Our Inactive Children – PediaCast 575

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Show Notes

Description

Dr Jim MacDonald, Dr Eileen Africa, and Travis Gallagher visit the studio as we consider the epidemic of inactivity in children and teenagers everywhere. Tune in as we explore causes, impacts, and solutions that can bring lasting change. We hope you can join us!

Topics

Our Inactive Children
Physical Fitness
Physical Literacy
Kinderkinetics
Play Strong

Guests

Dr Jim MacDonald
Sports Medicine
Nationwide Children’s Hospital

Dr Eileen Africa
Fulbright Visiting Scholar
Stellenbosch University

Travis Gallagher
Certified Athletic Trainer
Nationwide Children’s Hospital

Links

Sports Medicine at Nationwide Children’s Hospital
Play Strong at Nationwide Children’s
Stellenbosch Kinderkinetics
Stellenbosch Kinderkinetics – Meet the Team
Physical Fitness and Resistance Training – PediaCast 212

Episode Transcript

[Dr Mike Patrick]
This episode of PediaCast is brought to you by Sports Medicine at Nationwide Children's Hospital. 

Hello, everyone, and welcome once again to PediaCast. We are a pediatric podcast for moms and dads.

This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 575.

We're calling this one Our Inactive Children. I want to welcome all of you to the program. So, we have an important topic for you this week, and it is one that impacts the health of all children and their families in the United States and really all around the world.

Activity levels have plummeted over recent years for children, teenagers, and let's not kid ourselves, also adults. And this inactivity has a profound impact on the health and well-being of all of us. So today we are going to dive into the problem of inactivity.

What factors have led to this issue? Why is activity important? How exactly does inactivity impact our health?

What can we do about it? And how can we accomplish lasting change? Also, how can we support one another in our journey toward a healthy, more active lifestyle?

In our usual PediaCast fashion, we have a terrific panel of guests joining us for the conversation. Dr. Jim MacDonald is a sports medicine physician at Nationwide Children's Hospital. Dr. Eileen Afrika is a Fulbright Visiting Scholar from Stellenbosch University in South Africa. She's done a lot of work looking into inactivity and particularly how can we get kids and teenagers to be more active and how does that impact their health? Also, we have Travis Gallagher. He is an athletic trainer from Nationwide Children's Hospital.

Before we get to them, I do want to remind you that the information presented in our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you're concerned about your child's health, be sure to call your healthcare provider.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org. So, let's take a quick break. We'll get our guests settled into the studio and then we will be back to talk about our inactive children.

That's coming up right after this. Dr. Jim MacDonald is a sports medicine physician at Nationwide Children's Hospital and a professor of pediatrics at The Ohio State University College of Medicine. Dr. Eileen Afrika is an associate professor of medicine and health sciences at Stellenbosch University in South Africa and a Fulbright Visiting Scholar at The Ohio State University and Nationwide Children's Travis Gallagher is operations manager of sports medicine at Nationwide Children's and a certified athletic trainer in our sports medicine program. All three have a passion for supporting not only student athletes and their families, but all children as we consider the importance of physical activity and the impact of inactivity on our children's health and really on our health as well as we shall soon see. Before we get into that conversation, let's offer a warm PediaCast welcome to our guests, Dr. Jim MacDonald, Dr. Eileen Afrika, and Travis Gallagher. Thank you all so much for visiting us today.

[Dr Jim MacDonald]
Thanks very much, Dr. Mike. Really good to be here again.

[Dr Eileen Africa]
Thank you, Dr. Mike. It's lovely to be here. Thank you for having me.

[Travis Gallagher]
Yeah, it's really our pleasure. We're a big fan of the show and thrilled to be back.

[Dr Mike Patrick]
Yeah, and we are thrilled to have all of you. I'm going to start with Jim and Eileen. If you could just give us an idea of what the global trends in physical inactivity are and how do they compare to local trends in both the United States and South Africa?

So, Jim, why don't you go first, talk about the U.S. and then Eileen.

[Dr Jim MacDonald]
All right. Well, I'm really looking forward to Eileen's answer as our distinguished scholar from overseas, but the trends are poor in the United States, and I'll obviously let Dr. Afrika talk about South Africa specifically, but across the globe, the trends are poor. And this may not be headline news for your listeners, it's probably at least understood, but what I'm talking about is study after study, whether you're looking at how many pull-ups kids can do at age 10, how fast can they run a mile at age 14, what is their grip strength at age four, universally, not unique to the United States, these trends are going down.

So, our kids are getting less active, less strong, and less able to do fundamental movement skills that are associated with play, like running, jumping, skipping, etc. So, it's not good.

[Dr Mike Patrick]
And Eileen, what then is the situation in South Africa, because this is not a problem that is just unique to the United States, correct?

[Dr Eileen Africa]
Yeah, this is definitely. So, physical inactivity is a huge concern worldwide, and it contributes to almost 5 million deaths yearly. And I think what is more alarming is that almost 80% of teenagers are not physically active enough.

And that is according to the World Health Organization's recommendations of 60 minutes per day. And that is not a lot. I mean, 60 minutes per day throughout the day in short bursts is not a lot.

And obviously, when I look at South Africa, it's a low-income country. South Africa has seen slightly higher physical activity levels, but that is due to active transportation, like kids are still walking to school. But if you look at the lack of infrastructure, and the lack of resources, and just overall safety in South Africa, physical inactivity is increasing.

[Dr Mike Patrick]
Yeah. And this is really something that's important to address. As you mentioned, millions of deaths attributed to decreased activity in individuals.

