empowering youth through physical activity: using bright futures bonnie a. spear, phd, rd associate...

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Empowering Youth Empowering Youth Through Physical Through Physical

Activity:Activity: Using Bright FuturesUsing Bright Futures

Bonnie A. Spear, PhD, RDBonnie A. Spear, PhD, RD

Associate Professor PediatricsAssociate Professor Pediatrics

University of Alabama at BirminghamUniversity of Alabama at Birmingham

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Bright Futures Bright Futures GuidelinesGuidelines

Guidelines for Health Supervision for Guidelines for Health Supervision for Infants, Children and AdolescentsInfants, Children and Adolescents

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Bright Futures Bright Futures ManagementManagement

Web site: www.ncemch.org

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Bright Futures Bright Futures in Practice Seriesin Practice Series

Oral HealthOral Health

Nutrition Nutrition

Physical ActivityPhysical Activity

Mental Health (forthcoming)Mental Health (forthcoming)

Children with Special Health Children with Special Health

Care Needs (forthcoming)Care Needs (forthcoming)

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Surgeon General’s Surgeon General’s ReportReport

Nearly half of adolescent ages 12-21 Nearly half of adolescent ages 12-21 did not participate regularly in did not participate regularly in vigorous physical activityvigorous physical activity

About 14 percent of children and About 14 percent of children and adolescents did not participate in adolescents did not participate in light to moderate physical activitylight to moderate physical activity

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Physical Activity in Physical Activity in Children and Children and AdolescentsAdolescents

Benefits of Physical ActivityBenefits of Physical Activity Increase bone mass/reduce risk Increase bone mass/reduce risk

osteoporosisosteoporosis Reduce obesityReduce obesity Lower blood pressureLower blood pressure Improve blood lipidsImprove blood lipids Reduce anxiety and stressReduce anxiety and stress

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Benefits of Physical Benefits of Physical ActivityActivity

Increasing bone mass/reducing risk of Increasing bone mass/reducing risk of osteoporosisosteoporosis– PA helps build greater bone densityPA helps build greater bone density– Helps maintain peak bone mass into Helps maintain peak bone mass into

adulthoodadulthood– In order to increase greater bone In order to increase greater bone

mineralization children and adolescents need mineralization children and adolescents need to participate in weight-bearing PAto participate in weight-bearing PA• Jumping rope, walking, playing soccer, dancingJumping rope, walking, playing soccer, dancing

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Reduces ObesityReduces Obesity– PA is crucial for obtaining and PA is crucial for obtaining and

maintaining a healthy weightmaintaining a healthy weight– Increasing PA helps in reducing Increasing PA helps in reducing

sedentary behaviorssedentary behaviors– Reducing inactivity is a critical factor in Reducing inactivity is a critical factor in

reducing obesityreducing obesity– Helps in controlling blood sugars in Helps in controlling blood sugars in

children with Type 2 diabeteschildren with Type 2 diabetes

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Lowers Blood PressureLowers Blood Pressure– In children with elevated blood In children with elevated blood

pressure, PA can significantly lower pressure, PA can significantly lower both systolic and diastolic blood both systolic and diastolic blood pressurepressure

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Improve Blood LipidsImprove Blood Lipids– Regular PA in adults improves blood Regular PA in adults improves blood

lipid levels, particularly by increasing lipid levels, particularly by increasing HDL-C.. Which are associated with a HDL-C.. Which are associated with a reduction in arteriosclerosisreduction in arteriosclerosis

– Impact of PA on HDL-C in children is Impact of PA on HDL-C in children is unclear, but higher HDL-C have been unclear, but higher HDL-C have been seen in children with regular PAseen in children with regular PA

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Reduces anxiety and stressReduces anxiety and stress– Regular PA has the potential to promote Regular PA has the potential to promote

psychological well beingpsychological well being• Improve self-esteemImprove self-esteem• Reduce level of anxietyReduce level of anxiety• Reduce symptoms of depressionReduce symptoms of depression

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But How Do You But How Do You Get Kids More Get Kids More

Active?Active?

