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 Chapter 1
Importance of physical activity
and its impact on growth, development
and health

By Conor Hussey and Ananya Gupta

Physical activity (PA) as defined by the world Health Organisa-

tion refers to any bodily movement that requires contraction of skeletal
1

muscles and raises energy expenditure above the resting levels (Sommer,
Nussbaumer-Streit, & Gartlehner, 2021). Physical activity can be classi-
fied into four different types, such as, leisure-time physical activity (e.g.
sports and dancing), occupational physical activity (e.g. weight lifting,
carrying a load) physical activity at-home including activities of daily
living and physical activity for mobility or transport(Silva, Goldberg,
Teixeira, & Dalmas, 2011). Participation in physical activity can be in-
fluenced by multitude of factors including personal and environmental
factors and can be physical (e.g. built environment, land use), social and
economic (Mansfield, Ducharme, & Koski, 2012).
Participation in regular physical activity has a close relationship
with health and quality of life (Paffenbarger, Hyde, Wing, & Hsieh,
1986) (Lee, Paffenbarger, & Hennekens, 1997). The human body has
evolved to support movement and therefore needs to engage in regular
physical activity in order to function optimally. Lack of physical activity
can therefore lead to poor functionality and long term illness. Evidence
obtained from research has established that a sedentary lifestyle is a risk
factor for increased all-cause mortality due to the increased risk of devel-
oping chronic illnesses, such as cardiovascular diseases (CVD), obesity
and diabetes. In the western world CVD is the main cause of mortality
(D. E. Warburton, Nicol, & Bredin, 2006; D. E. Warburton, Nicol, Gatto,
& Bredin, 2007). In contrast, an active lifestyle not only results in good
health but is also associated with many social and psychological benefits.
Extent of physical activity has a direct correlation with life expectancy,
such that physically active populations tend to live longer than inactive
ones (Haegele, Famelia, & Lee, 2017; Healy & Owen, 2010). Sedentary

1
WHO, https://www.who.int/news-room/fact-sheets/detail/physical-activity.
28 | Conor Hussey and Ananya Gupta

people who become more physically active report feeling better from
both physically and mentally, reduced disease symptoms, reduce anxi-
ety, improve sleep and enjoy a much better quality of life (Gomez-Re-
dondo et al., 2022; Gopinath, Hardy, Baur, Burlutsky, & Mitchell, 2012).
Participation in regular physical activity, leads to many favourable
changes in morphology, physiology and functional parameters, which can
prevent or delay the onset of chronic illnesses and improve functional ca-
pacity and performance (Burnham, 1998) (Janssen & Leblanc, 2010). It
is currently evident that individuals who participate in regular physical
activity and have a physically active lifestyle experience a number of health
benefits, including the following (D. E. R. Warburton & Bredin, 2017):
1. Decreased risk of cardiovascular disease. If already diagnosed
with CVD physical activity can reduce symptoms and slow pro-
gression of disease. Prevention and/or delay the onset of hy-
pertension. Improved control of high blood pressure. Improved
cardio-respiratory function and cardio-respiratory capacity.
2. Maintain metabolic functions and lower risk of type 2 diabetes.
3. Reduce risk of obesity and improve fat utilisation and help in
weight management
4. Reduced risk of developing cancers, such as breast, prostate and
colon cancer.
5. Strengthen bones through improved mineralisation in young
ages, improved bone density and bone strength, contributing
to the prevention of osteoporosis and reduce risk of fractures
in older ages.
6. Improved digestion and regulation of the intestinal rhythm.
7. Maintenance of muscle mass and improvement in muscular
strength and endurance, resulting in an increase in functional
capacity to carry out all activities of daily living.
8. Improve motor functions including flexibility and balance.
9. Improved cognitive functions. Reduced risk of depression and
dementia. Lowered stress levels and improved sleep quality.
10. Improved self-image and self-esteem and increased enthusi-
asm, motivation and optimism.
11. Improved immunity and reduced susceptibility to infections
12. Improved productivity and decreased absenteeism from school.
13. In older adults, physical activity helps to maintain flexibility
and balance thus reducing the risk of falling and prevention or
delaying of chronic illnesses associated with ageing.

