200th Case for PediatricEducation.org!

We are pleased to announce that the case today is PediatricEducation.org’s 200th case!

Over the past 4 years, we have tried to offer a breadth of cases, which have aggregated into an unstructured curriculum of pediatric topics that closely parallels the structured curriculum of a pediatric residency, fellowship and continuing medical education programs.

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Respectfully yours,
Donna M. D’Alessandro and Michael P. D’Alessandro
Curators, PediatricEducation.org

How Far is 10,000 Steps?

Patient Presentation
A 17-year-old male came to clinic for his health supervision visit.
He was an active teenager who liked to play soccer with his friends and bike.
He also played videogames 1 hour/day.
He said that he had read that people should walk 10,000 steps a day for exercise and wanted to know how far that was.
He said he ate a variety of foods including daily milk and yogurt.
The family history was positive for the paternal family being overweight and having heart disease and strokes in older relatives.
The pertinent physical exam showed a male with normal vital signs.
His body mass index was 23 and was consistent over the past 2 years.
He had mild acne on his face and upper back. The rest of his examination was normal.
The diagnosis of a healthy male teenager was made.
The physician didn’t know the exact ratio of steps to distance, but a quick Internet search found information that about 2,000 steps = 1 mile = 100 calories (for a 150 pound person).
The teen said that he knew how far he had to bike to burn off 100 calories from when he used a stationary bicycle at school, so he could figure out how far he needed to bike to walk the equivalent of 10,000 steps.

Obesity is an increasing major problem in the United States. Its complications are numerous including heart disease, diabetes and musculoskeletal problems.
Historically in the U.S. when more jobs were very physical, people could get their exercise simply by doing their daily work. This is still true today in parts of the world where carrying water, gathering firewood, doing laundry, building and hunting are daily activities.
It is estimated that most adults only walk about 1,000-3,000 steps/day in their daily life.
At 2000 steps per 1 mile this is only 0.5-1.5 miles/day. Therefore people need to walk more or do other types of exercise in their daily life to get their necessary exercise.

For those looking to reduce weight, 3,600 calories needs to be expended to lose one pound ( or 7,900 calories for one kg).
Walking can be a simple activity for many families to include in their lives and can make a difference.
Walking at only 3 mph, a 30 minute walk = 1.5 mile or 150 calories expended.
If this is done 5 days/week = 750 calories/week = 39,000 calories/year.
This translates into 10.8 pounds weight loss over the year.

Playing on a playground for 30 minutes is also good exercise.
Using the chart below, 136 steps/minute x 30 minutes = 4,080 steps or 204 calories expended.
Again if this is done 5 days/week = 1,020 calories/week = 53,040 calories/year or 14.7 pound weight loss over the year.
Parents should be encouraged to play with their kids because of all the social benefits and its also good for the parents’ own health too!

As youth need more activity, their levels are increased above adults.
The President’s Council on Physical Fitness has a President’s Challenge which recommends the following activity:

  • Youth < 18 years
    • 60 minutes/day
    • Activity done in blocks of at least 5 minutes or more
    • 5 days/week
    • 11-13,000 steps/day
  • Adults
    • 30 minutes/day
    • Activity done in blocks of at least 5 minutes or more
    • 5 days/week
    • 8500 steps/day

Learning Point

Average steps/minute by activity

  • Everyday life
    • Cooking – 61
    • Gardening – 121
    • House cleaning – 91
    • Raking leaves and lawn – 121
    • Shopping – 70
    • Sitting – 30
  • Walking/Running/Hiking
    • Walking 2 mph – 76
    • Walking 3 mph – 100
    • Walking 4 mph – 152
    • Running 5 mph (12 minute miles) – 242
    • Running 6 mph (10 minute miles) – 303
    • Running 7 mph (8.5 minute miles) – 348
    • Running 8 mph (7.5 minute miles) – 409
    • Hiking – 273
    • Backpacking – 212
    • Rockclimbing – 273
  • Leisure Activities
    • Aerobics
      • Dance – 197
      • Step – 273
      • Water – 121
    • Basketball shooting baskets – 136
    • Basketball game – 242
    • Bicycling – 121-364, average 242
      • Stationary bicycling – 212-318
    • Dancing
      • Ballroom – 91-167
      • Square dancing – 136
    • Fishing – 91
    • Football, American – 242
    • Frisbee – 91
    • Golf
      • Miniature – 91
      • Regular – 136
    • Gymnastics – 121
    • Health club exercise – 167
    • Hockey, ice and field – 242
    • Skating, roller and ice – 212
    • Inline skating – 364
    • Jumping rope – 303
    • Kickball – 212
    • Martial arts – 303
    • Playing on a playground – 136
    • Rowing – 212-258
    • Sailing and Surfing- 91
    • Skateboarding – 152
    • Skiing
      • Cross country – 242
      • Downhill – 182
    • Sledding – 212
    • Soccer – 212
    • Softball – 152
    • Stair machine – 273
    • Swimming – 182-318
    • Tennis – 212
    • Volleyball – 121
    • Weightlifting – 121-182
    • Wresting – 182
    • Yoga – 76

Questions for Further Discussion
1. What are the recommendations for limiting television viewing to increase exercise?
2. What are your standards for physical education in the local school district?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Exercise and Physical Fitness and Exercise for Children.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

Corporation of Delta, British Columbia. Pedometer Step Equivalents for
Exercises and Activities.
Available from the Internet at http://www.corp.delta.bc.ca/stepsout/steps_equivalencies.pdf (cited 11/13/08).

Presidential Council on Physical Fitness. Why These Activity Amounts
Available from the Internet at http://www.presidentschallenge.org/the_challenge/why_activity_amount.aspx ( cited 11/13/08).

ACGME Competencies Highlighted by Case

  • Patient Care
    1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
    2. Essential and accurate information about the patients’ is gathered.
    3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
    4. Patient management plans are developed and carried out.
    5. Patients and their families are counseled and educated.
    6. Information technology to support patient care decisions and patient education is used.

  • Medical Knowledge
    10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
    11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.

  • Practice Based Learning and Improvement
    12. Evidence from scientific studies related to the patients’ health problems is located, appraised and assimilated.
    13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.

    15. Information technology to manage information, access on-line medical information and support the healthcare professional’s own education is used.

  • Professionalism

    22. Sensitivity and responsiveness to patients’ culture, age, gender, and disabilities are demonstrated.

    Donna M. D’Alessandro, MD
    Professor of Pediatrics, University of Iowa Children’s Hospital

    December 22, 2008