Systematic review of sedentary behaviour and health indicators in the early years (aged 0-4 years)

Teenagers, screens and social media: a narrative review of reviews and key studies

INTRODUCTION

In light of growing concerns about an increasingly digital adolescence, the academic field investigating how digital technologies affect adolescents' psychological well-being is growing rapidly. In the last years, much research has amassed, and this has been summarised in over 80 systematic reviews and meta-analyses.

MATERIALS AND METHODS

Systematic reviews, meta-analyses and key studies are reviewed to provide insights into the state of current research linking digital technology and social media use to well-being; possible future directions and improvements are discussed.

RESULTS

When examining the reviews, it becomes evident that the research field is dominated by cross-sectional work that is generally of a low quality standard. While research has highlighted the importance of differentiating between different types of digital technology use many studies do not consider such necessary nuances. These limitations aside, the association between digital technology use, or social media use in particular, and psychological well-being is-on average-negative but very small. Furthermore, the direction of the link between digital technology use and well-being is still unclear: effects have been found to exist in both directions and there has been little work done to rule out potential confounders.

CONCLUSIONS

Reviewing the last decade of reviews in the area, it is evident that the research field needs to refocus on improving transparency, interpreting effect sizes and changing measurement. It also needs to show a greater appreciation for the individual differences that will inherently shape each adolescent's reaction to digital technologies.

Infants' and toddlers' physical activity and sedentary time as measured by accelerometry: a systematic review and meta-analysis

BACKGROUND

Early experiences in physical activity (PA) are important to shape healthy movement behaviours long-term; as such, it is critical that PA is promoted from infancy, and that detrimental behaviours (e.g., prolonged sedentary time [ST]) are minimized. The purpose of this systematic review and meta-analysis was to examine infants' and toddlers' movement behaviours across daytime hours.

METHODS

Seven online databases were searched for terms related to infants (< 12 months), toddlers (12-35.9 months), PA, ST, and accelerometry. Two independent reviewers examined 4873 articles for peer-reviewed original research, published in English, that assessed infants' (counts/min) and/or toddlers' PA or ST (min/day) using accelerometry across daytime hours. Infants' mean PA level (counts/min) was averaged across studies, and ranges were produced. Estimates of toddlers' movement behaviours were aggregated meta-analytically to produce average daily rates, and accelerometer placement, cut-point validity, device type, and epoch length were tested as a moderating variables.

RESULTS

Twenty-four studies from 16 countries (published 2011-2019), representing 3699 participants, were included in the systematic review. Five studies reported on infants' PA, which ranged from 78.2 to 2580.5 cpm. Across 20 studies, toddlers' total PA, light PA, moderate-to vigorous-intensity PA, and ST ranged from 72.9 to 636.5, 48.5 to 582.4, 6.5 to 89.9, and 172.7 to 545.0 min/day, respectively. After taking into account accelerometer placement, cut-point validity, device type, and epoch length, we found that toddlers engaged in 246.19 min/day (SE = 28.50; 95% CI: 190.34, 302.04) of total PA, 194.10 min/day (SE = 28.76; 95% CI: 137.73, 250.47) of light PA, and 60.16 min/day (SE = 5.88; 95% CI: 48.64, 71.69) of moderate-to vigorous-intensity PA. Toddlers engaged in 337.04 min/day (SE = 32.67; 95% CI: 273.01, 401.07) of ST.

CONCLUSIONS

With limited studies conducted in infants (n = 5), PA estimates are inconclusive and largely heterogeneous. Overall, toddlers tend to exceed the total PA recommendation of 180 min/day; however, very little of this time is spent at higher movement intensities. Even with high PA rates, toddlers still engage in substantial ST. More consistent and valid measurement protocols are needed to improve comparability across studies.

Factors associated with overweight status, obesity, and sedentary behavior in elementary and junior high school students

BACKGROUND

Sedentary behavior increases the risks of obesity and cardiovascular disease in adults, but these relationships are uncertain in elementary and junior high school students. We investigated whether sedentary behavior is related to overweight status and obesity in high-risk children with lifestyle diseases.

METHOD

A cross-sectional study was performed in 115 children and primary caregivers who attended a lecture for preventing child lifestyle diseases in Ibaraki prefecture, Japan. The main outcome measure was excess weight (percent overweight). Factors associated with excess weight in children were evaluated using multiple regression analysis. Basic physical and demographic characteristics, biochemical data (total cholesterol [TC], low and high density lipoprotein cholesterol [LDL-C and HDL-C], alanine aminotransferase [ALT]), blood pressure, child and parental sedentary time, parental BMI, and family environment were evaluated.

RESULTS

In total, 107 children were eligible for participation in the study. Excess weight in these children was 28.6 ± 18.4. Sedentary time was 337.2 ± 122.5 min/day in children and 347.0 ± 196.2 min/day in parents. Multiple regression analysis revealed that children's sedentary behavior (β = 0.02, (95%CI: 0.00 to 0.04)) and HDL-C (β = -0.59, (95%CI: -0.81 to -0.38)) as independent predictors of children's excess weight.

CONCLUSION

Study findings suggest that decreasing children's sedentary behavior in addition to greater physical activity is important for the prevention of overweight status and obesity in high-risk children with lifestyle diseases. Reduction of sedentary time, and engaging in regular exercise are all important for proper weight maintenance in children.

SYSTEMATIC REVIEW OF PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOR INDICATORS IN SOUTH-AMERICAN PRESCHOOL CHILDREN

Objective:

To summarize indicators and describe in detail the methods used to physical activity and sedentary behavior measurement in South American preschool children.

Data source:

In 2017, we searched for articles on researches carried out in South American countries, which presented physical activity and/or sedentary behavior indicators in children aged two to six years. These searches were conducted in Spanish, English, and Portuguese in four electronic databases (LILACS, PubMed, SciELO, and Web of Science), Google Scholar, and in reference lists.

Data summary:

Out of 416 articles initially assessed, 13 composed the descriptive summary. Samples from Argentina, Brazil, and Chile were included. Three articles provided accelerometer-based estimates of moderate physical activity: 32, 70.1, and 71.3 minutes per day. The mean total sedentary behavior was 468.3 and 562.9 minutes per day and, considering the cut-off point of 2 hours per day of screen time, we found the following prevalence rates: 39.4, 40.3, and 100%. The studies adopted a wide number of instruments and strategies to evaluate those behaviors.

Conclusions:

Although the summary has pointed to high exposure to sedentary behavior in preschool children, with particular focus on screen time, it is essential to broaden the discussion and approximate the methods used to assess physical activity and sedentary behavior, making the evidence more comparable and strong, so as to elaborate preventive strategies and actions.

Educator perceptions on the benefits and challenges of loose parts play in the outdoor environments of childcare centres

It is important to consider physical activity and movement in early life to ensure children establish and maintain healthy physical activity patterns. Recent evidence has highlighted the importance of outdoor play and the childcare environment. Active outdoor play, especially free play, supports independence, self-regulation and allows children to explore their world and make decisions. Loose parts or open-ended materials are natural or synthetic resources that can be used in more than one way, allowing children to experiment through play. Incorporating loose parts into play environments creates opportunity for new play experiences. Despite growing evidence supporting loose parts play, the perspectives of childcare providers on the benefits and challenges of this type of play have been overlooked. The purpose of this study was to identify the benefits and challenges of incorporating loose parts play into the outdoor environments of childcare centres, from the perspectives of educators who took part in the Physical Literacy in the Early Years (PLEY) project. PLEY is a larger, mixed methods intervention study with the goal of evaluating a loose parts intervention in early childcare settings. This portion of the project used qualitative description to explore educators' perspectives. Data were collected using focus groups (n = 15) with early childhood educators (n = 3–5 in each group). Thematic analysis was used to identify five themes relating to benefits, and four themes relating to challenges. Benefit themes included: loose parts enable children to take risks; loose parts spark creativity and imagination; loose parts contribute to problem-solving abilities; loose parts cultivate independence and confidence; and loose parts build relationships and leadership. Challenges included: apprehension of loose parts; loose parts as a novelty; sustainability of loose parts; and loose parts present challenges with storage. Overall, we found educators perceived outdoor loose parts play to have multiple social and cognitive benefits for preschool-aged children that are critical for optimal growth and development, and overall health and wellness.

The effects of supplementing maternal and infant diets with lipid-based nutrient supplements on physical activity and sedentary behaviour at preschool age in Ghana

Evidence on whether nutritional supplementation affects physical activity (PA) during early childhood is limited. We examined the long-term effects of lipid-based nutrient supplements (LNS) on total PA, moderate-to-vigorous PA (MVPA) and sedentary behaviour (SB) of children at 4-6 years using an accelerometer for 1 week. Their mothers were enrolled in the International Lipid-based Nutrient Supplement-DYAD randomised controlled trial in Ghana, assigned to daily LNS or multiple micronutrients (MMN) during pregnancy through 6 months postpartum or Fe and folic acid (IFA) during pregnancy and placebo for 6 months postpartum. From 6 to 18 months, children in the LNS group received LNS; the other two groups received no supplements. Analysis was done with intention to treat comparing two groups: LNS v. non-LNS (MMN+ IFA). Of the sub-sample of 375 children fitted with accelerometers, 353 provided sufficient data. Median vector magnitude (VM) count was 1374 (interquartile range (IQR) 309), and percentages of time in MVPA and SB were 4·8 (IQR 2) and 31 (IQR 8) %, respectively. The LNS group (n 129) had lower VM (difference in mean -73 (95 % CI -20, -126), P = 0·007) and spent more time in SB (LNS v. non-LNS: 32·3 v. 30·5 %, P = 0·020) than the non-LNS group (n 224) but did not differ in MVPA (4·4 v. 4·7 %, P = 0·198). Contrary to expectations, provision of LNS in early life slightly reduced the total PA and increased the time in SB but did not affect time in MVPA. Given reduced social-emotional difficulties in the LNS group previously reported, including hyperactivity, one possible explanation is less restless movement in the LNS group.

