The healthy lifestyle pyramid for children and adolescents

The healthylifestyle pyramidfor childrenand adolescentsGUIDE FOR PARENTS



Practical guide foran active, healthy lifestylePhysical activity, playing, a varied and balanced diet,hydration, hygiene and habits that promote overallgood health are all important for the developmentof an active, healthy lifestyle among children andadolescents alike in current society.Authors: Prof. Dr. Marcela González-Gross, Juan José Gómez Lorente, JaraValtueña, Juan Carlos Ortiz, Francisco Fuentes, Dr. Agustín Meléndez. ©Universidad Politécnica de MadridEdited by Dr. Rafael Urrialde. Coca-Cola Spain©ISBN 13-978-84-96398-40-5Healthy lifestyle pyramid for children and adolescents©Coca-Cola España 2007Madrid (Spain), 2010



The healthy lifestyle pyramid for children and adolescentsIndex page 7 page 8 Foreword page 15 Chapter 1. The healthy lifestyle pyramid for children and adolescents page 18 Chapter 2. Forming habits (6 to 9 years) page 21 Chapter 3. Consolidating habits (10 to 13 years) page 24 Chapter 4. Maintaining habits (14 to 18 years) page 25 References and recommended reading Annexpage 5



The healthy lifestyle pyramid for children and adolescentsForewordThe healthy lifestyle pyramid for children and adolescents© is an educational tool specifically developed foryoung people taking into account current scientific knowledge. The main aim is to facilitate the acquisition ofhealth-promoting habits from childhood onwards. Primary focus is placed on the importance of an active,healthy lifestyle that includes a sensible,balanced diet and regular physical activity. Energy balance – balancingcalories in and calories out to achieve and maintain a healthy weight – is key to an active, healthy lifestyle.There is scientific evidence that risk factors for chronic diseases (obesity, diabetes, some cancers, cardiovasculardisease,among others) can develop during childhood and adolescence.Therefore,efforts to reduce the risk factorsshould start at an early age.The adoption of an active, healthy lifestyle is an important factor for growing up inan enjoyable and desirable way and can contribute to better health both in childhood and in adulthood.This guide is complementary to the pyramid. The pyramid helps communicate to children and adolescents thebasic messages regarding the importance of developing and maintaining an active, healthy lifestyle. Habits topromote overall good health should start at an early age. Chapter One deals with general messages, and inChapter Two to Four age-specific guidelines are introduced in order to promote life-long learning.It is our responsibility as adults to encourage the forthcoming generation to acquire healthy habits. This guideaims to contribute to this learning process towards adulthood. The authors page 7

Chapter 1 Educating children and adolescents regarding the importance of an active, healthy lifestyle, in particular the importance of balancingThe healthy lifestyle calories in with calories out to achieve and maintain a healthy weightpyramid for children in growth (what experts refer to as energy balance), should be a partand adolescents of the general education programme. Health education for these groups must have a different approach from that for adults as it should not force models of behaviour onto individuals or groups. The educational model we have developed is a three dimensional truncated and staggered pyramid with four faces and a base. Each face is oriented towards achieving a specific health-promoting goal. The concepts that have been imperative to take into account have been the following: dietary habits (daily intake, face 1 and food pyramid, face 3), daily physical activity (face 2), and hygiene and health (face 4). Topics are dealt with in this order in this chapter. On the base of the pyramid, advice about nutrition alternates with advice about physical activity and sports for achieving overall healthy growth.The pyramid represents an integrated concept that goes beyond other published pyramids and has been specifically developed for children and adolescents. Multicomponent educational programs based on behaviour change are much more efficient than dealing with these aspects individually. Apart from nutrition, hydration and physical activity, acquisition of both daily and life-long habits related to hygiene and health, organizing the daily schedule and the progression that should be achieved in sports practice are included. All messages have been formulated in a positive way, with the exception of those related to smoking and alcohol consumption. page 8

The healthy lifestyle pyramid for children and adolescentsThe healthy lifestyle pyramid for children and adolescents page 9

