By NASPEM member, Dr. Webb Smith
At its very core pediatric exercise science much like general pediatric medicine is focused on assessing and promoting child health and wellness. The field of pediatric exercise science has grown tremendously over the last thirty years with more research available now than ever. A few things have become clear with focused physical activity and exercise research on children, we know now that physical activity is a key stimulus for normal growth and development during childhood. We also know that physical activity rates have declined significantly over the last 20 to 30 years driven partially by a reduction of physical education in schools in favor of more academic instruction and the increasing popularity of electronic devices like video games and cell phones which are now ubiquitous in our society. This represents an important missed opportunity to improve health and wellness with an effective and low-cost treatment.
Research from pediatric exercise science professionals can add to clinical care models with prevention strategies, evaluation tools, and management of chronic disease. Pediatric exercise scientists have developed valuable resources to evaluate physical activity patterns, physical fitness, and health related quality of life. These tools range from surveys about health behaviors to detailed diagnostic evaluations of health-related physical fitness. Results from these tests can inform the focus and needed intensity of counseling sessions so that clinics can tailor information to the most impactful health behaviors for each family (e.g. reducing screen time and replacing with unstructured playtimes). More detailed evaluations like cardiovascular stress tests, or motor proficiency testing can be compared to normative ranges to understand how a patient may need to modify peer-based activities such as sports to ensure a successfully and rewarding experience or help with differential diagnosis in complex cases. A comprehensive understanding of a patient’s strength and weaknesses can be included in tailored interventions to improve physical fitness and health behaviors.
Development of intervention strategies to improve health and wellness in children with and without chronic disease has received considerable focus. This research has led to practical physical activity guidelines for prevention and management of chronic disease. There are brief counseling strategies perfect for including in a short clinic visit. These are effective at raising awareness on the importance of physical activity for health and provide actionable plans that parents can begin at home. For those with greater clinical concern or barriers to adopting better health behaviors, collaborating with and/or referring to a local pediatric exercise scientist may be a great way to get patients advanced care like individualize exercise prescription targeting their unique medical concerns, functional limitations, and other barriers to being physically active. These more prescriptive approaches have been shown to be an effective piece of a comprehensive care models and can greatly improve patient health outcomes.
Despite the strong evidence supporting physical activity and exercise prescription, these remain an under-utilized therapy to support normal growth and development as well as the prevention and treatment of underlying chronic disease. These effective and low-cost therapies are often not widely used in clinics due time restrictions, and lack of resources and knowledge about how to screen for physical activity and inactivity as well as how to intervene when screening reveals a deficit. These are well within the expertise of pediatric exercise science professionals setting up a perfect opportunity to establish a productive collaboration focused on improving the overall health of children regardless of ability.
Webb Smith, PhD, is an Assistant Professor at the University of Tennessee Health Science Centre and Clinical Exercise Physiologist at LeBonheur Children’s Hospital. Dr. Smith’s background and training in exercise physiology has led him to develop a clinical program that focuses on preventing and treating diseases associated with obesity.