It is never too early in life to start developing healthy habits. Active youth have a better chance of growing into healthy adults. Risk factors for chronic diseases such as heart disease, high blood pressure, type 2 diabetes, and osteoporosis have their roots early in life (40). Regular physical activity and healthy dietary habits are two ways to lower the chance of developing risk factors for chronic lifestyle diseases (19).
Kids who are active on a regular basis display higher levels of aerobic and muscular fitness, decreased body fat, and stronger bones (13, 21, 33). Children and youth who regularly engage in physical activity also have better mental health and well-being (21, 33). Although the benefits of physical activity are well established, the activity levels of youth are below desired levels, with only about 25 percent of U.S. youth meeting recommended physical activity guidelines (37, 40). The percentage of children and youth who take part in health-producing physical activity also decreases with age (6). Similarly, a gap exists between recommended diets for youth and what the majority of youth actually consume (19). Thus, it is vital that adults provide opportunities for children and adolescents to be physically active and make good nutrition choices.
Because children and adolescents are not small versions of adults, this chapter specifically addresses healthy eating for youth, including how adults can encourage children and adolescents to make healthier eating choices. The chapter also lays out physical activity recommendations that are appropriate for youth, from infancy through late adolescence, and describes practical ways for youth to be active in home, school, and recreational settings.
Focus on Nutrition
As discussed in chapter 3, good nutrition is important for attaining optimal health and promoting growth and physical development (41). Children who are 2 years of age and older should eat a diet in which sufficient (but not excessive) calories come from a variety of nutrient-dense foods and beverages (including fruits and vegetables, dietary fiber, whole grains, fat-free and low-fat dairy products) while limiting the intake of solid fats, cholesterol, sodium, extra sugars, and refined grains. Motivating children to eat well can be challenging, and the majority of U.S. youth are falling short of meeting national dietary guidelines (7, 16, 31, 39).
Childhood is a pivotal time to encourage healthy dietary choices, and adults can play an important role in modeling a positive attitude toward nutrition and health (38). Children can watch parents and caregivers snacking on fruits, vegetables, and whole grains and including these foods in family meals. Shopping with your children can also serve as an opportunity to teach them about healthy foods, and you can team up with your child in the kitchen to tear lettuce for a salad, add veggie toppings to a pizza, develop a great-tasting fruit smoothie, or experiment by making a new type of trail mix.
Providing youngsters with a variety of foods at home enables them to obtain the nutrients they need from different food groups while building their food “repertoire.” Healthy choices for protein include seafood, lean meat and poultry, eggs, beans, peas, soy products, and unsalted nuts and seeds. Serving a variety of fresh, canned, frozen, and dried fruits and colorful vegetables (dark green, red, and orange), along with peas and beans, can sustain healthy growth and development. Whole wheat bread, oatmeal, popcorn, quinoa, and brown or wild rice are healthy choices for nutrient-packed whole-grain foods, and low-fat milk and yogurt can provide essential nutrients while keeping calorie intake in check (41).
Although the “clean plate club” was used in the past to prompt kids to eat, the current recommendation is to encourage them to stop eating when they are full rather than when their plates are clean. Children who understand this concept are less likely to become overweight (38). Offering a number of healthy eating options and letting children make food selections allows them to decide what to eat while still allowing you to provide needed guidance. Because youngsters often don’t eat enough at a meal to tide them over until the next meal, a good option is to plan for three meals, plus a couple of snacks, each day (38). Snacks should be nutritious and should not substitute for meals skipped. Whenever possible, try to avoid serving sugary snacks like soda and juice drinks, cakes, cookies, ice cream, and candy on a regular basis. Instead, have different types of fruits available for youngsters to eat in between meals and encourage children to create healthy snacks from ingredients like dry whole-grain cereal, dried fruit, and unsalted nuts or seeds.
Although younger children are influenced to a great extent by parents, caregivers, and other adults, older children and adolescents eat more meals and snacks outside of the home and make more personal decisions about what to eat. One factor that can have a strong impact on food choices is the media. Consider, for example, the number of television advertisements that focus on sugar-laden breakfast cereals, cookies, candy, and fast-food restaurants. Then count the number of advertisements for fruits and vegetables (if you can find any at all). Of course, there is no comparison! Because adolescents tend to consume more sweetened beverages, french fries, pizza, and other fast-food items, many older youth do not meet healthy eating recommendations for fruits, vegetables, dairy foods, whole grains, lean meats, and fish. This results in too much fat in the diet and insufficient intake of nutrients such as calcium and iron, as well as vitamins A, D, and C and folic acid. Unfortunately, many adolescents skip breakfast and actually consume about one-third of their calories from snacks, with sweetened beverages being a major contributor (19).
