EXERCISE AS A MODALITY IN THE TREATMENT OF CHILDHOOD OBESITY

The prevalence of obesity in children and adolescents is higher than 20 years ago in all racial–ethnic, age, and sex groups. 32,38,54 Evidence continues to support reduced physical activity and sedentary behaviors, such as television viewing, as primary causes of the current worldwide obesity epidemic. 15,28,30 Several researchers have published results of programs that target decreases in sedentary behaviors as methods to increase physical activity and reduce obesity in children. 12,30,36,55 It is possible that, for many children, increasing physical activity may be adequate to prevent the onset of childhood obesity. 28,35,47,55 Because young animals, including humans, are inherently active, young children will be active if given encouragement and opportunity. 21,62 Childhood activity is often intermittent and sporadic 4 ; thus, children likely will not participate in prolonged exercise without rest periods; however, if given the opportunity, young children will perform relatively large volumes of intermittent, nonstructured physical activity. 4,21,62 Generous periods of free play are recommended highly, together with frequent periods of adult-initiated moderate to vigorous activities, including the participation of parents and teachers. 35,42,62 Encouraging active play as a means for increasing overall energy expenditure has been shown to be effective in reducing obesity in 5- to 8-year-old girls. 21 Providing safe environments for young children to play actively outdoors is essential to increasing the physical activity patterns of overweight children and those at risk for obesity. 35 This provision may be accomplished only through policy changes, environmental planning, and school and community educational efforts. Motivating young, nonobese, physically active children to maintain activity patterns may be less challenging than increasing patterns in already obese older children. Javernick 42 suggests that just monitoring children during free play does not encourage the participation of heavier children. Heavier children often are ignored and ridiculed 1 and often choose indoor, sedentary activities to escape negative activity situations. 42 Therefore, encouraging sedentary, obese children to participate in physical activity is difficult. In addition, even mildly overweight children have a decreased exercise tolerance; movement may be uncomfortable and, in some cases, painful. 64,66,69 Structured and vigorous, aerobic-type activities when prescribed to overweight children, regardless of the individual's cognitive, physical, and emotional stage of development, may result in noncompliance or physical injury. Prior failure to motivate and maintain increased physical activity in overweight or obese children may be attributed to inappropriate exercise recommendations 64,65,71 and a lack of physical opportunities for overweight children in the traditional school environment. 42 In addition, emotional problems further may inhibit successful motivation of sedentary children. 1,38,64