Promoción Salud Pública de la Salud y Epidemiología Physical activity and health in children and adolescents A guide for all adults involved in educating young people MINISTERIO MINISTERIO DE SANIDAD DE EDUCACIÓN Y CONSUMO Y CIENCIA 01 portadilla ingles 25/1/07 11:34 Página 1 Physical Activity and Health in Children and Adolescents A Guide for all Adults Involved in Educating Young People 01 portadilla ingles 25/1/07 11:34 Página 2 Institutional Coordinators Dr.Begoña Merino Merino,Ph.D.,MD Ministry of Health and Consumer Affairs Elena González Briones Ministry of Education and Science Working Group Dr.Susana Aznar-Laín Lecturer in the Faculty of Sports Sciences, University of Castilla La Mancha, Toledo, Spain. Ph.D.in the area of Physical Activity and Health, University of Bristol, U.K. M.Sc.in Exercise and Health Sciences, University of Bristol, U.K. Health and Fitness Instructor as recognized by the American College of Sports Medicine (ACSM). Dr.Tony Webster Ph.D.in the area of Exercise Physiology, University of Alberta, Canada. M.Sc.in Exercise and Health Sciences, University of Bristol, U.K. B.Sc.in Biochemistry, University of Bristol, U.K. Collaborator Dr.Jose López Chicharro Professor of Exercise Physiology, Complutense University, Madrid, Spain. Doctor of Medicine, Sports Medicine Specialist.Complutense University, Madrid, Spain. MINISTERIO DE SANIDAD Y CONSUMO © MINISTERIO DE EDUCACIÓN Y CIENCIA Secretaría General de Educación Centro de Investigación y Documentación Educativa (CIDE) © MINISTERIO DE SANIDAD Y CONSUMO Dirección General de Salud Pública Subdirección General de Promoción de la Salud y Epidemiología Imprime:Grafo, S.A. Depósito Legal:BI-3.390-06 NIPO:351-06-042-1 02 indice ingles 25/1/07 11:47 Página 3 Table of Contents Table of Contents Introduction.......................................................................................................... 7 1. Why this physical activity guide?...................................................................... 7 2. Who is this guide designed for? ...................................................................... 8 3. Objectives of this guide.................................................................................... 8 Part 1 . Important Concepts of Physical Activity and Physical Fitness ...................................................................... 11 1. Definitions........................................................................................................ 11 2. Important descriptors of physical activity and exercise .................................... 12 3. Clarification of moderate intensity physical activity.......................................... 13 4. Further methods for gauging intensity of physical activity................................ 13 4.1. The talk test ............................................................................................ 13 4.2. Heart rate ................................................................................................ 14 4.3. Rating of perceived exertion using a Borg Scale...................................... 15 4.4. Metabolic equivalent (MET) level ............................................................ 15 5. Different components of physical activity ........................................................ 16 5.1. Cardiovascular (aerobic) activities .......................................................... 16 5.2. Muscular strength and endurance activities ............................................ 17 5.3. Flexibility activities .................................................................................. 18 5.4. Coordination activities.............................................................................. 19 6. Health related vs.athletic performance physical fitness................................................................................................ 19 Part 2 . Physical Activity,Physical Fitness and the Health of Young People.................................................................................. 23 1. Dose-response issues concerning physical activity and health........................................................................................................ 23 2. The importance of physical activity for the health of young people .................. 24 2.1. Health benefits during childhood.............................................................. 25 2.2. Childhood activity and health as an adult ................................................ 26 2.3. Establishment of lifetime activity patterns................................................ 26 Physical Activity and Health in Children and Adolescents 3 02 indice ingles 25/1/07 11:47 Página 4 Table of Contents 3. Physical activity, sedentary behaviour and physical fitness in Spanish young people .................................................................................................. 27 4. The linkage between physical inactivity and childhood overweight and obesity...................................................................................................... 28 5. Definition and measurement of overweight and obesity .................................. 30 6. Health consequences of obesity in young people............................................ 31 7. Overweight and obesity in Spanish young people............................................ 32 8. Obesity and the NAOS initiative in Spain.......................................................... 33 9. Further safety issues regarding physical activity in young people .................................................................................................. 34 9.1. Risk of traumatic or overuse injury .......................................................... 34 9.2. Risk of heat or cold injuries...................................................................... 35 9.3. Risk of drowning and other water injuries ................................................ 35 Part 3 . Physical Activity Recommendations for Children and Adolescents .............................................................................. 37 1. Physical activity recommendations for children and adolescents .................. 37 2. How can children and adolescents achieve the physical activity recommendations?........................................................................................ 38 3. The Physical Activity Pyramids for children and teens.................................... 39 4. Measurement of physical activity in young people.......................................... 41 5. Why are children less active now? ................................................................ 42 6. Physical activity levels during the lifespan...................................................... 42 7. Prevention of inactivity during adolescence .................................................. 43 8. Influences on childrens’and adolescents’physical activity behaviour ...................................................................................................... 45 8.1. The familial environment........................................................................ 45 8.2. Personal characteristics (individual and demographic factors) .............. 46 8.3. The physical environment...................................................................... 46 8.4. The social environment.......................................................................... 47 9. Changing physical activity behaviour in young people .................................. 48 10. Physical activity in young people and gender inequality ................................ 49 11. Physical activity in young people and social inequality .................................. 51 Part 4. Practical Suggestions for the Promotion of Physical Activity in Young People .......................................... 55 1. Practical suggestions for encouraging lifelong physical activity among young people .................................................................................................. 56 2. Selecting appropriate physical activities for young people .............................. 58 3. How to encourage behaviour change in young people .................................... 