Empty nesters are a unique group. We all know who these people are: folks who spent the last 20+ years of their lives raising their children, who are now experiencing life without the responsibilities of their kids living under their roof. Like many parents, Empty Nesters put their growing children first, and found themselves getting less and less physical activity, while supporting their children's activities and interests. But now with the children gone, Empty Nesters, while still working full-time, have the opportunity to re-engage in the activities and sports they enjoyed years ago. They also make a great group to bring into a gymnasium at 6 a.m.

The Y took a unique approach to re-engage Nesters in physical activity and help them meet the PA guidelines. We looked at many theories of change, and created a program framework specifically for Empty Nesters to encourage their renewed interest in their own health and their pursuit of fitness. This framework and unique approach includes: establishing the feelings of support in a group setting, being active with people similar to each other, and recognizing the competence and skill each person gains while being more active.

The program framework that the Y created to help Nesters meet the PA guidelines looks like this:

1. Program focuses on activities or sports that Nesters participated in when they were younger (a "re-Beginner" instead of "new" Beginner).
2. Participants were recruited by age, re-beginner status and physical condition.
3. Two staff led the program - one as the "coach" and the other asthe "facilitator."
4. The facilitator's responsibility is to build group unity, create a sense of belonging, help in individual goal setting, and recognize group and individual achievement.
5. The coach's responsibility is to lead the physical activity (be it dance, basketball, cycling, etc.) at a level that is safe and appropriate to the group's skill and physical activity, while keeping the class fun and inspirational. Both the coach and the facilitator mirror the participant's age, life experiences, etc. as much as possible.
   
6. The program plan is to transition the group to be self-supporting.

This framework has resulted in some pretty interesting groups, including a dozen "slightly" obese, 50-55 year old ex-high school basketball stars, doing 60 minutes of basic ball handling drills, conditioning exercises, and half court games at 6 a.m., to a like-group of female ex-dancers, re-learning ballet routines, while also hitting the weight room. This works too for just about any activity many of us may have played as kids or in high school.

This framework is bringing attention to the PA guidelines, giving coaches, facilitators, and Nesters the ability to be creative in designing activities that meet the PA guidelines, and are fun to them.

Would this framework work in other settings, or with other groups?

Could you be a coach or facilitator yourself, and bring the PA guidelines to life in yet another group of re-Beginners?

What might you add?

Inattentiveness, procrastination, fidgetiness, and disorganized work habits are just a few of the symptoms of ADHD. For a child with ADHD, such behaviors impair functioning at school, home, and their ability to maintain relationships with peers. The cause of ADHD is largely unknown and likely to be a multi-factorial interplay between genetic and environmental influences. Current strategies for management include medications and intensive behavioral therapy which are not optimal for long term management of the disorder.

Can physical activity help symptoms of ADHD? There is burgeoning research in this area that suggests this may be the case. A recent review paper published by Jeffery M. Halperin and colleagues from Queens College of the City University of New York, in Neuroscience and Behavioral Reviews, January 2011, suggests ADHD in children should be viewed within the context of a “developmental trajectory” rather than a fixed medical condition. As such, ADHD can be modified by environmental influences, including exercise. Individuals with ADHD are never cured, but they can compensate. Environmental influences, including exercise, may affect the degree of later brain development and hence determine the extent to which an individual can compensate.

Functional magnetic resonance imaging (fMRI) scans of the brains of children show that exercise increases activity in the frontal lobes, which are responsible for executive function (see USA Today article). The executive functions consist of processes responsible for planning, rule acquisition, initiating appropriate actions/inhibiting inappropriate actions, and selecting relevant sensory information. ADHD is a disorder of executive function. In an NIH funded study performed by Catherine Davis and colleagues at the Medical College of Georgia, on 94 sedentary children randomized to a high dose exercise intervention group, found improvement in planning scores (i.e., executive function) in the high dose group compared to controls. 

