November 2009 Issue

Physical Activity for Toddlers
By Michele Silence, MA
Today’s Dietitian
Vol. 11 No. 11 P. 50

Suggested CDR Learning Codes: 3020, 4000, 4010, 4020, 4030, 4060, 4150, 5070, 6000, 6040; Level 1

Every health professional is concerned with the current state of young children’s health. Small children are being diagnosed with adult-onset diabetes and have numerous risk factors for heart disease. The childhood obesity rate is rising exponentially: Estimates indicate that four times as many children are obese now as in the 1960s.

The reasons for these problems are not difficult to discern. Fast-food and processed food sales are higher than ever and portion sizes continue to grow. Children not only eat differently than in years past, consuming more fat, salt, and sugar, but they are also less active. Parents no longer feel safe allowing their children to walk to school or play freely afterward. Kids have a plethora of sedentary attractions to keep them indoors.

While we must address the dietary issues, it is also vital to add regular physical activity to even very young children’s daily routine. This article will help dietitians recognize the capabilities of very young children to participate in regular exercise programs.

More than a few studies have shown that adding exercise to healthy eating is more effective in weight loss and weight control for children than using either approach alone.1-4 In fact, some researchers suggest that diet alone is the least effective method when comparing diet, exercise, and combination approaches.5

Unfortunately, most adults start thinking about helping children develop fitness habits after they’ve already become accustomed to inactive lifestyles. To truly change children’s health and steer them down the path to lifelong health and well-being, professionals should encourage parents to introduce physical fitness while their children are toddlers. Every major health organization—from the American Heart Association to the American Academy of Pediatrics—emphasizes that programs initiated during the preschool years hold the most promise.

Getting young children to achieve the recommended amount of daily exercise is not difficult. According to the National Association for Sport and Physical Education, preschool-aged children need between 30 and 60 minutes of planned exercise daily.6 And, even more importantly, young children should not be inactive for more than one hour at a time. That eliminates long hours spent watching television or playing computer games.

When working with children to develop healthy eating habits, professionals need to add exercise to the plan. For those without a fitness background, determining just what type of exercise to incorporate can be perplexing, especially when trying to design a motivating program or recommend effective exercise for parents to administer at home.

Toe touches and running around the playground will do little to help control children’s weight or reverse other risk factors for serious diseases. Effective exercise sessions must address important fitness components. The following items cover these essential components, which should be introduced now to have maximal lifelong effect. When implementing or recommending a fitness regimen for toddlers, be sure to include suggestions for how to cover each of these areas.

Warming Up
It’s common knowledge that people need to limber up prior to engaging in physical exertion, but adults often forget that children also need to warm up before exercising. Children may seem like little bundles of energy, but that doesn’t mean they’re ready for sudden bursts of exercise or strenuous activity without proper preparation.

There are several points to keep in mind regarding children’s warm-ups:

• Increasing blood flow is the goal. Children should gently move all of their muscles and joints—gently being the key word. At this point, they should avoid running, jumping, and fast-paced, strenuous movements. Fluid, rhythmic motions gradually help blood pump faster, allow the muscles to bathe in the warm blood, and prepare the body for a solid, well-rounded workout.

• Ensuring children warm up adequately (and to the extent that they break a sweat) is important. Taking an energetic walk through the park or playing a game in which they imitate a variety of animals is all they may need to ready their bodies for activity.

• Children should reserve stretching exercises for the cool down at the end of the workout, after their muscles are thoroughly warm, so as to fully elongate muscles.

Children are not simply “little adults”; they have unique needs in terms of their body physiology, which causes them to respond differently to exercise. Keep the following factors in mind when incorporating fitness ideas into programming for young children:

• Children tend to hyperventilate easily because they generally breathe more rapidly than adults.

• Although children have the same number of sweat glands as adults, they do not produce as much sweat per gland and, as a result, are more sensitive to hot environments. They heat up faster and cool down slower. By the time you notice a child sweating, he or she is most likely overheated.

• Children become fatigued sooner than adults when exercising in the heat.

• Children’s anaerobic threshold is higher than adults' anaerobic threshold.

• Children’s resting heart rate starts out high and gradually lowers with age.

• Energy expenditure is much higher in children than in adults. Children do not know the meaning of “pace yourself.” They have one exercise intensity, and it’s called “high.”

• Children’s bones often grow at a pace much faster than muscle and connective tissue, which means that warming up and stretching are vital to prevent muscle pulls and injuries. Children aged 4 to 5 are not as flexible as children who are only one year younger.

