Promotion of Physical Activity for Obesity Prevention in Youth

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Promotion of Physical Activity forObesity
Prevention in Youth

• Russell Pate
• Arnold School of Public Health
• University of South Carolina

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• Societal Trends
• Influencing Physical Activity

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Non-Motorized Transportation

• Percent of trips walked or biked by 5-15 year
  olds (McCann 2000)

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Transportation to School
How children get to school (US DOT 2000)
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Transportation to School
Percent of children walking and bicycling to
school by country (CA Safe Routes to Schools
1996, Dept. of Transport 2001, Gilewe et al.
1998, Carlin et al. 1997)
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Time Spent Viewing Television(Nielson Media
Research)
Hours Per Day
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TV Sets / VCRs / Computers / Internetper US
household
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Percentage of children ages 3 to 5 who are
enrolled in center based childhood care and
education programs
ChildStats.gov/ac2002
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Percentage of US StudentsEnrolled in PE
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Enrolled in PEYRBS
GRADE
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• Increasing Prevalence of
• Childhood Obesity

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Overweight (at or above 95th percentile of BMI)
children and adolescents 6-19 years of age
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Topics

• Feasibility
• Guidelines / Standards
• Status
• Promotion
• Recommendations

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Feasibility Of

• Preventing Obesity
• By Promoting
• Physical Activity in Youth

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Physical Activity and Physical Fitness in
African-American Girls With and Without Obesity

• Ward et al.
• Obesity Research
  19975572-577

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Methods

• 150 African American 5th grade students
• BMI greater than 85th percentile
• 54 with and 96 without obesity
• Completed 3 days of physical activity recall
• 3DPAR
• Week days
• After-school time

Ward et al., 1997
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Participation in Physical Activity
? 6 METs
?4 METs
Ward et al., 1997
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Effects of Decreasing Sedentary Behavior and
Increasing Activity on Weight Changein Obese
Children

• Epstein et al.
• Health Psychology
• 199514109-115

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Methods

• Obese children
• 8-12 years old
• From 61 families
• Randomized to treatment groups
• Increased exercise
• Decreased sedentary behaviors
• Both
• Followed for 1 year

Epstein et al., 1995
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Percent Overweight
0
4
8
12
P.026
Months
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Hypothetical Example

• Pre-obesity
• Age 6 years
• BMI 16.5 (12 Fat)
• Weight 22.7 Kg
• Obesity
• Age 12 years
• BMI 28.7 (35 Fat)
• Weight 64.5 Kg

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Hypothetical Example

• Weight Gain- Age 6-12
• 41.8 Kg
• Fat Gain - Age 6-12
• 20.2 Kg
• Excess Fat Gain- Age 6-12
• 13.1 Kg

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Hypothetical Example

• 100,870 Total Kcal
• 16,812 Kcal/Yr
• 323 Kcal/Wk
• 46 Kcal/ Day

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• How Physically Active Should Kids Be?

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Healthy People 2010Physical Activity in Children
and Adolescents   

• 22-6 Moderate physical activity in
  adolescents       
• 22-7 Vigorous physical activity in
  adolescents        
• 22-8 Physical education requirement in schools   
  
• 22-9 Daily physical education in schools 
• 22-10 Physical activity in physical education
  class   
• 22-11 Television viewing

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Healthy People 2010Physical Activity in Children
and Adolescents

• 22-6 Increase to at least 30 the proportion of
  young people in grades 9-12 who engage in
  moderate physical activity for at least 30
  minutes on five or more of the previous seven
  days.  

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Healthy People 2010Physical Activity in Children
and Adolescents

• 22-7 Increase to at least 85 the proportion of
  young people in grades 9-12 who engage in
  vigorous physical activity that promotes the
  development and maintenance of cardiorespiratory
  fitness 3 or more days per week for 20 or more
  minutes per occasion.

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San Diego ConsensusPhysical Activity Guidelines
for Adolescents

• Guideline 1
• All adolescents should be physically active
  daily, or nearly everyday, as part of play,
  games, sports, and transportation, recreation,
  physical education, or physical exercise, in the
  context of family, school, and community
  activities.

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San Diego ConsensusPhysical Activity Guidelines
for Adolescents

• Guideline 2
• Adolescents should engage in three or more
  sessions per week of activities that last 20 min
  or more at a time and that require moderate to
  vigorous levels of exertion.

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Health Education Authority Recommendation 1

• All children and youth should participate in
  physical activity that is of at least moderate
  intensity for an average of one hour per day.
  While young people should be physically active
  nearly every day, the amount of physical activity
  can appropriately vary from day to day in type,
  setting, intensity, duration, and amount.

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Health Education Authority Recommendation 2

• All children and youth should participate at
  least twice per week in physical activities that
  enhance and maintain strength in the musculature
  of the trunk and upper arm girdle.

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• How Active
• Are American Kids?