But in addition to deaths, there's a lot of other impact that physical inactivity can have. Why is it important to address this issue?

[Dr Eileen Africa]
So, it is incredibly important to look at globally, but also locally, because it has such an impact on not only the individual's health, but also the broader societal and economic well-being of a community or a country. So, addressing physical inactivity at both levels require a shared effort from individuals making the slightest changes in their lifestyles, or policymakers or government creating environments that make movement accessible and enjoyable for everyone. So, I think that is the challenge that we have in lower income countries, is the spaces and the actual investment in physical activity.

It's really non-existent.

[Dr Mike Patrick]
Yeah. We talk about the physical effects of inactivity, such as obesity, type 2 diabetes. I think that the audience out there is probably very aware of those associations.

But the inactivity also has an impact on our mental health, on academic performance. I mean, it really goes above and beyond just the physical effects, right?

[Dr Eileen Africa]
Yes, definitely. I mean, essentially, when you are physically active, you perform better academically, and you can concentrate in class, and you can actually sit and listen to what the teacher is saying.

[Dr Mike Patrick]
Yeah. Yeah. And Travis, I want to pull you in.

How does screen time, you know, we hear a lot about, oh, our kids are spending too much time on the screen. Is that really something that has impacted physical activity? And what can we do about that?

[Travis Gallagher]
Well, first, let's recognize that screens are fun. Screens are built to be addictive, and they're incredibly good at doing so. But the key is to find that balance.

And so, like, screens are okay, and screens can actually be helpful in getting kids to be physically active, whether it be activity games, such as the Wii and PlayStation has an active, or Pokémon Go on their phones. But it's finding that balance, and it's probably easier to increase physical activity than to try to decrease screens. The more active you are, then you will naturally have less screens.

But if you would just try to attack the screens, it's going to be a huge battle, and you're probably not going to be successful. Yeah.

[Dr Mike Patrick]
I really like that idea, that we can perhaps use screens to encourage kids to be more active. I hate to say it's kind of like throwing in the towel, but a little bit it is. But at the same time, the consequence of saying, okay, let's decrease screen time, but then physical activity is not really replacing it because there's not motivation.

But if we can motivate kids through the screen in some way, again, through active video games, through a lot more opportunities to have guided exercises, yoga, we can walk and listen to something as long as we're paying attention to the roads and what's around us. So, we really can use technology to encourage physical activity since it's something that kids and adults love so much. Travis?

[Travis Gallagher]
Yeah. The kids are on YouTube, they're on TikTok, and there's a bunch of different ways to be active on those mediums and on those channels. So, bringing the activity to them where they already are could be another way to accomplish that.

[Dr Jim MacDonald]
Yeah. May I interject and add what Travis is saying and jump the gun a little bit, Dr. Mike, because you may have this coming. Travis just used that phrase, you know, we need to meet people where they are, and that's whether it's adults or whether it's children.

And, you know, I would tell you maybe even already some listeners are like, yeah, yeah, I know my child needs to be more physically active, physical activity, physical activity. But what I hope to accomplish in this PediaCast is some sense of the nuance of that, of the nuance of the importance of that, but also that especially doctors, pediatricians, anybody like that listening to this, we need to be prescriptive in a positive sense. Nobody, Dr. Mike, when you see someone in the emergency room, you don't just give amoxicillin, you're going to give amoxicillin, 250 milligrams, QID, etc. For far too long, pediatricians like me have just said, get more active, get more active. We need the challenges families face, whether it's, I mean, a low-income, low-resource place like Dr. Africa's, to my kids always in front of screens. We've got to find ways to engage with people where they are to get people more active.

And it doesn't have to be a zero-sum game. I think you guys both touched on that in a really nice way there.

[Dr Mike Patrick]
Dr. Africa, what about in low-income places where there may not be that technology to encourage kids, to motivate them to be more active? How can we provide opportunity for all kids to be active regardless of their income level?

[Dr Eileen Africa]
So that is a loaded question. I think the first really important thing is that we need to think about is that sedentary behavior isn't just a personal choice sometimes. It's shaped by a lack of opportunities or to get people active.

And in South Africa, safety is a major concern. So, it is a big limiting factor. And communities where crime rates are extremely high, it isn't possible for kids to play outside or to even be active.

And then in some cases, screen time replaces active play. So, I agree with what Dr. MacDonald and Trevor said about using activities that are available for them. But that's a minority, especially in South Africa.

Low-income families often don't have access to affordable sport programs or gym memberships or even the basic equipment like sports shoes or bicycles. And so, when physical activity becomes a privilege rather than a norm, sedentary lifestyles increase. And that is what we see in the lower-income communities and countries.

And I think another limit is the fact that there's no investment in community sports or physical activity programs for all. So, the government, they don't invest in, they don't spend money, they don't make funding available. And I think the last thing that I want to add is that I know that in the US that you have parks, and you have community centers where kids can become active and can do activities.

We don't have that, unfortunately. And what I've seen is the limited inclusivity where most programs fail to include children with special needs is also very sad. So, to answer your question, I don't think there's an answer yet.

I think the main thing is that government needs to come to the party. So that's the only way that we're going to get funding so that we can make these opportunities available for all kids.

[Dr Mike Patrick]
You mentioned it may be that kids live in a dangerous neighborhood and not only is there a lack of opportunity like in parks and programs, but it may be dangerous for them to even go outside and play at all. What sort of things can they do in the home, like if that's legitimately a concern? How can they stay active but also stay safe?

