Obesity and Sports in Youth

Transcription

1 Obesity and Sports in Youth Donald E. Greydanus MD, Dr. HC (ATHENS) Professor, Pediatrics & Human Development Michigan State University College of Human Medicine East Lansing, Michigan USA

2 Spartan Pride

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6 Shaq Conducts Boston Pops Orchestra

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8 The Human Family Tree

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14 Introduction 1. Obesity Prevalence of over 20% a. United States b. Europe c. Asia: China, India d. Major health problem of 1 Billion People on the earth

15 Past 25 Years: Prevalence of Overweight/Obesity a. Doubled in Americans ages 6 to 11 years of age b. Tripled in Americans ages 12 to 17 years c. 75 percent relative increase in obesity

16 3. Obesity Complications a. Cardiovascular diseases b. Diabetes mellitus (Epidemic of Type II) c. Stroke d. Arthritis e. Cancers f. Psychological complications: depression, poor selfimage, others

17 4. Link to Adult Obesity a. Obese young Teen: 20 times more likely - obese adult b. 8 of 10 obese teens become obese adults c. 33%+ of Americans 20 yrs+ are overweight - obese d. 14% prevalence: yr old Americans - 21% if college experience e. 35% of American college students are overweight - obese

18 5. Key Points a. Prevention/management of obesity in pediatrics: Major Issue b. Prevent obesity development in the child/teen c. Aggressive management of obesity in the child/teen d. Long-term outcome of normal weight young adults better vs. obese e. Habits of nutrition and exercise develop in childhood/adolescence

19 DePietro, Med Sci Sports Exerc 31 (Suppl):S542-S546, 1999 (Physical Activity in the Prevention of Obesity) Review of longitudinal population-based adult studies Studies noted that physical inactivity was major factor in ADULT OBESITY Habitual physical activity prevents age-related weight gain (as in overt or non-overt sports play)

20 Berkey, Pediatrics 105:E56, 2000 Study of 10,000 children/teens ages 9-14 from USA Those who spent more time with TV/video games These children/teens gained more BMI each year

21 Unhealthy, Sedentary Lifestyle is Developed in Adolescent Years: Gordon-Larsen, Nat Longitudinal Study of Adol Health, J Peds 1999 Kimm, Med Sci Sports Exerc 32:1445-4, 2000 Van Mechelen, Med Sci Sports Exerc 32;1610, 2000 Kimm N Engl J Med 347:709-15, 2002 Patel, Greydanus, Baker, 2009

22 Janz: The Muscatine Study. Med Sci Sports Exerc 32:1250-7, year longitudinal cohort study of 126 preteens in Iowa Followed thru teen years Boys became more physically active as they became teens; not girls Sedentary lifestyle was more difficult to change in boys

23 Amisola, Adolescent Med 14:23, 2003: - Vigorous Physical Activity: Improves cardiovascular risk factors (improves blood pressure, lipids) Improves health of adolescents Leads to improve health of adults Includes lifestyle with exercise

24 Lifestyle Changes Epstein and Colleagues: Diet + exercise reduced weight in obese children over 10 years Exercise: aerobic activities including calisthenics Behavior Therapy 13:651, 1982 Behavior Therapy 16:345, 1985 JAMA 264: , 1990 Arch Pediatr Adolesc Med 154:220-6, 2000

25 Athletes may Need Increased Caloric Intake Some sports: Football, wrestling, others May gain weight if food intake continues and not playing Need balance of intake and expenditure Increased injuries if not proper stretching exercises: seconds per muscle groups 2-3 times/week

26 Prochaska, Diclemente: American Psychologist 47:1102, 1992 In search how people change Readiness to change is based on stage model: Precontemplation: not considering behavior change (lose weight) Contemplation: thinking about behavioral change (lose weight) Preparation: planning to change (lose weight) Action: initiating behavior change Maintenance of behavior change

27 Obesity Prevention and Management 1. Control balance between caloric intake and caloric expenditure 2. Assess for underlying risk factors for obesity a. Medical disorders 1. polycystic ovary syndrome, 2. congenital adrenal hyperpasia, others b. Genetics c. Sedentary lifestyle: Time spent with computers, media, etc

28 3. Role of these measures unclear for the child/teen: a. Behavioral modification therapy b. Pharmacotherapy (Greydanus, Ped Clin No Amer, February, 2011) c. Bariatric surgery (Greydanus, Pharmacologic Aspects of Adolescent Medicine, De Gruyter, 2012)

29 Role of Exercise 1. Positive benefits of exercise: a. Decrease 1. Body mass 2. Percentage Body fat 3. Visceral fat 4. Blood Pressure (arterial) 5. Triglycerides, LDL Cholesterol