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Families as partnersFamilies as partners

Families as caregiversFamilies as caregivers

Families as teachersFamilies as teachers

Families as resourcesFamilies as resources

Families Families Matter!Matter!

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Health professionalsHealth professionals

FamiliesFamilies

Child care professionalsChild care professionals

Social service professionalsSocial service professionals

SchoolsSchools

Local and state governmentLocal and state government

Community groupsCommunity groups

Business/industryBusiness/industry

Faith communitiesFaith communities

PayersPayers

Health Promotion Is Health Promotion Is Everybody’s BusinessEverybody’s Business

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Improve the health and physical Improve the health and physical status of infants, children, and status of infants, children, and adolescentsadolescents

Establish health supervision Establish health supervision guidelines focusing on physical guidelines focusing on physical activityactivity

Vision and Goals: Vision and Goals: Bright Futures in Bright Futures in Practice: Physical Practice: Physical

ActivityActivity

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How the Guide How the Guide Can Be UsedCan Be Used

Clinical Clinical

CommunityCommunity

PolicyPolicy

Education and Education and TrainingTraining

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How the Guide Can Be How the Guide Can Be Used: ClinicalUsed: Clinical

Incorporate into each health Incorporate into each health supervision visitsupervision visit

Develop and evaluate physical activity Develop and evaluate physical activity programsprograms

Implement standards of practice and Implement standards of practice and protocolprotocol

Educate children, adolescents, and Educate children, adolescents, and their familiestheir families

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How the Guide Can Be How the Guide Can Be Used: CommunityUsed: Community

Provide anticipatory guidance to Provide anticipatory guidance to families on developmentally families on developmentally appropriate physical activityappropriate physical activity

Develop physical activity programs Develop physical activity programs Help schools incorporate physical Help schools incorporate physical

activity education into health curriculaactivity education into health curriculaImplement standards of practice and Implement standards of practice and

protocolprotocol

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How the Guide Can Be How the Guide Can Be Used: PolicyUsed: Policy

Provide information to Provide information to policymakers, program policymakers, program administrators, and community administrators, and community leaders on relevant physical leaders on relevant physical activity issues and concernsactivity issues and concerns

Obtain support for physical Obtain support for physical activity policies and programsactivity policies and programs

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How the Guide Can Be How the Guide Can Be Used: Education and Used: Education and

TrainingTraining

Educate and train health Educate and train health professionals and professionals and paraprofessionalsparaprofessionals

Provide in-service education and Provide in-service education and training to stafftraining to staff

Use as a textbook or referenceUse as a textbook or reference

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Four Major Four Major Developmental Developmental

StagesStages

Infancy 0–11

Months

Early Childhood1–4 Years

Middle Childhood 5–10

Years

Adolescence

11–21 Years

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AsthmaAsthma Children and adolescents with special health Children and adolescents with special health

care needscare needs Eating DisordersEating Disorders DiabetesDiabetes Girls and Female Adolescents in Physical Girls and Female Adolescents in Physical

ActivityActivity Ergogenic aidsErgogenic aids Heat-related illnessHeat-related illness InjuryInjury ObesityObesity

Physical Activity Issues Physical Activity Issues and Concerns Chaptersand Concerns Chapters

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Motor Skills Development Motor Skills Development During Middle Childhood-During Middle Childhood-

p.58p.58AgeAge Motor skills Motor skills

being being developeddeveloped

Appropriate activitiesAppropriate activities

5-65-6 •Fundamentals Fundamentals (e.g., running, (e.g., running, galloping jumping, galloping jumping, hopping, skipping, hopping, skipping, throwing, catching, throwing, catching, kickingkicking

•Activities that focus on having Activities that focus on having fun and developing motor skills fun and developing motor skills rather than competitionrather than competition

• Simple activities that require Simple activities that require little instructionlittle instruction

•Repetitive activities that do not Repetitive activities that do not require complex motor and require complex motor and cognitive skills (e.g., running, cognitive skills (e.g., running, swimming, tumbling)swimming, tumbling)

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7-9 7-9 •FundamentalsFundamentals

•Transitional (e.g. Transitional (e.g. throwing for throwing for accuracy)accuracy)

