General practitioners (GPs) are in prime position to help shape their patients' lifestyle habits from a very young age. Learn the latest integrated activity guidelines for children and adolescents, and how GPs can get involved through patient assessment, physical activity promotion and referral to a specialist centre when needed.
Childhood is a critical period for adopting healthy lifestyle behaviours and shaping the foundation for present and future well-being.
The World Health Organization also advocates for early interventions in childhood to offer the best protection against noncommunicable diseases (NCDs) such as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes.1
To promote healthy lifestyle habits in Singapore children, the College of Paediatrics and Child Health, Singapore has published the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood (aged under seven years), and for Children and Adolescents (aged seven to 17 years) to provide up-to-date recommendations and resources.2-3
The proportion of Singapore students who were overweight (i.e., body mass index-for-age at or above the 90th percentile) increased from 13% to 16%, from 2017 to 2021.4
Furthermore, only 44.4% of children and adolescents met the Global Recommendations on Physical Activity for Health – a daily average of 60 minutes or more of moderate to vigorous physical activity (MVPA).5
There is strong evidence that regular physical activity among the paediatric population improves:6-7
Cardiometabolic health (e.g., blood pressure, fasting glucose and cholesterol)
There is also some evidence that physical activity reduces the risk of adiposity and depression, and improves motor skill development and cognitive function among this group.6-7
While the Singapore Integrated 24-Hour Activity Guidelines comprise physical activity, sedentary behaviour, sleep, and dietary and eating habits framed within a 24-hour concept, we will focus on the physical activity recommendations in this article.2-3
PHYSICAL ACTIVITY RECOMMENDATIONS
(0 to <1 year)
Be physically active several times daily within a safe and supervised environment
Activities include non-screen based, interactive floor-based play and tummy time
Build up tummy time towards 30 minutes or more, spread throughout the day
(1 to <3 years)
Accumulate 180 minutes or more of physical activity throughout the day within a safe environment
Daily outdoor play is highly encouraged
(3 to <7 years)
Physical activity for older pre-schoolers (5 to 6 years) should include 60 minutes or more of MVPA daily, and muscle- and bone-strengthening activities several times a week
Children and adolescents
(7 to 17 years)
Accumulate a daily average of 60 minutes or more of MVPA
Engage in muscle- and bone-strengthening exercises 3 times or more in a week
Engage in light physical activities throughout the day
GPs can provide advice on physical activity during routine check-ups of paediatric patients, and identify those who will benefit from physical activity counselling or prescription.
Additionally, GPs are also able to help them adopt these new lifestyle habits through regular reviews, and provide timely referral for those who require further assessments or treatment.
1. Assessment of physical activity
GPs can assess the amount of physical activity using the Get Active Questionnaire:8
During a typical week, on how many days do you do moderate- to vigorous-intensity aerobic physical activity (e.g., brisk walking, cycling or jogging)? (Days/week)
On days that you do at least moderate-intensity aerobic physical activity (e.g., brisk walking), for how many minutes do you do this activity? (Minutes/day)
2. Physical activity recommendations
GPs can provide advice on the recommended amount and type of activities for the respective age groups based on the Singapore Integrated 24-Hour Activity Guidelines.2-3
The guidelines include a practical reference section with examples of activities, practical tips and community resources available to help both GPs and parents/caregivers.
3. Referral to a specialist centre
GPs can refer patients to the Singapore Sport and Exercise Medicine Centre @ KK Women's and Children's Hospital (SSMC@KKH) for further evaluation or treatment.
The patients include but are not limited to the following:
Patients who 'failed' pre-participation screening using the Get Active Questionnaire
Patients requiring an exercise prescription or programme for treatment
Patients experiencing symptoms during exercise
SSMC@KKH is able to provide patient-centric exercise counselling and prescription, and conduct inpatient exercise programmes for children up to 18 years of age. SSMC@KKH also performs pre-participation screening and cardiopulmonary exercise tests for paediatric patients and athletes.
GPs play a pivotal role in shaping the patient's lifestyle habits from a very young age, and by adopting healthy lifestyle habits during childhood, we aim to provide them with the best start in life.
We hope that through the benefits of regular physical activity, the patient will continue to practise these healthy habits in his or her adulthood and reduce the risks of NCDs.
World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva: World Health Organization; 2013.
Loo BK, Tan B, Chia MY, Chan PC, Sirisena D, Zainuddin MA, Oh JY, Teoh OH, Tan TS, Lim MC, Lim EJ. Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents. Annals of the Academy of Medicine, Singapore. 2022 May;51(5):292-9.
Loo BK, Sirisena D, Müller-Riemenschneider F, Chia MY, Tan B, Tan NC, Teoh OH, Lim JK, Zainuddin MA, Gao JS. Consensus statement on Singapore integrated 24-hour activity guide for early childhood. Ann Acad Med Singap 2023;52:310-20.
Ministry of Health. Annual Prevalence of Obesityfor Children Aged Below 18 Over Past Five years, Their Profile and Assessed Effectiveness of Preventive Measures. https://www.moh.gov.sg/news-highlights/details/annual-prevalence-of-obesity-for-children-aged-below-18-over-past-five-years-their-profile-and-assessed-effectiveness-of-preventive-measures/#:~:text=From%202017%20to%202021%2C%20the,in%20the%20last%20two%20years. Accessed 22 August 2023.
Tay Z, Chen B, Kui KY, Padmapriya N, Chong MF, Müller AM, Lee EL, Troy E, Müller-Riemenschneider F. Results from the Singapore 2022 report card on physical activity for children and adolescents. Journal of Exercise Science & Fitness. 2023 Jan 1;21(1):20-5.
Poitras VJ, Gray CE, Borghese MM, et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6):S197-239.
Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: US Department of Health and Human Services; 2018.
Sport Singapore. Sports Safe U Guide. https://www.sportsingapore.gov.sg/sports-education/sports-safety/sports-safe-u-guide. Accessed 22 August 2023.
Dr Benny Loo is a Consultant Paediatrician at the Sport and Exercise Medicine Service in KK Women's and Children's Hospital. He graduated with MBBS in 2007 from the National University of Singapore and completed his SingHealth Paediatric Medicine Residency Programme in 2017. He obtained his Master of Sports Medicine with the University of Queensland, and Health Manpower Development Plan fellowship at the Children's Hospital at Westmead in 2022.
GPs can call the SingHealth Duke-NUS Sport & Exercise Medicine Centre for appointments at the following hotlines, or click here to visit the website:
Singapore General Hospital: 6326 6060
Changi General Hospital: 6788 3003
Sengkang General Hospital: 6930 6000
KK Women's and Children's Hospital: 6692 2984
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