Healthy Active Living Healthy Active Living Where Where Do Our Children Stand? Do Our Children Stand?

Claire LeBlanc MD, FRCP,

Dip Sport Med

*Adult Canadian Perceptions of *Adult Canadian Perceptions of Children’s Physical Activity LevelsChildren’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

Physical Inactivity Statistics *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

Why are Canadian Children Why are Canadian Children Inactive?Inactive?

Time pressures or competing priorities

Increased sedentary activities TV, computer, Nintendo

Inadequate role models - inactive parents

Why are Canadian Children Why are Canadian Children Inactive?Inactive?

Lack funds Unaware or lack of

recreational facilities Unsafe environments Lack of motor skills Seasonal (winter)

Why are Canadian Children Inactive?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

Health Implications of Health Implications of Physical InactivityPhysical 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

Childhood Obesity FactsChildhood 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

Canadian Obesity Epidemic 1985-1998Canadian Obesity Epidemic 1985-1998

Katzmarzyk, P. CMAJ 2002;166(8)

Childhood Obesity – Dietary Childhood Obesity – Dietary Factors *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

Childhood Obesity – Childhood Obesity – Sedentary FactorsSedentary 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

High Blood Pressure 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

High Blood PressureHigh 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

Type 2 Diabetes *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

Type 2 DiabetesType 2 Diabetes

Onset puberty Family history Ethnicity: African-

Americans, American Indians, Hispanics, Asians, Canadian Aboriginals

Osteoporosis 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

Osteoporosis 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

Adolescent depressionAdolescent 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

Canadian Youth Canadian Youth Mental Health - SmokingMental Health - Smoking

Average age onset smoking from 16 to 12 years over past 2 decades*

1998 grade 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

Canadian Youth Mental Canadian Youth Mental Health – Drugs *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

Canadian Youth Mental Canadian Youth Mental Health - DelinquencyHealth - 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

Canadian Youth - Pregnancy *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

Is Physical Activity the Answer?Is Physical Activity the Answer?

What Evidence Supports our What Evidence Supports our Case?Case?

PA Reduces Obesity*PA Reduces Obesity*

Healthy satisfying diet Family lifestyle

changes Reduce TV/video

games Regular physical

activity lifelong

*Bar-Or ACSM Roundtable Discussion Paper 1996

PA Reduces Hypertension *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

PA Prevents Type 2 Diabetes*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

PA Prevents OsteoporosisPA 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

PA Improves Mental HealthPA 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

Physical Activity Improves Physical Activity Improves Mental HealthMental 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

Physical Activity Improves Physical Activity Improves School Performance*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

High Academic AthletesHigh 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

There are Many Other Benefits of There are Many Other Benefits of

Physical ActivityPhysical Activity

Enjoyment Friends Learning new skills self confidence PA may track to

adulthood to reduce heart disease/stroke

How Much? How Often? 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.

Canada’s Physical Activity Guide to Canada’s Physical Activity Guide to Healthy Active Living for Children and Healthy Active Living for Children and

YouthYouth

2 guides Children 6-9 years old

– handbook, parent insert, tear sheet, interactive tool, teacher’s planning guide

Canada’s Physical Activity Guide to Canada’s Physical Activity Guide to Healthy Active Living for Children and Healthy Active Living for Children and

YouthYouth

Youth 10-14 years old– Handbook, family or

friend insert, tear sheet, interactive tool, teacher’s planning guide

EnduranceEndurance

Activities that increase breathing rate, increase heart rate, make the body warm – Walk, run, hike– Skate– Swim– Bike ride

FlexibilityFlexibility

Activities that promote good posture and balance– Bending– Stretching– Reaching– Yoga– Gymnastics

StrengthStrength

Activities that build muscles and bones– Rake the leaves– Shovel snow– Carry groceries– Wall or rope climbing

The Battle Against Physical The Battle Against Physical Inactivity Is Not a Solo FightInactivity Is Not a Solo Fight

RecommendationsRecommendations 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

Canadian Pediatric Society (CPS)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

Response from CPS membersResponse 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.”

CPS ActivitiesCPS Activities

grant 2001-2002 Created Healthy active

living advisory committee(2001) + liaison withCollege of FamilyPhysicians of Canada

Published positionstatement on healthy activeliving *

Developed workshop andconcurrent session for CPSannual meeting June 2002

*LeBlanc CMA et al. Paediatrics and Child Health 2002;7 (5):339-345

CPS Future PlansCPS 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

CPS Future PlansCPS Future Plans

Launch supplements to PA guides fall 2002

Workshop for CFP and CPS AGMs 2003

Board representation Foundation for Active Healthy Kids