Research Quarterly for Exercise and Sport
ISSN: 0270-1367 (Print) 2168-3824 (Online) Journal homepage: http://www.tandfonline.com/loi/urqe20
The Role of Physical Education and Children's Activity in the Public Heath Michael A. Nelson M.D. To cite this article: Michael A. Nelson M.D. (1991) The Role of Physical Education and Children's Activity in the Public Heath, Research Quarterly for Exercise and Sport, 62:2, 148-150, DOI: 10.1080/02701367.1991.10608704 To link to this article: http://dx.doi.org/10.1080/02701367.1991.10608704
Published online: 26 Feb 2013.
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Article views: 9
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Citing articles: 4 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=urqe20 Download by: [New York University]
Date: 27 June 2016, At: 22:09
Research Quarterlyfor Exercise and Sport
RQES Forum
© 1991 bythe American Alliance for Health,
Physical Education, Recreation and Dance Vol. 62, No. 2, pp.148-150
The Role of Physical Education and Children's Activity in the Public Heath Michael A. Nelson
Downloaded by [New York University] at 22:09 27 June 2016
Key words: exercise, pediatrics, public health, physical education
S
allis and McKenzie provide a refreshing perspective on the role of physical education in the schools. They have adequately addressed several issues of public health concern for children as well as adults. By highlighting the issues regarding the amount of physical activity needed to have an impact on cardiovascular risk factors, quality of physical education, and long-term effects of such instruction, their work should serve as an impetus for future investigation and resolution of unanswered questions. The Committee on Sports Medicine and the Committee on School Health of the American Academy of Pediatrics (AAP) released the following policy statement (1987): "Pediatricians must appeal to their local school boards to maintain, ifnot increase, the school's physical education program of physical fitness. School programs should emphasize the so-called lifetime athletic activities. They should decrease time spent teaching the skills used in team sports and should promote a lifelong habit of aerobic exercise." Those recommendations were predicated on three beliefs: (a) fitness programs are necessary to impact cardiorespiratory health and reduce associated risk factors, (b) quality of physical education classes could be changed to improve the potential for contributing to public health goals, and (c) proper instruction may encourage children to incorporate regular exercise into their daily lives and sustain those activities in adulthood. Since the publication ofthe AAP statement, new research regarding the level of physical activity needed to reduce cardiovascular risk factors among adults and children has been published. These studies imply moderate physical activity of less intensity than fitness enhancing exercise may adequately reduce cardiovascular risk factors
Michael A. Nelson, M.D., is the chairman of theAmerican Academy of Pediatrics Committee onSports Medicine andFitness. He is a clinical associate professor of pediatrics at the University of New Mexico Medical School andinprivate practice in Albuquerque, NM. He wasinstrumental inestablishing thesports medicine program in the public schoolsystemandhas worked extensively with high school athletes.
148
(Simons-Morton, O'Hara, Simons-Morton, & Parcel, 1987, p. 301). Consequently, the recommendation to "promote a lifelong habit of aerobic exercise" may be too demanding and should be reconsidered.
Effectof children's activityon currenthealth Sallis and McKenzie accept Simons-Morton et al. 's (1987) conclusion regular physical activity is important for children. Although I agree with that position, current data are inconclusive regarding the relationship between increased physical activity (in contrast to more intense fitness enhancing exercise) and the reduction of cardiovascular risk factors in children. Although changes from sedentary to moderate physical activity in adults have resulted in significant reductions in cardiovascular risk factors (Blair et al., 1989), results in pediatric research are mixed. Sallis and McKenzie appropriately conclude, "at the present time insufficient data on the level of physical activity needed for health benefits in children are available" (p. 126). A brief discussion of specific risk factors may help illuminate some of the deficiencies. Sallis and McKenzie state, "physical activity effectively promotes long-term weight loss in obese children (Epstein, 1984) and adolescen ts (Becque, Katch, Rocchini, Marks, & Moorehead, 1988)." However, applicabili ty of these in terventions to most current physical education programs is limited. The Epstein (1984) interven tion study involved behavioral con tracts with families for exercise and dietary protocols. In addition, most studies have demonstrated an inverse relationship between exercise and obesity only when accompanied by restrictions in caloric intake. Behavior change techniques and nutrition education may need to be included in physical education programs ifthey are to be successful in combating obesity. Subjects in the adolescent study (Becque etal., 1988) performed graded exercise, eventually attaining 40 min of continuous aerobic exercise designed to maintain heart rates between 60 and 80% of age-predicted maximums. The aerobic exercise was accompanied by 15 min ofwarm-up/ cool-down activities. It is unlikely exercise ofthis intensity and duration could be attained in most physical education programs as they are currently structured.
