Health Improvement: Enhancing Physical Activities among Children

Health Improvement: Enhancing Physical Activities among Children

Introduction

Physical activity (PA) is crucial to the mental, physical, social, and cognitive health of children and youth. In light of this, the World Health Organization (WHO) and the 2018 United States Report Card on Physical Activity for Children and Youth recommend that children and the youth spend a minimum of 60 minutes each day engaged in moderate to vigorous Physical Activity (National Physical Activity Plan Alliance, 2018). While the health consequences of Physical Activity in adults is well documented, there is very little documentation linking it with health in children; moreover, there has not been a rigorous scientific evaluation of the relationship between Physical Activity and health indicators among children; therefore, the purpose of this study is to perform a systematic review that examines the relationship between physical activity and health in children in the United States of America more specifically children in the state of Mississippi which has the highest obesity rate among kids ages 10-17 at 26.1% (Hampton and Staff, 2018) and propose recommendations for enhancing PA in children living in Mississippi.

Physical Activity and Health

A sedentary lifestyle (such as watching television and playing computer games) is one of the significant problems to health in children worldwide, especially in the United States and in other developed countries. Unfortunately, lack of PA which, as we will see later in this study, has increased over the years increases the risk of various diseases such as; Diabetes, Hypertension, obesity, coronary heart disease, cardiovascular disease, among others.

This section will highlight some of the risks factors associated with physical inactivity, it will also give statistical data on the frequency of this risks in children living in Mississippi and highlight consequences of the health risks such as high mortality and financial implications.

Physical Activity and Obesity

Obesity is one of Mississippi’s most pressing health issues. It is a medical condition that occurs when a person carries excess weight or body fat that might affect their health. Body Mass Index is a universal tool used for measuring obesity. A Body Mass Index (BMI) between 25 and 29.9 indicates that a person is carrying excess weight, and a BMI of 30 or over suggests that a person may have obese. Obesity is associated with medical conditions such as: heart disease, stroke, diabetes, musculoskeletal disorders, and cancers (Mendy et al., 2017)

Close to 35% of Americans have obesity, of this population, Mississippi makes up the highest percentage. Since 2005, Mississippi ranks first in the United States of America (U.S.A) a study on obesity conducted in 2011 on 4,235 students in public schools in the state revealed that the rates of obesity were higher than national averages (JR et al., 2012). Further studies conducted by the Mississippi State Department of health in 2015 revealed that over 40% of school-aged children and youth in Mississippi were either overweight or obese. The table below adapted from (Grant, Miller, and Zhang, 2018) reveals the epidemic in the state.

All Grades k-12

Elementary k-5

Middle School 6-8

High school

9-12

% Overweight

18.2

17.8

18.8

18.5

% Obese

25.2

22.6

27.3

28.2

% Overweight or Obese combined

43.4

40.4

46.1

46.7

Low Physical Activity is one of the factors that contribute to obesity in children (Gill, Hardman and Stensel, 2009). The Center for chronic disease prevention and health promotion in a study on the state of nutrition, physical activity and obesity revealed that 18.3 % of the adolescents in Mississippi were obese, the study further revealed that only 23% of the adolescent population in Mississippi were physically active for the recommended time of 60 minutes per day, only 26.1% of adolescents attended daily physical education classes in an average week while in school and an alarming 21.2% did not participate in at least 60 minutes of physical activity on any day during the seven days prior to the survey. Moreover, the study revealed that Among Mississippi’s children aged two years to less than five years, 13.7% were obese (Victor D. Sutton, 2012)

In a bid to address the issue of obesity in children, the state of Mississippi, the Mississippi state legislature enacted the health Students Act in 2007. One of the conditions set out in the Act is a minimum period of physical activity-based instruction for school going children and specific levels of Physical Education class for high school graduation. However, not all schools, particularly those in predominantly rural, low-income, racially concentrated communities, meet the in-school physical activity (ISPA) requirements (A, J.S and M.L, 2014).

Physical activity and Cardio-Vascular Heart Disease

Over half of the deaths in 2017 occurring in Mississippi were attributed to chronic diease such as Heart Disease (Cdc.gov, 2020). The table below was adapted from the Mississippi state department of health, 2017, it demonstrates the number of deaths attributed to chronic disease in Mississippi.

