The Evidence is in . . .

Hundreds of millions of dollars of child health research has been compiled over decades. It all points directly to the need for projects such as "Animal Exercise Fun." 

Contents:

OBESITY: Halting the Epidemic by Making Health Easier

Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity

Physical Activity Facts

Elementary School Physical Education:
A Scientifically Documented Position Statement

Healthy America: Wellness Where We Live, Work and Learn

Resources of Federal Agencies

Resources of Health and Fitness Organizations

Rates of Return to Additional Investments in

Human Capital for Disadvantaged Children

Health benefits of physical activity: the evidence

The health benefits of physical activity in children and adolescents: implications for chronic disease prevention

Exercise Treatment for Major Depression: Maintenance of Therapeutic Benefit at 10 Months

Exercise and well-being: a review of mental and physical health benefits associated with physical activity

Center for Disease Control

Report Home|
http://www.cdc.gov/nccdphp/sgr/intro.htm

Major Conclusions

1.People of all ages, both male and female, benefit from regular physical activity.

2.Significant health benefits can be obtained by including a moderate amount of physical activity (e.g., 30 minutes of brisk walking or raking leaves, 15 minutes of running, or 45 minutes of playing volleyball) on most, if not all, days of the week. Through a modest increase in daily activity, most Americans can improve their health and quality of life.

3.Additional health benefits can be gained through greater amounts of physical activity. People who can maintain a regular regimen of activity that is of longer duration or of more vigorous intensity are likely to derive greater benefit.

4.Physical activity reduces the risk of premature mortality in general, and of coronary heart disease, hypertension, colon cancer, and diabetes mellitus in particular. Physical activity also improves mental health and is important for the health of muscles, bones, and joints.

5.More than 60 percent of American adults are not regularly physically active. In fact, 25 percent of all adults are not active at all.

6.Nearly half of American youths 12-21 years of age are not vigorously active on a regular basis. Moreover, physical activity declines dramatically during adolescence.

7.Daily enrollment in physical education classes has declined among high school students from 42 percent in 1991 to 25 percent in 1995.

8.Research on understanding and promoting physical activity is at an early stage, but some interventions to promote physical activity through schools, worksites, and health care settings have been evaluated and found to be successful.

http://www.cdc.gov/physicalactivity/everyone/guidelines/children.html

OBESITY
Halting the Epidemic by Making Health Easier

The Obesity Epidemic

More than one third of U.S. adults—more than 72 million people—and 16% of U.S. children are obese. Since 1980, obesity rates for adults have doubled and rates for children have tripled. Obesity rates among all groups in society—irrespective of age, sex, race, ethnicity, socioeconomic status, education level, or geographic region—have increased markedly.

Health Consequences of Obesity

Obesity has physical, psychological, and social consequences in adults and children. Children and adolescents are developing obesity-related diseases, such as type 2 diabetes, that were once seen only in adults. Obese children are more likely to have risk factors for cardiovascular disease, including high cholesterol levels, high blood pressure, and abnormal glucose tolerance. One study of 5- to 17-year-olds found that 70% of obese children had at least one risk factor for cardiovascular disease and 39% of obese children had at least two risk factors.

Obesity is Costly

•In 2000, obesity-related health care costs totaled an estimated $117 billion.
 

•Since 1987, diseases associated with obesity account for 27% of the increases in medical costs.
 

•Medical expenditures for obese workers, depending on severity of obesity and sex, are between 29%–117% greater than expenditures for workers with normal weight.
 

•From 1979–1981 to 1997–1999, annual hospital costs related to obesity among children and adolescents increased, rising from $35 million to $127 million.

Halting Obesity Requires Policy and Environmental Change Initiatives

The determinants of obesity in the United States are complex, numerous, and operate at social, economic, environmental, and individual levels. American society has become ‘obesogenic,’ characterized by environments that promote increased food intake, non-healthful foods, and physical inactivity. Public health approaches that affect large numbers of different populations in multiple settings—communities, schools, work sites, and health care facilities—are needed. Policy and environmental change initiatives that make healthy choices in nutrition and physical activity available, affordable, and easy will likely prove most effective in combating obesity.

The Health Consequences of Obesity

•Coronary heart disease

•Type 2 diabetes

•Cancer (endometrial, breast, and colon)

•Hypertension (high blood pressure)

•Dyslipidemia (high total cholesterol or high levels of triglycerides)

•Stroke

•Liver and gallbladder disease

•Sleep apnea and respiratory problems

•Osteoarthritis (degeneration of cartilage and underlying bone within a joint)

•Gynecological problems (abnormal menses, infertility)

CDC’s Response

CDC’s Division of Nutrition, Physical Activity, and Obesity (DNPAO) is working to reduce obesity and obesity-related conditions through state programs, technical assistance and training, leadership, surveillance and research, intervention development and evaluation, translation of practice-based evidence and research findings, and partnership development.

Supporting State-Based Programs

Currently, 23 states are funded through CDC’s Nutrition and Physical Activity and Obesity (NPAO) Cooperative Agreement Program that coordinates statewide efforts with multiple partners to address obesity.

The program’s focus is on policy and environmental change initiatives directed towards increasing physical activity; consumption of fruits and vegetables; breast-feeding initiation, duration, and exclusivity; and decreasing television viewing and consumption of sugar-sweetened beverages and high-energy dense foods (foods high in calories). The program seeks to address health disparities and requires a comprehensive state plan.

Providing Technical Assistance and Training

CDC provides technical assistance to all states to develop comprehensive state plans, community interventions, and leadership capacity to address obesity. Our new Program Technical Assistance Manual provides a one-stop reference for NPAO program guidance. CDC also provides training to public health practitioners. In 2008, CDC cosponsored an obesity prevention course focused on policy and environmental change strategies with the Center of Excellence for Training and Research Translation at the University of North Carolina.

Convening National Leadership Activities

CDC is leading the development of the National Roadmap for Obesity Prevention and Control, expected in 2010. Two conferences convened in 2008 were stepping stones toward the Roadmap: the National Summit on Legal Preparedness for Obesity Prevention and Control and Community Approaches to Address Obesity. These conferences also laid the groundwork for the Weight of the Nation Conference, scheduled for summer 2009, which will highlight progress in obesity prevention and control and identify actions needed to reverse the epidemic.

Surveillance and Epidemiologic Research

CDC monitors obesity trends and conducts and supports research on obesity prevention and control strategies. Through our research activities, we do the following:

•Identify, translate, implement, and evaluate effective or promising interventions for obesity prevention and control.
 

•Describe and track priority policy, environmental, behavioral, and demographic correlates of obesity and overweight.
 

•Identify the measures of obesity that best characterize children and adults with increased risk for adverse health outcomes.

Progress in Obesity: Recent Findings

Early signs of success in the prevention and control of obesity—at both state and national levels—are now emerging. Major CDC surveys have found no significant increase in obesity prevalence among children, adolescents, women or men between 2003–2004 and 2005–2006. Also, obesity rates appear to be leveling among children in some states such as Arkansas.

CDC’s efforts have helped increase awareness of obesity as a national public health problem. During 2000–2007, media coverage on obesity in national print and newswires increased from about 8,000 to more than 28,000 articles.

A variety of innovative policy and environmental changes in communities, work sites, and schools are likely contributing to this progress.

Developing Innovative Partnerships

CDC is making progress in halting the obesity epidemic through innovative partnerships.

•The Healthy Eating Active Living Convergence Partnership (CP) seeks to foster policy and environmental change through innovative partnerships with others from fields not traditionally involved in public health. CP is currently focused on transportation and food systems to develop active living environments and improve access to healthy foods. (Partners: California Endowment, Kaiser Permanente, Nemours, Robert Wood Johnson Foundation, W.K. Kellogg Foundation, PolicyLink, Prevention Institute)
 

•Common Community Measures for Obesity Prevention (Measures Project) fills two crucial gaps hindering obesity efforts—the absence of standard measures for community-level policy and environmental change initiatives and a tool for monitoring these initiatives. The project developed 26 measures and a Web-based tool that local governments can use to assess them. Following pilot testing in 20 communities, the measures will be available nationwide. (Partners: Robert Wood Johnson Foundation, W.K. Kellogg Foundation, Kaiser Permanente, CDC Foundation, International City/County Management Association, Macro International Inc.)
 

•Early Assessment of Programs and Policies to Prevent Childhood Obesity is identifying a set of promising local programs and policies and determining which ones merit rigorous evaluation. Priority is placed on programs and policies implemented in community settings targeting low-income children to improve eating habits and physical activity levels. (Partners: Robert Wood Johnson Foundation, Division of Adolescent and School Health [CDC], Prevention Research Centers Program Office, CDC Foundation, Macro International Inc.)
 

•Addressing Obesity Through Commercial Health Plans. CDC is working to help public health professionals and health care plan administrators collaborate to improve obesity interventions designed for medical settings. (Partner: Deloitte Consulting)

Identifying Setting-Specific, Evidence-Based Guidelines for Obesity Interventions

In collaboration with the Task Force on Community Preventive Services (the Community Guide), CDC is conducting evidence-based reviews of obesity interventions in three settings—medical care, work sites, and communities.

