BOSTON – Writing an exercise prescription for obese children may not be child’s play – but it’s not brain surgery, either.

With a basic physical, some creative thinking, and a few caveats, obese children can safely tolerate 60 minutes of moderate to vigorous exercise every day. The rewards can be not only physical, but also psychosocial, as children build self-confidence and friendships.

But it’s not quite as easy as turning kids loose on the playground, Dr. Blaise A. Nemeth said at theannual meeting of the American Academy of Pediatrics.

Obese children have an increased risk of fractures and knee injuries, so pain complaints should be taken seriously, said Dr. Nemeth of the departments of pediatrics and of orthopedics and rehabilitation at the University of Wisconsin, Madison.

An obese child who presents with knee or hip pain may very well have a slipped capital femoral epiphysis. "Have a low threshold for ordering radiographs for the hips to assess this," he said. "It should be the first consideration in an overweight child," who presents with a limp or hip or knee pain.

Fractures also can be an issue with increased exercise. Since obese children aren’t as agile as nonobese kids, they are more prone to falling while exercising. Poor bone quality caused by diet or sedentary lifestyle means that fractures are more likely in a fall. The overlying adipose tissue also can make fracture diagnosis a bit tougher.

Ironically though, increased exercise is one of the best ways to reduce the fracture risk associated with obesity, he said. Exercise improves bone quality; increases muscle strength and coordination; and promotes weight loss – all of which positively affect fracture risk.

Writing an exercise prescription for these children is a three-step process:

• Obtain a baseline health status. A complete physical will identify any reasons to restrict or modify activity. It also provides a jumping-off point for tracking improvement. When children can see their progress on a chart, it helps motivate them to do more.

• Obtain a baseline fitness status. Exercise testing in a lab or under the eye of a trainer gets everyone on the same page with goal setting. It’s important to set reasonable goals, to maximize motivation by achievement, and to minimize discouragement through failure.

• Maintain follow-up visits. Don’t let go of your patient. Regular visits let you monitor health improvements and identify potential problems, like musculoskeletal issues.

Since most pediatricians’ offices don’t come equipped with a gym, it’s crucial to know your community resources. Help children pair up with a coach or trainer who can focus on strength and conditioning, or sport programs. Community centers will probably offer low-cost activity programs and often have a certified trainer on board. Obesity clinics usually offer exercise programs under medical supervision.

But remember, Dr. Nemeth said, that some community or private fitness facilities have age restrictions. "Usually a doctor’s prescription will provide an exception to this," he said. Some facilities and programs require parental involvement or adult supervision, especially for younger children.

It’s also important to fit the program to the child. "Group activities might be motivating, or they might be intimidating," for an obese child.

11/11/11  

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FROM THE ANNUAL MEETING OF THE AMERICAN ACADEMY OF PEDIATRICS

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