DAILY INTAKE: FACE 1Nutrition education for children and adolescents should be focused on food-based dietary guidelines and food patterns.If food intake is distributed over 5 meals per day, achieving a varied diet and getting the necessary energy and nutrientintakes will be easier.We should not forget that children and adolescents have a higher Breakfast should include a dairy product, fruit or juice, cereals or bread.metabolic rate than adults because of growth (that means that their Regular breakfast habits correlate with better performance at schoolenergy and nutrient requirements per kg body weight are higher than and also with better physical performance.those for adults). Consuming morning and afternoon snacks that provide important nutrients to meet the needs of children and adolescents broadens the possibility of food variety and structures the eating occasions per day. Sandwiches and rolls can have many different fillings and help to avoid boredom.Fruits and vegetables – fresh,canned,frozen or dried – are also options that children will enjoy. Sandwiches, fruits and vegetables also teach how to chew, something that many children find difficult to learn! Foods offered for lunch and dinner should be complementary regarding protein sources (eggs, meat, fish, pulses) and vegetables and salads.We should rediscover traditional meals and alternate those with modern food styles, but always trying to make sensible selections that are low in saturated fat. It is important to keep drinking liquids throughout the day, both during and between meals. When choosing liquids with calories, children and adolescents should keep in mind that all calories count in maintaining energy balance. Research shows that eating alone or while distracted, for example, by watching the T.V. at the same time, can encourage poor eating habits in all ages. We should keep in mind that the adequate diet for children and adolescents is not the same as for adults! Foods from this face should be changed for foods from the same food group shown on face 3. I page 10

The healthy lifestyle pyramid for children and adolescentsFOOD GROUPS: FACE 3Within a healthy diet, all foods and beverages can be included, but not in the same amounts and with the same frequency.The number of portions does not vary much with age, but portion size Bread, pasta, rice, potatoes and bananas are foods rich in carbohydrates,should increase with increasing age and according to the degree of low in fat and can be good sources of some minerals like calcium,physical activity children and adolescents perform. magnesium, potassium, phosphorus, and some B vitamins.Eating different coloured foods is a way to promote nutrient intake, As stated above,most children and adolescents like sweets.These can beespecially vitamins, minerals and antioxidants. included in small amounts and not necessarily on a daily basis in the framework of an active,healthy lifestyle that includes a sensible,balancedTwo or three times per week, meat or fish should be substituted by diet and regular physical activity. Young people should be educatedpulses. In this meal, pulses are the protein source that should be about the importance of consuming sweets and snacks in moderation.Icomplemented with vegetables or salads and some cereals; there is noneed to eat additional protein foods such as meat, fish or eggs withthese meals.Foods with a higher content of fat should be consumed two or threetimes per week. They supply fat-soluble vitamins and essential fattyacids which are necessary for optimal development in children andadolescents. Liquid fats, i.e. oils, for example, virgin olive oil, should bepreferred for consumption on a daily basis. Solid fats should be limited,because they contain significant amounts of saturated fatty acids.Optimal hydration should be obtained by means of water andbeverages throughout the day. When consuming beverages withcalories, it’s important to keep in mind that all calories count inmaintaining energy balance for a healthy weight. Children like to drinkdifferent beverages, especially those which are sweet like juices and softdrinks.This is because children have a taste preference for sweet foodsand because they have higher energy needs than adults. Thesebeverages can be offered with moderation, but should not be the onlybeverages that children consume. page 11

DAILY ACTIVITIES: FACE 2Children should learn how to organize their day from the time they are very young and onwards. Teach the child andthe adolescent how to programme their daily/weekly schedule! Regular physical activity is important to balance thecalories consumed.The amount of time dedicated to various activities will vary as a function It is quite common for positive habits related to physical activity to beof age. All activities are necessary and none should be neglected to lost during adolescence,something that should be avoided.Participationfavour others. in organized sports should not be abandoned because of the need to dedicate more time to studying or leisure time activities. Both activitiesAt all ages, at least 60 minutes per day should be dedicated to physical are compatible and we should help children and adolescents to learnactivity of moderate to vigorous intensity (that is, those which increase how to manage their time. Even more, regular engagement in physicalthe pulse and make us sweat). activity is related to better school performance, especially those aspects related to memory, problem solving and reading. Sedentary activities like learning to play a music instrument, reading and table games contribute to the intellectual development of children and should be encouraged. Sedentary activities (television, computer, etc.) should be limited to a maximum of 2 hours per day. Together with all these proposed activities, physical education lessons that children and adolescents receive regularly at school are important in developing and promoting an overall active, healthy lifestyle. I page 12