Making good nutrition choices is especially important for older boys and girls, as this is a time of active physical growth and development and a period in their lives when they begin to make personal decisions regarding dietary habits. It’s important to remember that there are no magic foods that can increase health and fitness; from a nutrition perspective, eating vegetables, fruits, whole grains, protein foods, and fat-free and low-fat dairy foods is the ticket to good health (19). Learning how to prepare healthy meals and snacks can also help reduce the consumption of sweets and high-calorie snacks like candies, cookies, and ice cream. For older girls, eating smart includes consuming fat-free or low-fat milk, cheese, and yogurt to build stronger and denser bones, as well as engaging in weight-bearing physical activities like walking, running, and skating (38).
Areas of the Diet to Increase for Youth
The dietary intake of some nutrients, including calcium, potassium, fiber, magnesium, and vitamin E, appears to be low for many youth (41). The low intake of fiber may be linked to underconsumption of whole grains, fruits, and vegetables. Also, low magnesium and potassium intake is reflected by insufficient fruit and vegetable intake. Low calcium intake usually results from inadequate consumption of milk and milk products. Vitamin E intake can be improved through the consumption of fortified cereals, as well as various nuts and oils.
Replacing less nutritious items with more nutritious ones can improve the diets of youth (42). Making some simple substitutions in dietary choices can help to strengthen these areas of deficiency and improve the nutrient content of children’s diets. The following are some practical ways to address these nutrition concerns:
· Substitute whole fruit for fruit juice.
· Replace starchy vegetables (e.g., white potatoes) with dark green vegetables (e.g., broccoli) and orange vegetables (e.g., carrots, sweet potatoes).
· Increase the consumption of low-fat or skim milk in place of soda.
· Eat breakfast on a daily basis, including cereals fortified with vitamin E.
Areas of the Diet to Reduce for Youth
Although experts promote the consumption of fruits, vegetables, and whole grains for optimal health, the top sources of calories for U.S. youth are grain desserts (e.g., cakes, cookies, doughnuts, pies, and granola bars), pizza, and sugar-sweetened beverages (soda and fruit drinks). Consequently, the amount of added sugar and fat consumed is excessive. Children need to reduce their consumption of solid fats and added sugars (SoFAS is a common abbreviation used for these dual targets). Nearly 40 percent of the calories youth consume are SoFAS (41)! For example, on average, youth consume 171 calories each day from sugar-sweetened beverages (soda and fruit drinks combined). SoFAS are overconsumed by youth and often result in excessive intake of calories with little nutritional value. Reducing the consumption of SoFAS may be one of the most important steps in stemming the growing prevalence of obesity in youth.
Because of the high calorie content but limited nutrient value of the foods youth often consume (e.g., soda and high-fat fried foods), the overall caloric intake of youth is higher than desired. When the number of calories consumed is not offset by physical activity, this can lead to overweight and obesity. Foods with a high fat content are considered calorie dense, meaning that, per gram, the calorie content is high and the nutrient content is relatively low. Ideally, foods should be high in nutrients (i.e., nutrient dense) relative to the number of calories they contain. Table 3.4 gives examples of reduced-calorie, lower-fat alternatives to foods with a higher fat content. In addition to making simple substitutions, adults can make other changes that can address overweight and obesity in youth, such as the following (41, 42):
· Limit fast-food meals.
· Limit screen time (TV, computer).
· Don’t let youth skip breakfast.
· Keep a check on portion size.
Taken together, these are action-oriented steps that can help address the growing problem of overweight and obesity in youth.
Dietary Focus for Youth
Improving the diets of children and adolescents requires greater attention to making nutritious choices at home, at school, and in community settings. Promoting good nutrition early in life and providing positive role models for healthy eating are two important ways of improving the eating patterns of youngsters. The purpose of making healthy dietary choices is not just to avoid chronic disease (although the benefits related to heart disease and other chronic conditions are clear), but also to meet nutrient requirements that lead to the best possible level of function and the ability to engage in physical activity. Food is the fuel for physical activity, and selecting high-grade fuels provides the nutrients needed to power routine daily activities, moderate and vigorous physical activity, and sport performance.
Following the Dietary Guidelines provides the best nutrition for kids.
Normal growth requires good nutrition (38). As with adults, children’s weight in relation to height can be assessed easily via the body mass index (BMI). However, use of BMI is a bit more complex for youth because weight and height change with age, and the relationship between body fatness and weight and height also varies with age. Consequently, BMI charts that are specific for age and sex must be used for youth between the ages of 2 and 20 (see figure 9.1 or go to www.cdc.gov/growthcharts/ and enter “BMI calculator” into the search window for an easy online calculator and individualized interpretation of BMI) (11). Once the child’s BMI has been calculated (see figure 18.1), follow the horizontal line matching the BMI value until it intersects with the vertical line for the child’s age, and note the percentile line closest to this point of intersection.
