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Decreased physical activity (PA) and increased sedentary behavior are major factors affecting overweight and obesity rates for all American children and adolescents. These behavioral changes have ultimately affected the musculoskeletal health and function for all American children and adolescents. In addition, these obesity trends have negative health effects of cardiovascular disease, metabolic syndromes, and decreased physical functioning, which last into adulthood (Ogden, Carroll, Curtin, Lamb, & Flegal, 2010). Overweight and obesity form the most significant future healthcare risks for children and adolescents in the United States. Furthermore, children with special healthcare needs, such as physical disabilities, face additional threats to their musculoskeletal health.



The National Association of Orthopaedic Nurses (NAON) promotes supporting the musculoskeletal health of children through 60 minutes of daily PA for all children and adolescents, including those with special healthcare needs. Physical activity should focus on a combination of (1) moderate to vigorous intensity of aerobic PA at least 3 days a week, (2) 3 days a week of muscle strengthening such as gymnastics or pushups, and (3) 3 days a week of bone strengthening PA such as running or jumping rope.



Obesity Rates

In 2007-2008, 32% of children and adolescents (age 2-19 years) were at or above the 85th body mass index percentile, 17% were over the 95th, and 12% were over the 97th percentiles (Ogden et al., 2010). Overweight is defined for children and adolescents as a body mass index for age at or above the 85th percentile.


Trajectory of PA for Children

The years prior to puberty are crucial for promoting good musculoskeletal and cardiovascular health by establishing patterns of PA. This time period represents formative years in the lives of children when they are open to developing optimal health and wellness practices, set patterns of PA, and provide an opportunity to teach and influence children to be physically active and prevent overweight (Katz et al., 2005).


Preschool, school-aged children, and adolescents experience less than recommended levels of PA, and additionally older children and adolescents near puberty experience increased sedentary behaviors (Epstein, Roemmich, Cavanaugh, & Paluch, 2011). Promoting PA for adolescents is complicated by a natural desire for sedentary behaviors. These behaviors require parents and nurses to employ different behavioral strategies to promote PA.


Children's and adolescents' desire to participate in team PA can change over time. Promoting PA as an individual goal focusing on strength and endurance, rather than team competition, is more likely to encourage patterns that last into adulthood. Nurses promoting increased activities should focus on the child/adolescent's personal preferences to facilitate continued participation in physical activities.


Being physically active is an important part of the development of a child's or adolescent's future concept of self and their beliefs of self-competence, as much as it is a vital health promotion activity to prevent overweight.


Parents' level of PA correlates to their child's levels of PA (Gentile et al., 2009). The orthopaedic nurse cannot ignore that the most influential factor on a child's level of PA is their parent's level of PA. Promoting PA for children also must address promoting PA for their parents.


Anticipatory Guidance From Orthopaedic Nurses

Anticipatory guidance is a model of clinical practice that prepares families for future encounters and is a clinical responsibility for all healthcare providers. Orthopaedic nurses are vital partners in teaching about environmental and developmental factors that promote musculoskeletal health.


Anticipatory guidance involves prioritizing problems that need to be addressed and sensing signals that may indicate receptiveness or readiness to change by assessing responses to open-ended questioning. Orthopaedic nurses should encourage conversations, shared goal-setting, and interventions to best prepare parents and children for anticipated developmental changes that affect their participation in PA.


Recommendations for Promoting PA


1st: Assess the child's level of PA at every healthcare visit with special attention to those who have barriers to PA or excessive levels of sedentary behavior.


2nd: Use a counseling approach based on the parent and child's current activity levels and readiness to change to promote shared goals.


3rd: Give a "prescription" of PA based on shared parent, child, and nurse goal-setting. Identify benefits of PA, past successes, and identified barriers to PA.


4th: Create a social climate for PA in your own practice. Be a good role model. Promote PA with educational material, videos, magazines, and posters in your clinics. Be positive when talking to clients about PA, and focus on physical function and strength and less on weight.


NAON promotes a prevention model of care through a focus on promoting PA and optimizing musculoskeletal health during each and every healthcare visit, supporting the presence of expert orthopaedic nurses in healthcare visit interactions and holistic assessments of clients encompassing health promotion and disease prevention.




Epstein L., Roemmich J., Cavanaugh M., Paluch R. (2011). The motivation to be sedentary predicts weight change when sedentary behaviors are reduced. International Journal of Behavioral Nutrition & Physical Activity, 8, 9. [Context Link]


Gentile D., Welk G., Eisenmann J., Reimer R., Walsh D., Russell D., Fritz K. (2009). Evaluation of a multiple ecological level child obesity prevention program: Switch what you do, view, and chew. BMC Medicine, 7, 49. [Context Link]


Katz D., O'Connell M., Yeh M., Njike V., Anderson L., Cory S., Dietz W. (2005). Public health strategies for preventing and controlling overweight and obesity in school and worksite settings: A report on recommendations of the task force on community preventive services, 54(RR10), 1-12. Retrieved February 1, 2012, from[Context Link]


Ogden C., Carroll M., Curtin L., Lamb M., Flegal K. (2010). Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA, 303(3), 242-249. [Context Link]