# Presentation: 046604

## Empowering Youth Through Physical Activity: Using Bright Futures

**Bonnie A. Spear, PhD, RD**
**Associate Professor Pediatrics**
**University of Alabama at Birmingham**

## Bright Futures Guidelines

**	****Guidelines for Health Supervision for Infants, Children and Adolescents**

**Notes:**
Bright Futures has benefited from the ongoing support of diverse public and private partners. Initiated by the U.S. Department of Health and Human Services in 1990, the project has been guided continually by the Health Resources and Services Administration’s Maternal and Child Health Bureau, with additional program support from the Health Care Financing Administration’s Medicaid Bureau. 

## Bright Futures Management

**Bright Futures ****Management**

- Web site: www.ncemch.org

**Notes:**
The project is managed by Georgetown University’s National Center for Education in Maternal and Child Health in Arlington, Virginia.

## Bright Futures in Practice Series

**Oral Health**
**Nutrition **
**Physical Activity**
**Mental Health (forthcoming)**
**Children with Special Health Care Needs (forthcoming)**

**Notes:**
With the Bright Futures guidelines as a cornerstone document, a series of Bright Futures in Practice implementation guides is being developed to focus on specific areas of health promotion and disease prevention. These implementation guides, though not distributed through Pfizer, provide specific in-depth information to meet the needs of a diverse number of health practitioners. 

Two of the implementation guides are already available: Bright Futures in Practice: Oral Health was published in 1996, and Bright Futures in Practice: Nutrition was released in February 2000. Bright Futures is currently developing three other implementation guides on physical activity, mental health, and children with special health care needs. Each volume offers health promotion/disease prevention information, strategies, and anticipatory guidance for professionals and families. 

## Surgeon General’s Report

**Nearly half of adolescent ages 12-21 did not participate regularly in vigorous physical activity**
**About 14 percent of children and adolescents did not participate in light to moderate physical activity**

## Physical Activity in Children and Adolescents

** ****Benefits of Physical Activity**
**Increase bone mass/reduce risk  osteoporosis**
**Reduce obesity**
**Lower blood pressure**
**Improve blood lipids**
**Reduce anxiety and stress**

## Benefits of Physical Activity

** ****Increasing bone mass/reducing risk of osteoporosis**
**PA helps build greater bone density**
** ****Helps maintain peak bone mass into adulthood**
**In order to increase greater bone mineralization children and adolescents need to participate in weight-bearing PA**
**Jumping rope, walking, playing soccer, dancing**

## Benefits of Physical Activity

** ****Reduces Obesity**
**PA is crucial for obtaining and maintaining a healthy weight**
**Increasing PA helps in reducing sedentary behaviors**
**Reducing inactivity is a critical factor in reducing obesity**
**Helps in controlling blood sugars in children with Type 2 diabetes**

## Benefits of Physical Activity

** ****Lowers Blood Pressure**
**In children with elevated blood pressure, PA can significantly lower both systolic and diastolic blood pressure**

## Benefits of Physical Activity

**Improve Blood Lipids**
** ****Regular PA in adults improves blood lipid levels, particularly by increasing HDL-C.. Which are associated with a reduction in arteriosclerosis**
**Impact of PA on HDL-C in children is unclear, but higher HDL-C have been seen in children with regular PA**

## Benefits of Physical Activity

** ****Reduces anxiety and stress**
**Regular PA has the potential to promote psychological well being**
**Improve self-esteem**
**Reduce level of anxiety**
**Reduce symptoms of depression**

## But How Do You Get Kids More Active?

## Families as partners
Families as caregivers
Families as teachers
Families as resources

**Families as caregivers**
**Families as teachers**
**Families as resources**

**Families Matter!**

**Notes:**
The Bright Futures guidelines are based on the belief that families matter: families as partners, as caregivers, as teachers, and as resources within the community. 

One of Bright Futures’ primary goals is to enhance families’ strengths while addressing their concerns and vulnerability, to build parents' confidence and competence in preventing illness and promoting health and safety at home and in their community. This goal can be fully achieved only when health professionals, families, and communities become partners in health, sharing information and resources for the benefit of all.

## Health professionals
Families
Child care professionals
Social service professionals
Schools
Local and state government
Community groups
Business/industry
Faith communities
Payers

**Families**
**Child care professionals**
**Social service professionals**
**Schools**
**Local and state government**
**Community groups**
**Business/industry**
**Faith communities**
**Payers**

**Health Promotion Is ****Everybody’s Business**

**Notes:**
Health promotion occurs not only in offices, clinics, and hospitals, but also in homes, schools, workplaces, churches, child care centers, and communities. Effective health promotion requires partnerships between health professionals, families, educators, and government, business, and community leaders. 

