We All Know That Increased Physical Activity Is Needed, Especially For Youngsters With Disabilities, But…
BY H. BARRY WALDMAN DDS, MPH, PHD, RICK RADER, MD, FAAIDD, DHL (HON), ANDREW G. SCHWARTZ, DDS, FACD, STEVEN P. PERLMAN, DDS, MSCD, DHL (HON)
"Worldwide, 1 in 4 adults, and 3 in 4 adolescents (aged 11–17 years), do not currently meet the global recommendations for physical activity set by WHO. As countries develop economically, levels of inactivity increase. In some countries, levels of inactivity can be as high as 70%, due to changing patterns of transportation, increased use of technology and urbanization…The global cost of physical inactivity is estimated to be INT $ 54 billion per year in direct health care, in 2013, with an additional INT$ 14 billion attributable to lost productivity. Inactivity accounts for 1–3% of national health care costs, although this excludes costs associated with mental health and musculoskeletal conditions."Physical activity can be undertaken in many different ways: walking, cycling, sports and active forms of recreation (for example, dance, yoga, tai chi). Physical activity can also be undertaken at work and around the home. All forms of physical activity can provide health benefits if undertaken regularly and of sufficient duration and intensity. 1
Physical activity levels also are influenced by cultural values. In most countries, girls, women, older adults, the underprivileged groups, and people with disabilities and chronic diseases, all have fewer opportunities to access safe, affordable and appropriate programs and places in which to be physically active.1
"If half of U.S. children 8 to 11 years old got the recommended amount of physical activity, the proportion of children who are overweight or obese would decrease by 4 percent, according to new research funded partially by AHRQ. This would save $8 billion in annual medical costs associated with obesity-related conditions, researchers concluded. Having this same 50 percent of kids receive the recommended amount of exercise would also avert approximately $14 billion in annual lost productivity costs over their lifetimes, researchers concluded. (It is)… estimated that only 32 percent of children currently get (the) recommended amount of exercise, which consists of 25 minutes of high-calorie-burning physical activity three times a week." 2 "Children and adolescents with physical and cognitive disabilities have a higher prevalence of being overweight compared to their non-disabled peers. ('…the prevalence of overweight and obesity in children with disabilities was almost twice that in their nondisabled peers.'3) This health risk can lead to a greater number of obesity-related secondary conditions (e.g., fatigue, pain, deconditioning, social isolation, difficulty performing activities of daily living) and can impose significant personal and economic hardship on the child and family." 4
The term "hypokinetic diseases" describes many of the diseases and conditions associated with inactivity and poor fitness and include: obesity, metabolic syndrome, high blood pressure, high cholesterol, osteoporosis, osteoarthritis, low back pain, type 2 diabetes, some cancers, depression and other bio-behavioral conditions. The lack of activity and movement may be a direct cause of the ailment, exacerbate or accelerate its development and potentially serve as an impediment to ongoing treatment strategies. Strategic and personalized fitness programs have proven to be of benefit in the management and control of these conditions.
AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE AND DENTISTRY
The American Academy of Developmental Medicine and Dentistry (AADMD) was organized in 2002 to provide a forum for healthcare professionals who provide clinical care to people with neurodevelopmental disorders and intellectual disabilities (ND/ID). The mission of the organization is to improve the quality and assure the parity of healthcare for individuals with neurodevelopmental disorders and intellectual disabilities throughout the lifespan.