Figure 9.1 a Body mass index for age charts for boys.
From ACSM, 2017, ACSM’s complete guide to fitness & health, 2nd ed. (Champaign, IL: Human Kinetics). Developed by the National Center for Health Statistics and the National Center for Chronic Disease Prevention and Health Promotion, 2000.
Figure 9.1 b Body mass index for age charts for girls.
From ACSM, 2017, ACSM’s complete guide to fitness & health, 2nd ed. (Champaign, IL: Human Kinetics). Developed by the National Center for Health Statistics and the National Center for Chronic Disease Prevention and Health Promotion, 2000.
Based on guidelines established by the Centers for Disease Control and Prevention, a BMI value between the 5th percentile and less than the 85th percentile is considered to fall within the healthy weight category (10). The BMI range for being classified as overweight is between the 85th and less than the 95th percentile, and a classification of obesity is indicated if BMI is equal or greater than the 95th percentile. A BMI that is less than the 5th percentile indicates underweight. As BMI does not take into account body composition (i.e., the relative contribution of fat and lean tissue to overall body weight), it is appropriate to schedule a visit with a health care provider for further evaluation and consultation for a child who is classified as overweight, obese, or underweight using the BMI calculation.
Consuming an appropriate number of calories and foods from various categories results in optimal nutrition. Table 9.1 provides age-specific daily calorie and serving size recommendations for grains, fruits, vegetables, and milk and dairy items for boys and girls. Because the calorie recommendations in this table are for an inactive child, about 200 calories would need to be added for a moderately active child, and 200 to 400 calories per day would need to be added for a very physically active child (19).
While table 9.1 can be helpful in providing guidelines for caloric intake for children from 1 to 18 years of age, the number of calories that youth need for healthy growth and development depends on various factors, such as age, sex, physical activity levels, and genetics (43). Nonetheless, it is possible to create sample meals that are healthy, composed of foods from each major food category, and also cater to your child’s tastes and food preferences. One way of planning a healthy meal is to select a food item from each food group listed in table 9.2 (note that these are examples of items in amounts that might commonly be consumed and do not necessarily reflect a defined serving size).
Based on the information presented in table 9.2, here are examples of meals for breakfast, lunch, and dinner:
· Breakfast: One banana, a slice of whole-grain bread with peanut butter, and low-fat milk
· Lunch: Turkey sandwich with cheese, dark leafy lettuce, tomato, and red peppers on whole wheat bread, 6-ounce yogurt snack pack, bottle of water
· Dinner: One whole wheat tortilla with chicken, low-fat cheese, chopped tomato, and romaine lettuce
As you can see, many combinations of foods in the four major food groups can be put together in creative ways to make healthy, tasty meals for youth of all ages.
Importance of Family Meals
While it can sometimes be challenging for family members to eat together, doing so provides a daily opportunity not only to enjoy a communal meal but also to talk about what’s going on in each person’s life and strengthen family bonds. From a nutrition point of view, eating meals as a family unit has been linked to increased fruit and vegetable consumption, higher intakes of nutrients such as dietary fiber, calcium, vitamins B6, B12, C, and iron, and less intake of fried foods and soda (29). Moreover, a greater frequency of eating dinner as a family is associated with a positive sense of the future, positive values and identity, higher levels of motivation and involvement in school, and a greater commitment to learning (18). In addition, research has shown that younger children (younger than 13 years old) who eat breakfast on a regular basis demonstrate greater on-task behavior in the classroom and higher school grades and achievement test scores (2).
Q&A
What are ways a family can develop healthy eating patterns?
The following tips can help a family eat well (38):
· Make half your grains whole. Select whole-grain foods more often (e.g., whole wheat bread, brown rice, oatmeal, low-fat popcorn).
· Vary your veggies. Eat a variety of vegetables, and in particular, seek out dark green and orange vegetables (e.g., spinach, broccoli, carrots, sweet potatoes).
· Focus on fruits. Fruits can be part of meals or snacks, whether they are fresh, frozen, canned, or dried.
· Eat calcium-rich foods. Low-fat and fat-free milk and other milk products should be consumed several times a day to help build strong bones.
· Go lean with protein. Protein can be found in lean or low-fat meats, chicken, turkey, and fish, as well as dry beans and peas.
· Change your oil. Good sources of oil are fish, nuts, and liquid oils (e.g., corn, soybean, canola, and olive oil).
· Don’t sugarcoat it. Check labels and choose foods and beverages that do not have sugar and sweeteners as one of their primary ingredients.
