Move more, sit less

Moving is key for health but beyond sport, it can be difficult to suggest practical ideas for busy families to get their kids off the couch.  This episode is all about movement and how to help families be healthier through being active.  

Today's guest, Dr Kathryn Fortnum is a Research Fellow at the Health and Wellbeing Centre for Research Innovation and an Accredited Exercise Physiologist. She has a particular interest in children and youth and mental health. Prior to moving to Brisbane to pursue research, Dr Fortnum worked clinically in inpatient and community settings for the Child and Adolescent Mental  

Health Service WA, and supported children impacted by neurological disorders including spina bifida and cerebral palsy to engage in community-based physical programs. 

Transcript

Health and Wellbeing Queensland acknowledges the Yuggera and Turrbal people, the traditional custodians on the lands on which this podcast was recorded and the traditional custodians on the lands of borders on which you are listening. We pay our respects to the Aboriginal and Torres Strait Islander elders past and present, for they hold the memories of the traditions, cultures and aspirations of Australia's First Nations people. 

[upbeat music] 

Dr Kathryn Fortnum [speaking over music]: If we come in with the fitness and health goals first, particularly for children, they're not interested in becoming fit and healthy, they're interested in being able to run cross country at school, so they might have a more activity-based goal. So, we're working towards those and if they're doing something, something is better than nothing and something is likely to lead on to more. 

Sam: Welcome to the Clinician’s Guide to Healthy Kids, a podcast series for health professionals brought to you by Health and Wellbeing Queensland's Clinician’s Hub. I'm your host Dr Sam Manger and in this series, we'll be diving deep into the topics that matter most in childhood weight management. We'll be talking to Queensland experts across a variety of topics including sleep, disordered eating in higher weight children, prevention and healthy growth with healthy diets.  

Let's get started. Today we're going to discuss physical activity and movement as this is an integral part of physical and mental good health. We'll look at how often and how much our kids should be doing each day. And to do so, we'll be welcoming Dr Kathryn Fortnum to the podcast. Dr Kathryn Fortnum is an Accredited Exercise Physiologist and has a particular interest in children and youth and mental health. She is a Research Fellow at the Health and Wellbeing Centre for Research Innovation. Her research specialty is on the role of physical activity in the management of chronic health conditions. So, the perfect person to have on. Thank you so much for joining me, Kat. 

Kathryn: Thank you for having me here today, it’s great to be here. 

Sam: So, I've obviously giving a little bit of a bio, but it would be lovely to here in your own words, you know, a little bit about yourself, and why you do what you do? 

Kathryn: So, I, for a long time have had a passion for physical activity. I was fortunate to grow up in quite an active family. Had a lot of opportunities to get out and go camping on the weekends, grew up swimming, dancing, doing circus and those kinds of things. And I think physical activity had such a big impact on my life and then transitioning through into, you know, through school into university, gaining that understanding that not everyone had those positive experiences. And particularly for children and youth, and in the changing society we live in today.  

So, I think it's something that just sparked real interest in me from way back when in the day, and something that I'm very passionate about being able to promote physical activity in any way we can and really facilitate and encourage people to be active where they can. 

Sam: And clearly, as a clinical Exercise Physiologist as well as a research one, you've seen that those benefits flow onto many people. 

Kathryn: Very much so. I mean, in our work, we focus holistically on physical activity as a modality to really be able to maximise people's quality of life and their functioning, regardless of any physical health limitations they have or any mental health limitations they might have. And we just want to make sure that we can give them the best opportunity to live the most fulfilled life using physical activity as a modality to do that. 

Sam: Yeah, beautiful. So, let's start right at the beginning. So, what are some current statistics and trends in physical activity and sedentary behaviour? 

Kathryn: Look, it's a little bit concerning at the moment around some of the participation rates in physical activity and particularly some higher rates of sedentary behaviour across the life span, but also particularly in children and youth. There are these things called Active Healthy Kids Global Alliance report cards that are produced every few years and this organisation will pull together national and state level data sources within Australia to capture the patterns of behaviour of children and young people from birth to 17 years and then map those across something called the 24-hour Movement Guidelines. So, the 24-hour Movement Guidelines basically pull together a range of different behaviours, so physical activity, sedentary behaviour and sleep, and make recommendations around what children and young people, all the way through to adulthood, should be doing with those.  

