臺灣兒童與青少年身體活動參與及競賽發展

Advocacy for Physical Activity Participation and Athletic Development Among Children and Adolescents in Taiwan

10.5297/ser.202306_25(2).0000

吳思嚴(Sz-Yan Wu)；李曜全(Yao-Chun Li)；吳昇光(Sheng-Kuang Wu)

大專體育學刊

25卷2期（2023 / 06 / 30）

i - viii

繁體中文;英文

前言。身體活動（physical activity）參與對於兒童與青少年身心健康發展非常重要，而身體活動可以是體育課、運動社團、動態遊戲、休閒活動、甚至是散步。過去研究已展現出參與身體活動對於健康的益處，像是降低心血管疾病與代謝症侯群的風險、改善沮喪或焦慮等負面心理狀態，以及增進認知功能與學業表現（Janssen & LeBlanc, 2010; Trudeau & Shephard, 2008）。大多數兒童與青少年在動作發展階段時積極地探索這個世界，他們到處爬、跑、跳、抓、丟和踢，然而隨著年齡增長，身體活動參與變成了眾多活動中的其中一個選項，特別是在現代影音科技蓬勃發展下，靜態活動的豐富性及趣味性都大幅提升，人們參與身體活動的動機與時間也大幅下滑。世界各國都發現了身體活動量不足及肥胖的問題在兒童與青少年間日趨嚴重，像是在2016年全球就有超過3.4億5至19歲的兒童與青少年有過重或肥胖的問題，這相當於40年期間成長了將近5倍（World Health Organization, 2021）。而在美國，更是不到四分之一的兒童與青少年有達到世界衛生組織建議的身體活動量標準（Merlo et al., 2020）。因此，如何促進兒童早期養成動態生活型態（active lifestyle）並持續至青少年甚至成年階段已成為現今全世界全民健康應需重視的重要議題。臺灣兒童與青少年身體活動與運動參與的現況及不足。根據Chang and Wu（2023）研究，臺灣兒童與青少年的整體身體活動量與運動社團參與分級分別為F（最低等）與D-（中間偏低），遠不及鄰近日本的B-與B-（Tanaka et al., 2022），以及南韓的D-與C（Lee et al., 2023）。影響兒童與青少年參與身體活動的因素很複雜且多元，而Welk（1999）所歸納的理論框架可以幫助我們瞭解且分析兒童與青少年是否能積極參與身體活動並發展動態生活型態。就使能因子 （enabling factors）而言，臺灣的學校、社區及政府所提供的場域及資源有達到中上標準（B+），學童體適能也有一定水準（B-），但值得注意的是我們對於兒童與青少年自覺與實際動作適能（perceived and actual motor skill competence）發展與精熟程度的瞭解與重視仍顯不足，特別是在針對傾向因子（predisposing factors）的調查中發現成就感或挫敗感是支持或阻礙他們參與運動（exercises and sports）的重要因素（教育部體育署，2022）。最後，增強因子（reinforcing factor）也是現今較為薄弱的一環，雖然臺灣政府針對體育教師、運動教練，及體育健康相關專業人員養成挹注不少資源，但在家庭及同儕的支持系統仍需進一步補強（達D等級）。而在身體活動的不同類型中，參與運動是可以提供大量、高強度，或兩者兼具的身體活動量，更重要的是早期運動參與乃是未來國家運動競技發展的基石，當兒童與青少年參與運動時，其中部分的人會想要追求更高的運動水平或是成為職業運動員，而體制內、外的指引與支持系統對於他們的運動生涯發展極其重要，尤其是兒童與青少年較容易受到傷害及遭遇問題，例如：運動傷害、沮喪、霸凌、性騷擾及禁藥等（Mountjoy et al., 2015）。