Physical inactivity or sedentary behaviour is a key determinant of

poor health outcomes across the life span (Bai et al., 2021; Bailey, 2017). A
lack of activity or movement increases the risk of developing many chron-
 Chapter 1. Importance of physical activity and its impact on growth… | 29

ic illnesses such as: heart disease, cancer, diabetes, obesity, hypertension,

osteoporosis, sleep disorders, anxiety and depression (Bai et al., 2021; Bai-
ley, 2017; Falk et al., 2022). The global health burden of physical inactivity
in terms of mortality has been found to be equivalent to that of cigarette
smoking and obesity. Indeed, the prevalence of physical inactivity, along
with this substantial associated disease risk, has been described as a mod-
ern day “pandemic” (Bailey, 2017; Mossavar-Rahmani et al., 2020).
Despite the strong correlation between regular physical activity and
a healthier, longer life majority of adults and young people globally are
not meeting the minimum physical activity needed for securing health
benefits (Donnelly et al., 2009; Oja, Bull, Fogelholm, & Martin, 2010; Rie-
be et al., 2015). A large body of research evidence highlights an alarming
decline in the levels of physical activity and physical fitness within all age
brackets worldwide (Guthold, Stevens, Riley, & Bull, 2018). This can be
attributed to a greater reliance on technology and desk based work. Phys-
ical inactivity is ranked between the second and sixth most important risk
factor in contributing to the population burden of disease in the western
society [3-5]. Its prevalence is higher than that of all other modifiable risk
factors [5]. Physical inactivity during the early years of life is currently
indicated as a major contributor to the increasing levels of obesity, and
other serious medical conditions, in children and adolescents in Europe
[6, 7]. The increased political, media and scientific interest in obesity has
placed the need for regular physical activity as high priority among cur-
rent public health issues. This has led to the development of international
guidelines recommending the minimum levels of PA needed for health
benefit. EU member states have adopted these guidelines at the national
policy level. These guidelines and the current status of PA in some of the
EU member states are discussed in Chapter 2.

FIGURE 1: PA benefits and recommendations for children. Taken from WHO

guidelines on physical activity and sedentary behaviour 2020. (Source: WHO report
ISBN 978-92-4-001512-8).
30 | Conor Hussey and Ananya Gupta

According to the recent global estimate less than 50% of children

and adolescents meet the required minimum PA levels recommended
by WHO evidence-based guideline (Aubert et al., 2021) (Figure 1) of
“minimum 60 minutes of moderate-intensity physical activity daily”.
Moreover, the proportion of youth who meet this guideline declines with
increasing age, so that younger children are more likely to be physically
active than adolescents and young adults. Further, daily opportunities
for incidental physical activity have declined significantly for children
and adolescents, as they have for adults, as a result of such factors as
increased reliance on nonactive transportation, automation of activities
of daily living, and greater opportunities for sedentary behaviour and
choice of sedentary leisure-time activities. Finally, substantial dispari-
ties in opportunities for physical activity exist across racial, ethnic, and
socio-economic groups further increasing the barriers towards being
active (Aubert et al., 2021).
The major cause underpinning the growing trend in physical in-
activity can be attributed to changes in children’s leisure time pursuits
(Katzmarzyk et al., 2008). In the past, children actively engaged in active
outdoor play both during free time in school and after school hours.
With the emergence of television, computer games and the internet,
children are now spending most of their free time engaged in sedentary
pursuits (Katzmarzyk et al., 2008). The role played by PA in the growth
and development of physical, mental and social health of youth is evi-
dent and well accepted, therefore it is crucial to take effort to “reintro-
duce” physical activity into the day to day lives of our youth. The growing
obesity and related illnesses in children is considered to be the biggest
health challenge in the 21st century and can be attributed to insufficient
PA (Millard, 2012). The responsibility to improve levels of childhood
physical activity and other health related childhood behaviours lies with
everyone in society. Schools, homes and the community are excellent lo-
cations to assist children in improving health related lifestyle behaviours
such as physical activity (Froberg & Andersen, 2005).

