Assessing physical fitness is very important when working with people who have youth disabilities. We know that globally, 81% of adolescents age 11 to 17 were insufficiently physically active and the girls are less active than boys and less than 30% of high school students get at least 60 minutes of physical activity per day (WHO). Our youth are overweight and have poor activity levels which puts them at risk for heart disease, stroke, diabetes, and some cancers (CDC, 2015) The US government recognizes this and has health initiatives supporting good nutrition, and increased activity levels (Subcommittee, 2008) and the APTA, Academy of Pediatric Physical Therapy has published an excellent fact sheet that includes the physical therapist’s role in fitness (2012). Obesity contributes to a multitude of musculoskeletal problems: alignment (genu valgus, pronated feet, ligamentous laxity), poor posture (lumbar lordosis, weak abdominal muscles, compensatory kyphosis), and muscle weakness that ultimately decrease activity level because the energy expenditure required for functional tasks is just too great.
The components of physical fitness are: body composition, cardiorespiratory endurance, musculoskeletal endurance and flexibility. Body composition is easy to obtain using parent report of height and weight with an online BMI calculator (CDC, 2013). If a child is in the overweight or obese range, referrals should be made to appropriate providers such as physicians, nutritionists or weight management clinics. Anthropometric information is also useful to understand biomechanical reasons why a person can’t do something: if you are overweight it might be difficult to reach to the floor, if you are underweight you might lack the energy to complete tasks.
As physical therapists, we are well trained to assess flexibility and musculoskeletal endurance. Manual muscle testing is inappropriate for most young children, but we can use functional measures that test musculoskeletal endurance including 5 times sit to stand test (Wang, 2011) and Timed Floor to Stand Test (Weingarten, 2016). Teens may benefit from Functional Movement Screen (Cook, et al 2006) or the HiMAT (Williams, 2006). Cardiovascular endurance measures include 2 minute walk test (RIC, 2010), 6 minute walk test (Fitzgerald, 2016; Li, 2007), timed running tests or the Energy Expenditure Index (Rose, 1991). In addition, ask whether the child is meeting the physical activity recommendations (CDC, 2014, 2015).
Body composition is inherently a body/structure function measure per ICF Model. Most of the measures discussed (with the exception of BMI) are activity measures, but the results will correlate with body/structure function impairments. For example, if you have a deficit in the 5 times sit to stand test, it may correlate with muscle weakness (hip extensors? trunk?), cardiovascular (can’t complete 5 repetitions), or range of motion (can’t extend hips to stand up straight). Assessing fitness and analyzing the results within the context of functional movement limitations will lead to better outcomes. You will be able to fine tune your interventions to identify deficits and remediate deficits.
Blogs this Fall will focus on sharing the "how to"s and thoughts around specific tests and some cool infographics to make things easy for you. Do you use fitness measures? Do you call them fitness measures? Do you use fitness terminology in your thought process as you identify neuromuscular impairments and functional limitations? Your thoughts on fitness???? GO!
References:
CDC. (2015). About BMI for children and teens. Retrieved July 12, 2012, from Centers for Disease Control, http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html/.
CDC. (2015). Physical activity recommendations for adults. Retrieved July 6, 2015, from Centers for Disease Control, http://www.cdc.gov/physicalactivity/basics/adults/index.htm.
CDC. (2015). About BMI for children and teens. Retrieved July 12, 2012, from Centers for Disease Control, http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html/.
Cook, G., Burton, L., & Hoogenboom, B. (2006). Pre-Participation screening: The use of fundamental movements as an assessment of function – part 2. N Am J Sports Phys Ther, 1(3), 132-139. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953359/.
Fitzgerald, D., Hickey, C., Delahunt, E., Walsh, M. and OʼBrienT. (2016) ‘Six-Minute walk test in children with Spastic cerebral palsy and children developing typically’, Pediatric physical therapy, 28(2), 192–9.
Li A, Yin J, Yu C, Jun TA, Hung K, Tsang T, Wong E, Fok TF, Ng PC. (2007). Standard reference for the six-minute-walk test in healthy children aged 7 to 16 Years. Am J Respir Crit Care Med. 176,174–180.
O’Neil, M., Fragile-Pinkham, M., Miles, C., & Rowland, J. (2012). The Role and Scope of Pediatric Physical Therapy in Fitness, Wellness, Health Promotion, and Prevention. Retrieved from http://pediatricapta.org/includes/fact-sheets/pdfs/12%20Role%20and%20Scope%20in%20Fitness%20Health%20Promo.pdf
Pate, R., Pillsbury, L., & Oria, M. (2012). Fitness Measures and Health Outcomes in Youth. Retrieved August 27, 2016, from Committee on Fitness Measures and Health Outcomes in Youth; Food and Nutrition Board; Institute of Medicine, http://www.pysc.org/resources/documents/FitnessMeasuresandHealthOutcomesinYouth.pdf.
Rehabilitation Institute of Chicago. (2010) Rehab measures: 2 minute walk test. Available at: http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=896 (Accessed: 27 August 2016).
Rose, J., Gamble, J., Lee, J., & Haskell, W. (1991). The energy expenditure index: A method to quantitate and compare walking energy expenditure for children and adolescents. Journal of Pediatric Orthopedics, 11(5), 571–578.
Wang, T., Hua-Fang, L., Peng, Y-C. (2011). Reliability and Validity of the Five-Repetition Sit-to-stand Test for Children with Cerebral Palys. Clin Rehab,26(7), 664-671.
Weingarten, G., Lieberstein, M., Itzkowitz, A., Vialu, C., Doyle, M., & Kaplan, S. (2016). Timed floor to stand-natural: Reference data for school age children. Pediatric physical therapy, 28(1), 71–76.
Williams, G., Greenwood, K., Robertson, V., Goldie, P., & Morris, M. (2006). High-level mobility assessment tool (HiMAT): Interrater reliability, retest reliability, and internal consistency. Physical Therapy, 86(3), 395–400.
World Health Organization. Insufficient physical activity. Retrieved March 3, 2015, from World Health Organization, http://www.who.int/mediacentre/factsheets/fs385/en/
Zaino, C., Marchese, V., & Westcott, S. (2006). Timed up and down stairs test: Preliminary reliability and validity of a new measure of functional mobility. Pediatric Physical Therapy, 16(2), 90–98.