• Children’s lower body strength is proportionately weaker than that of adults.

• Younger children do not have the oxygen uptake that older children have. Older children have the benefit of larger muscles, organs, blood volume, etc.

• As children grow, their resting metabolic rate increases.

• Even at the earliest ages, there are gender differences in VO2 max, lung volume, oxygen demand during exercise, and lean body mass. All figures are greater for boys.

• Based on biopsies, researchers believe that children have more slow-twitch muscle fibers than adults.

Sports Skills
Exposing children to various sports skills is very important, as these skills are necessary for competency in almost all future physical activity and provide children with the confidence to participate in a wide variety of fitness activities.

The public is inundated with sports, and the skills that professional athletes display can make fantastic feats appear simple to children. The example of adults paying rapt attention to televised sporting events is not lost on children and can fuel their youthful drive to excel. However, pushing organized sports is not an ideal way to motivate young children to engage in lifelong physical activity. In fact, forcing young children to compete may be psychologically detrimental.7

Children can certainly develop sports skills in the absence of score keeping. Preschoolers need more practice and less performance-based training. It shouldn’t matter whether they hit the ball every time, as long as they can connect with it most of the time. Hitting for distance or kicking a ball into the goal should not be a concern. Children aren’t yet able to be entirely accurate with these new skills. What’s more important is that they have fun with the activity; if they do, they’ll want to repeat it.

When teaching sports skills to young children, remember that variety is crucial. Research supports the contention that a critical period exists for children to develop and become truly proficient with sports skills. After that critical time frame—from the ages of 2 to 5—their learning is slower, resulting in inadequate hand/eye or foot/eye coordination skills. It’s easy to see why adults who missed this period may not be interested in attempting certain sports, fearing they will appear inept. Their embarrassment may lead them back to where they feel most comfortable: in front of the TV.

Utilize as many different types of sports skills as possible. Children love bouncing balls, striking balloons, throwing bean bags, catching hacky sacks in scoops, and playing mini-broom ball. These activities can teach them the basics for developing confidence and coordination.

Although all children develop at different rates, the chart below provides examples of what a typical child may (and may not) be able to do at a given age. These are not absolutes; some children will develop some motor skills sooner than others. The important thing to remember is to challenge children where their abilities lie while being careful not to frustrate them. Asking children to do what they are not physically able to accomplish leads to frustration and surrender.

Aerobic Exercise
To ensure children develop a healthy cardiovascular system, they should move continuously for at least 20 minutes or more at a time while using the large muscle groups in the legs. Sustained cardiovascular exercise will help them reduce risk factors for heart disease such as high blood pressure, high blood cholesterol, and high resting heart rate.8-11

If you think “aerobics” sounds a little pretentious and serious, recall that most of the games you played during childhood featured aerobic exercise (eg, Hokey Pokey, Chicken Dance, Pop Goes the Weasel). The idea is to add a song or silliness to nonstop locomoting with some type of gross motor skill (eg, tip-toe, march, gallop, hop, skip, run). Children can string together several of these to achieve continuous movement for more than 20 minutes.

Engaging in aerobic exercise is the first step toward lifelong heart health. It’s never too young to start warding off heart disease, since researchers are finding fatty streaks in the aortas of children as young as the age of 2.12 With heart disease killing more people in the United States than almost all other causes of death combined, prevention methods need to start early.

Anaerobic Exercise
The one area of exercise that is often overlooked in children is anaerobic exercise (strength training). Contrary to popular belief, even the youngest of children can benefit from age-appropriate strengthening exercises. Ozman and Robbins found that adding weights to toys is one way to enhance children’s fitness levels.13

Children’s resistance training should not include heavy barbells or weight machines. Common resistance training machines are not designed for small bodies. Exercises for strengthening need to be age appropriate and fun. Preschoolers have great fun shaking 2-liter soda bottles half-filled with colored water, pulling on a tug-of-war rope, and lifting a parachute. Simply using their own body weight can be enough to create a training effect; simple calisthenics such as push-ups, crab walking, squats, lunges, and abdominal crunches help develop more muscle mass, which is instrumental in controlling and reversing obesity. Developing muscle mass at a young age helps children become better calorie-burning machines.

Stretching
When quick bone growth surpasses muscular growth, the result is taut, achy muscles. “Growing pains” are real, though we often use that phrase to describe behavioral stages of life. Having children stretch regularly can help provide relief.

