Physical Activity Level of US Children, Teens Earns D- Grade

Kerry Dooley Young

October 02, 2018

WASHINGTON — An alliance of healthcare organizations has for the third time in a row given a D- grade for the overall physical activity level of American children and teenagers, saying that only about a quarter of them get the recommended hour of moderate-to-vigorous exercise a day.

The National Physical Activity Plan Alliance on Monday released its latest report card on the fitness of American youth. In it, the group maintained the same D- grade that it offered for the overall physical activity levels in the 2014 and 2016 reports.

Drawing from established datasets such as the National Health and Nutrition Examination Survey (NHANES), the report card draws a picture of a nation where children too often are driven to school and spend too much time sitting looking at computer screens. The initial toll of these habits can be seen in poor results on testing for physical fitness, with only about 42% of adolescents having "adequate" cardiorespiratory fitness levels as measured by the FITNESSGRAM "Healthy Fitness Zone" testing, according to the report card.

But the true cost of sedentary lifestyles may lie ahead, with poor exercise setting the stage for adult obesity and related illnesses such as diabetes and hypertension, said Boris Lushniak, MD, MPH, who served as the US deputy surgeon general during the Obama administration.

"Those patterns that we're seeing in youth carry over to adults," Lushniak said at a press conference about the 2018 report card. "That's a given."

Children living in poorer nations may have an advantage over those in wealthier ones, as they must travel to school by foot or on bicycles, Lushniak said.

"We've advanced as a society. 'Oh, we have cars, we have roads, we have buses, we have all of those things,' " said Lushniak, who now is dean of the University of Maryland's School of Public Health. "In essence, we have taken a step backwards in terms of what our body is supposed to be doing, which is moving."

Lushniak argued for a need for a "cultural shift" toward incorporating physical activity into daily lives, with an aim of turning the idea of preserving health into a "patriotic venture."

People should see exercise as something that benefits them personally and also can pay off for the nation, with increased physical fitness potentially holding off many cases of serious illness.

The alliance's 2018 report card noted that only about 38% of youth aged 12 to 19 years walk or use a bicycle for at least 10 minutes continuously once or more in a typical week to get to and from places, citing 2015-2016 NHANES data. Among the report card's recommendations were calls for schools to find ways to encourage more children to walk or bicycle to schools. These could include expanding infrastructure, the report states.

"It's Your Decision"

There's been too much emphasis in the United States on more extreme sports, such as marathon running and mountain climbing, and not enough on moderate exercise, such as building more safe sidewalks to encourage family walks, Lushniak said.

"We don't need an expensive pair of running shoes. We don't need a membership in a health club," he said. "We've been inundated with a society that says, 'Oh, if you are not superachieving, then it's not exercise.' No. As a nation, let's begin walking again, let's begin bicycling again."

Partners in the National Physical Activity Plan Alliance, which produced the report card, include medical associations that offer tools to help healthcare professionals counsel patients about getting enough exercise. The American Academy of Pediatrics, for example, has its Institute for Healthy Childhood Weight program. Other partners in the alliance that produced the report card include the American Medical Association, the American Cancer Society, and the American Diabetes Association.

The challenge for physicians remains finding a way to persuade patients and the parents and guardians of younger patients to opt for more active lifestyles, Lushniak said.

"You can't just say, 'Don't smoke, eat better, exercise more.' Americans aren't set up to take orders," Lushniak said. "Ultimately if we give out all of the information, correct information, and basically say 'It's your decision,' it's a setup for that person to make the right decision."

The 2018 report card also noted in several places that children from less affluent families may face greater challenges in developing active lifestyles. About 88% of children from high-income households (defined as those earning at least $100,000 per year) engage in at least some sport activity, for example, compared with 70% of children from low-income households (defined as those earning less than $25,000 per year), according to the report.

"This is another gap that we certainly need to address, providing broader access to organized sport participation for children in need," Peter T. Katzmarzyk, PhD, chair of the alliance's Report Card Research Advisory Committee, said at the press conference.

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