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Bright Futures in Practice: Physical Activity

TOOL B: HELPING CHILDREN AND ADOLESCENTS IMPROVE PHYSICAL ACTIVITY BEHAVIORS

A variety of factors motivate children and adolescents to participate in physical activity, including guidance and encouragement from health professionals.1 To promote physical activity in children and adolescents, health professionals need to consider factors (e.g., personal, social, environmental) that affect children's and adolescents' participation. Health professionals also need to consider children's and adolescents' readiness to change, because it affects the steps that children, adolescents, and their families need to take to improve or maintain their levels of physical activity.

Factors Affecting Physical Activity Levels

The following factors affect children's and adolescents' physical activity levels:2­4

  • Self-efficacy
  • Expectation of positive outcomes from physical activity
  • Barriers that make it difficult to participate in physical activity
  • Enjoyment of physical activity
Physical activity counseling can help children and adolescents do the following:
  • Increase self-efficacy
  • Understand the benefits of being physically active
  • Reduce barriers to physical activity
  • Select enjoyable activities

The counseling suggestions presented here are based on several models of behavior change. One of these models, the stages of change (shown below), illustrates the steps people go through when they are considering making a change.5­8

Although there is considerable research validating this model's applicability to adults, more limited research exists for its applicability to children less than 9 years of age. Thus, health professionals are encouraged to consider this model as only a general framework for health behavior change for children.

1. Precontemplation
Description: Is unaware of problem and hasn't thought about change. Has no intention of taking action within the next 6 months.

2. Contemplation
Description: Intends to take action within the next 6 months.

3. Preparation
Description: Intends to take action within the next 30 days and has taken some behavioral steps in this direction.

4. Action
Description: Has changed overt behavior for less than 6 months.

5. Maintenance
Description: Has changed overt behavior for more than 6 months.

Children and adolescents and their families may be at any of these stages in terms of their decision to increase or maintain their physical activity levels. Physical activity counseling is most helpful when it is tailored to the child's or adolescent's stage of change. For example, for children and adolescents at the precontemplation stage, explaining the benefits of physical activity is more useful than talking about specific activities. Children and adolescents at the contemplation and preparation stages need counseling to help them set realistic goals, make plans for change, and reduce barriers. Children and adolescents at the action and maintenance stages benefit from counseling on how to prevent a relapse.8

Counseling

The health professional begins physical activity counseling by assessing the child's or adolescent's self-efficacy, knowledge of the benefits of physical activity, perceived barriers to participation in physical activity, and stage of change. The health professional needs to consider these factors, along with the medical history and physical examination results, and family and community resources.

One example that demonstrates how health professionals have successfully used these factors to assess and counsel adults is the Patient-Centered Assessment and Counseling for Exercise (PACE) program.9­11 Preliminary research on the program's efficacy with adolescents ages 11 to 17 shows promising results. PACE researchers expect the program to be efficacious for children and adolescents of other ages. The following physical activity counseling approaches, which have been adapted from PACE research, describe how to counsel children and adolescents at different stages of change.
 

Stage 1: Precontemplation

Goal: Encourage the child or adolescent to participate in physical activity.

1. Identify the benefits of physical activity.

Rationale: Children and adolescents may not be aware of the benefits of physical activity (e.g., promotes well-being; helps reduce the risk of certain diseases such as coronary heart disease, hypertension, colon cancer, diabetes mellitus).

Counseling statement: "Elena, being physically active is one of the most important things you can do to stay healthy, both physically and mentally. It can also help you build strong bones and feel energetic."

2. Explain the benefits of physical activity as they pertain to the child or adolescent.

Rationale: Children and adolescents may understand that physical activity is good for them, but this may not be enough to convince them to become physically active. The health professional needs to personalize the benefits of physical activity and the risks of inactivity based on the child's, adolescent's, and family's health history.

Counseling statement: "Charlie, participating in physical activities, such as walking, might help reduce your risk of developing diabetes, which your older sister has. I know that you're concerned about this, and this is a way for you to do something about it."

3. Recommend that the child or adolescent consider beginning some type of physical activity.

Rationale: One study found that a physician's recommendation to exercise would be taken very seriously by more than 75 percent of high school students.12 So health professionals can influence BFPATO_PE59 children's and adolescents' attitudes toward physical activity.

Counseling statement: "Lauren, your weight is above the recommended weight range for your age and height. If you were to begin something as simple as brisk walking for 30 minutes each day, you'd probably feel a lot better and lose the extra weight."
 

 


Stages 2 and 3: Contemplation and Preparation

Goal: Help the child or adolescent develop a plan for participating in physical activity.

1. Help the child or adolescent identify the benefits of physical activity.

Rationale: Children and adolescents are more likely to participate in physical activity if they believe they will receive something in return. The health professional needs to help children and adolescents identify what they will gain by becoming physically active.

Counseling statement: "Hilary, why are you interested in becoming physically active now? What do you hope to gain by participating in physical activity?"

2. Help the child or adolescent choose appropriate physical activities.

Rationale: Children and adolescents are more likely to participate in physical activity if they are involved in planning the activities and participate in ones they enjoy. The health professional needs to provide guidance on the duration, intensity, and frequency of activities.