And looking at a few of the interesting statistics from the 2022 report card, they basically grade everyone based on their performance across countries including Australia and through to Japan and into Asia Pacific regions as well. For overall physical activity in Australia we were given a D minus and what that indicates is only a quarter of Australian children and young people are actually meeting the guidelines for physical activity for their age. So, being a very intelligent person yourself, I'm sure you're striving to stay away from things like a D minus and move up into the A's and unfortunately, we sit down there. We also sit down there for screen time, so a third of young children are meeting the national guidelines for their age. 

Positively in Australia, we do well for organised sport, which I don't think would necessarily surprise many people. We have a really big sporting culture, so we get a B for sporting culture. But school is the other environment that I think is one where we can really be promoting physical activity for kids, and we get a C plus in that space. So, you know a third of schools are scheduling sufficient curriculum time for physical activity and that's despite the fact that there's actually some state policies around that we should be doing. So, I guess it's a little bit concerning really and something that is really important that we pay some more attention to. 

Sam: And is that D minus is across all age groups, like the whole of Australia? 

Kathryn: Yes, in the whole of Australia and this is age groups from the birth to 17. So, they have got the individual data out there. But if we think about kind of that school age range which is where most of the data is pulled from? Yeah, you're looking at a D minus. 

Sam: Yeah, right. Yes, that is concerning, you're absolutely right. Especially considering we know what positive impact it can have on people. So, and we'll get into that in a moment, but let's talk about what therefore, what gives you an A. You know what's the, what's the ideal? What's going to give us the top marks here? What sort of activity and how much should school-aged kids be doing to stay healthy? 

Kathryn: Yeah, so there are some fabulous recommendations out there. I did briefly tap into the 24-hour Movement Guidelines that are used a lot more now and before we go any further with this, I think it's just important to clarify something from here on, when I talk about physical activity, it's anything where the body is moving. I think, you know, things like physical activity and exercise can be used quite interchangeably and you know, exercise, in my mind is more about structured movement. So, we're just thinking about any kind of physical activity. If we think about the 24-hour Movement Guidelines, the recommendations do differ slightly for each age range. If we think about the school age for 5 to 17-year-olds, and if we want to get to that A plus, we've got more than I think it's 80–90% of our population doing 60 minutes of moderate to vigorous physical activity every day, plus several hours of kind of light activities and dropping that screen time down. And, then there's some really cool sleep goals too that are in the 24-hour Movement Guidelines.  

And again, throughout the podcast today, we'll probably talk to kind of the different types of physical activities. So, the vigorous, moderate and low. And I think it's probably just important to let everyone know what it is that we're referring to. So, one thing that we can use a lot, as exercise physiologists and exercise professionals, is the talk test. So, what is vigorous physical activity? You can imagine you're out going for a run or riding your bike. You're really out of breath and you can only say a few words before we actually lose our breath. In the moderate intensity, you can maybe hold that conversation, but you're starting to feel a little bit puffed and maybe have to pause the conversation every now and then. Some say you can talk but not sing.  

And then in that low intensity, just like we are now, we're able to hold that full conversation. So, you know when we contextualise that and we think about maybe our own children or what we see in schools or what we think about when we see the community hitting that 60 minutes of really getting out of breath and really getting the heart rate up and the blood pumping, it's quite a big goal to achieve, so it's important to think about different ways that we can do that during the day. 

Sam: Mm-hmm. Yes, that is helpful. One of the other tools that I find helpful is the Borg’s perceived exertion rates, that's sort of zero to 10. I know sometimes it's zero to 20, but if we keep it simple for say, zero to 10. Then you know you've got zero to one, obviously is very little. And then you’ve got your light, moderate and sort of higher intensity. So, that could be quite helpful for us to say we're aiming for you to exert yourself to around a sort of 5 out of 10, 4 out of 10? Could you give us a bit of info about that? 

Kathryn: Yeah. So certainly, that vigorous activity is sitting in at that 8 to 10 realm. So, you know when we've used it with kids before, there's some fabulous book scales online that actually have pictures of emojis as well, where there's an emoji set in the 8 to 10 and it's red and it's sweating and it's really struggling. So that's 60 minutes in kind of that, you know, not doesn't all have to be in the vigorous really sweating time spot, but at least in that 7 to 8, minimum 6 and above, for 60 minutes a day.  

Then we're trying to get a couple of hours where we're sitting in more like kind of, I guess a 3 to 6 kind of space. So, we are feeling like we're doing a little bit of work that might just be going for a walk in the park with the dog or, you know, going down to the playground and having a little bit of a play. And, and then there's always going to be that time in the day where anything kind of sitting or just really gently moving around, is where we're sitting in that kind of zero to 3. So, zero is complete rest. So, if we're talking to a child, it might be when you're lying in bed, you're not doing anything at all. You're completely chilled out and your body is not working. That's a zero. When you've worked the hardest you have ever worked in your life, that's where we're pushing up to a 10. 