ROES: June 1991
Downloaded by [New York University] at 22:09 27 June 2016
Nelson
At exercise intensity levels comparable to those recommended by the American College ofSports Medicine (1990), studies have demonstrated decrements in blood pressure (Hagberg et al., 1984) among prepubescent children and adolescents. However, recent studies in preschool (Klesges, Haddock, & Eck, 1990) and adolescent populations (Pearl, Stafford, Martinko, Schydlower, & Imai, 1991) failed to demonstrate an association between increased physical activity and reduction of blood pressure or body weight. A priori, increased opportunities for more physical activity will impact on the most prevalent risk factor among children, that ofsedentary lifestyle. Clearly, there is no negative impact from enhanced physical activity on associated risk factors (i.e., obesity, hypertension, hypercholesterolemia, etc.). Therefore, the goal of increasing physical activity in children is laudable, regardless of the relative importance for reducing other cardiovascular risk factors. Additionally, enhanced self-esteem, learning skills, academic performance, and sense ofwellbeing associated with increased physical activity represents a cogent argument for incorporating public health goals in physical education. The authors correctly point out evidence linking higher levels of physical activity to lower triglyceride levels and higher HDL--cholesterol/total cholesterol ratios. However, in the study comparing high and low habitual activities in adolescents (Thorland & Gilliam, 1981), subjects participating in moderate, high, and very high activity levels were grouped together. Consequently, interpretation about the relative contribution of each activity level to changes in lipid profiles is difficult, if not impossible. Furthermore, methodological limitations in measuring habitual activity do not appear to have improved significantly since the commentary by Bar-Or (1987) on the Simons-Morton etal. review (1987). Interviews, recall questionnaires, use of heart rate monitors, movement sensors, and direct observation techniques have inherent deficiencies that reflect on the validity of their various measuremen ts. These methodological limitations in assessing children's physical activity make it difficult to develop recommendations regarding the amount of physical activity or exercise needed to reduce cardiovascular risk factors. It is hoped future studies will demonstrate refinementin measuring techniques ofchildren's activity levels and address potentially confounding variables associated with normal childhood growth and development.
Quality of physicaleducation programs Sallis and McKenzie (1991) have aptly identified the obstacles to quality physical education. As a clinician, I can only agree with the need for new curricula, more rigorous teacher qualifications, and increased time available for physical activity if physical education programs
ROES: June 1991
are to have a significant role in meeting public health goals. The physician community should workwith physical educators as well as other professionals in lobbying school boards to make these changes.
Long-term effectsof activity on risk factors Successful performance on childhood physical fitness tests has been positively correlated with subsequent adult activity levels (Dennison, Straus, Mellitis, & Charney, 1988). The authors indicated parental encouragement ofexercise, level ofeducation, participation in organized sports after high school, and spousal encouragement of exercise contributed to these results. Unfortunately, physical education classes were not identified as a discriminating predictor of adult physical activity. Researchers have had difficulty demonstrating more than a short-term carryover effect on cardiovascular risk factors after cessation of exercise programs. In their study on adolescent obesity Becque et al. (1988) state, "we do not know the long-term effects of the present treatment, but these short-term effects are encouraging" (p. 611). The best demonstrations of relatively long-term carryover effects are similar to those reported by Epstein (1984). Involvement of families, behavior change techniques, and limitation of caloric intake are examples of intervention strategies resulting in long-term impact on risk factors such as obesity. A recent study (Marti, Knobloch, Riesen, & Howald, 1991) ofadult male athletes who participated in lifelong running activities (variables compared for a IS-year interval) demonstrated contemporary behavioral factors and body composition (particularly abdominal fat) had the greatest influence on atherogenic risk patterns of serum lipid profiles. These conclusions were drawn by the authors despite significant continuity of physical training, aerobic power, and anthropometric characteristics over the 15-year time span. As the authors have indicated, education programs that do notincorporate physical activity in the curriculum have been relatively unsuccessful in facilitating healthy lifestyles. Therefore it appears health classes will not be an acceptable substitute for physical education programs. Rather, incorporation of concepts from health curricula into physical education classes may have greater potential for both short- and long-term intervention. Sallis and McKenzie have chosen to concentrate on elementary education. This may be the most pragmatic approach since, in addition to the general decline in physical education programs in schools, there is a precipitous drop in activity as children progress into secondary education. However, without an increase in physical education classes at the secondary school level, it will be difficult to influence children, particularly adolescents, to incorporate even moderate physical activity into subsequent adult lifestyles.
