INTRODUCTIONPhysical inactivity is a significant contributor to the obesity epidemic in U.S. children — with more than 24 million children overweight or obese (8). Childhood obesity, leading to adult obesity (10), is of national concern not only physiologically and psychologically but also threatens our nation’s economy (3) and military recruitment (1). Benefits of physical activity include increased health-related fitness, greater bone mass or density, decreased risk of developing type 2 diabetes, and improvements in self-esteem (17). Long-term benefits may include reducing the risk of developing some cancers, arthritis, heart disease, depression, and premature mortality (16). Considering that only one fourth of children meet physical activity recommendations and may have shorter life expectancies than their parents, interventions and policies to increase physical activity have become public health priorities (15). SPECIAL CONSIDERATIONS FOR PHYSICAL ACTIVITY ASSESSMENT AND FITNESS TESTING FOR CHILDREN When assessing physical activity and fitness in children, the fitness professional should consider the purpose of each test and the personal goals of the child. Children should be reassured that the testing protocol and instrumentation are safe, and demonstrations, age-appropriate language, and pictures should be used during the explanation of each test. Objective instruments such as pedometers to assess physical activity in children are popular because of their reliability, validity, and ease of use (13). Subjective measures of physical activity such as the Physical Activity Self-Efficacy Scale can be used to assess children’s confidence in overcoming barriers to physical activity (12). Whether choosing group-administered fitness tests or individualized clinic-based fitness tests, the use of appropriately sized equipment and protocols is critical. Fitness testing protocols that are easy to administer in a group setting for children include those published by Fitnessgram (4) and promoted by the Presidential Youth Fitness Program (9). Muscular strength, muscular endurance, cardiovascular fitness, flexibility, and body composition can be assessed in a variety of ways, all developmentally appropriate for age and sex. Table 1 presents components of fitness, definitions and recommendations, examples, and fitness tests for children.TABLE 1: Components of Fitness, Definitions and Recommendations, Examples, and Fitness Tests for ChildrenSPECIAL CONSIDERATIONS FOR EXERCISE PROGRAMMING FOR CHILDREN Although the goal is for all children to exemplify physical fitness, the reality is that most children rarely move. One way to begin to increase movement in children is to encourage them to accumulate pedometer steps. Research evidence suggests that 13,000 steps per day for boys and 11,000 steps per day for girls approximates 60 minutes of moderate- or vigorous-intensity physical activity (13). Although accumulating steps on a pedometer may not be sufficient to increase cardiovascular fitness, the first “step” a child should make is toward any type of physical activity in which he or she feels confident. Across time, the child then eventually will progress to exercising for fitness. Children’s self-efficacy toward physical activity should be established first before building their physical fitness because lifetime activity is the goal. Once children exhibit regular accumulation of daily physical activity, exercise programming can be the next step and should include a combination of aerobic, muscle-strengthening, and bone-strengthening activities (14). Because children grow and develop at different rates, qualified adult supervision, age- and ability-specific instruction, and safe equipment and facilities must be considered during exercise programming (Table 1). INNOVATIVE APPROACHES FOR INCREASING PHYSICAL ACTIVITY IN CHILDREN: A PUBLIC HEALTH APPROACH Because children’s physical activity behaviors are influenced by personal, family, social, and physical environmental factors, an ecological (multilevel) approach is recommended (11). Children are not completely autonomous in their acquisition and maintenance of physical activity pursuits. In addition to teaching children the knowledge, attitudes, and skills necessary to lead a physically active life, social networks (friends, family), environments (child-care facilities, schools), communities (neighborhoods, culture), and policies (access to safe physical activity spaces) can influence children’s activity levels as well. Refer to Table 2 for ecological model levels, definitions, and examples. A few exemplars are presented below.TABLE 2: Ecological Model of Physical Activity Influences for Children: Levels, Definitions, and ExamplesThe National Physical Activity Plan (6) suggests that increasing physical activity requires population-based strategies, considerations, and action within and among business and industry; education; health care; mass media; parks, recreation, fitness, and sports; public health; transportation, land use, and community design; and volunteer and nonprofit organizations. The Let’s Move! Campaign (17), launched by the First Lady of the United States, suggests that families, schools, and communities strive to provide access to physical activity opportunities and places for children and outlines specific strategies to facilitate success. The U.S. Centers for Disease Control and Prevention has recommended a coordinated school health program as an effective strategy to improve children’s health, prevent or reduce risk behaviors, and support lifelong learning (2). The National Association for Sport and Physical Education recommends that elementary schoolchildren should receive 150 minutes of physical education per week and middle and high school students receive 225 minutes per week (5). After-school time is crucial free time for children to accumulate physical activity; therefore, schools should provide and support extended-day programs through collaborating with parents, communities, and businesses. Lastly, walking or bicycling to school, encouraged by the National Safe Routes to Schools program (7), is an excellent strategy to increase children’s daily physical activity and physical fitness. CONCLUSIONS The evidence is convincing that the nation’s leaders and citizens support efforts to address the public health crises pursuant of a sedentary nation of children. The next Clinical Applications column will address the changing definition of sedentary behavior and the impact of this change with exercise programming.