AAP: Pediatricians should prescribe physical activity for patients
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The AAP encouraged pediatricians to begin prescribing exercise for children, including recommending that they write a “prescription for play” during well-visits in the first 2 years of life.
In a clinical report, members of the AAP’s Council on Sports Medicine and Fitness and Section on Obesity noted that previous research has shown that physician counseling (OR = 1.42; 95% CI, 1.17-1.73) and exercise referral systems (RR = 1.20; 95% CI, 1.06-1.35) can “promote improvements in adults patients’ physical activity for up to 12 months, with evidence supporting the notion that physical activity counseling can be successfully implemented in routine clinical practice and that protocols are acceptable among health care providers.”
Such strategies also have been shown to be cost-effective and scalable to national levels, but data among children are limited, according to Blaise A. Nemeth, MD, FAAP, a pediatrician at the University of Wisconsin School of Medicine and Public Health, and colleagues.
“It is a prescription that is ever changing, and evolves over a lifetime, but we need to start it in childhood if we hope for people to remain physically active as adults,” Nemeth told Healio.
Starting a conversation
Nemeth said it is not the recommendation of the AAP to provide literal prescriptions for exercise but to inform patients with ideas and options on becoming more physically active.
“We are not recommending prescriptions for physical activity in the sense that most people might think,” he said. “Helping a child become or remain physically active isn’t as simple as writing an order on a piece of paper. We want pediatricians to send their patients home with an understanding of how physical activity would be beneficial in their lives, and with some ideas on how to do that. Writing it down and discussing it with other providers and caregivers” — which the AAP recommended — “helps start the discussion on how each child might become more physically active, given their unique situation.”
According to Nemeth and colleagues, a prior effort to assess the percentage of patients aged 2 to 17 years who had an outpatient visit with a primary care physician with evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity each year showed that less than 60% of pediatric visits included counseling for physical activity.
They noted that a nationally representative sample (n = 811) of U.S. primary care physicians showed that 98% said they assessed physical activity in adolescents using general questions. But only 66% of pediatricians asked specific questions regarding duration, intensity and type of physical activity, and only 7% reported using a standardized questionnaire.
Recommendations for all ages
The AAP recommended the following for pediatric patients to meet national guidelines:
Infants should get 30 minutes of physical activity throughout the day, which could be in the form of tummy time while awake;
Toddlers should be active 3 or more hours per day, or about 15 minutes every hour they are awake, which could include neighborhood walks or free play outside;
Elementary and middle school students should get 60 minutes of physical activity on most days, “including vigorous muscle- and bone-building activities 3 days a week.” “Free play and organized sports are good options,” the AAP added. “For middle school students, focus on ways to encourage socialization, and avoid specializing only in one sport.”
Teens also should get 60 minutes of daily physical activity on most days, “including 3 days that include activities that build muscle and bone strength. Encourage activities that encourage socialization and competition, when appropriate.”
“Assessing physical activity in children isn’t easy,” Nemeth said. “We offer a number of suggestions so providers can identify what works best for them and their patients. In the simplest sense, asking a child if they enjoy being physically active opens the door for a discussion. Physical activity can be further quantified by asking how many times per week they are active and for how long.”
Ideally, physicians should develop a “prescription” with the child and their parents — “an appropriate, incremental step to help that specific child progress toward those guidelines,” Nemeth said.
“Everyone’s path will be different, and the timeline will be different. For example, for a child who is not physically active, a prescription for 1 hour a day wouldn’t be appropriate. If the child and family are interested and ready to be more active, then it would be identifying a way to start,” he said.
“There can be a lot to discuss at an individual visit, and physicians need to weigh what is most important at that time for the patient they are seeing. We hope that the publication of this clinical report brings the discussion regarding the role of physical activity into that conversation more consistently.” – by Ken Downey Jr.
Disclosures: Nemeth reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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