54 - Kids and Exercise (Dr. Luke Spellman)

Dr. Luke Spellman pediatrician at UnityPoint Clinic Pediatrics joins Dr. Arnold to discuss how much exercise kids should get, exercise routines, limits on screen time and more.

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Transcript

Dr. Arnold:
This is LiveWell Talk On...Kids and Exercise. I'm Dr. Dustin Arnold, chief medical officer at UnityPoint Health - St. Luke's Hospital. Joining us today is UnityPoint Clinic pediatrician, Dr. Luke Spellman, to talk about how active our middle and high schoolers should be. As you can see, you go in public screen times on the rise, whether it's devices, handheld or it is computer time at a desk or in school, and that's kind of getting crazy and we're seeing kids get, kids are bigger and bigger all the time. You know, we have kids in the hospital, their 14 years old, they're bigger than me. Which for people listening to podcast, that's relatively big. So I want to talk today about exercise and how much kids need and thanks for being here.

Dr. Spellman:
Alright. Well, it's good to be here. Nice to be a part of this.

Dr. Arnold:
How much exercise does a particular age group need each day?

Dr. Spellman:
So I look to, you know, guidelines, good organizations and get recommendations from trustworthy organizations. And for a lot of my recommendations, I go to the AAP, the American Academy of Pediatrics and their recommendation now, and it's pretty similar to adults, but with adults and with the like American Heart Association is an hour, a day of a good exercise, good activity.

Dr. Arnold:
Is there a corresponding time of when screen time becomes too much?

Dr. Spellman:
Well, I look to them too for recommended guidelines. That's a tough thing that we're dealing with now because kids need to know how to utilize that technology and that technology is here to stay. It's really going to be a vital part of our future. The recommendation with that too comes to, pretty easy to remember, about an hour of high quality screen time a day. So I think, you know, utilize the screen time in school and there, that's going to just be a part of school. And then I think when kids get home in the afternoon, evening, you look at budgeting that time and there are some resources out there through like the American Academy of Pediatrics to help you sort of budget that and make a schedule.

Dr. Arnold:
That's, that's probably a really good advice and a good resource for that. Not to be captain of the obvious, but what are the benefits of exercise and activity for kids?

Dr. Spellman:
You know, exercise is, you know, kids can, unlike adults, I think kids can sort of get by for awhile. But I think the way we should think about it as a society is making or putting kids into a good routine for the future. So having that as a component of a kids' daily schedule can get them into a good schedule for the future. It's just one of those things you look at, It's hard to tell a kiddo this can save your life 30 or 40 years from now. You know, you look at chronic illness like diabetes, you look at obesity and the effects when they, when you hit adult age. And I think that again, the major component is getting kids into a routine so that they stay healthy at that age, but as important, get them into that routine so they're healthy adults.

Dr. Arnold:
Dr. Spellman, that makes sense that inactive kids probably become in active adults for the most part. And that leads to sleep apnea, diabetes, hypertension.

Dr. Spellman:
Right.

Dr. Arnold:
You could, we've done other podcasts on those conditions, and their affliction for adults. Do you recommend any specific activity? Let's say I'm a parent and I have a child that I can, that needs some activity, but we're not athletic, we maybe don't have a membership to a gym. What can, what advice would you give me as a parent to the child to encourage activity? And maybe break it down between little ones and older ones on this one.

Dr. Spellman:
Okay. Well, so I would say first and foremost, one of the most important things and the easiest way to get activity and incorporate that into your daily life is to make it a family routine. You know, typically healthy parents have healthy kids. So if the family, if you're looking at a family and there's, you know, there's concerns about weight throughout the family, it's really a really good way to do this is to make a plan as a family and try to incorporate daily activity into the routine and try to do that as a family. I think, you know, for kids that aren't as athletic or more athletic, I think some kids are naturally drawn to certain sports. One of the most important things in my, from my perspective is that kids vary their activity. If you look at, you know, like the research and I had a colleague that looked at bearing activity between different sports and a decreased risk of injury. You look, you look at the results of studies like that and kids are less prone to injury if they vary their activity. I think one way you keep kids active is you make activity fun so you're not going to have really have to tell a two- or three-year-old go play cause they're going to be active, and even below that age. Now when you get into an older kid, they're going to probably get into more of a routine that the family gets into. So I really think one of the most important things is the family looking at it together, sitting down, making a plan and trying to incorporate daily activity into their daily life.

