Nutritional Disorders Telehealth Network Project

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Education on Physical Activity

Overweight or obese youth who have been cleared for physical activity (i.e., those with no medical or developmental factors that restrict their activity) are recommended to obtain 60 minutes per day of moderate to vigorous activity and to limit their screen time (TV, computer, videogame, etc. time) to 2 hours or less per day. The goal of increasing physical activity and reducing sedentary activity is to maximize caloric expenditure and promote healthy physical development. 
Background Education for Providers
The American Academy of Pediatrics Recommends that school age children and adolescents engage in 60 minutes of moderate or vigorous activity on a daily basis. For children and adolescents, this activity may take the form of developmentally appropriate games, or certain every day activities (e.g., yard work) and does not necessarily require involvement in traditional exercise activities that adults engage in (e.g., running on a treadmill). This 60 minutes is suggested to occur outside of school. 
Moderate activity refers to the level of effort which a person should experience while engaging in an activity. By definition, moderate activity is any activity that burns 3.5-6 calories per minute. Practically speaking, moderate activity leads to an increase in heart rate, feeling slightly out of breath or having difficulty holding a conversation, and results in sweating.   Examples of developmentally appropriate moderate activity include playing:
  • hopscotch
  • dancing
  • jump rope
  • climb stairs
  • walking longer distances (20-30 minutes)
  • playing in water (Marco Polo)
  • vacuuming
  • washing windows
  • scrubbing floors
  • mowing the lawn
  • baseball
  • basketball 
Vigorous activity is activity that raises heart rate, breathing rate, and gets you very sweaty. It is more intense than mild or moderate activity. By definition, vigorous activity burns 7 calories or greater per minute. Practically speaking, vigorous physical activity makes it nearly impossible to engage in a conversation. This is what people commonly think of when the word exercise is used. Examples of vigorous activity include:
  • Team sports like basketball, baseball, volleyball, soccer
  • Swimming to the other side of the pool and repeating several times
  • Long bike rides (20-30 minutes)
  • Jogging, running, playing tag
  • Running up and down stairs at home
Youth should not be expected to engage in physical activity alone. To the extent possible physical activity should incorporate family or peers. Most youth are not intrinsically motivated to engage in physical activity, so offering rewards for engaging in activity would be appropriate in these cases. 
Physical activity could be broken up into 15-20 minute increments, with several opportunities for activity throughout the day. The 60 minutes of activity does not need to occur all at once. 
Screen time refers to time spent in sedentary activities such as watching TV, playing video games, using a computer, etc. The American Academy of Pediatrics recommends that overweight or obese youth limit screen time to less than 2 hours per day. 
Instructions for Providers
For children presenting with low levels of physical activity, it is recommended that the primary care provider talk with the family about implementing the following plan at home:
  1. Identifying a list of physical activity options that the child enjoys.
  2. Identifying the people who can engage in that activity with the child.
  3. Using the Physical Activity Goal Worksheet to develop a specific plan for activity.
    1. Activity should be implemented gradually (e.g., in 15-20 minute increments) and increases in physical activity should occur only once the smaller activity goal has been met. Activity can be increased either in terms of duration on a given day or by the frequency of occurrence. For example, if an initial goal of physical activity is being active for 20 minutes three times a week, once that is mastered, appropriate next goals could include increasing activity to 40 minutes 3 times per week, or increasing activity frequency to 20 minutes 5 times per week.
    2. Activity can be broken up into 15-20 minute increments.
If Steps 1-3 are not effective in increasing physical activity, the family can consider implementation of a token economy system to encourage physical activity. Refer to the setting goals and using rewards handouts
Supplemental Materials
© 2015 Medical College of Wisconsin
Page Updated 04/15/2014