Counseling statement: "Beth, what types of physical activities do you enjoy? Are there any you have enjoyed in the past? If so, which ones? How much activity do you think you can handle right now?"

3. Help the child or adolescent identify barriers to physical activity.

Rationale: Children and adolescents may face barriers that prevent them from participating in physical activity. Identifying these barriers is the first step to overcoming them.

Counseling statement: "John, what is keeping you from participating in physical activity (e.g., fear, embarrassment, lack of time or transportation)? If you've participated in physical activity before, why did you quit? What would help you participate in physical activity now?"

4. Help the child or adolescent assess confidence in his or her ability to become physically active.

Rationale: Children and adolescents are good judges about whether they will continue to participate in physical activity. If their confidence is low, the physical activity plan may need to be revised to make it less daunting.

Counseling statement: "David, on a scale of 1 to 5, with 1 being the lowest and 5 being the highest, how confident are you that you will continue to swim for the next 3 months?" (An acceptable rating is 4 or 5.)
 

Stages 4 and 5: Action and Maintenance

BFPATO_ILP58Goal: Encourage the child or adolescent to participate regularly in physical activity.

1. Praise the child or adolescent for being physically active.

Rationale: Praising children and adolescents for participating in physical activity will increase the likelihood that they will participate in physical activity on a regular basis.

Counseling statement: "Susan, I am pleased that you are playing tennis regularly. I think being more physically active will really help you stay healthy."

2. Help the child or adolescent remain physically active.

Rationale: Most people can become physically active for a short period of time. However, maintaining physical activity is more difficult. The health professional needs to help children and adolescents identify strategies to help them remain physically active.

Counseling statement: "Stan, your physical activity plan is going well. What will help you remain physically active?"

3. Help the child or adolescent identify social support.

Rationale: Social support (e.g., encouragement from friends and family, participation in
physical activity with others) is crucial for helping children and adolescents remain physically active.

Counseling statement: "Lisa, does anyone support your decision to become physically active? You may want to ask your parents to help you stay active. Also, it may be helpful to participate in physical activity with your family and friends."

4. Help the child or adolescent assess confidence in his ability to remain physically active.

Rationale: If children or adolescents are not confident in their ability to remain physically active, they are likely to get discouraged and quit. The health professional needs to help the child or adolescent increase his confidence.

Counseling statement: "Cameron, on a scale of 1 to 5, with 1 being the lowest and 5 being the highest, how confident are you that you will continue to participate in regular physical activity for the next 3 months?" (An acceptable rating is 4 or 5.) "What will help you continue?"

 

References

  1. Sallis JF, Patrick K, Frank E, Pratt M, Wechsler H, et al. 2000. Interventions in health care settings to promote healthful eating and physical activity in children and adolescents. Preventive Medicine 31(2):S112­
    S120.
  2. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; President's Council on Physical Fitness and Sports. 1996. Physical Activity and Health: A Report of the Surgeon General. Washington, DC: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; President's Council on Physical Fitness and Sports.
  3. Sallis JF, Simons-Morton BG, Stone EJ, Corbin CB, Epstein LH, et al. 1992. Determinants of physical activity and interventions in youth. Medicine and Science in Sports and Exercise 24(6 Suppl.):S248­S257.
  4. Taylor WC, Baranowski T, Sallis JF. 1994. Family determinants of childhood physical activity: A social-cognitive model. In Dishman RK, ed., Advances in Exercise Adherence (pp. 319­342). Champaign, IL: Human Kinetics.
  5. Prochaska JO, DiClemente CC. 1984. The Transtheoretical Approach: Crossing Traditional Boundaries of Therapy. Homewood, IL: Dow Jones-Irwin.
  6. Sallis JF, Hovell MF. 1990. Determinants of exercise behavior. Exercise and Sports Sciences Reviews 18:307­330.
  7. Bandura A. 1985. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall Humanities/Social Sciences.
  8. Cullen KW, Bartholomew LK, Parcel GS, Koehly L. 1998. Measuring stage of change for fruit and vegetable consumption in 9- to 12-year-old girls. Journal of Behavioral Medicine 21(3):241­254.
  9. Patrick K, Sallis J, Long BJ, Calfas KJ, Wooten W, et al. 1994. Project PACE Physician-Based Assessment and Counseling for Exercise: A new tool for encouraging activity. Physician and Sportsmedicine 22(11):45­55.
  10. Long BJ, Calfas KJ, Wooten W, Sallis JF, Patrick K, et al. 1996. A multi-site field test of the acceptability of physical activity counseling in primary health care: Project PACE. American Journal of Preventive Medicine 12(2):73­81.
  11. Calfas KJ, Long BJ, Sallis JF, Wooten WJ, Pratt M, et al. 1996. A controlled trial of physician counseling to promote the adoption of physical activity. Preventive Medicine 25(3):225­233.
  12. Desmond SM, Price JH, Lock RS, Smith D, Stewart PW. 1990. Urban black and white adolescents' physical fitness status and perceptions of exercise. Journal of School Health 60(5):220­226.

 

  
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