The Contribution of Physical Activity and Sedentary Behaviours to the Growth and Development of Children and Adolescents

Article (PDF Available)inSports Medicine 37(6):533-45 · February 2007with2,935 Reads
DOI: 10.2165/00007256-200737060-00006 · Source: PubMed
The obesity epidemic is a global trend and is of particular concern in children. Recent reports have highlighted the severity of obesity in children by suggesting: “today’s generation of children will be the first for over a century for whom life expectancy falls.” This review assesses the evidence that identifies the important role of physical activity in the growth, development and physical health of young people, owing to its numerous physical and psychological health benefits. Key issues, such as “does a sedentary lifestyle automatically lead to obesity” and “are levels of physical activity in today’s children less than physical activity levels in children from previous generations?”, are also discussed. Today’s environment enforces an inactive lifestyle that is likely to contribute to a positive energy balance and childhood obesity. Whether a child or adolescent, the evidence is conclusive that physical activity is conducive to a healthy lifestyle and prevention of disease. Habitual physical activity established during the early years may provide the greatest likelihood of impact on mortality and longevity. It is evident that environmental factors need to change if physical activity strategies are to have a significant impact on increasing habitual physical activity levels in children and adolescents. There is also a need for more evidence-based physical activity guidelines for children of all ages. Efforts should be concentrated on facilitating an active lifestyle for children in an attempt to put a stop to the increasing prevalence of obese children.
Sports Med 2007; 37 (6): 533-545
© 2007 Adis Data Information BV. All rights reserved.
The Contribution of Physical Activity
and Sedentary Behaviours to the
Growth and Development of Children
and Adolescents
Implications for Overweight and Obesity
Andrew P. Hills,
Neil A. King
and Timothy P. Armstrong
1 School of Human Movement Studies, Institute of Health & Biomedical Innovation,
Queensland University of Technology, Brisbane, Queensland, Australia
2 Biopsychology Group, Institute of Psychological Sciences, University of Leeds, Leeds, UK
3 Department of Chronic Diseases & Health Promotion, Surveillance and Population-Based
Primary Prevention of Chronic Diseases, World Health Organization, Geneva, Switzerland
Abstract ....................................................................................533
1. Measurement of Physical Activity ..........................................................535
2. Physical Activity During the Growing Years..................................................535
3. Physical Activity During the Early Childhood Years ...........................................536
4. Physical Activity During Childhood and Adolescence........................................538
5. Physical Activity and Musculoskeletal Health ................................................539
6. Sedentary Behaviours and Obesity.........................................................539
6.1 Does a Sedentary Lifestyle Automatically Lead to Weight Gain?..........................539
6.2 Current Physical Activity Levels ........................................................540
7. Implications for Physical Activity Recommendations and Guidelines for Children and
Adolescents. Recommendations for Children: What is the Evidence? .........................541
8. Preventing a Worsening of the Situation ....................................................541
9. Conclusions .............................................................................542
The obesity epidemic is a global trend and is of particular concern in children.
Recent reports have highlighted the severity of obesity in children by suggesting:
“today’s generation of children will be the first for over a century for whom life
expectancy falls.” This review assesses the evidence that identifies the important
role of physical activity in the growth, development and physical health of young
people, owing to its numerous physical and psychological health benefits. Key
issues, such as “does a sedentary lifestyle automatically lead to obesity” and “are
levels of physical activity in today’s children less than physical activity levels in
children from previous generations?”, are also discussed.
Today’s environment enforces an inactive lifestyle that is likely to contribute
to a positive energy balance and childhood obesity. Whether a child or adolescent,
the evidence is conclusive that physical activity is conducive to a healthy lifestyle
534 Hills et al.
and prevention of disease. Habitual physical activity established during the early
years may provide the greatest likelihood of impact on mortality and longevity. It
is evident that environmental factors need to change if physical activity strategies
are to have a significant impact on increasing habitual physical activity levels in
children and adolescents. There is also a need for more evidence-based physical
activity guidelines for children of all ages. Efforts should be concentrated on
facilitating an active lifestyle for children in an attempt to put a stop to the
increasing prevalence of obese children.
