PENS COLUMN Column Editor: Terri H. Lipman PhD, CRNP, FAAN
Barriers to Physical Activity in Children Robin LeBoeuf MSN, CRNP * Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA
The Surgeon General emphasizes the importance of nutrition and physical activity to improve health and eliminate preventable diseases, including obesity (2008). However, physical activity has additional benefits beyond weight management that are often overlooked. A child's participation in physical activity promotes the development of gross motor skills, school performance, and social engagement and fosters physical and mental health (Barnett, 2011). The 2008 Physical Activity Guidelines for Americans recommend that children and adolescents participate in at least 60 minutes of daily, moderate to high-intensity physical activity that focuses on balancing cardiovascular exercise and strength training (U.S. Department of Health & Services, 2008). Yet routine physical activity is often inadequate during the formative years of childhood. With 56% of preschool-age children enrolled in childcare centers, even the youngest population is at risk for activity restrictions (Copeland, Sherman, Kendeigh, Saelens, & Kalkwarf, 2009). Limited physical activity could hinder gross motor skills and social development, as well as compromise weight management (Copeland, Sherman, Kendeigh, Kalkwarf, & Saelens, 2012). The purpose of this paper is to review the barriers to children participating in physical activity.
Socioeconomic Factors Families of low socioeconomic status are at a greater risk for compromised physical activity levels. Safety, time, financial status, and social values limit the activity levels of America's youth. Additionally, there are racial disparities affecting the children who receive physical activity counseling from pediatric providers. Hispanic ⁎ Corresponding author: Robin LeBoeuf, MSN, CRNP. E-mail address: [email protected]. 0882-5963/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pedn.2013.10.005
children typically receive the least physical activity counseling compared to Black and White children (Branner, Koyama, & Jensen, 2008). Safety is a major concern of both parents and childcare providers and hinders physical activity in children. Access to safe environments for outdoor play is especially limited to low-income urban families (Lipman et al., 2011). Furthermore, families with financial constraints may not be able to afford appropriate attire for outdoor play during periods of inclement weather (Copeland et al., 2009). With parents working extended hours, children are spending more time in daycare centers and after-school programs. These facilities may not have the finances for updated or interesting models of playground equipment to meet children's activity and developmental needs (Copeland et al., 2012). Additionally, access to indoor space and staffing to accommodate physical activity during inclement weather also impede activity levels (Copeland et al., 2012). Reduced federal and state funding for school athletics and physical education programs further contributes to inadequate physical activity levels in children. In a recovering economy, parents may not have the time, energy, or financial resources for their children to participate in organized recreational activities outside of their school or community (Copeland et al., 2012). Children with limited access to physical activity and healthy food options are at an even greater risk for developing obesity (Lipman et al., 2011).
The Pediatric Endocrinology Nursing Society (PENS) is committed to the development and advancement of nurses in the art and science of pediatric endocrinology nursing and to improve the care of all children with endocrine disorders through the education of the pediatric healthcare community. To aid in achieving that goal, the purpose of the PENS column is to provide up-to-date reviews of topics relevant to the PENS membership and to the general readership of the Journal of Pediatric Nursing.
PENS Column
Obesity Obese children have additional obstacles preventing achievement of the recommended physical activity levels. Additional weight contributes to total body deconditioning and exercise intolerance (Shim et al., 2013). Overweight and obese children are often discouraged by their body's appearance during physical activity and lack self-esteem and support from parents and peers (Zabinski, Saelens, Stein, Hayden-Wade, & Wilfley, 2012). These are barriers that can compromise the establishment of a routine exercise program. Without adequate support from family and pediatric healthcare providers, the cycle of inactivity, weight gain, and activity intolerance continues. Activity intolerance in obese children is further complicated in the context of other chronic medical conditions such as asthma (Shim et al., 2013).