1.1 Important Concepts of Physical Activity

and Physical Fitness

There are many different techniques that can be used to measure

and interpret physical activity. Caspersen et al. (Caspersen, Powell, &
Christenson, 1985) previously described physical activity as “Any bodily
movement produced by skeletal muscles that result in caloric expendi-
ture.” However a more recent conception, created through a roundtable
consensus conference of experts on physical activity research (Pettee
 Chapter 1. Importance of physical activity and its impact on growth… | 31

Gabriel, Morrow, & Woolsey, 2012) provides a more objective descrip-

tion of `PA and facilitates understanding and assessment. The new defi-
nition: “behaviour that involves human movement, resulting in phys-
iological attributes including increased heart rate, blood pressure, and
blood glucose levels”, describes “PA as a habit” thus providing recog-
nition of PA as a “behaviour”. This effectively conveys that PA or exer-
cise is “voluntary” by nature and is therefore influenced by the different
physiologic, psychological, and environmental factors. The “movement”
described can include both Structured activities (those that are repeti-
tious, planned, frequently guided by an adult, and carried out in physical
education classes) and Unstructured activities (i.e., play, unsupervised,
activity performed during recess or school breaks). Additionally, activ-
ities can be operationally classified based on their frequency (i.e., num-
ber of movements each day), duration (i.e., minutes of real movement
recorded), intensity (i.e., effort required to perform the movement), and
kind (i.e., activity) (i.e., nature of movement as being, for example, aer-
obic or bone-strengthening related activities). The term “dose” or “vol-
ume” of physical activity, which refers to the overall quantity of move-
ment made during a given time period, is frequently used to describe
the mix of frequency, duration, and intensity (Aarnio, Winter, Kujala, &
Kaprio, 2002; Gorely, Biddle, Marshall, & Cameron, 2009; Moore et al.,
2020; Muzenda, Kamkuemah, Battersby, & Oni, 2022; Pettee Gabriel et
al., 2012; Ridley & Dollman, 2019; Tye, Scott, Haszard, & Peddie, 2020;
Uijtdewilligen et al., 2011).

FIGURE 2: Physical Activity Behaviour and relationship to Health.

32 | Conor Hussey and Ananya Gupta

Definitions
Physical activity: is defined as “body movement produced by mus-
cle action that in- creases energy expenditure. It is a behaviour that in-
volves human movement, resulting in physiological attributes including
increased heart rate, blood pressure, and blood glucose levels”.

Physical exercise: includes PA that is “structured”, involves repet-

itive and purposeful movements, often with the goal of improving or
maintaining one’s physical fitness or is required for performance in a
sport. For example, cycling and swimming are forms of physical exercise
while gardening or walking upstairs in one’s home may not be classed as
structured “exercise”, but it is certainly physical activity.

Physical fitness: is a physiological state of well-being that defines

the capacity of an individual to carry out the various tasks of daily liv-
ing. It includes the capacity of an individual to perform in sports. It also
includes the ability of the individual to resist illnesses and is a measure
of their health. Physical fitness therefore consists of a set of physical
and physiological parameters that can be measured or quantified and
describes how well one can perform in physical activity and exercise.
Physical fitness parameters can be used to compare the relative capacity
of individuals to perform in a given physical activity.

Health: is a reflection of one’s overall physical, mental and social

capacity and condition and overall well-being. Good health does not
simply mean absence of disease. The health and wellness are conditions
of an individual that is not stable and it can vary over time through a
continuum (Draper, Tynan, & Christianson, 2008) from optimal physi-
ologic functioning (wellness) to near death (illness) (see Figure 1).

