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Melanie Cole: There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. This is Kid's Health Cast by Weill Cornell Medicine. I'm Melanie Cole, and I invite you to listen in as we discuss how we can help keep our kids active and healthy, even in this time of COVID. The guests in my panel today are Dr. Ben King. He's an attending Pediatrician at New York Presbyterian Weill Cornell Medical Center and Dr. Katherine Yao. She's an Assistant Professor of Clinical Rehabilitation Medicine at Weill Cornell Medicine. Doctors, thank you so much for joining today, Dr. King, I'd like to start with you and as a mother of two kids going through this right now, this topic really centers exactly on what parents are going through right now. Why is participating in physical activity and exercise and organized sports for that matter so important for our children in terms of wellness, especially right now?

Dr. King: Thank you so much for having me. And it's a pleasure to be here with Dr. Yao and to be here as a general pediatrician. To answer that question, it's something that's really important to me, and I'm really happy to be able to talk about it with you. I believe that the lowest hanging fruit for me, and probably the most headline grabbing reason as to why physical activity is so important is the obesity epidemic. Almost 19% of two to 19 year old children are now categorized as obese. And as general pediatricians, we really care about this because it has long-term health implications for our children, as they progress from childhood to adolescence and then into adulthood. And as general pediatricians, we care about a lot. We care about their nutrition, their built environment, genetics, the family units.

We advocate for vaccines, for healthy eating and more and more frequently as a community, we are learning how to better screen advocate and educate for physical activity and exercise. We know that physical activity is something that can improve our patient's body composition can lead to more muscle mass and lead to less fat mass. And the benefits of those are very broad. We can improve cardiorespiratory fitness, lipid levels, insulin sensitivity, ability to handle a glucose from our diet. And then also increasingly we're learning that physical activity and exercise have strong implications for improved behavior, cognition, social and emotional development, as well as academic performance, particularly in the general population, but also for children that may be experiencing ADHD or autism spectrum disorder.

Host: Well then Dr. King, thank you for that answer and sticking with you because I agree with you completely, this obesity epidemic. And now in light of COVID, how have you seen covert affecting our youth and their physical activity levels right now? And sporting events and sports are really, some of them have gone by the wayside. Are there some safe ones for them to play right now? What exercise do you recommend and what have you seen happening with them because of COVID?

Dr. King: So, there have been definite negative impacts on the ability for our children and youth to get involved in physical activity. And we're seeing in relation to the obesity epidemic prior to COVID a big topic of discussion is just increasingly sedentary lifestyles. So the way that we live now does not promote physical activity on a routine basis, and things like technology increasing in screen times less access to physical activity, sports, dance, things of that nature. Unfortunately, the COVID epidemic has kind of magnified the things that limit our patient's ability to exercise and exercise safely. A big part of that would be in schools. So now some places are having limited access to schools, school-based physical activity, and physical education. Anecdotally, we are seeing increased sedentary times increased screen times with the remote learning and decreased physical activity, physical education programs in schools, and ability to access sporting programs safely. There's nothing that has been, that I could find, that's been a published peer reviewed study that has shown increase in weight, kind of on a population level, but there's definitely anecdotal evidence between ourselves caring for patients in this community and strong concerns that the COVID pandemic is going to kind of further amplify the limitations in our children being able to get moving with frequency.

Dr. Yao: And I completely agree with Dr. King there from my clinical practice, I have also been seeing a transition of patients. Previously, children having a lot of sporting injuries from incidents or trauma in sports or overused injuries now to actually more sedentary injuries such as wrist tendonitis from playing video games, instead of playing soccer outside or whatnot. Parents are coming in with a lot of questions asking, how can I get my child more involved with activities? Everything is shut down. They are no longer as interested in it, nor are they able to do it if they want to. And so my best recommendation for those are to really be as creative as they can in terms of sports and physical activity, whatever they can find available outside or within their community to take advantage of whether it's kicking around a ball outside or playing in the park. That as well as getting the child involved with the parents, to have some workouts together, just to stimulate that interest and get things going.

Host: Dr. Yao, is working out, considered a sport? Is it better as an adjunct to a sporting activity for our kids that are not playing sports right now? And as you said, I hear you with the injuries to wrists and video games and that sort of thing. If we want them to be working out, we're doing it for their health, but also to prevent injuries, right? So tell us a little bit about that and how we can get our kids to do some of that.