The value of physical activity to normal growth youngsters to be physically active has reduced over
and development, including the health and well- time
probably due to a series of changing environ-
being of children and adolescents is undisputed.
mental factors. The environment exerts a strong
This includes the concept that humans have an evo- influence on physical activity.
lutionary-derived and genetically-primed need for
Physical activity and food are basic needs for
regular physical activity to maintain optimal meta-
survival; however, cultural changes in many parts of
bolic function
and to prevent chronic disease
the world have ‘engineered’ spontaneous physical
and death.
activity out of the daily lives of many.
activity and concomitant poor food choice contrib-
It is logical that at the extremes, under- (hypo)
ute to an increase in overweight and obesity, particu-
and over- (hyper) activity could be harmful to the
larly in the developed world. A recent phenomenon
growing child. Physical activity is one of a number
in developing countries is the combination of under-
of factors that influence the growth and develop-
weight children and overweight adults, frequently
ment of children and adolescents. During the forma-
coexisting in the same family.
tive years, changes in health and motor-related fit-
ness are influenced by growth and maturation. It is Despite gaps in the knowledge and understanding
difficult to isolate the specific effects of regular of the specific effect of regular physical activity in
physical activity on health and fitness status from children and the longer term impact on adult chronic
the inherent adjustments in growth and development disease, there is a general consensus that long term
during childhood and adolescence.
When assess- benefits to health, in respect to desirable body com-
ing habitual physical activity and associated activity position, require the incorporation of habitual physi-
interventions in children, caution is required; the cal activity from an early age.
The progressive
normal development of height and weight of chil- introduction of habitual physical inactivity into dai-
dren should not be jeopardised.
During childhood ly living has been a major contributor to chronic
and adolescence, nutrition and physical activity in- health conditions.
Potential benefits of physical
fluence the growth and development of numerous activity must be considered on the basis of the age at
body tissues, including body fat, skeletal muscle which regular activity commences and the nature of
tissue and bone.
It is important to bear in mind the physical activity experience. Desirable patterns
that growth and maturation will continue even when of habitual physical activity, if established during
physical activity is limited,
whereas appropriate the early years of life and sustained across the lifes-
nutrition (ideally in combination with physical ac- pan, may provide the greatest likelihood of impact
tivity) is essential for optimal growth and develop- on mortality and longevity.
Chakravarthy and
ment. Children who experience appropriate nutri- Booth
have hypothesised that there is a thresh-
tion and regular physical activity during the growing old of physical activity (for optimal expression of
years may be expected to display healthy patterns of inherited genes and genotypes) and falling below
physical maturation consistent with their genetic this threshold has been defined as ‘physical activity
potential. Unfortunately, the opportunity for many deficiency’. The manifestation of this concept, ‘sed-
© 2007 Adis Data Information BV. All rights reserved. Sports Med 2007; 37 (6)
Physical Activity and Obesity in Children and Adolescents 535
entary death syndrome’, contributes to a significant physical environment and social environment (pres-
public health burden associated with chronic disease ence of others and prompts or consequences for
and premature death.
Olshansky et al.
have physical activity). DuRant et al.
utilised the Chil-
recently provided a profound summary of the conse- dren’s Activity Rating Scale, which identifies types
quences of obesity by suggesting that “unless effec- of activities and intensities of those activities. The
tive population-level interventions to reduce obesity work of Pellegrini and Smith
also relied heavily
are developed, the steady rise in life expectancy on observational periods that allow classification of
observed in the modern era may soon come to an the types of activities that young children engage in.
end and the youth of today may, on average, live less
The gold standard for measuring total energy
healthy and possibly even shorter lives than their
expenditure is doubly-labelled water.
This tech-
parents.” In addition, one of the key conclusions
nique provides an accurate measure of daily energy
from the recent UK Health Committee on Obesity
expenditure in the free-living environment and al-
was that “…today’s generation of children
lows the energy cost of activity to be calculated if
will be the first for over a century for whom life
resting metabolic rate is known. The introduction of
expectancy falls.” Therefore, it is of little surprise
motion sensors (e.g. pedometers and accelerome-
that the combined benefits of adequate physical
ters) provides a relatively inexpensive alternative to
activity and sound nutritional practices have been
objectively measure physical activity levels of chil-
regularly cited as public health’s “best buy.”
dren. In most cases, motion sensors provide frequen-
The main aim of this article is to highlight the cy, duration and intensity of physical activity. Heart
important role of physical activity in the growth, rate monitors provide a continuous physiological
development and physical health of young people. response to physical activity; however, the validity
In addition, it aims to provide a balanced review of of this technique is reduced at lower levels of physi-
the evidence assessing physical activity levels in cal activity.
New variations on existing tech-
children and whether this contributes to the increas- niques are continuously being developed in an at-
ing prevalence of obesity. tempt to improve the range of techniques availa-
For a more extensive review of
measurement and validity issues related to physical
1. Measurement of Physical Activity
activity in children, see Livingstone et al.
The measurement of physical activity in children
and adults inherently involves methodological and
2. Physical Activity During the
validity problems. However, measurement problems
Growing Years
are augmented in paediatric research. A range of
subjective (e.g. activity diaries) and objective (e.g. Physical activity is particularly important for the
doubly-labelled water) techniques are available physical health of young people and should be a
each with their relative strengths and limitations normal part of growth and development.
