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Biggest public health concern this century

Thursday, December 5, 2013

There is a new diagnosis in town: EDD, or Exercise Deficit Disorder. It is typically a pediatric diagnosis, and one of those (likely) American-created labels that really means that your child is fat and out of shape with poor motor skills. This diagnosis is made when the child demonstrates “reduced levels of moderate to vigorous physical activity (MVPA) that are inconsistent with positive health outcomes.” Typically, a child should engage in 60 minutes or more of MVPA per day through play, sport, transportation, physical education or planned exercise. The fact that EDD has been made an official diagnosis speaks to a dire problem that has been festering globally for the last few years. We all know that people are getting less physically active, but the statistics are astounding and put the problem into perspective. Physical inactivity is now recognised as the fourth leading cause of global deaths, and should be described as a pandemic. It has become the biggest public health concern in this century. In fact, the Global School-based Student Health Survey showed that the majority of students involved failed to meet the required levels of physical activity, and that behaviours such as watching television and computer entertainment were prevalent.


Such a sedentary lifestyle is a massive risk factor for obesity, diabetes, heart conditions, cancer and many other non-communicable diseases. In fact, a recent study reported that 6-10% of all worldwide deaths from these diseases can be attributed to physical inactivity. Trinidad’s pediatric and adolescent population is no exception. Just look around you. Suffice to say that a large percentage of our nation’s youth are fat and out of shape. Adults who probably would have been diagnosed with EDD, had it existed in their time, cross my table everyday in the clinic at Total Rehabilitation Centre. Not only do they have non-communicable diseases, but they are also in a lot of pain—back pain, knee pain, hip pain, neck pain…you name it. They have never exercised a day in their life, and as a result have very poor gross motor skills like running, squatting, lunging, jumping, balance and very poor strength overall. They are a product of EDD. The cure? Exercise? Maybe, but it is not so easy. By the time these patients reach my table, it is late for many. The effects of a sedentary lifestyle, such as arthritis and degeneration, have already settled in and caused pain. Most of what these patients can do now is manage their symptoms. While therapy and exercise will help to a great extent, being physically active as a youth would have probably prevented such early onset pain and degeneration in the body. 

A love and appreciation for physical activity develop in childhood. Research has shown that those who are physically active as children, tend to carry their active lifestyle through their adult years. Those children who do not engage in MVPA do not develop their gross motor skills and are poorly coordinated and weak. In the adolescent years, when they begin to compare themselves to others, those who have not developed their motor skills are even less likely to engage in physical activity, and eventually end up like those patients on my table with conditions related to sedentary lifestyles. So a healthy, active lifestyle starts in childhood. I admit that in Trinidad these days it is difficult for a child to get the recommended amount of MVPA through just free play. It is no longer safe to have a childhood as I had, running and riding around the neighbourhood, climbing trees, and playing games in the road with friends. Also, with the drastically decreasing size of yards, as people prefer to erect mansions on 2x4 pieces of land, it is even harder for children to play in their own homes. As a result, many parents get their children into structured sports. 


With the onset of EDD as an official diagnosis (in the USA), it is now recommended that children be screened for EDD, just as they are screened for hearing and vision deficits. Once children with EDD are identified, parents can be educated on appropriate play and exercise, and the children can be placed with a pediatric exercise specialist who is trained in providing age-appropriate, structured MVPA through play and exercise that will develop the child’s motor skills, strength, balance and love for physical activity. In doing so, the child will be better equipped with skills and confidence to be physically active. However, Trinidad is a long way from implementing such programmes. But we don’t even have to go through all this…just encourage your child to play.


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