Pain, bony alignment and impaired muscle strength and balance can all impact on the functional activity of gait. Dynamic stability is affected through impairments in ability to correct anteroposterior and medio-lateral balance 97, Subsequently, children who are obese walk at a slower pace and spend more time in the stance phase of gait 99, This slowing effect can limit the distance covered by children who are obese when compared to lean peers In addition, impaired dynamic balance and strength can restrict the daily activity of moving from sit to stand Considering the structural and functional impairments described above it is understandable that children who are obese report lower health-related quality of life compared to lean peers , Increasing active play, physical activity level and physical fitness are aims of most obesity intervention programmes..
Physical activity can benefit children who are obese by increasing their lean body mass, increasing energy expenditure, improving their appetite and energy intake control, and improving their metabolic and psychological profiles Independent of any effect on weight, the above changes justify the promotion of physical activity in children. In order to support a child in increasing these indices, interventions should consider the physical impairment that most often present in this group.
Activities that are perceived as fun by the child should be targeted and efforts should be made to ensure that the child has someone to be play actively with.
Recommending games with parents, siblings and friends will help a very inactive child to become more confident in active play. Treatment aims should be to preserve fat-free mass and to improve fitness parameters.
As such, facilitating basic motor skill and balance will be important to improve confidence in movement, reduce the risk of falls and to improve self-efficacy. Studies integrating motor skill components e. Where standardized group treatment is offered, activity sessions should aim to establish movement and exercise as an enjoyable and rewarding experience.
Fun group games should favour aerobic activities which promote fat oxidation but with the minimal perceived exertion. The physical activity guidelines for children table 1 should be followed with regard to the type and amount of activity needed per week.
Clinicians should keep in mind that children who are obese will likely need to perform shorter age-appropriate bouts of activity dependant on their baseline level of fitness. As weight begins to reduce it will be necessary for the child to maintain or even increase their level of activity due to concomitant reductions in bodily energy expenditure for further information see chapter on energy expenditure.
It is likely that children would need more than 60 mins of moderate-vigorous activity per day to prevent weight regain , When prescribing activity for children who are obese the following principles should be followed:. For children with severe obesity, non-weight bearing activities may be an appropriate initial undertaking.
Recumbent cycling, stationary cycling, rowing ergometry and swimming are all suitable activities, though consideration should be given to the weight limits of any exercise equipment.
In addition, children with severe obesity may not wish to use public swimming area secondary to embarrassment. As such, hospital hydrotherapy facilities or rental of swimming pools for bariatric patients may be indicated. As a child progresses through treatment, attention should be given to activities that promote core stability and cardiorespiratory endurance. Similarly bone building activities such as jumping and skipping can be introduced and continued at least three times per week.
Gradual increases in the time spent doing activity should be promoted and age-appropriate daily activity goal charts using stickers or rewards may be useful to support motivation. Similarly, pedometers, accelerometers or smartphone applications may be useful aids for encouraging self-monitoring of active play and physical activity. As the child becomes more accustomed to moving, it is useful to advise that the child try a variety of games, sports and activities.
They should be encouraged to keep trying new games as it is usual to find new activities difficult when first undertaken. In addition, the whole family should be encourage to move more, to commute actively where possible and to spend family-time doing fun activities. For children who are wheelchair users or have limited mobility following surgical procedure activity and games may need to be modified.
Overall the physical activity interventions should be designed to:. In addition to the promotion of active play and physical activity, sedentary pursuits should also discouraged.
Television viewing and screen time have been directly related to the degree of obesity in childhood Similarly, treatment should address the nutritional health of the child see relevant chapters and should promote sleep. Short sleep duration has been shown to be associated with childhood obesity and cardiovasulcar health and when a child increases their level of activity imporvements in sleep will often be observed. Your email address will not be published. Save my name, email, and website in this browser for the next time I comment.
Select a page. Introduction Although rises in paediatric obesity are multi-factorial in origin, lifestyle changes in physical activity-related energy expenditure and increased consumption of energy-dense foods are considered to be of direct influence 1. Finally, low levels of physical activity during childhood have been associated with morbidity and mortality in adulthood 2.
The following chapter introduces the reader to a number of concepts including: The importance of physical activity for health-related fitness The relationship between physical activity and obesity Physical activity in weight management Measurement of physical activity Barriers to physical activity in children who are obese Physical activity and health-related fitness in childhood Health-related physical fitness HRPF includes: cardiovascular endurance; muscle strength and endurance; flexibility; coordination; body composition and metabolic components 3.
Crunches may be easier because they do not require a child with weak core muscles to go all the way down. Walk and cycle up and down hills to raise and lower the heart rate and use different muscles. Change strokes every few laps when swimming to vary muscle use. Try to add strength, flexibility and endurance exercises to each workout. For example, children can use dumbbells while walking or using an exercise bike.
Raise the intensity level of workouts after the child improves his cardio stamina and muscular endurance. Pick up the pace of walks or rides, trying to finish the course a few minutes early, or adding more minutes. Add a step aerobics workout, which is low impact. Add a few minutes of jumping rope and jumping jacks. Use a treadmill, elliptical machine, rowing machine or exercise bike. Your child does not need to do full aerobic workouts using these machines; just raise his heart rate each week as he improves his condition.