Two Approaches to Increase Physical Activity for Preschool Children in Child Care Centers: A Matched-Pair Cluster-Randomized Trial

Early childhood education settings are critical for promoting physical activity (PA) but intervention effects are often small. The aim of this study was to develop, test, and compare two approaches to increasing physical activity among preschoolers at child care centers: one focused on a teacher-led PA curriculum (Active Play!) and the other on increasing outdoor child-initiated free play time (Outdoor Play!). We conducted a matched-pair cluster-randomized study in 10 centers in and around Seattle, WA, USA (n = 97 children, mean age 4.6). Pre- and post-intervention data were collected from observations and accelerometers. At pre-intervention, 19% of Active Play! and 25% of Outdoor Play! children achieved >120 min/day of PA during child care. The total opportunity for PA increased in both interventions (Active Play! = 11 min/day; Outdoor Play! = 14 min/day), with the largest increase in outdoor child-initiated free playtime (Active Play! = 19 min/day; Outdoor Play! = 24 min/day). No changes in sedentary time, light or moderate- to vigorous-intensity PA (MVPA) were observed in either intervention and there was no difference between interventions in the percentage of children attaining more than 120 min/day of PA. A small (<3 min/day) relative increase in teacher-led outdoor activity was observed in the Active Play! intervention. Both intervention strategies led to an increase in active play opportunities, predominantly outdoors, but neither was able to substantially increase the intensity and/or duration of children's PA. Future studies are needed to better understand and inform sustainable approaches to increase PA in early learning settings.

Screen Use During Meals Among Young Children: Exploration of Associated Variables

Background and Objectives: There is evidence that eating meals or snacks while watching TV is an obesogenic factor. Moreover, the patterns of TV and other screen use during meals begin early and persist. However, there are only a few studies to date which address the prevalence and predictors of young children’s exposure to screen during mealtimes. Thus, the present study aimed to investigate the prevalence and the associated factors of screen use during meals in early childhood. Materials and Methods: A cross sectional survey was conducted in Lithuania. Data of 847 children aged 2 to 5 years old (51.5% boys) were analyzed in this study. Parents completed the Child Behavior Checklist (CBCL/1½-5) and reported their children’s daily screen time, exposure to background TV, screen use during child’s meals, child and parental height and weight, and sociodemographic data. Results: More than half of children were exposed to screen during meals: 33.7% occasionally, several times per week or per month, and 22%—daily or during every meal. Overall daily screen time, background TV, consumption of junk food, child age, and emotional and behavioral problems were related to mealtime screen use (all associations significant at p < 0.01). Longer daily screen time (OR 1.01; 95% CI 1.00–1.01), more background TV (OR 1.26; 95% CI 1.10–1.45), and elder child age (OR 1.02; 95% CI 1.00–1.03) were significant predictors of occasional use of screen during meals. Also, longer daily screen time (OR 0.99; 95% CI 0.98–0.99), background TV (OR 0.78; 95% CI 0.66–0.91) together with no siblings’ status of a child (OR 0.42; 95% CI 0.25–0.69) increased the probability that children were fed in front of screens daily. Conclusions: This study confirmed the unfavorable associations among screen use during meals, daily screen time and junk food consumption in early childhood. In addition, first-time parents should get particular health providers’ attention as they are more likely to use screens during child’s mealtime.

Factors associated with accelerometer measured movement behaviours among White British and South Asian children aged 6-8 years during school terms and school holidays

OBJECTIVES

To investigate factors associated with movement behaviours among White British (WB) and South Asian (SA) children aged 6-8 years during school terms and holidays.

DESIGN

Cross-sectional.

SETTING

Three primary schools from the Bradford area, UK.

PARTICIPANTS

One hundred and sixty WB and SA children aged 6-8 years.

PRIMARY AND SECONDARY OUTCOMES

Sedentary behaviour (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) measured by accelerometry during summer, winter and spring and during school terms and school holidays. Data were analysed using multivariate mixed-effects multilevel modelling with robust SEs. Factors of interest were ethnicity, holiday/term, sex, socioeconomic status (SES), weight status, weekend/weekday and season.

RESULTS

One hundred and eight children (67.5%) provided 1157 valid days of data. Fifty-nine per cent of children were WB (n=64) and 41% (n=44) were SA. Boys spent more time in MVPA (11 min/day, p=0.013) compared with girls and SA children spent more time in SB (39 min, p=0.017) compared with WB children in adjusted models. Children living in higher SES areas were more sedentary (43 min, p=0.006) than children living in low SES areas. Children were more active during summer (15 min MVPA, p<0.001; 27 LPA, p<0.001) and spring (15 min MVPA, p=0.005; 38 min LPA, p<0.001) and less sedentary (-42 min and -53 min, p<0.001) compared with winter. Less time (8 min, p=0.012) was spent in LPA during school terms compared with school holidays. Children spent more time in MVPA (5 min, p=0.036) during weekend compared with weekdays. Overweight and obese children spent more time in LPA (21 min, p=0.021) than normal-weight children.

CONCLUSION

The results of our study suggest that significant child level factors associated with movement behaviours are ethnicity, sex, weight-status and area SES. Significant temporal factors are weekends, school holidays and seasonality. Interventions to support health enhancing movement behaviours may need to be tailored around these factors.

Time Spent in Sedentary Activity Is Related to Gross Motor Ability During the Second Year of Life

Sedentary activity occupies a substantial amount of time during early childhood, with these habits influenced by changing trends in screen time for very young children. Among school-aged children, motor ability is inversely related to sedentary activity. However, the concept of sedentary activity is rarely investigated in toddlers, and thus little is known concerning its relationship with motor development during this rapidly changing and early period of life. Among two groups of toddlers, aged 18 months ( N = 26) and aged 24 months ( N = 16), this study investigated cross-sectional correlations of motor development (Bayley Scales of Infant Development—III) with daily sedentary activity (accelerometers). In both groups, gross motor ability, but not fine motor ability, was inversely correlated with time spent in sedentary activity. At 18 months, gross motor raw scores inversely correlated significantly with time in sedentary activity ( r = −.533, p < .001) but fine motor raw scores did not ( r = .182, p = .441). Also, at 24 months, gross motor raw scores inversely correlated with time in sedentary activity ( r = −.563, p = .029), while fine motor raw scores did not ( r = −.112, p = .425). These findings add important missing knowledge to the empirical literature regarding sedentary activity in toddlers and its relationship to emerging motor development. Future work might investigate best practices for measuring sedentary activity in this age-group and mechanisms behind its relationship with gross motor skills.

Study protocol for a cluster randomized controlled trial to test "¡Míranos! Look at Us, We Are Healthy!" - an early childhood obesity prevention program

BACKGROUND

One in three Head Start children is either overweight or obese. We will test the efficacy of an early childhood obesity prevention program, "¡Míranos! Look at Us, We Are Healthy!" (¡Míranos!), which promotes healthy growth and targets multiple energy balance-related behaviors in predominantly Latino children in Head Start. The ¡Míranos! intervention includes center-based (policy changes, staff development, gross motor program, and nutrition education) and home-based (parent engagement/education and home visits) interventions to address key enablers and barriers in obesity prevention in childcare. In partnership with Head Start, we have demonstrated the feasibility and acceptability of the proposed interventions to influence energy balance-related behaviors favorably in Head Start children.

METHODS

Using a three-arm cluster randomized controlled design, 12 Head Start centers will be randomly assigned in equal number to one of three conditions: 1) a combined center- and home-based intervention, 2) center-based intervention only, or 3) comparison. The interventions will be delivered by trained Head Start staff during the academic year. A total of 444 3-year-old children (52% females; n = 37 per center at baseline) in two cohorts will be enrolled in the study and followed prospectively 1 year post-intervention. Data collection will be conducted at baseline, immediately post-intervention, and at the one-year follow-up and will include height, weight, physical activity (PA) and sedentary behaviors, sleep duration and screen time, gross motor development, dietary intake and food and activity preferences. Information on family background, parental weight, PA- and nutrition-related practices and behaviors, PA and nutrition policy and environment at center and home, intervention program costs, and treatment fidelity will also be collected.

DISCUSSION

With endorsement and collaboration of two local Head Start administrators, ¡Míranos!, as a culturally tailored obesity prevention program, is poised to provide evidence of efficacy and cost-effectiveness of a policy and environmental approach to prevent early onset of obesity in low-income Latino preschool children. ¡Míranos! can be disseminated to various organized childcare settings, as it is built on the Head Start program and its infrastructure, which set a gold standard for early childhood education, as well as current PA and nutrition recommendations for preschool children.

TRIAL REGISTRATION

ClinicalTrials.Gov ( NCT03590834 ) July 18, 2018.

Changes in volume and bouts of physical activity and sedentary time across early childhood: a longitudinal study

Background

Understanding changes in physical activity and sedentary time (SED) during early childhood may provide insights into how to effectively promote a healthy start to life. This study examined changes in total volume and bouts of SED, light- (LPA), and moderate- to vigorous-intensity physical activity (MVPA) across early childhood, and explored differences in change between boys and girls.

Methods

Data were drawn from 330 children participating in the Melbourne InFANT Program, collected between 2008 and 2013 and analysed in 2017. Children’s physical activity and SED were assessed for at least 7 days at each timepoint using ActiGraph GT1M accelerometers at 19 months, 3.5 and 5 years of age. Total volume of SED (≤100 counts per minute [CPM]), LPA (101–1680 CPM) and MVPA (≥1681 CPM) were expressed as a percentage of wear time, and the frequency (number of bouts/day) and duration (mins/bout) of SED, LPA and MVPA bouts ≥1 min were calculated at each time point. Multilevel models with random intercepts and slopes were used to examine changes in total volume and bouts of SED, LPA and MVPA for boys and girls.

Results

Compared to aged 19 months, children’s total volume of SED and LPA decreased at 3.5 and 5 years old, while MVPA increased. The frequency of SED bouts at 3.5 and 5 years was greater than at 19 months, but the duration was shorter. Additionally, the frequency and duration of LPA bouts was lower and MVPA bout frequency and duration was greater at 3.5 and 5 years. In general, there was no evidence of sex differences in trajectories of children’s physical activity and SED. However, variations in trajectory were observed at the individual child level.

Conclusions

Children’s total volume and bouts of SED, LPA and MVPA change across early childhood, mostly in a favourable direction. Trajectories appear to be similar for boys and girls. Investigation of individual variation in trajectories is likely to provide greater insight into associations between physical activity and future health and behavioural outcomes.

Combined Longitudinal Effect of Physical Activity and Screen Time on Food and Beverage Consumption in European Preschool Children: The ToyBox-Study

Lifestyle behavioral habits such as excess screen time (ST), a lack of physical activity (PA), and high energy-dense food consumption are associated with an increased risk of children being overweight or obese. This study aimed to (1) track longitudinal adherence to PA and ST recommendations at baseline (T0) and follow-up (T1) and (2) assess the association between changes in adherence to PA and ST recommendations and food and beverage consumption at follow-up. The present study included 2321 preschool children (3.5 to 6) participating in the multicenter ToyBox-study. A lineal mixed effects model was used to examine the association between different types of food and beverages and their relationship with changes in adherence to PA and ST recommendations. Approximately half of the children (50.4%) did not meet the PA and ST recommendations at both baseline and follow-up. However, only 0.6% of the sample met both PA and ST recommendations. Preschool children who met both recommendations consumed fewer fizzy drinks, juices, sweets, desserts, and salty snacks and consumed more water, fruits and vegetables, and dairy products than did those not meeting both recommendations. In conclusion, the proportion of European preschool children adhering to both PA and ST recommendations was very low and was associated with a low consumption of energy-dense foods.