GETTING STARTED
Promoting healthy weight and addressing health behaviors can contribute to favorable health outcomes and quality of life for children and youths with special health care needs. Pediatricians need to be encouraged to assess risks contributing to obesity in collaboration with families and appropriate interdisciplinary specialists, which may include: psychologists, primary care providers, mental health professionals, social workers, physical therapists and dieticians.5
The number one factor in choosing appropriate activities for children with disabilities should be fun. Any activity chosen for your child, either by you, your child, or as a group, should offer varying degrees of fun. For example: children with mobility impairments (who use wheelchairs) are prone to have low participation levels in physical activity, which reduces fitness and wellbeing. Effective physical activity interventions that are fun and engaging for children are recommended to promote habitual participation as part of a healthy lifestyle.6 The primary reason that children participate in sports is to have fun, and the key reason they quit is because of a lack of fun. The question becomes, "How do I ensure that an activity that my child is interested in will be fun?" To be successful in helping your child (based on his/her abilities) create a healthy lifestyle, activities must be selected that will help your child achieve feelings of: belonging/acceptance, success, accomplishment, growth and competence. 5 To this end, goals should be set, including; • "making new friends • developing specific motor skills • learning independence • participating individually (recreationally or competitively) • participating on a team (recreationally or competitively) • increasing aerobic or anaerobic activity • interacting with peers who may or may not have a disability" 7
HELPING KIDS WITH DISABILITIES TO EXERCISE
No matter your child's age or level of mobility, doing some activity will really help. Simple activities that do not demand complex skills and have few rules are best. Choose activities that match your child's skill level and that are interesting and attractive, so he/she will be more likely to participate. If your child feels good at an activity, he/she probably will want to do more. Open-ended activities, in which there is no one right way to do things, will let your child participate at their level. Here are some ideas: • Moving to music or dancing and playing in a playground can be done any way your child wants. • Walking, riding and water exercise do not rely on complicated skills or instructions so they can be good for children with intellectual disabilities. What's more, the whole family can join in. • Older children with physical disabilities may enjoy a sport such as wheelchair basketball.
Use of active video games to prevent weight gain. There was a time, in the not too distant past, when children would meet outdoors and get involved in any number of sports activities. These excursions to streets, parks and other locales have been replaced by Long periods of inactivity before little electronic screens where one can sit and exercise their fingers to cause or prevent mayhem to little dancing figures. Some advancement to these hypnotic screens now require individuals to move about to fulfill their participation in these electronic (indoor) games. These advanced video games have been shown that they can prevent excessive weight gain. 10 But these efforts may be limited without parental (or caretaker) reinforcement. The behavior and encouragement of health professionals, and the social characteristics of parents determine their adherence to both the frequency per week, and duration per session, to support and lead children with developmental disabilities. Providing information during clinical encounters, advising how to include exercises into the daily routine, and checking skills and commitment during follow-up represent practical targets for clinicians aiming to improve the frequency of home exercise periods for children with developmental disabilities. 9
HELPING KIDS WITH DISABILITIES TO EAT WELL
Because it can be harder for children with disabilities to get enough physical activity, it's even more important for their health that they eat nutritious foods. "Generally, children with a disability do not need to eat differently from children without a disability." 8 • Some children with disabilities have difficulties with the physical act of eating and drinking. These difficulties may affect both how much they eat and drink and the kinds of food and drink they have.
ANCHORS AWEIGH: No matter your child's age or level of mobility, doing some activity will really help. Simple activities that do not demand complex skills and have few rules are best.
• Some of the difficulties may have to do with the muscles involved in eating and drinking or coordination problems. • Some disabilities, such as autism, have an increased risk of food sensitivities. 8
TIPS FOR EATING
• "Involve your child in menu planning and food preparation • Provide healthy alternatives to junk food • Consider vitamin and supplements if you child is a fussy eater. • It's always best to consult a health professional first." 8
FINALLY, IF YOU ARE UNSURE OF ALL THE ABOVE
There are always the 10 top unusual questionable reasons we're so fat. 1. Inadequate sleep: Much previous research has shown that sleep deprivation causes us to gain weight 2.Endocrine disruptors: There are substances in some foods that may increase fats in our bodies. 3.Nice temperatures: The air conditioner and furnace mean we don't burn calories i.e. sweating and shivering 4.Fewer people smoke: While no one is saying you should smoke to lose weight, smoking does suppress the appetite. 5.Medicine: Some prescription medicines may lead to weight gain. Who doesn't have a prescription these days? 6. Population changes: In addition to the aging baby boomers, the nation has seen an influx of immigrants, especially Hispanics, who have higher obesity rates. 7.Older birth moms: When older mothers give birth, they tend to have heavier children. 8.Genetic influences: Genetic influences during pregnancy mean fatter babies. 9.Darwinian! Fat people survive longer than skinny people. 10. Assortative mating: "Like mating with like" This is "rude" but means that fat people marry and procreate with other fat people. Eventually this skews the population toward being heavier. P.S. Another way to get your child to be more active is to get moving yourself. Multiple studies show that when parents become phyically active, the same occurs with their children and teenagers. So play tag, frisbee after dinner or whatever physical activity you prefer. And also consider a puppy. A 2013 study reported that children in homes with dogs were significantly more active than other youngsters. – "Fitness for Everyone". NY Times Magazine June 3, 2018, Pg 48.