•Activities with flexible rulesActivities with flexible rules

•Activities that do not require Activities that do not require complex motor and cognitive complex motor and cognitive skills (e.g., entry-level baseball)skills (e.g., entry-level baseball)

•Activities that require little Activities that require little instructioninstruction

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10-1110-11 •TransitionalTransitional

•Complex (e.g., Complex (e.g., playing playing basketball)basketball)

•Activities that focus on having fun Activities that focus on having fun and developing motor skills and developing motor skills

•Activities that require entry-level Activities that require entry-level complex motor and cognitive skillscomplex motor and cognitive skills

•Activities that continue to Activities that continue to emphasize motor skill development emphasize motor skill development but that begin to incorporate but that begin to incorporate instruction on strategy and instruction on strategy and teamworkteamwork

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Interview Questions Interview Questions (p55-(p55-56)56)

Are there any physical activities you enjoy Are there any physical activities you enjoy but don’t participate in? If so, which ones? but don’t participate in? If so, which ones? Why?Why?

Do you feel that you are good at physical Do you feel that you are good at physical activities you enjoy? If so, which ones? activities you enjoy? If so, which ones? Why?Why?

Do you think you are in good shape?Do you think you are in good shape? How much time each day do you spend How much time each day do you spend

each day watching TV?each day watching TV?

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Overweight Screening Overweight Screening Procedure (171)Procedure (171)

BMIBMI

OverweightOverweightBMI > 95BMI > 95thth%%

At risk for At risk for overweightoverweight

BMI >85BMI >85thth < 95 < 95thth % %

Not at risk for Not at risk for overweightoverweight

BMI <85thBMI <85th

In-depth medical In-depth medical assessmentassessment

ScreeningScreening Return next yr.Return next yr.

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Treatment- Treatment- p.172p.172

Treat uncomplicated obesity with:Treat uncomplicated obesity with:– Achieving healthy eating behaviorsAchieving healthy eating behaviors– Participating in regular physical activity Participating in regular physical activity – Achieve psychological well beingAchieve psychological well being

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Physical Activity Physical Activity Counseling (page 173)Counseling (page 173)• Begin intervention earlyBegin intervention early• Recommend that parents focus on Recommend that parents focus on

gradually changing the entire family’s gradually changing the entire family’s eating and physical activity behaviorseating and physical activity behaviors

• Encourage children and adolescents to Encourage children and adolescents to participate in physical activities they participate in physical activities they enjoyenjoy

• Encourage children and adolescent to Encourage children and adolescent to reduce sedentary behaviors (e.g., reduce sedentary behaviors (e.g., watching TV, playing computer games)watching TV, playing computer games)

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Frequently Asked Frequently Asked Questions (175)Questions (175)

How can I encourage my son to be How can I encourage my son to be more physically active?more physically active?• Encourage spur-of-the-moment Encourage spur-of-the-moment

physical activityphysical activity• Participate in physical activity Participate in physical activity

together- biking, hiking, skatingtogether- biking, hiking, skating• Involve child in family chores- raking, Involve child in family chores- raking,

walking the dogwalking the dog

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Appropriate Physical Appropriate Physical Activity for Children Activity for Children

(187)(187) Guidelines- Elementary: Guidelines- Elementary: • 30-60 minutes of age and 30-60 minutes of age and

developmentally appropriate physical developmentally appropriate physical activity from a variety of physical activity from a variety of physical activities on all, or most days. activities on all, or most days.

• Some of the child’s activity each day Some of the child’s activity each day should be in periods lasting 10-15 should be in periods lasting 10-15 minutesminutes

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The Stages of Change The Stages of Change ( pg 182-186)( pg 182-186)

Precomptemplation - unawarePrecomptemplation - unaware Contemplation – good Contemplation – good

intentionsintentions Preparation – getting readyPreparation – getting ready Action – is involved in PAAction – is involved in PA Maintenance – PA > 6 monthsMaintenance – PA > 6 months

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PrecontemplationPrecontemplationKey ConceptsKey Concepts

Identify the benefits of Identify the benefits of physical activityphysical activity

Explain the benefits relevant to Explain the benefits relevant to your patientyour patient

Recommend that your patient Recommend that your patient consider starting some type of consider starting some type of activityactivity

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Counseling Statements Counseling Statements for the for the

PrecomptemplatorPrecomptemplator ““Jane, being more physically active Jane, being more physically active

is one of the most important things is one of the most important things you can do to stay healthy, both you can do to stay healthy, both physically and mentally.”physically and mentally.”