MS Leading Causes of Death, 2017

Deaths

Rate***

State Rank*

U.S. Rate**

1. Heart Disease

7,944

231.6

1st

165.0

2. Cancer

6,526

183.1

2nd

152.5

3. Chronic Lower Respiratory Disease

2,037

58.3

3rd

40.9

4. Accidents

1,738

56.3

12th

49.4

5. Stroke

1,723

51.1

2nd

37.6

6. Alzheimer’s Disease

1,626

49.5

1st

31.0

7.Diabetes

1,164

33.3

2nd

21.5

8. Flu/ Pneumonia

782

23.0

2nd

14.3

9. Kidney Disease

741

21.7

1st

13.0

10. Septicemia

582

16.9

2nd

10.6

Source: Mississippi state department of health, 2017

In the United States, heart disease (including Cardio-vascular Heart disease (CVD), Coronary Heart Disease (CHD), and stroke) remains the number one cause of death. In 2016, 13% of the deaths in America were attributed to Coronary heart disease (EJ et al., 2019), making it the number one cause of death. One reason it has such a large effect on mortality is because of its prevalence. Regular physical activity in children has been shown to help protect against first the cardiac episode.

Besides being the number one cause of death, chronic diseases are among the most costly of all health problems in Mississippi. Over the years, Medical spending in Mississippi on chronic health conditions continues rapidly in recent years and is placing a significant burden on state budgets. The expenses are expected to continue to increase by up to 70% between 2010 and 2020 (Short, 2014). The table below presents the expected rise in costs of treating chronic diseases between 2010 and 2020.

Condition

Projected percentage increase in costs between 2010-2020

Stroke

70.7%

Disease of the heart

70.3%

Cardio-vascular Disease

69.1%

Diabetes

67.9%

Hypertension

65.4%

Source: Centres for Disease Control and Prevention: Chronic Disease Cost Calculator

Regular physical activity reduces the risk of dying prematurely from chronic disease. It also helps prevent the development of diabetes, helps maintain weight loss, and reduces hypertension, which are all independent risk factors for causing CVD. Less active, unfit persons have a 30-50% greater risk of developing CVD. Physical inactivity is a significant risk factor for CVD itself, it ranks as high as: cigarette smoking, high blood pressure, and elevated cholesterol.

Physical activity Hypertension

Hypertension, also known as High blood pressure increases the risk for stroke and heart disease. It is known as a silent killer because victims do not often exhibit any signs of illness at the offset. Lifestyle risk factors for Hypertension in adults include: physical inactivity, high alcohol intake, high sodium intake, and excessive caloric intake.

High blood pressure in children younger than six years old is usually caused by other medical condition such as: Chronic kidney disease, Polycystic kidney disease, Heart problems, such as severe narrowing of the aorta and Hyperthyroidism while Older children can develop high blood pressure for the same reasons as adults like excess weight, poor nutrition and lack of exercise. Lifestyle changes, such as eating a heart-healthy diet and physical exercise, can help reduce high blood pressure in children.

According to the Centres for Disease Control (Centres for Disease Control and Prevention, 2020) 1 in every 25 youth aged between 12 and 19 have hypertension in America and a further 1 in 10 has pre-hypertension, according to the CDC these numbers are as a result of obesity among the youth.

In Mississippi, high blood pressure in the pediatric population is commonly observed and it is known to be one of the major causes of mortality in the state. It poses long term health risks to children.

Initial steps to control Hypertension in the United States were first designed in 1987 when the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) commissioned a task force on Blood Pressure Control in Children to conduct surveys on hypertension in children.

The task force developed standards for blood pressure by conducting more than 83,000 person-visits of infants and children and developed percentile curves that showed the specific distributions of systolic and diastolic BP in infants and children, with corrections for height and weight (National Heart, Lung, and Blood Institute, 1987)

In sum, the rates of hypertension in children is increasing especially in light of the growing population of children with obesity (C, P, T, et al, 2016). However, the exact number of children with hypertension is not known. This is partly due to the arbitrary definition of hypertension and also the lack of blood pressure screening on children during routine pediatric medical visits. An evaluation on the rate of blood pressure screening revealed that just two thirds of routine pediatric visits had BP measurements and there was no BP screening in 20% of overweight or obese children during their routine visits (Dj, AL, et.al, 2012)

Furthermore, in children, the definition of hypertension is based exclusively on frequency-distribution curves for BP. As a consequence, estimates of the prevalence of pediatric hypertension lack a scientific basis. The number of children who might be defined as having hypertension and the frequency with which they develop complications during adulthood remain unknown. However, recent evidence indicates that hypertension in adults originates in childhood, because childhood blood pressure causes BP in the adult

The good news is that Hypertension can be prevented, one drug-free approach to preventing it is regular exercise. Regular exercise makes the heart stronger which in turn helps the heart pump more blood with little effort, as a result, the pressure in the arteries decreases thus lowering blood pressure.

Additionally, regular exercise can help prevent normal blood pressure at the desirable rate of less than 120/80 mm Hg from rising as children age. It can also help them maintain a healthy weight which is crucial in controlling hypertension.

Theory based solution.

Traditional approaches to addressing risk factors of physical inactivity focus on individual awareness and behavioural change, however it is well recognised that children’s social physical and cultural environments are strong contributors to the extent to which children are active. A survey by (L et al., 2010) revealed that the obesogenic environment is a substantial contributor to physical exercise in children. An obesogenic environment refers to an environment that promotes weight gain within the home or work place (Swinburn, et al., 1999).