## Improve the health and physical status of infants, children, and adolescents
Establish health supervision guidelines focusing on physical activity

**Establish health supervision guidelines focusing on physical activity**

**Vision and Goals: Bright Futures in Practice: Physical Activity**

## How the Guide Can Be Used

**Clinical **
**Community**
**Policy**
**Education and Training**

## How the Guide Can Be Used: Clinical

**Incorporate into each health supervision visit**
**Develop and evaluate physical activity programs**
**Implement standards of practice and protocol**
**Educate children, adolescents, and their families**
**                                    ****	**

## How the Guide Can Be Used: Community

**Provide anticipatory guidance to families on developmentally appropriate physical activity**
**Develop physical activity programs **
**Help schools incorporate physical activity education into health curricula**
**Implement standards of practice and protocol****	****                                    ****	**

## How the Guide Can Be Used: Policy

**Provide information to policymakers, program administrators, and community leaders on relevant physical activity issues and concerns**
**Obtain support for physical activity policies and programs**

## How the Guide Can Be Used: Education and Training

**Educate and train health professionals and paraprofessionals**
**Provide in-service education and training to staff**
**Use as a textbook or reference**
**                                    ****	**

## Four Major Developmental Stages

- Infancy
- 0–11 Months

- Early Childhood
- 1–4 Years

- Middle Childhood  5–10 Years

- Adolescence
- 11–21 Years

**Notes:**
The Bright Futures guidelines offer strategies to promote healthy behaviors, reduce morbidity and mortality, and improve health outcomes.  They address the physical, mental, cognitive, and social development and well-being of children throughout infancy, early childhood, middle childhood, and adolescence.

## Asthma
Children and adolescents with special health care needs
Eating Disorders
Diabetes
Girls and Female Adolescents in Physical Activity
Ergogenic aids
Heat-related illness
Injury
Obesity	

**Children and adolescents with special health care needs**
**Eating Disorders**
**Diabetes**
**Girls and Female Adolescents in Physical Activity**
**Ergogenic aids**
**Heat-related illness**
**Injury**
**Obesity****	**

**Physical Activity Issues and Concerns Chapters**

## Motor Skills Development During Middle Childhood-p.58

| Age | Motor skills being developed | Appropriate activities |
| --- | --- | --- |
| 5-6 | Fundamentals (e.g., running, galloping jumping, hopping, skipping, throwing, catching, kicking | Activities that focus on having fun and developing motor skills rather than competition
 Simple activities that require little instruction
Repetitive activities that do not require complex motor and cognitive skills (e.g., running, swimming, tumbling)
 |
|  |  |  |

## Motor Skills Development During Middle Childhood-p.58

| Age | Motor skills being developed | Appropriate activities |
| --- | --- | --- |
| 7-9  | Fundamentals
Transitional (e.g.                       throwing for accuracy) | Activities with flexible rules
Activities that do not require complex motor and cognitive skills (e.g., entry-level baseball)
Activities that require little instruction
 |
|  |  |  |

## Motor Skills Development During Middle Childhood-p.58

| Age | Motor skills being developed | Appropriate activities |
| --- | --- | --- |
| 10-11 | Transitional
Complex (e.g., playing basketball) | Activities that focus on having fun and developing motor skills 
Activities that require entry-level complex motor and cognitive skills
Activities that continue to emphasize motor skill development but that begin to incorporate instruction on strategy and teamwork |
|  |  |  |

## Interview Questions (p55-56)

**Are there any physical activities you enjoy but don’t participate in? If so, which ones? Why?**
**Do you feel that you are good at physical activities you enjoy? If so, which ones? Why?**
**Do you think you are in good shape?**
**How much time each day do you spend each day watching TV?**

## Overweight Screening Procedure  (171)

**BMI**

**Overweight**
**BMI > 95****th****%**

**At risk for overweight**
**BMI >85****th**** < 95****th**** %**

**Not at risk for overweight**
**BMI <85th**

**In-depth medical assessment**

**Screening**

**Return next yr.**

## Treatment- p.172

**Treat uncomplicated obesity with:**
**Achieving healthy eating behaviors**
**Participating in regular physical activity **
**Achieve psychological well being**

## Physical Activity Counseling (page 173)

**Begin intervention early**
**Recommend that parents focus on gradually changing the entire family’s eating and physical activity behaviors**
**Encourage children and adolescents to participate in physical activities they enjoy**
**Encourage children and adolescent to reduce sedentary behaviors (e.g., watching TV, playing computer games)**

## Frequently Asked Questions (175)

** ****How can I encourage my son to be more physically active?**
**Encourage spur-of-the-moment physical activity**
**Participate in physical activity together- biking, hiking, skating**
**Involve child in family chores- raking, walking the dog**

## Appropriate Physical Activity for Children (187)

**Guidelines- Elementary: **
**30-60 minutes of age and developmentally appropriate physical activity from a variety of physical activities on all, or most days. **
**Some of the child’s activity each day should be in periods lasting 10-15 minutes**

## The Stages of Change ( pg 182-186)	

**Precomptemplation -  unaware**
**Contemplation – good intentions**
**Preparation – getting ready**
**Action – is involved in PA**
**Maintenance – PA > 6 months**** **

## PrecontemplationKey Concepts

**Identify the benefits of physical      activity**
**Explain the benefits relevant to your patient**
**Recommend that your patient consider starting some type of  activity**