The healthy lifestyle pyramid for children and adolescentsHYGIENE AND HEALTH: FACE 4Although for children and adolescents being an adult seems a long time away for them, and reducing the risk of diseasessomething that is remote for them, they should be taught to take care of their own health and hygiene.Both while sitting and standing up, the back needs special care. School Sociological studies demonstrate that people who have not smokedbags should not weigh more than 10% of the children’s body weight,and before the age of 20 present a low probability of doing so duringthe weight should be well distributed. Pain in the back happens more adulthood.often in sedentary young people who are less physicall active and whooften have incorrect postures while sitting in the classroom. The base of the pyramid will be explained by means of age-adapted messages in the following 3 chapters. IIn addition to the routine visit to the paediatrician, children should alsovisit other physicians. Before increasing training intensity and frequency,the child or the adolescent should pass a sport’s medical check up thatincludes specific tests in order to detect diseases,disorders or other healthconditions that might be life-threating or that could reduce sportsperformance. Oral hygiene is important at any age, including duringchildhood. Regular brushing of the teeth and regular visits to the dentistare important habits to encourage. This will help reduce the risk ofdeveloping tooth decay and erosion. Adequate chewing of foods is thestart of a proper digestion and nutrient assimilation.Body hygiene and ashower should develop into a daily habit, even more so after engagingin physical exercise.Around 10 to 30% of all hospital admissions are due to accidental injuriesat home. Therefore, special care should be taken to avoid dangeroussituations.Road safety should form an integral part of a child’s education.In some countries, consumption of alcohol and tobacco is reported tostart around the age of 12 years old. These habits cause several healthproblems that adolescents should be aware of. Around 16% ofadolescents smoke and 75% drink alcohol on a regular basis. More than4,000 toxic substances have been detected in cigarettes. Many of themare carcinogenic.Practicing sports has been found to be one of the mosteffective prevention measures against these detrimental habits. page 13

HEALTHY GROWTH: BASE page 14

Chapter 2 The healthy lifestyle pyramid for children and adolescentsForming habits This stage is characterized by the need to move in a playful and(6 to 9 years) energising manner. A child's life, full of joy and emotion, is more than a game; finding new ways to motivate this age group to be physically active and follow a varied diet is important. Children 6 to 9 years of age engage in physical activity through play; movement has to be part of their daily schedule. Food must also be part of an active, healthy and enjoyable lifestyle and can even be included in play. Why is it so important for the child to play? By means of playing, the child has the opportunity for new experiences, has fun,learns skills,values,and grows both mentally and physically. He/she socializes while engaging with other children. Additionally, playing helps children cope with emotions. What does playing contribute to our knowledge about children? When playing,the child shows his/her personality,because he/she devotes all his/her energy without forming preconceptions and without needing to have a particular purpose. While children may be fully involved in playing a game, each reacts differently to winning or losing. Children of this age should be encouraged to think of games as a “time for fun” where it doesn’t matter if they win or lose, simply that they have fun. Due to the great changes and development occurring at this stage, two age groups should be differentiated, 6 to 7 years and 8 to 9 years. page 15

