PROMOTION OF CHILDHOOD PHYSICAL ACTIVIY

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Promotion of Childhood Physical Activity Emma Misco Morrisville State College

PROMOTION OF CHILDHOOD PHYSICAL ACTIVIY Abstract Over the last decade, the incidence of childhood obesity has increased to the point that it is now labeled as an “epidemic” (Sekhobo, Edmunds, Reynolds, Dalenius & Sharma, 2010).

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According to the authors, the root cause of the epidemic is twofold, improper nutrition and a lack of physical activity. Poor nutrition and inadequate physical activity combined, are the second most preventable causes of death in the United States. Being active builds healthy muscles, strengthens bones and helps maintain a healthy weight. It also reduces the risk of diabetes, heart attack and high blood pressure (New York State Department of Health, 2010). In order to overcome this epidemic, the promotion of physical activity among children and adolescents has become a top priority in the nation today. The Healthy People 2020 goal for Americans is to “improve health, fitness, and quality of life through daily physical activity” (United States Department of Health and Human Services [HHS], Healthy People 2020, 2011). Healthy People 2020 is a 10-year national health initiative run by the U.S. Department of HHS. Healthy People 2020 provides objectives for health promotion and disease prevention for Americans (Administration on Aging, 2010). This paper explores ways in which the physical activity of three to eighteen year old children can be promoted at the national, state and local levels and how nurses can be involved in this process. It is the desire of the author to motivate nurses to become actively involved in healthcare promotion as it related to the promotion of physical activity in children.

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The promotion of physical activity among children and adolescents has become a top priority in the nation today. The Healthy People 2020 goal for Americans is to “improve health, fitness, and quality of life through daily physical activity” (HHS, Healthy People 2020, 2011). Healthy People 2020 is a 10-year national health initiative run by the US Department of HHS. According to Agazzi, Armstrong, Bradley-Klug (2010), participation in daily physical activity in young people has a number of positive affects. Exercise helps to “develop healthy bones, muscles, and joints, increases flexibility, balance and endurance and prevents or delays the on-set of a number of cardiovascular diseases” ( A g a z z i e t a l . , 2 0 1 0 ) . The authors go on to describe the many psychological effects of physical activity, to include: increased wellbeing by boosting self-esteem and the lowering of anxiety and depression ( A g a z z i e t a l . , 2010). Over the last decade, the incidence of childhood obesity has gained much attention of the American public and has been labeled as an “epidemic” (Sekhobo, Edmunds, Reynolds, Dalenius & Sharma, 2010). According to the authors, the root cause of the epidemic is twofold, improper nutrition and a lack of physical activity. Poor nutrition and inadequate physical activity combined, are the second most preventable causes of death in the USA. Being active builds healthy muscles, strengthens bones and helps maintain a healthy weight. It also reduces the risk of diabetes, heart attack and high blood pressure (New York State Department of Health, 2010). It is the intended goal of this paper to describe some of the mechanisms through which physical activity can be promoted among America’s youth at the primary, secondary and tertiary levels. A discussion will be made describing how the Health Belief Model plays a role in the

PROMOTION OF CHILDHOOD PHYSICAL ACTIVIY promotion of physical activity in children. Current examples will then be provided concerning national, New York State, Madison County, Cazenovia Community and personal initiatives into the promotion of Physical Activity in youth. Obesity Although a discussion of childhood obesity is not the intention of this paper, a few statistics concerning this matter are important. Ogden and Carroll detail that nationally 17% (or 12.5 million) of children and adolescents aged 2-19 years fall into the category of obese. Since 1980, obesity among children and adolescents has almost tripled. Significant numbers of poor Hispanic and black boys girls are obese, compared to white children (Ogden and Carroll, 2010). Although lower than the national average, in New York State, 14.6% or 209,713 children are labeled as obese (Centers for Disease Control and Prevention, 2009). Locally, in Madison county, 15.9% of children ages 2-4 are categorized as obese (New York State Department of Health, 2010). Park describes the many health complications associated with children being overweight and under-active (2011). However, the author goes onto discuss the potential risks associated with diet alone as the only method for weight reduction. These risks include nutritional deficiency, growth retardation, and psychological problems such as depression. Using a Health Belief Model, Park research demonstrates the need to emphasize the importance of teaching children “healthful strategies for weight reduction” (Park, 2011). Butraporn, Pach, Pack, Masngarmmeung, Maton, Sri-aroon, Nyamete, and Chaicumpa, provide insight into the Health Belief Model which identifies understanding into the factors that could influence the comprehension, need and implementation of a physical activity program for youth (2011). According to Butraporn et al., the Health Belief Model is “an influential and