而國際奧林匹克委員會更是特別針對兒童與青少年運動發展提倡要將科學實證的正確觀點（evidence-informed perspective）傳遞給所有參與者，不論是教練、隨隊人員、醫療專家，或相關行政單位（Bergeron et al., 2015）。運動早期專項化或多元化？由於不少人有「贏在起跑點」及「一萬小時練習」的傳統觀念，運動早期專項化（early sport specialization）的風氣油然而生，然而近年來不少西方研究已發現其實不全然為真。早在兒童與青少年時期便沈浸於單一運動並不能保證成功，反而有較高運動傷害、倦怠（burnout）及退出（drop out）的風險（Myer et al., 2015）。相較之下，鼓勵兒童與青少年參與各種不同的動態遊戲、休閒活動與運動社團，或許更能促進整體身體識能（physical literacy）與多樣動作技巧的發展，而這些多元參與的經驗也能轉移到後續的運動競技生涯（Myer et al., 2016）。運動專項化的時機會隨著運動專項特性而調整，像是體操選手相較於徑賽選手可能需要較早開始專項化訓練，因此，大原則與針對特定運動的專項化可能帶來生心理危害的相關知識就相當重要。像是因為長時間訓練或是針對特定運動技術練習而導致的過度使用傷害（overuse injury），例如：棒球投手容易過早投變化球產生少棒肘（little league elbow）的傷害，而體操選手因為重複地壓迫腕部而導致體操腕（gymnast wrist）。再者，因為緊湊的訓練與競賽時程會讓兒童與青少年為贏得獎牌而增加心理壓力，逐漸失去參與運動的樂趣，進而產生倦怠甚至心智崩潰而選擇退出。為了能在成年運動表現達到巔峰時能打好基礎，或是養成終身至少有一項運動專長，如何在兒童與青少年時期專項化與多元化間達到平衡應是需要深思的議題，甚至進行這個領域專題長時間追蹤研究。結語：兒童與青少年身體活動參與及競賽發展之展望。有鑑於身體活動參與對於身心健康的短、長期效益，我們呼籲發展兒童與青少年運動的全民化與競技化來串聯起臺灣體育運動政策其中的三大主軸：學校體育、全民體育及競技運動（教育部體育署，2017）。美國衛生及公共服務部（U.S. Department of Health and Human Services, 2022）積極推動身體活動參與，目標在2030年前將兒童與青少年身體活動量達標率及運動參與率分別提高至30.4%及63.3%。臺灣亦有推動SH150方案（學生每週在校運動150分鐘）、普及化運動（例如樂樂足球）、學校運動團隊發展（例如強棒計畫）、精準運動科學等階段性計畫（吳昇光，2021；教育部體育署，2017）。而針對短中期目標我們則建議應著重於：一、如何因應嚴重特殊傳染性肺炎（coronavirus disease 2019, COVID-19）疫情所帶來的後續影響。全球兒童與青少年在疫情時每日總身體活動量下降約20%（Neville et al., 2022），而超過六成的臺灣兒童與青少年於疫情停課期間身體活動時間明顯減少（教育部體育署，2022），在這樣的限制下，可能會提高肥胖的風險、阻礙體適能與動作技巧發展，甚至是部分人還會有COVID-19後症候群的問題，因此，如何整合臨床、研究與教育領域來制定配套措施幫助學生找回失去的身體活動量與運動習慣乃為當務之急。二、如何將運動實證科學向下扎根與普及。雖然科學實證運動訓練已是運動競技領域之共識，但仍需積極推廣於基層教練、體育教師、個人訓練員、社區健康指導員，甚至是家長們，特別像是針對兒童與青少年生心理特性而發展的運動訓練模型（Lloyd & Oliver, 2012），應能更有效地協助他們發展運動技能及預防運動傷害，並能順利由多元化參與銜接至專項化發展，但對於高度競技的壓力議題仍要小心追蹤。最後，我們期盼能促進兒童與青少年運動知識與適能的發展（使能因子），激發他們的動機與自信（傾向因子），建立運動友善的支持系統（增強因子），以期養成規律的身體活動或運動習慣，或是在運動場上追求卓越的同時仍能維持身心健康。