(detailed reviews are available in the litera- lar weight-bearing activity: (i) contributes to the
). Inconsistencies in the relationship be- growth and maintenance of a healthy musculoskele-
tween habitual physical activity and cardiovascular tal system; (ii) helps maintain a desirable body com-
disease risk factors in younger children
can be position by controlling weight and minimising body
attributed to the variation in methods used to mea- fat; and (iii) helps to prevent and reduce high blood
sure physical activity.
In young children, direct pressure.
In addition to the physical benefits,
observation is the primary form of assessment of participation in physical activity plays a key part in
physical activity. McKenzie et al.
and Elder et the social and mental development of young chil-
utilised the Behaviours of Eating and Activity dren.
In recent years, the psychosocial benefits of
for Children Health Evaluation System, which physical activity have been highlighted, including a
characterises the child’s physical activity level, reduction in the symptoms of depression and possi-
© 2007 Adis Data Information BV. All rights reserved. Sports Med 2007; 37 (6)
536 Hills et al.
bly stress and anxiety,
and improvements in self- engage in active play with their children due to
increased demands on their time, or because of poor
confidence, self-esteem, energy levels, sleep quality
health or disability.
and the ability to concentrate.
There are a number of key periods and points of
3. Physical Activity During the Early
transition during childhood and adolescence where
Childhood Years
additional emphasis on the role of physical activity
may be important.
These include the early child-
Despite the well documented benefits of physical
hood years, the commencement of formal schooling,
activity to health, fitness, and normal growth and
the transition from primary or elementary school to
development in adults,
there is a paucity of infor-
high school
and, finally, between high school and
mation regarding the interrelationship between ha-
higher education or the workforce.
These criti-
bitual physical activity, physical fitness and health
cal points may be times when the physical activity
status in children of preschool age. A combination
patterns of some young people change considerably
of sound nutritional practices and adequate physical
and when they may not be sufficiently physically
activity for all young people represents a cost-effec-
active to gain a health benefit.
Insufficient levels
tive option to reduce the risk or prevent obesity and
of physical activity at any stage during the growing
other chronic diseases.
Regular physical activity
years, but particularly during these key periods of
and appropriate eating behaviours should be em-
transition, are major contributing factors to over-
ployed from birth. This requires a consolidated ap-
weight and obesity.
proach from all sectors, but particularly health pro-
Although few would contest the position that
fessionals, teachers and parents, to influence the
physical activity is a healthy behaviour, very little
knowledge, attitudes and behaviours of young peo-
direct evidence exists that demonstrate the health
ple. Part of this process is for all concerned to have
benefits of physical activity in children. It is logical
an appreciation of the normal individual variability
that an association is more difficult to demonstrate
in physical growth during infancy, childhood and
in children because the negative health outcomes
adolescence, particularly in relation to body size,
(with the exception of obesity and possibly type 2
shape and composition.
Very young children are
diabetes mellitus) are less prevalent during child-
dependent on responsible adults to provide gui-
hood compared with adulthood – hence, there are
dance, to act as role models for acceptable behaviour
fewer detectable markers of disease.
and to be conscious of special needs. Therefore,
due to the lack of direct, convincing evidence, quali-
adults need to be made aware of the importance of
tative recommendations, such as ‘desirable’, have
enjoyment and safety in physical activity and appre-
been used for the promotion of physical activity in
ciate the central place that activity should take in the
growth and development of a child. Shared environ-
mental factors have been shown to have a powerful
Participation in sport is a positive way to en-
influence on children’s physical activity.
courage children to be physically active. However,
is also evidence to support a genetic or familial
for some, the cost of equipment and uniforms can be
aggregation of physical activity.
Therefore, par-
an impediment. Additionally, if children are already
ents’ attitudes, encouraging family-based activity
overweight, they may feel uncomfortable or incapa-
and providing opportunities in the environment to
ble of participating in sport if the focus is more on
facilitate activity should be targeted when consider-
achievement rather than participation and having
ing interventions in children.
