Physical activity (PA) is a key component in the prevention and treatment of childhood and adolescent obesity . Being active is vital for young people’s overall health and wellbeing. Health professionals are in a prime position to support young people to be more active within the context of their family, social and school life.
Strategies to promote and maintain physical activity
Seek to understand current levels and types of PA undertaken by the child and family in a range of settings, e.g. home, community, school, transport.
Strategies should target the family’s physical activity level, not just the child.
Consider the unique enablers, barriers and preferences to commencing and maintaining activity for the child/family unit.
For those doing no or little PA, start slowly and build over time in duration and intensity. Educate the child on how to pace effectively.
Sports, games, free play and other age appropriate activities are effective ways to increase moderate to vigorous physical activity in children.
Consider activities/programs that offer variety and capture the interest of the child e.g. rock climbing, water sports, yoga, active gaming.
In young people that enjoy/ want to participate in team or competitive sports, this is a good option for them and should be encouraged.
Use of modified PA types in those that need such adjustments (see modifications).
Safety considerations for exercise in overweight or obese children and adolescence
Screening for readiness to do PA, e.g., Physical Activity Readiness Questionnaire for Children (PARQ-C).
Initial assessment should involve a screen for relevant orthopaedic history, the presence of pain/discomfort and the presence of gait or functional impairments.
Physiotherapy assessment is warranted where musculoskeletal issues are identified.
Obesity is inversely related to cardiorespiratory fitness; activities may require modification, such as allowing regular breaks.
Other comorbidities in children and adolescents with obesity such as asthma, hypertension and insulin resistance are potential exercise-limiting factors.
Activities involving vertical lifting of whole body weight and weight bearing exercise may be very difficult, and associated with pain. This may negatively influence a child’s experience and likelihood of continuation.
Making a physical activity plan
The goals of a PA plan should be to have fun, increase physical activity energy expenditure (PAEE), and to improve exercise tolerance. When developing PA plan for child and family, consider the following :
- The child should be actively involved in decision making
- Activities perceived as fun/enjoyable should be targeted
- Where possible, ensure child is being active with someone (siblings, parents, friends)
- Activities should be tailored for age, gender and preferences of child/family; as well as socioeconomic and access factors (e.g. environment, cost, availability)
- Activities should be adjusted for individual ability and physical barriers
- Use age appropriate National PA Guidelines as basis
- Use problem solving approach to overcome child/family barriers to engaging in PA
- Encourage parents and families to do activity outside of any PA program
- Activities should have a background focus of acquiring foundational motor skills
Modification of physical activities
Children identified as having physical constraints or those who are very obese and currently doing no or little activity, modified non-weight bearing exercise may be an appropriate starting point.
Start slowly and build over time.
Allow frequent breaks/rests and water during activity as needed.
In young people with obesity (> 95-97th percentile BMI) primarily non-weight bearing: swimming, cycling, strength or aerobic circuit training, rowing ergometer, recline biking and interval walking.
In young people with severe obesity (> 97th percentile BMI) non-weight bearing only: recline cycling, stationary cycling, rowing ergometry, seat (chair) aerobics, seated and lying circuit training and swimming are suitable activities.
In addition, children with severe obesity may not wish to use a public swimming area. If available, hospital hydrotherapy facilities or investigating private pool use may be an option.
National Physical Activity Guidelines summary
Babies (< 1 year)
Physical activity: Being physically active several times a day in a variety of ways, particularly through supervised interactive floor-based play, including crawling; more is better. For those not yet mobile, this includes at least 30 minutes of tummy time, which includes reaching and grasping, pushing and pulling, spread throughout the day while awake.
Toddlers (1 – 2 years)
Physical activity: Toddlers should spend at least 180 minutes in a variety of PA, including energetic play, spread throughout the day; more is better;
Sedentary behaviour: Not being restrained for more than 1 hour at a time (e.g., in a stroller, car seat or high chair) or sitting for extended periods. For those younger than 2 years, sedentary screen time is not recommended. For those aged 2 years, sedentary screen time should be no more than 1 hour; less is better. When sedentary, engaging in pursuits such as reading, singing, puzzles and storytelling with a caregiver are encouraged;
Sleep: 11 to 14 hours of good quality sleep, including naps, with consistent sleep and wake‑up times.
Pre-schoolers (3 – 5 years)
Physical activity: At least 180 minutes spent in a variety of PA, of which at least 60 minutes is energetic play, spread throughout the day; more is better.
Sedentary behaviour: Not being restrained for more than 1 hour at a time (e.g., in a stroller or car seat) or sitting for extended periods. Sedentary screen time should be no more than 1 hour; less is better. When sedentary, engaging in pursuits such as reading, singing, puzzles and storytelling with a caregiver is encouraged.
Sleep: 10 to 13 hours of good quality sleep, which may include a nap, with consistent sleep and wake‑up times.
For more, read the National Physical Activity and Sedentary Behaviour, and Sleep Recommendations for Children (Birth to 5 years)
Children and young people aged 5 – 17 years
Physical activity: Accumulating 60 minutes or more of moderate to vigorous physical activity per day involving mainly aerobic activities. Several hours of a variety of light physical activities; Activities that are vigorous, as well as those that strengthen muscle and bone should be incorporated at least 3 days per week. To achieve greater health benefits, replace sedentary time with additional moderate to vigorous physical activity, while preserving sufficient sleep.
Sedentary behaviour: Break up long periods of sitting as often as possible. Limit sedentary recreational screen time to no more than 2 hours per day. When using screen-based electronic media, positive social interactions and experiences are encouraged.
Sleep: An uninterrupted 9 to 11 hours of sleep per night for those aged 5–13 years and 8 to 10 hours per night for those aged 14–17 years. Have consistent bed and wake-up times.
For more, read the National Physical Activity, Sedentary Behaviour, and Sleep Recommendations for Children and Young People (5-17 years).
See the Growing Good Habits Get your family moving resource for families for more physical activity suggestions.
- Moore, J.B., et al., Physical activity and family-based obesity treatment: a review of expert recommendations on physical activity in youth. Vol. 8. 2018: Growing good habits has been developed by Children’s Health Queensland in collaboration with the Queensland Child and Youth Clinical Network, Preventive Health Branch, The University of Queensland.Clinical Obesity.
- O’Malley, G. and D. Thivel, Physical Activity And Play In Children Who Are Obese, in The ECOG’s eBook on Child and Adolescent Obesity, M.L. Frelut, Editor. 2015: ebook.ecog-obesity.eu.