60 4. Some important things for older children and adolescents to know.................. 61 5. Possible class projects for children and adolescents........................................ 63 6. Ideas tried by instructors for promotion of physical activity in school classes and elsewhere in the community ........................................................ 63 4 Physical Activity and Health in Children and Adolescents 02 indice ingles 25/1/07 11:47 Página 5 Table of Contents 7. Including everyone .......................................................................................... 67 7.1. Students with special needs .................................................................... 67 7.2. Gender inclusion...................................................................................... 68 7.3. Cultural inclusion .................................................................................... 68 7.4. Ability inclusion........................................................................................ 69 7.5. Very low fitness or obesity........................................................................ 69 7.6. Asthma.................................................................................................... 70 Part 5. Physical Activity in the School Environment and the Community............................................................................ 73 1. The changing influence of schools on behaviour of modern day children ........ 73 2. Strengths and limitations of school-based approaches for the promotion of physical activity............................................................................................ 74 3. The importance of physical education in schools ............................................ 75 4. «Traditional» vs.«modern» physical education................................................ 76 5. Adult perceptions of physical education and physical activity .......................... 77 6. Other methods of promoting physical activity in schools and communities...... 78 7. Recommendations for promoting physical activity in young people in school, community and home settings ........................................................................ 79 Part 6 . Healthy Nutrition to support a Physically Active Lifestyle .................................................................................. 83 Part 7 . Where do we go from here? .......................................................... 87 Definitions............................................................................................................ 89 Bibliography........................................................................................................ 93 Physical Activity and Health in Children and Adolescents 5 02 indice ingles 25/1/07 11:47 Página 6 03 introduccion ingles 25/1/07 11:35 Página 7 Introduction Introduction 1. Why this physical activity guide? The human body evolved to be physically active.In other words, our bodies re- quire physical activity to remain healthy. Throughout history, survival of the human species depended on hunting or gathering our food supplies, pursuits that demanded prolonged and often strenuous physical activity. The advent of mechanization and modern technology in the last few decades has resulted in the human race becoming less physically active than ever before – and we are paying for it with our health. Regular physical activity is associated with a healthier, longer life [1, 2].Howev- er, the majority of adults and young people in Spain are insufficiently physically active for health benefits.The situation is similar worldwide in both developed and developing countries, with a large body of research evidence indicating declining levels of physical activity and physical fitness within all age brackets.Physical inactivity is widely recog- nized as a major risk factor for chronic diseases, and ranks between the second and sixth most important risk factor in contributing to the population burden of disease in western society [3-5].Its prevalence is higher than that of all other modifiable risk fac- tors [5].Physical inactivity during the early years of life is currently indicated as a major contributor to the increasing levels of obesity, and other serious medical conditions, being seen in children and adolescents in Europe and elsewhere [6, 7].The increased political, media and scientific interest in obesity since the late 1990’s has placed physi- cal activity high among current public health issues. The nature of children’s recreational pursuits has changed dramatically over the last few decades.Whereas children used to spend much of their recreational time engaged in active outdoor play, the emergence of television, computer games and the internet has meant that children are now spending much more of their free time engaged in sedentary pursuits.The importance of physical activity for the physical, mental and social health of youth is undisputed, and therefore it is critically important that efforts are made throughout the world to “reintroduce” physical activity into our youth.The purpose of this guide is to assist in this drive towards a more physically ac- tive youth in Spain.The Government of Spain is keen that all parents, teachers and Physical Activity and Health in Children and Adolescents 7 03 introduccion ingles 25/1/07 11:35 Página 8 Introduction other child educators participate in improving the levels of physical activity among Spain’s youth.This needs to be an urgent priority. Unquestionably, the challenges posed by the growing issue of physical inactivity and childhood obesity can be considered to be some of the greatest challenges to public health in the 21st century.The responsibility to improve levels of childhood phys- ical activity and other health related childhood behaviours lies with everyone in society. However, as an individual directly involved with children, you are an especially impor- tant part of the influential network.Schools, homes and the community are excellent locations to assist children in improving health related lifestyle behaviours such as physical activity. Let’s start to get Spain’s kids active! 2. Who is this guide designed for? This guide is designed to inform adults that work with young people about the importance of physical activity for this population and how it can be promoted effec- tively both within the school environment, the home environment and elsewhere within the community.It is an important information source for all people involved in educa- tion of children and adolescents, including schoolteachers, trainers, coaches, moni- tors, parents and health professionals.It is a relatively detailed document yet has been written in a manner that is designed to be informative both for adults with advanced knowledge of physical activity (PE teachers, monitors, trainers, health professionals, etc.) and for those who have limited knowledge of the area. As much as possible, we have attempted to avoid excessively complicated word- ing.However, there is a list of key definitions and words that are used within the main text at the end of this guide in the event of confusion.In this guide, the term “young people” encompasses both children (under the age of puberty) and youth (adoles- cents). 3. Objectives of this guide The guide has been laid out in such a manner with the major goals being: 1. To improve understanding of important concepts and issues regarding physi- cal activity and physical fitness, 2. To provide information regarding the importance of physical activity for the health of young people, both during the younger years and also in later life, 3. To describe current physical activity recommendations for young people and how these recommendations can be achieved, 8 Physical Activity and Health in Children and Adolescents 03 introduccion ingles 25/1/07 11:35 Página 9 Introduction 4. To provide information regarding how physical activity may be effectively pro- moted in young people within schools, homes and the community, and 5. To briefly describe the characteristics of a sound diet to support a physically active lifestyle in young people. The overriding goal of this guide is to assist in improving the levels of physical activity in young people in Spain. Physical Activity and Health in Children and Adolescents 9