Docs should screen kids' daily physical activity as a 'vital sign' for health

Monday, November 12, 2018 3 p.m. CST

By Rob Goodier

(Reuters Health) - More than half of U.S. children may not be getting the recommended amount of physical activity and doctors can help by making exercise one of the "vital signs" assessed in routine health checks, researchers say.

"We need to start asking children and their parents questions about physical activity on a routine basis. Exercise guidelines for families should be specific, and education about what counts as 'moderate to vigorous physical activity' should be included," said the lead author of a study presented November 3 at the American Academy of Pediatrics annual conference in Orlando, Florida.

Julie Young, an athletic trainer at Nationwide Children's Hospital Division of Sports Medicine in Dublin, Ohio and her colleagues reviewed electronic medical records of 7,822 children ages 5 to 18 in their hospital's pediatric sports medicine clinic, who were asked about their physical activity by their doctors. One of the researchers' goals was to understand whether kids were meeting physical activity guidelines.

They found that 5 percent of the children were completely inactive, registering zero minutes of exercise per week. Nearly 50 percent were not active enough to meet guidelines, exercising less than the recommended 420 minutes per week. The remaining 45 percent of patients were sufficiently active, exercising more than 420 minutes per week.

Further questioning revealed that even the group getting sufficient physical activity still fell short in one sense. Only about 12 percent of the active kids, or 5.2 percent of the total study group, got the recommended 60 minutes of activity each day, while the rest were getting longer bouts of activity on fewer days per week. Exercising longer and for fewer days puts these kids at risk for burnout or repetitive injury, the researchers said in a statement.

Other notable findings include further evidence that boys exercise more than girls. The boys in this study averaged 61 minutes more exercise per week than girls, and as a result were 39 percent more likely to meet the guidelines.

The difference in activity levels between boys and girls was mostly a result of the number of days per week kids participated in physical activity, Young noted.

Another insight from the study is that physical activity appears to increase with age, with younger kids reporting the least exercise.

"While pediatricians often ask if children are physically active, many don't ask specifically if children are meeting current exercise guidelines of 60 minutes on daily physical activity," Young told Reuters Health in an email.

"There are vast benefits of physical activity," she added. "Children who are physically active are more likely to be active as adults - lifelong (physical activity) can decrease risks of common diseases."

"To me, the important finding is that older kids are more active," said Dr. William Phillips, who wasn't involved in the study. "This may be due to the greater availability of school related sports programs which may be less costly than many of the 'private' sports leagues/programs that younger children participate in," said Phillips, a pediatric orthopedic surgeon at Texas Children's Hospital in Houston.

"Defining a child's activity level as a 'vital sign' is a great way to emphasize its importance," Phillips said.

SOURCE: American Academy of Pediatrics National Conference & Exhibition, November 3, 2018.

Student-athletes given more access to mental health services

10/22/2018, 12:42pm

Eric Neugeboren | For the Chicago Sun-Times

As a high school swimmer, Northwestern University senior Jack Thorne was a three-time Colorado state champion and the No. 2 swimming recruit from the state. In college, he participated in U.S. National Swimming competitions and had a top 20 time at the 2018 Big Ten Championships.

But outside the swimming pool, Thorne has experienced anxiety and depression since middle school, when he first began to think about his homosexuality. During his freshman year in college, he suffered a tear in his shoulder, causing him to miss the rest of the swimming season, go on antidepressants and stop going to classes. Thorne described this time in his life as “rock bottom.”

Though he began seeing a psychologist in his senior year of high school, it wasn’t until Northwestern connected him to an athletic trainer who focused on both his physical and mental health that he saw long-term improvements with his mental health symptoms.

“I was in a really dark place,” Thorne said. “I thought about hurting myself and I’m glad I got help when I did. There was a point when it was starting to really negatively affect my future.”

To assist athletes like Thorne, college athletic departments are connecting athletes to mental health resources at higher rates than ever. A 2016 National Institutes of Health study found that nearly 135 Division I programs had a mental health clinician, compared to the fewer than 25 programs that had a clinician in 2014, according to ESPN.

