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The Pressure Of Obesity

Longer-duration Exercise Reduces Hypertension Risk


The epidemic of childhood obesity in the U.S. has led to growing numbers of children with heart disease risk factors such as high blood pressure, high cholesterol, and type 2 diabetes, which were previously only seen in adults.

And it’s going to take a multidisciplinary team — consisting of pediatricians, dieticians, concerned parents, and proactive PTs — to help reverse this alarming trend.

Fully 17% of children are obese and 20% are overweight, which means that about 12 million children younger than 18 are affected, says Bonita Falkner, MD, a professor of medicine and pediatrics at Thomas Jefferson University in Philadelphia. Obesity and hypertension are often linked, and are two components of metabolic syndrome, a cluster of risk factors that increases the risk of heart attack, stroke, and diabetes.

As it stands, 3.5% of children have high blood pressure and another 3.5% have pre-hypertension, meaning that they are at risk of developing hypertension in the future, she says.

There is no magic number that defines high blood pressure in children. Instead, a child’s sex, age, and height are used to determine systolic and diastolic blood pressure percentiles.

“The obesity epidemic pushes the expression of hypertension at an earlier age, so we are seeing it in [children] earlier,” Falkner says.

Front Line Intervention

“This is not a problem that can be solved by just going to the doctor or taking a gym class at school,” Falkner says. “It is about changing a child’s lifestyle. Children who are obese and have high blood pressure must lose weight, change their diet, and become more active.”

This is easier said than done, she admits. Exercise is a key component to these lifestyle changes. New research shows that it’s the amount of exercise, not the intensity, that is important for blood pressure lowering in children. The results appear online in Hypertension.

“The [children] who participated in more minutes of physical activity tended to have lower blood pressures than those who did high-intensity exercises for shorter periods of time,” Falkner explains.

“A physical therapist could try and facilitate the notion of just being more active, not necessarily constructing vigorous workouts that involve intense physical activity,” she says. “We need to get children to readjust their activities so they shift from being sedentary to playing outside or just moving around more.”

Enter Nintendo’s Wii Fit and other virtual exercise consoles. Although computers and video games often get a bad rap when it comes to their role in childhood obesity, times are changing with the advent of such virtual exercise systems as Wii Fit and games such as Dance Dance Revolution. It seems that the trend of breaking a sweat and raising your heart rate while dancing or fighting off avatars can indeed make a dent in the obesity epidemic.

“Wii Fit is great, but these games may not be terribly accessible,” Falkner says. “What’s equally important is getting kids to the park or zoo where they can be more physical without realizing it.”

Daniel L. Carl, PhD, an exercise physiologist at the University of Cincinnati in Ohio, who teaches PT students the tenets of exercise science, agrees.

“Any movement is good. It can be done on the Wii Fit or by participating in full body sports,” Carl says. “The bottom line is that we are trying to get these [children] as close to 60 minutes of exercise a day as possible.”

While futuristic virtual exercise is good, there is nothing wrong with old-fashioned play. “Running in the playground, chasing [each other], and playing kickball is as good as anything,” he adds.

More Info

Resources

    • American Academy of Pediatrics: www.aap.org
    • American Society of Hypertension: www.ash-us.org/contact.htm
    • Leary SD, Ness AR, Smith GD, et al. Physical activity and blood pressure in childhood. Findings from a population-based study. Hypertension. 2008;51(1):92-98.
Niche Practice

The childhood obesity epidemic shows little sign of letting up, and growing numbers of PTs likely will become more involved in teaching these children to lead more active lifestyles, Carl predicts.

Gregory Bucki, PT, a staff therapist at Presbyterian Rehabilitation Center in Matthews, N.C., also envisions PTs as becoming a pivotal component of pediatric wellness.

“Physical therapists should start lobbying local pediatricians and parents and let them know how we can help them,” he says. “There is definitely a place for physical therapists along with dieticians and pediatricians in preventing and treating obesity in children,” he says.

“Every six months or so, [children] can get a physical therapy checkup where we can teach parents and children about what they should be doing — and how often they should be doing it — so they can lead more active lives, lose weight, and lower their blood pressure, if it is elevated,” Bucki says.

For the most part, basic, moderate-intensity exercises such as walking, jogging, or swimming are best to help facilitate normal blood pressure, he says.

Denise Mann is a medical writer for the Gannett Healthcare Group. To comment, e-mail pteditor@gannetthg.com.