30 Increase 1. Insulin sensitivity 2. HDL Cholesterol 3. Physical fitness 4. Self esteem Greydanus DE, Bhave S: Obesity in Adolescence. Indian Pediatrics 41 (6): , 2004

31 Power of exercise to prevent and management Pediatric Obesity a. Himes JH, Am J Clin Nutr 1994; 59(2):307 b. Bar-Or O, Pediatric Exerc Sci 1994; 6: c. Epstein LH, Med Sci Sports Exerc 1999; 31: d. Sothern MS: Pediatr Clin No Amer 2001; 48:1-17 e. Bar-Or O: Sports Sci Exchange 2003; 16:1-6

32 Power of exercise to prevent and management Pediatric Obesity f. Berkey CS, Pediatrics 2003; 111: g. Amisola RB, Adolesc Med 2003; 14:23-35 h. Lee I-M: JAMA 2003: 290: i. Donohoue PA: Obesity Ch. 43: , 2004 j. Kurpad AV, Indian Pediatrics 2004; 41:37-62

33 Structured Exercise a. Can improve body composition in obese teens/adult Wilmore: 20 wks endurance training, Am J Clin Nutr 1999; 70:346 b. Reduce abdominal adiposity in adolescent males Dionne, Med Sci Sports Exerc 2000; 32:392

34 c. Prevent increase in obesity in females in school-based exercise program 1. Mosuwan, Am J Clin Nutr 1998; 68:1006: Preschool children 2. Gortmaker, Arch Pediatric Adolesc Med 1999; 153: : Teens

35 Weight loss greater if on low calorie diet and sustain exercise patterns 1. Sothern MS: Pediatr Clin No Amer 2001;48: Epstein, J Pediatr 1985; 7: Reybrouck, Acta Paediatr Scand 1990; 79:84

36 Even short exercise durations are beneficial 1. Improved lipid profiles seen in obese children with 8 weeks of exercise 2. Duration of exercise progressively increased 3. Jogging, walking, swimming, aerobic dancing 4. Heart rates were increased to 60% to 80% of maximum Becque, Peds 1988; 81:605

37 Increased physical activity can reduce/prevent obesity a. Sothern MS: Pediatr Clin No Amer 2001; 48:1-17 b. Moore, Young Children, Am J Epidemiology 1995; 142:982 c. Goran, Children, Int J Obes Reslat Metab Dis 1999; 23 (Suppl): 18 d. Robinson, Children, JAMA 1999; 282:1561 e. Berkey, Adolescents Pediatrics 2000; 105:E56 f. Epstein, Children, Arch Pediatr Adolesc Med 2000; 154:22

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40 It May Not Work to Recommend Increased Physical Activity a. Inappropriate exercise is recommended b. Chance to exercise not be available for the obese youth in school c. Exercise-induced discomfort or pain (or injury) d. Psychosocial problems encourage sedentary, isolated lifestyle

41 Problems of obese youth in sports a. Friction between their thighs b. Friction between their arms and torsos c. Impaired pulmonary function 1. Due to moving a heavy body 2. Need increased oxygen to move their muscles vs. thin person

42 Obese Youth Obese youth should be encouraged to participate in sports and exercise Often physically weaker than peers: Relatively higher fat mass than fat free mass May be vulnerable to injury, especially in collision sports The large male may be asked to play football High risk for Injuries & Disappointment

43 Perform Poorly in 1. Track 2. Soccer 3. Other sports with running/jumping 4. If weight-bearing exercise is necessary due to extra weight

44 Recommendations 1. Teach youth that physical activity can be fun & healthy a. Especially the fun aspects b. Can be part of organized sports c. Separate from organized sports

45 2. Try various types of physical activity 3. Choose for themselves what is enjoyable at different times in their lives 4. Self-selected activities often change from time to time 5. Such change should be viewed as normal and inevitable.

46 6. These youth should be actively taught about being physically active 7. Avoid passively monitored for their exercise patterns 8. Schools must be encouraged to examine their policies a. Change policies that discourage obese students from exercise b. Educate school leaders and community leaders

47 Aerobic Activities for Obese Youth 1. Indoor activities tailored for aerobic exercise a. Dance b. Treadmill c. Rowing Machine d. Stationary Bike e. Others

48 2. Outdoor activities for aerobic exercise a. Jogging b. Bicycling c. Long Distance Running d. Roller Blading e. Power-walking f. Others

49 3. Choose Exercise w/ the idea of emphasizing lifetime sports a. Running b. Swimming c. Skiing d. Golf e. Tennis

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53 4. Parents should strongly encourage exercise/sports in their children and youth a. Provide examples of exercise b. Give rewards to children who exercise c. Canada s Physical Activity Guide for Children and Youth -