Prediction of Physical Activity Intensity with Accelerometry in Young Children

Background: An algorithm for the classification of ambulatory and non-ambulatory activities using the ratio of unfiltered to filtered synthetic acceleration measured with a triaxial accelerometer and predictive models for physical activity intensity (METs) in adults and in elementary school children has been developed. The purpose of the present study was to derive predictive equations for METs with a similar algorithm in young children. Methods: Thirty-seven healthy Japanese children (four- to six-years old) participated in this study. The five non-ambulatory activities including low-intensity activities, and five ambulatory activities were selected. The raw accelerations using a triaxial accelerometer and energy expenditure by indirect calorimetry using the Douglas bag method during each activity were collected. Results: For non-ambulatory activities, especially light-intensity non-ambulatory activities, linear regression equations with a predetermined intercept (0.9) or quadratic equations were a better fit than the linear regression. The equations were different from those for adults and elementary school children. On the other hand, the ratios of unfiltered to filtered synthetic acceleration in non-ambulatory activities were different from those in ambulatory activities, as in adults and elementary school children. Conclusions: Our calibration model for young children could accurately predict intensity of physical activity including low-intensity non-ambulatory activities.

The equity impact of brief opportunistic interventions to promote weight loss in primary care: secondary analysis of the BWeL randomised trial

BACKGROUND

Guidelines recommend that clinicians should make brief opportunistic behavioural interventions to patients who are obese to increase the uptake of effective weight loss programmes. The objective was to assess the effect of this policy on socioeconomic equity.

METHODS

One thousand eight hundred eighty-two consecutively attending patients with obesity and who were not seeking support for weight loss from their GP were enrolled in a trial. Towards the end of each consultation, GPs randomly assigned participants to one of two 30-s interventions. In the active intervention (support arm), the GP offered referral to a weight management group. In the control intervention (advice arm), the GP advised the patient that their health would benefit from weight loss. Agreement to attend a behavioural weight loss programme, attendance at the programme and weight loss at 12 months were analysed by socioeconomic status, measured by postcode using the Index of Multiple Deprivation (IMD).

RESULTS

Mean weight loss was 2.43 kg (sd 6.49) in the support group and 1.04 kg (sd 5.50) for the advice only group, but these effects were moderated by IMD (p = 0.039 for the interaction). In the support arm, weight loss was greater in higher socioeconomic groups. Participants from lower socioeconomic backgrounds were more likely to accept the offer and equally likely to attend a weight loss referral but attended fewer sessions. Adjusting for these sequentially reduced the gradient for the association of socioeconomic status with weight loss from + 0.035 to - 0.001 kg/IMD point. In the advice only arm, 10% took effective action to promote weight loss. The decision to seek support for weight loss outside of the trial did not differ by socioeconomic status, but weight loss among deprived participants who used external support was greater than among more affluent participants (p = 0.025).

CONCLUSION

Participants' responses to GPs' brief opportunistic interventions to promote weight loss differed by socioeconomic status and trial arm. In the support arm, more deprived people lost less weight because they attended fewer sessions at the programme. In the advice arm, more deprived people who sought and paid for support for weight loss themselves lost more weight than more affluent people who sought support.

TRIAL REGISTRATION

This trial is registered with the ISRCTN registry, number ISRCTN26563137 . Date of registration: January 3, 2013; date of first participant recruited: June 4, 2014.

Accelerometry-measured physical activity and sedentary behaviour of preschoolers in Nova Scotia, Canada

The objective of this study was to describe the levels and bouts of physical activity (PA) and sedentary behaviour (SB) among preschoolers in Nova Scotia, Canada, and the proportion meeting PA and step guidelines. Children (75 boys, 49 girls; mean age = 4.2 (range = 3-5 years)) participating in the Physical Literacy in the Early Years (PLEY) study provided data. Average time (minutes, % of day) spent sedentary, in light PA (LPA), moderate-to-vigorous PA (MVPA), and total PA; average frequency; and duration of bouts of MVPA (≥5 min, ≥10 min) and sedentary bouts (≥10 min) per day were determined using published cut-points, using 15-s epochs. The proportion of children meeting PA and step guidelines was determined, and differences by sex explored. Children spent the majority (70.8%) of their day active; nearly all (≥97%) met PA guidelines. Most children met step guidelines on a weekly basis, but not daily. Only LPA differed by sex (greater in girls; p = 0.001). Little time was spent in sustained SB (bouts ≥10 min). Boys had greater and longer bouts of MVPA and spent more of their day in these (p < 0.05). Girls spent less time in sustained SB (p = 0.009). This is the first study to describe the PA and SB of Nova Scotia preschoolers using accelerometry. Findings suggest preschoolers spend the majority of their day active, and that there are sex-related differences in PA and SB, warranting further examination.

Exploring the physical activity and screen-viewing-related knowledge, training, and self-efficacy of early childhood education candidates

BACKGROUND

Early childhood educators greatly influence young children's physical activity and screen-viewing behaviours in childcare. However, educators have requested additional training in physical activity programming, and one logical place to provide this education is during their pre-service schooling. This study explored the physical activity and screen-viewing-related knowledge, training, and self-efficacy of early childhood education (ECE) candidates across Canada, to determine their confidence and ability to facilitate physical activity opportunities and limit screen-viewing among young children in childcare.

METHODS

Key program personnel at 61 (of 110) Canadian colleges/universities offering an ECE program agreed to participate in this cross-sectional study. An online survey (112 items; 9 domains), developed by experts using the Tailored Design Method, was administered via Qualtrics© to a sample of 1292 ECE candidates. Descriptive statistics, Mann-Whitney U-tests, and chi-square tests were used to report participant demographics and physical activity and screen-viewing-related knowledge (i.e., of physical activity and screen-viewing concepts), training (i.e., physical activity and screen-viewing courses/content received), and self-efficacy (i.e., to facilitate physical activity and limit screen-viewing in childcare) of candidates.

RESULTS

ECE candidates exhibited the least amount of knowledge regarding the impact of screen-viewing on physiological outcomes (i.e., blood pressure) in young children. Further, only 32.2 and 26.7% of candidates reported completing physical activity or screen-viewing courses during their post-secondary training, respectively. Candidates who completed one or more physical activity or screen-viewing courses exhibited significantly greater (p <.05) self-efficacy than those without such training related to ensuring children were engaging in adequate moderate-to-vigorous physical activity (MVPA). Confidence to limit screen time did not differ. Candidates reporting meeting national physical activity recommendations (i.e., 150+ minutes of MVPA/week) exhibited significantly greater (p <.05) physical activity-related self-efficacy than those not meeting these guidelines.

CONCLUSIONS

Findings from this work highlight both the need for and the potential of supplementary physical activity and screen-viewing content in post-secondary ECE programs to benefit candidates' knowledge and self-efficacy in these areas. Introducing this content at the post-secondary level will ensure that all early childhood educators are appropriately trained regarding physical activity and screen-viewing before entering a childcare-based profession, where they can positively influence young children's health behaviours.

Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews

OBJECTIVES

To systematically examine the evidence of harms and benefits relating to time spent on screens for children and young people's (CYP) health and well-being, to inform policy.

METHODS

Systematic review of reviews undertaken to answer the question 'What is the evidence for health and well-being effects of screentime in children and adolescents (CYP)?' Electronic databases were searched for systematic reviews in February 2018. Eligible reviews reported associations between time on screens (screentime; any type) and any health/well-being outcome in CYP. Quality of reviews was assessed and strength of evidence across reviews evaluated.

RESULTS

13 reviews were identified (1 high quality, 9 medium and 3 low quality). 6 addressed body composition; 3 diet/energy intake; 7 mental health; 4 cardiovascular risk; 4 for fitness; 3 for sleep; 1 pain; 1 asthma. We found moderately strong evidence for associations between screentime and greater obesity/adiposity and higher depressive symptoms; moderate evidence for an association between screentime and higher energy intake, less healthy diet quality and poorer quality of life. There was weak evidence for associations of screentime with behaviour problems, anxiety, hyperactivity and inattention, poorer self-esteem, poorer well-being and poorer psychosocial health, metabolic syndrome, poorer cardiorespiratory fitness, poorer cognitive development and lower educational attainments and poor sleep outcomes. There was no or insufficient evidence for an association of screentime with eating disorders or suicidal ideation, individual cardiovascular risk factors, asthma prevalence or pain. Evidence for threshold effects was weak. We found weak evidence that small amounts of daily screen use is not harmful and may have some benefits.

CONCLUSIONS

There is evidence that higher levels of screentime is associated with a variety of health harms for CYP, with evidence strongest for adiposity, unhealthy diet, depressive symptoms and quality of life. Evidence to guide policy on safe CYP screentime exposure is limited.

PROSPERO REGISTRATION NUMBER

CRD42018089483.

Prevalence of objectively measured sedentary behavior in early years: Systematic review and meta-analysis

BACKGROUND

The early years have been identified as a critical period during which sedentary habits may be established, as this behavior appears to track throughout life.

OBJECTIVE

The purpose of this systematic review and meta-analysis is to summarize the current literature on the prevalence of sedentary behavior in children aged 1-5.99 years, reporting differences between boys and girls, weekdays and weekend days, childcare hours and nonchildcare hours, and between time spent indoors and outdoors while children attended childcare.

METHODS

Five databases were searched until 26.10.2017 and meta-analyses were conducted to estimate prevalence and calculate mean differences in prevalence between groups.

RESULTS

Fifty studies representing 14 598 children (2-5.99 years) were included. Children spent 51.4% of their waking time in sedentary behaviors. Boys spent less time being sedentary than girls (estimate difference = -1.4%; 95%CI = -2.0: -0.7; P < .001). No significant differences were found between weekdays/weekend days (estimate difference = -0.4; 95%CI = -2.0: 1.2; P = .61) nor between childcare hours/nonchildcare hours (estimate difference = %; 95%CI = -0.9: 6.6; P = .136). While attending childcare centers, children were more sedentary indoors than outdoors (estimate difference = 14.4%; 95%CI = 11.8: 16.9; P < .001).