[Dr Eileen Africa]
So, what we've started is to educate teachers. And so, we work through schools to educate them and to show them some activities that they can do in their homes, in smaller spaces. We've brought to some of the schools active brain breaks, which is short bursts of activities that kids can do, and just to give them that love for movement and physical activity.

So those are some of the things that they can do at home, inside, and they don't have to go outside.

[Dr Mike Patrick]
And that's a great place to get that information out there. In that situation, kids may take things that they're learning at school as ways to be active, taking that home, and then inspiring hopefully their parents to increase their activity level as well. But the reverse also has to be true in that parents are influencing their kids to increase their activity level.

So, Travis, how can parents best encourage their kids to be active?

[Travis Gallagher]
Well, you said the first part, encourage their kids. So, if a child is more likely to be active, if the parent is encouraging them to be active. And if we just use the example of getting outside and free play.

If the parent asks the kid or tells the kid to go outside, they're more likely to do so than if the parent didn't say anything. If the parent actually goes outside with them, even if they're outside on the porch, on the steps, on their phone, the kid is even more likely to be active outside. And then the ultimate is if the parent themselves is active, either with the child or even in a role modeling situation, the parent is active, the kid is more likely to follow that path.

So, if we, you know, with sensitivity to the economic issues discussed earlier, you know, the parents are the ones that are providing the resources to get kids active. They have to be the ones who sign them up and get them to the activity if it's not the backyard and give them the resources they need to be active. So, it's really in the parent's hands, especially the younger ages, but even going up through my middle school child would not be active in his sports and other activities if we weren't the ones bringing them there and signing them up.

[Dr Mike Patrick]
Yeah, yeah. So really parents need to encourage their kids, give, you know, to the best of their ability, share the resources that would, that the kids need to be active. But there also are great things that you can do in the home as a family, like a dance party, you know, every, every couple of days, you know, put a couple of songs on and everybody dance or go up and down the stairs until you're a little out of breath and do that every day.

And maybe try to, you know, from week to week beat how many times you can do it, you know, all kinds of creative things that you can do at home, but it does take actually being intentional and thinking about those things. And then implementing them and that's going to improve your child's health, but also as parents, it'll improve our health as well. Jim, I wanted to talk a little bit more about the impact that inactivity has on childhood obesity, because we know that obesity is an issue here in the United States.

How can we improve that and kind of turn it around?

[Dr Jim MacDonald]
So, my thoughts kind of go like this. It is, it is such a figuratively large problem, childhood obesity now, with so many ripple effects throughout a young person's life that, you know, the way I think about it is that just like obesity is a complex syndrome, it's going to require a multi-prong approach when the child is already obese. So physical activity becomes a major piece, especially of weight management, and then also of mitigating some of the risks attended on obesity, even before you see the child lose weight.

So, what do I mean by that? Many studies have shown, and one thing I try to encourage a lot of my especially obese youngsters is, they're not going to feel good doing cardio, they're not going to feel good running. They're also, quite frankly, especially when they're adolescent, they're not going to feel good about how they look and how they might be teased.

But they can probably rock it in the weight room. And if a child like that does resistance training, and if I go again, well, maybe not even, they don't have access to weight room. Well, then they've got a floor where they can do things like push-ups and planks, etc.

Once they start getting even a little bit more muscle mass, you start seeing improved insulin sensitivity, improved measures in glucose, decreased risks of type 2 diabetes, decreased risks of hepatic steatosis, fatty liver. And so, my point being is, physical activity is a major, major player in the prevention of childhood obesity. Once the child is already obese, there's no way around the nutrition piece.

And in the modern world, especially in the United States, again, this well-resourced versus probably South Africa, the new GLP-1 medicines, there's no doubt those are being used, right? And if you have a child who's like 99.999 percentile obesity, just telling them to be active won't solve it. But once they start losing weight and they need to maintain that weight loss, physical activity is key.

And if they want some health measures improved, blood pressure is another one. Even before they have that weight loss, physical activity is where it's at.

[Dr Mike Patrick]
And I think you make a really great point that once you are in that obese range, being physically active is going to be more work. But it is work that pays off if you stick with it. And we also know that childhood obesity often leads to lifelong chronic health issues.

So, like, if you can turn that bus around early, you can really impact their life for many, many years down the road.

[Dr Jim MacDonald]
There's something you said I want to just follow up on that I've, you know, triggered. So, yes, like that idea of when a child is obese, they're moving a lot of weight around. They actually have oftentimes a really decent amount of muscle mass.

You now give them a GLP-1 inhibitor. What we're finding is, sure, people lose weight. They also lose lean muscle mass.

That's a problem. In other words, again, if I have a child who's obese and they're getting meds and their nutrition and they're losing weight and people are high fiving us, each other, but they haven't started the physical activity piece, major problem, major problem.

[Dr Mike Patrick]
Yeah. Because once you lose that muscle mass from your medicine, that then it becomes even more difficult to be active.

[Dr Jim MacDonald]
Yeah. And it gets to something we wanted to talk about. There's this, there's this nexus of, you know, most of the time, again, I think in America, we focus on, like, physical activity and, like, hey, what's my heart rate, resting heart rate, you know, how much, you know, like, how, like, many hours of, like, you know, running or, you know, vigorous physical activity that I did, which is important, but we neglect the strength piece.

And I know you're going to talk to us a little bit about physical literacy, just the movement of our body, the ability to move. So, if you have that obese person and now, they've lost strength, once they get a little bit lighter, and they may not even have the skills as well, the physical literacy skills, they're going to remain potentially inactive, though lighter. That doesn't change very much the life, the long-term effects of high blood pressure, stroke, you know, MIs, et cetera.

