1. Healthy Active Living Where Do Our Children Stand? Claire LeBlanc MD, FRCP, Dip Sport Med

2. *Adult Canadian Perceptions of Children’s Physical Activity Levels 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

3. Physical Inactivity Statistics * 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

4. Why are Canadian Children Inactive? Time pressures or competing priorities Increased sedentary activities TV, computer, Nintendo Inadequate role models - inactive parents

6. Why are Canadian Children Inactive? Lack funds Unaware or lack of recreational facilities Unsafe environments Lack of motor skills Seasonal (winter)

7. Why are Canadian Children Inactive? 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 * * CAHPERD 1999

8. Health Implications of Physical Inactivity 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

9. Childhood Obesity Facts 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 * Tremblay and Willms CMAJ 2000;163(11):1429-1433; CMAJ 2001;164(7):970

10. Canadian Obesity Epidemic 1985-1998 Katzmarzyk, P. CMAJ 2002;166(8)

12. Childhood Obesity – Dietary Factors * 1970-1994  absolute grams fat 154  159 g/d (USA) 200%  fast-food restaurant visits 1977- 1995 Fast-foods high in fat and energy (Big Mac + medium fries = 83% recommended daily fat intake) Mega-meals * French et al. Ann Rev Public Health 2001;22:309-35

15. Childhood Obesity – Sedentary Factors TV watching strong link (sedentary + commercials + eating fatty snacks * Despite  fat intake 1995 – 2001,  rate obese kids Labor-saving devices * Dietz and Gortmaker. Pediatrics 1985;75:807-12

17. High Blood Pressure ~ 3 million USA youths affected Associated with obesity Tracking from adolescence into adulthood established* * Anderson and Haraldsdottir J Int Med 1993;234:309-315

18. High Blood Pressure Tracking adolescence into adulthood established : ~ 50% HT boys, ~40% HT girls remain HT 8 yrs later * * Anderson and Haraldsdottir J Int Med 1993;234:309-315

19. Type 2 Diabetes * 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

20. Type 2 Diabetes Onset puberty Family history Ethnicity: African- Americans, American Indians, Hispanics, Asians, Canadian Aboriginals

21. Osteoporosis 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

22. Osteoporosis Peak bone mass 3 rd 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 *Wiktorowicz et al. Osteoporos Int 2001;12(4):271-8

23. Adolescent depression Adolescent depression 113,000 Canadian 12-17 year olds depressed * Suicide 2 nd 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

24. Canadian Youth Mental Health - Smoking 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

25. Canadian Youth Mental Health – Drugs * 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

26. Canadian Youth Mental Health - Delinquency ~ 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

27. Canadian Youth - Pregnancy * 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

28. Is Physical Activity the Answer?

29. What Evidence Supports our Case?

30. PA Reduces Obesity* Healthy satisfying diet Family lifestyle changes Reduce TV/video games Regular physical activity lifelong *Bar-Or ACSM Roundtable Discussion Paper 1996

31. PA Reduces Hypertension * 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

32. PA Prevents Type 2 Diabetes* 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

33. PA Prevents Osteoporosis 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

34. PA Improves Mental Health 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

35. Physical Activity Improves Mental Health 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

36. Physical Activity Improves School Performance* 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

37. High Academic Athletes 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

38. There are Many Other Benefits of Physical Activity Enjoyment Friends Learning new skills  self confidence  PA may track to adulthood to reduce heart disease/stroke

39. How Much? How Often? 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.

40. Canada’s Physical Activity Guide to Healthy Active Living for Children and Youth 2 guides Children 6-9 years old – handbook, parent insert, tear sheet, interactive tool, teacher’s planning guide

41. Canada’s Physical Activity Guide to Healthy Active Living for Children and Youth Youth 10-14 years old – Handbook, family or friend insert, tear sheet, interactive tool, teacher’s planning guide

42. Endurance Activities that increase breathing rate, increase heart rate, make the body warm – Walk, run, hike – Skate – Swim – Bike ride

43. Flexibility Activities that promote good posture and balance – Bending – Stretching – Reaching – Yoga – Gymnastics

44. Strength Activities that build muscles and bones – Rake the leaves – Shovel snow – Carry groceries – Wall or rope climbing

45. The Battle Against Physical Inactivity Is Not a Solo Fight

46. Recommendations 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, 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

47. Canadian Pediatric Society (CPS) 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

48. Response from CPS members “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.”

50. CPS Future Plans 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

51. CPS Future Plans Launch supplements to PA guides fall 2002 Workshop for CFP and CPS AGMs 2003 Board representation Foundation for Active Healthy Kids