Abstract
This issue of The Journal of School Nursing features four articles on student athlete health, recognizing the importance for school nurses to understand the physiological needs and risks involved in sport participation. The physiological, psychological, and developmental needs of school-age children and adolescents must be considered to maintain health and promote optimal functioning (Denehy, 2002). Student athletes have unique needs based on their age, the sport involved, and the associated demands of the sport. These articles focus on concerns about nutrition, eating disorders, and the use of ergogenic substances, as well as the importance of the preparticipation physical exam to determine readiness to participate in organized school sports. The goal is to prepare students for successful and healthy participation in sports activities. The school nurse has an important role in educating students, parents, and staff about the benefits and risks of participation, as well as monitoring the health of student athletes (Denehy, 2006).
On the other hand, a major concern is ensuring that all of today’s youth take part in adequate physical activity. The benefits of physical activity for children and adults have been promoted for years. Today there is strong evidence that a healthy lifestyle, including adequate and regular physical activity, can prevent or delay the onset of many of the chronic diseases seen in adulthood. However, even with this knowledge, the level of physical activity in today’s population continues to decline, especially among adolescent females (van Daalen, 2005).
The lack of physical activity has been of particular concern as the number of individuals, both adults and children, who are overweight or obese has risen sharply in the past few decades. Although there has been considerable emphasis on the importance of diet in maintaining and achieving a healthy weight, comparable guidelines for the type and amount of physical activity necessary to promote health and maintain a healthy weight have not been developed.
A systematic evaluation of the evidence about the effects of physical activity on the health of children was recently reported in The Journal of Pediatrics (Strong et al., 2005). The research literature reporting health or behavior outcomes related to physical activity for children was evaluated by a panel of experts representing a range of specialties. More than 1,220 research abstracts from 1980 to 2003 were reviewed, and about 850 were evaluated. Information from each research study was systematically recorded, including data about the sample, methodology, outcome measures, and findings. The studies reviewed reported the effect of physical activity by children and adolescents on such variables as overweight and obesity, cardiovascular health, blood pressure, asthma, mental health, musculoskeletal health, and injuries. On the basis of this information, the expert panelists provided a summary of each study and evaluated the strength (strong, moderate, weak) of the evidence related to the effect of physical activity on health and behavioral outcomes. The expert panel convened in 2004 to summarize their findings. After presenting and discussing the summaries of the research reviewed, “the co-chair and panelists met to develop a recommendation for physical activity for school-age youth in the context of the strength of evidence available for each health and behavioral objective” (Strong et al., 2005, p. 733).
The panelists recommended that “school-age youth should participate every day in 60 minutes or more of moderate to vigorous physical activity that is enjoyable and developmentally appropriate” (p. 736) to achieve desired health and behavioral outcomes. This physical activity should be in the context of normal daily activities, which are intermittent in nature rather than continuous. The type of activity changes with age and varies with interest, ability, and availability. However, to obtain maximum health benefits, moderate to high-intensity exercise is needed. “Brisk walking, bicycling, and active outdoor playing ordinarily reach this criterion” (p. 737).
Increasing the amount of vigorous physical activity during childhood and adolescence is not only a health promotion and disease prevention strategy, it has also been shown to promote learning and academic success. As examples, research reviewed in this study showed that the addition of physical education classes had a small positive effect on academic performance and that the time allotted to physical education did not affect academic performance. Other studies reviewed indicated that physical activity had a positive effect on cognitive function and concentration, as well as classroom behavior (Strong et al., 2005). These findings should speak to school nurses and educators as they work together to help students achieve optimum health and learning. Schools, communities, health care providers, and families need to work together to ensure that children and adolescents have the opportunities and encouragement to attain the recommended amount of physical activity daily.
Even in these times of budgetary constraints, it is important that schools offer a quality physical education program for youth of all ages during the school day (Gabbard, 2001). Many schools have decreased or cut physical education programs; however, many schools still maintain competitive athletic programs, such as football, basketball, and track for a select group of students. However, all students need an opportunity to participate in physical activities. Intramural or after-school club sports can involve students in structured physical activities that are fun and developmentally appropriate. It is also important for younger children to have regular recess where they have an opportunity to participate in moderate to vigorous physical activity. Schools need to provide adequate playground and gymnasium space that is not only used for school-related activities, but also is open to the community during nonschool hours. The school curriculum can integrate physical activity into the curriculum via teaching strategies to illustrate various concepts in numerous classes. Before- and after-school programs should incorporate physical activity as a main component of their planned activities.
Communities can work together to provide opportunities for physical activities not only for children, but also for families and individuals of all ages. Parks, recreational centers, hiking and biking trails, and safe streets, sidewalks, and neighborhoods are part of healthy, active, and vibrant communities. Community events, such as walkathons, races, and other community celebrations or events, involve community members in developing a sense of community, which is needed to support the type of activities that promote the health of the community.
Health care professionals, including nurses and physicians, need to teach children and families about the benefits of exercise and provide age-appropriate recommendations of how they can increase their physical activity to the daily recommended level considering the resources of the schools and the community. They can also advocate for more and better facilities for children of all ages, as well as encourage families to get activities together in ways that are fun for the entire family.
Families need to understand the importance of exercise and how they can work on increasing the physical activity of everyone in the family. This may involve limits on time spent in watching television, being on the computer, or playing with other electronic devices (screen time) and providing incentives for time spent in vigorous physical activity. For many families, this will be a challenge because of work requirements, previous activity patterns, and cultural values. However, families need to be part of the team in meeting physical activity goals, and they should not assume that the school is or will be responsible for assuring that their children will receive 60 minutes of vigorous physical activity on the days they are in school. Nor is it realistic for schools to expect that children and adolescents will be able to get all the needed physical activity outside of the school day.
According to William H. Dietz, MD, PhD, Director of Nutrition and Physical Activity, Centers for Disease Control and Prevention, the biggest challenge will be how to achieve these recommendations (Dietz, 2005). He states, “One of the most important barriers to increased physical activity of youth is the recent reduction of physical education programs in schools. This trend might well be reversed if studies demonstrate that physical activity improves classroom behavior and performance” (p. 719). School nurses provide the link among schools, communities, health professionals, and families in working together to promote the health and academic success of students. They must use their voices in speaking to the importance of physical activity to each of these stakeholders. School nurses need to be firmly based in the evidence that supports the benefits of physical activity for health, behavior, and academic performance. There are many challenges in meeting the recommendation of 60 minutes of moderate to vigorous physical activity daily in planning and implementing activities that are fun and age appropriate. However, we need to start now to make sure our schools and communities provide the environment and opportunities to make this goal a reality.