Clinical Implications Pediatric healthcare providers are required to incorporate physical activity into their anticipatory guidance counseling during well child visits (U.S. Department of Health and Human Services, 2008). This is a critical issue for all pediatric nurses. Unfortunately, several factors impede providers' ability to provide effective and consistent counseling to promote physical activity in children. Education in physical activity counseling is lacking from many pediatric nursing and medical curricula. Limited confidence on the topic in addition to constraints on time, reimbursement, and professional guidance all thwart incorporation of this important information during patient encounters (Goff, Holboe, & Concato, 2010). Pediatric nurses should be aware of the barriers that may affect the time and quality of a child's engagement in physical activity and their own lack of education on the topic. Nurses can begin by obtaining information related to the accessibility and frequency of once customary school programs, including recess, gym class, and after-school sports (Lipman et al., 2011). The level of intensity achieved during participation in physical activities should also be explored. Free activities that can be done within the home and are culturally relevant are highly successful with low-income families. For example, dancing is an enjoyable, inexpensive, and accessible form of physical activity that can be easily integrated into a routine exercise program (Lipman et al., 2011). Pediatric nurses should also educate parents of young children on developmentally appropriate attire to promote movement and play (Copeland et al., 2009). By acknowledging and discussing the barriers that families encounter, providers can deliver more effective physical activity counseling. Nevertheless, evidence that counseling directly translates into increased activity levels is not well established (Goff et al., 2010). Consequently, providers should be encouraged to explore other methods to support counseling efforts. The incorporation of technology through use of text messaging,
101 social media, and online modules has demonstrated positive behavior modifications in several health areas, including weight loss (Napolitano, Hayes, Bennett, Ives, & Foster, 2013; Thompson, Cullen, Boushey, & Konzelmann, 2012). In addition to counseling, healthcare providers can use this technology, including smartphone applications, to support routine physical activity. This approach to health care addresses the needs and interests of today's technologically proficient generation (Thompson et al., 2012). Finally, nurses are highly respected and influential members of our society. Through community partnerships, pediatric nurses can have a profound influence on policy development that affects access to physical activity in children. Advocacy to improve funding for after-school athletic programs and playground development in low-income communities are two examples of how nurses can support and promote physical activity within their communities (Lathrop, 2013).
References Barnett, A. L. (2011). Benefits of exercise on cognitive performance in schoolchildren. Developmental Medicine & Child Neurology, 53. Branner, C. M., Koyama, T., & Jensen, G. L. (2008). Racial and ethnic differences in pediatric obesity-prevention counseling: National prevalence of clinician practices. Obesity, 16, 690–694. Copeland, K. A., Sherman, S. N., Kendeigh, C. A., Kalkwarf, H. J., & Saelens, B. E. (2012). Societal values and policies may curtail preschool children's physical activity in child care centers. Pediatrics, 129, 265–274. Copeland, K. A., Sherman, S. N., Kendeigh, C. A., Saelens, B. E., & Kalkwarf, H. J. (2009). Flip flops, dress clothes, and no coat: Clothing barrier to children’s physical activity in child-care centers identifies from a qualitative study. International Journal of Behavioral Nutrition and Physical Activity, 6. Goff, S. L., Holboe, E. S., & Concato, J. (2010). Pediatricians and physical activity counseling: How does residency prepare them for this task? Teaching and Learning in Medicine: An International Journal, 22, 107–111. Lathrop, B. (2013). Nursing leadership in addressing the social determinants of health. Policy, politics, & nursing practice, 14, 41–47. Lipman, T., Schucker, M. M., Ratcliffe, S. J., Holmberg, T., Baier, S., & Deatrick, J. A. (2011). Diabetes risk factors in children: A partnership between nurse practitioner and high school students. The American Journal of Maternal/Child Nursing, 36, 56–62. Napolitano, M. A., Hayes, S., Bennett, G. G., Ives, A. K., & Foster, G. D. (2013). Using Facebook and text messaging to deliver a weight loss program to college students. Obesity, 21, 25–31. Shim, Y. M., Bumette, A., Lucas, S., Herring, R. C., Weltman, J., Patrie, J. T., & Platts-Mills, T. A. (2013). Physical deconditioning as a casuse of breathlessness among obese adolescents with a diagnosis of asthma. PLoS One, 8. Thompson, D., Cullen, K. W., Boushey, C., & Konzelmann, K. (2012). Design of a website on nutrition and physical activity for adolescents: Results from formative research. Journal of Medical Internet Research, 14. U.S. Department of Health and Human Services. (2008). 2008 physical activity guidelines for Americans. Retrieved from www.health.gov/ paguidelines. Zabinski, M. F., Saelens, B. E., Stein, R. I., Hayden-Wade, H. A., & Wilfley, D. E. (2012). Overweight children's barriers to and support for physical activity. Obesity Research, 11, 238–246.
