Exercise Deficit Disorder in Youth: Thinking Outside The Sandbox
June 19, 2013 19 Comments
As a pediatric sports medicine specialist, I typically spend my days ministering to the maladies of the active child or adolescent; but as a public health advocate, I worry more about the other end of the spectrum: the growing (pun intended), global pandemic of childhood underactivity and obesity.
The global problem of underactivity in youth is being investigated by many people. One of the leaders in this field is a Jersey boy; no, not Jon Bon Jovi…… I have been a big fan of Dr. Avery Faigenbaum, from the College of New Jersey, for some time. From his work investigating the safety of resistance training in children to his new focus on “Exercise Deficit Disorder” (EDD), his work has been an inspiration to me.
Last summer, I had the pleasure of working with him here in Columbus, Ohio, and we even got to record a session of Nationwide Children’s Hospital’s “Pediacast” where we discussed the problem of EDD. This summer, I got to catch up with Dr. Faigenbaum at the American College of Sports Medicine meeting in Indianapolis. Though he could probably bench press three of me, I successfully arm-wrestled him into doing a guest blog. Just in time: Dr. Faigenbaum is heading to Argentina in July as a guest professor.
And so before he can run away, it is with great pleasure that I present to the readership Dr. Faigenbaum’s blog post: “Exercise Deficit Disorder in Youth: Thinking Outside the Sandbox.”
The pervasive reach of physical inactivity has now spread worldwide and some authors have appropriately described this issue as a “pandemic” (4). Levels of physical activity among modern-day youth are down while time spent watching television and surfing the Internet are up. Researchers from Canada recently assigned a letter grade of D- to physical activity levels in 5- to 17-year olds (1) and findings from the Youth Risk Behavior Surveillance survey indicate that one-third of high school students in the United States played video or computer games for 3 or more hours on an average school day (5). The decline and disinterest in physical activity appears to emerge early in life, and by the time students enter high school their sedentary habits are difficult to break. As a professor of pediatric exercise science, I am deeply concerned that regular physical activity has become a neglected dimension of health that has yet to garner the medical power and political clout of other pediatric and adolescent health issues such as cigarette smoking or super-sized beverages.
While the benefits of daily physical activity during the growing years are undeniable, its proven role in reducing the risk of non-communicable disease is undervalued. Parents, policy makers and healthcare providers are missing a message that is vital to the health and well-being of youth. Daily exposure to physical activity early in life as part of transportation, play, recreation, sport, and physical education will reduce the development of future life-altering diseases. We need to identify the exercise deficient child early in life when the child’s body and brain are most responsive to learned behaviors. This practice will ensure that this clinically silent disorder is detected and treated before youth become resistant to our interventions.
My colleagues and I have recently coined the term “Exercise Deficit Disorder” or EDD to describe a condition characterized by reduced levels of daily moderate to vigorous physical activity (MVPA) (2, 3). That is to say, children and adolescents who are not accumulating at least 60 minutes of MVPA daily should be identified and treated with the same energy and resolve as would be applied to a young patient with hypertension or dyslipidemia. Exercise deficit disorder is a unique medical condition in that there are no clinical markers or laboratory tests to secure the diagnosis and there are no medications to treat physical inactivity. If we wait until youth become overweight we will perpetuate symptom-reactive treatment strategies that may be ineffective and costly in the long-term. We need to focus our efforts on the development of preventative strategies that provide a more effective and sustainable public health approach for identifying and treating youth with this modifiable risk factor.
A key tenet of this approach is that physical activity needs to be “prescribed” by physical education teachers, pediatric exercise specialists, and health care providers. The term exercise deficit disorder can be used to raise public awareness about the importance of daily exercise. Healthcare providers can then facilitate the development of a management plan that should include family education about healthy lifestyle choices. Simply stated, telling an inactive child to get more exercise is akin to asking an obese teenager to eat less food. Developmentally appropriate interventions that target deficits in muscle strength and motor coordination in a fun and socially supportive environment are needed. Such interventions have been found to enhance children’s physical competence and perceived confidence in their physical abilities.
The belief that exercise is good for health and well-being predates the historical writings of ancient Greek and Roman philosophy. Nonetheless, most health care providers lack formal training in the prescription of exercise. Some physicians and parents seem to underestimate the therapeutic potential of daily physical activity. Our societal response to the current pandemic of physical inactivity has been incomplete, second-rate and largely unsuccessful. It is time we collectively embrace the contention that the early recognition of physical inactivity, like smoking, be viewed as socially unacceptable and unattractive. We need to critically examine our current policies, practices and beliefs. For example, how would you react if your local school board voted to allow children to smoke during recess? On the other hand, how would you react if your local school board voted to eliminate daily physical education?
Clearly, the concept of identifying and treating youth with exercise deficit disorder is a contemporary health care issue that will require the collective support of physicians, nurses, parents, teachers, government officials, public health agencies and insurance companies. Costly medical procedures, forward-thinking technologies, and advanced pharmacotherapies are ineffective treatment options for this disorder. To the contrary, the most effective treatment may in fact be the least costly. Novel strategies are urgently needed to obviate the need for expensive and extensive medical procedures later in life. Identifying and treating children with exercise deficit disorder may seem unwarranted and intrusive to some observers, but what is the alternative?–Avery Faigenbaum, Ed.D., FACSM
Excercise Deficit Disorder. EDD. You’ll be hearing a lot more about it in the coming years. What do you think about it? Let us know. Comments on this blog are always appreciated! And take our poll on sports medicine apps at the CJSM home page.