Dr. Yao: In regards to physical training and working out in relation to sports, I believe it is definitely an important adjunct that is related to all sports and should be done in addition to sports or as potentially an alternative when the sports are not available. Things with cardiovascular exercise, strength training, conditioning, and endurance, all of that is important to do, whether you're an athlete or not, and all of that contributes to the overall health of the child and to a person. And for those who do play sports, having regular training and all of those components will just add to the effectiveness and ability that they will have as an athlete in whichever particular sport they are playing in. In regards to how to get kids motivated to do that, I think it is easier for those who are already participating in sports to be able to emphasize that the strength training and flexibility will help you gain better ability to master those particular skills.

Whether again it is you're doing a backhand spring in gymnastics, swimming that sprint faster than your opponents, or being able to handle the soccer ball better. Those are great motivating factors on how to get kids interested and motivated to do those extra training, cross training skills. For kids who are not so inclined and less interested in sports altogether, we need to still find those motivating factors that will get them going, and it will be unique to each child, but whether it is just, if they're interested in health and wellbeing, letting them know that this will help your overall health for your heart, your lungs, your muscles, or it is something that will bring your energy up and make you happier. Or if it's just, this is something that will let you spend more time with your parents if they're the ones playing it with you or with your friends, we need to find those factors for each individual child.

Dr. King: Thanks Dr. Yao, I agree with all of that. I think, and something I love talking about in my clinical practice is under the umbrella of physical activity, exercise and strength training, and how that can be a part of it. And that's something that the US Department of Health and Human Services and the WHO both agree on. And for kids ages six to 17 should be moving 60 minutes per day, every day, and more is better. And included in those recommendations are that children's from age of six to 17, should have muscle and bone strengthening exercises on average of three days per week. And more is better.

Dr. Yao: Playing on that, I think what parents often times are wanting clarification about in terms of strength, training and weight training and exercise is at what age should they start doing this? And to what extent and how much benefit will it have? And just as Dr. King said, those recommendations are important to keep in mind and that even those children who are pre pubertal, that is before they're going through all of those sex hormone changes, strength training is still a very important as it builds a lot of neuromuscular connections and control. Even though they won't bulk up in muscle, like their post pubertal siblings might both pre pubertal and post pubertal strength training is important, but at the same time, we do want to make sure that the kids are doing it in a safe manner where appropriate supervision is had, and proper technique is had when they are doing it.

Dr. King: Yeah, I totally agree with that. And it kind of brings me to this topic. Something that I've been learning about recently is the concept of what we call physical literacy. And that's in our children, is this fundamental, gross and fine motor movements that are kind of opening doors for physical activity as they progress through life. So the stronger, the more balanced our kids are, the more opportunities they'll have to get involved in activities, sports, dance, theater that involve those neuromuscular movements. And so promoting physical literacy from pediatrics is a really important concept for us.

Host: It's such an interesting topic and to watch what our kids are going through right now. I mean, we're all going through it, right? But it's a little bit harder for our kids and getting them to be active when there isn't that motivation. So I thank you both for talking about that. Are there some things Dr. King, that you might recommend as a pediatrician that you would say, you know, what if your kids really want to play this particular sport right now, I wouldn't really recommend it, or if they do? Because I know even my own daughter wants to do badminton and it's inside and I'm not completely comfortable, as I imagine some parents are not. Are there contact sports that you would say, probably not with COVID or take these precautions, give us some COVID specific precautions for sports that kids might want to be playing now?

Dr. King: That's a really good question and we're getting it very frequently. So the current and best guidelines I think are, it's hard to give a concrete recommendation to each specific family and each specific community and geographic location. It's certainly is a different and evolving picture based on where you are. There's three main things. I think we have to take into consideration when making recommendations to families and their kids. The first is trying to think about, the big thing that we're really talking about is what is, what are the inherent risks of getting reinvolved in sport and how can we best mitigate risks to make it as minimal as possible while still achieving all the benefits of physical activity, of sport, of socialization that are inherent to those activities? So to mitigate the risks, think about it in kind of three different things. And this comes from the latest guidelines from the American Academy of Pediatrics on returning to sport. So the first would be the sport and the setting.

So, you mentioned badminton and being indoors. Yes. Indoors with poorer ventilation is going to make it a bit more high risk than something that's outdoors. So indoors versus outdoors is the first thing to consider. Is it an individual versus a team sport? Is there a lot of shared equipment and what is the duration of the sport or the contact between the individual players? So right now in New York, we're not doing tackle football. For instance, the Fall schools are starting in various locations around the school, but tackle football for instance, is not going to be played this Fall and will potentially be restarted in the spring if things head in the right direction. But things like outdoor soccer are being played and things like individual sports, like golf, track and field activities, and certainly for sports like football or basketball and other higher risk, kind of indoor, a lot of close contact and shared equipment sport. Those teams, those organizations, you can still have team-based drills, exercise, fitness activities that can kind of build your fitness level and keep you prepared for the sport.

