Association for the Education of Young Children: https://www.naeyc.org/ (including Developmentally Appropriate Practice in Early Childhood Programs Serving Children from Birth through Age 8, Third Edition, as a resource for schools) SHAPE, Society of Health and Physical Educators.
- TABLE 7
Recommendations for Promoting Physical Activity Assessment and Counseling in Medical Education
1. Demonstrate assessment and counseling in practice for learners. a. Primary care pediatricians and health care providers: general physical activity assessment and screening, counseling and goal-setting, and activity or exercise prescription and referral to community partners and resources. b. Subspecialists: guidance on physical activity benefits and restrictions as related to relevant medical condition to patient, family, and other physicians involved in the patient’s care. 2. Advocate for the inclusion of education regarding physical activity guidelines within medical school and residency training. 3. Advocate for the inclusion of education regarding physical activity counseling and exercise prescription as part of longitudinal curricula within medical school and residency training.
Data Supplement
In this issue
Physical Activity Assessment and Counseling in Pediatric Clinical Settings
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- Article
- Abstract
- Introduction and Rationale for Physical Activity Assessment and Counseling
- Physical Activity and Health Outcomes in Children and Youth
- Current Physical Activity Guidelines in Youth
- The Importance of Physical Literacy in Shaping Physical Activity Participation
- Inactivity and Sedentary Time
- Evidence in Support of Physical Activity Promotion in Pediatric Care Settings
- Role of Parents in Physical Activity for Children
- Role of Schools in Promoting Physical Activity in Youth
- Tools for Assessing Physical Activity in Pediatric Clinical Settings
- Strategies to Overcome Barriers to Physical Activity Assessment, Counseling, and Referral in Clinical Practice
- Role of Physicians in Promoting Pediatric Physical Activity Outside of Direct Patient Care
- Recommendations
- Lead Authors
- Council on Sports Medicine and Fitness Executive Committee, 2017–2018
- Liaisons
- Staff
- Section on Obesity Executive Committee, 2017–2018
- Liaison
- Staff
- Footnotes
- References
- Figures & Data
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