Translating Practice-Based Evidence and Research

CDC translates practice-based evidence and research findings for use by practitioners, communities, and the public. Recent translation products include the following:

•The Lean for Life Web site (expected launch spring 2009, http://www.cdc.gov/leanforlife) guides companies in planning, building, promoting, and evaluating obesity prevention and control programs. It projects the cost of obesity and expected financial return from implementing a program.
 

•The Swift Work Site Assessment and Translation (SWAT) (http://www.cdc.gov/swat)evaluation method assesses work site health promotion programs that help employees attain or maintain a healthy body weight.
 

•Healthy Weight Web site (http://www.cdc.gov/healthyweight) includes a BMI calculator and provides consumers with relevant steps and tools to help them understand how to achieve and maintain a healthy weight for a lifetime.
 

•The Weight Management Research to Practice Series (http://www.cdc.gov/weightr2p) summarizes the science on various weight management topics, highlighting the implications of the research findings for public health and medical care professionals.

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Successes and Opportunities for Population-Level Prevention
and Control

Success Stories

Michigan: Building Healthy Communities

Michigan’s Building Healthy Communities Project is designed to improve the environment and change policies to make it easier for residents to be healthy. Local health departments were supported through funding and technical assistance to form community coalitions and develop 3-year plans for creating more opportunities for their residents to engage in healthful eating, physical activity, and tobacco-free lifestyles. Coalitions included representatives from local transportation, zoning and planning departments, law enforcement, the YMCA, hospitals, universities, nonprofit organizations, news media outlets, in addition to farmers, residents, public officials, and city engineers.

The Building Healthy Communities Project achieved significant success in making it easier for Michigan residents to be healthy by

•Creating or enhancing 11 trails covering 58.6 miles.

•Enhancing 7 parks with amenities such as new equipment, benches, and lighting.

•Providing residents with 14,000 walking maps.

•Conducting 129 community fitness classes.

•Opening 5 new farmers’ market locations with the ability to process Electronic Benefit Transfer capabilities for processing for food stamps.

•Creating 7 new school and community gardens.

•Distributing 5,000 coupon books to low-income seniors to redeem for fresh fruits and vegetables.

Texas: Farm to Work Delivers

In 2005, less than one quarter of Texas adults ate the minimum amount of fruits and vegetables recommended for good health. To increase access to fresh produce, the Texas Department of State Health Services Nutrition, Physical Activity, and Obesity Prevention Program worked with the department’s Building Healthy Texans Employee Wellness Program to create a Farm to Work program. This program enables employees at 10 Austin-area work sites to purchase fresh local produce, which is delivered weekly to their work site. Coordination with local farmers is handled by the Sustainable Food Center, a nonprofit organization. Participation is easy—employees order on a week-by-week basis, with no subscription required. Orders are prepaid through a secure server so no money is handled onsite. A Farm to Work tool kit was created and disseminated. Other state agencies and private companies in Texas are now implementing similar programs.

Employees took advantage of the program and saved money. In 1 year, 1,700 employees participated; 82,000 pounds of fresh local produce were delivered; and Central Texas farmers made $160,000 in sales. An informal cost comparison showed that grocery store produce was more expensive than the Farm to Work produce.

[A text description of this map is also available.]

California: California Convergence Partnership

Modeled after the national Convergence Partnership, the California Convergence is a statewide initiative that provides a unique opportunity not only to accelerate the movement to prevent obesity in California, but to promote learning and synergy across programs by bringing together seven separate funders—The California Endowment, Kaiser Permanente, the Robert Wood Johnson Foundation, the W.K. Kellogg Foundation, the U.S. Department of Health and Human Services, the California Department of Public Health, and the Centers for Disease Control and Prevention. The California Convergence partnership strategically connects existing resources, and creates an effective learning community that can take action and share information, tools, and resources across initiatives and funding streams to create healthy environments where people can thrive.

To create healthier communities across California, the California Convergence pursues the following goals:

•Shift the public and political discussion regarding obesity prevention to emphasize improving nutrition and physical activity environments.  

•Accelerate local and state policy efforts to change nutrition and physical activity environments to improve health.  

•Strengthen the network of leaders in California that are on the front lines in developing and implementing strategies to improve food and activity environments.  

•Increase opportunities for leaders and community coalitions to build their capacity and leadership skills to support this work.

Through the California Convergence, leaders from 26 communities are working collectively to develop a common policy agenda, build a statewide communication infrastructure, influence funding strategies, and generate public revenue to support their work including the following:

•Policy Change. Convene local and state policy advocates to support local—and eventual statewide—adoption of high-impact policy strategies.

•State Conference. Bring leaders together in a statewide conference to share strategies and lessons, resources, and tools.

•Leadership Building and Peer Networking. Create opportunities for local leaders to learn from each other.

•Skill Building. Communicate policy and systems change issues to decision makers and the public.

•Growing the Movement. Prepare local leaders to participate in the 2009 Childhood Obesity Prevention Conference.

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Related Materials

•CDC's Nutrition, Physical Activity and Obesity Web Site

•Preventing Obesity and Chronic Diseases Through Good Nutrition and Physical Activity

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Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity

Council on Sports Medicine and Fitness and Council on School Health

ABSTRACT

The current epidemic of inactivity and the associated epidemic of obesity are being driven by multiple factors (societal, technologic, industrial, commercial, financial) and must be addressed likewise on several fronts. Foremost among these are the expansion of school physical education, dissuading children from pursuing sedentary activities, providing suitable role models for physical activity, and making activity-promoting changes in the environment. This statement outlines ways that pediatric health care providers and public health officials can encourage, monitor, and advocate for increased physical activity for children and teenagers.

INTRODUCTION
In 1997, the World Health Organization declared obesity a global epidemic with major health implications. 1 According to the 1999–2000 National Health and Nutrition Examination Survey (www.cdc.gov/nchs/nhanes.htm), the prevalence of overweight or obesity in children and youth in the United States is over 15%, a value that has tripled since the 1960s.2 The health implications of this epidemic are profound. Insulin resistance, type 2 diabetes mellitus, hypertension, obstructive sleep apnea, nonalcoholic steatohepatitis, poor self-esteem, and a lower health-related quality of life are among the comorbidities seen more commonly in affected children and youth than in their unaffected counterparts.3–7 In addition, up to 80% of obese youth continue this trend into adulthood.8,9 Adult obesity is associated with higher rates of hypertension, dyslipidemia, and insulin resistance, which are risk factors for coronary artery disease, the leading cause of death in North America.10

Assessment of Overweight
Ideally, methods of measuring body fat should be accurate, inexpensive, and easy to use; have small measurement error; and be well documented with published reference values. Direct measures of body composition, such as underwater weighing, magnetic resonance imaging, computed axial tomography, and dual-energy radiograph absorptiometry, provide an estimate of total body fat mass. These techniques, however, are used mainly in tertiary care centers for research purposes. Anthropometric measures of relative fatness may be inexpensive and easy to use but rely on the skill of the measurer, and their relative accuracy must be validated against a "gold-standard" measure of adiposity. Such indirect methods of estimating body composition include measuring weight and weight for height, body mass index (BMI), waist circumference, skinfold thickness, and ponderal index.11 Of these, perhaps the most convenient is BMI, which can be calculated according to the following formulas (www.cdc.gov/growthcharts):

BMI varies with age and gender. It typically increases during the first months of life, decreases after the first year, and increases again around 6 years of age.11 A specific BMI value, therefore, should be evaluated against age- and gender-specific reference values. In the United States, such reference charts based on early 1970s survey data of children 2 to 20 years of age are readily available for clinical use.12 Children and youth with a BMI greater than the 95th percentile are classified as overweight or obese, and those between the 85th and 95th percentiles are designated at risk of overweight.13 Although BMI tends to underestimate overweight in tall individuals and overestimate overweight in short individuals and those with high lean body mass (ie, athletes), it generally correlates well with more precise measures of adiposity in individuals with BMI in the 95th percentile or greater.14

Factors Contributing to Obesity
Some children have medical conditions associated with obesity and/or require pharmacologic treatments resulting in significant weight gain. Others (1%–2% of obese children) have underlying genetic conditions such as Down, Prader-Willi, or Bardet-Biedle syndrome, which can be associated with obesity. Rarely, single-gene disorders, including congenital leptin deficiency and defects in the melanocortin 4 receptor, cause morbid childhood obesity.

Observations in twin, sibling, and family studies suggest that children are more likely to be overweight if relatives are similarly affected and that heritability may play a role in as many as 25% to 85% of cases. However, to suggest that only genetic factors have caused the recent global epidemic of childhood obesity would not be realistic. It is more likely that most of the world's population carries a combination of genes that may have evolved to cope with food scarcity. In obesogenic environments in which calorie-dense foods are readily available and low-energy expenditure is commonplace, this genetic predisposition would be maladaptive and could lead to an obese population.11

Nutritional factors contributing to the increase in obesity rates include, in no particular order, (1) insufficient infant breastfeeding, (2) a reduction in cereal fiber, fruit, and vegetable intake by children and youth, and (3) the excessive consumption of oversized fast foods and soda, which are encouraged by fast-food advertising during children's television programming and a greater availability of fast foods and sugar-containing beverages in school vending machines.15,16 Although nutritional issues have a significant role to play, this statement focuses on factors associated with decreased energy expenditure, namely excessive sedentary behaviors and lack of adequate physical activity.