Finally, as is the case for nutrition and appro-
priate eating behaviour, children may not be in-
The first years of life represent an intense period
clined to participate in physical activity if their
of motor learning that provides the foundation for
parents are not modelling active lifestyle behaviours
later, more complex and skilled performance. In
Again, parents may find it difficult to
later years (5–8 years of age), an active lifestyle is
© 2007 Adis Data Information BV. All rights reserved. Sports Med 2007; 37 (6)
Physical Activity and Obesity in Children and Adolescents 537
associated with improved motor skills and develop- play identified by Pellegrini and Smith.
and tumble play refers to vigorous behaviours such
The development of the fundamental
as wrestling, kicking and tumbling. This type of play
movement patterns of crawling, standing, walking,
is essentially a social behaviour, with the earliest
running and jumping in younger children is fostered
cases often supported by a parent. At 4 years of age,
by the opportunity to play. However, without this
this type of play accounts for 8% of observed
opportunity, habitual physical activity could be je-
child-parent behaviour and 3–5% of play beha-
opardised and, as a result, a lowering of energy
viour in preschool children. This type of play peaks
expenditure (and potentially weight gain) could oc-
at around 8–10 years of age.
Young children need to explore their envi-
ronment through movement and experiment with
Individual differences in growth and develop-
the movement capabilities of their bodies. They
ment contribute to variability in the attainment of
have both a desire and need to engage in progres-
motor milestones, physical maturational status and
sively more vigorous and physically challenging
the appearance of specific characteristics in young
activities. Whether this behaviour is biologically
children such as an awareness of the rewards of
or random is unknown.
physical activity, experiencing self-esteem and self-
confidence, and feelings of mastery and compe-
Pellegrini and Smith
identified three different
tence. Through movement, a child receives and acts
types of physical activity play that occur during
upon sensory information from external stimuli
early childhood and ascribed general age trends to
through visual, tactile and auditory mechanisms,
these behaviours. During infancy, ‘rhythmic stereo-
and internally from vestibular and kinesthetic recep-
types’ is the term assigned to activities that involve
tors. Gallahue
has suggested that young children
gross motor movements that are difficult to ascribe a
engage in movement activities that may be cat-
goal or purpose to, for example, foot kicking or body
egorised as tasks of ‘learning to move’ and ‘learning
rocking. These behaviours peak during the mid-
through movement’. Both of these activities play
point of the first year of life. At 6 months of age,
important roles in the overall growth and develop-
some infants spent 40% of the observational period
ment of children.
of the study in stereotypic behaviour. At the start of
the second year of life, children become involved in
McKenzie et al.
found that 4-year-old children
‘exercise play’, defined as gross motor movements
were sedentary (lying down, sitting and standing)
in the context of play. The characteristic feature of
during 58.9% of the observed 26-minute recess peri-
this play is physical vigour. This type of play may or
od, whilst 41.1% of the time was classified as mod-
may not occur in a social context and increases from
erate to vigorous physical activity. Elder et al.
toddler age onwards and peaks during the preschool
found that over a 2-year period, parental and peer
period (4–5 years of age) and then declines during
prompts (measured over a 1-hour period) to be phys-
the primary school years. At 4 years of age, 20% of
ically active decreased by more than one and a half
children’s activity is characterised as physically vig-
times, especially for children who were already sed-
entary. Compliance with physical activity prompts
increased over the 2-year period.
Early childhood is also a time when socialisation
becomes important and behavioural norms are es-
The early establishment of appropriate lifestyle
tablished with a strong dependence on responsible
practices is critical for young children. Sedentary
adults. Particularly in relation to movement and
behaviours in children can be reinforcing, which are
physical activity, there is an increasing reliance on
more likely to facilitate a habitually sedentary lifes-
parents as the child moves from a self-centred focus
tyle in later years.
Encouragement for physical
to actively seeking assistance then approval from
activity, however, must be paralleled with opportu-
others in relation to physical performance. ‘Rough
nity. It is not sufficient to suggest that physical
and tumble play’ is the third type of physical activity
activity is desirable if changes are not made to one’s
© 2007 Adis Data Information BV. All rights reserved. Sports Med 2007; 37 (6)
538 Hills et al.
environment in order to support the incorporation of mes and physical education curriculum are necessa-
ry to encourage the development of health and mo-
activity. The opposing forces of the changing envi-
tor-related fitness in all young children.
ronment are continually reducing such opportuni-
ties, thus making encouragement more of a futile
challenge. Unless interventions are introduced that
4. Physical Activity During Childhood
eradicate the environmental barriers to facilitate and
and Adolescence
promote an active lifestyle, the problem is going to
The gradual decline in physical activity between
get worse.
However, there is some evidence to
childhood and adolescence is a robust epidemiologi-
suggest that even when opportunity and choice (sed-
cal phenomenon.
Social, environmental and bio-
entary vs active) are provided, children elect to be
logical factors are likely to contribute to such a
Physical activity experiences need to
marked trend. Participation in school-based activi-
be positive and conducted in a manner that fosters
ties, sport clubs and general ‘play’ will be most
fun and enjoyment, capitalising on the spontaneity
prevalent during childhood. As a child enters ado-
and pleasure in movement that are hallmarks of
lescence, physical activity and exercise become less
most young children.
