Deborah Howell (Host): Exercise is one of the greatest joys in life. But are today's children getting enough? And if not, should it be prescribed? Today, Dr. Webb Smith, a Clinical Exercise Physiologist with Le Bonheur is here to tell us how exercise can be an important part of medical treatment plans in children. Welcome Dr. Smith.

Webb Smith, PhD: Thank you for having me.

Host: Boy, this is one of my topics that's near and dear to my heart. So let's dive right in. How much exercise and physical activity should children get each day?

Webb Smith, PhD: The guidelines suggest that children get 60 minutes of physical activity a day, you know, through some combination of movements, that some structured, some unstructured. But really the goal is to get to that 60 minutes per day of physical activity.

Host: Is that more or less than adults should get?

Webb Smith, PhD: The adult guidelines are slightly different. The adult guidelines are 150 minutes per week, but, we consider things like, intensity and those things because, adults are, they move differently. They interact with the world differently than kids. So they try to make it a little bit more conducive to an adult schedule there.

But generally, kids need more physical activity. You sort of hit this on the lead in, but important to keep in mind that exercise and activity are key stimulus for normal growth and development in kids.

Host: For sure. When I was growing up, we played capture the flag and hide and seek. And one day my dad said, I have a surprise. Come on out to the driveway. And he'd drilled a hole in the driveway and then he showed up with a tether ball pole and we played tether ball on the driveway for hours. I mean, he made it fun. So what's the difference between exercise and physical activity?

Webb Smith, PhD: Great question and I think it's one that I don't think that in general people have a great handle on. Physical activity is really any movement of the body, right? So things like tetherball and going for a walk and swimming and just generally moving your body, those things are physical activity.

And they fit in that sort of overarching group. Exercise a more specific case of physical activity where we're really thinking about things like what the activity is, what it's going to do physiology wise, like how it's going to stimulate the body, how intensely we're doing it, the time that we spend. So the duration of the session, and then also how frequently we do it.

So, you know, when we start talking about exercise, we are really thinking in terms of really specific prescriptions where we can measure the effect or we can prescribe it to drive an effect that we want. So exercise is really just a special case of physical activity. 

Host: Okay. Say just, you're doing squats and then suddenly you realize you have more muscles in your legs. Something like that?

Webb Smith, PhD: That's right. So say we, a kid that maybe is not as functional as they want to be. They fatigue really easily when they're doing general activities and they want to try to maybe go do a peer-based sport. When we assess them and we realize, oh, you're not as quite as strong as you need to be to really be successful in this group, then yes, maybe we'd prescribe something like squats, to try to increase, muscular strength or maybe we include like some biking at a certain wattage.

So that we're simulating those activities and making sure that they're well prepared, to meet the demands of, maybe it's an activity of daily living in a child with chronic disease, or maybe it's an athlete who wants to be bigger, stronger, faster than a peer.

I.

Host: Got it. Okay. Can you give us some examples if there are any that come to mind where exercise improves health outcomes in children?

Webb Smith, PhD: Yeah, there are definitely quite a few out there. I think in general exercise, is part of a, of a robust, healthy lifestyle and it can influence general health in a preventative way, which is really important. I think most people are familiar with that, right?

You want to be active and the more active you are, the healthier you are and the, the more active you are, the more activities you can do. When we start talking about improving health outcomes, like maybe we look at something like diabetes or pre-diabetes, where, you know, these you know, if you're diagnosed as a child with diabetes, that's a lifelong condition.

And we can actually prescribe exercise to help regulate glucose control and help improve the quality of your muscle, which actually, you know, research indicates that, that performs as well as our frontline medications, like metformin and some of those things. And in pre-diabetes going from being sedentary you know, not having a very intentional lifestyle, to including those things regularly in your activity can actually prevent the progression of pre-diabetes into diabetes.

Host: Wow, that's incredible. So how do you go about prescribing exercise to children with chronic health conditions? 

Webb Smith, PhD: This always starts, you know, I guess to broaden it a little bit, any exercise plan, whether you're dealing with an elite athlete or a child with chronic disease really starts out the same way and it's to assess where you are, right? If we want to know, how to improve, then we need to make sure that we really understand what your current health related physical fitness is.

So we would do things like measure your aerobic capacity, maybe through a walk test or, maybe a treadmill test. We'd measure body composition so we understand the breakdown of the content of your body. We would do strength assessments and those kind of things. So we really get a complete understanding of where you're starting out from.

And very important. You know, as adults sometimes, you know, we just decide that we're going to around New Year's generally, we're going to try to get healthy and we go hit the gym and then we're sore for two weeks and, don't quite ever get enough steam moving forward to stick to that.

And, you know, if we're really prescribing exercise well, we measure and we assess at the baseline so that we can make sure that we are challenging appropriately, but not overdoing it so we don't have to deal with soreness and potential injury risk and those kind of things. So once you know, in a child with chronic disease, that also includes understanding things like barriers.

You're going to be in and out of the doctor's office, so you've got time demands and effort demands around managing your medical care. So we would consider those kind of things. We'd consider health status. So if you are diabetic and you're taking medications for that, then we want to make sure that we're prescribing exercise to compliment the current medical treatments and not make it be something that becomes another thing that you're trying to manage in a period where you have this new diagnosis and you're really trying to get a handle on all of these things. We can, we can prescribe exercise to be a piece of that and to compliment the medical therapies that are going on.