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PROMOTION OF CHILDHOOD PHYSICAL ACTIVIY widely used theoretical model initially developed by the U.S. Public Health Service to provide a framework by which public health officials could predict who would engage in certain preventive behaviors” ( B u t r a p o r n e t a l . , 2 0 1 1 ) . The authors describe the model as a

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“value-expectancy' theory”, which means that perceptions of the participants of an activity, such as physical activity, are related to the value the participants believe they will derive from that activity. They describe key components of the Health Belief Model as: -Perceived Susceptibility- opinion of chances of getting a condition -Perceived Severity- opinion of how serious a condition and its consequences are - Perceived Benefits- belief in the efficacy of the advised action to reduce risk - Perceived Barriers- opinion of the costs of the associated with advised action - Cues to Action- strategies to activate "readiness" - Self-Efficacy - confidence in one's ability to take action. One possible way this author believes nurses might utilize the Health Belief Model, might be to communicate the importance of physical activity to children might be the following: -Peceived Susceptibility- Failure to exercise has the potential for severe health problems -Perceived Severity- By sitting in front of the TV, they will not feel as good -Percieved Benefits- By engaging in physical activity, they will feel better -Perceived Barriers- They will not miss TV as much as you think -Cues to Action- They will sign up for after school physical activities when available - Self-Efficacy- They will understand that they are responsible for their physical activity Primary Promotion of Physical Activity in Children School is the key setting in which children have the opportunity to engage in physical activities. Agazzi et al. found that nurses could work directly at the school district level to promote policies concerning Physical Education curriculum and recess objectives (2010). By doing this, school districts could be encouraged to increase physical activity opportunities for all students, not just those involved in student athletics. The authors believe that nurses could assist in health promotion efforts by serving on a school-wide committee to develop a healthy behaviors campaign for students to learn about and participate in health-promoting physical activities in the educational setting ( A g a z z i e t a l . , 2 0 1 0 ) .

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Nursing researchers Floriani and Kennedy of the University of California, Department of Family Healthcare Nursing discovered that despite the opportunity for participation in physical activity in the school setting (such as recess and physical education classes), children do not seam to be meeting the activity recommendations at school itself (2008). The authors found that access to neighborhood parks and recreational facilities raise opportunities for physical activity and reduced time spent in sitting around at home. They also found that reducing time watching television and in other inactive behaviors such as playing videogames added to more participation in physical activities. Frequency of physical activity also appears to be related to improved mental health status, although the direction of this relationship warrants further exploration (Kennedy & Floriani, 2008). Floriani and Kennedy concluded that physical activity is an “evidence-based intervention that offers benefits to both physical and mental health” (2008). By engaging in conversations with patients and families on the topic of physical activity, nurses could assisting them in finding ways to incorporate activity into daily life of their children (Kennedy & Floriani, 2008). Secondary Promotion of Physical Activity in Children Because girls and minorities are at higher risk for being overweight and having insufficient physical activity levels, secondary prevention strategies should target these subgroups ( P e r r y & H o f f m a n , 2 0 1 0 ) . Agazzi et al. suggested secondary prevention strategies directed at providing at-risk students with “skill development, support, and mentoring” (2010). They provide examples of secondary prevention strategies, which included “small-group exercise lessons, behavioral contracting (setting exercise goals and monitoring progress), specialized counseling from a school nurse, and special exercise groups for students at highest risk” (Asazzi et al., 2010). In addition, since children tend to become less active over time,

PROMOTION OF CHILDHOOD PHYSICAL ACTIVIY secondary prevention programs should focus on younger children who are at greater danger for decreased physical activity (Agazzi et al., 2010). Tertiary Promotion of Physical Activity in Children For children already labeled as obese, tertiary prevention is needed to help them engage in appropriate physical activity. Nurses can refer these children with appropriate community services that treat children who are overweight and providing them with mental health counseling to maintain their social and emotional health (Agazzi et al., 2010).