FIGURE 3: The Illness to Wellness Continuum.

 Chapter 1. Importance of physical activity and its impact on growth… | 33

Exercise Prescription - A “Dose-Response” principle

for training and fitness
It has been established that the health benefits of exercise and phys-
ical activity can be achieved only when the right amount and type of
exercise is undertaken. The “dose” of exercise required to produce a de-
sired “response” constituting favourable changes in health outcomes is
strongly correlated. Therefore it is important to be able to define and
prescribe the “dose” of exercise required accurately both for obtaining
health benefits and as part of training to improve performance.
The correct “dose” of physical activity that should be prescribed to
a person depends upon several factors such as frequency, intensity, type
of exercise and time/duration of exercise (FITT). The FITT principle (P.
D. Thompson, Arena, Riebe, Pescatello, & American College of Sports,
2013) is used to determine the value of each component required for the
correct dose of exercise. The FITT principle therefore help exercise pro-
fessionals to accurately plan and provide an exercise programme that
will maximise individuals health benefits. The components of the FITT
principle are described below.

Frequency (how often you exercise): This includes the number of

times that one engages in physical activity during a typical week.

Intensity (how hard you exercise): The intensity of the exercise or

how strenuous is the physical activity (described as light, moderate or
vigorous) is measured in terms of the effort needed to complete the
activity. The effort is measured based on the total number of METs
(metabolic equivalents) used to complete the activity, where 1 MET is
the amount of energy (oxygen) your body uses at rest (Jette, Sidney, &
Blumchen, 1990).
Any activity that burns <3 METs is considered light intensity
Any activity that burns 3-6 METs is considered moderate intensity
Any activity that burns >6 METs is considered vigorous intensity
The use of METs to estimate exercise intensity is discussed in more
details in the next section.

Time (how long do you exercise): the duration for which the phys-
ical activity session is undertaken also contributes to the total amount
of energy spent and is therefore an important component defining the
“dose” od PA. The Frequency, intensity and time taken together consti-
tutes the “Volume” of exercise performed (usually measured per week)
and determines the “dose” of exercise undertaken.
34 | Conor Hussey and Ananya Gupta

Type: the specific mode of exercise in which one engages (e.g. run-
ning, swimming, etc.). Different types of exercise contributes to the
improvement of different physiologic parameters. For example aerobic
exercise is required to improve cardiorespiratory capacity while weight
bearing exercise improve muscle strength and endurance. Therefore for
overall health benefits it is important to ensure that all the different types
of exercise are included in an individual’s exercise plan.

FIGURE 4: Represents a typical Exercise Prescription based on the FITT principle.

The Frequency Intensity Time Type or the “FITT” factors can be

manipulated to vary the “dose” of physical activity as needed for an indi-
vidual. The dose of exercise is expressed in terms of energy expenditure
(calories expended) or METs. What this means is that when participating
in physical activity that is more intense, one can spend more calories and
at a faster rate which may reduce the amount of time needed to burn a set
amount of calories. Burning a specific amount of calories while perform-
ing a type of exercise may be seen as a measure or “dose” that is needed
to see improvement or “response” in a particular physiologic parameter.
Other important factors that can contribute to exercise prescription
are:

Overload principle: In order to improve an individual’s fitness it is

important for the individual to stretch their current limit or threshold.
Overload refers to the load or intensity of each exercise, this should be
set at very close to or slightly higher than the individuals current maxi-
mum capacity providing a greater stress, or load, on the body than it is
normally accustomed to in order to. Placing an overload on the body
stimulates a physiologic mechanism of adaptation thus increasing ca-
pacity and contributing to increase in fitness.

Volume and Progression: is the way in which an individual should

increase overload in order to stimulate continuous increases in fitness
 Chapter 1. Importance of physical activity and its impact on growth… | 35

(often called progressive overload). It is a gradual increase in either fre-

quency, intensity or time, or a combination of all three components.
Progression must be gradual to be safe. Progressing too quickly can lead
to injury or unnecessary fatigue, both of which can be discourage or
prevent an individual from continuing to participate.