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National Children and YouthFitness Study I

• 1985
• n 8,000
• National probability sample
• Ages 10 - 18
• Six health-related fitness items
• Extensive physical activity report
• Itinerant testers

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NCYFSIWeekly minutes outside of PE
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YRBS - 2001

• 13,627 students completed questionnaires
• 50 states and the District of Columbia
• 87 items
• 7 physical activity items

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Youth Risk Behavior SurveillanceYRBS

• How many of the past 7 days
• Exercised or did PA for at least 20 min that made
  you sweat and breathe hard
• Participated in PA for at least 30 min that did
  not make you sweat or breathe hard
• Do exercise to strengthen or tone your muscles

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Youth Risk Behavior SurveillanceYRBS

• On an average school day, how many hours do you
  watch TV
• In an average week when in school, on how many
  days do you go to PE class
• During an average PE class, how many min do you
  spend actually exercising or playing sports?
• During the past 12 months, on how many sports
  teams did you play

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YRBS-20019th Grade
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YRBS-2001Boys
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YRBS-2001Girls
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CSA Monitor

• Computer Science and Applications, Inc.
• Model 7164
• Weighs 1.5 oz 5x5x1.5 cm
• Measures integrated accelerations in the vertical
  plane

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Amherst Health and Activity Study

• Subjects were recruited from 7 elementary
  schools, 1 junior high, and 1 senior high school
• 38 of the 3648 students enrolled in PE returned
  consent forms (n1379)
• Subjects (n400) were randomly selected to wear a
  CSA monitor for 7 days.
• Subjects were divided into 4 grade groups, A1-3,
  B4-6, C7-9 and Dgrades 10-12.

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Amherst Health Activity Cut-Points
METs2.7570(0.0015?Counts?min-1)-(0.0896?Age)-(0.
000038xcounts ? min-1?Age)
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Median MVPA Minutes/Day
males females (psignificantly different (pagegender interactions
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Median Vigorous Activity Minutes/Day
males females (psignificantly different (pagegender interactions
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Median Very Vigorous Minutes
males females (psignificantly different (pD No significant agegender interactions
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Percentage of children meeting HEA recommendation
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• Interventions
• To Promote Physical Activity
• In Youth

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Intervention Settings

• School
• Home
• Community
• Healthcare

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Active WinnersMethods

• A community-based physical activity intervention
• Quasi-experimental
• 1 Intervention County and 1 Comparison County
• Subjects were 5th grade students
• Intervention after school and summer camps
• Measures Students reported after-school
  activity
• 3 time points baseline, during and
  post-intervention

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Active WinnersMean daily blks of VPABoys
P.31
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Active WinnersMean daily blks of VPAGirls
P.43
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Go for HealthMethods

• Two intervention Schools and two control schools
• Classroom health education
• Environmental changes
• School Lunch
• Vigorous Physical Education

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Go For HealthMedian Minutes of MVPA in PE
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SPARKMethods

• Quasi-Experimental Design
• 7 schools assigned to 3 conditions
• Control
• Trained classroom teacher
• Physical Education specialist
• 4th and 5th grade, 955 students

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SPARKMVPA-Minutes per Lesson
PTC
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CATCHMethods

• A randomized, controlled field trial
• 4 field centers
• 56 Intervention schools, 40 Control schools
• 3rd to 5th grade, 5106 students

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CATCHVPA- of Lesson
F2.35, df5, 1979, P.04
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An Investigation of the Effects of Daily Physical
Activity on the Health of Primary School Students
in South Australia

• Dwyer et al., 1983
• Int J Epidemiol

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Methods

• 513 10-year olds from 7 primary schools in
  Adelaide, South Australia
• 3 classes per school- randomly allocated to
• Control - 3 half-hour periods of PE/ week
• Skill - 1.75 hr/day - skill instructions
• Fitness - 1.75 hr/day - vigorous PA
• 14 week program
• Measurements were made pre and post-intervention

Dwyer et al., 1983
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Changes after a 14 wk daily PE Program
Dwyer et al., 1983
p 64
Changes after a 14 wk daily PE Program
pDwyer et al., 1983
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LEAPMethods

• 8th grade girls from 24 high schools
• 1603 girls, 50 African-American
• School randomly assigned to control or
  intervention
• Physical activity 3DPAR
• In 8th grade at baseline
• In 9th grade during school based intervention

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LEAP Intervention Components

• Physical Education
• Other Health Components
• Health Education
• Health Environment
• Health Services
• Faculty/Staff Wellness
• Family/Community Environment

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LEAP PE

• Specific Objectives
• Develop behavioral skills
• Enhance physical activity self-efficacy
• Develop motor skills
• Provide enjoyable participation in physical
  activity
• Implement a personal out-of-school physical
  activity program

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Prevalence of Participation1 30-min blk of VPA
. Group P.05
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Prevalence of Participation1 30-min blk of VPA
Group P0.05 Trend P.02
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M-SPANMethods

• Environmental, policy, and social marketing
  intervention on physical activity.
• 24 middle schools randomly assigned to
  intervention or control condition.
• Over 2 years.
• Designed to increase physical activity in PE
  classes and through-out the day.
• Schools had a mean enrollment of 1109 and 44.5
  were non-white.

Sallis et al, 2003
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Moderate to Vigorous Physical Activity
P Sallis et al., 2003
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• Pates Recommendations
• For
• Increasing Physical
• Activity in
• Children and Youth

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Home/Family

• Limit electronic entertainment
• 1 hr/day
• Protect After-school
• Active recreation
• Maximize time outside
• Provide PA equipment

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Home/Family

• Be active with kids
• Help kids find Activities they enjoy
• Support sports, lessons, clubs

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School

• Enhance quality of PE
• Increase quantity of PE
• Retain/increase recess
• Diversify extracurricular opportunities
• Connect kids to community programs

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Community

• Provide comprehensive menu
• Support school to program to home transition
• Safe neighborhoods
• Parks, trails
• Safe routes to school

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Healthcare

• Screen for PA
• Patient evaluation
• Referral to Community providers
• Fund preventive services

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Public Health

• Make PA a priority
• Build infrastructure
• Invest in interventions