Children and youth are more sedentary than ever with the widespread availability of television, videos, computers, and video games. Data from the 1988–1994 National Health and Nutrition Examination Survey indicated that 26% of American children (up to 33% of Mexican American and 43% of non-Hispanic black children) watched at least 4 hours of television per day, and these children were less likely to participate in vigorous physical activity. They also had greater BMIs and skinfold measurements than those who watched <2 hours of television per day.17

Not only are the rates of sedentary activities rising, but participation in physical activity is not optimal. In a 2002 Youth Media Campaign Longitudinal Survey, 4500 children 9 to 13 years of age and their parents were polled about physical activity levels outside of school hours. The report indicated that 61.5% of 9- to 13-year-olds did not participate in any organized physical activities and 22.6% did not partake in nonorganized physical activity during nonschool hours.18

Youth at Risk of Decreased Physical Activity
Particular individuals at increased risk of having low levels of physical activity have been identified and include children who are from ethnic minorities (especially girls) in the preadolescent/adolescent age groups, children living in poverty, children with disabilities, children residing in apartments or public housing, and children living in neighborhoods where outdoor physical activity is restricted by climate, safety concerns, or lack of facilities.19,20 According to the Centers for Disease Control and Prevention (www.cdc.gov/nccdphp/sgr/adoles.htm), inactivity is twice as common among females (14%) as males (7%) and among black females (21%) as white females (12%). In a meta-analysis that evaluated physical activity and cardiorespiratory fitness, 6- to 7-year-olds were more active in moderate to vigorous physical activity (46 minutes/day) compared with 10- to 16-year-olds (16–45 minutes/day). Boys were approximately 20% more active than girls, and mean activity levels decreased with age by 2.7% per year in boys compared with 7.4% per year in girls.21 Many reasons are stated for the general lack of physical activity among children and youth. These reasons include inactive role models (eg, parents and other caregivers), competing demands/time pressures, unsafe environments, lack of recreation facilities or insufficient funds to begin recreation programs, and inadequate access to quality daily physical education (PE).

Physical Activity in Schools
Children and youth spend most of their waking hours at school, so the availability of regular physical activity in that setting is critical. Although the Healthy People 2010 report recommends increasing the amount of daily PE for all students in a larger proportion of US schools, such changes do not seem to be forthcoming.19 In 2000, a school health policies and program study22 looked at a nationally representative sample of private and public schools and found that only 8% of American elementary schools, 6.4% of middle schools, and 5.8% of high schools with existing PE requirements provided daily PE classes for all grades for the entire year. In addition, although approximately 80% of states have policies calling for students to participate in PE in all schools, 40% of elementary schools, 52% of middle schools, and 60% of high schools allow exemption from PE classes, particularly for students with permanent physical disabilities and those having religious reasons.22 The National Association of State Boards of Education recommends 150 minutes per week of PE for elementary students and 225 minutes per week for middle and high school students.23 Unfortunately, these requirements are not being implemented. In a study of 814 third-grade students from 10 different US data-collection sites, the mean duration of PE was 33 minutes twice a week, with only 25 minutes per week at a moderate to vigorous intensity level.24 In addition, 1991–2003 Youth Risk Behavior Surveillance data showed that although the percentage of high school students enrolled in PE class remained constant (48.9%–55.7%), the percentage of students with daily PE attendance decreased from 41.6% in 1991 to 25.4% in 1995 and remained stable thereafter (25.4%–28.4%).25

Management of the Obese Child
The successful treatment of obesity in the pediatric age group has been somewhat obscure to date. Studies have shown that younger children seem to respond better to treatment than adolescents and adults.11,26 Reasons given for this include greater motivation, more influence of the family on behavioral change, and the ability to take advantage of longitudinal growth, which allows children to "grow into their weight." Treatment programs that include nutritional intervention in combination with exercise have higher success rates than diet modification alone. Indeed, a research program that included dietary modification, exercise, and family-based behavioral modification demonstrated enhanced weight loss and better maintenance of lost weight over 5 years.27 Successful activity-related interventions include a reduction in sedentary behavior and an increase in energy expenditure. Improvements in BMI have been shown to occur when television viewing is restricted.28 In this regard, the American Academy of Pediatrics (AAP) recommends no more than 2 hours of quality television programming per day for children older than 2 years.29 Lifestyle-related physical activity, as opposed to calisthenics or programmed aerobic exercise, seems to be more important for sustained weight loss.30 Such treatment programs should be individually tailored to each child, and their success should be measured not just in terms of weight loss but also in terms of the effects of the programs on associated morbidities.

Health Benefits of Physical Activity
Regular physical activity is important in weight reduction and improving insulin sensitivity in youth with type 2 diabetes.31 Aerobic exercise has been shown in a prospective randomized, controlled study of 64 children (9–11 years old) with hypertension to reduce systolic and diastolic blood pressure over 8 months.32 Resistance training (eg, weight lifting) after aerobic exercise seems to prevent the return of blood pressure to preintervention levels in hypertensive adolescents.33 Weight loss through moderate aerobic exercise has been shown to reduce the hyperinsulinemia, hepatomegaly, and liver enzyme elevation seen in patients with steatohepatitis.6,34 Regular physical activity is also beneficial psychologically for all youth regardless of weight. It is associated with an increase in self-esteem and self-concept and a decrease in anxiety and depression.35

Prevention of Overweight in Children and Youth
Given the challenges of reversing existing obesity in the pediatric population, preventive tactics are likely to be the key to success. Unfortunately, controlled prevention trials have been somewhat disappointing to date. In a systematic Cochrane Database review,36 3 of 4 long-term studies combining dietary education with physical activity showed no difference in overweight, and 1 long-term physical activity intervention study showed a slight reduction in overweight. However, the randomized control design may not be ideal for the study of most health-promotion interventions. This is because these are typically population-based programs, which tend to be complex, are delivered over long periods of time, and present some difficulties in controlling all variables.11 Solution-oriented research, which evaluates promising interventions, often in a quasi-experimental manner, may be more appropriate in the long run.37 It is unlikely, however, that any single strategy will be sufficient to reverse current trends in pediatric obesity. Success is more likely to be achieved by the implementation of sustainable, economically viable, culturally acceptable active-living policies that can be integrated into multiple sectors of society.

Increasing Physical Activity Levels in Children and Youth
Physical activity needs to be promoted at home, in the community, and at school, but school is perhaps the most encompassing way for all children to benefit. As of June 2005, there is a new opportunity for pediatricians to get involved with school districts. Section 204 of the Child Nutrition and WIC [Supplemental Nutrition Program for Women, Infants, and Children] Reauthorization Act of 2004 (Public Law 108–265) requires that every school receiving funding through the National School Lunch and/or Breakfast Program develop a local wellness policy that promotes the health of students, with a particular emphasis on addressing the problem of childhood obesity. By the 2006–2007 school year, each school or school district is required to set goals for healthy nutrition, physical activity, and other strategies to promote student wellness. Parents, students, school personnel, and members of the community are required to be involved in the policy development. Pediatricians can take advantage of this requirement to get involved. In light of the school wellness policy, many schools are looking to modify their present PE programs to improve their physical activity standards.

In past years, PE classes used calisthenics and sport-specific skill acquisition to promote fitness. This approach did not meet the needs of all students, such as those with obesity or physical disabilities. PE curricula and instruction should emphasize the knowledge, attitudes, and motor and behavioral skills required to adopt and maintain lifelong habits of physical activity.38 Cross-sectional school-based studies have shown modest correlation between physical activity and lower BMI, although long-term follow-up data are lacking. In an observational study of 9751 kindergarten students, an increase in PE instruction time was associated with a significant reduction in BMI among overweight girls.39 Project SPARK (Sports, Play, and Active Recreation for Kids Curriculum) looked at increasing physical activity through modified PE and classroom-based teaching on health and skill fitness. Physical activity levels increased during PE classes, and fitness levels in girls improved as a result.40 It is interesting to note that, despite a significant increase in PE class time, there was no interference with academic attainment, and some achievement test results improved. A recent review of the literature suggests that school-based physical activity programs may modestly enhance academic performance in the short-term, but additional research is required to establish any long-term improvements. There does not seem to be sufficient evidence to suggest that daily physical activity detracts from academic success.41

An increase in school PE participation alone is not likely to be sufficient to reverse the childhood obesity epidemic. A 2-year study of elementary students showed that those who had enhanced physical activity education as well as modified PE classes to increase lifestyle aerobic activity increased their physical activity inside the classroom, but lower levels were noted outside the classroom in their leisure time, and no improvements on fitness testing or body fat percentage were seen.42 The PLAY (Promoting Lifestyle Activity for Youth) program, which encourages the accumulation of 30 to 60 minutes of moderate to vigorous physical activity daily beyond school time and during regular school hours outside of PE classes, has been shown to increase the physical activity levels of children, especially girls.43 Children can increase their physical activity levels in many other ways during school and nonschool hours, including active transportation, unorganized outdoor free play, personal fitness and recreational activities, and organized sports. Parents of children in organized sports should be encouraged to stimulate their children to be physically active on days when they are not participating in these sports and not rely solely on the sports to provide all their away-from-school physical activity. This should include participation in physical activities with the entire family. Communities designed with green spaces and biking trails help provide families the means to enjoy such active lifestyles.

