In the game
Monday June 11, 2012
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Sonja Lawrence, PTA, said she struggled most of her life with being overweight. "I weighed over 200 pounds at one point. And I never really liked to exercise. I didn’t like going to aerobics classes or ... just running on a treadmill," she said. "So I tried to find something I really enjoyed and started taking kickboxing classes."
More than three years later and 50 pounds lighter, Lawrence credits the sport with motivating her to move and lose the weight. She said she feels happier and better, and shares her story as she works to help patients at Children’s Hospital Colorado, Aurora, get fit.
Creative thinking is what often motivates kids who don’t like to exercise to get moving, according to Katelyn Adams, MSPT, inpatient physical therapist at Children’s Hospital Colorado. "We try to think outside the box and develop games instead of exercises for the kids to work on, as this is far more fun than just performing exercises for this population," Adams said. "Our games are function-based and do the same things as exercises can do; however, they are more motivating for the child to participate in, which is half the battle."
What works; what doesn't?
Convincing deconditioned and overweight children to become active is no small task, experts said. Telling children what they need to do, without asking what they like to do, doesn’t work, according to Lawrence. Before designing an exercise program, Lawrence asks patients what activities they like. Even those addicted to video games or television might reveal that they also like basketball, football, boxing and more, she said.
"I find out their interests and try to come up with activities along those lines. And if they really have no physical activity that they’re interested in, then I try different things with them," Lawrence said.
Lawrence’s interests in kickboxing and boxing led to her hanging a blue bolster from the ceiling in the hospital’s gym as a punching bag. She brought in a pair of her old boxing gloves. "I taught one kid some boxing moves. It got him moving. He was actually pretty angry about being in the hospital. It gave him a way to get some of that aggression out, as well," Lawrence said.
Michael Witten, MS, CSCS, clinical exercise physiologist, directs the multidisciplinary weight management program at Children’s Hospital Colorado. Participants range in age from 2 to older than 20. Witten said programs that are too routine, such as exercising on a treadmill, are not only boring, but also are not progressive. "We create an atmosphere of organized, structured chaos ... trying to find a balance between routine and variety," Witten said.
Like Lawrence, Witten asks children in the program what they like to do, then he and the participants use their imaginations to develop activities. Children who participate in making decisions about their programs have ownership in what they do, which according to Witten is important for an exercise program’s success.
To help the children, Witten might suggest traditionally adult activities, such as yoga, Pilates or weight lifting. "Weight lifting has been taboo, but it’s becoming clear that maybe it’s OK for kids as young as 6 years old to lift weights, with proper supervision. I can’t tell you how many times a kid has come into my program and said, 'Oh wow! You have weight machines. I’ve never done or seen that.’ And they enjoy it," he said.
Peggy Norman, RD, MS, CDE, program coordinator, Mary Bridge Pediatric Weight Management Program, which is part of the Mary Bridge Children’s Hospital, Tacoma, Wash., said one of the more successful activities in the program has been hourlong sessions where children run around wearing Kangoo Jumps, which are springy boots designed to reduce impact from running and jumping. "They run around for an hour, and you have to beg them to take them off," Norman said. "I was amazed at how easy they were for the kids. You’re off the ground maybe 4 or 5 inches, and they don’t seem to tip over. And [the boots] propel you forward."
PTs and PTAs in the outpatient Nutrition, Exercise and Weight management Kids Program at Children’s Hospital of Wisconsin, Milwaukee, focus on developing group games with participants’ parents, grandparents, friends, siblings and even pets. According to Chris Schroeder, PTA, who works with inpatients and outpatients, NEW Kids group activities include kickball in the backyard, tossing a beach ball around and going for walks or bike rides in the park.
Board games, such as Cranium Hullabaloo, and videogames that encourage participants to move are another enticing option for many children. These, according to Schroeder, have players dancing, skipping, hopping and more.
Video games are a popular choice among children who don’t like to exercise, according to Lawrence, who uses Xbox Kinect games. Lawrence likes this system because it promotes full-body movement, she said. The games respond to how users move. For example, if the user kicks, the avatar on the screen kicks. "Our hospital has even partnered with Microsoft to develop new Kinects games to use with special-needs kids," Lawrence said.
Lawrence cautioned boxing isn’t appropriate for all patients. Children with excessive aggression — after a head injury, for example — would be better off with other types of activities.
"I think it is important to always design an exercise program tailored to the individual child as everyone is different," Adams said. "Start at the child’s baseline and add activities or difficult tasks, slowly so they do not give up or become discouraged. Always watch the child’s form with any activity [or] exercise, as we want to protect their joints and muscles."
A team approach
Schroeder said the NEW Kids Program’s PTs do initial evaluations, a three-day food and activity record analysis and interviews with children and their families before designing participants’ treatment plans. Other providers in the program include physicians, registered dieticians, clinical psychologists, nursing staff and medical assistants, she said.
PTs guide PTAs and others in promoting activities that won’t hurt obese and deconditioned children. Lawrence said the physical therapy department sees children with a broad range of conditions — from those that are obesity-related to cancer. Many are deconditioned simply because of how long they’ve been in the hospital.
"After determining what the child’s areas of improvement are, I speak with Sonja about our plan of care and discuss ways in which we can make a generic exercise fun for kids," Adams said. "We figure out what muscle groups may be weak and design activities that work these muscles. Endurance is usually a key component, so any activities that are motivating for the patients and get them up moving we do." •
Lisette Hilton is a freelance writer.