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Ruebel, Heelan, Bartee, and Foster suggested that the treatment for obesity should center on healthy eating and increasing physical activity of the obese child and family (2011). Their recommendations included starting treatment with children as young as three and “involving the family in all aspects of treatment, educating on medical complications of obesity, instituting healthy lifestyle habits to include physical activity” ( R u e b e l e t a l . , 2 0 1 1 ) . The authors found that family-based treatments were more effective in improving nutrition and exercise habits of the child when the entire family was involved. Their findings showed that there was a high degree of correlation between a decrease in a parents body mass and the loss of weight in children ( R u e b e l e t a l . , 2 0 1 1 ) . National Initiatives Besides setting the Healthy People 2020 goal for physical activity in America, the national government has begun several initiatives to improve the overall health of its youth through activity. Two such initiatives are the “Let’s Move!” campaign and the “National Physical Activity Plan.” Let’s Move! is an initiative started by First Lady Michelle Obama in 2010 (2010). It’s stated objective is to "solve the challenge of childhood obesity within a generation so that

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children born today will reach adulthood at a healthy weight” (Let’s Move!, 2010). Let's Move! endeavors to fight the epidemic of childhood obesity and to encourage a healthy lifestyle through "a comprehensive initiative that addresses all of the various factors that lead to childhood obesity…engaging every sector of society that impacts the health of children to provide schools, families and communities the simple tools they need to help kids be more active, eat better, and get healthy" (Lets Move!, 2010). The CDC recommends that children engage in one or more hours of physical activity every day (2011). The CDC states that children should do three different types of activity: aerobic activity, muscle strengthening and bone strengthening (2011). According to Let’s Move! its purpose is to promote physical activity through “the support and cooperation of families, schools and communities” (2010). Concerning children, the initiative states, "those who feel supported by friends and families or are surrounded by others interested in physical activity, are more likely to participate and succed” (Lets Move!, 2010). A second national initiative is the National Physical Activity Plan (NPAP). The basic purpose of the NPAP is to help Americans to achieve the recommendations made in the 2008 Physical Activity Guidelines found in Healthy People 2020 ( N PA P, 2 0 1 1 ) . The NPAP provides guidelines gives detailed recommendations for “frequency, intensity, duration and mode of activity” (NPAP, 2011). The NPAP deals only with physical activity, whereas physical activity is only a portion of Healthy People 2020. It is hoped that the NPAP will fortify the goals set up by Healthy People 2020 activity guidelines (NPAP, 2011). State Initiatives At the New York State level, Eat Well Play Hard (EWPH) is an important childhood obesity prevention initiative provided by the New York State Health Department (New York

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State Department of Health [NYSHD], 2010). As noted previously, childhood obesity is a major problem in the State of New York (C e n t e r s f o r D i s e a s e C o n t r o l a n d P r e v e n t i o n , 2009). EWPH was initiated to help prevent childhood obesity and its effects by promoting healthy dietary choices and physical activity (NYSHD, 2010). According to its website, the core strategies of EWPH are to: Increase developmentally appropriate physical activity. Decrease exposure to television and other recreational screen time. Increase consumption of vegetables and fruits. Increase consumption of low-fat or fat-free milk, for children over age 2. Increase the initiation and duration of exclusive breastfeeding.

Local Initiatives Locally, the Madison County Health Department (MCDH) began in 2005 the “Active Kids - Childhood Obesity Prevention Program” ( M C D H , 2 0 0 9 ) . The goal of the Active Kids program is to prevent childhood obesity and promote healthy choices with children. The aim of Active Kids is to teach children before the age of eight a daily routine to include: “consuming at least five fruits and vegetables; engaging in at least one hour of physical activity; and reducing TV and video games screen time to fewer than two hours” (MCHD, 2009). In addition, MCHD assists schools within the county by providing them with resources to physical activity environments such as parks (MCHD, 2009). In this author’s local community of Cazenovia, New York, there are numerous initiatives and programs devoted to increasing physical activity among children and adolescents. As a lifelong resident of this community, this author is well acquainted with many of the local agencies and groups whose aim is to provide opportunities for physical activity. At the pre-school level, the Cazenovia Community Pre-School (CCPS), not only offers an

PROMOTION OF CHILDHOOD PHYSICAL ACTIVIY excellent program of intellectual stimulation for children, but also strives to include physical activity within this curriculum ( C C P S , 2 0 1 1 ) . In addition to the teaching young children,