149
Nelson
Downloaded by [New York University] at 22:09 27 June 2016
Conclusion Although recent research is encouraging, it appears current data are inadequate to state conclusively that increased physical activity in elementary physical education classes will significantly decrease cardiovascular risk factors. Nonetheless, there is no evidence to indicate harmful outcomes from increasing moderate physical activity. Changes in society that increasingly deny the opportunity for physical activity are not in the best interests of children. Since recent research is encouraging, it is prudent for school systems to implement suggested changes and increase availability of health-oriented physical education programs. I hope Sallis and McKenzie's recommendations for further definition of the level of physical activity necessary to promote health, incorporation ofbehavior change programs, development of effective methods of family involvement, and refinement and reinforcement of movementand planning skills throughout the educational career of students will be incorporated into long-term planning strategies by the physical education community. I agree thatwithout a commitment to public health goals, opportunities will be lost, and those who control school system finances will be less than responsive to maintaining or increasing physical education programs.
References American Academy of Pediatrics, Committees on Sports Medicine and School Health. (1987). Physical fitness and the schools. Pediatrics, 80, 449-450. American College of Sports Medicine. (1990). ACSM position stand: The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Medicine and Science in Sportsand Exercise, 22, 265-274.
150
Bar-Or, O. (1987). A commentary to "Children and fitness: A public health perspective". Research Qp.arterlyforExerciseand Sport, 58, 304-307. Becque, M. D., Kateh, V. L., Rocchini, A. P., Marks, C. R, & Moorehead, C. (1988). Coronary risk incidence of obese adolescents: Reductions byexercise plus diet in terven tion. Pediatrics, 81,605-612. Blair, S. N., Kohl, H. W., Paffenbarger, R S., Clark, D. G., Cooper, K H., & Gibbons, L. W. (1989). Physical fitness and all-cause mortality: A prospective study ofhealthy men and women. Journal oftheAmerican. MedicalAssociation, 262, 2395-2401. Dennison, B. A., Straus, J. H., Mellitis, E. D., & Charney, E. (1988) . Childhood physical fitness tests: Predictor ofadult physical activity levels? Pediatrics, 82, 324-330. Epstein, L. H. (1984). Adherence to exercise in obese children. Journal ofCardiacRehabilitation, 4, 185-195. Hagberg, J. M., Ehsani, A. A., Goldring, D., Hernandez, A., Sinacore, R P. T., & Holloszy,j. O. (1984). Effect ofweight training on blood pressure and hemodynamics in hypertensive adolescents.]ournal o/Pediatrics, 104, 147-151. Klesges, R C., Haddock, C. K., & Eck, L. H. (1990). A multimethod approach to the measurement of childhood physical activity and its relationship to blood pressure and body weight. Journal ofPediatrics, 116,888-893. Marti, B., Knobloch, M., Riesen, W. F., & Howald, H. (1991). Fifteen-year changesin exercise aerobic power, abdominal fat and serum lipids in runners and controls. Medicineand Science in Sportsand Exercise, 23, 115-122. Pearl, W.,Stafford, E. M., Martinko, T., Schydlower, M., & Imai, W. K (1991). Letter to the editor: Relationship ofphysical activity to blood pressure and body weight. Journal ofPediatrics, 118,165-166. Simons-Morton, B., O'Hara, N. M., Simons-Morton, D., & Parcel, G. S. (1987). Children and fitness: A public health perspective. Research Qy.arterlyforExercise and Sport, 58, 295302. Thorland, W. G., & Gilliam, T. B. (1981). Comparison ofserum lipids between habi tuallyhigh and lowactive pre-adolescent males. Medicineand ScienceinSportsand.Exercise, 13,316-321.
