10.4 Activity & Lifestyle History

Physical Activity Assessment by Age

The activity history is nutrition-relevant: it drives energy needs, interacts with growth and chronic disease, and completes the lifestyle picture. Core guidelines:

• Ages 6-17 — at least 60 minutes per day of moderate-to-vigorous physical activity, with muscle-strengthening and bone-strengthening activity at least 3 days per week.
• Ages 3-5 (preschool) — active play throughout the day, totaling about 3 hours per day of varied activity.
• Screen time limits (American Academy of Pediatrics) — avoid screens (other than video-chatting) under 18-24 months; limit to 1 hour/day of high-quality programming for ages 2-5; keep recreational screen time to about 2 hours/day or less for older children. Screen time matters nutritionally: it displaces activity, pairs with snacking, and correlates with adiposity. For children under 5, the WHO adds sedentary limits: restraint (stroller, high chair) for no more than 1 hour at a time, no sedentary screen time under age 2, and no more than 1 hour/day of sedentary screen time at ages 2-4.

How to measure activity: self-report overestimates activity in children, so combine methods. Brief validated questionnaires — the PAQ-C (roughly ages 8-14) and PAQ-A (adolescents) — are practical in clinic; device measures (accelerometers, pedometers) give objective minutes but miss swimming and cycling and add cost. Ask about type (weight-bearing activity supports bone accrual), intensity (the ability to talk but not sing during activity approximates moderate intensity), and context — physical education, recess, and active transport — because structured opportunities matter as much as motivation.

Sleep as a Nutrition-Related Behavior

Short sleep is consistently associated with childhood obesity through appetite-hormone changes, more waking eating opportunities, and fatigue-driven inactivity. Use the American Academy of Sleep Medicine durations (endorsed by the AAP):

Ask about bedtime routines, caffeine intake (soda, coffee, energy drinks), and screens in the bedroom. Adolescents average well under 8 hours on school nights, and the AAP recommends children and adolescents avoid caffeine-containing energy drinks entirely; regular caffeine worsens sleep quality and adds empty calories or stimulant load.

Energy Expenditure Inputs

Energy equations for children (Schofield, Dietary Reference Intake estimated energy requirement equations) require an activity input — the physical activity level (PAL) or activity factor — so the activity history directly changes the calorie prescription. Misclassifying a sedentary child as active can overestimate needs by 15-20%; document actual daily activity rather than assuming. The DRI equations define four physical activity level (PAL) categories — sedentary, low active, active, and very active — each with its own coefficient, and the history determines which coefficient applies. For athletes, revisit the estimate at each season change: needs during heavy training can run well above off-season needs, and high energy flux (high intake matched to high expenditure) supports growth and bone better than chronically low intake matched to low expenditure.

Sports Participation History

For young athletes capture: sport, season, training hours per week, position or weight class, and supplement use (protein powders, creatine, energy drinks, "pre-workout" products). Screen for low energy availability and Relative Energy Deficiency in Sport (RED-S). Indicators include amenorrhea or menstrual dysfunction in adolescent girls, recurrent stress fractures or overuse injuries, declining performance, low body mass index or weight loss, fatigue, and disordered eating. Risk concentrates in aesthetic sports (gymnastics, dance, figure skating), weight-class sports (wrestling, rowing), and endurance sports. Disordered-eating screening belongs in every athlete history.

Distinguish RED-S from overtraining syndrome, in which performance declines despite rest and is accompanied by mood disturbance, sleep disruption, and recurrent illness; the two overlap because both follow a mismatch between training load and recovery. Practical fueling points: carbohydrate needs scale with training hours, fluids should be scheduled rather than left to thirst, and most pediatric athletes do not need supplements — protein needs are met with food when total energy is adequate. Early sport specialization and year-round single-sport training raise overuse-injury and burnout risk and belong in the history.

Lifestyle Patterns That Shape Intake

• Family meals — frequent shared family meals are protectively associated with better diet quality and lower disordered-eating and obesity risk; ask how many dinners the family eats together each week.
• Eating out and fast food — frequency correlates with energy density and sugar-sweetened beverage intake.
• Breakfast skipping — common in adolescents and associated with poorer diet quality and concentration.
• Screen-time eating — distracted eating increases intake and weakens satiety cues.

Activity in Chronic Disease

• Cystic fibrosis — exercise is encouraged: it supports airway clearance, bone health, and lung function; energy needs remain high.
• Type 1 diabetes — exercise is encouraged with glucose management: check glucose before and after activity, carry fast-acting carbohydrate, and consider pre-exercise carbohydrate or insulin adjustment; watch for delayed hypoglycemia overnight after afternoon exercise.
• Obesity — use non-stigmatizing, person-first language, and focus on enjoyable, family-based activity and reducing sedentary time rather than prescribed calorie burn; shame undermines adherence.

School, Childcare, and Baseline Documentation

The child's environment fills much of the day: ask about physical education frequency, recess, active transport to school, after-school care (what snacks are provided?), and the vending and snack environment. Close the assessment by documenting a baseline — current activity minutes, screen hours, sleep duration, meals eaten out, and family meal frequency — so the monitoring and evaluation plan can measure change against something concrete.