Sam: Yeah, great. Thank you. That's very helpful. And nice to know there are little. Emoji ones that can actually be really useful to translate that. Now within the guidelines too, is, and we've touched on it, the talk around sedentary behaviour and trying to reduce that at every opportunity. So, what are some of the instructions and guidelines around that? 

Kathryn: So, we're trying to get a maximum of 2 hours of sedentary behaviour, and these guidelines sit outside of the school time. So, anything that has to happen at school is a different context in itself. Obviously, we, you know, school is a great time to promote physical activity, but the curriculum still needs to be adhered to. We still have to do those. So, it's 2 hours of sitting time, outside of school time, and that includes anything where we are sitting. So that's time on technology. It might be time doing – I know it's not technically school time – but, things like homework at the end of the day are generally sedentary time. So, there's a lot of it incorporated into our day and if we add a challenge, we can try and keep it under 2 hours, then we're generally going to be feeling much better about ourselves, so it's not just all about moving, it's also about less sitting. 

Sam: Mm-hmm. Yeah. Great. And what happens if a child or young Australian doesn't meet these guidelines, because some of those the guidelines sound great. And they clearly are what will be done to optimise health but it's, you know, some of those are not easy benchmarks to reach in some situations. So, what happens? What are the consequences? 

Kathryn: Being an exercise physiologist, we always like to see everything in more the positive space. So, what are we gaining from doing it as well as what are we missing out on if we're actually not meeting those guidelines. So, most people would know about the physical and mental benefits of increasing physical activity. Particularly, I would hope most people who listen to this podcast, so we've got the healthy growth and development around building up muscle strength, muscle endurance, bone health and our cardio-metabolic benefits, all the way through to then the decreased risk of disease. And particularly if we're thinking about the context of this podcast, that lower risk of an unhealthy weight gain, so for minimising sedentary time, increasing physical activity, combining that with also healthy diet, then we're less likely to get an unhealthy weight gain.  

Physical activity can also bring some fabulous cognitive benefits and also the mental health and mental wellbeing benefits, and particularly for children and youth, those social benefits as well. And I think when we look at the childhood context it's all about patterns of behaviour. So, if we get the positive experiences in childhood, it's more likely to lean towards developing the physical activity related interests and passions, and the skills we need to be physically active and also the confidence to engage.  

So, you know Sam, if you were to think back to your childhood what you did, what you enjoyed, what fun memories you have, and maybe how that shaped what you do now or what you enjoy now and then, and how you kind of act within the world that you live in. And, then I think if we go to having too much in sedentary time and not enough physical activity, you're not going to experience the benefits. And, you’re more likely to transition down the disease pathway, and potentially the unhealthy weight gain pathway. You're less likely to have the positive experiences, less likely to continue being physically active, more likely to continue being sedentary, and then you experience more barriers, increased low motivation and confidence, and challenges with the movement skills, and the possible health and disease related barriers as well, such as living with increased weight. So, we can get a lot of benefits from being active, and if we don't participate, we're going to get the negative health outcomes and also miss out on all those really positive benefits and lifestyle patterns as well. 

Sam:  Yeah, the benefits are huge and profound. And I like how you keep focusing on the positive experiences that people have because that is what drives further engagement in that. But the reality is that we often talk about long-term benefits, you know, reduction in cardiovascular risk, cardiometabolic risk, even any number of factors, and as you said, improvement of mental health. But, the relatively immediate short-term benefits need to be highlighted as well of physical activities, people feel better almost instantly most of the time.  

Kathryn: The endorphin release? Yeah. 

Sam: There may be pain in doing that, but they feel cognitively better, they feel mentally better, they feel physically better, and they often sleep better. They'll be better in their relationships and in a sense they'll be more patient, and they'll be more able to get through difficult times. So, the benefits are immediate and fairly profound and persistent. So, it's certainly something that is worthy to raise in every opportunity that we can. We'll be back after this short break. 

Community message [narrated by woman]: Every step counts and reaching 10,000 steps every day will help maintain a healthy lifestyle. The 10,000 Steps program raises awareness and increases participation in physical activity by encouraging the accumulation of incidental activity as part of everyday living. 10,000 Steps is a free program for individuals, workplaces and communities with step counting challenges and walkway signage. To find out how the 10,000 Steps program can help your patients live a healthier life through physical activity, visit 10000steps.org au. 

