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Kids Need More Exercise. What Role Should Schools Play?

New AHA recommendations challenge schools to play an active role in meeting guideline standards for childhood physical activity, and a new study urges us to exceed those standards.

With about 16% of U.S. children age 6 to 19 now classified as overweight, regular exercise is more important than ever. Current guidelines recommend that children engage in at least 1 hour of physical activity daily, but only 6% to 8% of primary and secondary schools provide daily physical education (PE).

The American Heart Association recognizes that schools are not the only places where children should exercise, but the AHA believes that schools should play a role in promoting physical activity. It has issued new recommendations regarding that role, including:

• Schools should ensure that all children participate in at least 30 minutes of moderate-to-vigorous physical activity during the school day, with options for more activity in extracurricular and school-linked community programs.
  
• School-based PE programs should be evidence-based, should include moderate-to-vigorous physical activity for at least 50% of PE class time, and should teach students the skills needed for lifelong physical activity.
  
• PE programs should meet national standards, including 150 minutes per week for grades K through 8 and 225 minutes per week for grades 9 through 12.
  
• Schools should promote walking and bicycling to school where possible, with routes made safe by the joint efforts of school leaders and local governments.
  

In a European study on this topic, researchers measured how much physical activity schoolchildren in Denmark, Estonia, and Portugal were getting and examined clustering of cardiovascular risk factors in these children. A total of 1051 nine-year-olds and 681 fifteen-year-olds, randomly selected from their schools, wore monitors that recorded their physical activity for 4 consecutive days (2 weekend days and 2 weekdays). Each child also received a combined cardiovascular risk-factor score, based on readings of blood pressure, weight, waist circumference, skinfold thickness, cholesterol, and insulin resistance.

The reference group comprised children in the highest quintile of moderate-to-vigorous physical activity (mean: 167 minutes/day for 9-year-olds, 131 minutes/day for 15-year-olds). Compared with these children, those in each other quintile had significantly greater odds of having a high clustered risk score, ranging from 2 times the odds in the second most active quintile to 3.3 times the odds in the least active quintile. Mean daily activity in the second most active quintile was 116 minutes for 9-year-olds and 88 minutes for 15-year-olds; means in the least active quintile were 38 and 34 minutes, respectively.

Comment: In the European study, the more exercise children engaged in, the lower their likelihood of having cardiovascular risk factors, with benefits accruing at well above the recommended level of at least 1 hour of physical activity per day. The new AHA recommendations for schools help to broaden efforts to get children to exercise as much as possible. They emphasize not only programmed activities but also integration of exercise into daily living. It is only with both types of exercise that we can hope to achieve population-wide levels of childhood activity that measurably minimize children’s cardiovascular risk burden.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology September 20, 2006

Citation(s):

Pate RR et al. Promoting physical activity in children and youth: A leadership role for schools: A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Physical Activity Committee) in collaboration with the Councils on Cardiovascular Disease in the Young and Cardiovascular Nursing. Circulation 2006 Sep 12; 114:1214-24.

• Original article (Subscription may be required)
• Medline abstract (Free)

Andersen LB et al. Physical activity and clustered cardiovascular risk in children: A cross-sectional study (The European Youth Heart Study). Lancet 2006 Jul 22; 368:299-304.

• Medline abstract (Free)