Getting small children to stretch all of the major muscle groups takes imagination and an ability to speak to them at their level. Ask children to roll up “like a rolly bug” to stretch their back, to lie down and extend a leg in the air and then “look into the periscope” to stretch their hamstrings, and to lie on their back and “pretend you’re a pencil” to gently stretch their abs.

Always have children stretch at the end of any strenuous exercise or strengthening work that causes their muscles to contract. They need to elongate all of their muscles not only to alleviate growing pains but also to keep their bodies flexible. A more flexible body recovers better from injuries later in life and is instrumental in lifelong mobility.

Mind/Body Techniques
Adults experience a tremendous amount of stress, and children not only feel their stress but also have their own to handle. Even small children assimilate and act out the stress they feel from their environment and fears. What makes stress so damaging is the constant release of hormones into the body, which wreaks havoc on the immune system and eventually leads to premature organ disease.

Helping children learn how to cope with stress and giving them the skills to diffuse it can help them lead a less stressful life. Teach children the same relaxation techniques that you would teach an adult. They can learn how to calm themselves through guided imagery, progressive relaxation, deep breathing, and focusing on their heart beat.

Family Effort
The core motivation, of course, comes from home. Parents are the most influential role models and determine more than anyone else how active their child will be. To help the next generation grow up more fit than the current one, it will take effort and determination on the part of parents. That’s not always easy, since many parents do not practice healthy lifestyle habits themselves.

Families need motivation to be active with their children—to learn that fitness can be fun, not agony, and to enjoy the myriad benefits that come from spending one-on-one time with children. Parents should learn to work fitness into daily routines. For example, preschool-aged children can help remove rocks while their parents weed the garden or run back and forth to toss those rocks in a special place. Families can start a “no TV night,” when instead, everyone takes a bike ride or walks the dog together. Incorporating physical activity into family holiday routines—when overeating and sedentary activities are typical—can shift the focus to being healthy and active. Gifts should promote physical, not sedentary, activity.

The task of adding in regular exercise is simple and revolves around structured active play. For young children, this equates to fun. Little ones already enjoy being active. To reduce the incidence of serious diseases shortening children’s lives, all health professionals need to integrate in their total program some type of exercise prescription that focuses on keeping children moving in a fun way.

What about older children? Don’t expect children who have been sitting on the couch or in front of a computer screen for the first 10 years of their lives to be ecstatic about getting up and moving. They’ve developed some very unhealthy habits that have already begun to take firm root. Change for older children needs to be motivating and fun, too. Parents should offer rewards at first, set a great example themselves by exhibiting an active lifestyle, and always call attention to the good feelings a trim body and healthy lifestyle create. They should show their children how much they love to exercise and the benefits they receive from it.

Don’t surrender if parents or children meet your attempts with strong resistance. You may be the deciding factor in whether or not a child grows up with a fondness for physical activity and the skills needed to be competent at it. That’s a gift no money can buy and one that lasts a lifetime. It’s also the most beneficial way to help the young ones develop overall health and wellness.

— Michele Silence, MA, is a fitness professional, a trainer, an educator, a studio owner, and a freelance writer serving as an advisory board member for P. E. Central. She is the president and CEO of Aerobic Fitness Consultants and the creator of KID-FIT, physical education classes for preschoolers.

Age-Appropriate Abilities

4 YEARS                                                           5 YEARS
Balances on one foot for 10 seconds                Balances on one foot for 10+ seconds
Bounces ball with two hands, some dribbling   Dribbles a ball
Catches ball with arms bent                             Catches ball more with hands
Dances to specific rhythm inconsistently           Dances in time to rhythm
Hops 5 to 10 times on one foot                        Hops 10 or more times on either foot
Jumps front to back 3 to 8 times                       Jumps front, back, left, right 8 times
Kicks ball for accuracy                                       Kicks ball with back swing and control
Rolls forward from squatting (unassisted)        Rolls forward from walk (unassisted)
Strikes a ball consistently with object               Strikes ball with bat
Leaps/skips                                                       Skips confidently across room
Throws ball 10 ft with body rotation                 Throws ball by stepping first
Volleys balloon from 5 ft                                    Volleys a ball

By the time children leave preschool, they should be able to do the following:
• Sit up from back on floor.
• Hop 25 ft in 10 hops.
• Skip 40 ft.
• Bounce and catch a ball 20 times without a miss.
• Balance on one foot for 10 seconds.

References
1. Bar-Or O, Foreyt J, Bouchard C, et al. Physical activity, genetic, and nutritional considerations in childhood weight management. Med Sci Sports Exerc. 1998;30(1):2-10.