Sam: And now back to the show. Now I'm slightly stuck on this D minus. So, what is impacting kids' ability to move so much these days? Why is the score so low? 

Kathryn: Look, I think there's a number of factors that come into play with that mix and a lot of those are at the individual level. So, the child and the young person and also the family circumstance. But they also stretch right through to what we do as communities and our kind of way of living today and society. So, do we have an active society? I'd say probably not. We certainly have active people within that. And again, the Active Healthy Kids Global Alliance Australia score cards can give us some really interesting insights to that. So, technology is a big one and screen time and social media. And you know, you say that physical activity releases endorphins immediately, well you get the same from engaging in social media without the pain in between. So that's a much easier kind of transition and a very tempting space for a lot of young people to go nowadays. And we get a D minus in that space, so you know, it's not sitting very positively. Non-active forms of transport have also become common place here in Australia and we are on a D plus for active transport. So, you know only a third of young people are actually using active transport for part of their journey. And I think that's been a transition based on multiple things you know perceived safety in the communities in terms of allowing kids to walk to school on their own or ride to school on their own, parents work commitments, and people living further away from schools. There's a range of factors that come into play with all of that.  

I think that cultural, structured sports and physical activity is also a really interesting one because it's got some really positive outcomes and we do sit really, really well as a country in that space. But on the same hand, if you're someone who maybe doesn't have the passion for being involved in a sport or a structured activity, if you maybe have a mental health barrier in the way or a physical disability that maybe limits your ability to participate in those kinds of activities, or potentially your family can't afford to actually do a structured sport or physical activity. There are limited options available in what people often think about as being options to be physically active. And I think a big part of it now is potentially around making that shift towards educating people around what they can do, that's not structured sport and physical activity, of which there are so many options out there, particularly here in South East Queensland. You've got bushland that's readily available down on the coast and so many parks and nature places that you can actually get out into and the beautiful weather to be able to enjoy it most of the time.  

And I think if we're thinking about those spaces, a cohort that's really missed is our teenagers, so spaces to be active need to be age appropriate. We've put a lot of funding and money into building incredible playgrounds for kids, and we've got some really cool outdoor sport equipment for adults now. And what about our teenagers who sit in the middle, who would potentially and likely really benefit from the access to more, what we call active play? So having somewhere to be active with the resources and the people to be active where they can, you know, use that creativity to actually participate and just have a really good time and we're often kick teenagers off playgrounds or they're not able to be there because they're over 12 years old and we've really missed this cohort in the middle who I think could be a good target space for making some relatively small changes systemically. But then hopefully getting a big population of people active, I think.  

You know, in terms of the trends, we're much more active when we're younger and as we start to get into the teenage space, you just see the rates of physical activity drop off and a lot of that is about a transition into competitive sports, which again doesn't suit a number of people having extra commitments with schooling. And then just not having the same opportunities to be active as we may have been when we were younger. And I think as well, potentially parents and guardians not really knowing how to support their teen to be active, there's a lot going on in those teenage years.  

Some of the final barriers are health related barriers. We look at the current mental health crisis that is going on at the moment. And more people living with overweight, chronic health conditions and all those kinds of factors that are naturally going to lean in very heavily towards not being able to be as active as kids and then transitioning into adults as well. 

Sam: Yeah, the active play is a really critical gap and opportunity for us as a sort of culture and society to play. You're absolutely right. You know, we've got things like skate parks, but you know that's a very narrow spectrum of teenagers who are keen on that. Therefore you haven't got many spaces as you said that are dedicated to them. I certainly know that, so many teenagers want to be active, and there's so many great and exciting, interesting ways and fun ways to be active. But we haven't yet created those spaces for it, so that's an interesting project for Queensland. 

Now that takes us into the next question really well, which is about your role in all of this, both as a clinical and as a research exercise physiologist, because part of what you do is really help personalise movement plans to support people regardless of their background and all of those barriers you just mentioned. So, for those who perhaps are not aware, you could give us some information about what an exercise physiologist (EP) does and what you would normally do on a consult. 