““Jane by starting something as easy Jane by starting something as easy as walking with your friends, it as walking with your friends, it could help you maintain a healthier could help you maintain a healthier weight and feel more energetic. weight and feel more energetic.

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Contemplator and Contemplator and Preparation PhasesPreparation Phases

Key ConceptsKey Concepts

Identify benefits of physical activityIdentify benefits of physical activity

Help your patient chose appropriate Help your patient chose appropriate physical activitiesphysical activities

Identify barriers to physical activityIdentify barriers to physical activity

Evaluate your patient’s confidence in Evaluate your patient’s confidence in their ability to make the changetheir ability to make the change

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Identify benefits of Identify benefits of physical activityphysical activity

“ “ What do you hope to gain?”What do you hope to gain?”

““ If active before, what did you If active before, what did you like or enjoy? Why did you like or enjoy? Why did you stop? stop?

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Help your patient Help your patient choose appropriate choose appropriate physical activitiesphysical activities

“ “ Jane, what types of physical Jane, what types of physical activities do you enjoy”?activities do you enjoy”?

““Are there any activities you have Are there any activities you have enjoyed in the past?”enjoyed in the past?”

““Do you participate in physical Do you participate in physical activities at school? With your activities at school? With your family?”family?”

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Identify barriers to Identify barriers to physical activityphysical activity

““If you were active before, If you were active before, why did you quit?”why did you quit?”

“ “ Do you feel that you are Do you feel that you are good at physical activities?good at physical activities?

““Is your neighborhood safe Is your neighborhood safe for walking/ jogging?”for walking/ jogging?”

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Evaluate your patient’s Evaluate your patient’s confidence confidence

““Jane, on a scale of 1 to 5 how Jane, on a scale of 1 to 5 how confident are you that youconfident are you that youwill start this physical activity will start this physical activity plan?”plan?”

If low, ask why, problem solve If low, ask why, problem solve and revise plan if neededand revise plan if needed

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Action and Action and Maintenance Phases Maintenance Phases

Key ConceptsKey Concepts

– Praise the adolescent for being physically Praise the adolescent for being physically activeactive

– Help the adolescent remain physically Help the adolescent remain physically activeactive

– Help the adolescent identify social Help the adolescent identify social supportsupport

– Help the adolescent assess confidence in Help the adolescent assess confidence in remaining activeremaining active

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Praise the Adolescent’s Praise the Adolescent’s Successful ActivitySuccessful Activity

““Jane, I am really pleased that Jane, I am really pleased that you have started walking to you have started walking to school. I bet you feel more school. I bet you feel more energetic and you have lost 3 energetic and you have lost 3 pounds since your last visit.”pounds since your last visit.”

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Help the adolescent Help the adolescent remain physically remain physically

activeactive ““Jane, I think walking to school is a Jane, I think walking to school is a

great start. Have you thought great start. Have you thought about what you could do on the about what you could do on the weekends that is fun and physically weekends that is fun and physically active?”active?”

““What activity have you thought What activity have you thought about doing this summer since you about doing this summer since you will not be walking to school each will not be walking to school each day?”day?”

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Help the adolescent Help the adolescent identify social support identify social support

““Jane, do you have a friend that can Jane, do you have a friend that can walk or do other physical activities walk or do other physical activities with you. It is always easier and with you. It is always easier and more fun to do things with your more fun to do things with your friends” friends”

““Are other family members Are other family members supportive of your choice to be more supportive of your choice to be more active? What do your parents do active? What do your parents do that is physically active?”that is physically active?”