Create a circuit training workout that includes a variety of exercise 3. Have the child spend 30 seconds of jumping jacks, 30 seconds of jump rope, 30 seconds of crunches and 30 seconds of stairs. Take a two- or three-minute break, then start another circuit, which might include:. Physical activity and cardiovascular exercise are very important factors for controlling body weight and for health. Being thin does not guarantee perfect health.
Walking to school, playing during breaks, hiking, going for a walk with a dog, and shortening screen time less time for TV and computer may be recommended for children in order to increase physical activity. It should be kept in mind that doing physical exercise is preventive against cardiovascular disease and cardiopulmonary risk factors, but other complications including obesity-associated osteoarthritis, reduced quality of life, social discrimination, and functional limitations persist.
In other words, exercise alone is not sufficient in the prevention and treatment of obesity, and must be applied in combination with calorie reduction. In adults, a kcal negative energy balance is targeted daily in weight loss programs. The duration of exercise required is 2 hours to provide this negative energy balance.
It has been reported that it is not possible for obese individuals to reach this duration regularly Farris et al. In other words, sustainability of exercise treatment is not so possible. Considering this finding, European Union Instructions included a statement recommending that school-age children should participate in moderate-high intensity physical activity at least 60 minutes daily In conclusion, treatment of obesity is difficult.
Therefore, the easiest way is prevention. Obesity epidemics should be evaluated well to prevent a rapid increase of this health problem in the twentieth century.
Treatment of obesity is considerably long and the possibility of treatment failure is high. Therefore, treatment objectives should be specified accurately.
Physical activity is very important for healthy children as well as for obese children with chronic problems. A few points to be noted when specifying treatment objectives, are as follows:. During these follow-up visits, treatment course should be discussed, the child be encouraged, and obstacles and how these obstacles can be eliminated should be discussed. In our current modern world, it is very difficult to develop a lifestyle including a behavioral model that increases physical activity in addition to diet treatment in children.
In addition, the efficiency and adverse effects of dugs recommended for use in treatment of obesity, are not yet clear in children. Therefore, the important point is prevention of obesity rather than favorable treatment. Peer-review: Externally peer-reviewed. Conflict of Interest: No conflict of interest was declared by the author. Financial Disclosure: The author declared that this study has received no financial support.
National Center for Biotechnology Information , U. Journal List Turk Pediatri Ars v. Turk Pediatri Ars. Published online Mar 9. Author information Article notes Copyright and License information Disclaimer. The known about this topic Obesity is an important health problem not only in developedcountries but also in developing countries aswell. Contribution of the study Physical activity to increase the compliance of children with obesity management programmes is discussed in this paper.
Received Feb 12; Accepted May This article has been cited by other articles in PMC. Abstract Changing lifestyles reduce the time spent by children on physical activity during the day. Keywords: Childhood, compliance to treatment, obesity, obesity treatment, physical exercise.
Introduction Although obesity has been defined as the most common health problem in modern societies; currently, it is a problem with gradually increasing frequency both in developed and developing countries.
Table 1 Approach in long-term follow-up of obesity treatment. Reducing calorie intake 2. Increasing exercise 3. Motivation for behavioral modification 4. Drug therapy 5. Open in a separate window. Daily activity status in children Changing lifestyles reduces the daily time period during which children are active. Exercise model to recommend for children Total and visceral adipose depots decrease, lean mass index increases, energy consumption at rest, and the insulin sensitivity of adipose tissue increases with exercise.
Exercise types and examples for children 22 : Aerobic exercise: This type of exercise increases heart rate and respiratory strength. Muscle strengthening: climbing a rope, tree, rock, push-ups, weightlifting Bone strengthening: Recommended to perform at least three times weekly, e. Table 3 Exercise intensity MVC: maximum voluntary contraction. Table 4 Physical exercise programs that can be recommended by applying FITT principles in children and adolescents 20 , Figure 1.
Table 5 Types of moderate exercise that can burn kcal Daily activities Sports activities Washing or polishing a car for 45—60 min Playing volleyball for 45—60 min Less tiresome, more time consuming Washing windows or the floor for 45—60 min Playing with soccer ball for 45—60 min Gardening for 30—45 min Walking 1. Table 6 Exercise treatment strategies according to age and the degree obesity in children. BMI: Body mass index. Table 7 Feasible exercise recommendations in prevention of obesity.
Glucose and glycogen are oxidized primarily with exercise, and fat oxidation begins in 90— minutes. The benefit of exercise persists for 24—72 hours. Footnotes Peer-review: Externally peer-reviewed. References 1. Ankara: Taslak; [ Google Scholar ]. Effectiveness of weight management programs in children and adolescents. Weight-related perceptions among patients and physicians:how well do physicians judge patients'motivation to lose weight?
J Gen Intern Med. Evaluation of data from the obesity outpatient clinic at the end of the second year as a newly formed unit in Istanbul training and research hospital. Istanbul Med J. A qualitative investigation into the levers and barriers to weight loss in children:opinions of obese children.
Arch Dis Child. Prevention and treatment of pediatric obesity:an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab. Response of severely obese children and adolescents to behavioral treatment.
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