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  • How is physical activity defined?

  • How can I assess physical activity and sedentary behavior in the clinical setting?

  • What are developmentally appropriate physical activity recommendations?

  • What approaches can I use to counsel patients and families about physical activity?

  • How can I make physical activity counseling part of my clinical routine?

This chapter will address the following American College of Graduate Medical Education competencies: patient care, medical knowledge, and interpersonal and communication skills.

Patient Care: This chapter will help the pediatric health care provider understand the developmental dimensions of motor development and activity in order to help families implement appropriate and effective obesity prevention and treatment plans.

Medical Knowledge: This chapter will help pediatric health care providers understand and accurately assess fitness and physical activity: key elements in obesity prevention and treatment.

Interpersonal and Communication Skills: Effective promotion of physical activity strategies requires a family-centered approach and effective interpersonal and communication skills. This chapter will aid the pediatric health care provider in communication about physical fitness and physical activity assessment and recommendations.


Physical activity is considered an essential element of normal growth and maturation.1 The development of motor ability, locomotion, and physical activity was elegantly described by Strong et al2 as follows:

“Physical activity begins in infancy with pushing up, turning, crawling, and eventually walking, and it progresses to more complex activities as neuromuscular control develops. Basic movement patterns develop during preschool ages and are the foundation for a wide range of physical activities at later ages. With growth in body size and function and experience, basic movements are integrated and coordinated into more specialized and complex movement skills that characterize the free play, games, sports, and other activities of school-age youth. Guided instruction and supervised practice, specifically by qualified teachers, coaches, and others who work with children, are important in learning movement skills. Types and contexts of activities are variable and change with age during childhood and adolescence. Activities of 6-9 year old children are largely short-term and intermittent (as in non-sustained activities or games such as ‘tag’), and they help the child learn basic and more specialized motor skills. As youth move into the pubertal transition (about age 10-14 years, earlier in girls than in boys), these skills are incorporated into a variety of individual and group activities, often times being organized sports. However, it is also during this period that habitual daily physical activity begins to decline. Indeed, adolescence (12-18 years) is marked by the greatest annual decline in physical activity throughout the lifespan.3,4 Mature structure and function are approached or attained in late adolescence (age 15-18 years), so that physical activity programs can be more structured.”

Although all youth move through the age-related sequence described above, there is increasing concern about the physical activity levels of the ...

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