During late childhood and adolescence, strength training may be additionally beneficial. Youth taking part in this type of exercise may gain strength, improve sport performance, and derive long-term health benefits.44 Obese children often prefer strength training because it does not require agility or aerobic ability, and the benefits become apparent within as little as 2 to 3 weeks. Because of their added body mass, overweight participants also tend to be stronger than their peers, giving them a relative psychological advantage. Recent studies have shown that obese students are more compliant and increase their free fat mass when weight training is added to aerobic exercise or a standardized energy-reduction diet.45,46

Recommended physical activity levels for children and youth vary somewhat in different countries. The Centers for Disease Control and Prevention and the United Kingdom Health Education Authority recommend that children and youth accumulate at least 60 minutes daily of moderate to vigorous physical activity in a variety of enjoyable individual and group activities.47,48 Health Canada guidelines recommend increasing physical activity above the current level by at least 30 minutes (10 minutes vigorous) and reducing sedentary activity by the same amount per day. Each month, physical activity should be increased and sedentary behavior should be decreased by 15 minutes until at least 90 minutes more active time and 90 minutes less inactive time are accumulated (www.paguide.com). The Canadian Paediatric Society has endorsed these recommendations and emphasizes a wide variety of activities as part of recreation, transportation, chores, work, and planned exercise to encourage lifestyle changes that may last a lifetime.49

Age-Appropriate Recommendations for Physical Activity
Clinicians should encourage parents to limit sedentary activity and make physical activity and sport recommendations to parents and caregivers that are consistent with the developmental level of the child.50 The following are guidelines from the AAP for different age groups.

Infants and Toddlers
There is insufficient evidence to recommend exercise programs or classes for infants and toddlers as a means of promoting increased physical activity or preventing obesity in later years. The AAP has recommended that children younger than 2 years not watch any television. The AAP suggests that parents be encouraged to provide a safe, nurturing, and minimally structured play environment for their infant.51 Infants and toddlers should also be allowed to develop enjoyment of outdoor physical activity and unstructured exploration under the supervision of a responsible adult caregiver. Such activities include walking in the neighborhood, unorganized free play outdoors, and walking through a park or zoo.

Preschool-Aged Children (4–6 Years)
Free play should be encouraged with emphasis on fun, playfulness, exploration, and experimentation while being mindful of safety and proper supervision. Preschool-aged children should take part in unorganized play, preferably on flat surfaces with few variables and instruction limited to a show-and-tell format. Appropriate activities might include running, swimming, tumbling, throwing, and catching. Preschoolers should also begin walking tolerable distances with family members. In addition, parents should reduce sedentary transportation by car and stroller and, as applies to all age groups, limit screen time to <2 hours per day.

Elementary School–Aged Children (6–9 Years)
In this age group, children improve their motor skills, visual tracking, and balance. Parents should continue to encourage free play involving more sophisticated movement patterns with emphasis on fundamental skill acquisition. These children should be encouraged to walk, dance, or jump rope and may enjoy playing miniature golf. There is little difference between the sexes in weight, height, endurance, and motor skill development at this age; thus, co-ed participation is not contraindicated. Organized sports (soccer, baseball) may be initiated, but they should have flexible rules and short instruction time, allow free time in practices, and focus on enjoyment rather than competition. These children have a limited ability to learn team strategy.

Middle School–Aged Children (10–12 Years)
Preferred physical activities that focus on enjoyment with family members and friends should be encouraged as with previous groups. Emphasis on skill development and increasing focus on tactics and strategy as well as factors promoting continued participation are needed. Fully developed visual tracking, balance, and motor skills are typical in late childhood. Middle school–aged children are better able to process verbal instruction and integrate information from multiple sources so that participation in complex sports (football, basketball, ice hockey) is more feasible. Puberty may begin at different rates, making some individuals bigger and stronger than others. Basing placement in contact and collision sports on maturity rather than chronologic age may result in less risk of injury and enhanced chance of success, especially for those at lower Tanner stages. Weight training may be initiated, provided that the program is well supervised, that small free weights are used with high repetitions (15–20), that proper technique is demonstrated, and that shorter sets using heavier weights and maximum lifts (squat lifts, clean and jerk, dead lifts) are avoided.44

Adolescents
Adolescents are highly social and influenced by their peers. Identifying activities that are of interest to the adolescent, especially those that are fun and include friends, is crucial for long-term participation. Physical activities may include personal fitness preferences (eg, dance, yoga, running), active transportation (walking, cycling), household chores, and competitive and noncompetitive sports. Ideally, enrollment in competitive contact and collision sports should be based on size and ability instead of chronologic age. Weight training may continue, and as the individual reaches physical maturity (Tanner stage 5), longer sets using heavier weights and fewer repetitions may be safely pursued while continuing to stress the importance of proper technique.

Office-Based Physical Activity Assessment
An accurate assessment of an individual child's physical activity level by history or questionnaire is difficult and fraught with methodologic problems. It may be easier for parents to recall the number of times per week their child plays outside for at least 30 minutes than to estimate the average daily minutes spent in physical activity. In addition, asking parents about the number of hours per day their child spends in front of a television, video game, or computer screen may be simpler to quantify and track than time spent in active play. Pedometers may also be helpful, because they provide a simple and more objective method of measuring activity, are inexpensive, and have a "gadget appeal" among youngsters. It has been recommend that adults accumulate 10000 steps per day to follow a healthy lifestyle.52 Requirements are less clearly defined in children, but guidelines range from 11000 to 12000 steps per day for girls and 13000 to 15000 steps per day for boys.53,54

CONCLUSIONS
The prevalence of pediatric obesity has reached epidemic proportions. It is unlikely that the medical profession alone will be able to solve this serious health problem. The promotion of decreased caloric intake and increased energy expenditure will need to take place within all aspects of society. Among the most difficult but most important challenges for society are making exercise alternatives as attractive, exciting, and enjoyable as video games for children, convincing school boards that PE and other school-based physical activity opportunities are as important to long-term productivity as are academics, changing both supplier and consumer attitudes about food selection and portion sizes, and reengineering living environments to promote physical activity.

RECOMMENDATIONS
Research has shown the importance of social, physical, and cultural environments in determining the extent to which people are able to be active in all facets of daily life, including work, education, family life, and leisure.55 Creating active school communities is an ideal way to ensure that children and youth adopt active, healthy lifestyles. These communities require a collaborative framework between families, schools, community recreation leaders, and health care professionals. Physicians can be instrumental in the development of active school communities by advocating for policy changes at the community, state, and national levels that support healthy nutrition, reducing sedentary time, and increasing physical activity levels while providing education and health supervision about regular physical activity and reduced sedentary time to families in their practices.

ADVOCACY
In addition to promoting healthy nutrition recommendations suggested by the AAP Committee on Nutrition, physicians and health care professionals and their national organizations should advocate for:

•Social marketing that promotes increased physical activity.

•The appropriate allocation of funding for quality research in the prevention of childhood obesity.

•The development and implementation of a school wellness counsel on which local physician representation is encouraged.

•A school curriculum that teaches children and youth the health benefits of regular physical activity.

•Comprehensive community sport and recreation programs that allow for community and school facilities to be open after hours and make physical activities available to all children and youth at reasonable costs; access to recreation facilities should be equally available to both sexes.

•The reinstatement of compulsory, quality, daily PE classes in all schools (kindergarten through grade 12) taught by qualified, trained educators. The curricula should emphasize enjoyable participation in physical activity that helps students develop the knowledge, attitudes, motor skills, behavioral skills, and confidence required to adopt and maintain healthy active lifestyles. These classes should allow participation by all children regardless of ability, illness, injury, and developmental disability, including those with obesity and those who are disinterested in traditional competitive team sports. Commitment of adequate resources for program funding, trained PE personnel, safe equipment, and facilities is also recommended.

•The provision of a variety of physical activity opportunities in addition to PE, including the protection of children's recess time and the requirement of extracurricular physical activity programs and nonstructured physical activity before, during, and after school hours, that address the needs and interests of all students.

•The reduction of environmental barriers to an active lifestyle through the construction of safe recreational facilities, parks, playgrounds, bicycle paths, sidewalks, and crosswalks.

PROMOTING A HEALTHY LIFESTYLE

Physicians and health care professionals should promote active healthy living within each family unit by:

•Serving as role models through the adoption of an active lifestyle.

•Inquiring about nutritional intake, calculating and plotting BMI, identifying obesity-related comorbidities, and promoting healthy eating as suggested by the AAP Committee on Nutrition.

•Documenting the number of hours per day spent on sedentary activities and limiting screen (television, video game, and computer) time according to AAP guidelines.

•Determining physical activity levels of the child and family members at regular health care visits.

•Tabulating the amount of physical activity the child or youth does each day at home, school, or child care as part of transportation, work, recreation, and unorganized sports, which should include determining the actual minutes of PE and recess-related physical activity achieved at school each week. In addition, the number of times per week spent in outdoor play for at least 30 minutes and/or the number of daily steps achieved (monitored by using a pedometer) should be documented. Specific involvement in organized sports and dance also should be noted.