ROES: June 1991
ISSN: 0270-1367 (Print) 2168-3824 (Online) Journal homepage: http://www.tandfonline.com/loi/urqe20
The Role of Physical Education and Children's Activity in the Public Heath Michael A. Nelson M.D. To cite this article: Michael A. Nelson M.D. (1991) The Role of Physical Education and Children's Activity in the Public Heath, Research Quarterly for Exercise and Sport, 62:2, 148-150, DOI: 10.1080/02701367.1991.10608704 To link to this article: http://dx.doi.org/10.1080/02701367.1991.10608704
Published online: 26 Feb 2013.
Submit your article to this journal
Article views: 9
View related articles
Citing articles: 4 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=urqe20 Download by: [New York University]
Date: 27 June 2016, At: 22:09
Research Quarterlyfor Exercise and Sport
RQES Forum
© 1991 bythe American Alliance for Health,
Physical Education, Recreation and Dance Vol. 62, No. 2, pp.148-150
The Role of Physical Education and Children's Activity in the Public Heath Michael A. Nelson
Downloaded by [New York University] at 22:09 27 June 2016
Key words: exercise, pediatrics, public health, physical education
S
allis and McKenzie provide a refreshing perspective on the role of physical education in the schools. They have adequately addressed several issues of public health concern for children as well as adults. By highlighting the issues regarding the amount of physical activity needed to have an impact on cardiovascular risk factors, quality of physical education, and long-term effects of such instruction, their work should serve as an impetus for future investigation and resolution of unanswered questions. The Committee on Sports Medicine and the Committee on School Health of the American Academy of Pediatrics (AAP) released the following policy statement (1987): "Pediatricians must appeal to their local school boards to maintain, ifnot increase, the school's physical education program of physical fitness. School programs should emphasize the so-called lifetime athletic activities. They should decrease time spent teaching the skills used in team sports and should promote a lifelong habit of aerobic exercise." Those recommendations were predicated on three beliefs: (a) fitness programs are necessary to impact cardiorespiratory health and reduce associated risk factors, (b) quality of physical education classes could be changed to improve the potential for contributing to public health goals, and (c) proper instruction may encourage children to incorporate regular exercise into their daily lives and sustain those activities in adulthood. Since the publication ofthe AAP statement, new research regarding the level of physical activity needed to reduce cardiovascular risk factors among adults and children has been published. These studies imply moderate physical activity of less intensity than fitness enhancing exercise may adequately reduce cardiovascular risk factors
Michael A. Nelson, M.D., is the chairman of theAmerican Academy of Pediatrics Committee onSports Medicine andFitness. He is a clinical associate professor of pediatrics at the University of New Mexico Medical School andinprivate practice in Albuquerque, NM. He wasinstrumental inestablishing thesports medicine program in the public schoolsystemandhas worked extensively with high school athletes.
148
(Simons-Morton, O'Hara, Simons-Morton, & Parcel, 1987, p. 301). Consequently, the recommendation to "promote a lifelong habit of aerobic exercise" may be too demanding and should be reconsidered.
Effectof children's activityon currenthealth Sallis and McKenzie accept Simons-Morton et al. 's (1987) conclusion regular physical activity is important for children. Although I agree with that position, current data are inconclusive regarding the relationship between increased physical activity (in contrast to more intense fitness enhancing exercise) and the reduction of cardiovascular risk factors in children. Although changes from sedentary to moderate physical activity in adults have resulted in significant reductions in cardiovascular risk factors (Blair et al., 1989), results in pediatric research are mixed. Sallis and McKenzie appropriately conclude, "at the present time insufficient data on the level of physical activity needed for health benefits in children are available" (p. 126). A brief discussion of specific risk factors may help illuminate some of the deficiencies. Sallis and McKenzie state, "physical activity effectively promotes long-term weight loss in obese children (Epstein, 1984) and adolescen ts (Becque, Katch, Rocchini, Marks, & Moorehead, 1988)." However, applicabili ty of these in terventions to most current physical education programs is limited. The Epstein (1984) interven tion study involved behavioral con tracts with families for exercise and dietary protocols. In addition, most studies have demonstrated an inverse relationship between exercise and obesity only when accompanied by restrictions in caloric intake. Behavior change techniques and nutrition education may need to be included in physical education programs ifthey are to be successful in combating obesity. Subjects in the adolescent study (Becque etal., 1988) performed graded exercise, eventually attaining 40 min of continuous aerobic exercise designed to maintain heart rates between 60 and 80% of age-predicted maximums. The aerobic exercise was accompanied by 15 min ofwarm-up/ cool-down activities. It is unlikely exercise ofthis intensity and duration could be attained in most physical education programs as they are currently structured.