1.2 Measuring the amount/intensity of physical activity

The intensity of exercise defined as moderate or vigorous activity is a

factor dependent on an individual’s current capacity and level of fitness.
As a result intensity is difficult to measure or quantify. The physical activ-
ity guidelines set out for adults and children (detailed in the next chapter)
recommends participation in exercise of at least of moderate intensity.
In order to achieve this an individual must know or be able to estimate
how much effort is needed. This can be better understood or explained by
observing certain physiologic responses to exercise. An individual who is
performing moderate intensity exercise should exhibit the following:
Breathing rate is increased, but it is still possible to engage in
conversation.
Heart rate is increased to approximately 60-70% of maximum.
The increased heart rate and pulse pressure can be felt easily at
the wrist, neck or chest.
Increased body temperature or feeling of warmth along with
sweating.

A healthy individual should be able to continue performing exercise

at a moderate intensity for an extended period without feeling exhausted
or fatigued. It is important to understand that since “moderate inten-
sity” depends on an individual’s current capacity so the actual volume
of exercise can differ for different people but the responses described
above should still be the same. For example, an individual with a higher
level of fitness would need to perform an activity at a higher absolute
intensity when compared to an individual with a lower fitness in order
to experience the same responses of increased breathing, heart rate and
temperature that are characteristic of a “moderate intensity” activity.
Below, various methods for assessing exercise intensity are dis-
cussed in further detail.

Further methods for gauging intensity of physical activity

The absolute measurement of intensity of exercise can be deter-
mined by measuring the calorie expenditure which can be estimated
36 | Conor Hussey and Ananya Gupta

from the oxygen consumed (VO2) during the activity. Such measure-
ments require complex equipment (metabolic cart), are expensive to
perform and require expertise. However there are numerous other in-
direct methods that can be used easily and reproducibly to estimate the
intensity of exercise. These methods can be used during an outdoor ac-
tivity or sport or while exercising at home. Some of these methods of
monitoring the intensity of physical activity are outlined below:

The talk test

The talk test (Persinger, Foster, Gibson, Fater, & Porcari, 2004) is
a simple method of measuring intensity and uses one’s ability to speak
while exercising.

Light intensity: when exercising at a light intensity such as a

leisurely walk an individual should be able to sing or carry on a
normal conversation without feeling out of breath.
Moderate intensity: during a moderate intensity activity the in-
dividual should be able to carry on a conversation but with some
difficulty or breathlessness but cannot sing. Example being brisk
walking, cycling.
Vigorous intensity: during vigorous intensity activity the indi-
vidual should be out of breath and unable to carry on a normal
conversation. Examples of vigorous activity would include jog-
ging or running and strenuous sports such as basketball, swim-
ming, handball, etc.

Heart rate
When exercising the cardiac output or the
amount of blood pumped by the heart must
be increased to meet the increased oxygen and
nutrients needed by the working muscles. As
a consequence the heart rate is increased. The
increase is directly proportional to the work in-
tensity and to the energy consumed. Therefore
percent increase in heart rate can be used easily and reliably as a measure
of exercise intensity (Karvonen & Vuorimaa, 1988). Heart rate can be
measured easily by counting the pulse at the wrist (the radial pulse) or
the neck (the carotid pulse). This can be then converted to the number
of beats per minute (bpm) to obtain the heart rate. One can feel the pulse
at the wrist and count the total number of beats in one minute. Alterna-
tively one can count for 15 seconds and multiply the number of beats by
4 to obtain the beats per minute or heart rate. The maximum heart rate
 Chapter 1. Importance of physical activity and its impact on growth… | 37

that an individual can attend depends on their age. This can be estimated
from the following: Maximum Heart rate = 220 – Age. For example, if a
child was 15 years old, their estimated maximal heart rate would be 220 –
15 = 205 bpm. Resting heart rate is best measured when an individual has
just awakened in the morning and is still lying down or is at rest or after
a few minutes of sitting quietly. It is usually 60-70 bpm.