54 6. Additional Recommendations a. Fun activities b. At least 30 minutes of moderate exercise several times a week 1. Dancing (seen as exercise, not sex!) 2. Martial arts 3. Swimming

55 c. Walk or bike to school if possible d. Park their car or bike far away from the school or mall entrance e. Participate in physical education at school or in the community f. Clinicians ask if patients are in fun activities make suggestions g. If bored, change the activity

56 7. Obese youth may be taller & stronger than some peers a. Try sports requiring height and/or strength b. Basketball c. Football d. Shot-put e. Discus

57 8. Obese youth may choose water-sports a. Thermal insulation adipose tissue allows (especially in cool water) b. Buoyancy that water provides c. Pain with joint motion is reduced d. Obese appearance is not as apparent in the water; skiing

58 Overweight Children: <150% IBW; >85-95%tile BMI a. Aerobic Activities/Weight Bearing 1. Brisk walking 2. Treadmill or stair climber b. Sothern MS, Pediatr Clin No Amer 2001; 48:1

59 c. Field Sports d. Roller Blading e. Hiking f. Racquetball or Tennis g. Martial Arts

60 h. Skiing i. Jump rope j. Indoor sports 1. Swim 2. Dance 3. Play tag 4. Aerobic dance

61 Obese Children: % IBW; >95-97%tile BMI a. Aerobic activities: Non-weight bearing b. Swimming c. Cycling d. Strength or aerobic circuit training e. Arm-specific aerobic dancing

62 f. Arm ergometer (crank) g. Recline Biking h. Interval walking with rest as necessary i. Gradually work up to longer walks with fewer rest stops

63 3. Severely obese children: >200% IBW; >97%tile BMI a. Weekly supervision by trained exercise professional b. Only non-weight-bearing aerobic physical activity: 1. Swimming 2. Recline biking 3. Arm ergometer 4. Seated (chair) aerobics 5. Seated or lying circuit training

64 Teen Fitness Plan: General Concepts 1. Early adolescence separates (non)-athletes 2. Often lose interest in sports a. Turned off by competitive nature of sports b. Turned off by strict disciplinary milieu c. Not interested in devotion to one sport d. Half do not join any team 3. Allow teen to choose the sport/exercise s/he wishes 4. Proper nutrition is always important for max effort

65 Four Components of Physical Fitness 1. Cardiorespiratory endurance (aerobic fitness) 2. Body composition (percentage of body fat) 3. Muscle strength and endurance 4. Flexibility

66 Take up Lifetime Sports 1. Walking 2. Swimming 3. Jogging 4. Golf 5. Bicycling 6. Tennis 7. Skating 8. Martial arts 9. Skiing

67 Teens with ADHD or Autistic-Spectrum Disorder 1. Tend to do better with structured sports 2. Such as: soccer, basketball, hockey, lacrosse 3. Less with: baseball, gymnastics, golf

68 Swimming/Track Place great aerobic conditioning demands for both long distance and short distance endurance Football Demands for frequent short-distance spurts

69 School Physical Activity Classes 1. Keep students moving around, working all muscles 2. Should be a fun, free-of-pressure milieu 3. Emphasis Lifetime exercise 4. Emphasize joy of exercise, not just winning 5. Teach teens benefits of exercise

70 Sports for the Disabled Teen 1. Participation Options a. Non-participation: spectator, scorekeeper, referee b. Limited participation 1. Tabletop games 2. Assisted involvement 3. Non-resistive motion

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75 c. Moderate participation 1. Active motion activities 2. Increased endurance sports act. d. Full participation

76 2. General rules a. List medications used b. List special medical needs c. List acute (temporary) restrictions

77 Wheelchair Sports a. Basketball b. Archery c. Tennis d. Table tennis e. Track f. Baseball g. Weight lifting h. Marathons i. Bowling

78 4. Amputee Sports: Bilateral, lower extremities: wheelchair + a. Swimming b. Skateboarding c. Roller skating d. Ice skating e. Skiing (snow, water) f. Hockey

79 Blind Athletes a. Skiing b. Horseback riding c. Hiking d. Swimming e. Weight lifting f. Judo

80 Cerebral palsy athletes a. Swimming b. Bowling c. Pool d. Tricycling e. Archery f. Horseback riding

81 Summary 1. Obesity--major cause of disability and/or premature death for millions 2. Research--adult obesity can be prevented 3. Preventive efforts should begin in childhood and adolescence 4. Key: Control of diet and exercise patterns.

82 5. Educate youth on youths of physical activity 6. Avoid passivity on part of parents, clinicians and society 7. Often not part of organized sports program 8. Find activity that is chosen by youth wide variety of exercise 9. Swimming may be the ideal sports for obese youth Guidelines for obese available based on severity of condition

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