Barriers to Physical Activity in Children Robin LeBoeuf MSN, CRNP * Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA
The Surgeon General emphasizes the importance of nutrition and physical activity to improve health and eliminate preventable diseases, including obesity (2008). However, physical activity has additional benefits beyond weight management that are often overlooked. A child's participation in physical activity promotes the development of gross motor skills, school performance, and social engagement and fosters physical and mental health (Barnett, 2011). The 2008 Physical Activity Guidelines for Americans recommend that children and adolescents participate in at least 60 minutes of daily, moderate to high-intensity physical activity that focuses on balancing cardiovascular exercise and strength training (U.S. Department of Health & Services, 2008). Yet routine physical activity is often inadequate during the formative years of childhood. With 56% of preschool-age children enrolled in childcare centers, even the youngest population is at risk for activity restrictions (Copeland, Sherman, Kendeigh, Saelens, & Kalkwarf, 2009). Limited physical activity could hinder gross motor skills and social development, as well as compromise weight management (Copeland, Sherman, Kendeigh, Kalkwarf, & Saelens, 2012). The purpose of this paper is to review the barriers to children participating in physical activity.
Socioeconomic Factors Families of low socioeconomic status are at a greater risk for compromised physical activity levels. Safety, time, financial status, and social values limit the activity levels of America's youth. Additionally, there are racial disparities affecting the children who receive physical activity counseling from pediatric providers. Hispanic ⁎ Corresponding author: Robin LeBoeuf, MSN, CRNP. E-mail address: [email protected]. 0882-5963/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pedn.2013.10.005
children typically receive the least physical activity counseling compared to Black and White children (Branner, Koyama, & Jensen, 2008). Safety is a major concern of both parents and childcare providers and hinders physical activity in children. Access to safe environments for outdoor play is especially limited to low-income urban families (Lipman et al., 2011). Furthermore, families with financial constraints may not be able to afford appropriate attire for outdoor play during periods of inclement weather (Copeland et al., 2009). With parents working extended hours, children are spending more time in daycare centers and after-school programs. These facilities may not have the finances for updated or interesting models of playground equipment to meet children's activity and developmental needs (Copeland et al., 2012). Additionally, access to indoor space and staffing to accommodate physical activity during inclement weather also impede activity levels (Copeland et al., 2012). Reduced federal and state funding for school athletics and physical education programs further contributes to inadequate physical activity levels in children. In a recovering economy, parents may not have the time, energy, or financial resources for their children to participate in organized recreational activities outside of their school or community (Copeland et al., 2012). Children with limited access to physical activity and healthy food options are at an even greater risk for developing obesity (Lipman et al., 2011).
The Pediatric Endocrinology Nursing Society (PENS) is committed to the development and advancement of nurses in the art and science of pediatric endocrinology nursing and to improve the care of all children with endocrine disorders through the education of the pediatric healthcare community. To aid in achieving that goal, the purpose of the PENS column is to provide up-to-date reviews of topics relevant to the PENS membership and to the general readership of the Journal of Pediatric Nursing.
PENS Column
Obesity Obese children have additional obstacles preventing achievement of the recommended physical activity levels. Additional weight contributes to total body deconditioning and exercise intolerance (Shim et al., 2013). Overweight and obese children are often discouraged by their body's appearance during physical activity and lack self-esteem and support from parents and peers (Zabinski, Saelens, Stein, Hayden-Wade, & Wilfley, 2012). These are barriers that can compromise the establishment of a routine exercise program. Without adequate support from family and pediatric healthcare providers, the cycle of inactivity, weight gain, and activity intolerance continues. Activity intolerance in obese children is further complicated in the context of other chronic medical conditions such as asthma (Shim et al., 2013).