•Encouraging children and adolescents to be physically active for at least 60 minutes per day, which does not need to be acquired in a continuous fashion but rather may be accumulated by using smaller increments. Events should be of moderate intensity and include a wide variety of activities as part of sports, recreation, transportation, chores, work, planned exercise, and school-based PE classes. These activities should be primarily unstructured and fun if they are to achieve best compliance.

•Identifying any barriers the child, youth, or parent might have against increasing physical activity, which might include lack of time, competing interests, perceived lack of motor skills, and fear of injury on the part of the child. Parents might be additionally concerned about financial and safety issues. Efforts must then be made to work with the family to educate them regarding the importance of lifelong physical activity and to identify potential strategies to overcome some of their barriers.

•Recommending that parents become good role models by increasing their own level of physical activity. Parents should also incorporate physical activities that family members of all ages and abilities can do together. They should encourage children to play outside as much as possible. Safety should be promoted by the use of appropriate protective equipment (bicycle helmets, life jackets, etc).

•Advising parents to support their children and youth in developmentally and age-appropriate sports and recreational activities. The child's favorite types of physical activity should be a priority. These might best occur in the school setting during extracurricular activities, in which parents/grandparents can take part as leaders and coaches.

•Suggesting that overweight children partake in activities that take advantage of their tall stature and muscle strength, such as water-based sports and strength training, rather than those that require weight bearing (eg, jumping, jogging).

•Recommending that parents of overweight children and youth play a supporting, accepting, and encouraging role in returning them to healthier lifestyles to increase self-esteem.

•Encouraging youth to promote physical activities for their peers and become role models and leaders for younger students.

Council on Sports Medicine and Fitness, 2005–2006

Teri M. McCambridge, MD, Chairperson

David T. Bernhardt, MD

Joel S. Brenner, MD, MPH

Joseph A. Congeni, MD

*Jorge E. Gomez, MD

Andrew J.M. Gregory, MD

Douglas B. Gregory, MD

Bernard A. Griesemer, MD

Frederick E. Reed, MD

Stephen G. Rice, MD, PhD

Eric W. Small, MD

Paul R. Stricker, MD

Liaisons

*Claire LeBlanc, MD

Canadian Paediatric Society

James Raynor, MS, ATC

National Athletic Trainers Association

Physical Activity Facts

(Citation: U.S. Department of Health and Human Services. The following facts are based on information from publications prepared by agencies and offices of the Department of Health and Human Services: the Centers for Disease Control and Prevention; the National Center for Health Statistics; the Office of the Surgeon General of the United States (Physical Activity and Health, 1996; Call to Action to Prevent and Decrease Overweight and Obesity, 2001), and the Office of Disease Prevention and Health Promotion (Healthy People 2010).

•Adults 18 and older need 30 minutes of physical activity on five or more days a week to be healthy; children and teens need 60 minutes of activity a day for their health.

•Significant health benefits can be obtained by including a moderate amount of physical activity (e.g., 30 minutes of brisk walking or raking leaves, 15 minutes of running, 45 minutes of playing volleyball). Additional health benefits can be gained through greater amounts of physical activity.

•Thirty to sixty minutes of activity broken into smaller segments of 10 or 15 minutes throughout the day has significant health benefits.

•Moderate daily physical activity can reduce substantially the risk of developing or dying from cardiovascular disease, type 2 diabetes, and certain cancers, such as colon cancer. Daily physical activity helps to lower blood pressure and cholesterol, helps prevent or retard osteoporosis, and helps reduce obesity, symptoms of anxiety and depression, and symptoms of arthritis.

•Heart disease is the leading cause of death among men and women in the United States. Physically inactive people are twice as likely to develop coronary heart disease as regularly active people.

•37% of adults report they are not physically active. Only 3 in 10 adults get the recommended amount of physical activity.

•Poor diet and inactivity can lead to overweight/obesity. Persons who are overweight or obese are at increased risk for high blood pressure, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems and some types of cancer.

•41 million Americans are estimated to have pre-diabetes. Most people with pre-diabetes develop type 2 diabetes within 10 years, unless they make changes to their diet and physical activity that results in a loss of about 5-7 percent of their body weight.

•Obesity continues to climb among American adults. Nearly 60 million Americans are obese. More than 108 million adults are either obese or overweight. That means roughly 3 out of 5 Americans carry an unhealthy amount of excess weight.

•The percentage of adults in the United States who were overweight or obese (body mass index greater than or equal to 25) in 1999-2002 was 65 percent. Overweight and obesity cuts across all ages, racial and ethnic groups, and both genders. A new study in the Netherlands found that excess weight cuts years off your life.

•16 percent of children and teens aged 6 to 19 were overweight in 1999-2002, triple the proportion in 1980. Fifteen-percent of children in the same age group are considered at-risk for overweight. The percentage of overweight African American, Hispanic, and Native American children is about 20%.

•More than 10 percent of children between the ages of 2 and 5 are overweight, double the proportion since 1980.

•Health risks associated with being overweight or obese include type 2 diabetes, high blood pressure, high cholesterol, asthma, arthritis.

•The major barriers most people face when trying to increase physical activity are time, access to convenient facilities, and safe environments in which to be active.

•School and worksite interventions have been shown to be successful in increasing physical activity levels.

•Type 2 diabetes, once called "adult onset" diabetes, high blood pressure, and high cholesterol, once thought to be age-related, are now diagnosed in children and teens.

•Physical activity among children and adolescents is important because of the related health benefits (cardio-respiratory function, blood pressure control, weight management, cognitive and emotional benefits).

•According to a study done by the National Association of Sports and Physical Education (NASPE), infants, toddlers, and pre-schoolers should engage in at least 60 minutes of physical activity daily and should not be sedentary for more than 60 minutes at a time except when sleeping.

•One quarter of U.S. children spend 4 hours or more watching television daily.

•Young people are at particular risk for becoming sedentary as they grow older. Encouraging moderate and vigorous physical activity among youth is important. Because children spend most of their time in school, the type and amount of physical activity encouraged in schools is important.

•Only 25 percent of students in grades 9 through 12 engaged in moderate physical activity for at least 30 minutes on 5 or more of the previous 7 days in 2003.

1. •Only 28 percent of students in grades 9 through 12 participated in daily school physical education in 2003, down from 42 percent in 1991.
   

2. •
   

Elementary School Physical Education:
A Scientifically Documented Position Statement

The paper is a supplement to Elementary Physical Education: A Position Statement (a concise statement of the benefits of a quality elementary physical education program. This paper is an expanded version of that position statement ). http://clem.mscd.edu/~quatrocj/position_state/tool.html

Benefits of Elementary Physical Education

Quality physical education programs, particularly for the elementary school student, can enhance all aspects of development. Areas of specific contribution include:

Academic performance. Aerobic activity can "...increase vigor and promote clear thinking." In addition, "involvement in physical activity can positively affect grade scores of students in primary schools," (International Society of Sport Psychology, 1992, p. 179-180). Regular physical activity also makes children more alert and energetic, which improves their capacity to learn (American Alliance for Health, Physical Education, Recreation, and Dance).

Health. "Nearly 40 percent of children age five to eight have health conditions that significantly increase their risk of early heart disease" (American Alliance for Health, Physical Education, Recreation, and Dance). "A primary benefit of regular physical activity is protection against heart disease." Physical inactivity appears to contribute to coronary risk factors like obesity, high blood pressure, and elevated blood cholesterol. In addition, physical activity appears to provide some protection against several other chronic diseases like certain cancers, osteoporosis, and depression. Not surprisingly, "...physically active people outlive inactive people..." (U.S. Centers for Disease Control and Prevention and American college of Sports Medicine, 1993, p.7) For all of these reasons, the American Heart Association has stated, "Children should be introduced to the principals of regular physical activity and recreational activities at an early age. Schools at all levels should develop and encourage positive attitudes toward physical exercise, providing opportunities to learn physical skills and to perform physical activities, especially those that can be enjoyed for many years ( American Heart Association, 1992).

Weight Control. About 25 percent of American youth are overweight (American Health Foundation, 1993) and percent of body fat significantly impacts health. Active participation in physical education increases energy expenditure and helps control excessive food intake and body fat levels. Significant reductions in percent body fat have been noted in studies examining the effect of physical education programs on the body fat levels of both boys and girls (Vogel, 1986). This is particularly important because studies examining societal trends have shown 54 and 39 percent increases in obesity among children aged 6 to 17 (Gortmaker, Dietz, Sobol, and Weber, 1987) and a 2 percent increase in children's overall body fat over the last 20 to 30 years (Pate and Shephard, 1989).

Physical fitness. By introducing children to developmentally appropriate, theoretically based, programs in physical education, students learn the principles and skills necessary for implementing and maintaining a physical activity regimen. This education is integral to the child's development, as it has the potential to improve short term fitness (Flexibility, cardiovascular endurance, muscular endurance, muscular strength, and body composition) while establishing a basis for the maintenance of fitness through life. "Increased physical fitness improves heart/lung function, reduces body fat, and decreases the risk of diseases associated with unhealthy lifestyles," enhances "school moral [and] class behavior ..." and is "...an alternative to drugs for today's youth: (National Fitness Leaders Association, 1990).