So, physical activity is core to the prevention and the treatment, no question.

[Dr Mike Patrick]
So, the medicines that decrease our appetite so that we eat less and then we lose weight, because our body starts to metabolize our fat and our muscle too, that can, if you're not combining physical activity and strength training with those kind of medicines, as soon as you stop the medicine, one, you're going to gain weight again, because you're not, your appetite's not going to be suppressed, and more than likely, that weight gain is going to be fat, not muscle, because you're not moving, and now you're worse off than you were to begin with, and that's why really long-term changes in our nutrition, our diet, our activity level, is really where it's at in terms of long-term change. Am I overstating that?

I don't think so. We also, sometimes I've heard the term vicious cycle with regard to inactivity, but what is that?

[Dr Jim MacDonald]
Again, let me address this from, I've already used the phrase, but it's a passion of mine, as it is of Dr. Afrika's and Travis, this idea of physical literacy. So, when starting really young, if a child is not active, they're also not necessarily learning the grammar of being active. What I mean by that is, if they tend to be on the couch playing with an iPhone, the way even like two-year-olds are now, not crawling, not wrestling with their brothers and sisters, maybe not trying to climb things, they don't then have the upper body strength to do things, they then, once they start getting a little older, where they might play with their friends, throw a ball, catch, skip, they're not good at those things. They don't do those things. For that matter, they even get injured doing those things.

And so, they'll be regulating themselves to do less activity, maybe less play, less chance of getting injured, less chance of demonstrating how poor I throw a ball, and they're more comfortable continuously sitting and doing sedentary activity. And that's the vicious cycle, like the tendency toward less activity, less play creates a milieu, so to speak, of more of that over time. And that's not a good cycle.

[Travis Gallagher]
Yeah, Travis. Yeah. And then, you know, inactive children create inactive teenagers, create inactive young adults and inactive adults, and then that, as we talked about before, they influence their kids.

And if you are an inactive adult, you're more likely to have an active child. So, that's another cycle of inactivity.

[Dr Mike Patrick]
Yeah. So, where does physical literacy and that vicious cycle kind of intersect? Like, how does physical literacy sort of break that cycle?

[Dr Jim MacDonald]
Again, it's almost like you can think of a pyramid. There's, you know, physical activity usually measured in, are they vigorous or moderate physical activity, which we could get into the weeds of what physiologically that means. But that's basically, my child is running around, or they're climbing on something, or they're throwing a ball back and forth with their friends, maybe they're even just walking to school.

So, there's physical activity, then there's the strength to do certain things, that's another part of the pyramid. And then there's the literacy. So, the way I think about it is physical literacy is very much like our verbal literacy.

Like, how did every one of us learn the English that we're now speaking now? Well, we were exposed to it from our parents, we gained some skills, then we go to school and intentionally learn a grammar and then use it. And then potentially over life, we do even more work in it, right?

And get on podcasts and Dr. Mike, your English is outstanding because you've interviewed for thousands of hours people, right? So, if physical literacy is very similar, like we're born to move, children will move from crawling to toddling to walking. But if, for instance, they're told to sleep on their backs, prevent SIDS, but then parents don't give them tummy time, now kids aren't developing upper body strength to push up, neck strength and control because they're on their tummies.

Once they start toddling, then they are less apt to climb, they don't have the strength, they're more apt to get injured. They may like trip and now can't break a fall, they get injured playing, oh my gosh, no, that's really dangerous, I don't want to do that. Or I can't climb, I don't want to do that.

And that's the piece that, and Eileen alludes to it, maybe it's still happening in South Africa. In America, we could usually a generation ago at least rely on, by the time they got to school, there was an intentional thing called PE, where we learned, we actually practiced the grammar of being physically active. I know some kids hated it, but we practiced the grammar of a push-up, a sit-up, you know, volleyball, playing things, tag.

We don't do that anymore. And we don't, we certainly don't allow our children a lot of free play to try to learn it on their own. And we think we solved the problem with sports, but I got to be honest with you, that is no panacea, and I can go down that rabbit hole at any point.

But I think that the thing I'd want to leave some listeners to is, if I make it really quick, all the listeners here know, I just got off of knee surgery, I've been on crutches for like six weeks. I had no problems with crutches. That's not a pat on my back.

What I'm trying to say is, I see plenty of my 16-year-old like lacrosse players with a knee injury, they cannot figure out how to use a crutch. They do not have the upper body strength or the physical literacy to be in crutches, and some of them wind up in a wheelchair. And they're 16 years old and supposedly strong and playing sports, but they don't have the literacy, they don't have the strength to pull that off.

That's a tragedy, I think. That's saying something.

[Dr Mike Patrick]
Yeah, yeah. So, as we think about physical literacy, it's really an awareness of the importance that being active has for us as human beings. And that vicious cycle is that, well, when we try to be active, we try to do the right thing, and we get injured, or it hurts, or it's just we can't find the time to do it, then that makes us weaker and makes it even harder to be active.

And so that's that vicious cycle. But if we could just understand how important it is through physical literacy, which I would suppose is a subset of health literacy, then maybe we would be more motivated to actually be more active and understand that it may be uncomfortable at first as we're building new muscle. And we may get injured a little bit, especially if we're not doing things slowly, edging up.

Some people, I would imagine, want to just go right into it and then hurt themselves by overdoing it. But we want to be smart all around with physical literacy. Now, is there research to show that improved physical literacy can break that vicious cycle?