FIGURE 5: How to determine your heart rate from your pulse.

The heart rate reserve method (HRR or Karvonen method) is the

best method to determine target heart rate ranges for monitoring intensi-
ty of physical activity [8]. In this method, resting heart rate (RHR) is first
subtracted from the maximal heart rate (MHR) to obtain HRR. For ex-
ample, let us assume that a 15 year old child had a resting heart rate of 80
bpm. The HRR of this individual is MHR (205) – RHR (80) = 125 bpm.

To calculate a heart rate range for practical purposes, one must first
consult Table 1 below to determine the relevant % values of HRR:

(*See definition of RPE in the section below)

TABLE 1: Classification of physical activity intensity using the %HRR and RPE methods.
(Adopted from Reference 9, American College of Sports Medicine Position Stand 1998).
38 | Conor Hussey and Ananya Gupta

We can see that moderate intensity corresponds to 40-59% of heart

rate reserve = 50 (0.40 x 125) – 74 (0.59 x 125).We must now add the rest-
ing heart rate back onto each number to determine the final target heart
rate range. Therefore, the corresponding heart rate range for our child for
moderate intensity activity is 130 (50 + 80) to 154 (74 + 80) bpm.

For vigorous intensity exercise, the heart rate range for this child
would be 155 to 185 using exactly the same procedure as above.

2.4.3 Rating of perceived exertion using a Borg-scale

Perceived exertion is an estimate of the effort an individual has
to make in order to carry out the physical activity or in other words
how hard one feels they need to work. This is a subjective assessment
based on the physical sensations experienced by an individual during
exercise(Carvalho, Bocchi, & Guimaraes, 2009; Hommerding, Donadio,
Paim, & Marostica, 2010; Potteiger & Weber, 1994). An example of a
Borg scale is shown below in Figure 6.

FIGURE 6: The Borg scale of Rating of Perceived Exertion (No-

ble, Borg, Jacobs, Ceci, & Kaiser, 1983).

While exercising, an individual is advised to look at the rating scale,

and estimate the level of exertion they are experiencing as best as possi-
ble and provide the appropriate number from the scale. This is defined
as the “rating of perceived exertion” or RPE. The scale shown in Figure
6 is known as the Borg scale.
A moderate intensity physical activity (Table 1) is represented by
a RPE of between 12 to 13 on the Borg scale (described as “some- what
hard”). Light and vigorous activities fall into the ranges of 10-11 and
14-16 respectively.
 Chapter 1. Importance of physical activity and its impact on growth… | 39

Metabolic equivalent (MET) level

One metabolic equivalent (1 MET) is the amount of energy required
and is equivalent to the amount of oxygen the body uses when at rest
(Jette et al., 1990), such as while lying down, or sitting quietly, reading a
book or watching television. Any physical activity can be defined by the
intensity which is expressed as a multiple of this value depending on the
extent of energy required.
The more intense the work out the higher the energy required and
the higher the METs.
Any activity that burns <3 METs is considered light intensity.
Any activity that burns 3-6 METs is considered moderate inten-
sity.
Any activity that burns >6 METs is considered vigorous intensity.

Table 2 below list the METs required for some common activities.

TABLE 2: Intensities and Energy expenditure (METs) associated with common

types of physical activity. (Adopted from Ainsworth et al, 2000)(Ainsworth, 2000).

