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Re Early determinants of physical activity in adolescence: prospective birth cohort study
- Wenbin Liang (12 April 2006)
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Re: Re Early determinants of physical activity in adolescence: prospective birth cohort study
- Pedro C Hallal, Jonathan C. K. Wells, Felipe F. Reichert, Luciana Anselmi, Cesar G Victora (20 April 2006)
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Physical activity in adolescence: Let us not forget the adolescents with disability
- Meir Lotan, C Michael Henderson, and Joav Merrick (28 April 2006)
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Wenbin Liang, master candidate School of Public Health Curtin University of Technology
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Dear Editor, This is an interesting study [1]. Given that physical activity in adolescence would be affected by combinations of other factors (interactions) and the sample of the study was large, it may be worthwhile to divide the sample by key variables such as sex, birth weight, and further determine the effect of other variables on different sub-samples. Reference: Hallal, P. C., Wells, J. C., Reichert, F. F., Anselmi, L. & Victora, C. G. 2006, 'Early determinants of physical activity in adolescence: prospective birth cohort study', Bmj. Competing interests: None declared |
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Pedro C Hallal, Associate Professor Federal University of Pelotas, Brazil (96030002), Jonathan C. K. Wells, Felipe F. Reichert, Luciana Anselmi, Cesar G Victora
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Dear Editor, We thank the reader for the interest in our manuscript "Early determinants of physical activity in adolescence: prospective birth cohort study". We have run analyses stratified by sex and birthweight as suggested by the reader. There was no evidence of interaction between any of these variables and the exposures evaluated in the paper. All P values for interaction were above 0.10, and this was not explained by lack of power because each sub-group had, at least, 400 subjects. Competing interests: None declared |
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Meir Lotan, Director Dept Physiotherapy, Zvi Quittman Residential Center, The Millie Shime Campus, Elwyn Jerusalem, Isr, C Michael Henderson, and Joav Merrick
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EDITOR---This letter in response to the excellent paper by Hallal et al on early determinants of physical acticity in adolescence (1). In this context we would like to focus on the importance of physical activity also for adolescent with disability or intellectual disability (ID or in the UK learning disability). STUDIES ON ADOLESCENTS WITH INTELLECTUAL DISABILITY The literature on the subject of exercise and sports often combines individuals with those who only have ID and with those who have physical disabilities (2). Many people with cognitive impairment have concurrent physical disabilities. Participation in exercise and sports in children with disabilities are associated with both reductions in maladaptive behavior as well as improved physical fitness, self-esteem and social competence (3). Adolescents and young adults with Down syndrome have shown gains in walking capacity after participating in a 10-week walking/jogging exercise training study (4). Improved physical and psychosocial functioning are revealed in studies of both children and adults with ID, as well as in research specifically directed toward athletes enrolled in Special Olympics (3). Young individuals with ID (mean age = 22) in Special Olympics was found to improve physical competence, social acceptance, general self-worth, adaptive behaviors (5) and social competence (6). The results of a 20 weeks aerobic exercise demonstrated an improvement of self-concept and physical fitness in fifty-four boys with learning disabilities (7). A daily treadmill program has revealed gains in both physical fitness as well as functional abilities of children with ID (8,9). This current small but consistent body of knowledge supports the notion that physical activity confers physical and psychological benefits in children and adolescents with ID. These findings infer that exercise and physical activity will result in similar positive effects the broad population of young people who have ID. This leads to questions regarding how to motivate and in other ways encourage young people with ID to regularly participate in fitness programs. HIGHER HEALTH RISKS Lack of physical activity has been repeatedly associated with higher health risks. It has been established that the low levels of physical activity in childhood and adolescence can result in obesity and a sedentary life style in adulthood. Despite such knowledge, findings from many countries suggest that increasing numbers of adults are adopting a sedentary life style (10). In individuals with intellectual disability (ID) of all ages, yet lower levels of physical fitness and higher rates are obesity (11) are found compared to people without ID. People who have ID are thus relatively vulnerable for the later-life onset of serious health disorders. In addition to the emotional turmoil typical of adolescence, those teens with ID have additional obstacles posed by their cognitive and physical limitations. The present review demonstrated that current literature on fitness in children and adolescents is lacking, and more evidence-based research is needed, to make solid inferences on the association between childhood and teen years sedentary lifestyles on adult -onset health disorders. In addition, more work is needed on the connection between education and implementation strategies to promote healthy lifestyles in younger