1. Empowering Youth Through Physical Activity: Using Bright Futures Bonnie A. Spear, PhD, RD Associate Professor Pediatrics University of Alabama at Birmingham

2. Bright Futures Guidelines Guidelines for Health Supervision for Infants, Children and Adolescents

4. Bright Futures Management Web site: www.ncemch.org

5. Bright Futures in Practice Series Oral Health Oral Health Nutrition Nutrition Physical Activity Physical Activity Mental Health (forthcoming) Mental Health (forthcoming) Children with Special Health Care Needs (forthcoming) Children with Special Health Care Needs (forthcoming)

6. Surgeon General’s Report  Nearly half of adolescent ages 12-21 did not participate regularly in vigorous physical activity  About 14 percent of children and adolescents did not participate in light to moderate physical activity

7. Physical Activity in Children and Adolescents  Benefits of Physical Activity  Increase bone mass/reduce risk osteoporosis  Reduce obesity  Lower blood pressure  Improve blood lipids  Reduce anxiety and stress

8. Benefits of Physical Activity  Increasing bone mass/reducing risk of osteoporosis –PA helps build greater bone density – Helps maintain peak bone mass into adulthood –In order to increase greater bone mineralization children and adolescents need to participate in weight-bearing PA Jumping rope, walking, playing soccer, dancingJumping rope, walking, playing soccer, dancing

9. Benefits of Physical Activity  Reduces Obesity –PA is crucial for obtaining and maintaining a healthy weight –Increasing PA helps in reducing sedentary behaviors –Reducing inactivity is a critical factor in reducing obesity –Helps in controlling blood sugars in children with Type 2 diabetes

10. Benefits of Physical Activity  Lowers Blood Pressure –In children with elevated blood pressure, PA can significantly lower both systolic and diastolic blood pressure

11. Benefits of Physical Activity  Improve Blood Lipids – Regular PA in adults improves blood lipid levels, particularly by increasing HDL-C.. Which are associated with a reduction in arteriosclerosis –Impact of PA on HDL-C in children is unclear, but higher HDL-C have been seen in children with regular PA

12. Benefits of Physical Activity  Reduces anxiety and stress –Regular PA has the potential to promote psychological well being Improve self-esteemImprove self-esteem Reduce level of anxietyReduce level of anxiety Reduce symptoms of depressionReduce symptoms of depression

13. But How Do You Get Kids More Active?

15. n Families as partners n Families as caregivers n Families as teachers n Families as resources Families Matter!

16. Health professionals Families Child care professionals Social service professionals Schools Local and state government Community groups Business/industry Faith communities Payers Health Promotion Is Everybody’s Business

17. Improve the health and physical status of infants, children, and adolescents Improve the health and physical status of infants, children, and adolescents Establish health supervision guidelines focusing on physical activity Establish health supervision guidelines focusing on physical activity Vision and Goals: Bright Futures in Practice: Physical Activity

18. How the Guide Can Be Used Clinical Clinical Community Community Policy Policy Education and Training Education and Training

19. How the Guide Can Be Used: Clinical Incorporate into each health supervision visit Incorporate into each health supervision visit Develop and evaluate physical activity programs Develop and evaluate physical activity programs Implement standards of practice and protocol Implement standards of practice and protocol Educate children, adolescents, and their families Educate children, adolescents, and their families

20. How the Guide Can Be Used: Community Provide anticipatory guidance to families on developmentally appropriate physical activity Provide anticipatory guidance to families on developmentally appropriate physical activity Develop physical activity programs Develop physical activity programs Help schools incorporate physical activity education into health curricula Help schools incorporate physical activity education into health curricula Implement standards of practice and protocol Implement standards of practice and protocol

21. How the Guide Can Be Used: Policy Provide information to policymakers, program administrators, and community leaders on relevant physical activity issues and concerns Provide information to policymakers, program administrators, and community leaders on relevant physical activity issues and concerns Obtain support for physical activity policies and programs Obtain support for physical activity policies and programs

22. How the Guide Can Be Used: Education and Training Educate and train health professionals and paraprofessionals Educate and train health professionals and paraprofessionals Provide in-service education and training to staff Provide in-service education and training to staff Use as a textbook or reference Use as a textbook or reference

23. Four Major Developmental Stages Infancy 0–11 Months Early Childhood 1–4 Years Middle Childhood 5–10 Years Adolescence 11–21 Years

