"If exercise could be packaged in a pill, it would be the single most widely prescribed and beneficial medicine in the nation."

Robert Butler, M.D., the founder of the National Institute on Aging, made this statement in the 1980s, and it is as true today as it was then. For decades and even centuries, no single treatment has exceeded the benefits of exercise on immune function, mental health and cardiopulmonary health. Exercise is also a key component in the prevention and management of chronic disease.

Physical inactivity has been a growing problem for decades and is known to lead to loss of muscular and cardiorespiratory fitness, weight gain, psychosocial problems and poor academic achievement. This crisis has been accelerated by the COVID-19 pandemic and will unfortunately persist long after the pandemic has passed. The potential impact of natural disasters on physical activity was demonstrated after the 2011 earthquake and tsunami in East Japan, which led to a significant decrease in children's physical activity over three years following the disaster.

Surveys done on U.S. and Canadian children in the years leading up to the COVID-19 pandemic have found rates as high as 80%-90% not meeting physical activity recommendations. Shelter in place, social distancing and remote learning have led to increased sedentary behaviors and social isolation, which are clearly negatively impacting our children's mental and physical health.

I am heartbroken by the loss of joy, hope and creativity I encounter in my patients on a daily basis. Not only are our children affected by the physical constraints and daunting gravity of this pandemic but also by the challenges of screen time. We have seen a considerable increase in leisurely screen time during this pandemic.

As much as the internet may have helped us as a society maintain productivity and connection, it cannot replace direct human interaction. Recent research has shown that adolescents who spend more than seven hours a day on screens are twice as likely as those spending one hour to have been diagnosed with anxiety or depression.

Could the COVID-19 pandemic present an opportunity for us to make better and healthier choices for our community, our children and future generations?

Nature-based recreation has been shown to potentiate the beneficial effects of exercise on overall well-being, resilience and cognition. Connection and engagement with nature are known to lead to pro-environmental attitudes and sustainable human behavior, such as conservation of energy and water, anticonsumerism, and financial support for environmental organizations. The amount of time spent in nature as a 6-year-old is related to environmental attitudes and behavior as a young adult.

Unfortunately, technology and globalization have led to reduced interactions with nature and widespread psychological and physical disconnection from nature. Now more than ever, we need a society that is not only physically active but also in tune with nature and our environment.

We can overcome social isolation and associated mental and physical health problems by safely connecting with others outdoors, and by doing so, we may also slow global warming.

Palo Alto is recognized as a national model for providing its community with a strong Safe Routes to School program and active transportation choices for families. These efforts have been extremely successful in promoting healthy, active and sustainable lifestyles. In 2019, more than 58% of all Palo Alto's school children either walked or rode their bikes to school every day, compared to 13% nationally. With schools now virtual, our children risk losing these hard-earned habits, and it is in our hands to not let this happen.

This is the time to make a difference and take advantage of our exceptional infrastructure and open spaces, which took our community decades to develop. We can turn around this concerning trend by reframing our mindset and opening our eyes to the unique opportunities to safely connect while maintaining a healthy exercise routine.

Practice your walking or biking to school route with your children and make it fun by having a contest or incorporating a scavenger hunt (look for different colors, shapes, animals) along the way. Play "Active Transportation Bingo" or set up a "Neighborhood Rainbow Hunt." Discover or re-discover the phenomenal Palo Alto self-guided historic preservation tour, the self-guided Stanford walking tour or the Palo Alto self-guided public art tour. See the city of Palo Alto's Walk and Bike Route page for planning maps and links here.

As the days get shorter, branch out into your backyard after school. Practice sport-specific drills and help your young athletes advance their skills. Build an obstacle course, play hide and seek, badminton or basketball. Engage in martial arts or have a dance party.

And most importantly, exercise as a family. Children who regularly exercise together with family members are much more likely to make exercise a lifelong habit.

Masks and 6-feet social distancing will continue to be a necessity throughout the COVID-19 pandemic, even outdoors. However, they should not represent barriers. It is safe and extremely important for families to continue to exercise.

The U.S. Department of Health and Human Services recommends one hour a day of moderate to vigorous intensity exercise for children above 6 years, three hours a day for children between 3 and 5 years. This is most easily and effectively achieved through outdoor activities.

Let's look beyond COVID-19 and remind ourselves of the importance of exercise and the dire consequences of physical inactivity and social isolation, which have the potential to weaken the immune response and thereby increase our vulnerability to COVID-19 as well as any future pandemics. Let's find connection with our loved ones and nature by maintaining healthy habits, and let's together instill hope and compassion in our children and future generation.

Mona Luke-Zeitoun, M.D., is a Pediatric Pulmonary and Exercise Medicine physician practicing in Palo Alto and San Carlos. She can be contacted at [email protected].