More than three years later and 50 pounds lighter, Lawrence credits the sport with motivating her to move and lose the weight. She said she feels happier and better, and shares her story as she works to help patients at Children’s Hospital Colorado, Aurora, get fit.
Creative thinking is what often motivates kids who don’t like to exercise to get moving, according to Katelyn Adams, MSPT, inpatient physical therapist at Children’s Hospital Colorado. "We try to think outside the box and develop games instead of exercises for the kids to work on, as this is far more fun than just performing exercises for this population," Adams said. "Our games are function-based and do the same things as exercises can do; however, they are more motivating for the child to participate in, which is half the battle."
What works; what doesn't?
Convincing deconditioned and overweight children to become active is no small task, experts said. Telling children what they need to do, without asking what they like to do, doesn’t work, according to Lawrence. Before designing an exercise program, Lawrence asks patients what activities they like. Even those addicted to video games or television might reveal that they also like basketball, football, boxing and more, she said.
"I find out their interests and try to come up with activities along those lines. And if they really have no physical activity that they’re interested in, then I try different things with them," Lawrence said.
Lawrence’s interests in kickboxing and boxing led to her hanging a blue bolster from the ceiling in the hospital’s gym as a punching bag. She brought in a pair of her old boxing gloves. "I taught one kid some boxing moves. It got him moving. He was actually pretty angry about being in the hospital. It gave him a way to get some of that aggression out, as well," Lawrence said.
Michael Witten, MS, CSCS, clinical exercise physiologist, directs the multidisciplinary weight management program at Children’s Hospital Colorado. Participants range in age from 2 to older than 20. Witten said programs that are too routine, such as exercising on a treadmill, are not only boring, but also are not progressive. "We create an atmosphere of organized, structured chaos ... trying to find a balance between routine and variety," Witten said.
Like Lawrence, Witten asks children in the program what they like to do, then he and the participants use their imaginations to develop activities. Children who participate in making decisions about their programs have ownership in what they do, which according to Witten is important for an exercise program’s success.
To help the children, Witten might suggest traditionally adult activities, such as yoga, Pilates or weight lifting. "Weight lifting has been taboo, but it’s becoming clear that maybe it’s OK for kids as young as 6 years old to lift weights, with proper supervision. I can’t tell you how many times a kid has come into my program and said, 'Oh wow! You have weight machines. I’ve never done or seen that.’ And they enjoy it," he said.
Peggy Norman, RD, MS, CDE, program coordinator, Mary Bridge Pediatric Weight Management Program, which is part of the Mary Bridge Children’s Hospital, Tacoma, Wash., said one of the more successful activities in the program has been hourlong sessions where children run around wearing Kangoo Jumps, which are springy boots designed to reduce impact from running and jumping. "They run around for an hour, and you have to beg them to take them off," Norman said. "I was amazed at how easy they were for the kids. You’re off the ground maybe 4 or 5 inches, and they don’t seem to tip over. And [the boots] propel you forward."
PTs and PTAs in the outpatient Nutrition, Exercise and Weight management Kids Program at Children’s Hospital of Wisconsin, Milwaukee, focus on developing group games with participants’ parents, grandparents, friends, siblings and even pets. According to Chris Schroeder, PTA, who works with inpatients and outpatients, NEW Kids group activities include kickball in the backyard, tossing a beach ball around and going for walks or bike rides in the park.
Board games, such as Cranium Hullabaloo, and videogames that encourage participants to move are another enticing option for many children. These, according to Schroeder, have players dancing, skipping, hopping and more.
Video games are a popular choice among children who don’t like to exercise, according to Lawrence, who uses Xbox Kinect games. Lawrence likes this system because it promotes full-body movement, she said. The games respond to how users move. For example, if the user kicks, the avatar on the screen kicks. "Our hospital has even partnered with Microsoft to develop new Kinects games to use with special-needs kids," Lawrence said.
Lawrence cautioned boxing isn’t appropriate for all patients. Children with excessive aggression — after a head injury, for example — would be better off with other types of activities.
"I think it is important to always design an exercise program tailored to the individual child as everyone is different," Adams said. "Start at the child’s baseline and add activities or difficult tasks, slowly so they do not give up or become discouraged. Always watch the child’s form with any activity [or] exercise, as we want to protect their joints and muscles."
A team approach
Schroeder said the NEW Kids Program’s PTs do initial evaluations, a three-day food and activity record analysis and interviews with children and their families before designing participants’ treatment plans. Other providers in the program include physicians, registered dieticians, clinical psychologists, nursing staff and medical assistants, she said.
PTs guide PTAs and others in promoting activities that won’t hurt obese and deconditioned children. Lawrence said the physical therapy department sees children with a broad range of conditions — from those that are obesity-related to cancer. Many are deconditioned simply because of how long they’ve been in the hospital.
"After determining what the child’s areas of improvement are, I speak with Sonja about our plan of care and discuss ways in which we can make a generic exercise fun for kids," Adams said. "We figure out what muscle groups may be weak and design activities that work these muscles. Endurance is usually a key component, so any activities that are motivating for the patients and get them up moving we do." •
Lisette Hilton is a freelance writer.
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Monday June 11, 2012