6 TO 7 YEARSAt ages 6 and 7 years old, basic physical qualities such as speed, How to motivate children at this age?strength, endurance and flexibility increase as a result of the maturationof the nervous system, enabling the child to perform more complex It is essential to positively reinforce the importance of children in this agetasks and coordination. group being active, but the parents should not force a child to be active.The development of logical reasoning skills and the child’s growingcuriosity leads to wanting to know everything and to asking abouteverything. It's the time to learn social behaviour, to share toys and toget to know that the spotlight is not only on him or her. It is animportant time to begin learning that games can be won or lost.What is the meaning of sport at this age?Learning basic skills (running, jumping, turning, throwing). Instead ofregulated sport, the 6 to 7 year old child should practice introductorygames to sport, such as: tag, the whip, leap frog, jump rope. Games canbe individual, in pairs or in groups. Being active on the playgroundshould be encouraged.Recommended GamesI Those games which lead to exact imitation and fiction that awakens the imagination, the child creates a world of fantasy.I Those which require rules that are fixed and agreed on with the other children.I Those which lead to improving knowledge or to putting into practice what they already know.I Those that encourage the child to be physically active. page 16

The healthy lifestyle pyramid for children and adolescents8 TO 9 YEARSAt 8 to 9 years of age, analytical capabilities develop, permitting the and the play experience increases his/her self-confidence to try newexecution of more complex and precise play and tasks.Friendship is more proposals and accept new challenges.important; children may have a ‘best’ friend. Food at age 6 to 9: explore, discover and enjoy food What is the meaning of sport at this age? New foods should be introduced slowly. If a child refuses a food, look forAt this age,the child can be introduced to organized sports. It is important indirect stimuli (e.g. games) that encourage the child to try that food.to ensure that the playful aspects of sport’s activities are retained, thateveryone participates and that excessive competition is avoided. The participation of children in the preparation of meals and snacks is an added stimulus and can help them to try newChildren at this age begin to relate to one another and to compare the dishes. It is a way of introducing new foods and encouragesphysical skills and abilities that each is acquiring. them to try something different. A colourful apron can be a gift which makes them feel excited about being a chef and Recommended Games can help encourage the child to participate in the preparation of delicious dishes, both sweet and savory.I Games with rules attract the interest of 8 and 9 year olds.These games allow them to demonstrate their physical activity and intellectual GAME: WITH GREAT TASTE! capacities to their friends.The ability to be creative create leads them to Give the children different peeled,cut fruits to try,with their eyes covered. enjoy more sophisticated games. The game consists in guessing what fruit it is.It works better with several children and when their successes are applauded…I Bicycles and skates stimulate their physical development and allow them to channel their energy. Other examples include volleyball,soccer, GAME: WITH GREAT FEELING! basketball with age-adapted rules. Children can even agree among A variant of the previous game is to get the children, with their eyes them selves on their own rules. covered, to touch different foods with different textures, and to get to know them.This game is great fun and they love it.I The more complex puzzles allow them to develop their manual and intellectual skills.I Strategy games give them a good intellectual and reflective capacity. At this stage the concept of a varied diet distributed in 5 meals per day should be established. How to motivate children at this age? Hygiene during the preparation of food is essential. Washing hands isThrough appropriate definition of the game to be played, the child essential,as is brushing teeth after meals.In this way we promote hygienicunderstands and executes it correctly.When successful, the child is happy habits in children. page 17

Chapter 3 This stage is a transition between childhood and adolescence.There are important physical, cognitive and pschycosocial changes that theConsolidating habits adolescent should know and understand. Puberty is the end of(10 to 13 years) childhood. Adolescence is a time of rapid growth in height and weight, changes in the proportions and body shapes and the onset of sexual maturity occur. As a result, it is the stage of life, with the exception of the first year of life, with the greatest needs for energy and nutrients. Therefore, it is essential in the years leading up to adolescence that children focus on the quality, quantity and variety of foods in a varied and balanced diet and that regular physical activity becomes a habit. At this stage we should differentiate between biological age and chronological age. Each child has his/her peculiar mode of growing so that within the same school year and same chronological age, there are differences in the morphological and functional characteristics of the children. Girls usualy develop about 2 years earlier than boys. Why is it so important that children engage in physical and sporting activities? Play becomes a more complex activity between 10 and 13 years of age, thanks to the physical and intellectual maturity of the child. It is important for children to try different types of sports and activities and that they learn to relate to their companions and rivals, and face new challenges, using different means to achieve their objectives. At this age, children should choose the sport they like best to keep up the habit as they move to adolescents and adulthood. At 14 years old it may be too late for the child to get enthusiastic about a sport (habit formation).The child’s interest and motivation to engage in a sport can help in the development of basic skills. Engaging in sports can also play an important role in helping children cope with aggressiveness. page 18

