AAP Issues recommendations for promoting physical activity

The American Academy of Pediatrics has issued recommendations on encouraging physical activity during clinic visits.

Strong evidence shows that physical activity improves body composition, decreases cardiovascular disease risk and is a preferred treatment for fatty liver disease and prediabetes. Additionally, research shows benefits in children with ADHD and depression.

The new AAP clinical report aims to give clinicians guidance to help patients achieve physical activity levels for improved health.

The report and recommendations, aimed at meeting the 2018 Physical Activity Guidelines for Americans with title Physical Activity Assessment and Counseling in Pediatric Clinical Settings from the Council on Sports Medicine and Fitness and Section on Obesity are published in Paediatrics.

Major highlights for clinicians include-

• Assess and document gross motor skill development, physical literacy and physical activity levels at all health supervision visits, with early referral to assess and treat identified delays or deficits. If children are insufficiently active, help identify barriers and strategies to help overcome barriers using tools such as motivational interviewing.
• Pay particular attention to physical activity assessment and counselling for children most at risk of inactivity or likely to face barriers to activity, including children of minority, urban or rural status, adolescent girls, and children and youths with special health care needs.
• Evaluate gross motor skills, "physical literacy", and activity levels at each well visit. (Physical literacy is defined as "the ability, confidence, and desire to be physically active for life.") Adding a physical activity vital sign to the electronic health record may be helpful.
• For children who aren't active enough, seek out why and use behavioural techniques (e.g., motivational interviewing) to help them and their caregivers decide on realistic strategies for increasing activity.
• Consider physical activity prescriptions for those with barriers to exercise. Youth with special healthcare needs, minority children, those in urban or rural settings, and adolescent girls may be at increased risk for low activity.
• Paediatricians often advise children and families to aim for 60 minutes of physical activity each day. The new report encourages paediatricians to further promote physical literacy and activity in children in one or more of the following ways:

• Provide children with a physical activity prescription. Coordinate recommendations with specialists as indicated for children and youths with special needs. Clearly document the prescription so other providers, therapists, caretakers and parents can help implement it.
• Discuss the benefits of physical activity on physical and mental health and social growth and development at well-child and sick visits.
• Model and encourage parents to model a physically active lifestyle.
• Provide tools and resources to help families build skills and take advantage of community-based activity resources.
• Advocate for increased access to physical activity opportunities for children at child care and preschool, school, home, in the community and anywhere kids live, learn and play.
• Advocate for inclusion of validated activity assessment measures in electronic health records and fair payment for their administration.

Work with medical schools, residency programs and health care institutions to increase training in physical activity assessment and exercise prescription.

The guidance has outlined numerous activity recommendations and screening and counselling strategies.

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Paediatrics article