Exercise for Healthy and Not-So-Healthy Kids

It's been almost half a century since "sports medicine" became a concept in this country. Initially, it was simply about treating athletic injuries. The focus then extended to injury prevention and wellness.

Today, sports medicine is at the forefront of a movement pushing children to be athletic despite their illnesses. Lyle Micheli, MD, director of Sports Medicine at Children's Hospital Boston says, "The evolving role for the field across the country is sports medicine as a health intervention. It's a very ennobling idea."

Sports as a health intervention
Recommending sports as a health intervention (promoting a behavioral change to create a more healthful lifestyle) can be complex when it comes to children who have certain diseases or conditions. The biggest challenge, according to Dr. Micheli, isn't figuring out which sport is best. Instead, it's changing the national mindset about what children who are ill can do. "There's still this tendency to not let children with illnesses play sports," he says. "Parents think it's risky because their child's asthma might flare up or think they might get hurt."

Helping kids with personal achievement
Dr. Micheli and his sports medicine colleagues have become more and more aware of the overall benefits that sports can have on children with diseases. He says, "Generally, kids who are ill respond very well to sports because it's a way for them to make personal gains." He's also honed in on which particular sports suit which patients. When it comes to obesity, for example, he's found that a non-aerobic activity can actually work best.

"Obese kids sometimes aren't very agile, but they make tremendous gains in strength training programs," Micheli explains. "They start out being able to bench-press 10 pounds, and soon they can do 15. They've achieved something."

Dr. Micheli sees many patients who have diabetes. For them, he recommends endurance sports, in particular running or swimming, as they stabilize insulin uptake by the body. He's also seen impressive results in kids with Muscular Dystrophy who play sports-strength training, in particular, to help the muscles directly.

Changing the nation's mindset
Dr. Micheli's colleague, Jonathan Rhodes, MD, senior associate in Cardiology, specializes in Exercise Physiology. He's found that the nationwide tendency to limit the activities of children with illnesses can be counterproductive-even harmful. He estimates that the vast majority of kids recovering from congenital heart disease-he puts the number at about 90 percent-can and should exercise and play sports.

But they don't. "Some of that is because of residual health problems," says Dr. Rhodes, "but another reason is that they're couch potatoes. They're completely out of shape because their parents or coaches or doctors tell them not to exercise. And that only exacerbates the problem. Should these kids play on varsity? No. Can they do aerobic exercise in a not-highly-competitive setting? Absolutely."

Of all the physical activities Dr. Micheli has recommended to children with or recovering from diseases, he's had tremendous success with one in particular: "I love for kids to try martial arts," he says. "They can learn balance, flexibility, endurance and strength, and there's a strong psychological component that teaches them self-worth and responsibility."

Good for social and emotional health, too
These psychological components are of particular interest to Ariel Botta, LICSW, clinical social worker and coordinator of the Group Therapy Team in Children's Department of Psychiatry. She agrees that team sports can be beneficial in fostering physical, social and emotional growth in all children. However, she says, the consultation with the patient and the family is crucial in determining which sport is appropriate, especially if a child has low self-esteem related to his or her disease.

Of course, the added benefit that all children get from sports-whether they're healthy or recovering from an illness-is that it's play. "Sports can be very central to a kid's life," says Dr. Micheli. "These kids can get all the enjoyment that comes from having that kind of camaraderie, and they'll make some of the best friends in their lives through their sports teams."

Suggested sports
General guidelines for recommending sports to children who are recovering from an illness or living with a chronic disease

Diabetes
Endurance sports like running, swimming or lacrosse to stabalize insulin uptake

Muscular Dystrophy and Multiple Sclerosis
Strength training like weightlifting to help muscles develop

Attention Deficit Disorder
Dance to teach moving and discipline or martial arts to help with the psychological component

Asthma
Aquatic sports because of the warm, moist air; cold, dry air can cause asthma symptoms

Cardiac disease
Aerobic activity is often recommended to stimulate the heart muscle

Epilepsy
Regular exercise can decrease the symptoms of this condition. No contact sports, but others with sustained exercise, like basketball and baseball.

Obesity
Any sport is beneficial, but strength training and martial arts are particularly good

Autism
Any team sport, depending on how mainstreamed the child is at that stage

Mental retardation
Dance helps teach how to discipline their movements

(Photo: LEFT- Jonathan Rhodes, MD, Senior Associate in Cardiology; RIGHT- Lyle Micheli, MD, Director of Sports Medicine, Children's Hospital Boston)

For more information about Children's Hospital Boston, please visit our website at: www.childrenshospital.org