Dr. Arnold:
That certainly is good advice. Do you have any tricks to motivate children and your patients in this realm?

Dr. Spellman:
You know, I think it's just generally a discussion. Again, it's hard to tell young, younger kids and even teenage kids, young adults, hey, you need to be doing this because in 40 years this is going to affect you. I think, you know, I just tried to basically, you know, sit down and talk with them and sort of try to put it in perspective and tell them, you know, you're going to probably feel a lot better just overall if you incorporate some daily activity. And then also, you know, working with your parents and the rest of your family, incorporating some healthy diet skills too. So I think it's really just sitting with them and trying to motivate them, you know, to tell them both physically and emotionally, you're going to feel better if you get into some sort of routine.

Dr. Arnold:
In regards to that, what is your approach to, if you will, clearing a patient to participate in activity?

Dr. Spellman:
There's a very specific set of questions that have been developed over time and that's a lot of smart people that develop the pre-participation questions. That's really honed down to about, if you look at whether it's organizational questions at UnityPoint where you look at the, you know, like the form that Iowa provides, it's down to around 30 questions and those really are utilized to make sure there's no major red flags to prevent kids from increasing their heart rate, getting more involved with activity. And really, if, you know, a lot of those screening, you know, if those screening questions are unremarkable, there's really few indications for kids not to exercise very few conditions where kids can't really get their heart rate up and be involved and get active. So I think the pre-participation questions were developed that we utilize to clear kids and make sure it's safe for them to exercise.

Dr. Arnold:
Exercise-induced asthma. That certainly is going to limit a segment of the patient population that you see. What's your experience with that and how, how easy is it to treat and to get that young person back to full participation?

Dr. Spellman:
You know, actually there's a lot of components that go into asthma and especially exercise-induced asthma. So one thing you really have to hone down with the kiddo, or young adult or younger patient, you have to figure out what triggers it. So you know, if you have a cross country runner in the fall and they get some allergy symptoms in the fall or even the temperature of the air or whatnot, you have to look at all those triggers and you try to maximize what you can do to help them. With most cases have exercise induced asthma it's usually using like a bronchodilator, like an Albuterol, about 15 to 20 minutes before exercise and then basically following up the patient, trailing that, following up and seeing how they're doing. And then you try to treat any other potential triggers as well as you can like allergies to get them to the best possible position they can to participate. Now you're going to run into things with like exercise-induced asthma, but you really want to have the goal of putting them into the best situation where they can have the least amount of symptoms.

Dr. Arnold:
Certainly in the adult population you have extrinsic and intrinsic asthma and that sometimes you'll hear an adult say, well, I had asthma when I was a kid, but I grew out of it. Well you probably removed from whatever agent was triggering that, whether it's home or whatever. Is exercise asthma something that people grow out of it or does that carry on in adulthood?

Dr. Spellman:
So in my experience, I do think it's potentially something that kids, you know, can grow out of. You know, I've seen, it's really been for me sort of a case-by-case type of situation. I've had kids that one season needed, you know, a rescue inhaler or needed a, you know, a pre-participation inhaler and then the next season did find, so it's really, it's almost like a moving target in kids. That's what I would say. Age with kids seems to be a big factor in how they generally if they, how they do with asthma, reactive airway. I think exercise-induced asthma I think is is again, a lot of environmental factors contribute to that. And I do think age does too. So I think it's one of those things where probably the best thing in that situation is just to have periodic follow up and see how they do through different seasons and hopefully, you know, some things just get better and I'm thankful for that.

Dr. Arnold:
Exactly. As far as motivate, coming back to the motivation question, is it healthy to use screen time as a negotiating tool with children to say, you know, you can have an hour screen time to match your hour of activity. I think that could be a dangerous path that go on. One, I have two teenage daughters and they're difficult to negotiate with, you know.

Dr. Spellman:
I'm sure they are.

Dr. Arnold:
President Trump might think he's the art of the deal, but I'd like to see him negotiate with teenagers.

Dr. Spellman:
Yeah, good luck with that.

