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Children in the USA spend 75% of their waking hours being inactive, compared with remarkably little time in vigorous physical activity; estimated at only 12 min per day.156 Opportunities for physical activity have decreased for various reasons. Physical education, typically considered less important than academic disciplines, has been eliminated in some school districts. In schools that do offer physical education, large class size and lack of equipment present barriers to successful programme implementation.157 After-school participation , because of absence of pavements (sidewalks), bike paths, safe playgrounds, and parks in many neighbourhoods. Moreover, our culture
places a premium on convenience: the car is preferred to walking, the lift to stairs, and the remote control to manual adjustment. These cultural forces arguably culminate in the drive-through window of fast-food restaurants, where a maximum of energy can be obtained with a minimum of exertion.
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