Thorne isn’t alone in his experiences with mental health. A University of Michigan study found that while 33 percent of college students have symptoms of anxiety and depression, only 10 percent of student-athletes seek help.

“With a culture of sport, there’s this ethos of invulnerability that ‘I don’t want to let anybody see any kind of weakness I might perceive of myself,’” Ohio State University sports psychologist Jen Carter said. “That culture of toughness can be a barrier in dealing with mental health for student-athletes.”

The college-level efforts mirror what’s happening in professional sports. The NBA recently announced the creation of a new position, the director of mental health and wellness, to run a new independent wellness program.

The new director, William Parham, said he’s focusing on four main aspects in his new role: creating a network of mental health professionals in each NBA city, establishing a mental health hotline for players to access, starting a campaign to educate players on mental illness and available resources and developing relationships with players. He agreed with Carter, saying athletes typically aren’t comfortable discussing mental health.

“My goal is to start a national conversation about mental health awareness and demystify the current thinking about mental illness,” Parham said. “Mental health and wellness is a human situation and condition. When you add a dimension of celebrity or the status of these players, there’s even more incentive to keep things packed in.”

Parham’s appointment comes as high-profile NBA players, such as San Antonio Spurs guard DeMar Derozan and Cleveland Cavaliers forward Kevin Love, have spoken publicly this year about their experiences with anxiety and depression.

Love, who suffered a panic attack during a basketball game last November, opened up about his struggles in an article for The Players’ Tribune, a medium for athletes to write about feelings and experiences.

“Coaches, trainers and nutritionists have had a presence in my life for years,” Love wrote. “But none of those people could help me in the way I needed when I was lying on the floor struggling to breathe. The biggest lesson for me since November wasn’t about a therapist — it was about confronting the fact that I needed help.”

Justin Anderson, the founder of Premier Sports Psychology and the sports psychologist for the University of Minnesota, said the efforts have been “really positive for mental health and treating mental health.”

“You look at these all-stars and players that others look up to and think, ‘If it can happen to him, it can happen to me,’” Anderson said. “So that’s really helped and the NBA has taken notice of that.”

Thorne, the Northwestern swimmer, echoed Anderson’s beliefs, saying the NBA players’ posts inspired him to do the same.

“Using that platform doesn’t only destigmatize it but also normalizes it,” Thorne said. “It shows kids that dealing with the issues doesn’t make them a freak, doesn’t make them weird, doesn’t make them dangerous. I really wanted to be a role model and someone I didn’t have when I was growing up.”

The increase in mental health resources has also been spurred by more student-athletes demanding help, Anderson said.

“At the collegiate level, it’s more about overwhelmed counseling centers and coaches starting to say ‘we have people here that aren’t doing so well and we need that support and we need that support now,’ ” Anderson said.

The trend has trickled down to the high school level, too. High schools across the country are providing their student-athletes with more mental health resources, including a focus on resiliency skills. Anderson said his company’s client base, comprised mostly of high schools, has at least tripled in recent years.

But while some say the stigma has decreased over the years and point to the increase in resources, many people are still hesitant to admit mental health struggles, said Jenelle Gilbert, professor at California State University Fresno’s department of kinesiology.

“There’s still a huge group of people who are not being serviced,” Gilbert said. “Sometimes a coach thinks that if you’re working on the mental game, there’s something wrong with you. Parents don’t see the value in it, and they think their kids should be able to focus and cope with their anxiety.”

Not all professional sports teams have taken a stance in addressing mental health and the nearly 135 programs that have full-time clinicians represent only 39 percent of all Division I schools, meaning there’s more work to be done.

“We have two psychologists that work with athletics and I think that’s really helpful,” Thorne said. “While I think not every program needs one, I think having a few designated psychologists to work with student-athletes is really helpful.”

Still, all expect the trend of providing more mental health resources to athletes to continue.

“Everybody’s getting coached very similarly in terms of technique and conditioning,” Anderson said. “The one area that’s still gray is the mental side. That’s really what’s setting the greatest players from the not greatest players in many sports. More people are looking at it. It’s here and it’s here to stay.”

Eric Neugeboren is senior at Walt Whitman High School in Bethesda, MD.