Dr. Arnold:
But I, you don't want to reward them and then, when we were kids we were rewarded with food and you know, I've always thought that's a bad thing to do because then you equate food with rewards and that can lead to a vicious cycle at some point in your life. Do you have any recommendations on the screen time and motivation?

Dr. Spellman:
Sure. I think it's, you know, I think especially with teenagers in my experience working with teenagers and nephews and nieces, sometimes you got to try about anything.

Dr. Arnold:
Anything that works. Yes, I totally agree.

Dr. Spellman:
But I think, you know, from my perspective, and again I think it's different for everybody and it's different when somebody is directly working with their kids. I think if you set sort of a standard in the household, an expectation, I think, and know that this is the expectation and including that as, you know, we need to be getting outside, we need to be doing some different activities, finding some things we enjoy. And then if they're not meeting that, you know, it's like with, I mean the cell phones, you know, that's a big tool to utilize as far as this is the expectations we have and if, you know, if we meet those as a family, then, you know, that's, that's part of what you get to have. But I do think if you get into the bartering, you know, system where it's like an hour activity and an hour more screen time, that could get you into maybe a little trouble. So I think it's with parents, I think parents have every right to say, listen, these are the expectations we have, i=I'm trying to do what's best for your future, and one of those is going to be exercise and, you know, we can barter to a certain extent, but I'm looking forward for your life 20, 30 years down the road.

Dr. Arnold:
Sure, sure. That makes sense.

Dr. Spellman:
But teenage girls, you know, good luck.

Dr. Arnold:
Yeah, I'll tell you. Speaking of my daughters, both of them are multi-sport athletes. Both of them, they do a lot of conditioning and a lot of activity. So when is, when are you over-training as a teenager? Can a teenager over train?

Dr. Spellman:
Sure. I think there's red flags with anything. So if you look at various illnesses, like if you're screening someone, like what are the red flags, what this kid is, you know, his illnesses, his or her illnesses, progressing. You know, I talk to parents about red flags. I definitely think there's over training, over conditioning. I think very important if you're in a club sport, you're a dedicated athlete. Having good coaches is a big component to it. And then having parents that are there and are reasonable and can monitor for certain things. A couple red flags that I look at, I look at number one, are they enjoying it? So if they, if a young person stops enjoying the sport they're playing, there's an issue. So, and you see that with especially a lot of the club sports, you see that with the year round sports. You know, if a kid's not enjoying what he or she is doing, then they, you know, there needs to be a discussion, are you doing okay? Is this too much? And then I think you have to look at just health, because over-training can leave, have some health consequences too. So fatigue, increased stress and along with those, you know, that does make kids more susceptible to illness, acute illness. So a good example would be wrestling. And I think, uh, the state of Iowa and other states take, they take a lot of caution now with weight gain, weight loss, and they watch that closely because that there are sports that traditionally have been sports where you could over train, lose interest and then, and then also can affect you in other ways.

Dr. Arnold:
Yeah. I wrestled in the era of when you could cut a bunch of wait till the night before...

Dr. Spellman:
Right.

Dr. Arnold:
Weigh in that morning, on Friday for Saturday and then gain all the weight back Friday. So I always used to laugh that here I'm going out on the mat with another guy that we both shed 30 pounds and then gain it right back. So why didn't we just wrestle at the weight that we were? So there was no advantage of course. And I know they've changed that. I know the weigh in is a much different and much closer to mat time with the wrestling, which totally makes sense. Is there, you mentioned the clubs and the younger and younger and younger, this club participation is, I can't, I heard it on the radio some news story, the number of billions of dollars of this industry has become training children.

Dr. Spellman:
Amazing.

Dr. Arnold:
It was multiple billions. Three or four, I can't remember. Is there an age that developmentally you say, OK, this is our ceiling, you can't go lower in this age for club participation?