ROES: June 1991
Downloaded by [New York University] at 22:09 27 June 2016
Nelson
At exercise intensity levels comparable to those recommended by the American College ofSports Medicine (1990), studies have demonstrated decrements in blood pressure (Hagberg et al., 1984) among prepubescent children and adolescents. However, recent studies in preschool (Klesges, Haddock, & Eck, 1990) and adolescent populations (Pearl, Stafford, Martinko, Schydlower, & Imai, 1991) failed to demonstrate an association between increased physical activity and reduction of blood pressure or body weight. A priori, increased opportunities for more physical activity will impact on the most prevalent risk factor among children, that ofsedentary lifestyle. Clearly, there is no negative impact from enhanced physical activity on associated risk factors (i.e., obesity, hypertension, hypercholesterolemia, etc.). Therefore, the goal of increasing physical activity in children is laudable, regardless of the relative importance for reducing other cardiovascular risk factors. Additionally, enhanced self-esteem, learning skills, academic performance, and sense ofwellbeing associated with increased physical activity represents a cogent argument for incorporating public health goals in physical education. The authors correctly point out evidence linking higher levels of physical activity to lower triglyceride levels and higher HDL--cholesterol/total cholesterol ratios. However, in the study comparing high and low habitual activities in adolescents (Thorland & Gilliam, 1981), subjects participating in moderate, high, and very high activity levels were grouped together. Consequently, interpretation about the relative contribution of each activity level to changes in lipid profiles is difficult, if not impossible. Furthermore, methodological limitations in measuring habitual activity do not appear to have improved significantly since the commentary by Bar-Or (1987) on the Simons-Morton etal. review (1987). Interviews, recall questionnaires, use of heart rate monitors, movement sensors, and direct observation techniques have inherent deficiencies that reflect on the validity of their various measuremen ts. These methodological limitations in assessing children's physical activity make it difficult to develop recommendations regarding the amount of physical activity or exercise needed to reduce cardiovascular risk factors. It is hoped future studies will demonstrate refinementin measuring techniques ofchildren's activity levels and address potentially confounding variables associated with normal childhood growth and development.
Quality of physicaleducation programs Sallis and McKenzie (1991) have aptly identified the obstacles to quality physical education. As a clinician, I can only agree with the need for new curricula, more rigorous teacher qualifications, and increased time available for physical activity if physical education programs
ROES: June 1991
are to have a significant role in meeting public health goals. The physician community should workwith physical educators as well as other professionals in lobbying school boards to make these changes.
Long-term effectsof activity on risk factors Successful performance on childhood physical fitness tests has been positively correlated with subsequent adult activity levels (Dennison, Straus, Mellitis, & Charney, 1988). The authors indicated parental encouragement ofexercise, level ofeducation, participation in organized sports after high school, and spousal encouragement of exercise contributed to these results. Unfortunately, physical education classes were not identified as a discriminating predictor of adult physical activity. Researchers have had difficulty demonstrating more than a short-term carryover effect on cardiovascular risk factors after cessation of exercise programs. In their study on adolescent obesity Becque et al. (1988) state, "we do not know the long-term effects of the present treatment, but these short-term effects are encouraging" (p. 611). The best demonstrations of relatively long-term carryover effects are similar to those reported by Epstein (1984). Involvement of families, behavior change techniques, and limitation of caloric intake are examples of intervention strategies resulting in long-term impact on risk factors such as obesity. A recent study (Marti, Knobloch, Riesen, & Howald, 1991) ofadult male athletes who participated in lifelong running activities (variables compared for a IS-year interval) demonstrated contemporary behavioral factors and body composition (particularly abdominal fat) had the greatest influence on atherogenic risk patterns of serum lipid profiles. These conclusions were drawn by the authors despite significant continuity of physical training, aerobic power, and anthropometric characteristics over the 15-year time span. As the authors have indicated, education programs that do notincorporate physical activity in the curriculum have been relatively unsuccessful in facilitating healthy lifestyles. Therefore it appears health classes will not be an acceptable substitute for physical education programs. Rather, incorporation of concepts from health curricula into physical education classes may have greater potential for both short- and long-term intervention. Sallis and McKenzie have chosen to concentrate on elementary education. This may be the most pragmatic approach since, in addition to the general decline in physical education programs in schools, there is a precipitous drop in activity as children progress into secondary education. However, without an increase in physical education classes at the secondary school level, it will be difficult to influence children, particularly adolescents, to incorporate even moderate physical activity into subsequent adult lifestyles.