Kathryn: Yeah. So, we, as I mentioned earlier, we very much focus on physical activity and that is our bread and butter really. And I guess the specifics of the consult are going to depend on the reason for each person engaging with an exercise physiologist. We are trained to work in a clinical space. So, we might get referrals for a range of different reasons. But if we're thinking about, more in that chronic health space, or just general health or preventative management consults, we generally sit in a 45–60 minute mark and an initial consult or how I would like to very much take on the consult is to be very open, very conversational and really just trying to learn about a person's experiences and a person's behaviours. When we're thinking more in the teenage space, we would probably just work directly with them, and if we’re thinking with a child, you really need to understand the parents’ and guardians' perspectives as well to get a full picture of what's going on.  

So, in an initial consult, I would always engage in an activity as well. So, we might be playing card games, and really trying to take a back seat and be non-threatening to a young person, particularly if they have been referred to an exercise physiologist. They're likely are barriers to engaging in physical activity. It's likely not to be their favourite topic to talk about. So, really just taking it nice and relaxed, learning about what they like, what they dislike, and really generically understanding what they like to do in a day-to-day life, and then starting to really delve down into more the physical activity, specific things as the conversation shifts in that direction. What I also really like to understand is their previous experiences in physical activity. I think that's a really important one for recognising and learning about where we can go next and what our options might be for looking at increasing that physical activity and then again depending on the referral building and physical assessment around anything that's relevant. So, it might be assessments around fitness, strength, flexibility and if there's any injuries that we need to be considering or bearing in mind, or any other chronic health conditions that we're managing or any mental health specific conditions that we're managing.  

Moving on from that then, particularly in a teen space, we’re potentially looking at how satisfied they are with what their current patterns of behaviour are, and whether there's anything they'd like to change and what might stand in the way of that. And then as we go down the track, you know, using techniques like motivational interviewing and really starting to let the young person, family or teen guide how we're moving forwards rather than being really too prescriptive, particularly if someone hasn't been active and we're trying to get them up to being active in some capacity. 

Sam: So, there’s clearly a physical activity and movement coaching component where you're trying to really instil that and help people support those behaviours. There's an assessment component and then there's a prescription component. For example, if people have really any background, I mean any disability or any other sorts of concerns, you can adapt and create programs that will work for that person, and that situation that is safe. 

Kathryn: Exactly. So, taking the evidence base and moving that into what fits best for that individual and that specific situation. 

Sam: Yeah, and that's so important. So, many of our listeners will be working the primary care space where we don't have a lot of time, full stop. But you know when you actually look at the studies, you can see sometimes a minute, or 60 seconds here, if you're lucky to get on exercise. So, what are the top 2 or 3 things that primary care practitioners could do and could being asking families about in regard to movement, and perhaps could be starting in the prescription process. 

Kathryn: I think this is a really interesting one because obviously there's those real time barriers there and I think something like physical activity, was a natural way of being, that is transitioning now into something a little bit more clinical, which I think is an important lens to it. But sometimes, it can be critical to take that step back, and not apply such a clinical approach to physical activity. I think also there can be a lot of perceived kind of stigma and judgement around what we should be doing from a physical activity standpoint because it has been given so much focus in the media and in campaigns and things like that lately. So, you know the fastest option if you're really, really time limited, is to ask directly what people like to do as a family or with their children, from a physical activity standpoint. The high risk from that, and what I found in my clinical work, is when we do ask those direct questions without a good understanding of people's perceptions of physical activity, is people can often come through and say what they think you want them to hear rather than what their reality is and, I know particular being an exercise physiologist, we see that a lot. I think there is already that approach of, oh, you're an exercise physiologist, that's your focus. And, other primary healthcare clinicians might not see that in quite the same way. But I think that's just certainly something to bear in mind. If you really are time limited and you have to go direct to the question, just maybe having a few more probing questions behind that to really understand what it is that someone does. How often do you do that? Where do you go to do that? And just to see whether those questions are actually piecing together. 

If there is that little bit more time, maybe a few more minutes or even 5 minutes, it might be starting with something a little bit more open and generic. So, one of my 3 main points that I'd really like to get across that people can then hopefully take from this and apply within their own time and knowledge constraints, is to be curious and conversational. So, starting open and generic, what do you like to do as a family? What does your child or children like to do on the weekends and then seeking clarification and transitioning into the specifics? So, say a child does do a sport, let's learn more. You mentioned that your child does Surf Club in summer. Tell me more about that? What do they do while they're there? How often do they do that? How does it look for them? Trying to understand that intensity and duration of the time. If the child or family appear to be active, again, let's learn more. It sounds like you get outside a lot as a family? How often do you do that? What do you do? What does your child like to do when you're out? Because if they're going outside, but the child's just sitting on the picnic rug, then they're not actually getting that physical activity. If there's no mention of physical activity in that kind of initial conversation of what you like to do or what does your child like to do, then you might be directing the conversation more to, ‘It sounds like Johnny really does like technology. Is there anything else he likes, like sports or physical activity?  

