How healthy are America’s children? According to a statement issued earlier today by the American Heart Association (AHA), not very. The authors wrote: “[N]early 60% of American children do not have healthy cardiorespiratory fitness (CRF), a key measure of physical fitness and overall health…” This is cause for concern as an adult’s health can be strongly influenced by their health as a child. In addition, poorer health among children can affect their performance in school and contribute to anxiety and depression, which also can affect their adult lives.

It’s often been said that childhood now is not the same as childhood of our past. Children are less likely or able to play freely outside, to run, cycle, and just burn off a lot of physical energy as they move their body. Much of this has to do with parents trying to keep their children safe and to accommodate everyday life with work, school, daycare and family time. So what can we do to reverse this trend and raise a generation of healthier children?

The researchers evaluated cardiorespiratory (aerobic) health among children, one of four health-related fitness components. The other three aspects are muscular health or fitness, body flexibility, and body composition (mass). “Cardiorespiratory fitness is crucial for good heart and overall health both in childhood and as children become adults,” said Geetha Raghuveer, M.D., chair of the writing committee for the new scientific statement. Raghuveer is a cardiologist at Children’s Mercy Hospital and professor of pediatrics at the University of Missouri in Kansas City. “We’ve got to get kids moving and engaged in regular physical activity, such as in any sports they enjoy. The best activity is the activity a child or teen likes and that is sustained for a longer period. The habits they learn when they’re young will directly benefit their health as they become adults.”

Calls for Regular Cardiorespiratory Fitness Testing

The authors believe that annual cardiorespiratory fitness testing may be a good first step in improving children’s health, aside from actually getting them outside and moving. At this point, the testing is only done if there is a specific health condition. “Every child would benefit from CRF testing as part of a yearly physical and doing so may identify children who would benefit from lifestyle interventions that can help improve health,” Raghuveer wrote. By identifying children at risk, the parents or guardians can take steps to counter the health risks.

Laboratory blood testing can be helpful in determining a child’s health, but what may be more accurate are the in-office tests, such as using treadmills to look at a child’s endurance, physical work capacity (measuring heart rate while doing a task that increases the heart rate), and step tests, to name a few. Self-reported questionnaires, a common way of gathering information, are not good methods for gauging health as they depend a lot on memory.

Things Parents Can Modify and Those They Can’t

Modifiable risk factors are those you can do something about and what parents and guardians should focus on. For example, modifiable risk factors include:

  • Physical activity
  • Diet
  • Sedentary time

Non-modifiable factors are those you have no control over, such as:

  • Ethnicity or race
  • If a child was born premature
  • Age
  • Sex

Parents who enroll their children in organized sports activities may feel they are providing their children with ample opportunity to exercise and play. But organized sports have time limits and they are controlled by adults. The activities don’t often give children the opportunity to break free and play as they wish. In addition, depending on the sport or activity, there may be a lot of sitting and waiting for each child to get a turn. This isn’t to say that organized activities have no value. But they should be an add-on to regular physical activity, not a replacement.

Healthier Living Through Play

Unlike adults who often consciously have to make time to exercise, children have a built-in, natural ability to play physically. Free, unstructured play has been declining since the 1950s, when experts say that parents began taking a more active role in guiding their children’s activities. Peter Gray, PhD, a psychology professor at Boston College was interviewed for the Atlantic article said, “It is hard to find groups of children outdoors at all, and, if you do find them, they are likely to be wearing uniforms and following the directions of coaches while their parents dutifully watch and cheer." He also noted that pre-school and kindergarten, once a time when children were taught to socialize and play in preparation for learning once they entered first grade, are now focusing on academic interests over play value. The Alliance for Childhood says much the same thing in a 2010 policy brief. They call the lack of play a public health issue.

Activity Recommendations

Although activity should start in infancy, the AHA suggests that children aged 3 to 5 years old should be as physically active as possible throughout the day, without a specific target time. Once children turn 6 though, the association recommends at least one hour of moderate to vigorous activity per day, increasing as they age. This exercise should make them sweat and breathe harder, but not so hard that they can’t have a conversation. The time could be broken up between recess, outside activities and scheduled activities, as long as the total is at least 60 minutes. The AHA also recommends that children have a more intense activity at least three times a week, including activities that strengthen bone and muscle.

Examples of vigorous activities include:

  • Running (playing tag, running races, etc.)
  • Jumping rope
  • Playing tennis
  • Swimming laps
  • Hiking
  • Cycling (with effort)

Exercises for bone and muscle include:

  • Tennis
  • Basketball
  • Jumping rope

Exercise for Children with Medical Conditions

Finding exercises for children who live with chronic medical conditions can be challenging, but with some creativity, it is possible. With their physician’s approval, children with health issues should start slowly with different activities and work themselves to a more challenging pace. Any activity they enjoy and can do is helpful, whether it’s participating in a game of wheelchair basketball, or simply going for a hike or swimming in the pool.

Keeping our children healthy helps us all in the future. Physical exercise is a good start.