149
Nelson
Downloaded by [New York University] at 22:09 27 June 2016
Conclusion Although recent research is encouraging, it appears current data are inadequate to state conclusively that increased physical activity in elementary physical education classes will significantly decrease cardiovascular risk factors. Nonetheless, there is no evidence to indicate harmful outcomes from increasing moderate physical activity. Changes in society that increasingly deny the opportunity for physical activity are not in the best interests of children. Since recent research is encouraging, it is prudent for school systems to implement suggested changes and increase availability of health-oriented physical education programs. I hope Sallis and McKenzie's recommendations for further definition of the level of physical activity necessary to promote health, incorporation ofbehavior change programs, development of effective methods of family involvement, and refinement and reinforcement of movementand planning skills throughout the educational career of students will be incorporated into long-term planning strategies by the physical education community. I agree thatwithout a commitment to public health goals, opportunities will be lost, and those who control school system finances will be less than responsive to maintaining or increasing physical education programs.
References American Academy of Pediatrics, Committees on Sports Medicine and School Health. (1987). Physical fitness and the schools. Pediatrics, 80, 449-450. American College of Sports Medicine. (1990). ACSM position stand: The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Medicine and Science in Sportsand Exercise, 22, 265-274.
150
Bar-Or, O. (1987). A commentary to "Children and fitness: A public health perspective". Research Qp.arterlyforExerciseand Sport, 58, 304-307. Becque, M. D., Kateh, V. L., Rocchini, A. P., Marks, C. R, & Moorehead, C. (1988). Coronary risk incidence of obese adolescents: Reductions byexercise plus diet in terven tion. Pediatrics, 81,605-612. Blair, S. N., Kohl, H. W., Paffenbarger, R S., Clark, D. G., Cooper, K H., & Gibbons, L. W. (1989). Physical fitness and all-cause mortality: A prospective study ofhealthy men and women. Journal oftheAmerican. MedicalAssociation, 262, 2395-2401. Dennison, B. A., Straus, J. H., Mellitis, E. D., & Charney, E. (1988) . Childhood physical fitness tests: Predictor ofadult physical activity levels? Pediatrics, 82, 324-330. Epstein, L. H. (1984). Adherence to exercise in obese children. Journal ofCardiacRehabilitation, 4, 185-195. Hagberg, J. M., Ehsani, A. A., Goldring, D., Hernandez, A., Sinacore, R P. T., & Holloszy,j. O. (1984). Effect ofweight training on blood pressure and hemodynamics in hypertensive adolescents.]ournal o/Pediatrics, 104, 147-151. Klesges, R C., Haddock, C. K., & Eck, L. H. (1990). A multimethod approach to the measurement of childhood physical activity and its relationship to blood pressure and body weight. Journal ofPediatrics, 116,888-893. Marti, B., Knobloch, M., Riesen, W. F., & Howald, H. (1991). Fifteen-year changesin exercise aerobic power, abdominal fat and serum lipids in runners and controls. Medicineand Science in Sportsand Exercise, 23, 115-122. Pearl, W.,Stafford, E. M., Martinko, T., Schydlower, M., & Imai, W. K (1991). Letter to the editor: Relationship ofphysical activity to blood pressure and body weight. Journal ofPediatrics, 118,165-166. Simons-Morton, B., O'Hara, N. M., Simons-Morton, D., & Parcel, G. S. (1987). Children and fitness: A public health perspective. Research Qy.arterlyforExercise and Sport, 58, 295302. Thorland, W. G., & Gilliam, T. B. (1981). Comparison ofserum lipids between habi tuallyhigh and lowactive pre-adolescent males. Medicineand ScienceinSportsand.Exercise, 13,316-321.
ROES: June 1991