Movement knowledge/Motor skill development. Motor skill development is one of the most efficient and sustainable ways to develop physical fitness. The Council on Physical Education for Children (1992) has stated, ÒOptimal development of the musculoskeletal and cardiorespiratory systems is enhanced through childrenÕs regular involvement in planned programs designed by professional educators to maximize movement skill development through sequenced instruction.Ó ÒBy conducting regular, vigorous physical education programs and helping children become skillful in a variety of movement forms fitness is builtÓ (Council on Physical Education for Children, 1992, p.6). Furthermore, the early establishment of movement skills facilitates the acquisition of more complex skills introduced later. It also allows children to feel competent in movement, which motivates them to be more physically active in their leisure time.

Self-esteem. ÒSelf-esteem is the value we place on ourselves and our self-imageÓ (Gruber, 1985, p. 30). According to a quantitative review of over 100 studies conducted within the last 20 years, Ò...directed play and physical education programs contribute to the development of self-esteem in elementary school childrenÓ (p.42). This research also concluded that the greatest gain in self-esteem was found in those children with the greatest need for improvement. The positive attitudes developed through proper physical education experiencesÓ...may be the prime determiner of future behaviorÓ (p.42).

Stress management. Like adults, children and adolescents experience stress in their daily lives. Physical activity is a positive method for coping with this stress. According to the International Society for Sport Psychology, ÒAerobic activity reduces anxiety, depression, tension, and stress...Ó Studies have also found that physical activity can be Ò...as effective as different forms of psychotherapy and that exercises have had an anti depressive effect on patients with mild to moderate forms of depressionÓ (1992,p.180).

Social development. Research has found that participation in games, sports, and play seems to be related to children learning to Òfit intoÓ their society by learning social expectations. These activities also enhance the childÕs social mobility, which can affect such long-term endeavors as educational aspiration and achievement. Furthermore, through participation and appropriate instruction in physical activities, moral ideals and attitudes concerning fair play are shaped (Coakley,1993)

General Statement

The above mentioned benefits can be achieved through quality physical education programs. For optimum results, programs should be regular, frequent, developmentally appropriate, success-oriented, and instructed by trained physical education teachers. Research has shown that competent teachers credentialed in physical education provide the best physical education. However, providing classroom teachers with special training has also proven beneficial.

According to one study comparing physical education specialists and specially trained classroom teachers with classroom teachers who had not received special in-servicing in physical education, trained teachers provided more and better quality instruction spending, over three times more class time on instruction in fitness activities, and over twice as much time on skill drills. In addition, students of trained teachers were twice as likely to be very active (McKenzie, Sallis, Faucette, Roby, and Kolody, 1993).

Increased emphasis on the quantity and quality of physical education programs is in direct compliance with Healthy People 2000, our national strategy for improving the health of all Americans over the next 10 years. Specifically, Healthy People 2000 seeks to increase the proportion of: 1) children and adolescents in first through twelfth grade who participate daily in school physical education, and 2) school physical education class time that students spend being physically active, preferably engaged in lifetime physical activities. According to the American Academy of Pediatrics (1992). ÒThe inclusion of a national health objective calling for daily physical education classes underscores the importance of frequent physical education.Ó

Greg Payne is the primary author of Elementary School Physical Education: A Position Statement, a publication of the California GovernorÕs Council. He is a professor in the Department of Human Performance, San Jose State University, San Jose, CA.

References

American Academy of Pediatrics. (1992). Press release: Physical education - the facts. Elk Grove Village, IL: American Alliance for.

American Alliance for Health, Physical Education, Recreation and Dance. ItÕs time to stop shortchanging our children: Making the case for daily physical education. Reson, VA: American Alliance for Health, Physical Education, Recreation and Dance.

American College of Sports Medicine. (1993). News release: Experts release new recommendation to fight AmericaÕs epidemic of physical inactivity. Indianapolis: American College of Sports Medicine.

American Heart Association, Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology (1992). Statement on exercise: Benefits and recommendations for physical activity programs for all Americans. Circulation, 86, 340-344.

American Health Foundation. (1993). News release. New York: American Health Foundation.

Coakley, J. (1993). Socialization and sport. In R.N. Singer, M, Murphey, and L.K. Tennant (Ed.), Handbook of research on sport psychology (pp. 571-586). New York: Macmillan.

Council on Physical Education for children. (1992). Guidelines for elementary physical education. Reson, VA: National Association for Sport and Physical Education.

International Society for Sport Psychology. (1992). Physical activity and psychological benefits. The Physician and Sports Medicine, 20, 179-184.

Gortmaker, S.I., Dietz,W.II., Sobol, A.M., and Weber, C.A. (1987). Increasing pediatric obesity in the U.S. American Journal of diseases in Children, 14, 535-540.

Gruber, J.J. (1985). Physical activity and self-esteem development in children: A meta-analysis. The Academy Papers, 19, 30-48.

National Fitness Leaders Association. (1990). Youth fitness: Information and tips to achieve a healthier lifestyle. Chantilly, VA: National Fitness Leaders Association.

McKenzie, T.L., Sallis, J.F., Faucette, N., Roby,J., and Koldy, B. (1993). Effects of a curriculum and in-service program on the quality and quantity of elementary physical education classes. Research Quarterly for Exercise and Sport, 64, 178-187.

Pate,R.R., and Shephard, R.J. (1989). Characteristics of physical fitness in youth. In C.V. Gisolfi and D.R. Lamb (Eds.), Perspectives in exercise science and sports medicine (pp. 1-46). Indianapolis: Benchmark.

United States Center for Disease Control and Prevention and American college of Sports Medicine. (1993). Summary Statement: Workshop on physical activity and public health. sports Medicine Bulletin, 28, 7.

Vogel, P.G. (1986). Effects of physical education programs on children. In V. Seefeldt (Ed.), Physical activity and well being (pp.456-509). Reston, VA: American Alliance for Health, Physical Education, Recreation, and Dance

Healthy America: Wellness Where We Live, Work and Learn

In September, 2005, Arkansas Governor Mike Huckabee launched Healthy America, a year-long initiative that marks his tenure as Chair of the National Governor’s Association.

Through Healthy America, Governor Huckabee brings together public and private sector organizations to help Americans live happier, healthier lives. Specifically, the initiative focuses on what can be done at home, at work, and in schools to make healthier choices easier choices.

Governor Huckabee is a remarkable role model. He lived the sedentary, overweight life that he is trying to combat. He was diagnosed with Type 2 Diabetes and was told by his doctor that he needed to lose weight or suffer the consequences of life with the disease. Fortunately, Governor Huckabee chose to change his lifestyle and almost two years after his diabetes diagnoses, he was 110 pounds lighter. He is now a two-time marathon runner, proving that individuals are capable of making lifestyle alterations to improve health and their quality of life.

Resources of Federal Agencies

Federal Agencies & Programs

Nutrition.gov

U.S. Department of Agriculture (USDA)

•Eat Smart. Play Hard.

•Food and Nutrition Service

•MyPyramid.gov

U.S. Department of Health and Human Services (DHHS)

•Centers for Disease Control and Prevention (CDC)

•Behavioral Risk Factor Surveillance System (BRFSS)

•Body and Mind (BAM!)

•National Bone Health Campaign

•VERB

•Girl Power!

•Healthfinder

•Health Resources and Services Administration (HRSA)

•Healthy People 2010

•National Institutes of Health (NIH)

•National Heart, Lung and Blood Institute (NHLBI)

•National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

•Weight-Control Information Network (WIN)

•Office of Disease Prevention and Health Promotion (ODPHP)

•Prevention Communication Research Database (PCRD)

•Office of Public Health and Science (OPHS)

•Office of the Surgeon General (OSG)

•Office on Women's Health (OWH)

•Quick Health Data Online

•Substance Abuse and Mental Health Services Administration (SAMHSA)

White House

•HealthierUS

Resources of Health and Fitness Organizations

Health and Fitness Organizations

Action for Healthy Kids

AllRefer Health

Amateur Athletic Union (AAU)

American Alliance for Health, Physical Education Recreation and Dance (AAHPERD)

•American Association for Active Lifestyles and Fitness (AAALF)

•American Association for Health Education (AAHE)

•American Association for Leisure and Recreation (AALR)

•National Association for Girls and Women in Sport (NAGWS)

•National Association for Sport and Physical Education (NASPE)

•National Dance Association (NDA)

•Research Consortium

American Academy of Family Physicians

American Academy of Orthopedic Surgeons (AAOS)

American Academy of Pediatrics (AAP)

American Association of Retired Persons (AARP)

American Association of School Administrators (AASA)

American Cancer Society (ACS)

American College of Sports Medicine (ACSM)

American Council on Exercise (ACE)

American Diabetes Association

American Dietetic Association (ADA)

American Heart Association (AHA)

American Hiking Society (AHS)

American Kinesiotherapy Association (AKTA)

American Medical Association (AMA)

American Orthopedic Society for Sports Medicine (AOSSM)

American Physical Therapy Association (APTA)

American Public Health Association (APHA)

American Running Association (ARA)

American Red Cross

American Volkssports Association

American Youth Soccer Organization (AYSO)

Aquatic Exercise Association (AEA)

Arthritis Foundation

Association for Supervision & Curriculum Development (ASCD)

AthleticRunner.com

Boys and Girls Clubs of America

Boy Scouts of America

California Governor's Council on Physical Fitness and Sports

Christopher and Dana Reeve Paralysis Resource Center

Cooper Institute for Aerobics Research

Diabetes and Wellness Foundation

•www.diabetespresidentschallenge.org

Disabled Sports USA (DS/USA)

