Sports and Physical Activities for Children in Health and Disease
A Statement from the Hong Kong College of Paediatricians
March 1997

It is common knowledge that sports and physical activities are important factors for a person's well being, and essential elements for optimal growth and development. Children in Hong Kong have been found to participate little in sports and poor in physical fitness and have high levels of cholesterol in the blood. In the light of current medical knowledge, these findings may be associated with a higher incidence of disease in adulthood. These include cardiovascular diseases, diabetes, osteoporosis and many others. Apart from factors like diet, physical limitations in schools and deficiencies in the curriculum, the level of physical activities and sports is crucial in protecting individuals from these long term health problems. The Hong Kong College of Paediatricians wishes to provide the following recommendations:-

1. All children should be encouraged to participate regularly in sports and physical activities in an intensity appropriate to their developmental and health status.
2. Parents should serve as role models by regularly arranging activities which the whole family can participate.
3. There should be more time and facilities for physical education in the schools in Hong Kong.

Children with Active Illness

The decision to participate in sports during an acute illness should be based on individual assessments. Parents should consult their children's doctor for advice. In general, one should limit activities during a febrile illness.

Children with Epilepsy

Epilepsy is a chronic disease with paroxysmal exacerbations. Epilepsy can be controlled by regular treatment with anticonvulsants. The individual is entirely normal between attacks. Some sports are more likely to precipitate attacks while others might pose unnecessary dangers for the individual in case an attack occurs during the sport events. The recommendations are:-

1. Epileptics children should be encouraged to participate in normal school activities.
2. When the disease is well controlled, indoor swimming should be allowed if an informed lifeguard is present.
3. Scuba diving and swimming in the ocean should be prohibited.
4. Cycling should be allowed, but an epileptic child should avoid cycling on public roads.
5. The epileptic child should avoid contact sports or sports as high altitude or sports associated with potential life threatening falls, like skiing.
6. Strong lights and sounds are generally not a concern for epileptic children unless specified by the attending doctor.
7. Athletic exercises generally do not pose excessive danger to epileptic children.
8. Teacher and related personnel should be informed and trained in the acute management of an epileptic attack.

Children with Asthma

Asthma is a chronic disease of the airways with periodic exacerbations. Exercise ability is diminished during an attack of asthma. The disease can now be adequately controlled by taking continuous preventive medications. On the other hand, exercise can precipitate an attack of asthma. However there is now very effective medications that prevent exercise induced asthma. The recommendations therefore are:-

1. Children with asthma should be encouraged to participate in all sports when their disease is well controlled.
2. Exercise induced asthma can be prevented by good baseline control with preventive medication, pre-exercise bronchodilator administration and an adequate warm up.
3. Exercise in a warm and humidified environment, for example indoor swimming, is least likely to induce attacks.
4. Exercise in bursts with short rests in between is less asthma inducing than prolonged sustained activity.
5. Scuba diving or exercise that exposes the child to known allergens should be avoided.
6. Each child should have an individualized treatment plan which include prevention of exercise induced asthma and emergency treatment of an asthma attack. Parents are advised to ask the doctor about this

Children with Cardiac Disease

Cardiac disease may potentially limit the child's ability to exercise. In some cases the disease may be adversely affected by exercise. However, as most children with heart disease have mild disease with minimal effects on their exercise capacity, they should be allowed to take part in sports appropriate to their ability. Individual assessment by the doctor concerned is necessary. The recommendations are:-

1. In general, no restriction to exercise is necessary for children with innocent murmur, mild cardiac conditions such as small defects or mild narrowing of blood vessels, and mild hypertension.
2. In moderate to severe cardiac conditions such as cyanotic heart disease, the attending doctor's advice is necessary. A stress test may be necessary to determine the child's exercise capacity. Usually some gentle exercise is allowed.
3. Children with severe cardiac conditions should not take part in competitive sports.
4. No exercise should be allowed for children with myocarditis, myocardial ischaemia or heart failure.