Studies are underway to determine the optimal frequency and amount of physical activity appropriate for children with ADHD. There is some consensus however, that certain types of physical activities may be more beneficial in children with ADHD (see article). Activities that require memorization and sequencing of behaviors help focus attention and repeat learned movement patterns, e.g., yoga, martial arts, dance/ballet, gymnastics, swimming and team sports. One study of the brains of judo players (adults) by Jacini and colleagues found significantly higher volume of gray matter in the frontal, parietal, occipital, temporal, and cerebellar regions of the brains of judo players versus controls. Interestingly, neuroimaging studies have shown reduced volume of the frontal, posterior, and cerebellar areas of brains of children with ADHD.

There is also evidence that physical activity outdoors may be more beneficial for children with ADHD. Dr. Frances Kuo from the University of Illinois found that green outdoor settings (green backyard, park, or neighborhood space) appeared to reduce the symptoms of ADHD in children compared to the same activities performed in indoor settings AND built outdoor settings (concrete areas, not much green).  Lastly, in July 2010, Yale Researcher, Dr. David Katz published preliminary results of the ABC Fitness Program (Activity Bursts in the Classroom) which focuses on physical activity during the school day.  The study compared an intervention group (schools that incorporated bursts of physical activity throughout the day) versus a control group. Preliminary results indicated that medication use for ADHD decreased in the intervention group. Green settings for playgrounds at schools, physical activity in the morning before class (tai chi on the lawn anyone?), and incorporating physical activity during the day in the classroom, may be just the prescription needed to help children overcome the hurdles of ADHD.

Thanks to Farzana L. Walcott, MD, MPH, for submission of this post.

Childhood obesity has become one of the most widespread public health problems in the United States, and it has received tremendous media attention in recent years. Obesity in children and adolescents has also been thought to be a significant risk factor for cardiac disease, diabetes, and high blood pressure later in life.

Do American children meet the Guidelines?

Does much of the childhood population engage in 60 minutes of physical activity, and does that activity level increase or decrease over time? Laura Basterfield et al. published a study in the January 2011 edition of Pediatrics that showed that the physical activity levels of children are low. They found that the children averaged 26 minutes per day of moderate-to-vigorous physical activity at an average of 7 years old and 24 minutes per day at an average of 9 years old. Only 6.4% of children averaged the recommended 60 minutes per day of moderate-to-vigorous physical activity at age 7 and 5.7% did age 9.

A Proposed Solution

As gloomy as this data seems, there might be a fairly simple solution. Russell Jago et al. published a study in the February 2011 edition of Medicine & Science In Sports & Exercise looking at the influence of best friends on a child's physical activity level. The authors determined that the physical activity levels of 10- to 11-year-old children were closely related to physical activity levels of their best friends.

Encouraging children and adolescents to get outside with their friends and play will largely meet the Physical Activity Guidelines. It really isn’t that complicated. There are numerous examples of activities that kids can do together that are both fun and also have aerobic, muscle-strengthening, and bone-strengthening properties.

For example, riding a bicycle or walking a dog can serve as moderate-intensity aerobic activity. Games with friends, such as playing tag, or more formal sports, are terrific ways to get vigorous-intensity aerobic activity. Likewise, playing on playground equipment, playing tug of war, or climbing a tree are muscle-strengthening activities, while push-ups, sit-ups, or more formal resistance training can be used by older adolescents. Impact sports and activities, such as running, jumping rope, and formal sports like tennis and volleyball can help strengthen bones.

It is important to remember that children and adolescents should meet these Guidelines with a variety of activities. Engaging in activities that stress different body parts will avoid overuse issues and decrease the chance of injury. The STOP Sports Injuries campaign aims to keep kids active in sports and exercise while decreasing injuries that can occur. There are a variety of resources available to parents, coaches, and physicians to educate them and promote safety in sports and other activities.

Patterns of low levels of activity and high levels of sedentary activity are established in childhood and only get worse as they get older. Let’s work to get kids outside playing with their friends, exercising, and playing sports to keep them healthy for life.

What are some other ways that each of us can work with our community, schools, employers and our own families to  get kids outside and active more frequently?