[Dr Jim MacDonald]
Yeah. So, forgive me, there's, where there's, sorry if I interrupted anybody, there is research that, like, at least they're aware of the research that shows the more physically literate the child that can, so, if, in Travis and Aline's world, they can be broken down to very specific things, like, how do they perform on the functional movement skills test? That's things like, how well do they squat?

Can they balance in a side plank? They're very, very specific. It can be really broken down grammatically, like, is that a participle or is that a past pluperfect that you use, Dr. Mike?

But the idea would just be that the more literate children, I can throw a ball, like, with good mechanics. I can skip. I know how to skip.

Or the, like, very specific skills, they will tend to have better strength. Like, as a general measure, there's this thing called grips, normalized grip strength, which is basically based on your age and your weight. How strong can you grip something?

There are plenty of studies that show the more literate a child is physically, the greater their hand grip strength is. That's a surrogate measure for overall strength, and the more active they are. So, I don't know if there's a literature, like, I have just identified somebody who's very physically illiterate at, so to speak, at age 12, and right then I'm going to teach them spend time jumping rope.

Like, aside from just the cardiorespiratory benefit of jumping rope at that moment, I don't know about it as a direct intervention, but again, as a prevention. Teaching our children these skills over the course of their life, there is absolutely literature that demonstrates that benefit. Yeah.

[Dr Mike Patrick]
And this may be something for folks who are in academic medicine, in sports medicine, in primary care, in orthopedics. It may be worthwhile to have a study that actually shows we're going to increase physical literacy and then longitudinally follow these kids and see if it makes a difference in their long-term health. And then something like that, having data to show that this is worthwhile, maybe that would help bring phys ed back into schools and to have, you know, particular programs that say, hey, this really is a worthwhile thing that governments should be spending money and time on.

[Dr Jim MacDonald]
Yeah, I think so. I mean, I think that it's your point. I think there are, this is that classic, it's correlation, is it correlation or causation?

But at the same time that PE has been, PE rates in schools across at least the United States have declined dramatically, inactivity, sedentary lifestyle, obesity has gone up. So that is something of a correlation causation. I think the people who live in this world and are on the, you know, front line, so to speak, are quite convinced that the substitution of like STEM courses for PE is a short-sighted thing.

And that PE is the ideal place for children to learn these skills for a lifetime of movement, just like we need a lifetime of our English skills. But yeah, to your point, that is more of just like an ecological, like epidemiological kind of assessment than a straight up randomized controlled trial kind of thing.

[Dr Mike Patrick]
Yeah, yeah. As we think about physical literacy, one of the things that kids learned in PE class when it was, you know, something that they did sometimes daily as, you know, one hour at school every day, and certainly during recess as well, that there are different types of physical activity that kids learned about in those programs. And now parents may actually have to be the ones to make sure that their kids are getting those different types of physical activity.

Travis, what are those types, and what can parents do to ensure their kids are learning about being physically active and actually doing it?

[Travis Gallagher]
Yeah, I want to expand the idea of what physical activity is as parents listening to this, or maybe even kids listen to this, or they hear the message, they may be thinking old school activity, push-ups, sit-ups, jumping jacks. And I would challenge them that there are hundreds of ways to be physically active. And it's great to have a balance, but let's find what the kid likes, and let's go that route.

So, there could be sports, whether it be soccer or basketball. I'll throw rugby in there for Dr. Africa. It's much larger there than it is here.

Or just different activities, archery, bowling, different places to play, whether it be playgrounds at their school or the metro parks, or even in their backyard. Nature, going out on hikes, getting down in the creek and exploring. We're fortunate here in Columbus to have the metro parks that have free programming at every park every week of the year.

There are toys that encourage physical activity. There's a National Toy Hall of Fame, and there's sections in there that have toys that have stood the test of time to get kids physically active and moving. We mentioned before that their screens can be helpful in getting kids to move.

And then there's just importance of free play, and just, it's not as structured. It's just play and use your imagination. And every single one of those is physical activity and has benefits in different ways.

So, I would encourage just to find out what your child wants to do, or what they're willing to try, or even what their friends or cousins participate in, and then take that little seed of interest and nurture that to try to change their interest, their enjoyment, their habits, instead of trying to jump to, oh, well, the literature says you need to do this, this, and this at this intensity. Just start with something that they enjoy, and changing those habits will then lead to where you want to get to.

[Dr Mike Patrick]
And free play and just, you know, being outside in nature and moving, you know, kicking a ball back and forth, it doesn't necessarily have to be something that completely takes you out of breath. There's lots of different ways that you can get that activity, and it's not just with organized sports.

[Travis Gallagher]
Yeah. The phrase of, no matter how slow you're going, you're still going faster than the person on the couch, movement is good, and we'll take whatever we can get, and it will grow from there the more interest and habits you grow.

[Dr Mike Patrick]
Yeah, yeah. Aileen, is there research on looking at those different kinds of activities? So, you know, exercise, organized sports, unstructured playtime.

Is there anything to tell us, like, is one more important than the other? Are they all important in their own right?

[Dr Eileen Africa]
Good question. So, play is often described as the work of childhood, and if you look at research, and you look at studies that's been done, it supports the critical role of play in overall development of a child. So, studies show that unstructured active play helps kids develop their motor skills, just their overall development, but also it helps them to be creative, it helps them with problem-solving, it helps them with social skills just to interact with their peers.