ABOUT THE AUTHORS: H. Barry Waldman, DDS, MPH, PhD is a SUNY Distinguished Teaching Professor, Department of General Dentistry, School of Dental Medicine, Stony Brook University, NY. Rick Rader, MD, FAAIDD, DHL (hon) is Director of Habilitation Center, Orange Grove Center, Chattanooga, TN. He is Exceptional Parent Magazine's Editor in Chief. Andrew G. Schwartz, DDS, FACD is a Clinical Assistant Professor, Director, Division of Behavioral Sciences and Practice Management Department of General Dentistry, School of Dental Medicine, Stony Brook University, NY. Steven P. Perlman, DDS, MScD, DHL (Hon) is Global Clinical Director, Special Olympics, Special Smiles Clinical Professor of Pediatric Dentistry, The Boston University Goldman School of Dental Medicine.
References 1. WHO. Global action plan on physical activity 2018-2030. Available from: apps.who.int/iris/bit- stream/handle/10665/272722/9789241514187-eng.pdf?ua=1 Accessed June 20, 2018. 2. Agency for Healthcare Research and Quality. Increased physical activity for kids would have health and economic benefits. Available from: ahrq.gov/news/newsletter/e-newsletter/567.html Accessed June 19, 2018. 3. Reinehr T, Dobe M, Winkel K, et al. Obesity in disabled children and adolescents: an overlooked group of patients. Deutsches Arzteblatt International 2010; 107(15):268-275. 4. Rimmer JH, Rowland JL, Yamaki K. Obesity and secondary conditions in adolescents with disabilities: addressing the needs of an underserved population. Journal Adolescent Health, 2007; 41(3):224-249. 5. Abeysekara P, Turchi R, O'Neil M. Obesity and children with special healthcare needs: special considerations for a special population. Current Opinions in Pediatrics. 2014; 26(4):508-15 6. O'Brien TD, Noyes J, Spencer LH, et al. 'Keep fit' exercise interventions to improve health, fitness and well-being of children and young people who use wheelchairs: mixed-method systematic review protocol. Journal Advanced Nursing 2014;70(12):2942-51. 7. My Child Without Limits.org. Physical activities for children with disabilities. Available from: mychildwithoutlimits.org/act/family-life/physical-activities-for-children-with- disabilities/Physical Activities for Children with Disabilities Accessed June 19, 2018. 8. Raising Children Network. Eating and exercise for children with disabilities. Available from: http:/raisingchildren.net.au/articles/disabilities_eating_exercise.html Accessed June 20, 2018. 9. Medina-Mirapeix F, Lillo-Navarro C, Montilla-Herrador J et al. Predictors of parents' adherence to home exercise programs for children with developmental disabilities, regarding both exercise frequency and duration: a survey design. European Journal of Physical Rehabilitation Medicine 2017;53(4):545-555. 10. Simons M, Chinapaw MJ, van de Bovenkamp M, et al. Active video games as a tool to prevent excessive weight gain in adolescents: rationale, design and methods of a randomized controlled trial. BMC Public Health 2014;24(14):275.