Promoting Physical Activity at Well Child Visits A Training for CHDP Providers Developed by: State of California CHDP Nutrition Subcommittee July 2012

2 Objectives After the training, providers will be able to: Identify the benefits of regular physical activity (PA) in youth Describe the key PA guidelines for children and adolescents Recognize developmentally-appropriate PA Identify effective ways to promote PA for all children

3 Role of Provider in Promoting Physical Activity Screen for appropriate PA at each health assessment visit* Share developmentally appropriate PA with family* Discuss PA and healthy lifestyles for obesity prevention Recommend PA community resources for low- income families * CHDP Health Assessment Guidelines Section 54

4 Benefits Associated with Physical Activity Improves cardiorespiratory fitness Builds and maintains healthy bones and muscles Promotes a positive self-image Positively affects concentration, memory, and classroom behavior Reduces risk of developing chronic diseases: obesity, type 2 diabetes and heart disease

5 PercentileWeight Status > 95 th Obese 85 th to < 95 th Overweight 5 th to 85 th Normal < 5 th Underweight BMI for Children and Teens

6 Overweight & Obese Children California children ages 2 to < 5 years 2010 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report

7 Overweight & Obese Children California children ages 5 to < 20 years 2010 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report

8 Guidelines for Children Birth to Five Years All children from birth to age 5 should engage in daily physical activity that promotes movement skillfulness and foundations of health-related fitness* *National Association for Sport and Physical Education, 2009

9 Physical Activity for Infants Structured & unstructured activities: Safe area, easy to explore, small space Toys to promote development of motor skills Focus on large muscles Limit periods of restricted movement (bouncy seat or car seat) Skills to promote: Head control, grasping Rolling, crawling, standing Low-cost PA ideas to share: Peek-a-boo and pat-a-cake, Rattle, kitchen pans

10 Physical Activity for Toddlers Structured activity: At least 30 minutes/day Unstructured activity: At least 60 minutes/day Not be sedentary for > 60 minutes at a time Low-cost PA ideas to share: Climbing on the playground, playing tag, tumbling, or tossing a ball through hoops

11 Physical Activity for Preschoolers Structured activity: At least 30 minutes/day Unstructured activity: At least 60 minutes/day Not be sedentary for > 60 minutes at a time Low-cost PA ideas to share: Running or tumbling Throwing & catching

12 How Much Physical Activity do Children and Adolescents Need? 1 hour (60 minutes) or more of aerobic physical activity (PA) that is at least moderate* Most of the 1 or more hours/day should be either moderate- or vigorous-intensity PA Do vigorous-intensity PA at least 3 days/week Encourage participation in PA that is: Age appropriate, enjoyable, offers variety *2008 Physical Activity Guidelines for Americans, Children & Adolescents (ages 6-17)

13 Physical Activity Definitions Moderate activity = activity of an intensity equal to a brisk walk, such as hiking, active recreation, softball Can be performed for relatively long periods of time without fatigue Vigorous activity = movement of a higher intensity than a brisk walk, such as running, sports, martial arts May require frequent rests between bouts

14 Guidelines for Children and Adolescents (ages 6-17) Aerobic Activity Muscle Strengthening Activity Bone Strengthening Activity

15 Aerobic Activity Should make up most of the 60 minutes of daily activity and be either moderate- or vigorous-intensity aerobic activity Include vigorous activity at least 3 days/week Activities that involve rhythmic movement of large muscle groups Running, hopping, skipping, jumping rope, swimming, dancing, bicycling, tag, skating

16 Muscle Strengthening Activity Include at least 3 days/week as part of 60 minutes Conditioning using resistance to increase muscular strength Can be unstructured and part of play – playing on playground equipment, climbing trees, and playing tug-of-war Can be structured – free weights, weight machines or resistance bands, push-ups

17 Bone Strengthening Include at least 3 days per week as part of 60 minutes Activities that produce an impact or tension force on the bones Include running, jumping, basketball, tennis, hopscotch

18 Brief Focused Advice Step #1: Engage the Patient/Parent How do you feel about your child’s weight? Step #2: Share Information Your child’s current weight puts him/her at risk for diabetes, heart disease, asthma… Step #3: Make a Key Advice Statement I would strongly encourage you to … Get up and play hard at least one hour a day Cut back on screen time to < 2 hours a day Eat at least 5 helpings of fruits & vegetables every day Cut back on soda, sports drinks, juice and sweetened drinks Step #4: Arrange for Follow-up Let’s set up a future appointment to talk about how things are going. Effective Communications with Families, Kaiser Permanente © 2004

Brief Focused Advice: Role Playing Exercise

20 Weight Assessment & Counseling for Nutrition & Physical Activity for Children/Adolescents HEDIS 2011 HEDIS measures assess the quality of healthcare delivered To meet the HEDIS requirement, the chart note should include one of the following: Discussion of current PA behaviors, indication that PA was addressed, counseling or referral for PA, educational materials or anticipatory guidance for PA HEDIS Measure available at:

21 PM 160 Documentation Enter follow up code in appropriate column under “PROBLEM SUSPECTED” if child is outside the healthy weight range Document any discussion of, or referral for, physical activity XXXXXXXXXXXX

22 Meeting the Guidelines Youth Who Don’t Meet the Guidelines Slowly increase activity in small steps Participate in enjoyable activities Youth Who Meet the Guidelines Continue being active on a daily basis Work toward becoming more active Youth Who Exceed the Guidelines Maintain activity level Vary the kinds of activities to reduce injury risk

23 Local Physical Activity Resources Parks & Recreation Department/Community Centers YMCA Boys & Girls Club Boy/Girl Scouts Girls on the Run American Youth Soccer Organization (AYSO) Police Activities League (PAL) PA multi-media (YouTube, fitness shows on TV) Team sports & classes (soccer, baseball, basketball, dance, gymnastics etc.)

24 Exercise Prescription

25 Summary/Promoting Physical Activity Provider Discuss PA as part of routine screening Brief Focused Advice Refer to community programs Office* Foster a healthy office PA posters and incentives * Refer to AIM-HI Practice Manual, American Academy of Family Physicians. Available:

26 References NASPE. Active Start: A Statement of Physical Activity Guidelines for Children From Birth to Five Years NASPE. Physical Activity for Children. A Statement of Guidelines for Children Ages U.S. Department of Health and Human Services Physical Activity Guidelines for Americans. Active Children and Adolescents. For the AIM-HI Practice Manual, go to:

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