The healthy lifestyle pyramid for children and adolescents What do physical activity and sports activities Recommended physical activity bring to children at this age? We must take advantage of these stages to establish the types of tasksI Being physically active: that we will use with children.   Helps increase and maintain muscle strength, cardiorespiratory endurance, speed and muscle and joint flexibility. At ages 10 to 12 years, team sports work only moderately well, with the   Provides basic sports training. most effective activities for both sexes being aerobic endurance (e.g.,   Helps promote overall goodect health. continuous running), reaction time (e.g., short sprints), and flexibility.   Improves the quality of sleep. Girls 10 to 12 years can start gently with explosive force (e.g., throwing a ball) and both cyclic and acyclic maximum speed (e.g., racing).I At the social level, physical activity:   Provides opportunity for competition and cooperation. After 12 years of age, these qualities can be increased. Boys can start   Encourages the formation of groups and teams. working on strength and speed, in direct connection with the sport   Helps develop social skills and specific roles. practiced. Overall, the best approach is for children 12 years and older   Fosters acceptance by the group and self-acceptance. to engage in all kind of sports of moderate to vigorous intensity.I On a cognitive level, physical activity: The importance of warming up   Develop self esteem and confidence. before exercise and streching after exercise   Improves physical and intellectual performance.   Improves self-assurance. Before performing any physical exercise, some warm-up exercises   Improves body image. should be done that benefit the muscles, the cardiovascular system and joints. The duration should be between 10 to 20 minutes (see in the What does sport mean at this age? annex).In childhood there are phases of positive developement, called sensitive Stretching should also be part of the routine of the warm-up and cool-periods and phases of stagnation and delay called critical periods. down. Muscles should be stretched after doing the warm-up exercises. Stretching exercises should not be too complicated, 4 to 5 exercises thatIt is imperative in sport that motor skills are encouraged and developed. stretch most of the muscles should be enough, both when warming upThis includes qualities of fitness, like speed, strength, endurance and and at the end of the activity (see in the annex). Both practices alsoflexibility, and coordinational qualities, such as situation in space and reduce the risk of injury.time, balance, laterality, visual-motor and psychomotor coordination. Allmust be worked on to develop. page 19

Why do we sweat while practicing sports? How to motivate the child at this age?Our muscles are able to move because in each of our cells energy is As this can be a behavioural crisis stage as a result of physical changes,produced for this muscle work. This is called the combustion process, improvement in athletic ability should be emphasized because itand additionally to energy, heat is also produced. If this heat contributes to building self-esteem and body image. It is important thataccumulated, our bodies would overheat. In order to maintain body we adults should be near them to know about and share their activitiestemperature close to 36.5 - 37ºC, both the production of sweat and and have common interests.evaporation contribute to cool the body (this process is calledthermoregulation).Therefore, sweat is a physiological process essential Food at this age: food variety and taking time for mealsduring sports or physical activity, especially in hot weather. At this age, all foods should be eaten and all flavours accepted. For mid morning and afternoon snack, easy-to-transport foods and drinks should be chosen. Bread rolls admit a great variety of fillings. “Tasty sandwich” = bread with... There are many and varied options for preparing a tasty sandwich or roll. It is very important to pay attention to proper fluid intake during and after sport practice and games, especially where the level of activity has been over a long period or it has been very intense. When sweating during intense or prolonged physical activity, we lose body water and electrolytes, which must be replaced immediately in order to avoid overheating and other possible adverse health effects.Therefore, to the litre and a half that they should drink every day we should add the volumn lost via sweating. This means that children who do intense or prolonged sports must drink more. page 20

