SUNDAY FORUM

• Best advice for kids: Move, move, move • Winning the battle for fit kids • Time to 'run outside and play' • No room in schedule for exercise • Health concern led to quest for fitness • Fitness bits • What you can do now • Part #1 of series (Sep. 26) • Part #2 of series (Oct. 3) YOUR VOICE

Experts now say the even greater culprit may be a drastic decline in fitness that is undermining children's development, sapping their energy and strength, and threatening their adult health.

"We have seen an increase in kids' calorie intake, but that's not as dramatic as the sharp decrease we're seeing in their activity level," says Dr. Chris Bolling, a Crestview Hills pediatrician.

Kids still should be steered away from junk food and too much fat, but it may be more important - and far more effective - to steer them toward more activity.

In little more than a generation, the typical child has devolved from being a slugger and sprinter to a technology-entranced, nimble-fingered sitter. As University of Cincinnati health education associate professor Keith King says, adolescents today would rather play a sport on the computer than work up a sweat with the real thing outdoors.

WEB FORUM: ASK THE EXPERT

Ready to make a commitment to helping your children be more active? Here's your chance for expert advice as your family gets started. Dr. Jon Divine, medical director of Children's Hospital's Sports Medicine Biodynamics Center, will answer Enquirer readers' questions on children's exercise and fitness. Today and Monday, readers can e-mail their questions to letters@enquirer.com. In the subject line, write "questions for Dr. Divine." Please include your name, neighborhood and a daytime telephone number. On Tuesday, we'll post questions and Dr. Divine's responses on our Web site, Cincinnati.Com. Keyword: Children. This link also connects you to our Healthy Children, Healthy Future series.

And it's not just fat children who are affected. The average American child spends more than three times as much time in front of the TV or computer as he does being active. And while 30 percent of American children are obese or at risk of becoming it, twice that number - many normal weight kids - leave adolescence with at least two risk factors for heart disease, according to the Journal of the American Heart Association.

In his pediatric practice at Children's Hospital Medical Center, chief of staff Dr. Michael Farrell has witnessed the fitness decline firsthand. "I see it when kids come in for their annual exam," he says. "A 7-year-old used to just put his hands back on the (exam) table and jump up. Now 7-year-olds don't have the upper-body strength to do that."

The problem crosses gender, race and economics, taking a toll on the upper-income child who is lulled into inactivity by a TV in his bedroom and the poor child who doesn't have a safe place to play. "Children's strength, endurance, flexibility and overall fitness have been declining for the last 20 years," says Melissa Johnson, executive director of the President's Council on Physical Fitness and Sports. "Kids are just not getting the activity they need. Everyone is waking up to the crisis at hand."

The Enquirer Editorial Board is addressing that crisis with a five-part series, "Healthy Kids, Healthy Future." We're sounding the alarm on the medical calamity that threatens our children, and asking our community to make the large and small changes that can reverse it.

There is no more urgent place to start than with fitness.

Poor fitness is a precursor to a host of adult diseases, from heart disease to arthritis to osteoporosis. In children, inactivity wreaks havoc on normal development. Sedentary kids often lack coordination and balance, are far more likely to become overweight and pick up habits of inactivity that linger into adulthood. "A sedentary lifestyle, along with poor eating habits, is the second leading cause of preventable deaths in this country," says Johnson of the President's Council. "It's quickly closing in on deaths from smoking."

The annual cost: $105 billion.

HEALTHY CHILDREN, HEALTHY FUTURE Click here to view an Acrobat PDF file (1.4mb) showing a detailed look at the physical toll of childhood inactivity. (Enquirer graphic/Randy Mazzola)

The rise in childhood inactivity seems odd given the growth of organized sports, which end up being both a great benefit and part of the problem. Many sports feature short bursts of activity followed by time on the sidelines - just the opposite of Centers for Disease Control recommendations for at least 20 minutes of steady exertion at least four times a week that leaves kids breathing hard and sweating heavily.

And, while sports have led to superb conditioning for elite athletes, they have driven less-athletic children further from physical pursuits. "With some kids, their neuromuscular skills are shot because they're so big," says Dr. Jon Divine, medical director of the Sports Medicine Biodynamics Center at Children's Hospital. "They have problems with balance and coordination. Kids are going to make fun of them, and who wants to put up with that?"

In her work with school districts, Dr. Sue Weinstein, executive director of the nonprofit health education organization Discover Health, unearthed an unsettling cause for children's inactivity: They simply don't know how to play.

"We've heard a lot lately about kids at recess who just stand around," she says. "They're so used to organized sports that they really don't know what to do spontaneously. In our program, we give kids props - a ball, a jump rope - and we talk about what they could play by themselves or with one other person. We're re-teaching play."

At its simplest, Weinstein's work encapsulates a multitiered approach that may be the best hope for improving childhood fitness: a blend of good instruction, safe facilities and a push to get kids more active in everyday life.

A growing chorus of medical experts insists the place to start is requiring more physical education and simple activity in schools. Kentucky and Ohio mandate only a half-credit of high school physical education, letting individual school districts decide how much or little instruction to require beyond that. But in their report, Health, Mental Health and Safety Guidelines for Schools, 30 health organizations, including the American Academy of Pediatricians, call for daily physical education classes for students K-12, and more recess, intramurals and after-school fitness programs.

But between prepping students for high-stakes proficiency tests and battling budget cuts, many local school districts say they're losing, rather than gaining, time for phys ed.

After voters rejected two levies, Fairfield City Schools implemented a pay-to-play program that costs varsity athletes $630 per sport. The result: High school participation dropped 30 percent this fall, and middle school participation was cut in half. School officials say a third levy failure would mean more staff cuts, and phys. ed. class size would rise from 27 to 40.

Joe Clear, physical education teacher at the Stewart Elementary School in Sharonville, has his 3rd grade class jumping rope. (Enquirer photo/TONY JONES)

"It would be terrible," says Fairfield Middle School phys ed teacher Walt Squier. "With 40 students to a class, each child would not have time to participate. Individualized instruction would be almost impossible."

But formal instruction and organized sports are only part of the solution for out-of-shape kids. What they need, in a phrase, is a more physical life - fewer conveniences, more walking and more physical work. Their families have to do what seems nearly impossible - resist a culture that worships ease and efficiency.

Those families will find growing support from public officials, community planners and health officials. In one notable effort, the National Highway Traffic Safety Administration and national legislators are working to provide more and safer bike and walking routes. Locally, Erlanger officials have drafted a master activity plan that would connect the city by sidewalks and thus encourage physical activity.

Children's Hospital chief Farrell says such efforts can make a profound difference for children. "Make the neighborhoods safer and more accessible, and a lot will flow from that," he says.

Statistics show a picture of declining activity

• A fourth of young people ages 12 to 21 admit they have not participated in even light exercise recently, and half don't exercise regularly, according to the President's Council on Physical Fitness and Sports.

• In 1991, 42 percent of students took physical education class daily. Today, 25 percent do - even though both the surgeon general and Centers for Disease Control and Prevention recommend daily physical education classes.

• Locally, many college-bound students substitute a four-week summer course for regular phys. ed., allowing them to opt out of physical activity for the entire school year. Some get credit for such low-exertion courses as bowling and badminton.

• Participation in walking and biking - formerly two of the most common childhood activities - dropped by 40 percent among children ages 5 to 15 from 1977 to 1995, according to the Centers for Disease Control.

• Ten-year-olds surveyed for the 2003 Roper Youth Report were far more likely to own Nintendos or Sony PlayStations than in-line skates or skateboards. A third said they gave up sports because of time demands.