The U.S. Department of Agriculture My Plate for kids is an excellent nutrition resource. The website www.choosemyplate.gov/kids includes resources for younger age groups, including games, activity sheets, and recipes.
Children begin to establish dietary habits and preferences during the first years of life. Working together, parents and caregivers can guide, educate, and motivate youngsters to make wise nutrition choices. Developing healthy eating habits during childhood and adolescence is a foundational life skill that can help prevent the genesis of diet-related diseases later in life.
Focus on Physical Activity
From 1960 to 2010, the prevalence of obesity in American youth increased in dramatic fashion. Based on current estimates, nearly one out of three youth in the United States is overweight, while more than one in six is obese (12, 32). Not surprisingly, children who are overweight and obese do not typically meet current physical activity guidelines for youth (12).
Budget-related cutbacks in physical education and increased time spent in sedentary activities have led to an escalation in the overweight status of youth and have contributed to a substantial reduction in childhood physical activity. Over half of young boys and three out of four young girls do not participate in daily physical activity (9). Moreover, children and youth spend more than 7 hours a day in sedentary pursuits, and inactivity increases with age (6). The long-term consequences of high levels of body weight and physical inactivity include a greater risk of early death and the presence of chronic health conditions, such as heart disease, high blood pressure, diabetes, and certain forms of cancer (17, 26, 35).
Q&A
Do all children and adolescents need a medical screening before engaging in physical activity?
Most healthy children and adolescents can begin a physical activity program without a visit to a physician or health care provider (3). However, if a preexisting condition exists (e.g., asthma, diabetes, or obesity), or if there are any other special circumstances or concerns, then consulting with a physician or health care provider before increasing activity is warranted. Often, simple adjustments can be made to the activity program, such as starting out with a lower amount of activity and progressing more slowly. For youth involved in competitive sports, a sport physical is typically required to ensure that no health conditions exist that could limit the ability to endure the rigors of a particular sport.
Benefits of Physical Activity for Children and Adolescents
Involvement in regular physical activity during childhood and adolescence can enhance cardiovascular and musculoskeletal health, can produce beneficial changes in blood lipid (cholesterol) levels, and has been tied to higher levels of physical self-concept and better cognitive and academic performance (4, 33, 36). Because youth who are overweight are more likely to become overweight adults (15), adopting a physically active lifestyle early in life can play a key role in establishing good health and avoiding unhealthy weight gain (28). Inactivity and low physical activity patterns tend to be harder to modify with age (34); this reality further emphasizes the need to encourage youth to develop and maintain an active lifestyle.
Right From the Start
How early is too early to encourage children to be active? This is an issue the National Association for Sport and Physical Education (NASPE) addressed for children up to 5 years of age in a recent book titled Active Start (24). Now in its second edition, Active Start highlights the role that parents, child care providers, and teachers can play in motivating very young children to be active, which includes serving as active role models and creating environments that facilitate play and movement exploration. The overall position of NASPE is that all children from birth to age 5 should engage daily in physical activity that promotes movement skillfulness and a foundation in health-related fitness (24).
Increasing physical activity levels to 20 to 30 minutes three or more days a week has been shown to improve bone health, motor skills, aerobic fitness, and some aspects of self-esteem in children 2 to 5 years of age (36). Based on evidence that physical activity behavior tends to track during early childhood (30) and that a sizable portion of preschool-aged boys and girls do not meet current activity recommendations to improve physical fitness and competency in performing motor skills (23), it is important to provide a wide range of opportunities for children to be active during the earliest years of life.
Physical Activity Guidelines From Birth to Late Adolescence
The next section presents physical activity guidelines for each developmental phase of the child relative to the frequency, intensity, time, and type (i.e., FITT profiles) of recommended physical activity. The intensity range of physical activity varies from moderate to vigorous. Moderate-intensity physical activities (such as briskly walking to school) can be performed and maintained easily, whereas vigorous-intensity activities (such as running on the playground) feature substantial increases in heart rate, breathing rate, and sweating and often require more rest periods (40).
Infants (Birth to 1 Year)
From the first days of life, the ability to move and explore allows infants to begin to understand and make sense of their surroundings. During the first year, infants start to develop and repeat movement patterns as their muscles learn to respond to information sent from the brain. Consequently, infants need numerous opportunities to participate in a variety of physical activities that promote skill development and movement competency. The acquisition of new movement skills also helps newborns adapt to unfamiliar physical surroundings (1).
FITT Profile for Infants
Parents and caregivers should play with infants several times a day during waking hours, especially when infants are alert and happy. Although parents and caregivers should engage infants in active play, the intensity level of physical activity is determined by the child. When infants are not interested in engaging in active play, they typically communicate this by crying or looking away. A variety of positive facial and other nonverbal and verbal expressions can be used to motivate infants to be active.