To establish habitual physi-
of a priority and is displaced by other behaviours
cal activity for the longer term, each child must
and interests. Participation in physical activity dur-
experience a measure of success in the activity set-
ing childhood could have important implications for
ting, as poor experiences may be associated with
adulthood. Although the evidence is limited, it has
diminished levels of participation and perpetuate
been shown that physical activity in childhood can
any weight problem that might exist.
Many chil-
predict participation in activity during adult-
dren are not given the opportunity to be sufficiently
In contrast, there is also evidence to
active to establish a sound motor-skill base. A good
suggest weak associations.
level of motor skill is necessary to broaden activity
Children spend a majority of their waking day at
opportunities, although this should not be confused
school, hence, it is during this window of opportuni-
with a high level of proficiency. Competency in the
ty that physical activity could be influenced the
activity domain is one of the factors likely to have a
most. The combination of breaktimes and physical
bearing upon participation levels in later years.
education classes should provide the opportunity to
Improving self-efficacy, enjoyment and all-round
significantly contribute to overall daily activity and
competence related to physical activity and knowl-
energy expenditure. However, children will also
edge of healthy eating habits are associated with
spend a large amount of time seated during study
beneficial effects of exercise and diet interventions
and education classes at school. With a trend to-
in children.
A reasonable standard of compe-
wards less time for physical education and sport
tency, along with knowledge and understanding of
participation in the schools,
the amount of time
the health benefits of physical activity should assist
spent sedentary at school will gradually increase.
informed decision making.
The net impact of physical education classes on total
To achieve the goals mentioned in this section
daily energy expenditure has been questioned.
and prevent obesity in young people requires far
Indeed, one study demonstrated that physical activi-
more than the current ad hoc approach. Numerous
ty was independent of the amount of curriculum-
multi-level strategies are required to maximise the
based physical education.
That is, children who
impact of intervention work to address the level of
attended schools with more time allocated to curric-
inactivity and prevent or reduce undesirable weight
ulum-based physical education classes had similar
gain in young people.
All young children
levels of total net daily physical activity compared
should be provided with a wide range of movement
with children who spent less time doing physical
experiences from birth to harness their natural en-
education classes. These results need to be consid-
joyment and spontaneity. Quality activity program-
ered in the context of the quality of the physical
© 2007 Adis Data Information BV. All rights reserved. Sports Med 2007; 37 (6)
Physical Activity and Obesity in Children and Adolescents 539
education experience. More specifically, time in and adolescents who are overweight or obese may
physical education classes does not necessarily be vulnerable with respect to skeletal health as they
equate with time spent in activity per se. Greater commonly have marginal nutrition and are sedenta-
attention needs to be given to ‘active’ physical edu- ry, which are the most common risk factors for low
cation where time on the physical activity task is bone mineral.
The importance of physical activity to skeletal
health must also be considered in concert with the
5. Physical Activity and ingestion of calcium. Interestingly, the beneficial
Musculoskeletal Health effects of physical activity are only noted when
or circulating sex steroids
are ade-
The foundation for longer term skeletal health is
quate. Exercise has been described as a double-
established during childhood and adolescence.
edged sword in relation to skeletal health. Immobili-
Physical activity represents a major mechanical
ty results in bone loss while moderate weight-bear-
loading factor for bone through a combination of
ing activity has been correlated with increased bone
growth (determining bone size), modelling (deter-
mineral in children and young adults.
mining the shape of bone) and remodelling (main-
levels of activity do not usually cause problems;
taining the functional competence of bone).
however, at the other end of the physical activity/
bone mass and density is achieved in early adult-
exercise continuum, high levels of more intense
and this serves as a ‘bone-bank’ for the
training may create conditions in which the suscepti-
remainder of adult life.
bility of injury increases,
along with the risk of
Childhood and adolescence are commonly dy-
osteopaenia and bone fracture.
namic periods for skeletal growth and development,
6. Sedentary Behaviours and Obesity
including deposition of bone mineral. In healthy
children and adolescents, the tempo of bone mineral
When considering the relationship between ha-
acquisition largely parallels the pattern of linear
bitually activity, sedentary behaviours and obesity
growth, increasing rapidly during infancy, more
in children, the following two issues need to be
gradually throughout childhood and accelerating
addressed: (i) does a sedentary lifestyle automatical-
again at puberty. Gains in bone mineral and the
ly lead to weight gain and obesity? and (ii) how do
ability of bone to adapt to mechanical loading are
current levels of physical activity compare with
much greater at or before puberty than after physical
physical activity recommendations, and are current
Under normal conditions of growth
levels of physical activity low compared with previ-
and development approximately half of the peak
ous generations?
bone mass is gained during the adolescent period.
