Children living in the United States are less active and more obese than ever before.¹ They are, therefore, at increased risk for negative health outcomes such as diabetes, hypertension, and cardiovascular disease, which are associated with sedentary lifestyles. Multiple social, cultural, and environmental factors have converged to promote sedentary behaviors in children. To date, targeted national public health efforts² have done little to slow rising rates of obesity or promote increased physical activity in children. Currently, 40 percent of U.S. children five to eight years of age have at least one risk factor for heart disease³; one in eight is considered obese. While the health effects of this rise in obesity will not be known for years,⁴ the time to act is now because risk factors track from childhood to adolescence⁵ and adulthood.⁶ To overcome this pandemic of sedentary behavior and resultant obesity, multiple factors must be addressed to ensure that children obtain sufficient levels of physical activity.

Currently, the most popular activities among children are watching television and playing video games.⁷ Children watch an average of 25 to 27 hours of television a week.⁸ In contrast, children spend only 14 minutes a day engaged in physical activity.⁹ While schools have historically provided opportunities for physical activity, cutbacks in space and funding have drastically reduced the number of children who participate in daily physical education classes. Additionally, during physical education classes and recess, children actually spend very little time engaged in physical activity.¹⁰ Other important environmental barriers include lack of access to play space and concerns about physical safety. To overcome these issues it is important for adults to take the following measures:

• Moderate the amount of time children spend in front of television, computers, and video terminals.¹¹

• Encourage spontaneous physical activity during recess and physical education classes.

• Provide safe opportunities for children to play.

The role that childrens' families play in fostering longitudinal patterns of activity for children is somewhat ambiguous. For instance, a parent's level of physical activity does not directly correlate with a child's level of activity.¹² Parents who are active do not necessarily raise children who are active. Many parents also incorrectly assume that because their children are involved in organized sports that they are physically fit.¹³ Finally, children who are forced to exercise are much less likely to be regularly active in adulthood.¹⁴ For children especially, exercise should be modeled as playful and fun rather than competitive and punitive.

Important cultural differences in physical activity also exist. Black and Hispanic children are more sedentary than white children,¹⁵ and they are more likely to be overweight or obese.¹⁶ Additionally, persons belonging to certain ethnic groups may not view a dedicated exercise program as a worthwhile use of time.¹⁷

Exercise need not be synonymous with “workout.” Cumulative small periods of physical activity throughout the day can easily provide children with the recommended 20 to 30 minutes of activity.¹⁸ To help promote regular physical activity, it is important to encourage parents and families to support children in the following ways:

• Foster a child's self-efficacy (the sense that they are “good” at a particular activity).¹⁹

• Support regular physical activity at home, at school, and within the community.

• Promote activities that the child enjoys.

• Promote physical activity within a cultural context that is appropriate for each child.

Ultimately, the benefits of regular physical activity are well established and irrefutable. Unfortunately, in the setting of primary prevention, health care professionals do a very poor job of counseling children and parents about the benefits of exercise.²⁰ Promoting physical activity must be a routine part of well-child care.

To reverse the trend of increasing obesity and sedentary behaviors in children, they must be provided with regular opportunities for physical activity; physical activity must be supported in a way that is sensitive to their culture, environment, and family; children and their families must be routinely advised about the benefits of regular physical activity. As medicine shifts to an evidence-based approach that focuses on health-related outcomes, the time has come to challenge traditional modes of physical education and physical fitness as largely ineffective, and focus on new ways to promote and sustain healthy behaviors in children. A body at rest tends to stay at rest until acted on by an external force. Let's be that external force.