Transcript 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
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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 *
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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
Inactive?
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Time pressures or
competing priorities
 Increased sedentary
activities TV,
computer, Nintendo
 Inadequate role
models - inactive
parents
Why are Canadian Children
Inactive?
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Lack funds
Unaware or lack of
recreational facilities
Unsafe environments
Lack of motor skills
Seasonal (winter)
Why are Canadian Children Inactive?
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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 *
Health Implications of Physical
Inactivity
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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 Facts
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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
Canadian Obesity Epidemic 1985-1998
Katzmarzyk, P. CMAJ 2002;166(8)
Childhood Obesity – Dietary
Factors *
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1970-1994 absolute
grams fat 154  159 g/d
(USA)
200%  fast-food
restaurant visits 19771995
Fast-foods high in fat and
energy (Big Mac +
medium fries = 83%
recommended daily fat
intake)
Mega-meals
Childhood Obesity –
Sedentary Factors
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TV watching strong
link (sedentary +
commercials + eating
fatty snacks *
 Despite  fat intake
1995 – 2001,  rate
obese kids
 Labor-saving devices
High Blood Pressure
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~ 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 Pressure
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Tracking adolescence
into adulthood
established :
~ 50% HT boys,
~40% HT girls remain
HT 8 yrs later *
Type 2 Diabetes *
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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 Diabetes
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Onset puberty
 Family history
 Ethnicity: AfricanAmericans, American
Indians, Hispanics,
Asians, Canadian
Aboriginals
Osteoporosis
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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
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
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*Wiktorowicz et al. Osteoporos Int 2001;12(4):271-8
Adolescent depression
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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
Mental Health - Smoking
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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 Health
– Drugs *
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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 Health
- Delinquency
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~ 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 *
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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?
What Evidence Supports our
Case?
PA Reduces Obesity*
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Healthy satisfying diet
 Family lifestyle
changes
 Reduce TV/video
games
 Regular physical
activity lifelong
*Bar-Or ACSM Roundtable Discussion Paper 1996
PA Reduces Hypertension *
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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*
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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 Osteoporosis
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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 Health
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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
Mental Health
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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
School Performance*
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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 Athletes
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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
Physical Activity
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Enjoyment
Friends
Learning new skills
self confidence
 PA may track to
adulthood to reduce
heart disease/stroke
How Much? How Often?
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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
Healthy Active Living for Children and
Youth
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2 guides
 Children 6-9 years old
– handbook, parent
insert, tear sheet,
interactive tool,
teacher’s planning
guide
Canada’s Physical Activity Guide to
Healthy Active Living for Children and
Youth
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Youth 10-14 years old
– Handbook, family or
friend insert, tear sheet,
interactive tool,
teacher’s planning
guide
Endurance
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Activities that
increase breathing
rate, increase heart
rate, make the body
warm
– Walk, run, hike
– Skate
– Swim
– Bike ride
Flexibility
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Activities that
promote good
posture and balance
– Bending
– Stretching
– Reaching
– Yoga
– Gymnastics
Strength
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Activities that build
muscles and bones
– Rake the leaves
– Shovel snow
– Carry groceries
– Wall or rope climbing
The Battle Against Physical
Inactivity Is Not a Solo Fight
Recommendations
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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,
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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)
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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 members
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“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 Activities
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grant 2001-2002
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Created Healthy active
living advisory committee
(2001) + liaison with
College of Family
Physicians of Canada
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Published position
statement on healthy active
living *
Developed workshop and
concurrent session for CPS
annual meeting June 2002
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*LeBlanc CMA et al. Paediatrics and Child Health 2002;7 (5):339-345
CPS Future Plans
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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 Plans
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Launch supplements
to PA guides fall 2002
 Workshop for CFP and
CPS AGMs 2003
 Board representation
Foundation for Active
Healthy Kids