Chapter 4 The healthy lifestyle pyramid for children and adolescentsMaintaining habits At this stage it is important to maintain and reinforce acquired habits,(14 to 18 years) as sports activities and consumption of a varied and balanced diet are often abandoned. Both boys and girls are able to carry out any sport or physical activity,even those which require intense training.Adolescents are already able to plan their own sports program. The challenge is keeping them motivated. Why is it important for adolescent to engage in regular physical activity, including organized sport? The regular practice of physical exercise, including organized sports, facilitates the growth and strengthening of bones,improves posture,helps prevent injury,and facilitates social communication and interaction.It can improve cognitive capabilities like attention,memory,decision making,etc. Maintaining habits that promote an active, healthy lifestyle helps to prevent the acquiring of harmful habits. What does sport mean at this age? All components of physical fitness should be trained at this age: strength, endurance, speed and flexibility. This can be done as part of individual activities, or through organized sports. It should be borne in mind that once an initial training phase has passed,the effects of exercise are specific and it is necessary to vary the type,intensity and areas activated to improve fitness.The practice of sports skills should be constantly maintained to be able to adjust and adapt them to new morphological characteristics. It is at this stage that technical-tactical features of strategic abilities are perfected. It is fundamental to have made a good choice of sport at the previous stage, as adolescents commit totally to intense sports practice if they like the sport, although it is never too late to change or begin to practice a new sport. page 21

The important point is to promote physical activity and organized sports I The exercise can be accumulated by performing intermittent activitiesfor better overall health. If they enjoy the sport and training, they can in which a short period of vigorous or more intense activity,e.g.soccer,pursue it at a competitive level.To practice “regulated competitive sports” tennis or volleyball, is followed by a periods of less intensity.a more meticulous physical training is required which is adapted to therequisites of the sport or sports which are chosen. In this case, the I The way that moderate and vigorous intensity is mixed is flexible,collaboration of a sport professional is unavoidable in order to supervise provided that it is performed 3 times a week. The fact of breathingprogression in sports practice. faster during the activity and feeling slight difficulty in breathing can be used as an indicator that the exercise is vigorous.The hours devoted to studying should be compatible with those devotedto physical activity,including organized sports,so that it is necessary that I As part of the 60 minutes of daily physical activity two or three daysadolescents organize their time well. per week should include muscle training. Exercises with moderate weights are enough to improve general conditioning. Resistance aids Recommended activities can be used (weights, rubber bands, etc.). In general 8 to 15 repetitions in three series of repetitions of a correctly executedAdolescents can practice any type of regulated sports, physical activities exercise should be sufficient.like aerobics, dancing, skating, or design their own training program. Inall cases, professional advice should be sought (trainer, PE teacher, sport I All parts of the body should be exercised: neck, chest, back, abdomen,scientist, etc.). arms and legs.To be able design their own sports program they have to decide what I It is important to facilitate the growth and development of bones,they want to achieve: especially in girls, so weight-bearing exercises and activities can be used or those where the muscles act on the skeleton.Walking quicklyI To maintain a healthy body, at least 60 minutes of physical activity or jumping increases the impact on the ground and stimulates the should be performed daily. Of these, at least 30 minutes should be of growth and strengthening of the skeleton. moderate intensity 5 days a week, or if preferred, 20 minutes of vigorous activity 3 days a week. I The additional time needed to complete the minimum of 1 hour can be devoted to functional activities of daily life like walking to school,I Activities can be performed in short segments over the course of the riding a bike, stair climbing, or any task or work at home which imply day, for example three 10 minutes sessions per day at moderate moving the body and exercising the muscles. intensity would be equivalent to 30 minutes daily. I Prolonged sedentary activity should be avoidedpage 22