2. Epstein LH, Coleman KJ, Myers MD. Exercise in treating obesity in children and adolescents. Med Sci Sports Exerc. 1996;28(4):428-435.

3. Sothern MS. Exercise as a modality in the treatment of childhood obesity. Pediatr Clin North Am. 2001;48(4):995-1015.

4. Sothern MS, Hunter S, Suskind RM, et al. Motivating the obese child to move: The role of structured exercise in pediatric weight management. South Med J. 1999;92(6):577-584.

5. Epstein LH, Goldfield GS. Physical activity in the treatment of childhood overweight and obesity: Current evidence and research issues. Med Sci Sports Exerc. 1999;31(11 Supp):S553-S559.

6. California Department of Health Services. Obesity Prevention for Health Care Systems: Executive Summary and Literature Review. Sacramento, Calif.: California Obesity Prevention Initiative Health Systems Work Group; 2002.

7. Washington RL, Bernhardt DT, Gomez J, et al. Organized sports for children and preadolescents. Pediatrics. 2001;107(6):1459-1462.

8. Alpert B, Field T, Goldstein S, Perry S. Aerobics enhances cardiovascular fitness and agility in preschoolers. Health Psychol. 1990;9(1):48-56.

9. Shea S, Basch CE, Gutin B, et al. The rate of increase in blood pressure in children 5 years of age is related to changes in aerobic fitness and body mass index. Pediatrics. 1994;(4 Pt 1):465-470.

10. DuRant RH, Baranowski T, Johnson M, Thompson WO. The relationship among television watching, physical activity, and body composition of young children. Pediatrics. 1194;94(4 Pt 1):449-455.

11. Williams CL. Coronary heart disease prevention in childhood part 1: Background and rationale. Med Exerc Nutr Health. 1994;3:194-205.

12. Ozman J, Robbins L. Weighted blocks study. Indiana State University. Presented at the Annual Meeting of the American College of Sports Medicine. Denver, Colo. May 31, 2006.

13. Rosmond R, Lapidus L, Marin P, Bjorntorp P. Mental distress, obesity and body fat distribution in middle-aged men. Obes Res. 1996;4(3):245-252.

Learning Objectives
After completing this continuing education exercise, the student should be able to:

1. Identify six core components of an effective fitness program for preschool-aged children.

2. Know how young children differ physiologically from adults and how those differences will impact fitness programming.

3. Learn a variety of sports skills important for children to develop at a young age.

4. See how physical abilities differ in children aged 2 through 5.

5. Understand the role of the family and the challenges in helping preschool children develop early fitness habits.

Examination
1. Health professionals generally agree that efforts to reduce diabetes, risk factors for heart disease, and obesity hold the most potential when initiated in children of which age group?
a. Newborn to 2 years
b. Preschoolers aged 3 to 5
c. Elementary children aged 5 to 7
d. Older children aged 8 to 10
e. All of the above

2. According to the National Association for Sport and Physical Education, young children should not be inactive for more than how long at a time?
a. 10 minutes
b. 20 minutes
c. 1 hour
d. 4 hours
e. None of the above

3. Excellent exercise(s) for controlling weight is/are:
a. toe touches.
b. stretching.
c. open play on the playground.
d. anaerobic exercises.
e. All of the above

4. Which of the following is true regarding children’s physiology?
a. Their lower body strength compared with adults is proportionally weaker.
b. They have more fast-twitch fibers than adults.
c. Resting heart rates increase with age.
d. Young boys and girls have about the same amount of lean body mass.
e. All of the above

5. Fatty streaks have been found in the aortas of children as young as the age of:
a. 6 months.
b. 1 year.
c. 2 years.
d. 3 years.
e. 5 years.

6. What is the approximate amount of time a child aged 3 should be able to stand on one leg?
a. 10 seconds
b. 8 seconds
c. 5 seconds
d. 2 seconds
e. They are unable to stand on one foot for more than 1 second.

7. The core motivation in sustaining an active lifestyle, especially during the preschool years, comes from:
a. teachers.
b. peers.
c. pets.
d. parents.
e. All of the above

8. Which of the following is true of stress and small children?
a. They act out the stress they experience in their environment.
b. Release of stress hormones is constant as long as the stressor is present.
c. It impairs immune system function.
d. It leads to premature disease of vital organs.
e. All of the above

9. Children need stretching to alleviate:
a. growing pains.
b. stress.
c. fear.
d. overeating.
e. All of the above

10. Adding regular physical activity to a sound nutritional plan will increase the effectiveness of diet alone.
a. True                        
b. False