and pediatric health care professionals [1]. This may, in part, be a result of the lack of consistent
professional guidelines for nutrition and — especially — exercise therapy. To date, no one professional
medical organization provides specific recommendations for intensity, duration, frequency,
or modality of exercise for the management of pediatric obesity [2–7]. Pediatric health care
professionals must thus rely on the available scientific literature when determining initial exercise
recommendations for obese children.
Pediatric exercise science research indicates that there are both advantages and disadvantages
to the obese child during physical activity [8]. Obese children typically display advanced physical
(bone age and density [9]) and sexual maturation (increased sexual hormone levels [9,10]), promoting
increased body mass and height [11]. This may provide a technical advantage during
physical activities and sports in which enhanced height and arm span provide an advantage, such
as in football, shot put, volleyball, and basketball [8]. In addition, because of their higher ratio of
fat to lean body mass, obese children are more buoyant than their healthy-weight peers. This
provides an advantage during water-based games and other swimming activities. Furthermore, obese
children are more thermally insulated and, therefore, are able to perform for longer durations in
cooler water. Despite these advantages, obesity in children is associated with low levels of physical
fitness [12] and reduced speed and agility. Thus, obese children are often unable to perform certain
physical activities as well as their normal weight peers.
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