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Assess adolescent’s Assess adolescent’s confidenceconfidence

““Jane, on a scale of 1 to 5 how Jane, on a scale of 1 to 5 how confident are you that you will confident are you that you will

continue regular physical continue regular physical activity over the next three activity over the next three

months?”months?”

If low, ask why and problem If low, ask why and problem solve with the child/adolescentsolve with the child/adolescent

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Counseling ParentsCounseling Parents

Review the child/adolescent’s plan for Review the child/adolescent’s plan for increasing her physical activityincreasing her physical activity

Provide positive reinforcement for Provide positive reinforcement for any small improvementany small improvement

Be a positive role modelBe a positive role model

Participate in physical activity with Participate in physical activity with your daughteryour daughter

Provide healthy choices for snacksProvide healthy choices for snacks

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Features of excellent Features of excellent coaching coaching (pg 196) (pg 196)

Makes the sport/activity funMakes the sport/activity fun

Improves existing skills & teaches new onesImproves existing skills & teaches new ones

Helps the adolescent feel successfulHelps the adolescent feel successful

Uses a positive style of interactionUses a positive style of interaction

Recognizes & avoids competitive stressRecognizes & avoids competitive stress

Avoids overemphasis on competition’s Avoids overemphasis on competition’s outcomeoutcome

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Physical Activity Physical Activity Resources- Resources- p. 198p. 198

For health providers there are over 100 For health providers there are over 100 web sites in different areas of physical web sites in different areas of physical activity. Such asactivity. Such as– American College of Sports MedicineAmerican College of Sports Medicine– National Association for Health and FitnessNational Association for Health and Fitness– YMCAYMCA– Rails to Trails ConservancyRails to Trails Conservancy– Shape Up America!Shape Up America!– President’s Council on Physical Fitness and President’s Council on Physical Fitness and

SportsSports

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In Summary In Summary

Health professionals are one part of Health professionals are one part of our country’s efforts to encourage our country’s efforts to encourage children and adolescents to adopt a children and adolescents to adopt a physically active lifestyle. physically active lifestyle.

Bright Futures in Practice: Bright Futures in Practice: Physical Activity, can enhance Physical Activity, can enhance health professional’s ability to health professional’s ability to deliver this important message in a deliver this important message in a more knowledgeable, effective and more knowledgeable, effective and developmentally appropriate fashion.developmentally appropriate fashion.

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Bright Futures In Practice Bright Futures In Practice Physical ActivityPhysical Activity

– Disease specific Disease specific recommendations for activity recommendations for activity

– Strategies for effective Strategies for effective behavioral change counselingbehavioral change counseling

– Advocating for the promotion of Advocating for the promotion of physical activity in clinics, physical activity in clinics, schools, and within communities.schools, and within communities.

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Bright Futures In Practice Bright Futures In Practice Physical ActivityPhysical Activity

A user-friendly source of practical A user-friendly source of practical information for the promotioninformation for the promotion of of physical activity covering:physical activity covering:

– Benefits of Physical ActivityBenefits of Physical Activity– Assessment of Physical ActivityAssessment of Physical Activity– Developmentally Appropriate Developmentally Appropriate

Activity Recommendations Activity Recommendations – Common problems/ issues related Common problems/ issues related

to physical activityto physical activity

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To order additional To order additional materials and to find out materials and to find out

more about Bright Futures, more about Bright Futures, contact:contact:

Bright Futures ProjectBright Futures ProjectNational Center for Education in National Center for Education in Maternal and Child HealthMaternal and Child HealthGeorgetown UniversityGeorgetown University2000 15th Street, North, Suite 7012000 15th Street, North, Suite 701Arlington, VA 22201-2617Arlington, VA 22201-2617Tel: (703) 524-7802Tel: (703) 524-7802Fax: (703) 524-9335Fax: (703) 524-9335

E-mail: [email protected]: [email protected]

Bright Futures Web site: Bright Futures Web site: www.brightfutures.orgwww.brightfutures.org

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

empowering youth through physical activity: using bright futures bonnie a. spear, phd, rd associate...

Documents

forthcoming slide

physical activity visio

vigorous physical activity

regular pa slide

stress slide

birmingham slide

diabetes slide

dancing slide