The healthy lifestyle pyramid for children and adolescents How to motivate adolescents? Adolescence is the period in life apart from the first year, when energy and nutrient requirements are the highest. In principal, if the guidelinesRegularly practising physical exercise promotes the harmonious are followed, the diet should provide the energy, nutrients and otherdevelopment of the body and improves physical appearance, components that are necessary for optimal development. In the casesomething which is very important at this age. It is important to of increased demand it could be necessary to take a supplement. Beforehighlight personal assertion, achievements, companionship and the taking one, a dietician or nutritionist should be consulted who willsocialization involved in sports activities as well as the feeling of perform a precise evaluation of the necessity of the supplement,independence which comes with personal fulfillment. especially in the case of sport practice.Diet at this stage: a varied and balanced diet does not need to be boringAdolescents are always hungry. They should have readily availableoption that satiate their hunger, while also providing importantnutrients to meet their needs. The number of calories consumed shouldnot exceed their daily needs, and should be balanced with and adjustedto regular physical activity.Their creativity can be stimulated encouraging them to design differentmeals with their friends.As was mentioned in the last chapter, muscles need energy formovement. This energy is obtained from carbohydrates and fats.Different from fat, carbohydrate stores in the body are limited, andtherefore is it necessary to include foods rich in carbohydrates in thedaily diet, especially in the case of regular sport practice.In the case that the adolescents participate in prolonged, intensecompetitive sport, hydration during sport practice can becomplemented with sport drinks. page 23

References andrecommended readingI Alcohol. Informes de la Comisión Clínica. Delegación del Gobierno para el Plan Nacional sobre Drogas. MSC. Febrero 2007.I Casas J, González-Gross M, Marcos A. Nutrición del adolescente. En: R Tojo, editor.Tratado de Nutrición en Pediatría. Barcelona: Ediciones Doyma, pp. 437-453, 2001.I González-Gross M, Gómez-Lorente J, Valtueña J, Ortiz JC, Meléndez A. The development of the healthy lifestyle pyramid for children and adolescents. Nutr Hosp 2008; 23(2):161-170.I Megias E, Ballesteros JC, Conde F, Elzo J, Laespada T, Megias I, Rodríguez E. Adolescentes ante el alcohol. Colección de Estudios Sociales.Volumen 22. Obra Social Fundación La Caixa. 2007.I Moreno Esteban B, Charro Salgado A. Nutrición, Actividad Física y Prevención de la Obesidad. Madrid: Ed. Panamericana, 2007.I Ortega FB, Ruiz JR, Castillo MJ, Moreno LA, González-Gross M, Wänberg J, Gutiérrez A y grupo AVENA. (2005). Low Level of Physical Fitness in Spanish Adolescents. Relevance for Future Cardiovascular Health (AVENA Study). Rev Esp Cardiol; 58(8):898-909.I Redondo C, González-Gross M, Moreno LA, García-Fuentes M (eds). Actividad Física, Deporte, Ejercicio y Salud en niños y adolescentes. León: Ed. Everest. 2010.I Santonja Medina F. Papel del profesor de educación física ante las desalineaciones de la columna vertebral. Selección 2004;13(1):5-17.I Strong WB, Malina RM, Blimkie CJR, et al. Evidence based physical activity for school-age youth. J Pediatrics 2005; 146:732-737.I The State of the Drugs Problem in Europe, Annual Report.The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). UE. 2006. page 24

The healthy lifestyle pyramid for children and adolescentsAnnex: Warm upand stretching exercisesWARM UPThe warm up literally warms the body up to prepare for the activity The warm up should include:we are going to do.Whatever the intensity of the activity that is going to be done, the 1. A generic part: (15 minutes) using general physical fitnesswarm up should always be part of the routine. exercises involving the most important muscle groups.This part should include three types of exercise:Warming up before exercise brings many benefits. Firstly, the warmup limbers up the muscles so that we don’t feel tense and rigid.   5 minutes start up with exercises like walking, slow jogging,Secondly it increases the heart rate preparing the body for physical cycling on an exercise bike, etc.exercise. Thirdly it speeds up the nerve impulses, improving ourreflexes and sending oxygenated blood to the muscles. Finally, as it   5 minutes stretching the main muscles used in the previouslyincreases the flexibility and mobility of the joints, the warm up reduces described exercises.the risk of suffering an injury, especially in the connective tissue, likethe tendons.   5 minutes of generic exercises like jumping, sit ups, and low back exercises.The warm up should last between 10 and 20 minutes (perhaps more 2. A specific part: (10 minutes) This is where we start doingtime is needed in cold climates to warm up the muscles). Jogging can exercises which are directly related to the activity we are goingbe combined with massages and stretching to complete the perfect to perform, for example if we are going to play basketball wewarm up. It should be sufficiently intense to increase the heart rate would do some exercises with the ball: dribbling, passing,and prepare the muscles that are going to be used during the activity, shooting at the basket, entries, etc.and individually adapted to the person and the type of activity to beperformed. For example, if we are going to run at a relaxed pace for To start the training session or match we should ideally allowfive minutes we can warm up by starting to trot very slowly or by 5 – 10 minutes for recovery, if this period is longer than 20 minwalking for a minute or two before starting to run. the effects of the warm up will begin to fade. page 25