I think secondly, it's understanding how families feel about their current behaviour patterns and if there's anything they want to change. If they're not ready to change, it’s then really difficult to move into the prescriptive side of things, because at the end of the day, they're not ready. So, that might be where thinking about referrals to people like exercise physiologists is really important, because families are going to need more time and support to make that change, or to really help their child to engage in those e healthy lifestyle patterns. And that's what we're there for as a profession, is to be able to focus specifically on physical activity, and that's a luxury we have and like to make the most.  

And I think finally, again, when we're time poor, it can be simple to think this is the guideline – you have to do 60 minutes of physical activity every day. But if they've gone from doing nothing, it's so out of reach for families that, you know, it can be important to try and think about making suggestions or trying to set small goals as a family like in the next week. What might you try and achieve while also then adding your clinical knowledge on top of knowing what those guidelines are and knowing where they're trying to go. But starting small and then supporting the family to kind of build up to bigger goals down the track and again using those referrals if required to get that extra specialist support. 

Sam: Yeah, excellent. Thank you very much. Now that's from the clinician point of view and now thinking about the patients and families themselves. So, what are your – you know, I'm going to go with 3 again – what are your 3 top ways that patients and their families can improve their physical fitness and what sort of advice can we give them that you've found again quite useful? 

Kathryn: So, I think it's finding things that you enjoy. So, if we're working with patients and families, I like to go with the model in which participation and enjoyment come first. And fitness and health come second. If they're doing something they enjoy, they're more likely to go out and do it more, build up, make it harder, make it more intense and spend longer doing what they're doing – maybe they’ll do a nice long bushwalk on the weekends or build in a bushwalk, plus climbing a mountain and then they can start to progress towards really meeting some of those fitness and health goals. I think if we come in with the fitness and health goals first, particularly for children, they're not interested in becoming fit and healthy, they're interested in being able to run cross country at school. So, they might have a more activity-based goal. So, we're working towards those and if they're doing something, something is better than nothing and something is likely to lead on to more. So that's one of them.  

I think really working within the lifestyle health constraints, time availabilities and what's available in communities and the financial situation is also another one that's really important to think about. So, if they've got all the money in the world, then great. What is it that you want to do? Go join a rock-climbing club, go down and join a swimming club, go join a surf club, or maybe they just go and buy a stand-up paddle board. So that's a really simple way to just identify that funding isn't an issue. What do you like doing? Great. Go buy that thing. Let's set some goals and then let's review when you come back. This is a really simplistic approach, obviously, but it makes it a little bit easier.  

Once there are financial constraints in the mix we've got to think a little bit more broadly. Again, educating about the active play options and what's available in their local community. It doesn't have to be going out and paying for things. And I think of a family holistic approach as well. So, what can we go and do together? And, really thinking about those models, and those things we can do at home. Do you have a couch? Do you have cushions that we can build obstacle courses around in the house and your child can be active that way? Do you have a playground down the road? Let's go and play on that playground together. So really trying to build in a family model I think is an important approach there. 

Sam: Excellent. So, enjoyable, and make sure it's some sort of positive experience, whether that's pleasure – and, you know, I think from a GP point of view, who does a lot of mental health – I think the positive emotions aren't just pleasure. You know, they're senses of connection with people. They’re senses of meaning and senses of awe over of a view that you happen to see. So, there's plenty of positive experiences that don't have to be purely about pleasure, but they're just encouraging and highlighting and savouring those aspects during the movement, not just retrospectively. There's some interesting research saying that people who highlight those positive emotions whilst they're doing it – for example, ‘I feel good now doing this’ or ‘I'm loving this view’ or ‘this fresh air is amazing’. To do this in the moment helps the rewiring of the brain and various other processes that people actually go, ‘or now I want to keep doing this’. Incentive salience is really important.  

Then the socioeconomic status sort of assessment. And within that as social prescribing, it sounds like what you're saying. So, consider what is available in the community, what’s around you and consider social prescription and then if you can make it social. So, make it, whether its family based or with other kids or some other aspect like that. So, there are 3 really good tips and that answers my next question, which is should this be a family change, or a kid led change and I suppose, it depends like all situations. 