Dwarf Athletic Association of America (DAAA)

Girl Scouts of the USA

Health Insurance (non-profit information)

IDEA, The Fitness Source

International Food Information Council (IFIC) Foundation

International Health, Racquet & Sportsclub Assoc. (IHRSA)

International Platform on Sport and Development

Ladies Professional Golf Association (LPGA)

Maternal and Child Health Library

•Knowledge Path: Physical Activity and Children and Adolescents

National Association for Health and Fitness (NAHF)

National Association of Elementary School Principals (NAESP)

National Association of Police Athletic Leagues (PAL)

National Association of Secondary School Principals (NASSP)

National Athletic Trainers´ Association (NATA)

National Basketball Association (NBA)

National Center on Physical Activity and Disability (NCPAD)

National Coalition for Promoting Physical Activity (NCPPA)

National Disability Sports Alliance (NDSA)

National Education Association (NEA)

National Fitness Therapy Association (NFTA)

National Football League (NFL)

National Osteoporosis Foundation (NOF)

National Parents/Teachers Association (PTA)

National Middle Schools Association (NMSA)

National Recreation & Parks Assoc. (NRPA)

National Sporting Goods Association (NSGA)

National Sports Center for the Disabled (NSCD)

National Strength & Conditioning Association (NSCA)

New York State Physical Activity Coalition (NYSPAC)

P.E.4LIFE

Professional Golf Association (PGA)

Project ACES (All Children Exercise Simultaneously)

Road Runners Club of America (RRCA)

Shape Up America

Show-Me State Games

Special Olympics International

Sporting Goods Manufacturers Association (SGMA)

USA Deaf Sports Federation (USADSF)

USA Hockey, Inc.

United States Association of Blind Athletes (USABA)

United States Olympic Committee (USOC)

•United States Paralympics

United States Sports Academy

wellness4one

Wellness Councils of America (WELCOA)

Wheelchair Sports USA

Winter Trails

Women's National Basketball Association (WNBA)

Women's Sports Foundation

World Health Organization (WHO)

YMCA of the USA

YWCA of the USA

http://www.healthcorps.net/index.jsp DR OZZZZZZZZZZ!!!!!!!!!!

Heckman, J. “Investing in Disadvantaged Young Children Is Good Economics and Good Public Policy,”

Testimony before the Joint Economic Committee, Washington D.C., June 27, 2007

Rates of Return to Additional Investments in

Human Capital for Disadvantaged Children

School interventions

Fulfilling America’s Promise

The Birth to Five Policy Alliance works to fulfill the American promise of opportunity for all. Forty-two percent of our nation’s children under 6 live in low-income families and the “opportunity gap” is rooted in these very early years. The Alliance’s goal is to shift the odds for our youngest, most vulnerable children so they can grow up eager to learn and ready for success in life.

UNITED WAY

Advancing the Common Good: Creating Opportunities for a Better Life for All

Everyone deserves opportunities to have a good life: a quality education that leads to a stable job, enough income to support a family through retirement, and good health.

That’s why United Way’s work is focused on the building blocks for a good life:

•Education – Helping Children and Youth Achieve Their Potential

•Income – Promoting Financial Stability and Independence

•Health – Improving People’s Health

Advancing the common good is less about helping one person at a time and more about changing systems to help all of us. We are all connected and interdependent. We all win when a child succeeds in school, when families are financially stable, when people are healthy.

United Way’s goal is to create long-lasting changes by addressing the underlying causes of these problems. Living united means being a part of the change. It takes everyone in the community working together to create a brighter future. Give. Advocate. Volunteer. LIVE UNITED.

Our Work in Health

United Way addresses pressing health and healthcare issues facing communities across the country. Community by community, United Ways and their partners target childhood obesity, health insurance coverage, healthcare quality, childhood immunizations, substance abuse, family violence, oral health or other healthcare concerns voiced by their community.

Deeper dive on Health

Health is such a basic need, it impacts every aspect of a person’s daily life. A child with a toothache is unable to concentrate in school and succeed. A family without health insurance is often overwhelmed to the point of bankruptcy by the financial burdens of an illness. Seniors without prescription assistance have to make frightening decisions on which medicine they can afford and which ones they will go without.

Whether it is a neighbor without health insurance, a victim of abuse, or someone struggling with mental illness or an addiction, United Ways work to ensure everyone has access to affordable and quality care so they can lead safe, healthy, and rewarding lives. United Way supports local health and human service programs as well as partners with local advocates, faith leaders, healthcare professionals, the business community, and policy makers to create sustainable answers to the current healthcare crisis.

Join United Way and make your community stronger by ensuring families receive the healthcare they need to stay healthy and thrive. Every day our friends, neighbors and colleagues are forced to live with the fear of getting sick or injured. We can make a difference and the time is now.

Key Health Facts

•During the past four decades, obesity rates have soared among all age groups, increasing almost fivefold among children ages 6 to 11. RWJF

•Today, more than 33 percent of children and adolescents are overweight or obese. That's nearly 25 million kids and teenagers. RWJF

•Children with health coverage are better prepared to learn in school and succeed in life. (Institute of Medicine. From Neurons to Neighborhood: The Science of Early Childhood Development. Washington DC: National Academies Press, 2000.)

• The number of Americans without health insurance has increased steadily since the beginning of the century, now totaling about 47 million. Nearly 9 million of these are children, and more than 8 out of 10 are from working families.

• Despite the success of SCHIP, there are still 8.7 million children living without health insurance – more than the total number enrolled in the first and second grades in U.S. public schools. (Compiled by the State Health Access Data Assistance Center (SHADAC), University of Minnesota School of Public Health, using data from the U.S. Census Bureau’s Current Population Survey 2007.)

1. •More than 8 in 10 of the nonelderly uninsured live in families where the head of the family works. (Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.)
   

Pediatric Exercise Training Programs

http://www.naspem.org/training.cfm

The Pediatric Exercise Training Program directory is designed to provide information on academic programs currently conducting research in the area of pediatric exercise, child health and physical activity. To be included in this list, contact:

Anthony D. Mahon, Ph.D.

Ball State University

Human Performance Laboratory

Muncie, IN 47306

Phone: 765-285-8693

Fax: 765-285-8596

E-mail: tmahon@bsu.edu

Directory of Training Programs

Iowa State University

Michigan State University

Ball State University

Middle Tennessee State University

University of Saskatchewan

University of Pittsburgh

McMaster University (Chedoke Hospital)

McMaster University (Department of Kinesiology)

University of North Carolina

University of Exeter

University of Massachusetts at Amherst

Katholik University of Leuven

University of Utah

University of Illinois- Champaign-Urbana

Liverpool Hope University Hope Park

East Carolina University

Wake Forest University

San Diego State University

University of Arizona

University of South Carolina

Manchester Metropolitan University

The Children's Hospital of Philadelphia, Division of Cardiology, Exercise Physiology

University of Minnesota

University of Wisconsin - La Crosse

Iowa State University

257 Forker Building

Department of Health and Human Performance

Ames, IA 50011

Contact:

Greg Welk

Phone: 515-294-3583

Fax: 515-294-8740

E-mail: gwelk@iastate.edu

http://exercise.educ.iastate.edu/profiles/faculty/gwelk

Michigan State University

3 IM Sports Circle Building

Departments of Kinesiology and Epidemiology

Center for Physical Activity and Health

East Lansing, MI 48824-1049

Contact:

James M. Pivarnik, Ph.D.

Phone: 517-353-3520

Fax: 517-353-2944

Lab: 517-355-4734

Center: 517-432-8399

Karin Pfeiffer

Phone: 517-353-5222

Email: kap@msu.edu

Joe Eisenmann

Phone: 517-432-5105

Email: jce@msu.edu

Ball State University

Human Performance Laboratory

Muncie, IN 47306

Contact:

Anthony D. Mahon, Ph.D.

Phone: 765-285-8693

Fax: 765-285-8596

E-mail: tmahon@bsu.edu

Middle Tennessee State University

Department of Health and Human Performance

P.O. Box 96

Murfreesboro, TN 37122

Contact:

Don W. Morgan, Ph.D.

Phone: 615-898-5549

Fax: 615-754-9067

E-mail: dmorgan@mtsu.edu

University of Saskatchewan

College of Kinesiology

Saskatoon, Saskatchewan, Canada S7N 5C2

www.usask.ca/kinesiology/research_index.php

Bob Faulkner, Ph.D.

Phone: 306-966-6465

Fax: 306-966-6464

E-Mail: faulkner@duke.usask.ca

University of Pittsburgh

Center for Exercise and Health-Fitness Research

107 Trees Hall

Pittsburgh, PA 15261

Contact:

Robert J. Robertson, Ph.D.

Phone: 412-648-8251

Fax: 412-648-7092

E-mail: rrobert@pitt.edu

McMaster University

Children's Exercise & Nutrition Centre

Chedoke Hospital, Evel Bldg, Room 469

Sanatorium Road, P.O. Box 2000

Hamilton, ON Canada L8N3Z5

Contact:

Brian W. Timmons, Ph.D.