Infants should be encouraged to participate on a daily basis in a variety of activities that promote the development of basic movement skills, such as reaching, grasping, holding, squeezing, pushing, pulling, crawling, sitting, standing, and moving their arms and legs. Examples of activities include playing games such as patty cake and peek-a-boo; placing objects of different sizes, textures, colors, and shapes within or just beyond their reach; and assisting with movement skills such as sitting, crawling, standing, and stepping. Infants may also enjoy banging objects and moving to music, crawling across a surface decorated with brightly colored objects, bouncing in a baby seat, lying or sitting in a supported position while reaching out and manipulating a suspended mobile, and playing and moving while taking a bath. Many toys and objects used for play by infants can be found at home or can be purchased inexpensively.
Recommended Activity Settings for Infants
Infants should be placed in settings during the day that are safe and promote movement and exploration of their surroundings. If the play environment is too small, or if the infant is placed in a sedentary or restrictive setting (e.g., a baby seat or playpen) for extended periods, a delay may occur in learning and practicing fundamental behaviors such as rolling over, sitting, crawling, creeping, and standing. Play equipment should be nontoxic, should contain no sharp edges or points, and should be free of pieces that can be swallowed. Playing, rolling, and crawling activities can be performed on a rug or blanket in a floor-based setting that is at least 5 feet by 7 feet (1.5 by 2.1 m) (24).
Toddlers (1 to 3 Years)
Once a child can walk, a new vista of physical activity choices emerges. Learning to stand and walk in an upright, hands-free posture allows the toddler to acquire and refine fundamental movements (e.g., walking, running, jumping, leaping, throwing, catching, kicking, bouncing) that form the basis of many sport, fitness, and dance activities. Although the ability to perform these core movement patterns is a partial by-product of physical growth, an environment that is supportive and stimulating and that provides opportunities for the toddler to safely engage in structured and unstructured physical activity is also essential. Regular exposure to age- and developmentally appropriate physical activities helps toddlers become more confident in their attempts to master their physical environment while developing cardiorespiratory endurance, strength, balance, and flexibility.
FITT Profile for Toddlers
When alert and awake, toddlers should engage in multiple bouts of short-burst, moderate to vigorous physical activity in indoor and outdoor settings. Although the length of these bouts will vary depending on the age and developmental stage of the child, at least 30 minutes of structured physical activity and at least 60 minutes (and up to several hours) of unstructured physical activity should be accumulated each day. Toddlers should not be sedentary for longer than 60 minutes at a time except when sleeping (24). Structured physical activities for toddlers are planned and directed by a parent or caregiver and can include activities such as action-oriented follow-along songs, dancing to rhythms of taped music or music videos, moving through an obstacle course that provides opportunities to employ manipulative or movement skills, and simple chase games. Unstructured physical activity is initiated by the toddler during exploration of the surrounding environment. Examples might include playing on and around playground structures, moving on a variety of riding toys (e.g., tricycles, scooters) while wearing a safety helmet, and digging and building in a sandbox. A toddler’s interest in being physically active can be enhanced through the use of age-appropriate toys and equipment in a variety of movement environments.
Recommended Activity Settings for Toddlers
Indoor and outdoor play areas for toddlers should meet or exceed recommended safety standards and be large enough to facilitate large-muscle activities. Play environments should also be childproof, accessible, and inviting. Each toddler should have a minimum indoor activity space of 35 square feet (3.3 sq m) of activity room and an outdoor activity space of at least 75 square feet (7 sq m) (24).
Preschoolers (3 to 5 Years)
The preschool years are an optimal time to learn and refine fundamental movements and locomotor activities in a variety of settings so that the child can develop motor skill proficiency before entering kindergarten. Performing a gross motor skill is the result of a learned sequence of movements that allow preschoolers to complete physical tasks in a smooth and coordinated fashion. Promoting the development of needed movement patterns at this stage of life will carry forward into the future. The period from 3 to 5 years of age is also a good time to help children develop good nutrition habits; expend enough calories to ward off excessive weight gain; and increase heart fitness, muscular strength, flexibility, and bone density. The physical activity profile of a preschooler depends on a number of factors, including age, maturity, ability, and previous exposure to motor learning and development, as well as their natural activity patterns, which feature spontaneous and intermittent movement (36). Parents and caregivers should also keep in mind that at a given age, preschoolers can exhibit varying degrees of proficiency in performing motor tasks.
