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One-third of American children are overweight or obese. Although many factors contribute to this epidemic, one cause for the rise in childhood obesity is a decrease in physical activity. We now live in a society where more children are driven to school than walking themselves. Video games and social media are now the entertainment of choice instead of riding bikes or playing tag. More than half of communities are without sidewalks and parks, which makes physical activity difficult or dangerous.

As nurses, we must act now because it’s estimated that 80% of children who are obese will grow up to be obese adults. Obese adults lead lives plagued with diabetes, hypertension, respiratory conditions, and heart disease. It’s possible that this obesity epidemic will lead to a generation of children that will have shorter lives compared to past generations. Nurses who work in settings where health care is provided for children and families can take the opportunity to provide education concerning the benefits of physical activity. The focus of this article is to provide nurses with information about the Centers for Disease Control and Prevention (CDC) recommendations concerning physical activity in children and discuss strategies to help families increase physical activity in our busy society.

Physical activity recommendations

The CDC divides its recommendations by age group.

  • Unstructured play several times each day is recommended for children younger than 6 years. (Unstructured play is described as child-led free play that includes adult engagement, support, and prompts as needed.)
  • Children over the age of 6 should participate in at least 60 minutes of physical activity each day.

A well-balanced physical activity regimen includes three components: aerobic activity, muscle strengthening, and bone strengthening.

Aerobic activity

Aerobic activity is moderate to vigorous intensity exercise that increases heart rate and causes one to breathe harder than normal. Children should engage in aerobic activity for most of the 60 minutes each day and at least 3 days each week. A variety of outdoor and indoor activities can be used to meet this goal, including running, bicycling, swimming, dancing, jumping rope, playing tag, skating, and playing sports such as basketball, soccer, and tennis.

Muscle strengthening

Children should engage in muscle strengthening activities at least 3 days each week. Muscle strengthening activities can go beyond standard push-ups, sit-ups, pull-ups, and weight lifting. Playtime that includes activities such as tree climbing, rock climbing, running, handstands, and tug of war also can help to build strong muscles.

Bone strengthening

Bone strengthening activities also should be included at least 3 days each week. A bone strengthening exercise is any activity that promotes impact to the bones such as jumping rope, dancing, hiking, running, skipping, playing basketball, and playing tennis.

These three components — aerobic activity, muscle strengthening, and bone strengthening — can be achieved through a variety of activities that may meet the requirements in one or more components. One example of a multiple component activity is the “7-minute workout” which uses one’s body weight, a chair, and a wall. The workout includes 12 exercises that incorporate high-intensity aerobic activity (jumping jacks, chair step-ups), muscle strengthening (push-ups, abdominal crunches, squats), and bone strengthening (high-knees running in place) into 7 minutes. (An app for this workout is available for Apple and Android devices.) The activity can be repeated multiple times in one setting or throughout the day to achieve recommended activity recommendations. See Exercises that address multiple components of physical activity for other examples.

Identifying barriers

Nurses can help children and parents identify common barriers to physical activity. First, recognize that finding the time, energy, and resources for regular physical activity can be a challenge. Then, ask the child and/or parent what barriers they have experienced.

We all know today’s families live fast-paced lives that can drain them of time and energy. Sometimes in trying to maximize their time, physical activity is sacrificed. Many of us can empathize with the habits of driving most places instead of walking and parking in the closest parking spot to save a few minutes of time. Morning and evening routines often do not include making time for physical activity. The alarm goes off in the morning and everyone scurries to get out the door to school and work. At the end of the busy day it is easy to come home and sit in front of the television or play computer games to relax.

Environment and financial resources also can be barriers to physical activity. Neighborhoods that do not have safe outdoor areas such as walking trails or parks may cause parents to keep their children inside. Parents may decide that extracurricular activities such as sports or gymnastics are too expensive.

Perhaps most importantly, children may lack role models who are active themselves and view exercise as fun and important. When parents do not engage in regular physical activity, children are less likely to value this as an important health-promoting part of life.

Overcoming barriers

Once barriers are identified, you can help parents think outside the box and be creative in how they can get their children to be more active. Most important is for parents to be active themselves to set a good example. Engaging in physical activity as a family is a great way to do this. Discuss obtainable and sustainable beginning goals to build confidence in making changes that can become part of the daily family routine. This might be taking a 15-minute walk, jog, or bike ride together before or after dinner.

Breaking the habit of using television and computers for entertainment instead of physical activity can be difficult. The American Academy of Pediatrics recommends no more than 2 hours of screen time per day. Encourage parents to set limits on electronic device usage. Suggest alternatives, such as dance videos or other aerobic exercise DVDs or playing charades. Even when watching television, setting up jumping jacks, push-ups, and sit-ups competitions during commercials is a creative way of incorporating exercise into daily life.

Another way of increasing physical activity is by using a pedometer. Pedometers provide the wearer with instant, accurate feedback. Individuals are often amazed when they use a pedometer and see just how inactive they really are. After the initial shock, however, pedometers are a great way for family members to monitor activity, and competitions can be held amongst family members to increase activity.

When children or parents fall below the recommended activity level they should plan for slow progression to meet their ultimate goal. The American College of Sports Medicine and The U.S. President’s Challenge Physical Activity and Fitness Awards program recommends 12,000 steps each day for children and 8,500 steps for adults. 

Using the whole day

Physical activity does not have to occur in one 60-minute time frame each day. Nurses can provide children and parents with examples of how physical activity can be spread throughout the day. (See Spreading activity across the whole day.) 

Long-term benefits

Parents play the most significant role in influencing physical activity in their children. Finding ways to improve physical activity can be challenging and parents can feel overwhelmed. As nurses, we can help families address their specific needs, overcome barriers, and find creative ways to incorporate physical activity into their lives.

To make physical activity a part of a child’s daily life, encourage parents to keep it fun and allow children to explore their individual abilities and interests when possible. The hope is to reverse the inactivity epidemic by establishing healthy habits during childhood so that the future generations of adults will only know active lifestyles. The benefits in the long-term can reach beyond the individual child and family and flow into our communities to initiate change and improve health.

MeeDeessa Livingston is a staff nurse practitioner at U.S. Naval Hospital in Guantanamo Bay, Cuba, and Beth Kelsey is DNP program director and an assistant professor at Ball State University in Muncie, Indiana. 

Selected references

American College of Sports Medicine. Children’s daily step count can be used to gauge physical activity goals. 2012.

Centers for Disease Control and Prevention. Childhood overweight and obesity. 2012.

Centers for Disease Control and Prevention. How much physical activity do children need? 2012.

Centers for Disease Control and Prevention. Youth physical activity: The role of families. 2009.

Klika B, Jordan C. High intensity circuit training using body weight: maximum results with minimal investment. Am Coll Sports Med. 2013;17(3):8-13.

Nemours Health and Prevention Services. Best practices for physical activity: a guide to help children grow up healthy. 2009.

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