CONCLUSIONS

Our results suggest that young children spend a significant portion of their waking hours in sedentary behaviors. While at childcare, young children accumulated more sedentary behavior indoors than outdoors. Girls were more likely to be more sedentary than boys. No significant differences were found between weekdays and weekends, or between childcare and nonchildcare hours. There is a need for higher-quality studies with strong designs, using age and device appropriate cut-off points, to improve evidence-base and to better establish prevalence of sedentary behavior in young children.

What exposures in early life are risk factors for childhood obesity?

Globally, estimates show that 41 million children younger than 5 years of age are affected by overweight and obesity. In many regions of the world, these prevalence rates have increased dramatically, especially in low- and middle-income countries, making childhood obesity a global policy issue. Recent data show that many children are already affected by overweight or obesity by the time they start school; hence, the examination of early exposures, with interventions around these exposures, is warranted. In this review, we outline the main modifiable exposures in early life that can lead to an increased risk of obesity. These exposures can be broadly categorised into parental factors such as obesity and gestational diabetes; dietary exposures in early life, including breastfeeding and complementary feeding and feeding behaviours; physical activity, sedentary behaviours and sleep; and environmental exposures such as maternal exposure to tobacco. We also identify research gaps and opportunities for further research.

Mothers' and father's perceptions of the risks and benefits of screen time and physical activity during early childhood: a qualitative study

Background

This study sought to explore mothers’ and fathers’ perceptions of the risks and benefits of screen time and active play during early childhood.

Methods

In-depth semi structured telephone interviews were conducted with mothers and fathers (n = 28) of children aged 3–5 years who had earlier taken part in a larger quantitative study in Australia and identified willingness to be re-contacted were recruited. Interviews were audio recorded, transcribed verbatim, and analysed using NviVo. Coding was performed to produce themes. Quotes were extracted from the transcripts to illustrate common responses. COREQ guidelines for qualitative papers were followed.

Results

Parents reported active play was beneficial for many health and developmental outcomes such as imagination, enjoyment and socialisation, while reporting risks such as safety and stranger danger. There were mixed perceptions of screen time, with benefits such as learning, education and relaxation, and risks including habit formation, inappropriate content, negative cognitive and social outcome, and detriments to health being reported. A few differences between mothers’ and fathers’ perceptions were evident.

Conclusion

This study identified that some parental perceptions of benefits and risks of screen time and active play were consistent with published evidence, while others were contradicted by current evidence. Future studies should consider evidence-based education to ensure parents are aware of evidence-based outcomes of children’s behaviours. Interventions may wish to capitalise on parents perceived benefits to enhance engagement.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6199-6) contains supplementary material, which is available to authorized users.

The relationship between sedentary behaviour and physical literacy in Canadian children: a cross-sectional analysis from the RBC-CAPL Learn to Play study

BACKGROUND

Physical literacy is the foundation of a physically active lifestyle. Sedentary behaviour displays deleterious associations with important health indicators in children. However, the association between sedentary behaviour and physical literacy is unknown. The purpose of this study was to identify the aspects of physical literacy that are associated with key modes of sedentary behaviour among Canadian children participating in the RBC-CAPL Learn to Play study.

METHODS

A total of 8,307 children aged 8.0-12.9 years were included in the present analysis. Physical literacy was assessed using the Canadian Assessment of Physical Literacy, which measures four domains (Physical Competence, Daily Behaviour, Motivation and Confidence, Knowledge and Understanding). Screen-based sedentary behaviours (TV viewing, computer and video game use), non-screen sedentary behaviours (reading, doing homework, sitting and talking to friends, drawing, etc.) and total sedentary behaviour were assessed via self-report questionnaire. Linear regression models were used to determine significant (p<0.05) correlates of each mode of sedentary behaviour.

RESULTS

In comparison to girls, boys reported more screen time (2.7±2.0 vs 2.2±1.8 hours/day, Cohen's d=0.29), and total sedentary behaviour (4.3±2.6 vs 3.9±2.4 hours/day, Cohen's d=0.19), but lower non-screen-based sedentary behaviour (1.6±1.3 vs 1.7±1.3 hours/day, Cohen's d=0.08) (all p< 0.05). Physical Competence (standardized β's: -0.100 to -0.036, all p<0.05) and Motivation and Confidence (standardized β's: -0.274 to -0.083, all p<0.05) were negatively associated with all modes of sedentary behaviour in fully adjusted models. Knowledge and Understanding was negatively associated with screen-based modes of sedentary behaviour (standardized β's: -0.039 to -0.032, all p<0.05), and positively associated with non-screen sedentary behaviour (standardized β: 0.098, p<0.05). Progressive Aerobic Cardiovascular Endurance Run score and log-transformed plank score were negatively associated with all screen-based modes of sedentary behaviour, while the Canadian Agility and Movement Skill Assessment score was negatively associated with all modes of sedentary behaviour other than TV viewing (all p<0.05).

CONCLUSIONS

These results highlight differences in the ways that screen and non-screen sedentary behaviours relate to physical literacy. Public health interventions should continue to target screen-based sedentary behaviours, given their potentially harmful associations with important aspects of physical literacy.

Subjectively and Objectively Assessed Behavioral, Social, and Physical Environmental Correlates of Sedentary Behavior in Preschoolers

OBJECTIVE

To investigate associations between preschoolers' objective leisure-time sedentary behavior and a comprehensive set of subjective and objective potential correlates of sedentary behavior across the behavioral, social, and physical environmental domains on both the family and community level.

STUDY DESIGN

In 3- to 6-year-old preschoolers (n = 738) from 52 preschools in Southern Germany, leisure time spent in sedentary behavior was assessed by accelerometry in 2008-2009. Family- and community-level potential correlates of sedentary behavior from different domains (behavioral, social, and physical environmental) were subjectively (ie, by parent-proxy report) and objectively (ie, by routine administrative data) assessed.

RESULTS

None of the objective social and physical environmental correlates showed associations with sedentary behavior. Leisure-time sedentary behavior decreased with greater levels of moderate-to-vigorous physical activity (both weekends and weekday afternoons), participation in organized sports, parental leisure-time physical activity, as well as greater parental traffic safety perceptions (weekends only).

CONCLUSIONS

Targeting multiple health behaviors at the same time (ie, physical activity and sedentary behavior) and focusing on the entire family (ie, preschoolers, parents, and potentially older siblings) might be useful opportunities to reduce sedentary behaviors in preschoolers.

Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics

The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.

Effects of total fat intake on bodyweight in children

BACKGROUND

As part of efforts to prevent childhood overweight and obesity, we need to understand the relationship between total fat intake and body fatness in generally healthy children.

OBJECTIVES

To assess the effects and associations of total fat intake on measures of weight and body fatness in children and young people not aiming to lose weight.

SEARCH METHODS

For this update we revised the previous search strategy and ran it over all years in the Cochrane Library, MEDLINE (Ovid), MEDLINE (PubMed), and Embase (Ovid) (current to 23 May 2017). No language and publication status limits were applied. We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing and unpublished studies (5 June 2017).

SELECTION CRITERIA

We included randomised controlled trials (RCTs) in children aged 24 months to 18 years, with or without risk factors for cardiovascular disease, randomised to a lower fat (30% or less of total energy (TE)) versus usual or moderate-fat diet (greater than 30%TE), without the intention to reduce weight, and assessed a measure of weight or body fatness after at least six months. We included prospective cohort studies if they related baseline total fat intake to weight or body fatness at least 12 months later.

DATA COLLECTION AND ANALYSIS

We extracted data on participants, interventions or exposures, controls and outcomes, and trial or cohort quality characteristics, as well as data on potential effect modifiers, and assessed risk of bias for all included studies. We extracted body weight and blood lipid levels outcomes at six months, six to 12 months, one to two years, two to five years and more than five years for RCTs; and for cohort studies, at baseline to one year, one to two years, two to five years, five to 10 years and more than 10 years. We planned to perform random-effects meta-analyses with relevant subgrouping, and sensitivity and funnel plot analyses where data allowed.

MAIN RESULTS

We included 24 studies comprising three parallel-group RCTs (n = 1054 randomised) and 21 prospective analytical cohort studies (about 25,059 children completed). Twenty-three studies were conducted in high-income countries. No meta-analyses were possible, since only one RCT reported the same outcome at each time point range for all outcomes, and cohort studies were too heterogeneous to combine.Effects of dietary counselling to reduce total fat intake from RCTsTwo studies recruited children aged between 4 and 11 years and a third recruited children aged 12 to 13 years. Interventions were combinations of individual and group counselling, and education sessions in clinics, schools and homes, delivered by dieticians, nutritionists, behaviourists or trained, supervised teachers. Concerns about imprecision and poor reporting limited our confidence in our findings. In addition, the inclusion of hypercholesteraemic children in two trials raised concerns about applicability.One study of dietary counselling to lower total fat intake found that the intervention may make little or no difference to weight compared with usual diet at 12 months (mean difference (MD) -0.50 kg, 95% confidence interval (CI) -1.78 to 0.78; n = 620; low-quality evidence) and at three years (MD -0.60 kg, 95% CI -2.39 to 1.19; n = 612; low-quality evidence). Education delivered as a classroom curriculum probably decreased BMI in children at 17 months (MD -1.5 kg/m2, 95% CI -2.45 to -0.55; 1 RCT; n = 191; moderate-quality evidence). The effects were smaller at longer term follow-up (five years: MD 0 kg/m2, 95% CI -0.63 to 0.63; n = 541; seven years; MD -0.10 kg/m2, 95% CI -0.75 to 0.55; n = 576; low-quality evidence).Dietary counselling probably slightly reduced total cholesterol at 12 months compared to controls (MD -0.15 mmol/L, 95% CI -0.24 to -0.06; 1 RCT; n = 618; moderate-quality evidence), but may make little or no difference over longer time periods. Dietary counselling probably slightly decreased low-density lipoprotein (LDL) cholesterol at 12 months (MD -0.12 mmol/L, 95% CI -0.20 to -0.04; 1 RCT; n = 618, moderate-quality evidence) and at five years (MD -0.09, 95% CI -0.17 to -0.01; 1 RCT; n = 623; moderate-quality evidence), compared to controls. Dietary counselling probably made little or no difference to HDL-C at 12 months (MD -0.03 mmol/L, 95% CI -0.08 to 0.02; 1 RCT; n = 618; moderate-quality evidence), and at five years (MD -0.01 mmol/L, 95% CI -0.06 to 0.04; 1 RCT; n = 522; moderate-quality evidence). Likewise, counselling probably made little or no difference to triglycerides in children at 12 months (MD -0.01 mmol/L, 95% CI -0.08 to 0.06; 1 RCT; n = 618; moderate-quality evidence). Lower versus usual or modified fat intake may make little or no difference to height at seven years (MD -0.60 cm, 95% CI -2.06 to 0.86; 1 RCT; n = 577; low-quality evidence).Associations between total fat intake, weight and body fatness from cohort studiesOver half the cohort analyses that reported on primary outcomes suggested that as total fat intake increases, body fatness measures may move in the same direction. However, heterogeneous methods and reporting across cohort studies, and predominantly very low-quality evidence, made it difficult to draw firm conclusions and true relationships may be substantially different.