Kathryn: Definitely. And I think, in part it has to come from the child. We've got to be focusing on what they enjoy. But at the same time, it has to fit within the constraints of the family model. And I think family modelling is such a big part of how we develop as children and young people into our own adults is what we see. Monkey see, monkey do – that saying exists for a reason.  

So, it might even be that for a teenage cohort, it's more about the young person taking the lead. Let's really tap into the fact that they want to be independent. They want to have some ownership over what it is they're doing, and it might not be realistic that the parent or guardian and young person go out together. But maybe they can set their own movement goals. For example, if the parent or guardian wants to go and swim 3 times a week or go for 3 long walks during the week and the teen has the goals. Then they can come back together and compare how they've maybe met those goals. I think it's got to be a big picture. It can't just be landing on the child itself. If the child is trying to drive change, but they have no one to take them to a sporting event or no way to pay for that, then that change isn't going to happen either. If they they're too young to go down to the park on their own, they might have these dreams. I know one young person I worked with in mental health myself and she just wanted to go back to gymnastics and the family just couldn't afford it. So, I couldn't sit down with her and focus on how she could get back into gymnastics because it wasn't a realistic goal for them. So, we had to sit down as a whole family unit and piece together what they could do that was going to be realistic for the family and then also meet the needs of the young person in terms of what they wanted to do from an enjoyment perspective as well, which is so important. 

Sam: Yeah, absolutely. We'll be back after this short message. 

Community message [narrated by male]: Unhealthy weight is one of our greatest public health challenges. Two in 3 Queensland adults and one in 4 children live with overweight or obesity. We need to shift the dial. That's why Health and Wellbeing Queensland has created Clinician’s Hub for you, our clinical workforce. Clinician’s Hub is a digital ecosystem of initiatives, resources and tools including this podcast series for multidisciplinary health professionals to support best practice prevention, identification, treatment and management of overweight or obesity. And it offers a variety of clinical tools and training to help you transform health for children, adults and families. Find out how Clinician’s Hub can help you at hw.qld.gov.au/hub. 

Sam: And now back to the show. Now 2 nuanced questions. So, one is the opposite of what we're saying here, which is, is there a point when we should be concerned about levels of exercise being too much? 

Kathryn: Look, yes, and it happens to a very small proportion of the population, and it's quite a complex one because there's not necessarily a set amount of physical activity that's too much physical activity. Hence, it's not prescribed or identified in that way, but it's more about someone's emotional relationship with exercise. So, there's a few different signs that we can be aware of, such as, really engaging in very high levels of physical activity. So, it might be high intensity physical activity before or after school that are beyond the requirements of a sport or multiple sports. Experiencing high levels of fatigue, potentially fainting, light headedness and then alongside the decreased engagement in other previously enjoyed activities, in preference for physical activity, like saying, ‘oh no, I can't go out and see my friends because I need to go for a run’. And it's almost becoming a controlling factor in someone's life, and their intake patterns may also become defined around what they're doing from a physical activity standpoint as well, for example, saying ‘I went for a run today’ or ‘I burnt X many calories therefore I can now eat this dinner’. So, when a few of those signs come together, then that can be a bit of a tell-tale sign that maybe we need to start seeking some support for this and just getting some more information.  

Physical signs might be again rapid weight loss. Safe weight loss at any level is that kind of zero or a half to one kilo per week. So, for anyone at any stage of the weight journey, if they're losing a rapid amount because their intake isn't there, alongside their exercise, and they're suddenly exercising a lot, again these are tell-tale signs, or, if there's an unexpected emotional response to not being able to exercise. So, if there's a real breakdown when there's a change of plans in the day – ‘I'm sorry, you can't go for a run after school today, we're going off camping’ – and that leads to a lot of distress, then that might be another tell-tale sign that you need to seek some help from your primary care professionals. 

Sam: Yep, good to know. Thank you. And now the second scenario is back to the under activity generally, but what about younger children and devices because we mentioned earlier that being a significant barrier. So, how do parents not fall into the trap of too much device use which then begets sedentary use? 

Kathryn: I think this is a really tricky one.  

Sam: It is the million-dollar question. 

Kathryn: It is the million-dollar question. Oh wow, this might be my life changing moment. Look I think certainly from what I've seen and, in my experience, but again, I'm not going to be able to provide all the answers. But I think when technology is introduced, it's starting with good habits and rules because it's harder to change those rules later. So, where we have seen parents have success is with things like saying, ‘you can have your iPad between 5pm and 6pm and then it needs to go away for us to have dinner as a family’ and putting technology actually away in lockable cupboards and things like that when it's not in use. I think building in more structured time for different activities including technology.  

