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Encouraging exercise in children and teenagers

Key learning points:

  •  Exercise is important for weight management and wider health

  •  Sedentary behaviour is increasing and affecting children’s health and wellbeing

  •  Understanding barriers children face in engaging in physical activity will help nurses to develop an action plan encouraging them to engage

Recent figures from the National Childhood Measurement Programme (NCMP) remind us that we are far off from reducing childhood obesity levels in England. In 2015/2016, childhood obesity levels increased from 9.1% to 9.3% in reception and from 19.1% to 19.8% in Year 6.[1] The Government’s plan to tackle this issue came through the ‘Childhood Obesity Strategy: A Plan for Action’, which outlines key strategic motions that aim to ‘significantly reduce the rates of childhood obesity over the next 10 years’.[2] Within the strategy, physical activity was positioned as a key priority in helping the nation’s children maintain a healthy weight.

Indeed, evidence shows body fat percentage decreases in children who engage in physical activity during weight management interventions, thereby having a positive impact on maintaining a healthy weight.[3] Additionally, when children are physically active, they make better food choices, which could result in a decreased risk of obesity.[4]

However, weight management is not just about physical activity. It is also about food intake, and the solutions to tackle obesity are far more complex than ‘energy in – energy out’. Therefore, aside from helping maintain a healthy weight, far more attention needs to be paid to the other benefits physical activity
has on children’s wellbeing and the vital role it has on their development.

Benefits of physical activity

From a young age, engaging in physical activity helps a child develop motor and cognitive function and also develop basic skills such as understanding rules, discipline and socialising.[5] Additionally, there has also been some evidence to suggest that physical activity enhances academic performance and helps create healthy behaviours that can be transferred into adult life.[6]

Across the age groups five to 18, engaging in physical activity has a significant impact on children’s cardiorespiratory, metabolic, musculoskeletal health and mental health.[7]

Physical activity recommendations

The Chief Medical Officer recommends that children aged five to 18 undertake at least 60 minutes of moderate to intense activity every day.[8 This advice also relates to children with physical, emotional, mental or intellectual impairments or challenges. However, it is recommended that due to safety concerns some specific activities may need to be adapted to individual needs.[8]

In order to achieve the benefits of physical activity, children should reach ‘moderate to intense activity’, which is characterised as breathing harder, with an increased heart rate while active.  Examples of physical activities include running, cycling, swimming and playing football.

Additionally, active travel and other forms of play also form part of physical activity as long as the moderate intensity level is reached.

Despite these recommendations and the clear evidence demonstrating the benefits of physical activity, in England only 21% of boys and 16% of girls aged five to 15 years old are meeting the recommended levels.[9]

Fewer children are exercising as a consequence of the modern lifestyle, whereby children are spending more time in sedentary activities such as watching TV and activities at the computer.[10]
Lack of physical activity and engagement in sedentary behaviours increases the risk of obesity and metabolic risk factors and has
a detrimental effect on children’s health.

Identifying young people who are not exercising

Identifying children who are not exercising can be a challenge because appearances can be deceiving. A young person who appears to be a healthy weight is not necessarily physically
active.

One way of determining if the child is physically active is to find out about their activities during assessments and history taking.  Direct questions such as 'do you exercise?' or 'are you physically active?' are unlikely to reveal the true picture. Instead you may want to ask the following:

  •      What is your understanding of being physically active?
  •      What do you spend your time doing after school or during holidays?
  •      How much time do you spend playing or doing outdoors activities?
  •      How much time do you spend on your phone at home or watching TV?

These questions can give a picture of the child’s involvement in physical activities.

Additionally, asking families to write a physical activity diary might also help in understanding what current activities they are engaging in. Just as food diaries have the potential of supporting people to change their diets, physical activity diaries help people understand what their current activity levels are and thereby help the individual to pinpoint where they can change and what would be realistic for them to alter.

You may also find asking children how they feel when they do physical education (PE) to be a revealing factor on whether they are engaging in the lesson. Even though children attend two PE lessons a week on average, their engagement varies. At this point, it would also be beneficial to describe how ‘moderate intense activity’ should feel so the child knows they are meeting that intensity next time they are active.

Encourage children to exercise

In order to encourage children to exercise, it is important to understand the barriers children face when trying to engage in physical activity.

Common barriers children face are:

  •      Living in urban areas, so no space to be active in.
  •      No access to open spaces or, if there is access, safety is an issue.
  •      Active travel is not an option, especially for secondary school children whose home is further away.
  •      Parents' working patterns mean children cannot play outside supervised.
  •      Cost of gym or swimming sessions.
  •      Children state they attend PE, but are not really engaging.
  •      Weather; some families believe their children will catch a cold if they play outside.

With these barriers and others, it is important for primary care nurses to support children and their families to find solutions to overcome them.

More importantly, by taking a patient-centred approach, primary care nurses can tease out the answer from the children or family. If the family finds a solution to their barrier they are more likely to engage with the solution rather than the one health professionals provide.

By talking about physical activity positively and about the benefits it brings, primary care nurses can demonstrate that physical activity can be fun, which will make it more likely for families to engage. It is also important for primary care nurses to highlight how physical activity can be incorporated in a person’s day-to-day life as the accessibility and relative ease of this will make families more likely to engage rather than seeing it as another chore.

What advice, support and signposting to other organisations can primary care nurses provide?

We recommended that primary care nurses:

Research local activity offers and make flyers with these initiatives to give to people in their clinics.

Find out about active travel in their area, including information about cycling lessons provided by the local council.

Familiarise themselves with the NHS campaign Change4life, which has good resources for children.

     Ask children about The Daily Mile in their schools.

     Print the infographic (left) and give it to families.[11]

References

1.     NHS Digital. National Child Measurement Programme – England, 2015-16 [NS].tinyurl.com/hvo45e8 (accessed 1 December 2016).

2.     HM Government. Childhood Obesity: A Plan for Action. 10800. Crown Copyright. 2016.

3.     Waters E, de Silva-Sanigorski A, Burford BJ et al. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews.2011; Issue 12. Art. No: CD001871.

4.     Scaglioni S, Arrizza C, Vecchi F et al. Determinants of children's eating behavior. Am J Clin Nutr 2011; 94(6 Suppl): 2006S-2011S.

5.     Gleave J, Hamilton I. A literature review on the effects of a lack of play on children’s lives.Play England, 2012.

6.     Public Health England. The link between pupil health and wellbeing and attainment. 2014491. Crown Copyright, 2014.

7.     World Health Organisation.Global Recommendations on Physical Activity for Health. QT 255. World Health Organisation, 2010.

8.     Department of Health. Physical Activity, Health Improvement and Protection. Start Active, Stay Active: A report on physical activity for health from the four home countries’ Chief Medical Officers.16306. Department of Health, 2011.

9.     Townsend N, Wickramasinghe K, Williams J et al. Physical Activity Statistics 2015. British Heart Foundation, 2015.

10.   Department of Health. Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence (2010) gov.uk/government/uploads/system/uploads/attachment_data/file/ (accessed 1 December 2016).

11.              UK Chief Medical Officers' Guidelines