Active healthy living: prevention of childhood obesity through increased physical activity

Effects of Structured Physical Activity Program on Chinese Young Children's Executive Functions and Perceived Physical Competence in a Day Care Center

Purpose

To examine the effects of a structured physical activity program on executive functions and perceived physical competence as compared to a traditional recess among preschool children.

Methods

Participants were 40 preschool children aged 4-5 from an urban child care center in a southern Chinese metropolitan area. Prior to the intervention, baseline assessments of children's executive functions and perceived physical competence were conducted. Children were then assigned to (1) intervention condition: a structured physical activity intervention group; (2) control condition: free-activity recess. The structured physical activity or recess programs were provided to the intervention and control groups 30 minutes daily for 3 months, respectively, followed by the identical postintervention measures.

Results

Thirty-nine children (19 girls; mean age = 4.67 years old, BMI = 15.54 ± 1.21) were included in the analysis. In general, children's executive functions and perceived physical competence increased over time. Repeated measures analysis of variance revealed the intervention group had significant greater increases in executive functions compared to the control children (F(1, 37) = 4.20, p = 0.04, η² = .10), yet there were no greater increases in perceived physical competence (F(1, 37) = 2.35, p = 0.13, η² = .06).

Conclusion

The intervention exerted significant greater increases in executive functions in preschool children. It is meaningful to offer structured physical activity programs in day care centers.

A review of early influences on physical activity and sedentary behaviors of preschool-age children in high-income countries

PURPOSE

Promoting physical activity (PA) is a key component of preventing and controlling childhood obesity. Despite well-documented benefits of PA, globally, rates of PA among young children have declined over the past decades, and most children are not accruing sufficient PA daily. Helping children develop the foundation for PA habits early in life is critical for the promotion of health in childhood and prevention of chronic diseases later in life, and will ultimately promote longer and healthier lives for individuals and the general population. The purpose of this review is to provide a synthesis of current evidence on influences on PA and sedentary behaviors of preschool-age children in high-income countries.

DESIGN AND METHODS

A systematic review of three databases was performed. Studies conducted in high-income countries and published from 2000 onward that addressed influences on PA and sedentary behaviors of preschool-age children were identified and reviewed. Additionally, reference lists of identified articles and relevant published reviews were reviewed. Studies that met the following inclusion criteria were considered: (a) sample included preschoolers (age ≤5 years); (b) PA and/or sedentary behaviors or factors associated with PA and/or sedentary behaviors was assessed; (c) published in English; (d) used either quantitative or qualitative methods; and (e) conducted in a high-income country. Data were extracted from selected studies to identify influences on PA and sedentary behaviors of preschool-age children and organized using the social-ecological model according to multiple levels of influence.

RESULTS

Results from included studies identify multiple factors that influence PA and sedentary behaviors of young children in high-income countries at the various levels of the social-ecological model including intrapersonal, interpersonal, environmental, organizational, and policy.

PRACTICE IMPLICATIONS

Given pediatric nurses' role as primary care providers, and their frequent and continued contact with parents and their children throughout childhood through well-child visits, immunization, and minor acute illnesses, they are well positioned to promote and support the development of early healthful PA habits of children starting in early childhood.

Prescribing Outdoor Play: Outdoors Rx

Studies support the use of exercise prescriptions in adults, but few studies have evaluated their use in children. One common barrier to effective physical activity counseling is lack of resources. Outdoors Rx is a collaboration between the Appalachian Mountain Club and the Massachusetts General Hospital for Children that pairs exercise prescriptions with guided outdoor programs to increase physical activity among children. This article describes the design and implementation of Outdoors Rx at 2 community health centers serving ethnically diverse, low-income, urban families, as well as evaluates feedback from participating pediatricians regarding the utility of the program, barriers to success, and suggestions for improvement. Our results illustrate the feasibility of implementing a pediatric physical activity prescription program in community health centers serving traditionally underserved populations. Our data suggest that physical activity prescription programs are well received by both pediatricians and families and are a useful tool for facilitating physical activity counseling.

Children's Physical Activity and Depression: A Meta-analysis

CONTEXT

Research regarding the protective effects of early physical activity on depression has yielded conflicting results.

OBJECTIVE

Our objective was to synthesize observational studies examining the association of physical activity in childhood and adolescence with depression.