FITT Profile for Preschoolers
Parents and caregivers of preschoolers should plan structured physical activity sessions that are moderate to vigorous in intensity and that last between 6 and 10 minutes. A minimum of 60 minutes of structured physical activity should be accumulated daily (24). Although preschool children have the capacity to sustain structured, developmentally appropriate physical activity for longer durations (e.g., 30 to 45 minutes), they should also be encouraged to accumulate multiple shorter bouts of structured activity spread throughout the day. In addition to engaging in structured activity, preschoolers should participate in inside and outside unstructured physical activity lasting at least 60 minutes to several hours a day at self-selected intensity levels. With the exception of sleeping, periods of sedentary activity lasting more than 1 hour should be avoided (24).
Preschoolers can enjoy an array of structured physical activities, including obstacle courses that promote movement and manipulative skills, mimicking animal movements to develop strength and flexibility, and cardiorespiratory activities that improve aerobic fitness. Playing imitative games (such as Simon Says) using a variety of movement patterns, dancing to music of various tempos and rhythms, and receiving formal instruction in various motor skills are other structured forms of physical activity that are appropriate for preschool children. Unstructured physical activities for 3- to 5-year-olds include climbing on playground structures; playing with bats and balls; running up and down inclined surfaces; riding a variety of wheeled riding toys (while wearing a safety helmet); and chasing bubbles, balls, and hoops. Active play is another less formal activity option for the preschool child and might involve “dressing up,” going on treasure hunts, or performing specific movement patterns (e.g., galloping like a horse) while another child or other children mimic the activity.
Climbing on playground structures is fun and also helps to build muscular fitness.
Recommended Activity Settings for Preschoolers
Activity spaces for preschoolers should be large enough to accommodate child-directed play or physical activities supervised by adults. The play environment should be one that can be modified or reconfigured to allow for different types of activity. Ideally, each child should have a minimum indoor space of 35 square feet (3.3 sq m) for structured movement activities and a minimum of 75 square feet (7 sq m) of outdoor play space (24). Larger play areas may be required to accommodate activities such as running, skipping, and kicking.
Children and Adolescents
The association between physical activity and good health in school-aged youth is well established (21, 25, 33, 40). Regular physical activity during childhood and adolescence has beneficial effects on cardiovascular and musculoskeletal health, body composition, bone mineral density, blood lipid levels, and blood pressure (21, 33). In addition, a positive influence of physical activity and fitness on mental health (e.g., anxiety, depression, self-concept), academic performance, and classroom behavior has been observed in schoolchildren (8, 33).
Current guidelines indicate that school-aged youth (ages 6 to 17) should accumulate a minimum of 60 minutes, and up to several hours, of age-appropriate physical activity of at least moderate intensity on all, or most, days of the week (21, 25, 33, 40). However, because some improvement in health-related fitness can be achieved by being active for an average of just 30 minutes a day (21), accumulating even less than the recommended amounts of physical activity on a daily basis would appear to be beneficial, especially for children and adolescents who are relatively inactive. Experts recommend that children and adolescents avoid extended periods (over 2 hours) of sedentary behavior (e.g., screen time) each day (27).
Q&A
What type of physical activity should children and adolescents do?
The physical activity profile of children and adolescents should feature activities that stimulate the aerobic system, increase muscular fitness, and produce stronger bones. School-aged youth should also participate in activities that are enjoyable and appropriate for their age, developmental status, and personal preferences. A variety of physical activities, games, and sports can be used to meet the recommended guidelines.
FITT Profile for Aerobic Fitness
The majority of children’s daily 60-minute activity period should incorporate rhythmic, large-muscle, moderate to vigorous aerobic physical activities. Moderate-intensity activity can be considered a level 5 or 6 on a 10-point scale of effort (in which 0 is sitting at rest and 10 is the highest level of effort possible) (40). Vigorous-intensity aerobic activity (level 7 or 8 on the 10-point scale) should also be performed at least three days a week (40). Youth frequently engage in short bursts of activity interspersed with brief rest intervals; any time spent in moderate or vigorous aerobic activities can be counted toward meeting the aerobic guidelines. However, a majority of the 1-hour target time should be spent being active. For example, during a 20-minute recess, a child might accumulate 12 minutes of physical activity in periods lasting between a few seconds and several minutes and 8 total minutes of rest. Some activities, such as bicycling, can be classified as either moderate or vigorous depending on how intensely energy is being expended. Table 9.3 lists aerobic activities for children and adolescents that can be performed at moderate or vigorous intensities.
Kids of all ages enjoy bike riding, which is a great way to increase aerobic fitness.