But you may not be able to partake in the sport just quite yet. The second thing to think about is, and maybe this should be the first thing to think about is your local disease activity and what are the rules in the area in which you live. If things are not available based on the guidelines of your local government, that kind of makes it an easy decision. So taking that into consideration is extremely important. And the third thing that we talk about with our families is your family circumstances. So what's the individual risk profile for your child. Do they have any chronic diseases, any autoimmune conditions, any immune suppression, and who do you live with? Who's your family unit? Do you live with your grandparents? Do you live with people that have higher risks that if exposed to COVID, could potentially be more of a devastating illness for them? So all three of those kinds of complex and moving targets are things that we have to talk about and help families make decisions for themselves and their children.

Host: This is such great information. You both just helped me personally. So I know you're helping a lot of parents with this kind of information. I'd like to give you each a chance to finish up and wrap up with your best advice, Dr. Yao, starting with you. Please give your best advice as a rehabilitation specialist on what you would like parents to know about their kids being involved in exercise, working out, but as you mentioned, form is very important. So I'd like you to speak about the link between strength training, athletic performance for kids. I mean, because they want to know if, while they're not doing their sport and they're working out, is it going to make their sport better and just generally keeping them active without getting them injured?

Dr. Yao: Absolutely. And again, thank you for having me today. And as a rehab specialist and sports medicine specialist, my best advice is especially during this time of COVID, physical activity and sports are so important and probably more important than ever to keep kids active. It'll not only benefit their physical being, but their mental health well being as we are all struggling through this. I would say again, take into what Dr. King had mentioned into consideration and keeping both themselves and their families safe with whatever scenario they are having in their location. But at the same time, I think again, the safest non-contact physical activity would be training at home with a cardiovascular strength, training, flexibility, and drill work. This can easily be done at home on an individual basis or with family members who are within the unit, and this will help with the physical conditioning and the skill building for any sports. Then in terms of how to do this safely and not obtain injuries as they're doing this, I would say number one is having appropriate supervision is I think the most important.

 

If you're a parent and you are not quite sure if you're able to supervise appropriately, then change up the activity to something that you are confident that you will be able to have your child do safely. Whether it is doing body weight, strength, training, or body, weight, yoga, or even core work, some of those can be simpler than others. And then in addition to that, what I would recommend is do everything in moderation. That is the key to how to avoid overuse injury. What we don't want is people doing the same thing over and over again, that is a fast and quick road to overuse injury, everything in moderation. We want to hit all the different body parts and you don't necessarily want to do it every day. We want to change things up so that we are again, not overloading one part of the body significantly over and over again. In terms of staying safe, again, we want to allow the kids to do what they want as much as we can, but again, keeping into consideration how much contact there is and how high risk those contact activities are. And ideally we could have them playing outside as much as they can as weather permits, and as the environment permits

Host: And Dr. King last word to you, what would you like parents to know about keeping their kids active and healthy during this COVID time and really how they can get involved, be good role models, do it with their kids, all of those things. Wrap it up with your very best advice for parents about getting our kids off the couch right now and getting them involved in physical activity.

Dr. King: Sure. And thank you so much for having me as well, cannot over state how challenging of a time this is for parents and for families. I think how difficult it is to be a parent in the modern society has only been multiplied by the fact that our children are missing out on school, on activities and have put the magnifying lens on parents to take over so much of the things that are spread out to the community. So we, as your pediatricians have a big heart for what you're going through how challenging this time is. But with challenge comes opportunity. And like you said, this is probably the most important time now, more than ever to start moving as a family. So get moving, move daily, exercise as a family, get outside, and then also utilize online resources. You do a quick Google search on children friendly exercise classes. There's a ton of resources on the web for you and your family as well. And lastly, come and talk to your pediatrician. We want to be a resource for you. We want to go through this time with you and your family together and continue to encourage you as parents to do everything you can to keep your children healthy, which more and more includes being as active as possible.

Host: Absolutely great information. What an informative episode, thank you both so much for coming on and sharing your expertise with us today. And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. I want to thank our guests and our listeners, and that concludes today's episode of Kid's Health Cast. Please remember to subscribe, rate, and review this podcast and all the other Weill Cornell Medicine podcasts. For more health tips and updates like this, please follow us on your social channels. I'm Melanie Cole.

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