AUTHORS' CONCLUSIONS

We were unable to reach firm conclusions. Limited evidence from three trials that randomised children to dietary counselling or education to lower total fat intake (30% or less TE) versus usual or modified fat intake, but with no intention to reduce weight, showed small reductions in body mass index, total- and LDL-cholesterol at some time points with lower fat intake compared to controls. There were no consistent effects on weight, high-density lipoprotein (HDL) cholesterol or height. Associations in cohort studies that related total fat intake to later measures of body fatness in children were inconsistent and the quality of this evidence was mostly very low. Most studies were conducted in high-income countries, and may not be applicable in low- and middle-income settings. High-quality, longer-term studies are needed, that include low- and middle-income settings to look at both possible benefits and harms.

Test of a Conceptual Model to Explain Television Exposure of Head Start Children

Excessive television (TV) viewing by children can lead to negative health and developmental outcomes. Using structural equation modeling, this study tests a conceptual model to understand social and familial factors associated with TV exposure among a sample of 767 Head Start families with children between the ages of 3 and 5 years. Fit statistics suggested that the overall model provided an acceptable fit to the observed data. Specifically, significant structural paths suggest that parents' social support affects child TV exposure. Additionally, lower levels of social support were associated with significantly greater parental stress, which also predicted child TV exposure. Findings suggest that physicians and other team members of the patient-centered medical home may benefit from broad-based interventions that address familial factors to combat excess TV exposure among children. Urging parents to turn off the TV could fail to address the underlying causes of child TV exposure.

Determinants of Change in Physical Activity in Children 0-6 years of Age: A Systematic Review of Quantitative Literature

BACKGROUND

Understanding the determinants of children's health behaviours is important to develop successful behaviour-change interventions.

OBJECTIVE

We aimed to synthesise the evidence around determinants ('preceding predictors') of change in physical activity (PA) in young children (0-6 years of age).

METHODS

As part of a suite of reviews, prospective quantitative studies investigating change in physical activity in children aged 0-6 years were identified from eight databases (to October 2015): MEDLINE, Embase, CINAHL, PsycINFO, Web of Knowledge, British Nursing Index, Applied Social Sciences Index and Abstracts, and Sociological Abstracts. Determinants and direction of association were extracted, described and synthesised according to the socio-ecological model (individual, interpersonal, organisational, community, policy).

RESULTS

Forty-four determinants, predominantly in the interpersonal and organisational domains, were reported across 44 papers (six prospective cohort, 38 interventional); 14 determinants were assessed in four or more papers. Parental monitoring showed a consistent positive association with change in PA; provider training was positively associated with change in children's moderate-to-vigorous PA only. Five (sex, parental goal setting, social support, motor skill training and increased time for PA) showed no clear association. A further seven (child knowledge, parental knowledge, parental motivation, parenting skills, parental self-efficacy, curriculum materials and portable equipment) were consistently not associated with change in children's PA. Maternal role-modelling was positively associated with change in PA in all three studies in which it was examined.

CONCLUSIONS

A range of studied determinants of change in young children's PA were identified, but only parental monitoring was found to be consistently positively associated. More evidence dealing with community and policy domains from low-/middle-income countries and about lesser-explored modifiable family- and childcare-related determinants is required. INTERNATIONAL PROSPECTIVE REGISTER FOR SYSTEMATIC REVIEWS (PROSPERO) REGISTRATION NUMBER: CRD42012002881.

Reciprocal Associations between Electronic Media Use and Behavioral Difficulties in Preschoolers

The use of electronic media has increased substantially and is already observable in young children. The present study explored associations of preschoolers’ use of electronic media with age, gender, and socio-economic status, investigated time trends, and examined reciprocal longitudinal relations between children’s use of electronic media and their behavioral difficulties. The study participants included 527 German two- to six-year-old children whose parents had provided information on their use of electronic media and their behavioral difficulties at two time points, with approximately 12 months between baseline and follow-up. The analyses revealed that older vs. younger children, as well as children from families with a lower vs. higher socio-economic status, were more often reported to use electronic media. Furthermore, the usage of mobile phones increased significantly between 2011 and 2016. Most interestingly, baseline usage of computer/Internet predicted more emotional and conduct problems at follow-up, and baseline usage of mobile phones was associated with more conduct problems and hyperactivity or inattention at follow-up. Peer relationship problems at baseline, on the other hand, increased the likelihood of using computer/Internet and mobile phones at follow-up. The findings indicate that preschoolers’ use of electronic media, especially newer media such as computer/Internet and mobile phones, and their behavioral difficulties are mutually related over time.

Physical activity and sedentary behavior legislation in Canadian childcare facilities: an update

Background

Within the childcare sector, physical activity and sedentary behaviors are not legislated at a national level in Canada. Efforts have been undertaken to identify factors within childcare facilities which support and deter physical activity and sedentary behaviors. The purpose of this paper was to provide an amended review of the legislative landscape, at the provincial and territorial level, regarding physical activity and sedentary behaviors (via screen-viewing) in Canadian childcare centers.

Methods

Individual childcare acts and regulations for each province and territory were collected; documents were reviewed with a focus on sections devoted to child health, physical activity, screen time, play, and outdoor time. An extraction table was used to facilitate systematic data retrieval and comparisons across provinces and territories.

Results

Of the 13 provinces and territories, 8 (62%) have updated their childcare regulations in the past 5 years. All provinces provide general recommendations to afford gross motor movement; but the majority give no specific requirements for how much or at what intensity. Only 3 provinces (Northwest Territories, Nunavut, and Nova Scotia) explicitly mentioned daily physical activity while all provinces’ and territories’ required daily outdoor play. Only 1 province (New Brunswick) made mention of screen-viewing.

Conclusions

The variability in childcare regulations results in different physical activity requirements across the country. By providing high-level targets for physical activity recommendations, by way of provincial/territorial legislation, staff would have a baseline from which to begin supporting more active behaviors among the children in their care. Future research is needed to support translating physical activity policies into improved activity levels among young children in childcare and the role of screen-viewing in these venues.

Cross sectional associations of screen time and outdoor play with social skills in preschool children

Screen time and physical activity behaviours develop during the crucial early childhood period (0–5 years) and impact multiple health and developmental outcomes, including psychosocial wellbeing. Social skills, one component of psychosocial wellbeing, are vital for children’s school readiness and future mental health. This study investigates potential associations of screen time and outdoor play (as a proxy for physical activity) with social skills. Cross sectional data were available for 575 mothers with a child (54% boys) aged 2–5 years. Mothers reported their child’s screen time, outdoor play time and social skills (Adaptive Social Behavior Inventory; ASBI). Multiple linear regression analyses assessed associations of screen and outdoor play time (Model 1) and compliance with screen time and physical activity recommendations (Model 2) with three ASBI subscales. Boys and girls spent a mean of 2.0 and 2.2 hours per day in screen time, and 3.3 and 2.9 hours per day in outdoor play, respectively. Girls scores for express and comply skills were significantly higher than boys (p<0.005). After applying the Benjamini-Hochberg Procedure to adjust for multiple associations, children’s television/DVD/video viewing was inversely associated with their compliant scores (B = -0.35 95% CI -0.26, -0.14; p = 0.001) and outdoor play time was positively associated with both expressive (B = 0.20 95% CI 0.07, 0.34; p = 0.004) and compliant (B = 0.22 95% CI 0.08, 0.36; p = 0.002) scores. Findings indicate that television/DVD/video viewing may be adversely, and outdoor play favourably, associated with preschool children’s social skills. Future research is required to identify the direction of causation and explore potential mechanisms of association.

Development and feasibility of a wearable infant wrist band for the objective measurement of physical activity using accelerometery

Background

It is important to be able to reliably and feasibly measure infant and toddler physical activity in order to determine adherence to current physical activity guidelines and effects on early life development, growth and health. This study aimed to describe the development of an infant wearable wrist-worn band for the measurement of physical activity; to determine the feasibility of the device data for observational measurement of physical activity and to determine the caregiver reported acceptability of the infant wearable wrist band.

Methods

After various iterations of prototypes and piloting thereof, a final wearable band was designed to fit an Axivity AX3 monitor. Mother and infant/toddler (aged 3–24 months) pairs (n = 152) were recruited, and mothers were asked for their child to wear the band with enclosed monitor at all times for 1 week (minimum 3 days). Feasibility was assessed by determining technical reliability of the data, as well as wear time and compliance according to requirements for observational measurement. Acceptability was assessed via questionnaire.

Results

Technical reliability of the Axivity AX3 monitors in this age group was good. After excluding days that did not have at least 15 h of wear time, only 2% of participants had less than three valid days of data remaining, and 4% of participants had no data (due to device loss or data loss). Therefore, 94% of participants were compliant, having three or more days of wear with at least 15 h of wear per day, thus providing enough valid data for observational measurement. The majority (60%) of mothers reported being “very happy” with the safety of the device, while only 8% were “a little worried”. A large majority (86%) of mothers stated that the band attracted attention from others, although this was mostly attributed to curiosity about the function of the band. Most (80%) of participants rated the comfort of the band as “comfortable”, and 10% rated it as “very comfortable”.

Conclusions

The infant wearable band proved to be feasible and acceptable according to the criteria tested, and compliance wearing the band was good. We have therefore provided a replicable, comfortable and acceptable wearable band for the measurement of infant and toddler physical activity.

Electronic supplementary material

The online version of this article (10.1186/s40814-018-0256-x) contains supplementary material, which is available to authorized users.

Parental Education and Pre-School Children's Objectively Measured Sedentary Time: The Role of Co-Participation in Physical Activity

Parental co-participation in physical activity (PA) may be a beneficial parenting practice for diminishing children's sedentary time (ST). Less information is available, however, on the explanatory role of co-participation in PA regarding parental educational differences in children's ST. Preschool-aged children (N = 864, mean age 4.8, 52% boys) with their parents participated in a cross-sectional DAGIS (Increased Health and Wellbeing in Pre-schools) study between years 2015 and 2016. Children (N = 821) wore an accelerometer for one week. Parents were informed of their educational background, and the frequency of visits with their child in nature, to parks or playgrounds, their own yard, and indoor sport facilities (N = 808). Testing the associations required multiple regression analyses. Parents with a low educational background reported more frequent visits with their child to their own yard, and these visits were associated with children's lower ST. More highly educated parents co-visited indoor sport facilities more frequently, although this did not have a significant association with children's ST. More frequent visits in nature were associated with a lower ST at weekends, regardless of educational background. Future health promotion strategies should inform parents that frequent co-participation in PA, for example, in one's own yard, is beneficial for lowering children's ST.