24. Asthma Asthma Children and adolescents with special health care needs Children and adolescents with special health care needs Eating Disorders Eating Disorders Diabetes Diabetes Girls and Female Adolescents in Physical Activity Girls and Female Adolescents in Physical Activity Ergogenic aids Ergogenic aids Heat-related illness Heat-related illness Injury Injury Obesity Obesity Physical Activity Issues and Concerns Chapters

25. Motor Skills Development During Middle Childhood- p.58 Age Motor skills being developed Appropriate activities 5-6 Fundamentals (e.g., running, galloping jumping, hopping, skipping, throwing, catching, kicking Fundamentals (e.g., running, galloping jumping, hopping, skipping, throwing, catching, kicking Activities that focus on having fun and developing motor skills rather than competition Activities that focus on having fun and developing motor skills rather than competition Simple activities that require little instruction Simple activities that require little instruction Repetitive activities that do not require complex motor and cognitive skills (e.g., running, swimming, tumbling) Repetitive activities that do not require complex motor and cognitive skills (e.g., running, swimming, tumbling)

26. Motor Skills Development During Middle Childhood- p.58 Age Motor skills being developed Appropriate activities 7-9 Fundamentals Fundamentals Transitional (e.g. throwing for accuracy) Transitional (e.g. throwing for accuracy) Activities with flexible rules Activities with flexible rules Activities that do not require complex motor and cognitive skills (e.g., entry-level baseball) Activities that do not require complex motor and cognitive skills (e.g., entry-level baseball) Activities that require little instruction Activities that require little instruction

27. Motor Skills Development During Middle Childhood- p.58 Age Motor skills being developed Appropriate activities 10-11 Transitional Transitional Complex (e.g., playing basketball) Complex (e.g., playing basketball) Activities that focus on having fun and developing motor skills Activities that focus on having fun and developing motor skills Activities that require entry-level complex motor and cognitive skills Activities that require entry-level complex motor and cognitive skills Activities that continue to emphasize motor skill development but that begin to incorporate instruction on strategy and teamwork Activities that continue to emphasize motor skill development but that begin to incorporate instruction on strategy and teamwork

28. Interview Questions (p55-56)  Are there any physical activities you enjoy but don’t participate in? If so, which ones? Why?  Do you feel that you are good at physical activities you enjoy? If so, which ones? Why?  Do you think you are in good shape?  How much time each day do you spend each day watching TV?

29. Overweight Screening Procedure (171) BMI Overweight BMI > 95 th % At risk for overweight BMI >85 th 85 th < 95 th % Not at risk for overweight BMI <85th In-depth medical assessment Screening Return next yr.

30. Treatment- p.172  Treat uncomplicated obesity with: –Achieving healthy eating behaviors –Participating in regular physical activity –Achieve psychological well being

31. Physical Activity Counseling (page 173) Begin intervention early Begin intervention early Recommend that parents focus on gradually changing the entire family’s eating and physical activity behaviors Recommend that parents focus on gradually changing the entire family’s eating and physical activity behaviors Encourage children and adolescents to participate in physical activities they enjoy Encourage children and adolescents to participate in physical activities they enjoy Encourage children and adolescent to reduce sedentary behaviors (e.g., watching TV, playing computer games) Encourage children and adolescent to reduce sedentary behaviors (e.g., watching TV, playing computer games)

32. Frequently Asked Questions (175)  How can I encourage my son to be more physically active? Encourage spur-of-the-moment physical activityEncourage spur-of-the-moment physical activity Participate in physical activity together- biking, hiking, skatingParticipate in physical activity together- biking, hiking, skating Involve child in family chores- raking, walking the dogInvolve child in family chores- raking, walking the dog

33. Appropriate Physical Activity for Children (187)  Guidelines- Elementary: 30-60 minutes of age and developmentally appropriate physical activity from a variety of physical activities on all, or most days.30-60 minutes of age and developmentally appropriate physical activity from a variety of physical activities on all, or most days. Some of the child’s activity each day should be in periods lasting 10-15 minutesSome of the child’s activity each day should be in periods lasting 10-15 minutes

34. The Stages of Change ( pg 182-186)  Precomptemplation - unaware  Contemplation – good intentions  Preparation – getting ready  Action – is involved in PA  Maintenance – PA > 6 months

35. Precontemplation Key Concepts  Identify the benefits of physical activity  Explain the benefits relevant to your patient  Recommend that your patient consider starting some type of activity

36. Counseling Statements for the Precomptemplator Counseling Statements for the Precomptemplator  “Jane, being more physically active is one of the most important things you can do to stay healthy, both physically and mentally.”  “Jane by starting something as easy as walking with your friends, it could help you maintain a healthier weight and feel more energetic.