The amount of bone deposited by early adulthood
6.1 Does a Sedentary Lifestyle Automatically
is largely determined by genetic factors, but envi-
Lead to Weight Gain?
ronmental factors, such as diet and physical activity,
account for 20–40% of the variability in peak bone The principle of energy balance is simple; if
The achievement of one’s genetic potential energy intake (EI) exceeds energy expenditure (EE),
for peak bone mass is only possible when environ- a positive energy balance occurs, which if it persists
mental factors are favourable; however, there is a will automatically lead to weight gain. However,
poor understanding of the type, intensity, duration understanding the underlying factors and mecha-
and frequency of exercise that will optimise bone nisms that contribute to a low EE and high EI is
mineral accumulation. Similarly, both the chrono- more complex. A combination of environmental
logical age at which exercise would be most crucial pressures, technological factors and societal transi-
and the extent to which physical activity can modify tions from childhood to adolescence are likely to
the development of bone is unclear.
Children promote sedentary behaviour, which could poten-
© 2007 Adis Data Information BV. All rights reserved. Sports Med 2007; 37 (6)
540 Hills et al.
tially lead to weight gain.
As a result of the cause- school and playing outdoors compared with previ-
effect problem and methodological flaws in measur-
ous generations of parents. However, suggestions of
ing physical activity per se, proving a direct link
an increased danger to children are not evidence-
between a sedentary lifestyle and weight gain is
based and could be as a result of parents’ mispercep-
difficult. In adults, there is convincing evidence to
tions. Despite this, Harten and Olds
have reported
show that a sedentary lifestyle is associated with
that active transport levels of Australian children are
debilitative lipoprotein regulation,
and a greater
very low. In addition, children are gaining little
risk of cardiovascular disease and mortality in
benefit from incidental exercise with the widespread
The evidence for a causal link between
use of labour-saving devices. Changes in children’s
sedentariness and obesity in adults is weaker.
entertainment choices have also contributed to an
However, there is some evidence to demonstrate
increase in sedentary behaviour. Playing console
that sedentary behaviours are associated with over-
and computer games and watching television and
weight and obesity in children.
For example,
DVDs/videos are very popular leisure pursuits
television viewing is associated with lower habitual
among children.
Coupled with unprecedented ac-
physical activity and cardiorespiratory fitness,
cess to the internet and mobile phones, children need
and increased obesity.
In contrast, it has been
not even leave home to maintain contact with their
proposed that sedentary and active behaviours can
friends outside school hours. As a result, there is
and that one type of behaviour does not
speculation that activities undertaken by children
automatically displace the other. For example, it is
are predominantly sedentary in nature and involve
possible for children to combine physically active
minimal EE.
behaviours (e.g. participate in sport and exercise)
with sedentary behaviours (e.g. computer games,
Due to a lack of comparable data, it is difficult to
watching television) within the same day. In es-
demonstrate that the level of physical activity (and
sence, the most important issue is that EE is equal to
EE) in today’s children is low compared with their
EI. Despite this, there is some controversy over the
counterparts several decades ago. However, this is
true, direct effect of sedentary behaviours on weight
an area that has attracted some controversy because
gain and obesity in children.
It is intuitive that
of the lack of a ‘benchmark’ of physical activity
sedentary behaviours should be limited because of
with which to compare current levels.
Most of
their contribution to a reduction in EE and promo-
the evidence comes from indirect, surrogate mea-
tion of a positive energy balance. One of the key
for example, walking and cycling to
features of sedentary behaviours is that they typical-
school being replaced by the car.
ly co-exist with eating, which, in turn, could aug-
there is some evidence that, similar to adults, many
ment the obesity epidemic.
Recent evidence sup-
children do not participate in appropriate levels of
ports this phenomenon by demonstrating that seden-
physical activity
and that activity levels are
tary behaviours are associated with a higher snack
lower than recommended.
Indeed, Salbe et
intake in children and adolescents.
demonstrated that 5-year-old white and Pima
Indian children had a physical activity level (PAL)
6.2 Current Physical Activity Levels
[PAL = EE/basal metabolic rate] of 1.35, which is
significantly lower than the WHO recommendations
There is a trend for sedentary lifestyles across
of 1.7–2.0 for children aged 4–6 years. The indica-
most of the developed world.
