Physical Activity and Technology and their Roles in Childhood Development

Abstract:

It is no question that physical activity is important at every life-stage, but it is vital for children. In one meta-analysis, the authors found that physical activity, whether it be acute (short term) or longitudinal (long term) had positive effects on executive functions, academic performance, and attention.1 Children who do not regularly receive physical activity could be hindered in numerous ways compared to their peers who exercise regularly. For instance, two studies explained that children who do not regularly participate in physical activity have a higher chance of obesity2,3 (both in their childhood and adulthood). Inadequate physical activity is also associated with heart disease4 and other health problems. Insufficient physical activity was associated with increased risk of high blood pressure, poor blood lipid levels, increased risk of developing metabolic syndrome, and increased risk of becoming overweight or obese.4

It has been well established that physical activity will improve children’s overall health and decrease the risk of numerous preventable diseases. What many people forget is the role technology and screens have on our lives. Technology has given us the ability to connect with people around the world in a matter of seconds, however, it may be doing more harm than good for our health. Children nowadays can often operate their parents’ cell phones or iPads by the age of two, if not younger. The purpose of this systematic review is to examine the effects technology has on our children’s physical and mental health, and to determine what protocols should be in place for schools, daycares, and after-school programs. Technology and physical activity usually do not go hand-in-hand, however, with the right protocols, less technology (screen time) might give more time for children to participate in physical activity, thus increasing their quality of life.

Introduction:

Research on the role of technology on our children’s health and physical activity levels is just starting to come out. We know there is a clear positive connection between physical activity and childhood development, ranging from improved memory, attention, academic performances and overall health.1 Physical activity is not only associated with improved school performance, as noted above, but it is also highly related to decreased health problems down the road. One study found that increased physical activity was associated with improved cardiovascular health, lower chances of developing metabolic syndrome, lower risk of becoming overweight or obese, and improved blood lipid levels.2, 3, 4 With all the positive effects that physical activity has on our health, why are one third of school aged children obese?5 Obesity is a complex problem around the world. There is simply not one stand-alone problem that results in the disease. One must consider the role of genetics, socioeconomic status, climate, physical activity levels, neighborhoods, and technology/screen time. The list could go on, but for this literature review, we will be focusing on the role of technology and screen time has on our children’s health and physical activity levels.

What we are now finding is that screen time and technology are having detrimental effects on our children. According to the American Academy of Pediatrics, increase screen time (sedentary behaviors) is associated with increased obesity risk, increased aggressive behaviors towards peers, and poor school performance.6 The current guidelines for physical activity for children ages 6 - 17 years include: 1 hour or more of accumulated physical activity per day; this 1 hour of activity should be comprised mostly of moderate or vigorous intensity aerobic activity with vigorous intensity activities being included at least 3 days a week; and muscle-strengthening and bone-strengthening activities should also be included on at least 3 days week.7 The current recommendations from the American Academy of Pediatrics for screen time are as follows: limit pediatric screen time from all media sources (television, video games, computer, etc.) to ?2 hours per day for children ?2 years old and no media exposure for children Literature Review:

There have been studies showing the harms of too little physical activity, and too much screen time (from televisions, iPads, cell phones, video games, etc.) One study wanted to determine what the relationship between physical activity and screen time had on health-related quality of life on children from a rural, agricultural area of the Delta Region of Arkansas, Louisiana, and Mississippi. The study hypothesized that higher physical activity levels and lower screen time exposure would increase the children’s’ health related quality of life.8 Researchers received their data from random phone interviews of 36 different counties of the Delta Region. Phone interviews consisted of a 24-hour diet recall, self-report screen time, self-reported physical activity levels, and questions from the Pediatric Quality of Life Inventory Questionnaire. Researchers found physically active children had significantly better health related quality of life compared to their physically inactive peers with higher mean total score on the Pediatric Quality of Life Inventory Questionnaire (84.3 vs 80.8; p < 0.05). Interestingly enough, the study examined the relationship between screen time and Pediatric Quality of Life Inventory Questionnaire scores and found no significant difference between high and low screen time groups.8 Again, we find the benefits of physical activity, but don’t have a correlation between screen time and overall quality of life in this study. The authors of the study did report that one flaw in their questionnaire about screen time could have affected the results of the study. When the participants of the study were asked about screen time, they were simply asking about the previous day’s screen time (not a “normal” day). The authors feel if they had asked about the “normal day’s” screen time they would have gotten different results.