Clinical Implications Pediatric healthcare providers are required to incorporate physical activity into their anticipatory guidance counseling during well child visits (U.S. Department of Health and Human Services, 2008). This is a critical issue for all pediatric nurses. Unfortunately, several factors impede providers' ability to provide effective and consistent counseling to promote physical activity in children. Education in physical activity counseling is lacking from many pediatric nursing and medical curricula. Limited confidence on the topic in addition to constraints on time, reimbursement, and professional guidance all thwart incorporation of this important information during patient encounters (Goff, Holboe, & Concato, 2010). Pediatric nurses should be aware of the barriers that may affect the time and quality of a child's engagement in physical activity and their own lack of education on the topic. Nurses can begin by obtaining information related to the accessibility and frequency of once customary school programs, including recess, gym class, and after-school sports (Lipman et al., 2011). The level of intensity achieved during participation in physical activities should also be explored. Free activities that can be done within the home and are culturally relevant are highly successful with low-income families. For example, dancing is an enjoyable, inexpensive, and accessible form of physical activity that can be easily integrated into a routine exercise program (Lipman et al., 2011). Pediatric nurses should also educate parents of young children on developmentally appropriate attire to promote movement and play (Copeland et al., 2009). By acknowledging and discussing the barriers that families encounter, providers can deliver more effective physical activity counseling. Nevertheless, evidence that counseling directly translates into increased activity levels is not well established (Goff et al., 2010). Consequently, providers should be encouraged to explore other methods to support counseling efforts. The incorporation of technology through use of text messaging,
101 social media, and online modules has demonstrated positive behavior modifications in several health areas, including weight loss (Napolitano, Hayes, Bennett, Ives, & Foster, 2013; Thompson, Cullen, Boushey, & Konzelmann, 2012). In addition to counseling, healthcare providers can use this technology, including smartphone applications, to support routine physical activity. This approach to health care addresses the needs and interests of today's technologically proficient generation (Thompson et al., 2012). Finally, nurses are highly respected and influential members of our society. Through community partnerships, pediatric nurses can have a profound influence on policy development that affects access to physical activity in children. Advocacy to improve funding for after-school athletic programs and playground development in low-income communities are two examples of how nurses can support and promote physical activity within their communities (Lathrop, 2013).
References Barnett, A. L. (2011). Benefits of exercise on cognitive performance in schoolchildren. Developmental Medicine & Child Neurology, 53. Branner, C. M., Koyama, T., & Jensen, G. L. (2008). Racial and ethnic differences in pediatric obesity-prevention counseling: National prevalence of clinician practices. Obesity, 16, 690–694. Copeland, K. A., Sherman, S. N., Kendeigh, C. A., Kalkwarf, H. J., & Saelens, B. E. (2012). Societal values and policies may curtail preschool children's physical activity in child care centers. Pediatrics, 129, 265–274. Copeland, K. A., Sherman, S. N., Kendeigh, C. A., Saelens, B. E., & Kalkwarf, H. J. (2009). Flip flops, dress clothes, and no coat: Clothing barrier to children’s physical activity in child-care centers identifies from a qualitative study. International Journal of Behavioral Nutrition and Physical Activity, 6. Goff, S. L., Holboe, E. S., & Concato, J. (2010). Pediatricians and physical activity counseling: How does residency prepare them for this task? Teaching and Learning in Medicine: An International Journal, 22, 107–111. Lathrop, B. (2013). Nursing leadership in addressing the social determinants of health. Policy, politics, & nursing practice, 14, 41–47. Lipman, T., Schucker, M. M., Ratcliffe, S. J., Holmberg, T., Baier, S., & Deatrick, J. A. (2011). Diabetes risk factors in children: A partnership between nurse practitioner and high school students. The American Journal of Maternal/Child Nursing, 36, 56–62. Napolitano, M. A., Hayes, S., Bennett, G. G., Ives, A. K., & Foster, G. D. (2013). Using Facebook and text messaging to deliver a weight loss program to college students. Obesity, 21, 25–31. Shim, Y. M., Bumette, A., Lucas, S., Herring, R. C., Weltman, J., Patrie, J. T., & Platts-Mills, T. A. (2013). Physical deconditioning as a casuse of breathlessness among obese adolescents with a diagnosis of asthma. PLoS One, 8. Thompson, D., Cullen, K. W., Boushey, C., & Konzelmann, K. (2012). Design of a website on nutrition and physical activity for adolescents: Results from formative research. Journal of Medical Internet Research, 14. U.S. Department of Health and Human Services. (2008). 2008 physical activity guidelines for Americans. Retrieved from www.health.gov/ paguidelines. Zabinski, M. F., Saelens, B. E., Stein, R. I., Hayden-Wade, H. A., & Wilfley, D. E. (2012). Overweight children's barriers to and support for physical activity. Obesity Research, 11, 238–246.