But there is a difference between play and exercise. So, play is more your spontaneous, flexible, less structured, almost improvised activities, and it's so important for early childhood development. So, children explore the environment, they are born to move.

So, kids are not made to sit still for extended periods of time, and that is why play is so important. And I think another difference between play and exercise is play is through intrinsic motivation. So, the child wants to do it, where exercise is more intentional, it is focused, it focuses on specific skill development, and it focuses on fitness improvement, and it's typically planned by someone, and it's almost goal orientated.

So, you want to achieve a specific goal, but in saying that, the beautiful thing is play and exercise go hand in hand, and play-based activities or exercise or sport, like running and climbing and playing hide-and-seek and just playing normal childhood games, they all meet the criteria to be physically active and for children to feel that it's not a chore, it is fun, and it's natural, and it's something that they want to do.

[Dr Jim MacDonald]
Dr. Mike, can I interject something? Because I'd be remiss with work that Dr. Africa has done while here. This team you have on here, plus some others, are right now at the very beginning of some data analysis.

But if you can imagine real quickly, I think it was around 60, but kids were assigned to a play intervention in Nationwide Children's Play Strong program that Travis is intimately involved in. And then high-intensity interval training session hit, okay, right? And then they would cross over, and the different kids would be exposed to the other.

And the outcome measures included things like validated instruments looking at how much fun they had, perceived exertion, how hard they thought they were working. And I'm always going to get this wrong, but Travis will get it. It wasn't an accelerometer, but like a Fitbit.

But see, imagine the listener an objective measure of exactly how hard they were working. And what we're finding in our initial analysis we'll be publishing is that the play cohort perceived they were working less hard. Objectively, they were working harder.

They spent more time at the highest levels of physical activity than in the high-intensity interval training, and they had more fun. So, play was more fun, felt like less work, they worked harder. And like we're so excited to publish that, but like it's almost like intuitively obvious.

This is what your grandmother knew. Get outside and play, kids. Get out of here.

And we're going to be publishing on that. But the listeners, get your kids outside playing if it's safe and you can't wrong. Yeah.

[Dr Mike Patrick]
Like a game of tag, you know, kids can be running around the yard and out of breath and working, you know, working hard. That's going to be more fun and exciting than, you know, doing something on like a stationary bike, for example. And it's just.

[Dr Jim MacDonald]
And they'll go to your point, they'll go way beyond where, oh my God, I'm too tired, I'm going to stop. No, they're like, they're chasing Dr. Mike. They want to get Dr. Mike and tag him. Like they're not going to stop unless self-regulated, like this is too much. I got to stop. Yeah.

It's magic.

[Travis Gallagher]
Yeah. And it comes through in so many different lessons that we have in the Play Strong program, which we'll talk about later. But if I told the kids, all right, we're going to have you run back and forth in this gym about 80 times today.

No way. And if we start it, they will make it a quarter of the way before they're too tired. But you introduce some punch balloons that they are using to keep up in different games, then they want to stay after class because they want even more.

And it's the same activity. It's just you put a different spin on it, you add an element of fun and it changes everything.

[Dr Mike Patrick]
Yeah. Yeah. Aileen, there's a program in South Africa called Kinder Kinetics, which really does encourage movement and activity in kids to make it fun.

Tell us about that program.

[Dr Eileen Africa]
So Kinder Kinetics is an honors program. So, in South Africa, we don't, we have an undergraduate and then you have an honors before you can go on to doing a master's or PhD. So Kinder Kinetics is a specialized field that focuses on using movement and physical activity as a vehicle to promote optimal development in all kids.

And when I say all kids, I mean, including kids with special needs because they are often the kids that are left behind. So, the profession is rooted in the belief that movement is important and essential for kids' holistic development, for their physical, for their cognitive, emotional, and social development and growth. So essentially Kinder Kinetics bridges the gap between play, exercise, movement, and therapy.

And it focuses on the fun element, and we make sure that it's age-appropriate for the group or the individual. And it's also a program that's tailored to a specific individual.

[Dr Mike Patrick]
Is that something then that is required of all kids to do, or is it voluntary?

[Dr Eileen Africa]
So, it's, it's more like a therapy and it's a paid, a paid profession, obviously, but the work that we do at the university is mostly social impact. So, all the work that we do is community-based. We go out and we do activities and programs with the kids.

Within Kinder Kinetics at Stellenbosch, we have a program that's called Kids Move, and Kids Move is almost similar to Play Strong at Nationwide. So, Kids Move is the program, Kinder Kinetics is the profession.

[Dr Mike Patrick]
Okay, okay. That makes sense. So, you're really offering opportunity for kids to move, and Kinder Kinetics is one vehicle by which now you have professionals in how to improve physical literacy and how to get kids moving through a program that is voluntary but hopefully is out there.

Lots of word of mouth, awareness, so that hopefully lots of kids get involved with it. And then how does that compare with our Play Strong program? Tell us about that program, Travis, and what that's like for the kids who are participating.

[Travis Gallagher]
Yeah, Play Strong started about 12 years ago here at Children's, and it has been my passion ever since. It started off for cancer survivors who had the mindset to get back into play and sports, but their bodies weren't quite there. And it has now grown to any kid that needs to be more physically active.

We had providers all over the hospital saying, well, we have kids that need to move more, can we send them to you? And it just kind of grew organically. And really, our goal is to change the thoughts and the habits of these children.

Their thoughts towards physical activity and ideas to be active, and then to try to influence their habits. And we do this, we play a lot. We also do exercise.