37. Contemplator and Preparation Phases Key Concepts  Identify benefits of physical activity  Help your patient chose appropriate physical activities  Identify barriers to physical activity  Evaluate your patient’s confidence in their ability to make the change

38. Identify benefits of physical activity  “ What do you hope to gain?”  “ If active before, what did you like or enjoy? Why did you stop?

39. Help your patient choose appropriate physical activities  “ Jane, what types of physical activities do you enjoy”?  “Are there any activities you have enjoyed in the past?”  “Do you participate in physical activities at school? With your family?”

40. Identify barriers to physical activity  “If you were active before, why did you quit?”  “ Do you feel that you are good at physical activities?  “Is your neighborhood safe for walking/ jogging?”

41. Evaluate your patient’s confidence “Jane, on a scale of 1 to 5 how confident are you that you will start this physical activity plan?” “Jane, on a scale of 1 to 5 how confident are you that you will start this physical activity plan?” If low, ask why, problem solve and revise plan if needed If low, ask why, problem solve and revise plan if needed

42. Action and Maintenance Phases Action and Maintenance Phases  Key Concepts – Praise the adolescent for being physically active – Help the adolescent remain physically active – Help the adolescent identify social support – Help the adolescent assess confidence in remaining active

43. Praise the Adolescent’s Successful Activity “Jane, I am really pleased that you have started walking to school. I bet you feel more energetic and you have lost 3 pounds since your last visit.”

44. Help the adolescent remain physically active  “Jane, I think walking to school is a great start. Have you thought about what you could do on the weekends that is fun and physically active?”  “What activity have you thought about doing this summer since you will not be walking to school each day?”

45. Help the adolescent identify social support Help the adolescent identify social support  “Jane, do you have a friend that can walk or do other physical activities with you. It is always easier and more fun to do things with your friends”  “Are other family members supportive of your choice to be more active? What do your parents do that is physically active?”

46. Assess adolescent’s confidence “Jane, on a scale of 1 to 5 how confident are you that you will continue regular physical activity over the next three months?” If low, ask why and problem solve with the child/adolescent

47. Counseling Parents  Review the child/adolescent’s plan for increasing her physical activity  Provide positive reinforcement for any small improvement  Be a positive role model  Participate in physical activity with your daughter  Provide healthy choices for snacks

48. Features of excellent coaching (pg 196) Features of excellent coaching (pg 196)  Makes the sport/activity fun  Improves existing skills & teaches new ones  Helps the adolescent feel successful  Uses a positive style of interaction  Recognizes & avoids competitive stress  Avoids overemphasis on competition’s outcome

49. Physical Activity Resources- p. 198  For health providers there are over 100 web sites in different areas of physical activity. Such as –American College of Sports Medicine –National Association for Health and Fitness –YMCA –Rails to Trails Conservancy –Shape Up America! –President’s Council on Physical Fitness and Sports

50. In Summary  Health professionals are one part of our country’s efforts to encourage children and adolescents to adopt a physically active lifestyle.  Bright Futures in Practice: Physical Activity, can enhance health professional’s ability to deliver this important message in a more knowledgeable, effective and developmentally appropriate fashion.

51. Bright Futures In Practice Physical Activity – Disease specific recommendations for activity – Strategies for effective behavioral change counseling – Advocating for the promotion of physical activity in clinics, schools, and within communities.

52. Bright Futures In Practice Physical Activity  A user-friendly source of practical information for the promotion of physical activity covering: – Benefits of Physical Activity – Assessment of Physical Activity – Developmentally Appropriate Activity Recommendations – Common problems/ issues related to physical activity

53. To order additional materials and to find out more about Bright Futures, contact: Bright Futures Project National Center for Education in Maternal and Child Health Maternal and Child Health Georgetown University 2000 15th Street, North, Suite 701 Arlington, VA 22201-2617 Tel: (703) 524-7802 Fax: (703) 524-9335 E-mail: BrightFutures@ncemch.org Bright Futures Web site: www.brightfutures.org

54. Permission must be requested in writing from the National Center for Education in Maternal and Child Health before using any slides contained in this presentation