In my last column, I discussed the high prevalence of childhood obesity and some of the interventions done to help create a heart-healthy lifestyle. I would like to focus a bit more on exercise in this column.
Sedentary behavior is associated with mortality, with up to nine percent of premature death attributable to lack of exercise. The benefits of exercise in general are well studied and well established. Exercise improves the cardiac, respiratory, musculoskeletal, and metabolic systems. Reductions in blood pressure and cholesterol can occur. Prolonged sitting has recently been shown to increase the risk of cardiovascular disease, diabetes, and cancer in adults. Nearly every study has shown some benefit to physical health and mortality rates with exercise, regardless of type and even duration. “Weekend warriors” who exercise for a few hours on weekend days and very little, if any, during the week, were also shown to have positive outcomes.
Beyond physical fitness and improvement in cardiac outcomes over time, there is a strong psychological impact to those who exercise and have a healthy weight. Quality of life measures were shown to improve in a randomized controlled trial of adults. In a four-year study of early teenage children, fitness was associated with improved global self-worth/self-esteem. Studies have also shown improved cognition and attention in chi ldren who exercise regularly.
For children, major medical groups such as the American Academy of Pediatrics and American College of Cardiology recommend at least 60 minutes of daily physical activity after six years of age. On at least three days per week, the physical activity should be intense enough to make their heart and respiratory rates faster, and make their muscles and bones stronger. The 60 minutes do not have to be in one duration, but can be broken into smaller intervals throughout the day.
The choice of activity is critical. Children need to have fun; we have to find activities that the children we are trying to motivate to exercise will enjoy, in order to ensure long-term commitment and success. When younger children are offered these fun opportunities, they may not even need to be asked or encouraged to play. Parents often need to be role models or actively engage their children and participate with them. Making physical activity part of a daily routine can be quite helpful. Taking walks or family bike rides, inviting neighborhood friends to come over to play, or Sunday hikes are a few examples.
We are fortunate to have some new good team sports options for the community, as described in past issues of Kol HaBirah. Team sports can help motivate children, as they often include their friends and healthy competition can help push them to improve and work harder. Additionally, team sports can help children learn leadership, social skills, teamwork, and a sense of belonging.
We must be careful as parents and coaches, however, not to push children too hard and make competition the primary reason for participation. Children who are not “into” team sports should be able to find other outlets, many of which can be very low-cost, and there are many options in Montgomery and Fairfax County parks. Even exercise videos on YouTube can be very beneficial, especially when older children or adults do not want to leave the house.
Pre-participation screening is controversial and will be a topic of a future column. Most young children, though, can participate in most, if not all, sports without concern. The benefits of exercise are marked in all children and adults, even in those that have medical problems and need to have some restrictions.
In the religious community, making time for exercise is usually the hardest factor to overcome. A prominent rabbi who travels frequently and lectures on childhood development and educational issues has told me that a precondition for his visit to a community is a treadmill in his host’s home.
Making this a goal for personal growth, just like any other value, is necessary to help us stay healthy and live a long, successful life.
By Jared Hershenson
Jared Hershenson, MD, is a pediatric cardiologist with expertise in general pediatric cardiology, fetal cardiology, and sports cardiology. He is the director of the exercise physiology lab at Child Cardiology Associates, which has offices throughout Maryland and Northern Virginia. Please visit www.childcardiology.com for details. Jared lives in Silver Spring, Maryland, with his wife and five children. He is a member of Ohr HaTorah and Young Israel Shomrai Emunah shuls in Silver Spring, and is on the Board of Directors of the Torah School of Greater Washington and Yeshiva of Greater Washington - Tiferes Gedaliah.