1.3 Different Types of physical activity

Based on the main physiologic responses elicited physical activity

can be classified into different types which contribute to the develop-
ment of different aspects of physical fitness. The most important types of
physical activity for health in children and adolescents are:
1. Activities for Cardio-respiratory (aerobic) Fitness.
2. Activities for building muscle strength and/or endurance (resis-
tance or strength training).
40 | Conor Hussey and Ananya Gupta

3. Activities for enhancing flexibility (Stretching).

4. Activities involving coordination (Balance, agility etc.).

Cardio-respiratory (aerobic) exercise

Physical activities that involve an increase
in cardio-respiratory function, are also known as
“cardio-respiratory” or “aerobic” activities. Such
activities usually require complex movements
involve large muscle groups. As a result such ac-
tivities have a high energy requirement impos-
ing an increased demand for oxygen. The cardio-respiratory system is
responsible for uptake and transport of oxygen to the working muscles.
Cardiovascular endurance is the capacity of our body to perform tasks
that require the use of large muscle groups usually for relatively pro-
longed periods of time (several minutes or more). Such activities are
associated with increased heart rate and blood pressure. Training that
involves repeated participation in such endurance exercises can enhance
the capacity of the cardio-respiratory system through adaptation. The
heart and lungs can function more efficiently at providing the working
muscles with the oxygenated blood which is needed to perform the task.
Some examples of physical activities that can improve cardio-respi-
ratory endurance are walking, running, swimming, bicycling, paddling,
dancing, etc. All of these activities involve complex movements brought
about by the coordinated action of multiple large muscle groups.

Muscular strength and endurance exercise

Movement is produced due to the force generated
by the contracting muscles. The capacity of the muscle
to generate force or tension against an opposing force or
resistance is known as muscular strength. The ability of
the muscle to remain contracted for a prolonged period
or length of time in order to produce the force or ten-
sion is defined as muscular endurance. The activities or
exercise which involves movement against a resistance
helps to build strengthen and endurance of muscles. Weight bearing
exercises which apply a load on the bones stimulate bone deposition
and this contributes to increased bone density and strength. Muscular
strength and endurance is required for activities such as pushing, pull-
ing, lifting or carrying a heavy load.
Some examples of activities that can help to build muscular strength
and endurance are:
 Chapter 1. Importance of physical activity and its impact on growth… | 41

1. Weight bearing exercises such as skipping, climbing, push ups,

hanging on a monkey bar, etc.
2. Load bearing exercises such as lifting weights and dumbbells.
3. Activities such as throwing a ball, paddling, rowing, using resis-
tance machines in a gym which involves muscular contraction
against an opposing force or load.

Flexibility exercise
Flexibility can be described as the capacity of
joint(s) when facilitated by the muscles to move
through a full range of motion, unrestricted and
pain free. Flexibility therefore depends on the
specific part of the body or joints involved and is
determined by the elasticity of the joint components – muscles, tendons
and ligaments. Improved flexibility is necessary for pain free movement
and is essential to be able to carry out activities of daily living. Good
flexibility has been shown to be correlated to a higher quality of life.
Flexibility is required for such activities that require bending, lunging,
twisting, reaching out and stretching. Some activities that improve flex-
ibility are: gentle stretching of muscles, sports such as gymnastics and
karate, Yoga, Pilates, etc. During resistance training for muscle strength
flexibility is required to in order to move the joint through a full range
of motion. Usually flexibility exercise are built in as part of the warm
up and cool down session before and after an exercise session. These
involve different types of stretching exercises and helps to prepare the
joints and muscles for the bout of exercise.
It is important to note that girls often have greater flexibility when
compared to boys and also varies significantly during the major growth
phases of life. Flexibility is decreased during a growth spurt as the bones
grow faster than muscles and tendons.