Environmental interventions impact PA. Generally, supportive environments are known to change and influence health behaviours such as smoking (C and, M, 2004). In the United States, Current national policy embraces the environment as an option for promoting health-enhancing physical activity, especially active travel. A study by the task force on community preventive services (EB et al., 2002) revealed that creating or improving access to places for PA can result in a 25% increase in the number of people active. The task force recommended community level intervention to enhance access to places for physical activity such as parks. Moreover, various studies that previously examined physical activity among residents living near walking trails found an increase in several incidences of physical activity.

Consequently, this paper recommends the Mississippi state health department coordinate the following environmental changes in the state to increase physical activity in children.

1. Encourage development and maintenance and equitable access to public spaces such as parks, trails and community gardens as well as recreational facilities in all sub counties that promote physical activities for all people.
2. Conduct assessments for public investment in new improved facilities for PA such as bike trails and pedestrian walks to be used by children when going to school as opposed to children using vehicles.

Implementation

The purpose of this section is to apply the RE-AIM framework to discuss how environmental changes can be applied to enhance PA in children living in Mississippi. The RE-AIM framework is divided into five components namely: Reach, Effectiveness, Adoption, Implementation, and Maintenance (EB et al., 2002). It is an evaluation process that balances internal and external validity factors in PA and it is a framework that is broadly applied in the U.S as well as other high-income countries across a wide array of PA-related research and programming.

From this paper’s perspective, the goal of the RE-AIM framework is to provide the information necessary for individuals, organizations, members of the legislature, and educators to make informed environmental adoption and implementation decisions based on the degree of a program that can reach the targeted audience, and effectively change the outcome of physical activity in children in an aim to achieve these, the RE-AIM process is broken down in this discussion as follows:

1. Reach.

This involves identifying the target population which will be affected by the proposed environmental changes. In this case the implementation process will target school going children aged between five and seventeen years in Mississippi. This stage will be followed closely by the second step;

1. Efficiency or effectiveness

Which involves measuring results of the proposed implementation on the target group. This is achieved by making follow ups on the impact of environmental interventions in PA children living in Mississippi. It will also include a measure of positive and negative effects as well as unanticipated consequences of the proposed implementation.

1. After measuring the impact of the proposed implementation, the next step will be the Adoption stage.

This stage involves bodies and individuals responsible for adopting environmental changes. Such bodes include legislature, business owners, school administration and the target population. Moreover, it involves an assessment of those needed to approve projects such as side-walks, and public parks (city council), and maintain public spaces (parks and recreation, police).

1. The nest stage is the implementation stage.

This stage evaluates whether the standards for implementing environmental change are followed or implemented. It also evaluates whether the costs for making such environmental changes are sustainable and documents other changes needed to support environmental projects such as traffic engineering.

1. Maintenance is the final stage of implementation

It assess whether there are agencies or individuals in a position to monitor the behaviour of target groups and whether the rare any polices in place that support proposed improvements and maintenance on environmental changes.

Evaluation

The recommended implementation will be evaluated through the Formative Evaluation process. The reason for making this choice is because this evaluation process allows for modifications to be made the plan before full implementation begins just in case there is any error in the data provided or any other error whatsoever.

Formative evaluation seeks to improve interventions by promoting the delivery of the intervention, the quality of the implementation, and the personnel and structure organization. As a change oriented evaluation approach, it is especially attuned to assess the recommended environmental changes, and any strengths and weaknesses or unexpected outcomes arising from implementation.

The process involves collection and analysis of data, feedback from this data is then designed to fine-tune proposed implementations. The data also contributes to policy-making at the margins through piecemeal adaptation. Formative evaluation is most useful in case studies such as this one, using methods which include: focus groups, stakeholder analysis (policy makers), and nominal group techniques.

Overall, formative evaluation involves many different tasks which include; identifying evaluation goals, planning data collection, generating evaluation findings and making value judgements. It will ensure that the researcher identifies whether the proposed implementation is understood by various stake holders and target groups and the extent to which the implementation is possible on the goals and objectives of promoting PA in children living in Mississippi.

Conclusion

In conclusion, this research identified substantive relationships between PA and a wide array of indicators covering physical, mental, social and cognitive health in children. Generally, there is strong evidence linking Physical activity physical health, bone fitness and adiposity. However, this conclusion is based on limited pediatric data, basic psychological data and a richer adult database. This emerging pattern ought to be supported by more evidence in the future.

Finally, it should be remembered that physical activity is the human beings’ evolutionary heritage. Human beings are designed as a species for PA but we currently exist in an environment where opportunities to be physically active are fast disappearing. Only progressive environmental policy changes regarding public amenities such as parks and walk ways, among others can improve matters of health and PA in children.

Works cited

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