DATA SOURCES

Studies (from 2005 to 2015) were identified by using a comprehensive search strategy.

STUDY SELECTION

The included studies measured physical activity in childhood or adolescence and examined its association with depression.

DATA EXTRACTION

Data were extracted by 2 independent coders. Estimates were examined by using random-effects meta-analysis.

RESULTS

Fifty independent samples (89 894 participants) were included, and the mean effect size was significant (r = -0.14; 95% confidence interval [CI] = -0.19 to -0.10). Moderator analyses revealed stronger effect sizes in studies with cross-sectional versus longitudinal designs (k = 36, r = -0.17; 95% CI = -0.23 to -0.10 vs k = 14, r = -0.07; 95% CI = -0.10 to -0.04); using depression self-report versus interview (k = 46, r = -0.15; 95% CI = -0.20 to -0.10 vs k = 4, r = -0.05; 95% CI = -0.09 to -0.01); using validated versus nonvalidated physical activity measures (k = 29, r = -0.18; 95% CI = -0.26 to -0.09 vs k = 21, r = -0.08; 95% CI = -0.11 to -0.05); and using measures of frequency and intensity of physical activity versus intensity alone (k = 27, r = -0.17; 95% CI = -0.25 to -0.09 vs k = 7, r = -0.05; 95% CI = -0.09 to -0.01).

LIMITATIONS

Limitations included a lack of standardized measures of physical activity; use of self-report of depression in majority of studies; and a small number of longitudinal studies.

CONCLUSIONS

Physical activity is associated with decreased concurrent depressive symptoms; the association with future depressive symptoms is weak.

Shared use agreements between municipalities and public schools in the United States, 2014

Shared use agreements allow public use of school facilities during non-school hours. Such agreements can cover outdoor facilities alone or may be more comprehensive by also including indoor facilities. Our aim was to: 1) estimate the prevalence of shared use agreements and facility types covered among U.S. municipalities and 2) identify differences in prevalence by municipality characteristics. The 2014 National Survey of Community-based Policy and Environmental Supports for Healthy Eating and Active Living is a representative survey of US municipalities (n=2029). Data were analyzed using survey weights to create national estimates. Logistic and multinomial regression models determined odds ratios adjusting for municipality characteristics. Among 1930 municipalities with a school, 41.6% had a shared use agreement as reported by a local official, 45.6% did not, and 12.8% did not know. Significant differences in prevalence existed by population size, rural/urban status, poverty prevalence, median education level, and census region; however, after adjustment for other municipality characteristics significant differences remained only by population size, median education level, and census region. Among municipalities with a shared use agreement, 59.6% covered both outdoor and indoor facilities, 5.5% covered indoor facilities only, and 34.9% covered outdoor facilities only. Opportunities exist to expand the use of shared use agreements particularly in municipalities with small populations, lower education levels, and in the South, and to promote more comprehensive shared use agreements that include both indoor and outdoor facilities.

Trend of Endurance Level Among Healthy Inner-City Children and Adolescents Over Three Decades

The aim of this study was to understand how endurance time, a proxy for physical fitness, has changed in healthy inner-city children and adolescents in the past three decades. This was a retrospective cross-sectional study. This study used exercise stress test in a laboratory of an inner-city teaching hospital. We reviewed all consecutive healthy children and adolescents who underwent an exercise Bruce protocol treadmill test from 1983 to 2010. The study population was divided into five groups of 5-year intervals based on the year of testing. Temporal trend in endurance time was analyzed, adjusting for gender, ethnicity, age, and body mass index (BMI). We analyzed the records of 435 healthy children and adolescents (mean age 12.6 ± 3.2 years, 57% males).There was a significant difference in the mean endurance time between children grouped in 5-year intervals (P < 0.001) with a significant downward trend in endurance time over the years (P < 0.001), especially after 2001. In contrast, there was no statistically significant change in the mean BMI between children grouped in 5-year intervals (P = 0.205). Multivariate linear regression model demonstrated that the date of testing was independently predictive of endurance time, adjusting for age, gender, BMI, and ethnicity (P < 0.001). Gender was the strongest independent predictor of endurance time, followed by age, BMI, and ethnicity. There is a downward trend in endurance time over the 27-year period among inner-city children and adolescents. Temporal decline in endurance time was independent of factors known to affect this parameter, such as age, gender, BMI, and ethnicity. Factors such as deconditioning due to sedentary lifestyle and lack of motivation to endure on the treadmill among later generations may have played a role in such decline.