Introduction. Participation in physical activity (PA) programs is critical for physical and psychosocial development among children and adolescents. There are various sources of PA, such as physical education classes, exercise programs, organized sports, active play, leisure activities, and even dog walking. Participation in PA has been shown to reduce the risk of cardiovascular disease and metabolic syndrome, improve mental health (i.e., depression and anxiety), and enhance cognitive functioning and academic performance (Janssen & LeBlanc, 2010; Trudeau & Shephard, 2008). Most children energetically explore the world during the early stage of motor development. During childhood, children crawl, run, jump, and throw/kick something everywhere, but this enthusiasm gradually decreases as age increases. Because of various entertainmental factors and surge in sedentary activities, nowadays PA participation becomes a less attractive choice of many options, leading to a substantial decline in motivation and the actual amount of PA. For example, more than 340 million children and adolescents aged 5-19 years, have overweight or obesity conditions in 2016, which has risen about 5 times in 40 years (World Health Organization [WHO], 2021). In the United States, less than a quarter of children and adolescents attain the PA goal recommended by the WHO (Merlo et al., 2020). It is therefore, warranted to promote an active lifestyle in childhood, and need to be continued in adolescence, youth, and adulthood. Physical Inactivity Among Children and Adolescents in Taiwan. Based on the recent study of Chang and Wu (2023), the overall PA grades (F, the lowest level) and organized sport and PA participation (D-) in Taiwan were much lower compared with Japan (B- and B-) (Tanaka et al., 2022) and South Korea (D- and C, respectively) (Lee et al., 2023). Due to the complicated and multifactorial structure of the underlying factors of PA participation in pediatric and youth population, Welk (1999) proposed a solid theoretical framework to help understand whether children and adolescents could actively participate in PA and foster an active lifestyle. Regarding the enabling factors, the resource from or access to schools, communities, and the government is fairly adequate in Taiwan (from B+ to A-). The overall physical fitness level among students in Taiwan was also reached a grade of B- (Chang & Wu, 2023). Notwithstanding, we still know little about children's perceived and actual motor competence, even though a sense of achievement/frustration (as a predisposing factor) had been shown to bolster/impede their participation in PA (Sports Administration, Ministry of Education, 2022). Lastly, a noticeable deficiency was found in the category of family and peers as one of the reinforcing factors (D) (Chang & Wu, 2023). It apparently needs further work on establishing a stronger support system, even though the Taiwan's government has invested in career training for physical education teachers, coaches, health professionals, etc. Among the different forms of PA, engaging in exercises or sports can provide a great amount and/or high intensity of PA. More importantly, participation in organized sports during childhood is a foundation for national athletic development in later life. It comes naturally that some of the children and adolescents involved in exercises and sports pursuit of an advanced level of sports skills or even becoming a professional athlete. It is imperative to have someone or a team to guide and support children's career development, particularly due to the reason that children and adolescents are typically vulnerable to get injuries, depression, bullying, sexual harassment, substance abuse, etc. (Mountjoy et al., 2015). International Olympic Committee made a strong statement regarding the importance of promoting evidence-informed perspective to coaches, athlete entourage, medical providers, and administrators (Bergeron et al., 2015). Early Sport Specialization or Diversification? Under the traditional viewpoints of "win at the starting line" and "10,000-hour rule," people believe that early sport specialization is better for athletic development. However, this is not always true based on the previous studies. Involving in one sport early before pubertal maturation is not guarantee for the success, whereas the risk of getting sports injury, burnout, and dropout may be higher than in those who did not (Myer et al., 2015). In contrast, encouraging children to diversly participate in PA may build a broader set of motor skills, maximize their physical literacy development, and further transfer these experiences to their later careers (Myer et al., 2016). When to be specialized is usually depends on that sport's features (e.g., it could be earlier in gymnasts than track athletes). Thus, the general and sport-specific knowledge of the physiological and psychosocial risk of early sport specialization is crucial. Specifically, overuse injury is prevalent for a long year-round training or a large amount of practice on a specific sport skill. For example, little league elbow is exhibited in baseball pitchers, who learned and practiced change-up too early, and gymnast wrist is caused by chronic repetitive compressive impact. Furthermore, a tight schedule of training and competition may lead to high performance stress, a lack of fun, burnout, and further break-out and then withdrawal. To enhance children's physical and mental readiness to accomplish peak sports performance or to nurture an exercise habit in later life, balance specialization and diversification requires further investigation and evidence supported by longitudinal research. Conclusion: Prospective of PA Participation and Athletic Development in Taiwan. Our advocacy for promoting PA participation and athletic development among children and adolescents aligns with physical education and sports policy of Taiwan's government (Sports Administration, Ministry of Education, 2022). The U.S. Department of Health and Human Services (2022) aimed to increase the proportion of children who do enough aerobic PA and play sports to 30.4% and 63.3%, respectively. There are some long-term projects in Taiwan, such as SH150 (at least 150 minutes PA per week at school), Sports for All (e.g., Happy Soccer), Active Schools (e.g., Strong Bat Project), Precision Sports Project, etc. (Sports Administration, Ministry of Education, 2017; Wu, 2021) to promote PA. For the short- and mid-term objectives, we suggest focusing on the health consequences after the coronavirus disease 2019 (COVID-19) pandemic and promoting of evidence-based sports science. First, the overall PA of children and adolescents decreased 20% during the pandemic (Neville et al., 2022), and more than 60% of students in Taiwan reported a significant loss of PA (Sports Administration, Ministry of Education, 2022). Limited PA may increase the obesity risk and impede the development of physical fitness and motor competence. Moreover, some children may have a post-COVID-19 condition. Therefore, integration of resources and professionals from medical, research, and education fields is highly needed to help children and adolescents to regain their PA and exercise habits. Secondly, we should vigorously promote evidence-based training to coaches (especially working in elementary schools or local/small clubs), physical education teachers, personal trainers, community health advisors, and even parents. For example, the Youth Physical Development Model, individualized with one's physiological and psychosocial characteristics (Lloyd & Oliver, 2012), should be more efficient in developing sports skills, preventing overuse injury, and transitioning from diverse participation to sport specialization. However, the issue of highly athletic competition to occur pressure for children and adolescents should be monitored carefully. Lastly, sport governing bodies should endorse the development of physical literacy in children and adolescents (enabling factors) to intrigue their motivation and confidence (predisposing factors), and creating a PA-friendly environment and social support system (reinforcing factors). The ultimate goal is to ensure their physical and mental health, while developing an active lifestyle or pursuing excellence in sports.