Dr. Spellman:
So I haven't really seen, so a good example, I went to, you know, my, one of my best friends, I went to their, a couple of baseball games this year and they're going down to six, seven years old for club sports now. And you know, I don't know that there is a specific age, but I think you have to be really cautious. I think again, younger kids, the reasons they should be involved in sports at young ages is to enjoy it and to get some good activity, comradery, meet people, have fun, you know, it's not, you know, you say the win-loss thing, it's, you know, it becomes a pretty important thing to a lot of people right away. But I think if parents keep that in perspective and you know, with a lot of these clubs, sports, a lot of the coaches parents, so if you have reasonable parents, working with these kids, then usually have a really good experience. What I've noticed too with club sports now is a lot of the parents I think are really enjoying the camaraderie and the friendships they develop with other parents. So, you know, I think like we said before, I think you look for red flags for kids. If they're not wanting to get to practice, they're not enjoying themselves. I think there needs to be a discussion you have to say, should we back off this a little bit? And another big component with club sports is, you know, I had a, again, a colleague that did a study looking at a risk of injury with relative to number of sports. The kids with the decreased risk of injury were kids that played multiple sports.

Dr. Arnold:
Yeah. I've seen that same research that indicates that, which, which we encouraged, but on the same token, coaches encourage multi sport athletes as long as it's their sport, that is the primary one. You know.

Dr. Spellman:
Exactly.

Dr. Arnold:
Like, you know, their territorial on that. I don't think we can get away from this subject without talking about diet and as it relates to exercise. You know, there, there's like three things in life that you really shouldn't discuss with people and that's religion, politics and diet because people are committed to those and it becomes a heated argument quite quickly. And there's a lot of stuff out there about diet and, but can you, what supplements, protein levels, protein drinks. My wife does CrossFit, she has protein drinks, she has these supplements. Is that something that a teenager should be doing or not?

Dr. Spellman:
So I've given a fair amount of supplement talks and there really aren't, there really are not too many supplements I'd recommend in teenagers. Teenagers and adults are still, they're very different, from a physical perspective. So for example, I give this example to a lot of kids, I talk about if a young man's playing football and he's doing off season training, he's lifting and all he's eating is protein, then he might actually lose weight. So you look at, you know I talk about, especially teenagers, they're like, they're like steam engines and you need to feed that steam engine. Their metabolism is so high. So a well-balanced diet with some carbohydrates is a smart way to go. If you get to, you know, a young man or a young woman that's a high intense, dedicated athlete and you start just giving them just protein or something, you know, or something like that, then you actually might get in trouble and you might actually see some problems with that as far as lack of weight gain, appropriate weight gain, lack of appropriate calories. So I think you have to be very careful. I'm also very cautious when I talk to teenagers, I'm very cautious on talking with them about creatine supplements like that. Creatine, energy drinks are, I think are a bad idea probably in anybody, but more so in teenagers. So there's really not a lot of supplements out there, especially for young athletes that are really geared towards them. Now I would go like an adult athlete and you're doing more protein and things like that, I think there is some appropriate good supplements. You just want to use a trustworthy supplement and a good supplement.

Dr. Arnold:
It certainly makes sense.

Dr. Spellman:
Yeah.

Dr. Arnold:
The flip side of that, the myth, the carbohydrate load prior to exercise, is it myth or a just a urban legend?

Dr. Spellman:
So for high endurance athletes, so if you have like triathletes, you know, and or you have like long distance runners, actually carbohydrate load is not a bad idea. They need fast energy. So you look at like the, you know, different products like there's the packets with a high carbohydrate load. You look at recommendations by sports nutritionist and one of the best actually supplements they utilize for like high endurance athletes, triathletes, things like that is chocolate milk because it has a good amount of fat, has good carbohydrate. So I thought that was really interesting. That always stuck with me when I was doing my fellowship. The sports nutritionists talked about different diets and they actually said chocolate milk was a good nutritional source for high endurance athletes. So I do think there's times where a good amount of fast energy, carbohydrates, good for, especially for someone who's going to be active for multiple hours.

Dr. Arnold:
That chocolate milk reminds me of elementary school. Wednesdays was our chocolate milk day. Did you have that?

Dr. Spellman:
Yeah, we did have, I think ours was Fridays. I loved it. I waited for Friday.

Dr. Arnold:
Yeah. Well I really want to thank you for stopping by. This has been very interesting and I think it's a dynamic topic, with a lot of information out there and it's been enjoyable to discuss this and I think we're going to have more conversations with you about this as the year goes on. Again, this was Dr. Luke Spellman, a pediatrician from UnityPoint Clinic Pediatrics. If you have a topic you'd like to suggest for our LiveWell Talk On... podcast, shoot us an email at stlukescr@unitypoint.org and we encourage you to tell your family, friends, neighbors about our podcast. Until next time, be well.