And so from that, you know, really understanding where we're starting from, then you know, we start writing workouts and laying things out so that we're just taking tiny little stair steps to challenge you and allow your body to respond to it until we build up and get bigger and stronger and faster and hopefully able to do the kind of activities that they want to do. In children with chronic disease, we may also be considering what your lab values are or what other functional things, tasks that you need to do, rather than just really thinking performance space. We may be, you know, trying to help adjust medications and provide feedback to the medical team with information about how you're doing outside of these individual tests that where they only get to see you in a clinic visit.

Host: I'm glad you said things that they are more interested in doing. You do take that into account when you talk to a, a kid saying, well, he hates anything to do with a racket and a ball, but he likes maybe sprinting. Do you tailor it to their preferences?

Webb Smith, PhD: A hundred percent. I think that is the key difference from prescribing exercise in kids to adults because particularly little kids, they kind of do what they want, to a certain extent. So you can try to get them to try and work and if it's something they don't like, then they just kind of don't do it, right. They just sit in the floor and, and stare at you. So it definitely blends what they're interested in with also, often children, are a little naive to some of these things. So maybe we, give them activities that they already know a little bit about, but we're pushing them into sampling new activities so that hopefully, we're not only just reinforcing what they like, but introducing them to new tasks so that they really understand what they like and dislike and how that can all factor in to a really thoughtful plan.

And, you know, I think when I'm working with kids, I'm always thinking ahead to, my goal is to have them be lifelong exercisers. So if we can help the, you know, connect them to a new activity that they really love or, or help them stay engaged because they get bored with one activity by giving them multiple options and some flexibility to explore; I think that's very important. That was the basis of physical education in schools, was that we're going to, you know, introduce you to all these activities, so that you, you have a broad, physical literacy of how your body moves and how to do different tasks.

So, having these different inputs and all I think is critical for kids.

Host: I know a lot of schools are introducing pickleball because it's, uh, you know, easy to learn and I've heard kids say, you know what? I can't stand gym class, but I'll play pickleball all day long.

Webb Smith, PhD: We actually did an adaptive sport event here at Le Bonheur, and we had children of, truly all ability and pickleball was a favorite. Kids in wheelchairs playing and, it really can be adapted. And I think there's a variety of activities there if you're interested in exploring activity, almost all activities can be adaptive, wheelchair basketball, all these things. There's tons of range of, of what can be done. You just end up limited by the creativity of whoever's facilitating.

Host: I have a final question for you. Are there things that parents can do at home?

Webb Smith, PhD: Absolutely. I mean, I think anytime we talk about physical activity and the physical activity guidelines, I think we also have to talk about the guidelines for screen time and sedentary behavior and those kind of things. Because they're really two sides of the same coin, right?

I think when you start limiting screen time to an hour a day, which is the AAP, the American Academy of Pediatrics guideline, that frees up time where you can do other things, and we're not directly competing with, with a device that is perfectly designed to hold your attention.

If we limit those, then there's a greater opportunity to explore some of these things. Obviously, keeping track of sedentary time. School often there's a, a lot of learning time and, and that inherently is sedentary and that's necessary. That's fine. Managing the time outside of that to encourage there to be activity breaks and homework sessions and, you know, in times where they can engage is really a key point.

I think another key point for parents is to model the kind of behaviors, the kind of health behaviors that you want your children to have. So, being active with your kids, if it's playing pickleball or if it's going for a walk as a family, there are a lot of very easy entry points into encouraging activity in your family without having to sort of dictate that and then it can become a family activity where everybody is benefiting from because it's just a modeled part of the family interaction. Those tend to be a little less stressful long-term because then you don't have this power dynamic of you've gotta go do whatever activity. Instead, this is a welcoming thing we do.

So I, modeling some of these behaviors, being intentional about paying attention to how you spend your time and how your child spends your time is also a really key point. Because I think a lot of times there's just people really don't have a good grasp on how much time they're spending doing things.

And, you know, the old saying, what gets measured, gets managed. I think that really applies to physical activity and exercise and sedentary time and those things. If we're monitoring those things then there's a better chance that we're going to be on top of making adjustments when we need to.

Host: Yep. Use it or lose it, but be mindful about how you use it. Right.

Webb Smith, PhD: That's exactly right.

Host: Is there anything else you'd like to add to our conversation before we wrap up?

Webb Smith, PhD: No, I really appreciate you having me. I, I would say if anybody is, sort of struggling in this space, there are lots of qualified exercise professionals that can help. And you know, I think one of my roles with that is often to just facilitate and support parents and, and help them be creative and problem solve some of these things.

So it doesn't necessarily mean that you have to go to the gym and you have to have a trainer right there with you. I think sometimes there are simple solutions here and, and getting with the right person that has experience to help you, work through it and be creative. This really doesn't have to be a burdensome process.

Host: Right on. Well, Dr. Smith, thank you so much for being with us today and shining a light on how beneficial exercise can be for our young ones and for us too.

Webb Smith, PhD: Thank you. for having me today. I appreciate the opportunity to talk about exercise.

Host: It was wonderful. To learn more about Dr. Smith and how he uses exercise as medicine visit LeBonheur.org This is the Peds Pod by Le Bonheur Children's Hospital. I'm Deborah Howell. Thank you for listening and have a great day.