Children thrive on structure, so we might have structured family time. We can use that to be active, but we don't have technology during that time and parents sticking to that as well. So, parents not being on their phones or not checking emails all the time. Like I think again, a lot of it is that monkey see monkey do. If parents are on their phones all the time, of course young people are going to think that they can do exactly the same and particularly children learn so much. They're just sponges, aren't they? They're taking everything in from the world around them. I think the more fun things that families have to do together, the less likely a child's going to need to default to technology. I know that is also really difficult with the big commitments that a lot of people have to work and those kinds of things too, but they can be simple things like when making dinner, involve the kids in making dinner together. Yes, it might make a mess, but we can have a bit of fun. Let's involve the kids in going shopping or making shopping lists or walking the dog or whatever we're doing, making that activity a little bit more challenging for the parent, but a lot more engaging for the child and keeping them off technology and building in those really good habits when they're younger. If there's any concerns then of more like technology addiction or anything really taking over where it's becoming too much, and again big emotional responses to not being able to access technology, I think that's where you're going back to your healthcare providers and seeking some extra support.  

Kathryn: Yeah, keep coming back to the GPs. 

Sam: I wonder on that, it's a sort of modern question, but what's your opinion on the devices that – I don't know the names of them – but the devices of like gaming stations where you you're physically active, you know, so the hand-held ones. 

Kathryn: It can come into a beneficial space, right? If we can be active while using technology, then we're getting the activity benefits while also potentially ticking off some of that technology time. My personal opinion would be to still use similar rules around technology use so that it's not just taking over everything. Particularly good though, if the weather's really hot or really cold or really wet outside, and you can't then get outside and go move. Great, let's default, and let's use some technology. 

Technology isn't all bad. It's got some really positive things, you know, things like smart watches and actually for kids to see how many steps they're doing each day. We be teaching them things like the 10,000 Steps and going out and trying to achieve that in their day. So, I think there are some positive ways we can use technology as well. It's not just a demon. 

Sam: No, absolutely. And I think of the various sporting games where people actually have to get up and move around, like boxing or dancing and those sorts of things. Yeah, that can be a family activity too. So, you can engage that sort of social component. So, thank you so much for your time so far. The last question is a good question to ask. It is about the good resources that you might recommend for health professionals and/or the public. That's the videos or handouts or online courses or even if you ever have recommended apps or you mentioned bio-metric devices for young people or families. 

Kathryn: Yes. I think again, smartwatches and those things can be a great motivating tool, particularly to start to change behaviours or just to start to learn what you're doing. I know I went through a phase and I was doing very little physical activity, but I just wasn't aware and I put my watch on and saw that I was only doing 2,000 steps a day and that was my kick-start to know that I needed to start doing more and then you can get behaviour change from there.  

There are some really good online resources that open up a world of different things that are out there. This includes this concept called physical literacy, which is all about the motivation and confidence and skills to be physically active and there's some cool resources as well, through the Australian Sports Commission website.  

The Australian Government Department of Health and Aged Care have all the details around the 24-hour Movement Guidelines, and they also have some resource pages there about how to get people being more active.  

The Australian parenting website (raisingchildren.net.au) is a fabulous Australian parenting website that have some cool resources for the younger ones, as does Blue Earth, which has a lot of focus on active play. I think some of these things, again, they're currently targeted at young kids, but with a bit of creativity and imagination can be transitioned into the older children and younger teens as well. 

Outdoors Queensland is another online source that has some fabulous information and links to different outdoor activities and organisations, and there's actually a section on there as well around inspiration for kids to be active and we know that being active in nature has some really good mental health benefits too. And again, is an affordable way to access physical activity.  

There's also a great podcast, Total Teen Health and Wellness: a Doctor's Guide for Parents, and that's got some really interesting things about a full range of health conditions in teens but does have some physical activity focus in there as well. 

Sam: Well, that is fascinating. Thank you so much for all those useful insights, tips, and points of knowledge Kat that was really wonderful. Thank you so much for your time and you take care. 

Kathryn: No worries. Well, thanks for having me. 

Today we've been talking to Dr Kathryn Fortnum from the Health and Wellbeing Centre for Research Innovation. For more information on today's topics, visit the Health and Wellbeing Queensland website at hw.qld.gov.au. We'll see you next time on the Clinician’s Guide to Healthy Kids.