Physical activity and intestinal failure

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Physical activity plays an important role in improving the social, emotional and physical health of children who have intestinal failure.

Key points

  • Playing and being physically active are important parts of a child’s motor and social development, and have positive impacts on overall health.
  • Children with intestinal failure are encouraged to participate in physical activity and sport.
  • Physical activity can help to build muscle mass, increase your child’s strength and help their bones grow and get stronger.
  • Children with medical devices such as central venous access devices (CVADs), feeding tubes and stomas can still participate in physical activities, sports and physical education classes. It is important to have a discussion with the medical team about any considerations or precautions related to your child’s medical device.

Why be physically active?

Physical activity should be an important part of your child’s life as they grow from infancy to adulthood. Playing and being physically active can help your child:

  • Develop their motor skills
  • Strengthen their muscles and bones
  • Increase their energy level and endurance
  • Develop their social skills and provide opportunities to interact with peers
  • Increase their confidence in their ability to be physically active
  • Improve their overall health

For more details on the benefits of physical activity, see Physical activity: Benefits of exercise for health and wellbeing.

The importance of learning how to play

Developing fundamental movement skills

Building physical activity skills in children with intestinal failure starts at a young age. It is important that children learn fundamental motors skills such as running, jumping, skipping and hopping. Physical activity provides an opportunity to practice these skills and to spend time playing with family and friends. Learning these skills helps children to feel confident and competent while playing with their friends and family at home, in the park and at school. It also lays the foundation for the development of specific skills needed to participate in structured physical activity and sport.

As a family, you can work together to help your child develop movement skills and participate in both structured and unstructured physical activities and sports. It is important to remember that not all children will learn these skills at the same time or in the same way. However, given the opportunity to participate, children with intestinal failure can develop their motor skills like any other child, ensuring they get the social, physical and mental health benefits of physical activity participation.

Your child’s health-care team is committed to working with you and your child to help overcome any barriers that might negatively impact your child and prevent your family from having an active lifestyle. They can provide education and support related to motor skill development, managing your child’s lines and medical devices during physical activity, and exercise programming.

How much physical activity does my child need?

Current guidelines recommend that infants should have supervised floor-based play several times a day, while toddlers and preschoolers should participate in at least 180 minutes (3 hours) of physical activity throughout the day.

Children between the ages of five and 17 years old should participate in at least 60 minutes of moderately-to-vigorously intense physical activity every day. Gym class, recess and after-school programs offer important opportunities to participate in physical activity. Children often move between short bursts of activity and short periods of rest. Adolescents do more structured activities, such as individual or team sports, fitness classes, or planned walks.

Activities should be age-appropriate, enjoyable, and include:

  • a variety of aerobic activities
  • muscle strengthening exercises at least 3 days per week
  • bone building exercises at least 3 days per week

The Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years) and for Children and Youth (age 5 to 17 years) provide more detail on the recommended levels of physical activity, including rest and relaxation, for a child’s entire day. You can also review the article Physical activity: Guidelines for children and teens for more information.

What are aerobic activities?

Aerobic activities, also called cardio, are activities that keep your body moving enough to increase your heart rate and breathing over extended periods of time. This type of exercise gets the heart pumping and oxygen flowing through the bloodstream, which strengthens the heart and lungs, lowers blood pressure and helps keep body weight in check.

There are two intensities of aerobic activity:

  • Moderate intensity: your heart rate and breathing will be faster than normal. You will sweat and breathe a little harder, but you can still talk while you move your body. On a scale of 0-10, moderately intense activity is a 5 or 6.
  • Vigorous intensity: your heart rate and breathing will be much faster than normal. You will feel “out of breath” and won’t be able to speak more than a few words between breaths. On a scale of 0 to 10, vigorously intense activity is a 7 or 8.

Examples of aerobic activities for infants include tummy time, reaching and grasping, pushing and pulling, and crawling. Examples for toddlers and children include playing outside, dancing, running and swimming. Examples for teens include rollerblading, riding a bike and playing competitive team sports like soccer and hockey.

What types of activities strengthen muscles?

Muscle strengthening activities make the muscles do more work than your usual activities. They help build muscle mass and increase your child’s strength and may include both unstructured play activities or structured exercise. Some examples of muscle strengthening activities include climbing and playground activities, gymnastics, push-ups, sit ups, resistance exercises with exercise bands, using hand weights or weight machines.