Coordination exercises
Coordination refers to the ability to control
the movement. This is a function of the central
nervous system. The motor unit regulates the ac-
tivation or recruitment and contraction of a mus-
cle, or group of muscles, which may be required
for a specific task, activity or movement. Motor
coordination is the capacity to use the brain and the central nervous sys-
tem together with the motor unit and locomotor system to develop sta-
ble, controlled, smooth and precise movements. Good coordination is re-
42 | Conor Hussey and Ananya Gupta

quired for may sports in which precision is the key to performance such
as tennis and golf. Good coordination is also important for activities such
as gymnastics and dancing. Good coordination can be developed through
exercises that use such movements repeatedly. Some examples are:
Balancing exercise involving the body, such as one leg stand of
walking on a tight rope.
Repeated activities that follow a rhythm, such as dancing to mu-
sic or gymnastics.
Activities involving kinaesthetic awareness and spatial coordi-
nation, such as learning how to perform a somersault or learn-
ing a new dance move.
Activities involving foot-eye coordination, e.g. kicking or drib-
bling a ball as in football.
Activities involving hand-eye coordination, e.g. racquet sports,
throwing or catching a ball.

1.4 Health-related and skill-related fitness

Physical fitness is defined as a set of attributes that people have or

achieve that relates to the ability to perform physical activity. Compo-
nents of physical fitness are:
Cardiorespiratory endurance
Muscle strength, endurance, and power
Flexibility
Balance
Reaction time
Body composition

Physical fitness is determined by an assessment of an individual’s

physiologic capacity. Based on the type of physical activity physical fit-
ness can be classified into two types: health-related physical fitness and
sports or athletic performance or skill-related physical fitness. Health-re-
lated physical fitness is a sub-component of fitness and refers to those
physiologic parameters which determine an individual’s health (Asz-
talos et al., 2009; Kim, Shin, Nam, Choi, & Kim, 2008). This components
reflect the individuals risk of developing chronic illness. Components of
health-related physical fitness are:
Cardiorespiratory fitness
Muscular strength
Muscular endurance
Flexibility
Body composition
 Chapter 1. Importance of physical activity and its impact on growth… | 43

For example, an individual with a good cardiorespiratory capacity is

less likely to develop hypertension and heart disease. An individual with a
low percent body fat is less likely to suffer from obesity. Thus, good aero-
bic fitness and low body fat constitute important components of health re-
lated physical fitness. High health related fitness reduces the risk of illness,
however, the individual may not have a high level of athletic performance.
Skill related physical fitness is a subcomponent of physical fitness,
that determines an individual’s performance in a specific sport. As each
sport requires a different set of skills for optimal performance, the skills
required to excel in them will vary and will be composed of a combi-
nation of different facets of fitness. Skill related fitness is also known as
performance-related fitness and contributes to more skilled and efficient
functioning. Some components of skill related fitness are:
Agility
Power
Balance
Reaction time
Coordination
Speed

For example, athletics requires high levels of flexibility and agility

whereas competitive long distance swimming requires high aerobic fit-
ness and endurance. To appropriate skill-related fitness the athlete must
undergo training specific to their sport. Skill related fitness will also im-
prove physiologic capacity and therefore it will also contribute to health
benefits and health related fitness.

Figure 7, A and B below outlines the key components of health-re-

lated physical fitness and skill related physical fitness.
44 | Conor Hussey and Ananya Gupta

FIGURE 7: Aspects of (A) Health related Fitness (B) Skill or performance

related Fitness.
 Chapter 2
Health Benefits of Physical Activity

By Conor Hussey and Ananya Gupta

Dose-response issues concerning physical activity

and health

According to the FITT principle “dose” of exercise is determined by

Frequency, Intensity, Time and Type of exercise. This is crucial to pre-
scribe optimal amount of exercise to obtain health benefits. The figure
1 below shows that there is a parabolic relationship between physical
activity and health status. That is with increase in the levels of physi-
cal activity and fitness there is a much greater improvement in health
status (Hamer, Stamatakis, & Steptoe, 2009; Lee, 2007; Pate, 1995) (see
figure 1). Physically active people therefore have a much lower risk of
illness. The most significant change in health status is observed when the
most sedentary individual becomes physically active (Ekkekakis, Hall,
& Petruzzello, 2005) (Figure 1). This relationship has significant public
health implications, for both young people and adults.

FIGURE 1: The Dose-Response relationship between physical ac-

tivity and health benefits.

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