Effects of total fat intake on bodyweight in children

BACKGROUND

As part of efforts to prevent childhood overweight and obesity, we need to understand the relationship between total fat intake and body fatness in generally healthy children.

OBJECTIVES

To assess the effects of total fat intake on measures of weight and body fatness in children and young people not aiming to lose weight.

SEARCH METHODS

For this update we revised the previous search strategy and ran it over all years in the Cochrane Library, MEDLINE (Ovid), MEDLINE (PubMed), and Embase (Ovid) (current to 23 May 2017). No language and publication status limits were applied. We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing and unpublished studies (5 June 2017).

SELECTION CRITERIA

We included randomised controlled trials (RCTs) in children aged 24 months to 18 years, with or without risk factors for cardiovascular disease, randomised to a lower fat (30% or less of total energy (TE)) versus usual or moderate-fat diet (greater than 30%TE), without the intention to reduce weight, and assessed a measure of weight or body fatness after at least six months. We included prospective analytical cohort studies in these children if they related baseline total fat intake to weight or body fatness at least 12 months later. We duplicated inclusion decisions and resolved disagreement by discussion with other authors.

DATA COLLECTION AND ANALYSIS

We extracted data on participants, interventions or exposures, controls and outcomes, and trial or cohort quality characteristics, as well as data on potential effect modifiers, and assessed risk of bias for all included studies. We extracted outcome data using the following time point ranges, when available: RCTs: baseline to six months, six to 12 months, one to two years, two to five years and more than five years; cohort studies: baseline to one year, one to two years, two to five years, five to 10 years and more than 10 years. We planned to perform random-effects meta-analyses with relevant subgrouping, and sensitivity and funnel plot analyses where data allowed.

MAIN RESULTS

We included 24 studies comprising three parallel-group RCTs (n = 1054 randomised) and 21 prospective analytical cohort studies (about 25,059 children completed). Twenty-three were conducted in high-income countries. No meta-analyses were possible, since only one RCT reported the same outcome at each time point range for all outcomes, and cohort studies were too heterogeneous.For the RCTs, concerns about imprecision and poor reporting limited our confidence in our findings. In addition, the inclusion of hypercholesteraemic children in two trials raised concerns about applicability. Lower versus usual or modified total fat intake may have made little or no difference to weight over a six- to twelve month period (mean difference (MD) -0.50 kg, 95% confidence interval (CI) -1.78 to 0.78; 1 RCT; n = 620; low-quality evidence), nor a two- to five-year period (MD -0.60 kg, 95% CI -2.39 to 1.19; 1 RCT; n = 612; low-quality evidence). Compared to controls, lower total fat intake (30% or less TE) probably decreased BMI in children over a one- to two-year period (MD -1.5 kg/m2, 95% CI -2.45 to -0.55; 1 RCT; n = 191; moderate-quality evidence), with no other differences evident across the other time points (two to five years: MD 0.00 kg/m2, 95% CI -0.63 to 0.63; 1 RCT; n = 541; greater than five years; MD -0.10 kg/m2, 95% CI -0.75 to 0.55; 1 RCT; n = 576; low-quality evidence). Lower fat intake probably slightly reduced total cholesterol over six to 12 months compared to controls (MD -0.15 mmol/L, 95% CI -0.24 to -0.06; 1 RCT; n = 618; moderate-quality evidence), but may make little or no difference over longer time periods. Lower fat intake probably slightly decreased low-density lipoprotein (LDL) cholesterol over six to 12 months (MD -0.12 mmol/L, 95% CI -0.20 to -0.04; 1 RCT; n = 618, moderate-quality evidence) and over two to five years (MD -0.09, 95% CI -0.17 to -0.01; 1 RCT; n = 623; moderate-quality evidence), compared to controls. However, lower total fat intake probably made little or no difference to HDL-C over a six- to 12-month period (MD -0.03 mmol/L, 95% CI -0.08 to 0.02; 1 RCT; n = 618; moderate-quality evidence), nor a two- to five-year period (MD -0.01 mmol/L, 95% CI -0.06 to 0.04; 1 RCT; n = 522; moderate-quality evidence). Likewise, lower total fat intake probably made little or no difference to triglycerides in children over a six- to 12-month period (MD -0.01 mmol/L, 95% CI -0.08 to 0.06; 1 RCT; n = 618; moderate-quality evidence). Lower versus usual or modified fat intake may make little or no difference to height over more than five years (MD -0.60 cm, 95% CI -2.06 to 0.86; 1 RCT; n = 577; low-quality evidence).Over half the cohort analyses that reported on primary outcomes suggested that as total fat intake increases, body fatness measures may move in the same direction. However, heterogeneous methods and reporting across cohort studies, and predominantly very low-quality evidence, made it difficult to draw firm conclusions and true relationships may be substantially different.

AUTHORS' CONCLUSIONS

We were unable to reach firm conclusions. Limited evidence from three trials that randomised children to a lower total fat intake (30% or less TE) versus usual or modified fat intake, but with no intention to reduce weight, showed small reductions in body mass index, total- and LDL-cholesterol at some time points with lower fat intake compared to controls, and no consistent differences in effects on weight, high-density lipoprotein (HDL) cholesterol or height. Associations in cohort studies that related total fat intake to later measures of body fatness in children were inconsistent and the quality of this evidence was mostly very low. Twenty-three out of 24 included studies were conducted in high-income countries, and may not be applicable in low- and middle-income settings. High-quality, longer-term studies are needed, that include low- and middle-income settings and look at both possible benefits and risks.

Feasibility and Efficacy of a Parent-Focused, Text Message-Delivered Intervention to Reduce Sedentary Behavior in 2- to 4-Year-Old Children (Mini Movers): Pilot Randomized Controlled Trial

Background

Despite public health guidelines to limit sedentary behavior, many young children spend large amounts of time sedentary (eg, screen and sitting time) during waking hours.

Objective

The objective of this study was to test the feasibility and efficacy of a parent-focused, predominantly text message–delivered intervention to support parents to reduce the amount of time their children spend in sedentary behavior.

Methods

Mini Movers was a pilot randomized controlled trial delivered to parents of 2- to 4-year-old children in Melbourne, Australia. Participants were recruited through playgroups, social media, and snowball sampling. Eligibility criteria were having an ambulatory child (2-4 years), English literacy, and smartphone ownership. Participants were randomized to intervention or wait-list control on a 1:1 ratio after baseline data collection. The 6-week intervention was predominantly delivered via text messages, using a Web-based bulk text message platform managed by the interventionist. Intervention strategies focused on increasing parental knowledge, building self-efficacy, setting goals, and providing reinforcement, and were underpinned by the Coventry, Aberdeen & London-Refined taxonomy of behavior change techniques and social cognitive theory. The primary outcome was intervention feasibility, measured by recruitment, retention, intervention delivery, and fidelity; process evaluation questionnaires; and qualitative interviews with a subsample of participants. Secondary outcomes were children’s screen and restraint time (parent report), sitting time (parent report, activPAL), and potential mediators (parent report). Linear regression models were used to determine intervention effects on secondary outcomes, controlling for the child’s sex and age and clustering by playgroup; effect sizes (Cohen's d) were calculated.

Results

A total of 57 participants (30 intervention; 27 wait-list control) were recruited, and retention was high (93%). Process evaluation results showed that the intervention was highly acceptable to parents. The majority of intervention components were reported to be useful and relevant. Compared with children in the control group, children in the intervention group had significantly less screen time postintervention (adjusted difference [95% CI]=−35.0 [−64.1 to −5.9] min/day; Cohen's d=0.82). All other measures of sedentary behavior were in the expected direction, with small to moderate effect sizes.

Conclusions

Mini Movers was shown to be a feasible, acceptable, and efficacious pilot intervention for parents of young children, warranting a larger-scale randomized control trial.

Trial Registration

Australian New Zealand Clinical Trials registry: ACTRN12616000628448; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?ACTRN=12616000628448p (Archived by WebCite at http://www.webcitation.org/ 6wZcA3cYM)

Environmental characteristics of early childhood education and care centres and young children's weight status: A systematic review

The aim of this systematic review was to summarize ECEC environmental correlates of weight status in children under the age of 6years. Six databases (PubMed, PsycINFO, CINAHL, SPORTDiscus, Scopus, and Web of Science) were searched until March 2017. Observational studies examining the relationship between ECEC environmental characteristics and weight status in children aged 0-6years were included. Data was extracted using a predesigned form. Eight studies, representing 4862 children, met the inclusion criteria. Twenty-two environmental characteristics were identified and classified into four domains (physical, political, economic, and sociocultural); of these, six correlates were found. 'Active environment' 'sedentary opportunities', 'active play time', 'high sugar and high fat served', 'educators' weight' and 'educators' habitual physical activity level' were associated with weight status in young children. However, for most environmental characteristics examined, strong evidence is not available yet, due to variations across studies on the measures of environmental characteristics and analytical methodologies. Stronger empirical evidence in greater quantity is needed. Future studies in this area are recommended to investigate the environmental influence using an ecological approach and to examine the potential mediators, with a focus on the settings of family-based centres and samples representing toddlers and/or infants.

Physical activity, sedentary behaviour, and psychosocial well-being among young South Korean children

OBJECTIVE

To examine associations between television (TV) viewing, reading, physical activity (PA), and psychosocial well-being among a representative sample of young South Korean children aged 0-5 years.

METHODS

Findings are based on 1,774 children who participated in the Korea Children and Youth Survey. All measures were questionnaire-derived. Psychosocial well-being included social, interactive, and emotional skills (α = .7-.9), and the top quartile denoted high psychosocial well-being. Multiple logistic regressions were performed to examine relationships after controlling for several confounders.

RESULTS

Compared to children who participated in PA for <1 hr/week, those who participated in PA for 1- <3 hr/week were more likely to show high emotional skills (odds ratio [OR]: 1.40, 95% confidence interval [CI] [1.02, 1.93]), and those who participated ≥3 hr/week were more likely to show high social (OR: 2.01, 95% CI [1.45, 2.78]) and interactive skills (OR: 1.39, 95% CI [1.01, 1.92]). During weekdays, children who read 1- <3 hr/day and ≥3 hr/day, compared to <1 hr/day, were more likely to show high social (OR: 1.61, 95% CI [1.20, 2.16] and OR: 2.47, 95% CI [1.31, 4.67]) and emotional skills (OR: 1.57, 95% CI [1.16, 2.13] and OR: 2.58, 95% CI [1.34, 4.98]). In addition, children who read 1- <3 hr/day, compared to <1 hr/day, were more likely to show high interactive skills (OR: 1.44, 95% CI [1.08, 1.92]). Similar findings for reading on weekends were observed. TV viewing was not associated with social skills or interactive skills. TV viewing for 1- <3 hr/day, compared to <1 hr/day, was associated with increased odds of high emotional skills (OR: 1.71, 95% CI [1.28, 2.27] on weekdays; OR: 1.90, 95% CI [1.39, 2.61] on weekends).

CONCLUSION

PA and reading primarily showed favourable associations with psychosocial well-being, whereas TV viewing did not; thus, PA or reading may be a better option over TV viewing for optimal psychosocial well-being among young South Korean children. These findings should be confirmed with stronger study designs.

Describing objectively measured physical activity levels, patterns, and correlates in a cross sectional sample of infants and toddlers from South Africa

BACKGROUND

Physical activity is considered to have health benefits across the lifespan but levels, patterns, and correlates have not been well described in infants and toddlers under the age of two years.

METHODS

This study aimed to describe objectively and subjectively measured physical activity in a group of South African infants aged 3- to 24-months (n = 140), and to investigate individual and maternal correlates of physical activity in this sample. Infants' physical activity was measured using an Axivity AX3 wrist-worn accelerometer for one week and the mean vector magnitude was calculated. In addition, mothers reported the average amount of time their infant spent in various types of activities (including in front of the TV), their beliefs about infants' physical activity, access to equipment in the home environment, and ages of motor development milestone attainment. Analysis of variance (ANOVA) and pair-wise correlations were used to test age and sex differences and associations with potential correlates.

RESULTS

There were significant age and sex effects on the distribution of time spent at different physical activity intensities (Wilks' lambda = 0.06, p < 0.01). In all cases, the trend was for boys to spend more time in higher intensity physical activity and less time in lower intensity activity than girls; and for time spent in higher intensity activities to be higher in older children. Time spent outside was higher in boys, and this reached significance at 18-months (F = 3.84, p = 0.02). Less concern around floor play was associated with higher physical activity at 12-months in females only (p = 0.03, r = 0.54), and no other maternal beliefs were correlated with physical activity. The majority (94%) of children were exceeding TV time recommendations. When controlling for age and sex, overall TV time was positively associated with BMI z-score (β=0.01, p = 0.05).

CONCLUSION

This study is the first to show sex and age differences in the patterns of physical activity, and to report on objectively measured and maternal reported physical activity and sedentary behaviour in the first two years of life in South Africa infants. Infants and toddlers should be provided with as many opportunities to be active through play as possible, and TV time should be limited.

Physical Activity Opportunities Within the Schedule of Early Care and Education Centers

BACKGROUND

Physical activity has many benefits for young children's health and overall development, but few studies have investigated how early care and education centers allot time for physical activity, along with measured individual physical activity levels for indoor/outdoor activities during a typical day.

METHODS

Fifty early care and education centers in central North Carolina participated in 4 full-day observations, and 559 children aged 3-5 years within centers wore accelerometers assessing physical activity during observation days. Observation and physical activity data were linked and analyzed for associations between child activity and type of classroom activity.

RESULTS

Children averaged 51 (13) minutes per day of moderate to vigorous physical activity and 99 (18) minutes per day of light physical activity while in child care. Children averaged 6 (10) and 10 (13) minutes per day of observed outdoor and indoor daily teacher-led physical activity, respectively. Outdoor time averaged 67 (49) minutes per day, and physical activity levels were higher during outdoor time than during common indoor activities (center time, circle time, and TV time).

CONCLUSIONS

Physical activity levels varied between indoor and outdoor class activities. Policy and program-related efforts to increase physical activity in preschoolers should consider these patterns to leverage opportunities to optimize physical activity within early care and education centers.

Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep

BACKGROUND

The Canadian Society for Exercise Physiology convened representatives of national organizations, research experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These novel guidelines for children of the early years embrace the natural and intuitive integration of movement behaviours across the whole day (24-h period).

METHODS

The development process was guided by the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Four systematic reviews (physical activity, sedentary behaviour, sleep, combined behaviours) examining the relationships within and among movement behaviours and several health indicators were completed and interpreted by a Guideline Development Panel. The systematic reviews that were conducted to inform the development of the guidelines, and the framework that was applied to develop the recommendations, followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Complementary compositional analyses were performed using data from the Canadian Health Measures Survey to examine the relationships between movement behaviours and indicators of adiposity. A review of the evidence on the cost effectiveness and resource use associated with the implementation of the proposed guidelines was also undertaken. A stakeholder survey (n = 546), 10 key informant interviews, and 14 focus groups (n = 92 participants) were completed to gather feedback on draft guidelines and their dissemination.

RESULTS

The guidelines provide evidence-informed recommendations as to the combinations of light-, moderate- and vigorous-intensity physical activity, sedentary behaviours, and sleep that infants (<1 year), toddlers (1-2 years) and preschoolers (3-4 years) should achieve for a healthy day (24 h). Proactive dissemination, promotion, implementation, and evaluation plans were prepared to optimize uptake and activation of the new guidelines.

CONCLUSIONS

These guidelines represent a sensible evolution of public health guidelines whereby optimal health is framed within the balance of movement behaviours across the whole day, while respecting preferences of end-users. Future research should consider the integrated relationships among movement behaviours, and similar integrated guidelines for other age groups should be developed.

Systematic review of the relationships between sedentary behaviour and health indicators in the early years (0-4 years)

Background

The purpose of this systematic review was to examine the relationships between sedentary behaviour (SB) and health indicators in children aged 0 to 4 years, and to determine what doses of SB (i.e., duration, patterns [frequency, interruptions], and type) were associated with health indicators.

Methods

Online databases were searched for peer-reviewed studies that met the a priori inclusion criteria: population (apparently healthy, 1 month to 4.99 years), intervention/exposure and comparator (durations, patterns, and types of SB), and outcome/health indicator (critical: adiposity, motor development, psychosocial health, cognitive development; important: bone and skeletal health, cardiometabolic health, fitness, risks/harm). The quality of the evidence was assessed by study design and outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Results

Due to heterogeneity, meta-analyses were not possible; instead, narrative syntheses were conducted, structured around the health indicator and type of SB. A total of 96 studies were included (195,430 participants from 33 countries). Study designs were: randomized controlled trial (n = 1), case-control (n = 3), longitudinal (n = 25), longitudinal with additional cross-sectional analyses (n = 5), and cross-sectional (n = 62). Evidence quality ranged from “very low” to “moderate”. Associations between objectively measured total sedentary time and indicators of adiposity and motor development were predominantly null. Associations between screen time and indicators of adiposity, motor or cognitive development, and psychosocial health were primarily unfavourable or null. Associations between reading/storytelling and indicators of cognitive development were favourable or null. Associations between time spent seated (e.g., in car seats or strollers) or in the supine position, and indicators of adiposity and motor development, were primarily unfavourable or null. Data were scarce for other outcomes.

Conclusions

These findings continue to support the importance of minimizing screen time for disease prevention and health promotion in the early years, but also highlight the potential cognitive benefits of interactive non-screen-based sedentary behaviours such as reading and storytelling. Additional high-quality research using valid and reliable measures is needed to more definitively establish the relationships between durations, patterns, and types of SB and health indicators, and to provide insight into the appropriate dose of SB for optimal health in the early years.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4849-8) contains supplementary material, which is available to authorized users.

Cross-sectional associations between sleep duration, sedentary time, physical activity, and adiposity indicators among Canadian preschool-aged children using compositional analyses

Background

Sleep duration, sedentary behaviour, and physical activity are three co-dependent behaviours that fall on the movement/non-movement intensity continuum. Compositional data analyses provide an appropriate method for analyzing the association between co-dependent movement behaviour data and health indicators. The objectives of this study were to examine: (1) the combined associations of the composition of time spent in sleep, sedentary behaviour, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) with adiposity indicators; and (2) the association of the time spent in sleep, sedentary behaviour, LPA, or MVPA with adiposity indicators relative to the time spent in the other behaviours in a representative sample of Canadian preschool-aged children.

Methods

Participants were 552 children aged 3 to 4 years from cycles 2 and 3 of the Canadian Health Measures Survey. Sedentary time, LPA, and MVPA were measured with Actical accelerometers (Philips Respironics, Bend, OR USA), and sleep duration was parental reported. Adiposity indicators included waist circumference (WC) and body mass index (BMI) z-scores based on World Health Organization growth standards. Compositional data analyses were used to examine the cross-sectional associations.

Results

The composition of movement behaviours was significantly associated with BMI z-scores (p = 0.006) but not with WC (p = 0.718). Further, the time spent in sleep (BMI z-score: γ_sleep = −0.72; p = 0.138; WC: γ_sleep = −1.95; p = 0.285), sedentary behaviour (BMI z-score: γ_SB = 0.19; p = 0.624; WC: γ_SB = 0.87; p = 0.614), LPA (BMI z-score: γ_LPA = 0.62; p = 0.213, WC: γ_LPA = 0.23; p = 0.902), or MVPA (BMI z-score: γ_MVPA = −0.09; p = 0.733, WC: γ_MVPA = 0.08; p = 0.288) relative to the other behaviours was not significantly associated with the adiposity indicators.

Conclusions

This study is the first to use compositional analyses when examining associations of co-dependent sleep duration, sedentary time, and physical activity behaviours with adiposity indicators in preschool-aged children. The overall composition of movement behaviours appears important for healthy BMI z-scores in preschool-aged children. Future research is needed to determine the optimal movement behaviour composition that should be promoted in this age group.

Meeting new Canadian 24-Hour Movement Guidelines for the Early Years and associations with adiposity among toddlers living in Edmonton, Canada

BACKGROUND

Canada has recently released guidelines that include toddler-specific recommendations for physical activity, screen-based sedentary behaviour, and sleep. This study examined the proportions of toddlers meeting the new Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years) and associations with body mass index (BMI) z-scores in a sample from Edmonton, Canada.

METHODS

Participants included 151 toddlers (aged 19.0 ± 1.9 months) for whom there was complete objectively measured physical activity data from the Parents' Role in Establishing healthy Physical activity and Sedentary behaviour habits (PREPS) project. Toddlers' physical activity was measured using ActiGraph wGT3X-BT monitors. Toddlers' screen time and sleep were measured using the PREPS questionnaire. Toddlers' height and weight were objectively measured by public health nurses and BMI z-scores were calculated using World Health Organization growth standards. Meeting the overall 24-Hour Movement Guidelines was defined as: ≥180 min/day of total physical activity, including ≥1 min/day of moderate- to vigorous-intensity physical activity; no screen time per day (for those aged 12-23 months) or ≤1 h/day of screen time per day (ages 24-35 months); and 11-14 h of sleep per 24-h period. Frequency analyses and linear regression models were conducted.

RESULTS

Only 11.9% of toddlers met the overall 24-Hour Movement Guidelines, but this finding was largely driven by screen time. The majority of toddlers met the individual physical activity (99.3%) and sleep (82.1%) recommendations, while only 15.2% of toddlers met the screen time recommendation. No associations were observed between meeting specific and general combinations of recommendations within the guidelines and BMI z-scores.

CONCLUSIONS

Most toddlers in this sample were meeting physical activity and sleep recommendations but were engaging in more screen time than recommended. Consequently, only a small proportion of toddlers met the overall guidelines. Based on the findings of this study, identifying modifiable correlates of screen time to inform appropriate strategies to reduce screen time appears key for increasing the proportion of toddlers meeting the 24-Hour Movement Guidelines for the Early Years. Future research should examine the associations between meeting the new guidelines and other health indicators. Furthermore, future high-quality studies examining dose-response relationships between movement behaviours and health indicators are needed to inform guideline updates.

Compliance with the Australian 24-hour movement guidelines for the early years: associations with weight status

BACKGROUND

For effective public health and surveillance it is important to document the proportion of young children who meet the new Australian Integrated 24 h Movement Guidelines for the Early Years and how these associate with health outcomes. We aimed to (i) assess compliance with the new Integrated 24 h Movement Guidelines for the Early Years in a sample of Australian toddlers; and (ii) ascertain whether compliance with the guidelines associates with weight status.

METHODS

The sample comprised 202 toddlers (104 girls) aged 19.74 ± 4.07 months from the GET UP!

STUDY

Participants wore accelerometers (Actigraph GT3X+) for 24 h over 7 consecutive days to assess physical activity, sedentary time and sleep. Parents reported participants' screen time. Weight and height were measured and body mass index (BMI) z-scores by age and sex were calculated. Analysis of Covariance (ANCOVA) was performed to test differences in BMI z-scores between participants complying with (i) none or any individual guideline, (ii) any combination of meeting two guidelines, and (iii) those who met all three guidelines, adjusting for child age, gender and socioeconomic status.

RESULTS

Only 8.9% of the sample met the overall 24 h movement guidelines. Most of the sample met the physical activity (96.5%) and sleep (79.7%) guidelines but only 11.4% met the sedentary behavior guideline. Average BMI Z-scores did not significantly differ between children who complied with none or any individual guideline, any combination of meeting two guidelines, and those who met all three guidelines (p > 0.05). Although the lack of significant differences, participants who accomplished any combination of two guidelines or all three guidelines appear to have had a lower BMI Z-score than those complying with one of the guidelines or none.

CONCLUSIONS

Just under 9% of our sample met the overall Australian 24 h Movement Guidelines for the Early Years. BMI was not associated with the accomplishment of any of the 24-h Movement Guidelines. Strategies to promote adherence to the 24-h movement guidelines in toddlers, particularly for screen time, are necessary, as promoting health-related behaviors in early childhood has the potential to provide children a strong foundation for lifelong physical and mental health.

Does Childhood Temperamental Activity Predict Physical Activity and Sedentary Behavior over a 30-Year Period? Evidence from the Young Finns Study

PURPOSE

We examined associations between childhood temperamental activity, physical activity (PA), and television (TV) viewing over a 30-year period.

METHOD

The participants (1220 boys and 1237 girls) were aged 3, 6, 9, and 12 years in 1980 and were followed until 2011. Temperamental activity was evaluated by participants' mothers at baseline. The PA was assessed based on maternal ratings of the child from ages 3 to 6 and via self-report age from the age of 9 across all measurements. TV viewing was assessed using self-reports taken from 2001 to 2011. The associations between temperamental activity and the level and change of PA and TV viewing were determined using linear growth modeling stratified by gender and age group.

RESULTS

High temperamental activity assessed from ages 9 to 12 was associated with high levels of childhood PA in both genders, but with a steeper decline in PA levels during the first 9 years of follow-up in boys. High temperamental activity assessed from ages 3 to 6 was associated with the decline of PA from childhood to youth in girls. High childhood temperamental activity was associated with decreased levels of PA in adulthood in men, but not in women. The associations between childhood temperamental activity and TV viewing during adulthood seemed to be positive but not consistently significant in all age and gender groups.

CONCLUSION

High temperamental activity may contribute to the development of a physically inactive lifestyle. More evidence is needed with regard to gender differences among participants in similar study settings.

Preschool children's context-specific sedentary behaviours and parental socioeconomic status in Finland: a cross-sectional study

OBJECTIVES

This study examined the associations of parental socioeconomic status (SES) with preschoolers' objectively measured sedentary time (SED) over the course of a week and with parent-reported children's screen and reading times at home as indicators of sedentary behaviours (SB).

DESIGN

Cross-sectional.

SETTING

In years 2015 and 2016 in Finland.

PARTICIPANTS

864 children, aged 3-6 years, with their parents.

OUTCOME MEASURES

Children's accelerometer data were transformed into average SED minutes per hour in different contexts (preschool, home during preschool days, weekend and total). Parent-reported children's screen and reading times were expressed as average daily minutes. The SES indicators (maternal and paternal education and relative household income) were grouped into three categories. Linear or logistic regression analyses were used, with municipality, season, and children's gender and age as covariates. CIs were adjusted for clustering at the preschool group level.

RESULTS

Children with low maternal (β=17.21, 95% CI: 8.71 to 25.71) and paternal (β=10.54, 95% CI: 0.77 to 20.30) education had more overall screen time at home than their more advantaged counterparts. SES differences in overall screen time were mostly explained by TV viewing. Children with low as opposed to high maternal education (β=-2.66, 95% CI: -4.95 to -0.38) had less reading time at home. Children whose fathers were on the middle (β=-1.15, 95% CI: -2.01 to -0.29) educational level had less weekend SED than those with high paternal education. Otherwise, parental SES was not related to objectively measured SED.

CONCLUSIONS

The results of this study highlight the fact that the associations between parental SES and preschoolers' SB are dependent on the indicators of SES and SBs, and vary between different contexts. Generally, parental SES was not associated with SED, whereas some SES differences existed in screen time and reading time at home. Interventions aiming to diminish SES differences in children's SB should focus on home hours.

TRIAL REGISTRATION NUMBER

ISRCTN57165350.

Adherence to the 24-Hour Movement Guidelines among 10- to 17-year-old Canadians

INTRODUCTION

The Canadian 24-Hour Movement Guidelines for Children and Youth were released in 2016. They contain specific recommendations on the daily time that 5- to 17-year-olds should devote to moderate-to-vigorous physical activity, recreational screen time, and sleep. The objective of this study was to estimate the proportion of Canadians aged 10 to 17 years that meet the recommendations contained within the 24-Hour Movement Guidelines for Children and Youth.

METHODS

A nationally representative sample of 22 115 young people was examined. Movement behaviour data were self-reported. Adherence to the guideline recommendations were based on the following: accumulation of at least 60 minutes per day of moderate-to-vigorous physical activity, no more than 2 hours per day of recreational screen time, and 9 to 11 hours/night of uninterrupted sleep for those aged 10 to 13 years or 8 to 10 hours/night for those aged 14 to 17 years.

RESULTS

Only 3% of the sample met all three of the key recommendations contained in the guidelines. Twenty-five percent met two of the recommendations, 51% met one of the recommendations, and 21% met none of the three recommendations. More children and youth met recommendations for sleep duration (66%) than for moderate-to-vigorous physical activity (35%) and screen time (8%).

CONCLUSION

A small minority (< 3%) of Canadians aged 10 to 17 years met all three of the key recommendations contained in the 24-Hour Movement Guidelines for Children and Youth.

Impact of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention on preschoolers' physical activity levels and sedentary time: a single-blind cluster randomized controlled trial

BACKGROUND

Physical activity levels among preschoolers in childcare are low and sedentary time high. The Supporting Physical Activity in the Childcare Environment (SPACE) intervention had three components: 1. portable play equipment; 2. staff training; and, 3. modified outdoor playtime (i.e., shorter, more frequent periods). This study aimed to examine the effectiveness of the SPACE intervention on preschoolers' physical activity levels and sedentary time during childcare hours (compared to standard care).

METHODS

Via a single-blind cluster randomized controlled trial, 338 preschoolers (39.86 ± 7.33 months; 52% boys) from 22 centre-based childcare facilities (11 experimental, 11 control) were enrolled. Preschoolers wore an Actical™ accelerometer for 5 days during childcare hours at baseline, post-intervention, and 6- and 12-month follow-up, and were included in the analyses if they had a minimum of two valid days (5 h each day) at baseline and one additional time point. Intervention effectiveness was tested using a linear mixed effects model for each of the four outcome variables (i.e., sedentary time, light physical activity [LPA], moderate-to-vigorous physical activity [MVPA], and total physical activity [TPA]). Fixed effects were further evaluated with t-tests, for which degrees of freedom were estimated using a Satterthwaite approximation.

RESULTS

One hundred and ninety-five preschoolers were retained for analyses. The intervention did not significantly impact LPA. MVPA was significantly greater among children in the experimental group when comparing post-intervention to pre-intervention, t(318) = 3.50, p = .0005, but no intervention effects were evident at 6- or 12-month follow-up. TPA was significantly greater for children in the intervention group at post-intervention when compared to pre-intervention, t(321) = 2.70, p = .007, with no intervention effects evident at later time periods. Finally, sedentary time was significantly lower among preschoolers in the experimental group when comparing post-intervention to pre-intervention, t(322) = 2.63, p = .009, with no significant effects at follow-up.

CONCLUSIONS

The SPACE intervention was effective at increasing MVPA and TPA among preschoolers, while simultaneously decreasing sedentary time. The ability of the SPACE intervention to target higher intensity activity is promising, as MVPA levels have been documented to be low in centre-based childcare. The changes in physical activity were not sustained long term (6- or 12-month follow-up).

TRIAL REGISTRATION

ISRCTN70604107 (October 8, 2014).