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the school also offers the local community educational seminars promoting health and well-being (CCPS, 2011). Currently, the Cazenovia School District offers a wide range of activities to foster physical activity in its students. There are numerous organized sports teams on which students can participate (Digital Sports, 2011). The goal of the Cazenovia sports program is to provide a “broadening experience in which harmony of mind and body functions are created through striving for physical and mental excellence. A well coordinated program is vitally important to the morale of the school and our community” (Cazenovia School District, 2007). The Village of Cazenovia itself offers abundant opportunities for children interested in participating in physical activities. There are plentiful parks are all within easy walking distance of all village residences ( C a z e n o v i a S c h o o l D i s t r i c t , 2 0 0 7 ) . In addition, the Village Parks and recreation uses a variety of sports fields, a pool and a lake for different sports teams along with organized swimming lessons in both summer and winter (C a z e n o v i a C o l l e g e F i t n e s s a n d We l l n e s s D e p a r t m e n t , 2 0 1 1 ). Personal Initiatives One of the ways this author has promoted physical activity in youth is through my participation in local church program. Specifically, for the past eight years this author has taken a leadership roll in my churches AWANA, Approved Workman Are Not Ashamed, program. Besides taking time once a week in the evening to teach children strategies on how to live lives of compassion and service, a big part of their time together is spent playing games involving strenuous running and other forms of exertion. For many of the children, this game time is a

PROMOTION OF CHILDHOOD PHYSICAL ACTIVIY highlight of their week. Another way this author has promoted physical activity with youth this year was by

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writing Governor Cuomo. While attending the New York Sate Fair this past August, there was the opportunity to sit at a computer and write Governor Cuomo about any topic you thought might make an improvement to the state (Governor, 2011). This author took time to propose to the governor a “reverse daylight savings” plan. The contention of this plan was, that instead moving the clocks ahead an hour in November (a month when the days are already short) to move the clocks back an hour, providing an additional hour of afternoon play outdoors for children. Not surprisingly, so far the only response from the governor’s office was an acknowledgement that he received the message. Conclusion In order to participate more fully in alleviating the epidemic of childhood obesity through the promotion of physical activity in youth, nurses need to take a more active roll in health promotion through the entire spectrum of childhood and adolescence. Nurses need to take time to educate themselves in understanding the benefits of physical activity and to grave consequences of inactivity. Nurses need to involve families in discussions of physical activity promotion. Conversations need to begin when children are infants and continue right through their teenage years. As a person who has suffered a majority of her lifetime from the consequences of inactivity, it is this author’s desire that all nurses come to a better understanding of the benefits of the promotion of physical activity in children.

PROMOTION OF CHILDHOOD PHYSICAL ACTIVIY References

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Administration on Aging. (2010, November 29). Health, prevention, and wellness program. Retrieved from h t t p : / / w w w. a o a . g o v / A o A R o o t / A o A _ P r o g r a m s / H P W / i n d e x . a s p x A g a z z i , H . , A r m s t r o n g , K . , & B r a d l e y, K . L . ( 2 0 1 0 ) . B m i a n d physical activity among at-risk sixth- an ninth-grade students,d h i l l s b o ro u g h c o u n t y, f l o r i d a , 2 0 0 5 - 2 0 0 6 . R e t r i e v e d f r o m http://www.cdc.gov/pcd/issues/2010/may/09_0120.htm Burke, L. E., Thompson, D. R., Roos, S., van Rijssen, V., & Troe, E. (2011). Global cardiovascular disease prevention: A call to action for nursing. Journal of Cardiovascular Nursing, 26(4), 15- 21. B u t r a p o r n , P. , P a c h , A . , P a c k , R . , M a s n g a r m m e u n g , R . , M a t o n , T. , S r i - a r o o n , P. , N y a m e t e , A . , & C h a i c u m p a , W. ( 2 0 1 1 ) . T h e h e a l t h belief model and factors relating to potential use of a vaccine for shigellosis in kaeng koi district, saraburi province, thailand. Journal of Health, Population and Nutrition, 22, 170180. C a z e n o v i a C o l l e g e F i t n e s s a n d We l l n e s s D e p a r t m e n t ( 2 0 1 1 ) . F a l l 2 0 11 c o m m u n i t y p r o g r a m s . R e t r i e v e d f r o m h t t p : / / w w w. c a z e n o v i a . e d u / p o r t a l s / 4 / d o c s / s t u d e n t l i f e / f i t n e s s a n d We l l n e s s / s u m m e r _ p r o g r a m s _ f a l l _ 1 1 . p d f Caz enovia Community Pre-School. (2011). Cazenov ia community preschool. Retrieved from

