Promoting Physical Activity at Well Child Visits

A Training for CHDP Providers

Developed by:State of California CHDP Nutrition Subcommittee

July 2012

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Objectives

After the training, providers will be able to:Identify the benefits of regular physical

activity (PA) in youthDescribe the key PA guidelines for children

and adolescentsRecognize developmentally-appropriate PAIdentify effective ways to promote PA for all

children

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Role of Provider in Promoting Physical Activity

Screen for appropriate PA at each health assessment visit*

Share developmentally appropriate PA with family*

Discuss PA and healthy lifestyles for obesity prevention

Recommend PA community resources for low-income families

* CHDP Health Assessment Guidelines Section 54

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Benefits Associated with Physical Activity

Improves cardiorespiratory fitnessBuilds and maintains healthy bones and

musclesPromotes a positive self-imagePositively affects concentration, memory, and

classroom behaviorReduces risk of developing chronic diseases:

obesity, type 2 diabetes and heart disease

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Percentile Weight Status> 95th Obese

85th to < 95th Overweight

5th to 85th Normal

< 5th Underweight

BMI for Children and Teens

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Overweight & Obese ChildrenCalifornia children ages 2 to < 5 years

2010 Prevalence Rates

16.6 15.6 12.9 14.8 16.1

18.813.8

11.913.2

17.3

0

10

20

30

40

Hispanic White Asian Black All Groups

Per

cent

age

Overweight: 85 - < 95% BMI Obese: > or = 95% BMI

2010 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report

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Overweight & Obese ChildrenCalifornia children ages 5 to < 20 years

2010 Prevalence Rates

19.5 17.6 13.9 17.8 18.8

24.820.2

12.6

21.2 23.3

0

10

20

30

40

50

Hispanic White Asian Black All Groups

Per

cent

age

Overweight: 85 - < 95% BMI Obese: > or = 95% BMI

2010 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report

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Guidelines for Children Birth to Five Years

All children from birth to age 5 should engage in daily physical activity that promotes movement skillfulness and foundations of health-related fitness*

*National Association for Sport and Physical Education, 2009

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Physical Activity for InfantsStructured & unstructured activities:Safe area, easy to explore, small space Toys to promote development of motor skillsFocus on large musclesLimit periods of restricted movement (bouncy seat

or car seat)Skills to promote:Head control, graspingRolling, crawling, standing Low-cost PA ideas to share:Peek-a-boo and pat-a-cake, Rattle, kitchen pans

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Physical Activity for Toddlers

Structured activity:At least 30 minutes/dayUnstructured activity:At least 60 minutes/dayNot be sedentary for > 60 minutes at a time

Low-cost PA ideas to share:Climbing on the playground, playing tag,

tumbling, or tossing a ball through hoops

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Physical Activity for Preschoolers

Structured activity:At least 30 minutes/dayUnstructured activity:At least 60 minutes/dayNot be sedentary for > 60 minutes at a time

Low-cost PA ideas to share:Running or tumblingThrowing & catching

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How Much Physical Activity do Children and Adolescents Need?

1 hour (60 minutes) or more of aerobic physical activity (PA) that is at least moderate*Most of the 1 or more hours/day should be

either moderate- or vigorous-intensity PADo vigorous-intensity PA at least 3

days/weekEncourage participation in PA that is:

Age appropriate, enjoyable, offers variety*2008 Physical Activity Guidelines for Americans, Children & Adolescents (ages 6-17)

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Physical Activity DefinitionsModerate activity = activity of an intensity

equal to a brisk walk, such as hiking, active recreation, softballCan be performed for relatively long

periods of time without fatigueVigorous activity = movement of a higher

intensity than a brisk walk, such as running, sports, martial artsMay require frequent rests between bouts

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Guidelines for Children and Adolescents (ages 6-17)

Aerobic Activity

Muscle Strengthening Activity

Bone Strengthening Activity

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Aerobic ActivityShould make up most of the 60 minutes of

daily activity and be either moderate- or vigorous-intensity aerobic activity

Include vigorous activity at least 3 days/weekActivities that involve rhythmic movement of

large muscle groupsRunning, hopping, skipping, jumping rope,

swimming, dancing, bicycling, tag, skating

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Muscle Strengthening ActivityInclude at least 3 days/week as part of 60

minutesConditioning using resistance to increase

muscular strengthCan be unstructured and part of play –

playing on playground equipment, climbing trees, and playing tug-of-war

Can be structured – free weights, weight machines or resistance bands, push-ups

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Bone Strengthening

Include at least 3 days per week as part of 60 minutes

Activities that produce an impact or tension force on the bones

Include running, jumping, basketball, tennis, hopscotch

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Brief Focused AdviceStep #1: Engage the Patient/ParentHow do you feel about your child’s weight?Step #2: Share InformationYour child’s current weight puts him/her at risk for diabetes,

heart disease, asthma…Step #3: Make a Key Advice StatementI would strongly encourage you to …Get up and play hard at least one hour a dayCut back on screen time to < 2 hours a dayEat at least 5 helpings of fruits & vegetables every dayCut back on soda, sports drinks, juice and sweetened drinksStep #4: Arrange for Follow-upLet’s set up a future appointment to talk about how things

are going. Effective Communications with Families, Kaiser Permanente © 2004

Brief Focused Advice:Role Playing Exercise

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Weight Assessment & Counseling for Nutrition & Physical Activity for Children/Adolescents

HEDIS 2011HEDIS measures assess the quality of

healthcare deliveredTo meet the HEDIS requirement, the chart

note should include one of the following:Discussion of current PA behaviors, indication

that PA was addressed, counseling or referral for PA, educational materials or anticipatory guidance for PA

HEDIS Measure available at: www.ncqa.org

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PM 160 Documentation Enter follow up code in

appropriate column under “PROBLEM SUSPECTED” if child is outside the healthy weight range

Document any discussion of, or referral for, physical activity

XXXXXXXXXXXX

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Meeting the GuidelinesYouth Who Don’t Meet the Guidelines

Slowly increase activity in small stepsParticipate in enjoyable activities

Youth Who Meet the GuidelinesContinue being active on a daily basisWork toward becoming more active

Youth Who Exceed the GuidelinesMaintain activity levelVary the kinds of activities to reduce injury risk

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Local Physical Activity ResourcesParks & Recreation Department/Community CentersYMCABoys & Girls ClubBoy/Girl ScoutsGirls on the RunAmerican Youth Soccer Organization (AYSO)Police Activities League (PAL)PA multi-media (YouTube, fitness shows on TV)Team sports & classes (soccer, baseball, basketball,

dance, gymnastics etc.)

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Exercise Prescription

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Summary/Promoting Physical ActivityProvider

Discuss PA as part of routine screeningBrief Focused AdviceRefer to community programs

Office*Foster a healthy officePA posters and incentives

* Refer to AIM-HI Practice Manual, American Academy of Family Physicians. Available: www.americansinmotion.org

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References

NASPE. Active Start: A Statement of Physical Activity Guidelines for Children From Birth to Five Years. 2009

NASPE. Physical Activity for Children. A Statement of Guidelines for Children Ages 5-12. 2004

U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Active Children and Adolescents.

For the AIM-HI Practice Manual, go to: www.americansinmotion.org

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