We're also going to kick their butt and try to improve some of that functional movement abilities. We introduce them the different ways of being active, whether we play pickleball or kickball in our gym, or we go on a field trip to parkour the Metroparks, or we bring in a guest instructor like a yoga or a Zumba instructor because you don't want me teaching yoga or Zumba, it's not going to go well. So, we bring in the experts to help with that.

And we just, as I mentioned before, the key, we nurture their motivation, we try to make it fun and enjoyable. It's not a boot camp. One session of exercise does not override the overall feeling they get when they're there.

So, we let them play with their friends and giggle and talk, and they come out of here having sweated and having smiled, and that's really the key. And so, this changing of kids' habits to be physically active is a huge mountain to climb, and we are starting them on that path. We're giving them the tools to be active, we're giving them the motivation, we're giving them the roadmap, and then it's up to them to move forward with that.

And so, the logistics of the program, it's ages five and up, a referral from their physician, we bill insurance, it's twice a week for three months, and at the end of three months, we kick them out no matter where they are to try it on their own. If they need to come back, they can, but it's not the long-term answer of I'm just going to come there and exercise every week for three years. It is trying to change their habits.

We've received some funding through the foundation Eat, Learn, Play, which is Steph Curry and his wife, Aisha Curry, who you may know from the Warriors and Food Network, they believe in the Play Strong program, and it's given us funding that our kids get incentives for attending the program. So, if they want a soccer ball, they get a soccer ball. If they want a baseball mitt and a ball, they get that.

And when they graduate the program, they get a Play Scholarship, and we have kids picking up bicycles and just giving them what they need to keep going. And we're just running with that, and with their support, we're now developing a mobile app as well to just increase that engagement and get more touch points throughout the week and help to incentivize and gamify their activities.

[Dr Mike Patrick]
And we'll put a link in the show notes over at pdacast.org for this episode 575 to the Play Strong program so folks can learn more about it. And we have a lot of providers around Central Ohio who listen to this show, so you may have folks in your practice that you think could benefit from Play Strong, and so we'll have that link for you so you can find it and be able to make referrals if you need to. Eileen, in your research, you know, it seems like this, what Travis is talking about, building new activity habits is going to be really important for folks then to continue being active even after they may be done with a program.

What are some effective strategies for building new active habits?

[Dr Eileen Africa]
So, I think, like parents and the kids and families, start with realistic expectations. So, start small and then you build gradually. Even if you start with a 10-to-15-minute walk per day, that is enough.

And remember, and I think Travis mentioned it, kids learn by example. So, family activities are encouraged and those create the opportunities for movement. So, involve the whole family because then you have the increased accountability, and it can also be more fun if the whole family engages and participates.

So yeah, I mean, integrate movement and physical activity into your daily lives. Just a simple example, rather take the stairs and not the elevator. Those are the things that I think that you can incorporate.

It's not difficult, it's easy enough. And also remember that the goal isn't just to get the kids moving, but the goal is to help them develop a lifelong love for moving and for physical activity. So, we need to keep it fun and flexible and engaging and also create that positive relationship with physical activity and movement so that it can last well into adulthood.

[Dr Mike Patrick]
And I love that idea of getting the parents and the whole family involved, especially as an individual kid may go through a program like this. And then when they go home, sharing what they've learned and the activities that they're doing with their siblings and with their parents may also help the whole family to embark on these new habits.

[Dr Eileen Africa]
It's also not just about being the best in a particular sport or lifting the heaviest weights in the gym. It's about making movement natural. And it's about making physical activity fun and like an existing part of the everyday life.

[Travis Gallagher]
To put that into action, one of our lesson plans talk about scheduling a family activity night. And our lives are super busy, and it's packed with everything. If you put it on the calendar and you treat it like a doctor's appointment, that this is something we're committed to and we're going to do it, it makes it much more likely to happen.

And then what it is, you can rotate, like, all right, Timmy picks this activity this month or this week, and then Susie picks it this time, and then dad picks it this time, and mom picks it this time, and everyone rotates. Now everyone has a chance to do it. We're doing it together and it's on the calendar and gets done.

[Dr Mike Patrick]
We've talked about providing opportunity, encouraging kids, building habits for activity. There is also some sort of rules that surround physical activity to sort of help us not get injured. How can education play a role in making sure that kids are doing activities safely?

Travis?

[Travis Gallagher]
I think it kind of goes in line with what we talked about. If you are starting slow and building up, not only does it help to create a sustainable habit change, but it'll also help to condition the movements in the body as you're going with any activity. So, you're not overdoing it right from the start would be the first thing I would say.

And I would encourage Dr. MacDonald or Dr. Africa to jump in as well.

[Dr Jim MacDonald]
I think what I would first say is that the younger the child, the more the parent needs to survey the landscape for acute injury, right? So, what I mean by that is to state that like a three-year-old around the pool, you need to be on it, right? Or like, yes, resistance training, weight training is great even for kids, but if John and Jane are down in the basement weight room without supervision, potentially dropping weight plates on their toes, there's going to be injury.

But what's interesting from an overuse point of view, as opposed to that acute injury, just surveying the landscape of safety, play is self-regulatory. We have an abundance of research that you can overdo it in sports. And there are simple metrics, Dr. Mike, of like, if your child, by the way, listeners, is doing gymnastics or any organized sport, the number of hours per week they're doing that sport exceeds their age in years, they just double to triple their overuse risk. That formula does not work in a good way for play. They can play as much as they want. When kids self-regulate play, they stop when they're tired.