PROMOTION OF CHILDHOOD PHYSICAL ACTIVIY h t t p : / / w w w. c a z e n o v i a c o m m u n i t y p r e s c h o o l . c o m Cazenovia School District. (2007). Cazenovia central schools: Extracurricular handbook for students and parents. Retrieved F r o m h t t p : / / w w w. c a z . c n y r i c . o r g / j o o m 9 / f i l e s / H a n d b o o k Updated2007.pdf Cent ers for Disease Control and Prevention. (2011). How much physical activity do children need?. Retrieved from

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h t t p : / / w w w. c d c . g o v / p h y s i c a l a c t i v i t y / e v e r y o n e / g u i d e l i n e s / c h i l d r en.html. Centers for Disease Control and Prevention. (2009). Obesity prevalence among low-income, preschool-aged children : United states, 1998-2008. Retrieved from h t t p : / / w w w. c d c . g o v / m m w r / p r e v i e w / m m w r h t m l / m m 5 8 2 8 a 1 . h t m . Digit al Sports. (2011). Cazenov ia high school: Home of the lak ers. Retrieved from http://cazenovialakers.digitalsports.com/ G o v e n o r. ( 2 0 11 ) . E m a i l t h e g o v e r n o r . R e t r i e v e d f r o m h t t p : / / w w w . g o v e r n o r . n y. g o v / c o n t a c t / G o v e r n o r C o n t a c t F o r m . p h p Kennedy, C., & Floriani, V. (2008). Translating research on healthy lifestyles for children: Meeting the needs of diverse populations. Nursing Clinics of North America, 43(3), 397417. Lets Move!. (2010). Get active. Retrieved from h t t p : / / w w w. l e t s m o v e . g o v / g e t - a c t i v e Madison County Health Department. (2009). Overweight and obesity

PROMOTION OF CHILDHOOD PHYSICAL ACTIVIY in madison county: Strategies to build a healthier community. Retrieved from

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h t t p : / / w w w . h e a l t h y m a d i s o n c o u n t y. o r g / M a d i s o n H D / l i n k e d d o c s / d ata/data-obesitymc3-2.pdf. Nation al Physica l Act ivity Plan. (2011).The plan. Retr ieved from h t t p : / / w w w. p h y s i c a l a c t i v i t y p l a n . o r g / t h e p l a n . p h p N e w Yo r k S t a t e D e p a r t m e n t o f H e a l t h . ( 2 0 1 0 ) . O b e s i t y s t a t i s t i c s f o r rest of state. Retrieved from h t t p : / / w w w . h e a l t h . n y. g o v / s t a t i s t i c s / p r e v e n t i o n / o b e s i t y / c o u n t y / r estofstate.htm. New York State Department of Health. (2010, June). Eat well play hard. Retrieved from http://www.health.ny.gov/prevention/nutrition/resources/eat_well_play_hard/ Ogden, C., & Carroll, M. (2010). Prevalence of obesity among children and adolescents:united states, trends 1963–1965 through 2007–2008. Retrieved from http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.pdf Park, D. Y. (2011). Utilizing the health belief model to predicting female middle school students’ behavioral intention of weight reduction by weight status. Nutrition Research and Practice, 5(4), 337-348. P e r r y, C . , & H o f f m a n , B . ( 2 0 1 0 ) . A s s e s s i n g t r i b a l y o u t h p h y s i c a l activity and programming using a community-based participatory research approach. Public Health Nursing, 27, 104-114. R u e b e l , M . , H e e l a n , K. , B a r t e e , R . , & Fo s t e r, N. ( 2 0 11 ) . O u t c o m e s

PROMOTION OF CHILDHOOD PHYSICAL ACTIVIY of a family based pediatric obesity program: Preliminary results. International Journal of Exercise Science, 4(4).

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Sekhobo, J. P., Edmunds, L. S., Reynolds, D. K., Dalenius, K., & Sharma, A. (2010). Trends in prevalence of obesity and overweight among children enrolled in new york state wic programs, 2002-2007. Public Health Reports, 125, 218-224. United States Department of Health and Human Services, Healthy People 2020. (2011, September 23). Physical activity. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=33 Village of Cazenovia. (2007). Village of cazenovia parks and recreation. Retrieved from http://www.villageofcazenovia.com/dept/parks.php