FITT Profile for Muscular Fitness and Bone Strengthening
Current recommendations are that a portion of the 60-minute period of daily physical activity of children and adolescents include muscle-strengthening activities at least three days a week (40). The primary targets of strengthening should be the major upper and lower body muscle groups (legs, hips, back, abdomen, arms, chest, shoulders). Table 9.4 lists games and resistance training exercises that promote muscle strengthening and can be included as part of indoor or outdoor play activity. An example of a properly aligned weight machine is shown in figure 9.2.
Figure 9.2 Ensure correct alignment when using weight machines.
The ACSM supports the use of resistance training for youth provided that the training program is properly designed and competently supervised (14). Myths still abound regarding resistance training for youth, including the idea that growth plates can be injured, resulting in stunted growth, or that strength gains are not possible in younger kids. In reality, resistance training improves muscular strength and endurance in youth, helps strengthen bones while having no negative effect on physical growth, and confers no greater injury risk than other childhood sports or recreational activities (14). In addition, resistance training, rather than causing injury, can potentially decrease the incidence and severity of injury (5).
To maximize safety during resistance training, adults must ensure that children and adolescents are mature enough to follow directions. Sessions should also be supervised by a knowledgeable adult who understands standard safety guidelines. Youth should be instructed to start with relatively light loads, gradually increase resistance as strength develops, and use controlled movements for all resistance training activities. Using proper technique is a key requirement, and emphasis should be placed on improvement of personal performance rather than on how much weight is lifted. Warm-up and cool-down periods should also be part of each resistance training session.
Q&A
How young is too young to start resistance training?
Strength training has been used with boys and girls as young as 7 to 8 years of age (13). Options include using rubber tubing or weight machines designed specifically for children. Younger children may also be able to engage in muscle-strengthening activities such as push-ups (either regular or modified) or sit-ups. The goal of resistance training is to improve musculoskeletal strength as part of a well-rounded fitness program that also features the development of endurance, flexibility, and agility.
The guidelines for resistance training outlined in chapter 6 can be modified for children and adolescents by having them do one to three sets of 8 to 15 repetitions of a given exercise (3). Resistance training can occur two to three days a week, with one day between sessions to allow the muscles to respond and recover. The intensity of training should not be maximal (i.e., to the point of muscle failure). Rather, training intensity should be moderate and should focus on learning and performing resistance exercise with good technique (14).
Muscle-strengthening activities that generate high-impact forces, such as running, jumping, and basketball, also cause bones to become stronger and denser. Because the greatest gains in bone mass occur just before and during puberty (22, 40), engaging in weight-bearing activities during the childhood and adolescent years can have a positive impact on bone health later in life (22). As with muscle-strengthening activities, bone fitness activities should be performed at least three days a week as part of the 60-minute period of daily physical activity (20). Table 9.4 identifies various activities that can be used to increase bone strength in school-aged youth.
Children and adolescents who do not meet the aforementioned guidelines should gradually raise their physical activity levels over time by initially aiming to be active more frequently, for longer time periods, or both (40). As levels of physical activity start to improve, the activity intensity can also be raised gradually as well. Youth who are following the physical activity recommendations should consider becoming even more active, especially in view of recent research suggesting that additional health benefits can be realized when minimum recommended levels of physical activity are exceeded (20). Lastly, youth who exceed the recommended activity guidelines should continue to maintain their level of performance and vary their physical activity routines to avoid overtraining, boredom, or injury (40).
Although children and adolescents can meet the recommended physical activity guidelines by participating in the activities listed in tables 9.3 and 9.4, they should also look for opportunities to be active throughout the day. Examples of lifestyle physical activity include walking or riding a bicycle with friends, taking a “physical activity break” from studying or playing video games, or helping with active household chores such as vacuuming and washing the family car. Having a posted checklist is one way to visually promote these lifestyle activities. After all the items have been checked off, a small reward may be given (e.g., gift card, tickets to a sporting or fitness event, new exercise clothes). An even simpler approach to promoting physical activity in youngsters is to maximize outside time and minimize inside time (it’s much harder to be sedentary when you’re outdoors and very easy to be sedentary when inside). Parents, family members, and teachers who participate in regular physical activity can also be real-life models of how to integrate activity and movement into everyday living.