Phone: 905-521-2100, ext. 77218 or 77615

Fax: 905-385-5033

E-Mail: timmonbw@mcmaster.ca

Visiting Scholars and Post-doctoral Research Fellows are welcome.

McMaster University

Department of Kinesiology

Hamilton L8S 4K1

Ontario, Canada

Contact:

C.J.R. Blimkie, Ph.D., FACSM

Phone: 905-528-2112, Ext 24702

Fax: 905-523-6011

E-Mail: blimkie@mcmaster.ca

University of North Carolina

Dept. of Exercise and Sport Science

CB #8700, Fetzer Gym

Chapel Hill, NC 27599-8700

Contact:

Robert G. McMurray

Phone: 919-962-1371

Fax: 919-962-0489

E-Mail: exphys@email.unc.edu

University of Exeter

Children's Health and Exercise Research Center

School of Postgraduate Medicine and Health Sciences

Heavitree Rd. Exeter, UK EX1 2 LU

Contact:

Neil Armstrong, Ph.D., FACSM

Brian J. Kirby, M.B., Ch.B.

JoAnne Welsman, Ph.D.

Phone: 0392-264812

E-Mail: n.armstrong@exeter.ac.uk

University of Massachusetts at Amherst

Totman Gym

Box 37805 Amherst, MA 01003-7805

Contact:

Patty S. Freedson, Ph.D.

Phone: 413-545-2620

Fax: 413-545-2906

E-Mail: psf@excsci.umass.edu

Katholik University of Leuven

Department Sport and Movement Science

Faculty of Physical Education and Physiotherapy

Tervuurse vest 101, B3001 Leuven, Belgium

Contact:

Prof. dr. Gaston Beunen

Phone: 32 16 32 90 81

Fax: 32 16 32 91 97

E-Mail: gaston.beunen@flok.kuleuven.ac.be

University of Utah

Department of Exercise and Sport Science

College of Health

250 S. 1850 E. Rm. 200

SLC, UT 84112

http://www.health.utah.edu/ess/

Contact:

Dr. James C. Hannon

Phone: (801) 581-7646

Fax: (801) 585-3992

E-Mail: James.Hannon@hsc.utah.edu

University of Illinois - Champaign Urbana

College of Applied Lifes Studies

110 Huff Hall, MC-586

1206 S. Fourth Street

Champaign, IL 61820

Contact:

Bo Fernhall, Ph.D.

Phone: 217-333-2131

Fax: 217-333-0404

E-mail: Fernhall@uiuc.edu

Liverpool Hope University Hope Park

Deanery of Sciences and Social Sciences

Liverpool, L16 9JD

United Kingdom

Contact:

Vish Unnithan, Ph.D.

Phone: (0151(-291-2045

Fax: (0151)-291-3172

E-mail: unnithv@hope.ac.uk

East Carolina University

Department of Exercise and Sport Science

East Carolina University

Greenville, NC 27858

Contact:

Matthew T. Mahar, Ed.D.

Director, Activity Promotion Laboratory

Phone: 252-328-0008

Fax: 252-328-4654

E-mail: maharm@ecu.edu

Wake Forest University

PO Box 7868

Winston-Salem, NC 27109-7868

Contact:

Patricia A. Nixon, PhD

Associate Professor of Health & Exercise Science

Associate Professor of Pediatrics

Phone: 336-758-4642

Fax: 336-758-4680

E-mail: nixonpa@wfu.edu

San Diego State University

School of Exercise and Nutritional Sciences

San Diego State University, ENS 216

San Diego CA 92182-7251

Contact:

Thomas L. McKenzie, Ph.D.

Phone: 619-594-4817

Fax: 619-594-6553

University of Arizona

Department of Physiology and Nutritional Sciences

Ina E. Gittings Building

Room 110, PO Box 210093

Tucson, AZ 85721

Contact:

Scott Going

Tim Lohman

Phone: 520-621-4705

Fax: 520-626-3995

E-mail: going@u.arizona.edu

University of South Carolina

Children’s Physical Activity Research Group

Department of Exercise Science

921 Assembly St.

University of South Carolina

Columbia, SC 29208

Contact:

Russ Pate

Phone: 803-777-2456

E-mail: rpate@gwm.sc.edu

Manchester Metropolitan University

Exercise & Sport Science

Alsager Campus

Hassall Rd

Alsager ST7 2HL

ENGLAND

Contact:

Keith Tolfrey

Phone: 0161 247 5688

E-mail: k.tolfrey@mmu.ac.uk

The Children's Hospital of Philadelphia

Division of Cardiology

Exercise Physiology

Division of Cardiology

Exercise Physiology

34th & Civic Center Blvd

Philadelphia, PA 19104

Contact:

Stephen M. Paridon, MD

E-mail: paridon@email.chop.edu

Michael G. McBride, PhD

E-mail: mcbride@email.chop.edu

Phone: 215-590-3532

Fax: 215-590-8776

Laboratory: 215-590-1811

University of Minnesota

110 Cooke Hall

1900 University Avenue S.E.

Minneapolis, MN 55455

Contact:

Donald R. Dengel, Ph.D.

Associate Professor

Phone: 612-626-9701

Fax: 612-625-8867

E-mail: denge001@umn.edu

University of Wisconsin - La Crosse

Department of Exercise and Sport Science

132 Mitchell Hall

University of Wisconsin - La Crosse

Contact:

Rebecca A. Battista, Ph.D.

Assistant Professor, Associate Director of the Human Performance Lab Director, Undergraduate Fitness Program

Phone: 608-785-8182

Health benefits of physical activity: the evidence
http://www.cmaj.ca/cgi/content/abstract/174/6/801

Darren E.R. Warburton, Crystal Whitney Nicol and Shannon S.D. Bredin

From the School of Human Kinetics, University of British Columbia (Warburton, Nicol, Bredin), and the Healthy Heart Program, St. Paul's Hospital (Warburton, Nicol), Vancouver, BC

Correspondence to: Dr. Darren E.R. Warburton, Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, Unit II, Osborne Centre, 6108 Thunderbird Blvd., Vancouver BC V6T 1Z3; fax 604 822-9451; darren.warburton@ubc.ca

Abstract

The primary purpose of this narrative review was to evaluate the current literature and to provide further insight into the role physical inactivity plays in the development of chronic disease and premature death. We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death. We also reveal that the current Health Canada physical activity guidelines are sufficient to elicit health benefits, especially in previously sedentary people. There appears to be a linear relation between physical activity and health status, such that a further increase in physical activity and fitness will lead to additional improvements in health status.

        

The health benefits of physical activity in children and adolescents: implications for chronic disease prevention

M. S. Sothern1, M. Loftin2, R. M. Suskind1, J. N. Udall1 and U. Blecker1

(1) 

Department of Pediatrics, Louisiana State University Medical Center, Louisiana, USA, US

(2) 

Department of Human Performance and Health Promotion, University of New Orleans, New Orleans, Louisiana, USA, US

Journal

European Journal of Pediatrics

Conclusion Moderate intensity exercise of a non-structured nature seems to facilitate most of the disease prevention goals and health promoting benefits. With new guidelines promoting a less intense and more time-efficient approach to regular physical activity, it is hoped that an upward trend in the physical activity patterns, and specifically children at risk for chronic disease, will develop in the near future.

Exercise Treatment for Major Depression: Maintenance of Therapeutic Benefit at 10 Months
http://www.psychosomaticmedicine.org/cgi/content/abstract/62/5/633

Michael Babyak, PhD, James A. Blumenthal, PhD, Steve Herman, PhD, Parinda Khatri, PhD, Murali Doraiswamy, MD, Kathleen Moore, PhD, W. Edward Craighead, PhD, Teri T. Baldewicz, PhD and K. Ranga Krishnan, MD

CONCLUSIONS: Among individuals with MDD, exercise therapy is feasible and is associated with significant therapeutic benefit, especially if exercise is continued over time.

Current Opinion in Psychiatry:Volume 18(2)March 2005p 189-193

Exercise and well-being: a review of mental and physical health benefits associated with physical activity

[Behavioural medicine]

http://www.co-psychiatry.com/pt/re/copsych/abstract.00001504-200503000-00013.htm;jsessionid=JkqS2JrH7KyTnLyPTrdrPLKcLJVVN6YTlb3wyKnpzG4tylScN9Ky!-858031623!181195628!8091!-1

Penedo, Frank Ja; Dahn, Jason Ra,b

aDepartment of Psychology and Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables

bMiami Veteran's Affairs Medical Center, Miami, Florida, USA

Recent findings: Results of the studies continue to support a growing literature suggesting that exercise, physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes. Generally, participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions. Similarly, participants in randomized clinical trials of physical-activity interventions show better health outcomes, including better general and health-related quality of life, better functional capacity and better mood states.

Exercise and the Treatment of Clinical Depression in Adults: Recent Findings and Future Directions

[Leading Article]

Brosse, Alisha L.1; Sheets, Erin S.1; Lett, Heather S.2; Blumenthal, James A.2

1 Department of Psychology, University of Colorado, Bolder, Colorado, USA

2 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA

The available evidence provides considerable support for the value of exercise in reducing depressive symptoms in both healthy and clinical populations. However, many studies have significant methodological limitations. Thus, more data from carefully conducted clinical trials are needed before exercise can be recommended as an alternative to more traditional, empirically validated pharmacological and behavioural therapies.