In another study, researchers from Canada wanted to examine the relationship early childhood screen time had on fourth grade academic, psychosocial, and lifestyle characteristics. This was a prospective longitudinal research study and looked at data from more than 2000 participants. The study found that average television exposure at 29 months was 6.17 hours for the entire week and rose to 8.05 hours per week by 53 months. These quantities are within current recommendations of not more than 2 hours per day beyond 2 years of age. Nevertheless, 11% of the children at 29 months and 23.4% of the children at 53 months viewed more than 2 hours of television daily.9 With these results in mind, the authors found that with more than 2 hours of screen time viewed per day, children at fourth grade had lower attention spans compared to their peers. The researchers also found that with increased television viewing came decreased math scores. Reading scores had no association between amount of screen time per day, and this result surprised the researchers. According to the teachers of this study, higher levels of early childhood television exposure was associated with greater chances of peer rejection experiences such as being teased, assaulted, or insulted by other students. The authors found that with higher levels of screen time came higher levels of sedentary behaviors. Lastly, researchers found that with higher levels of screen time came higher BMIs, higher consumption of sweets and soda, and lower consumption of fruits and vegetables.9 What we can take away from this study, is that increased screen time at an early age (preschool and younger) can have lasting effects on academic performance, social interactions, BMI, and overall health of the child.

Another study examined the amount of screen time children viewed and whether their parents set time limits on non-school related screen time. Researchers of this study examined data from over 7000 participants and ran logistic linear regression analysis to determine the chances of children having more than two hours of screen time per day. The researchers found that children whose parents reported consistent limits and who themselves reported consistent rules about time spent watching television or playing on an iPad or video games had the lowest prevalence of exceeding the recommended limits (of two hours per day). Data suggested that the odds of children exceeding recommended limits decreased as physical activity in the previous week increased.10 Meaning, children of parents who limited screen time did not exceed the recommend two hours or fewer of screen time per day. At the same time, the less screen time the child had, the more physical activity they participated in.

Data from Youth Risk Behavior Survey from 1999 was examined to determine if there was a relationship with TV viewing, physical activity levels, and weight in United States youths age 14-18. Researchers looked at data from more than 15,000 people and found that 45% reported participating in moderate physical activity ?3 days/week, 65% reported participating in vigorous physical activity ?3 days/week, and 25% reported watching TV ?4 hours/school day. Researchers found that the mean BMI varied significantly between the highest levels of physical activity and the lowest levels of physical activity. The study found that boys and girls were ?20%-25% less likely to be classified as overweight if they reported 2 to 3 hours of TV per day. They also found that teens were ?40% less likely to be classified as overweight if they reported ?1 hour of TV per day compared with those who watched ?4 hours of TV.11 Basically, those who participated in more physical activity-whether that be moderate or vigorous, were less likely to be overweight or obese and less likely to watch more than two hours per day of television. The more television teens watched, the higher chances of them being overweight or obese. This is another study that reveals the relationship between physical activity and screen time and what it can do to our health.

In another study taking place in Australia, researchers examined the relationship of family television watching and physical activity levels. Families were recruited and children and parents each filled out a questionnaire, and children wore an accelerometer for eight days (this give researchers an idea of how active the children were. Data was received from more than 800 children and their families and was examined for differing patterns of television watching and physical activity behaviors. Researchers found that the average time children spent watching TV was 130.7 (±68.9) minutes per day. They found 61% of boys and 57% of girls watched 2 or more hours of TV per day. They also found that mothers’ and fathers’ TV viewing was positively associated with their child's TV viewing. The study revealed boys who enjoyed playing video games and who were limited for the TV viewing were significantly more likely to be low-active.12 Interestingly, the study found that boys moved significantly more than girls (using data from the accelerometer). This is yet another study showing the significance of watching greater than two hours or more of television and what it can do to children’s physical activity levels.

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