What types of activities strengthen bones?

Bone strengthening activities produce a force on the bones that help bones grow and get stronger. Activities that help to build bone include running and jumping because of the impact the feet make when they hit the ground. Bone strengthening activities are especially important for children and adolescents, as the greatest gain in bone mass occurs around the start of puberty. These activities also help to improve bone mineral density. Some examples of bone strengthening activities include games that involve hopping, skipping or jumping; running activities; sports like gymnastics, soccer, basketball.

How to support your child in being physically active

Enjoyment is one of the main motivators for physical activity participation, so encourage your child to try a variety of activities and sports to help them discover what they enjoy most. You can help your child’s participation in physical activity and help them overcome barriers by:

  • having a positive attitude about physical activity and helping your child believe in their ability to be physically active
  • setting an example—being physically active yourself, and playing/participating with your child
  • assisting your child with developing the motor skills they need to participate in physical activity and sports
  • providing opportunities for your child to be physically active with others by signing them up for activities at their school or in the community—it is often easier to be active by exercising with other people
  • giving them toys and equipment that help develop their motor skills (e.g., balls, hula hoops, light weights, a bicycle, etc.)
  • taking advantage of low or no-cost resources such as public parks, community fields and courts, or local recreation centre programs
  • helping them with transportation to and from physical activities/sports
  • encouraging them to talk about their positive experiences and supporting their choices

For more ideas on getting school-aged children physically active, take a look at Health Canada's physical activity tips for five- to 11-year-olds and 12- to 17-year-olds.

Considerations and resources for children with medical devices

Children with medical devices such as central venous access devices (CVADs), feeding tubes and stomas can still participate in physical activities, sports and physical education classes. The following are some considerations during activity, but it is important that you also have discussions with your child’s medical team about any precautions related to your child’s medical device. It is also important to communicate these guidelines to your child’s physical education teacher or sports coach.

If your child has a central venous access device

  • Schedule activities your child can do when the CVAD is not in use. Think of other physical activities that your child can do while their CVAD is in use.
  • Make sure the CVAD is always taped in place. The tube(s) of the CVAD should also be taped to your child’s body to prevent twisting or kinking. Elastic bandage wrap and a tight-fitting shirt can be used to secure the lines close to the body. There are also commercial options available for chest line securement, such as central line vests.
  • Assess their dressings before and after your child engages in sport and monitor for excessive moisture or rash due to sweating.
  • Assess and plan for the risk of heat injury and excessive fluid loss by keeping “as needed” fluid intake or boluses on hand.
  • Ensure that a CVAD emergency kit remains with your child at all times.
  • Speak to your child’s medical team about additional considerations if your child wants to participate in contact sports or swimming. Waterproof covers are commercially available for many different devices.
  • If your child has a newly inserted CVAD, please refer to the following information on activity recommendations after the procedure:
  • If your child has had a CVAD for more than 6-8 weeks, please discuss physical activity guidelines with their medical team.

If your child has a feeding tube (G-tube or J-tube)

  • Schedule activities your child can do when the feeding tube is not in use. Think of other physical activities that your child can do while their feeding tube is in use.
  • A tight-fitting shirt can be used to secure the tube against the body. Additionally, commercial options are available to prevent skin irritation from the tube and to help secure the tube against the body.

If your child has a stoma

  • Empty the stoma bag prior to engaging in physical activity and ensure it is well secured.
  • Use of a stoma belt/wrap can help secure the stoma to the body. Various commercial options are available, including waterproof options.

We’re all in this together

Creating a culture of physical activity within your family is important. Parents can set an example by being physically active themselves and by making family time an opportunity for physical activity. Simple day-to-day ideas include:

  • going for walks or doing activities outside together as a family
  • walking or biking to school or other short distances, if able
  • planning activity-based family events or birthday parties
  • planning active vacations
  • setting goals for physical activity together and scheduling them in your calendar
  • taking turns choosing an activity for the whole family to do
  • limiting screen time
    • Current national guidelines recommend no screen time for children under 2 years of age, less than one hour per day for children aged 2 to 4 years and a maximum of 2 hours for children and teens aged 5-17 years
  • using motivators like pedometers to count how many steps you take each day
    • A general recommendation is 10,000 steps

Speak to your child’s physiotherapist if you have any questions or concerns about your child’s motor development or physical activity.

Last updated: February 15th 2022