They're not going to get overuse injuries. So, just be mindful about the drowning risk, be mindful about the fall risk, be mindful about running out into the busy street risk. But play, hey, man, essentially you can't overdose because the child will know when they're overdosing, they'll stop.

[Dr Mike Patrick]
Yeah, yeah. Really important. We've also talked about how so many people and so many institutions play a role in increasing activity, developing habits.

So, we've talked about families, schools. We've talked about how pediatricians can give guidance during exams on activity. Why is teamwork so essential, and how can we start working more together rather than being in independent silos?

Jim?

[Dr Jim MacDonald]
Wow. Well, that's big, Dr. Mike. I mean, on one level, I would just say from the biggest level, you know, one person can't do it all.

It takes a village, famously. I mean, I sincerely mean that. Like, on its most basic level, everything, including in medicine, requires a team.

And embedding change in team culture is how you get long-term, you know, lasting outcomes. So, there's that. But I'd also say what it triggers in me is that we're seeing in our country especially, but like around the world, a lot of pullback by governmental, you know, institutions, funding, you name it, that supports, you know, parks.

Like the metro park. The metro parks would not exist without public support, including government support. And governments who do not recognize the importance of getting kids active young are facing unbelievable costs down the road.

Because the intersection of kids getting more sedentary, less active, obese, et cetera, is intersecting with people living longer. And there's an abundance of literature that the fitter you are when you're young, the less likely you are to be a burden on society with morbidity of type 2 diabetes, amputations, et cetera, et cetera, down the road. So, governments who don't address that now are, it's going to be a sorry, sorry state.

So, Dr. Mike, you asked a specific question, I'd say like, yes, it's on families. Yes, it's on individuals. Yes, it's on pediatricians and other people who are charged to take care of kids.

But we've relied on that support from governments. We still need it. And the governments themselves are going to pay a big, big price if they don't pay attention to this.

And that's global, not just the United States. Yeah. Yeah.

[Dr Mike Patrick]
And I think one starting point is just having more awareness that physical activity is so important and making it fun. Because when you just hear, oh, you need to watch what you're eating and exercise more without giving kids the tools to do that in a fun way, it's going to fall flat. And if we can all collaborate as families and schools and healthcare professionals in raising awareness, sort of letting families and kids know how important this is so that they keep hearing that message over and over from lots of different people can hopefully make a difference for kids and families everywhere.

Well, this has been a wonderful conversation. And again, I really appreciate all of you stopping by for it. We are going to have, again, links in the show notes over at pediacast.org for this episode of 575. We'll have a link to the sports medicine program at Nationwide Children's, the Play Strong program in particular, we'll have a link to that. Also, if you're interested in learning more about the Stellenbosch University Kinderkinetics program, we will have a link in the show notes for that too. And then an old episode of PediaCast that may be helpful all the way back to 212 on physical fitness and resistance training.

The information in that particular episode is still valid and important. And we'll put a link to that episode in the show notes as well. So once again, Dr. Jim MacDonald, Dr. Eileen Africa and Travis Gallagher. Thank you all so much for being here today.

[Dr Jim MacDonald]
It was great being here. Thank you, Dr. Mike.

[Dr Eileen Africa]
Thank you, Dr. Mike. It was lovely to be here with these like-minded colleagues. And I want to say to the listeners, keep moving, keep playing, and most importantly, keep having fun.

[Travis Gallagher]
And the three of us can talk about this all day. This is our passion. So, if anyone wants to reach out to us individually, please do so.

Thank you.

[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that. Also, thank you to our guests this week, Dr. Jim MacDonald with sports medicine at Nationwide Children's Hospital, Dr. Eileen Africa. She's a Fulbright visiting scholar from Stellenbosch University in South Africa and Travis Gallagher, certified athletic trainer at Nationwide Children's. Don't forget, you can find us wherever podcasts are found. We're in the Apple Podcast app, Spotify, iHeartRadio, Amazon Music, Audible, YouTube, and most other podcast apps for iOS and Android.

Our landing site is pediacast.org. You'll find our entire archive of past programs there, along with show notes for each of the episodes, our terms of use agreement, and that handy contact page if you would like to suggest a future topic for the program. Reviews are helpful wherever you get your podcasts.

We always appreciate when you share your thoughts about the show, and we love connecting with you on social media. You'll find us on Facebook, Instagram, Threads, LinkedIn, X, simply search for PediaCast. We're also on Blue Sky now, and last I looked, we had like four followers because we just added Blue Sky to our social media lineup.

So, if you are there, be sure to search for PediaCast, and to give us a like. It'd be very much appreciated. Also, don't forget about our sibling podcast, PediaCast CME.

That stands for Continuing Medical Education. It's similar to this program. We do turn the science up a couple notches and offer free continuing medical education credit for those who listen.

Of course, that includes physicians, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists, and it's because Nationwide Children's is jointly accredited by all of those professional organizations that we can offer the credits you need to fulfill your state's continuing medical education requirements. Shows and details are available at the landing site for that program, pediacastcme.org. You can also listen wherever podcasts are found.

Simply search for PediaCast CME. And there is an additional podcast that I host called FAMEcast, F-A-M-E-C-A-S-T. It is a faculty development podcast from the Center for Faculty Advancement, Mentoring, and Engagement at The Ohio State University College of Medicine.

So, if you are a teacher in academic medicine or a faculty member in any of the health sciences, then this is a podcast for you. You can find FAMEcast at famecast.org and wherever podcasts are found by searching for FAMEcast. Thanks again for stopping by, and until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.