Children are at risk
tions are that for today’s children, physical activity
as a result of their susceptibility to a technologically
levels are low and, more importantly, progressively
changing environment and issues concerning their
decreasing. If this behavioural trend occurs in syner-
perceived safety. A possible implication of a more
gy with an increase in EI, levels of overweight and
safety-conscious culture is that parents are increas-
obesity will escalate.
ingly protective of their children during transport to
© 2007 Adis Data Information BV. All rights reserved. Sports Med 2007; 37 (6)
Physical Activity and Obesity in Children and Adolescents 541
7. Implications for Physical Activity activity would be a positive outcome. In very young
Recommendations and Guidelines for children, the promotion of physical activity could be
Children and Adolescents. more successful by encouraging play rather than
Recommendations for Children: What is focusing on the physical health benefits.
the Evidence? mendations should target parents and schools by
encouraging physical activity and incorporating ac-
Recommendations about physical activity and tivity into the habitual lifestyle.
Such approaches
healthy lifestyle are continually being made, for should be widespread and form the foundation upon
example, “…when daily physical activity of 1 hour which more definitive guidelines are based as evi-
is performed in combination with a natural food diet, dence becomes available.
high in fibre-containing fruits, vegetables and whole
grains, and naturally low in fat, containing abundant
8. Preventing a Worsening of
amounts of vitamins and minerals, and phytochemi-
the Situation
cals, the vast majority of chronic diseases may be
The most important and immediate action re-
Despite the well established and un-
quired is to prevent the obesity problem getting
contested health benefits associated with physical
worse. A wholesale reduction in obesity (i.e. via
and the increasing epidemic of obesity,
treatment) is an almost impossible task. Therefore,
relatively less attention is paid to generating evi-
efforts should be concentrated on facilitating an
dence-based knowledge to formulate physical activ-
active lifestyle for children in an attempt to put a
ity recommendations and guidelines for chil-
stop to the increasing prevalence of obese chil-
However, a recent review contributed sig-
Although it can be considered as simplistic
nificantly to the understanding of the effects of
and vague, one approach is to recommend reducing
regular physical activity on health in children.
the proportion of sedentary to active behaviours,
addition to providing support for the beneficial ef-
rather than quantifying specific amounts of physical
fects of physical activity on a wide range of health
activity (periodicity, intensity, duration). In theory,
outcomes in children, Strong et al.
by limiting sedentary behaviour, physical activity
a minimum of 1 hour/day of moderate to vigorous
should automatically increase; the activity does not
activity. This is similar to other recommendations
necessarily have to be structured or prescribed ses-
concerning physical activity in children.
sions of exercise.
Therefore, it may be more
Making recommendations is relatively easy –
useful to make recommendations about limiting sed-
achieving the recommendations is the most chal-
entary behaviours rather than targeting a threshold
lenging task. To make the situation more complicat-
of physical activity (e.g. 1 hour/day). Of course, this
ed, there is also the issue of differentiating between
is not simple to achieve given the continuing envi-
the health benefits of activity when making physical
ronmental pressures that promote and facilitate a
activity recommendations. For example, should the
sedentary lifestyle. Therefore, environmental factors
recommendations be the same for cardiovascular-
need to change if physical activity strategies and
related and bodyweight (prevention or treatment of
interventions are going to be successful.
weight gain) benefits?
It is only recently that
ing transport policies
and replacing car
recommendations for adults have differentiated be-
travel to and from school with walking and cy-
tween these two activity-related health benefits.
are a few examples of suggestions for
Most physical activity recommendations are too
interventions that could significantly contribute to
general and do not take into consideration factors
increasing physical activity.
such as body mass index.
For children, it is
not necessary or pragmatic to complicate the situa- If incidental activity of children is decreasing, the
tion further by differentiating between the different participation in structured physical activity becomes
health benefits. Any significant increase in physical even more important in the maintenance of a healthy
© 2007 Adis Data Information BV. All rights reserved. Sports Med 2007; 37 (6)
542 Hills et al.
weight and body composition. In turn, a major deter- ronmental and policy changes in children and ado-
minant of participation in structured physical activi- lescents.
ty is the availability of public facilities, such as
playgrounds, bike paths, parks and so on, and
whether this physical environment is conducive to
No sources of funding were used to assist in the prepara-
exercise by children.