STRETCHINGStretching should also be part of the warm up and cool down routine. reduce the tension. Hold each stretch approximately 10 to 30 secondsThe muscles should be stretched after doing the warm up exercises. without bouncing.Opposite muscle groups should be stretched one afterStretching exercises should not be too complicated, if we choose 4-5 another. For example, stretch the quadriceps (the muscles at the front ofexercises which stretch the majority of the muscles,this will be enough, the thigh) and then the hamstrings (the muscles at the back of the thigh).especially in the warm up and the cool down. A couple of exercises for We should always breathe normally when stretching.the lower body and 2-3 exercises for the upper body and that’s it.Whenstretching a muscle, we should stretch until we feel slight discomfort.If it Below are some stretches for several of the most important musclehurts then we are stretching a particular area too much, and we should groups: I QUADRICEPS (FRONT OF THE THIGH):   Standing, leaning on the wall or on a chair to maintain balance, bend the right knee backwards and hold the right ankle in the right hand. Make sure to keep the knee near the body as the knee approaches the buttock.   We should feel slight tension in the front of the thigh. Maintain the position for about 15 seconds and repeat with the other leg. Do not force the knee too much. I HAMSTRINGS (BACK OF THE THIGH):   Standing with the legs shoulder width apart, the knees slightly bent and the toes pointing forward.   Bend forward and hold the ankles with the hands. We should feel slight tension at the back of the thighs.   Maintain the position for about 15 seconds. page 26

The healthy lifestyle pyramid for children and adolescentsI BICEPS (FRONT OF THE ARM):   This stretch can be done standing or sitting. Stretch the right arm out in front with the palm facing upwards. Hold the fingers of the right hand with the left hand and stretch the fingers of the right hand gently backwards and towards the body.   We should feel slight tension in the front of the arm. Maintain the position for about 15 seconds and then repeat with the other arm.I TRICEPS (BACK OF THE ARM):   This stretch can be done standing or sitting. Lower the chin onto the chest and lift the right arm over the head with the palm facing forwards. Bend the elbow and move the right hand to the back of the neck. Now the palm of the hand is facing inwards. Lift the left hand over the head hold on to the right arm just below the elbow. Gently pull the right arm to the left.   We should feel slight tension at the back of the right arm. Maintain the position for about 15 seconds and then repeat with the other arm.I CALVES (BACK OF THE LOWER LEG):   Standing about three feet from the wall, with feet shoulder width apart and flat on the floor. Place the hands on the wall, with the arms straight to get support.   Bend the hips forward and slightly bend the knees to stretch the calves. page 27

I SHOULDERS:   Stand at about three feet from the wall, place the hands on the wall with the arms straight to get support and bend the trunk forward to about 90º keeping the arms aligned with the trunk.   We should feel how this stretches the shoulders.I HIPS AND LOWER BACK:   Sitting on the floor with the legs crossed, lift the right leg and cross it over the left leg, which remains bent. Lift the right leg to the chest and bend the trunk to look over the right shoulder.   Change the leg and repeat, that is look over the left shoulder. page 28

Edited in colaboration with:





Edited in colaboration with: