 Physical activity
Physical activity gives protection from many of our common
illnesses. Research shows that low and medium-intensive activity is
more important than short sessions of intensive training. Therefore,
children and adolescents need safe paths to and from school and
after-school activities, so they can get there by walking or
bicycling.
Figure 1. Key factors concerning physical activity among
adolescents.
Health effects of physical activity
We know today that many common illnesses in adults begin in younger
years. That applies, for example, to coronary disease, high blood
pressure, stroke, cancer, brittle bones, diabetes, chronic anxiety, and
depression [1-5].
We also know that physical activity in adults somewhat guards against
these illnesses. Therefore, there is an increased interest in preventive
measures directed at physical activity already during childhood and
younger years [6].
Studies show that a young person who is physically active also
continues to be active as an adult (Telama, 1997)
Small children are constantly moving and in that manner they build up
their muscle strength, co-ordination, balance, and reflexes [7]. If the
child's possibilities to train its gross motor skills are reduced, it
can harm the child's development of motor skills. But there are no
studies which show that physically inactive children and young people
are less healthy than those who maintain physical activity.
Overweight children are physically less active. Which is the cause
and which is the effect is unclear. There is only a weak connection
between overweight in children and obesity in adult years, but if the
weight problem is expressed, remains, or begins in the teens, then the
risk increases significantly of lasting weight problems [8].
Recommendations
It is not known exactly how much activity children need for normal
development to prevent illnesses. Today there are no detailed
recommendations in Sweden [7].
With regard to adults, recent experience has shown that it is not the
intensity of the workout that gives beneficial health results, but
rather the regularity. A half-hour of activity per day is enough, for
example in the form of a swift walk, biking, tennis, mowing the lawn or
cleaning. It is the accumulated time which makes a big difference [1-4].
In the USA, there are recommendations for adolescents: "All
young people should be physically active every day or nearly every day,
as a part of playing, sports, games, transportation, work, athletics,
recreation, or planned training." Further, it is recommended that
young people should be active on at least three occasions per week, for
at least 20 minutes at a high-intensity level[16].
Figure 2. Exercise among boys aged 11-15. Answer to the
question "How often do you work out so that you become out of
breath or get sweaty?" School questionnaire, Stockholm county, 1996
[21].
How common is physical activity?
Systematic studies of children's and young people's total physical
activities are rare. Therefore, there is no exhaustive basis for us to
speak with authority on whether children and young people have become
more or less active.
Figure 3. Exercise among girls aged 11-15. Answer to the
question, "How often do you work out so that you get out of breath
or become sweaty?" School questionnaire, Stockholm county, 1996
[21].
Associations for sports activities have increased [9]. But at the
same time, the amount of children and young people who participate in
sports without being in some club has shrunk drastically during the past
decades. Besides, the amount of children and adolescents who do not
participate in any kind of after-school sports has increased during the
same period. Every third girl and every third boy did not get the amount
of exercise equivalent to a walk, according to the study.
Other reports show that 15-year olds as a group are both active and
in good shape [10,11]. Swedish children and young people are growing in
both weight and height, according to other studies. But since weight
gain is happening more quickly than height gain, we can suppose that
problems of overweight are increasing [12,13]. The weight gain can,
however also be due to increased muscle mass.
Study results in Stockholm county
Children and adolescents in Stockholm county have answered the same
questions about exercise which were asked of children in other countries
in repeated questionnaires during the last few decades, within the WHO
project "Health habits among schoolchildren" [14].
Figure 4. The amount of boys and
girls aged 11-15 who watch TV, play video or computer games at least 4
hours a day. School questionnaire, Stockholm county, 1996 [21].
Girls exercise less than boys (see figures 2 and 3). By the age of
15, 76% of boys exercised intensively two to three times a week or more,
whereas only 58% of girls in the same age group exercised that amount.
Neither an increasing nor a decreasing trend from 1990 to 1996 can be
discerned.
Comparing the results in Stockholm county with the national figures,
boys in Stockholm appear to exercise as much as other boys in Sweden.
But girls in Stockholm exercise less than the average Swedish girl.
Sitting in front of the TV, playing
computer games and TV games were also measured in school questionnaires.
In Stockholm more boys than girls spent time on sedentary activities,
which applied to all the years 1990, 1993 and 1996 (see figure 4). The
largest difference was for computer games. In 1996, slightly more than
30% of 15-year old boys in Stockholm county spent four or more hours per
day playing a computer game or watching TV. That is nearly double the
amount compared to 1993.
Social position
The family's social position is significant for both how much the
child exercises and in what form [9,24]. Among teenagers and young
adults, more of those who exercised had finished their upper secondary
school education and exercise was more common among university level
students. Girls from families with low socio-economic status are less
physically active. No such a difference is seen among boys [25-27].
Protective factors
The range of children and adolescents' physical activity depends on
both the physical conditions in the area and on social experiences in
the family, school, and among friends [17-20].
Opportunities for activities
It is often the environment which makes it difficult for children and
adolescents to exercise freely and spontaneously, especially in modern
cities. Traffic is heavier and requires more space, thus there are fewer
forests. Walking and cycle paths are not seldom poorly maintained.
Because of the traffic risk, many children are forced to be driven to
and from school. Children spend many breaks inside. In certain
neighbourhoods, parents do not allow their children to play outside out
of their range of vision, and often drive their children to activities
or to friends' houses. Children are in that sense living in a more
restricted environment, and they are more dependent on their parents
which it comes to opportunities for activities [23].
Certain areas also lack suitable outdoor activity areas, exercise
fields, and premises.
Type of activity
There is a larger likelihood that individuals continue with
low or medium-intensity exercise rather than with high-intensity
workouts [36]. Possibilities to control activities by him or
herself are said to be important factors [37].
Competing activities
New
enticing sedentary activities such as TV, video- and computer
games compete with the time children and adolescents could use
to exercise. Studies from the USA show that children who spent a
lot of time watching TV were often overweight and had poor blood
lipid values [32,33].
Social norms
Parents have an important role as examples when it comes to
physical activity [28]. In most studies, experiences with
physical activity during childhood and adolescence, especially
membership in sports clubs and grades in physical education at
school, were shown to be good predictors of physical activity
during adult years [29-31]. ndividual factors
Among adolescents in the WHO study, "improving
health" along with "having fun" and "meeting
friends" were the most important reasons to be physically
active [34]. Competing was not so important to adolescents, and
became less important as they grew older. Confidence in their
own abilities to be physically active and feel happy with the
activity, on the other hand, has been shown to be strongly
related [35].
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Prevention
In both the long and short run, it is most important to support
daily, spontaneous, and low-stress physical activity which leads to
fewer injuries. Evaluations of prevention programmes in order to
increase physical activity have given generally doubtful results.
Isolated information campaigns have proven to be mostly ineffectual.
Successful programmes have most often had a broad approach and have been
directed towards particular target groups [21]. The programmes have
contained components which aim to influence the individual's factors
(knowledge, values, self-esteem, health awareness), behaviour factors
(ability, goals, encouragement) and environmental factors (possibilities
and obstrades, influence and support of parents and friends, positive
models, cultural norms and expectations) [22].
Possibilities for activity
It is desirable that municipalities are continuously aware in their
planning of children's and adolescents' need to be spontaneously active.
Bicycling and walking should be prioritised. Children should have the
right to a safe and stimulating play area in their neighbourhoods. They
should be guaranteed safe paths to and from pre-school, school, and
various after-school activities. Moreover, places for free movement,
dance and sports should exist for children where they can go without
paying.
Municipal support should go primarily to the activities that children
themselves can control and which are not highly intensive. Resources
might have to be redistributed from the sports and after-school sectors
to enable municipalities to do this.
Pre-school
When it comes to small children, activities should be directed
towards developing all motor skills. A study shows that a stimulating
outdoor environment in connection with day-care increases a child's
physical activity [46].
School
Physical education classes in school have been considerably reduced.
This has happened despite the importance of exercise for health. But the
modest total of three hours per week cannot be expected to fulfil the
need for physical activity. Studies also show that time in physical
education classes is used poorly. The teaching is adapted mostly to
those children who participate in sports during their spare time.
Children who are inactive in their spare time are most often negative
towards school sports. Injuries are common, which indicates that another
direction is necessary [39]. For teenagers, the teaching should give
general exercise and good feelings about movement, and should contribute
to an interest in physical activity that lasts beyond the school years.
Individual factors
Special "health programmes" are one way for pre-schools or
schools to influence physical activity. Even if there are examples of
successful school programmes to increase the level of physical activity
[40,42], the result is often less than good. One of the explanations for
poor results can be that, until now, no one has used current knowledge
on how a health information programme should be formed. Modern
programmes on how to stop smoking could have been used as guides
[41,43].
Social environment
Since parents are important role models, it ought to be possible to
increase physical activity in children by making it easier for parents
to be physically active.
Secondary prevention
Girls from families with poorly educated parents need the most urgent
attention in trying to influence physical activity. This group is the
most inactive. Measures must start with the girls' own goals. Health
programmes should focus on the entire lifestyle and the peer group,
since inactivity is often just a part of a generally unhealthy lifestyle
with poor eating habits and smoking. Changes in the environment are
especially important for this group, and activities which do not require
special knowledge or special equipment should be offered.
Risks with physical activity
Increased physical activity is not just beneficial. It can,
conversely, lead to increased health risks. Today all children are
exposed to uneducated adult trainers who transfer adult training methods
directly to children. Acute injuries due to extreme movements, falls,
and jolts, or a tough and monotonous training can lead to strain
injuries which are especially serious if they affect the skeleton's
growth zones. Girls who train intensively in individual sports where low
weight and stamina are rewarded run an especially high risk of
developing eating disorders, so-called sports anorexia [44-45].
Children and adolescents therefore should avoid drawn-out stamina
training, weight-lifting, monotonous training and training with extreme
body movements.
Suggested indicators
Figure 1 suggests as an indicator the number of students in ninth
grade who are moderately or intensively physically active at least three
times a week. It is either low or medium-intensive activity which most
likely protects best from illnesses. Indicators based on this view can
be the amount of children who regularly walk or cycle to school and the
amount of children who spend time outside for a number of hours each
week.
Summary
- Physical activity protects against most of the common sicknesses.
- Low or medium-intensive physical activity, which children
themselves can control , is most significant and has the best chance
of forging long-lasting effects.
- Among Stockholm county's ninth graders in 1996, 76% of boys and
58% of girls were active.
- Children should have access to stimulating play areas in their
neighbourhoods.
- Children should be guaranteed safe paths to and from school and
after-school activities so they can walk or cycle there. Children
would thus not need to be driven or take the bus.
- Children should have free and easy access to places where they can
play, dance, and practise sports.
- Physical education at school should stimulate a thorough
development of gross motor skills and give exercise and a positive
feeling for movement, especially for the group that is inactive
during spare time.
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