The lack of suitable physical
tion of this review. The authors have no conflicts of interest
infrastructure or the perception that a physical space that are directly relevant to the content of this review.
is unsafe, actively discourages parents and children
alike. Evidence suggests that physical activity inter-
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    • "Particularly in childhood, PA is important for children's healthy growth (Strong et al. 2005; Andersen et al. 2006) and the benefits of PA on motoric, emotional and social development have been established sufficiently (Strong et al. 2005; Andersen et al. 2006 ). Regular PA promotes, besides perception, concentration and learning abilities children's motoric performance (Hills et al. 2007; Eime et al. 2013). Especially the formation of fundamental motor skills plays an important role in childhood. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: Physical activity (PA) has positive effects on children's development. Particularly in childhood, PA plays an important role for children's motor skills. The objective of this study was to examine the influence of the intervention program "Join the Healthy Boat" on motor abilities of primary school children. Methods: The baseline measurements of this longitudinal intervention study with an intervention (IG) and control group (CG) were taken at the beginning of the school year 2010/2011 (T1) and follow up measurements in 2011/2012 (T2). Efficacy of the intervention on children's motor abilities was assessed using a standardized and validated test battery (Dordel-Koch-Test). An exploratory factor analysis was performed in order to reduce dimensions. Differences between CG and IG were examined using analysis of covariance adjusting for age, gender, BMI percentiles and baseline data. Results: Children in the IG showed an significant improvement in the conditional skills (F(1,1571) = 5.20, p ≤ 0.02) and less decline in flexibility (F(1,1715) = 6.68, p ≤ 0.01) than children in the CG. Additionally, positive differences in the flexibility tests were ascertained for girls, F(1,839) = 100.88, p ≤ 0.02). Conclusion: The study showed that an intervention that aims to increase PA affects certain parts of children's motor skills significantly. This was achieved without any extra PA lessons at school but with a low-threshold intervention integrated into the daily school routine.
    Full-text · Article · Jun 2016
    • "Despite increased knowledge about the importance of physical activity in everyday life, the number of diseases associated with movement insufficiency is increasing (Abrams & Levitt Katz, 2011; Must & Strauss, 1999; Wang, Gortmaker, Sobol, & Kuntz, 2006). Furthermore, inactivity in childhood has been found to influence activity patterns in adulthood (Hills, King, & Armstrong, 2007 ). As such, promoters of health-related activities should offer sessions that are intrinsically interesting, in order to encourage lifelong participation. "
    [Show abstract] [Hide abstract] ABSTRACT: The study aimed to assess the physiological demands of indoor wall climbing in children. Twenty-five children (aged 8–12 years) from a climbing school, with a performance RP (red point) of IV to V+ UIAA (Union Internationale des Associations d'Alpinisme) scale (5.4 to 5.7 YDS [Yosemite Decimal System] and 4a to 5a Sport/French scale), participated in the study. All 25 children climbed the first vertical route (IV UIAA, 5.4 YDS, 4a Sport/French) and 10 went on to complete the 110° overhanging route (IV+ UIAA, 5.5 YDS, 4b Sport/French). Both routes were climbed in a top rope style, at a self-selected pace. A portable gas analyser was used to assess the physiological response to the climbs. In addition, the time spent climbing by the children was recorded during the subsequent eight-week period. There were no significant differences found in the peak oxygen consumption between boys and girls, or for the route inclinations, with mean values of around 40 ml·kg− 1·min− 1. The children also achieved similarly high mean % values of HRmax, of between approximately 81–90%. To conclude, a typical children's climbing session involves short intermittent high intensity climbing, interspersed with longer periods of rest. It is possible that climbing in short intermittent bursts, as seen in the present research, may be considered high intensity training, with sufficient intensity to influence aerobic fitness in children.
    Full-text · Article · Oct 2014
    • "Hence, obesity during childhood is a risk factor for subsequent chronic diseases in later life which should not be neglected [7, 8]. Sufficient physical activity and a well-balanced diet on the other hand are essential for normal growth and development [9] and play an important role in the prevention of increased weight and obesity [10]. Research shows that children lead an active lifestyle because of factors which they acquired as habits in early life and therefore profit from health benefits in adulthood [11]. "
    [Show abstract] [Hide abstract] ABSTRACT: Studies have shown preventive effects of an active lifestyle during childhood on later life; therefore, health promotion has to start early. The programme “Join the Healthy Boat” promotes a healthy lifestyle in primary school children. In order to evaluate it, children’s behaviours in respect of increased physical activity (PA), a decrease in screen media use (SMU), more regular breakfast, and a reduction of the consumption of soft drinks (SDC) were investigated. 1943 children (7.1 ± 0.6 years) participated in the cluster-randomised study and were assessed at baseline and 1736 of them at follow-up. Teachers delivered lessons, which included behavioural contracting and budgeting of SMU and SDC. Daily SMU, PA behaviours, SDC, and breakfast patterns were assessed via parental questionnaire. After one-year intervention, significant effects were found in the intervention group for SMU of girls, children without migration background, and children with parents having a low education level. In the control group, second grade children skipped breakfast significantly more often. Tendencies but no significant differences were found for PA and SDC. This intervention seems to affect groups, which are usually hard to reach, such as children of parents with low education levels, which shows that active parental involvement is vital for successful interventions.
    Full-text · Article · Sep 2014
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