Meeting the Physical Activity Guidelines for Children and Adolescents
An endless number of routines that combine aerobic activity with muscle-strengthening and bone-building activities can be created to meet current physical activity recommendations for school-aged youth. Some youth may be involved in competitive sports while others enjoy various play and general activities. Parents and children can work together to come up with a weekly “physical activity menu” that lists several activities from which to choose, providing variety and promoting creativity. These are some examples:
· Active chores: washing the car, mowing the grass, doing yardwork
· Fun games: tag, kickball, Frisbee golf
· Playground activities: swinging on monkey bars, climbing on playground equipment, jumping rope, playing hopscotch
· Team sports: soccer, basketball, flag football, volleyball
· Other activities: swimming, tennis, dancing, lifting weights
Promoting Active Living and Healthy Eating in Youth
The use of the FitnessGram program to assess various components of health-related fitness is discussed in chapters 5, 6, and 7. FitnessGram is a part of the Presidential Youth Fitness Program (PYFP), which provides a model for educating school-aged youth about fitness within the context of a quality school-based physical education program. Children in kindergarten through third grade can participate in the PYFP Fitness Club and receive recognition for learning about various fitness components, while youth in 4th through 12th grade complete the FitnessGram assessment to determine whether their fitness scores fall within the Healthy Fitness Zone (HFZ). To track scores, use figure 9.3.
Families are encouraged to make healthy eating and active living a regular part of their lives. One way to promote these behaviors is to pledge to be a MyPlate Champion. This program encourages the following:
· Eat more fruits and veggies. Make half your plate fruits and vegetables every day.
· Try whole grains. Ask for oatmeal, whole-wheat breads, or brown rice at meals.
· Re-think your drink. Drink fat-free or low-fat milk or water instead of sugary drinks.
· Focus on lean protein. Choose protein foods like beans, fish, lean meats, and nuts.
· Slow down on sweets. Eat sweets, like cakes or cookies, once in a while and in small amounts.
· Be active your way. Find ways to exercise and be active for at least 1 hour a day like walking to school, riding your bike, or playing a sport with friends.
Kids that pledge to take these healthy actions can print a personalized certificate (see https://www.choosemyplate.gov/kids-become-myplate-champion).
When looking at ways to encourage activity, the PYFP suggests some ways that family members can become more active:
· Provide children with toys and play equipment (e.g., balls, kites, jump ropes) that can be used during play and physical activity.
· Encourage youngsters to learn or try to perform a new physical activity.
· Limit time spent watching television and don’t place a TV in a child’s bedroom. Children and youth who are 2 years of age and older should limit TV viewing to a maximum of 2 hours daily.
· Spend time together as a family performing an activity that requires moving, like going to the park, exploring trails, or biking on a greenway.
See what other activities are enjoyed by the family and make ongoing plans to be active together.
Q&A
What are some practical ways to encourage activity and healthy eating for a child who is overweight?
Developing a plan in consultation with the child's pediatrician along with talking over options with the child is key. The following are some ideas:
· Create an activity chart on which the child tracks physical activity (e.g., walking to school, taking the dog for a walk around the neighborhood park, riding a bike), and create a chart for the parents as well. The first one to reach 300 minutes of activity chooses the next weekend family outing (e.g., window shopping at the mall, a picnic at a local park, a day at the beach). At that point, everyone starts over and again works up to 300 minutes. This encourages each family member to find ways to increase activity, and the low-level competition can create a fun atmosphere of encouraging more activity.
· Limit TV viewing to one program per night. Replace television viewing with physical activity such as shooting baskets, playing Frisbee golf, or doing dance videos together. Replacing screen time with fun activities not only provides more physical activity, but also cuts down on the consumption of unneeded calories from snacking that often goes along with TV viewing.
· Commit to decreasing the number of visits to fast-food restaurants. Preparing some bulk meals on the weekend allows the family to quickly and easily prepare workday and school-day meals.
· Eat breakfast together. Setting the alarm clock to go off 20 minutes earlier allows time for breakfast together.
· Replace soda with low-fat milk for the child at breakfast and dinner. Water flavored with a lemon can be substituted at other meals and snacks.
All of these changes are steps toward helping the family increase physical activity and create a more nutritious diet.
Changes Over Time
Movement exploration and the acquisition of basic motor skills start early and continue during the first years of life. Once children enter school, their exposure to movement possibilities expands and motor skill patterns undergo further refinement. The school years are also a time when youth receive specialized instruction in physical education and gain familiarity with playing various games and sports. With the onset of adolescence, greater emphasis can be placed on using physical activity to improve and maintain cardiovascular and musculoskeletal health. Figure 9.4 illustrates how the relative contributions of motor skill development and physical activity as an agent for improving health and fitness change from birth to age 18 (33).
Figure 9.4 Relative contributions of motor skill development and prescriptive physical activity during childhood and adolescence.
Reprinted by permission from Strong, Malina, Blimkie, et al., 2005, p. 736.
With a balanced nutrition plan to complement a well-rounded physical activity program, children and adolescents can reap numerous health and fitness benefits and positive behavioral outcomes that can improve the ability to perform daily living activities and successfully engage in recreational and sport pursuits. Healthy youth also have a better chance of growing into healthy adults. It is never too early, or too late, to develop habits that promote healthy eating and active living.