## Counseling Statements for the Precomptemplator 

**“****Jane, being more physically active is one of the most important things you can do to stay healthy, both physically and mentally.”**** **
**“****Jane by starting something as easy as walking with your friends, it could help you maintain a healthier weight and feel more energetic. **

## Contemplator and Preparation PhasesKey Concepts

**Identify benefits of physical activity**** **
**Help your patient chose appropriate physical activities**** **
**Identify barriers to physical activity**** **
**Evaluate your patient’s confidence in their ability to make the change**

## Identify benefits of physical activity

**“ ****What do you hope to gain?”**** **** **
**“**** ****If active before, what did you like or enjoy? Why did you stop? **** **

## Help your patient choose appropriate physical activities

**“ ****Jane, what types of physical activities do you enjoy”?**** **
**“****Are there any activities you have enjoyed in the past?”**** **
**“****Do you participate in physical activities at school?  With your family?”**** **

## Identify barriers to physical activity

**“****If you were active before, why did you quit?”**** **
**“ ****Do you feel that you are good at physical activities?**** **
**“****Is your neighborhood safe for walking/ jogging?”**** **

## Evaluate your patient’s confidence 

**“****Jane, on a scale of 1 to 5 how confident are you that you****will start this physical activity plan?”**** **
**  ****If low, ask why, problem solve and revise plan if needed**

## Action and Maintenance Phases  

**Key Concepts**** **
**Praise the adolescent for being physically active**** **
**Help the adolescent remain physically active**
**Help the adolescent identify social support**
**Help the adolescent assess confidence in remaining active**** **

## Praise the Adolescent’s Successful Activity

**“****Jane, I am really pleased that you have started walking to school. I bet you feel more energetic and you have lost 3 pounds since your last visit.”**

## Help the adolescent remain physically active

**“****Jane, I think walking to school is a great start. Have you thought about what you could do on the weekends that is fun and physically active?”**** **
**“****What activity  have you thought about doing this summer since you will not be walking to school each day?”**

## Help the adolescent identify social support 

**“****Jane, do you have a friend that can walk or do other physical activities with you. It is always easier and more fun to do things with your friends” **
**“****Are other family members supportive of your choice to be more active? What do your parents do that is physically active?”**** **

## Assess adolescent’s confidence

**“****Jane, on a scale of 1 to 5 how confident are you that you will continue regular physical activity over the next three months?”**** ****If low, ask why and problem solve with the child/adolescent**

## Counseling Parents

**Review the child/adolescent’s plan for increasing her physical activity**** **
**Provide positive reinforcement for any small improvement**** **
**Be a positive role model**
**Participate in physical activity with your daughter**
**Provide healthy choices for snacks**

## Features of excellent coaching (pg 196) 

**Makes the sport/activity fun**** **
**Improves existing skills & teaches new ones**** **
**Helps the adolescent feel successful**** **
**Uses a positive style of interaction**** **
**Recognizes & avoids competitive stress**
**Avoids overemphasis on competition’s outcome**

## Physical Activity Resources- p. 198

**For health providers there are over 100 web sites in different areas of physical activity.  Such as**
**American College of Sports Medicine**
**National Association for Health and Fitness**
**YMCA**
**Rails to Trails Conservancy**
**Shape Up America!**
**President’s Council on Physical Fitness and Sports**

## In Summary 

**Health professionals are one part of our country’s efforts to encourage children and adolescents to adopt a physically active lifestyle. **** **
**Bright Futures in Practice: ****Physical  Activity, can enhance health professional’s ability to deliver this important message in a more knowledgeable, effective and developmentally appropriate fashion.**

## Bright Futures In Practice Physical Activity

**Disease specific recommendations for activity **
**Strategies for effective behavioral change counseling**
**Advocating for the promotion of physical activity in clinics, schools, and within communities.**** **

## Bright Futures In Practice Physical Activity

**A user-friendly source of practical information for the promotion**** of physical activity covering:**
**Benefits of Physical Activity**
**Assessment of Physical Activity**
**Developmentally Appropriate Activity Recommendations **
**Common problems/ issues related to physical activity**

## To order additional materials and to find out more about Bright Futures, contact:

**Bright Futures Project**
**National Center for Education in **
**    ****Maternal and Child Health**
**Georgetown University**
**2000 15th Street, North, Suite 701**
**Arlington, VA 22201-2617**
**Tel: (703) 524-7802**
**Fax: (703) 524-9335**
**E-mail: BrightFutures@ncemch.org**
**Bright Futures Web site: www.brightfutures.org****	**

**Notes:**
The Bright Futures project staff at the National Center for Education in Maternal and Child Health supports state and community Bright Futures programs and initiatives, and can offer coordination, networking, and technical assistance. The National Center is supported by the U.S. Department of Health and Human Services through the Health Resources and Services Administration’s Maternal and Child Health Bureau.
It is our hope that the Bright Futures materials will help integrate current content and practice into programs and services to improve the health status of all infants, children, and adolescents.
Thank you!

**	****Permission must be requested in writing from the National Center for Education in Maternal and Child Health before using any slides contained in this presentation**