people, and positive health gains in adults who have ID (12-16). Despite the present paucity of knowledge, a positive connection is hypothesized to exist between physical exercise and promotion of physical, psychological, educational and cognitive status of adolescents with ID. CONCLUSIONS Due to the severe future health implications of inactive life style during childhood and adolescence, and higher rates of success that incorporate fitness activities with socialization, the authors suggest the organization of social physical exercise program models for people with ID, who constitute a population that is vulnerable to the health consequences of unhealthy lifestyles. This call replicates similar demands by authors around the globe (11,17, ). [10,21,26,32,43,45,66,67] Experts should emphasize the importance of a regular physical activity lifestyle during childhood and adolescence. To preserve health and other positive outcomes, a health lifestyle must continue during the transition years and throughout adulthood [68], for the health and well- being of individuals, who have ID and physical disability. Programs that correspond with an active life style should be based on clinical and research findings, centered within local community resources, and easily accessible to all individuals with disability. AFFILIATION Meir Lotan, MScPT, is a physiotherapist working at Israeli National Rett Syndrome evaluation team. He has a special interest in physiotherapy and persons with intellectual disability, Snoezelen and physical activity for children and adults with intellectual disability with an emphasis on individuals with Rett syndrome. He lectures on assistive technology at the Department of Physical Therapy, Academic College of Judea and Samaria in Ariel and the Ben Gurion University of the Negev in Beer-Sheva. Awarded in 2000 by the IRSA (Int Rett Syndr Ass) for his donation to individuals with Rett syndrome. E-mail: ml_pt_rs@netvision.net.il C Michael Henderson, MD, Department of Medicine, University of Rochester, Highland Hospital and Strong Memorial Hospital, Rochester NY, United States of America. E-mail: chender3@rochester.rr.com Joav Merrick, MD, DMSc is professor of child health and human development, director of the National Institute of Child Health and Human Development and the medical director of the Division for Mental Retardation, Ministry of Social Affairs, Jerusalem, Israel. E-mail: jmerrick@internet-zahav.net. Website: www.nichd-israel.com REFERENCES 1. Hallal PC, Wells JCK, Reichert FF, Anselmi L, Victora CG. Early determinants of physical activity in adolescence: prospective birth cohort study. BMJ 2006;332:1002-7. 2. Rimmer JH. State of the scientific evidence in research on physical activity and intellectual disability/developmental disability. Philadelphia, PA: AAMR Conf, 2004. 3. Dykens EM, Rosner BA, Butterbaugh G. Exercise and sports in children and adolescents with developmental disabilities. Positive physical and psychosocial effects. Child Adolesc Psychiatr Clin Neurol Am 1998;7(4):757-71. 4. Millar AL, Fernhall B, Burkett LN. Effects of aerobic training in adolescents with Down syndrome. Med Sci Sports Exercise 1993;25(2):270- 4. 5. Weiss J, Diamond T, Demark J, Lovald, B. Involvement in Special Olympics and its relations to self-concept and actual competency in participants with developmental disabilities. Res Dev Disabil 2003;24(4):281-305. 6. Dykens EM, Cohen DJ. Effects of Special Olympics International on social competence in persons with mental retardation. J Am Acad Child Adolesc Psychiatr 1996;35(2):223-9. 7. MacMahon JR, Gross RT. Physical and psychological effects of aerobic exercise in boys with learning disabilities. Dev Behav Pediatr 1987;8:274-7. 8. Lotan M, Isakov E, Kessel S, Merrick J. Physical fitness and functional ability of children with intellectual disability: Effects of a short-term daily treadmill intervention. ScientificWorldJournal 2004;(4):449-57. 9. Lotan M, Isakov E, Merrick J. Improving functional skills and physical fitness in children with Rett syndrome J Intellect Disabil Res 2004;48(8):730-5. 10. Seefeldt V, Malina RM, Clark MA. Factors affecting levels of physical activity in adults. Sports Med 2002;32(3):143-68. 11. Rimmer JH. The national center on physical activity and disability (NCPAD): providing web-based resources on physical activity for people with disabilities. Philadelphia, PA: AAMR Conf, 2004. 12. Twisk JW. Physical activity guidelines for children and adolescents: a critical review. Sports Med 2001;31(8):617-27. 13. Bar-Or O. Childhood and adolescent physical activity and fitness and adult risk profile. In: Bouchard C, Shephard RJ, Stephens T, eds. Physical activity, fitness, and health: International proceedings and consensus statement. Champaign, Ill, Human Kinetics, 1994:931-942. 14. Rowland TW. Exercise and Children's Health. Champaign, IL: Human Kinetics, 1990. 15. Bar-Or O. Pediatric sports medicine for the practitioner: From physiologic principles to clinical applications. New York, NY: Springer, 1983. 16. Malina RM. Physical activity and fitness: pathways from childhood to adulthood. Am J Human Biol 2001;13(2):162-72. 17. Nat Center Chr Disease Prev Health Promotion, CDC. Guidelines for school and community programs to promote lifelong physical activity among young people. J School Health 1997;67(6):202-19. 18. Yoshinaga M, Shimago A, Koriyama C, Nomura Y, Miyate K, Hashiguchi J, Arima K. Rapid increase in the prevalence of obesity in elementary school children. Int J Obesity Rel Metabol Disord 2004;28(4):494-9. 19. Huang TT, Harris KJ, Lee RE, Nazir N, Born W, Kaur H. Assessing overweight, obesity, diet, and physical activity in college students. J Am Coll Health 2003;52(2):83-6. Competing interests: None declared |
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