Using group model building to understand factors that influence childhood obesity in an urban environment

BACKGROUND

Despite increased attention, conventional views of obesity are based upon individual behaviors, and children and parents living with obesity are assumed to be the primary problem solvers. Instead of focusing exclusively on individual reduction behaviors for childhood obesity, greater focus should be placed on better understanding existing community systems and their effects on obesity. The Milwaukee Childhood Obesity Prevention Project is a community-based coalition established to develop policy and environmental change strategies to impact childhood obesity in Milwaukee, Wisconsin. The coalition conducted a Group Model Building exercise to better understand root causes of childhood obesity in its community.

METHODS

Group Model Building is a process by which a group systematically engages in model construction to better understand the systems that are in place. It helps participants make their mental models explicit through a careful and consistent process to test assumptions. This process has 3 main components: (1) assembling a team of participants; (2) conducting a behavior-over-time graphs exercise; and (3) drawing the causal loop diagram exercise.

RESULTS

The behavior-over-time graph portion produced 61 graphs in 10 categories. The causal loop diagram yielded 5 major themes and 7 subthemes.

CONCLUSIONS

Factors that influence childhood obesity are varied, and it is important to recognize that no single solution exists. The perspectives from this exercise provided a means to create a process for dialogue and commitment by stakeholders and partnerships to build capacity for change within the community.

Park use is associated with less sedentary time among low-income parents and their preschool child: The NET-Works study

Introduction

Parks are an important component of the neighborhood environment, and their presence is believed to support higher levels of physical activity among residents.

The present study examined park use frequency among a sample of 534 low-income parents of preschool aged children. Associations with child and parent physical activity, neighborhood characteristics and physical characteristics of the block immediately surrounding the home were examined.

Methods

Data are from baseline measurements completed in 2012–2014 as part of larger study (NET-Works: Now Everybody Together for Amazing and Healthy Kids) targeting low-income preschool children and their parents (N = 534 parent-child dyads). Physical activity was measured in parent and child using accelerometry. Parents reported their frequency of use with their child of parks within a half kilometer from their residence. Block audits were performed by trained research staff to describe the quality and walkability of the streets around the home.

Statistical analysis

Bivariate associations between demographic variables, perceptions of the neighborhood environment, parent support for child physical activity, and physical activity were examined using regression or Chi square analysis.

Results

Park use frequency was not significantly associated with child accelerometry light, moderate or vigorous physical activity. However, it was marginally significantly inversely associated with child accelerometry sedentary time (p < 0.06). Television viewing hours on weekend days (but not on weekdays) were significantly fewer among children in the high park use group compared with children who visited the park less frequently (p < 0.01). Park use frequency was significantly positively associated with parent accelerometry moderate physical activity (p < 0.004), and was significantly inversely associated with parent accelerometry sedentary time (p < 0.002). Frequent park use was significantly positively associated with parent report of the child frequency of being taken to a park or playground outside the home (p < 0.0001), past week visit to park and recreation center (p < 0.0001) and parent-reported supportive behaviors for child physical activity (p < 0.0001). Parents who reported having to cross busy streets to reach play areas reported less frequent park use (p < 0. 02). Walkable neighborhoods (p < 0.003) and more incivilities (p < 0.02) in the immediate block surrounding the home were significantly associated with more frequent park use.

Conclusions

Frequent park use with their preschool child may support higher levels of physical activity among low-income parents and reduce sedentary time for both child and parent.

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Moderate physical activity is higher among low income parents who visit parks with their preschool-aged child.

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Sedentary behavior is lower among parents and preschool-aged children who together visit parks frequently.

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Low-income preschool-aged children whose parents take them to parks watch less television.

Direct observations of active school transportation and stroller use in kindergarten children

Little is known about kindergarten students' active school transportation (AST) and stroller/wagon use as sedentary travel devices. The primary objective of this cross-sectional study was to determine the prevalence of kindergarten children arriving to school by active and sedentary modes, including strollers, in Toronto elementary schools and compare to students in kindergarten to grade 6 (K–6). The secondary objective was to examine factors associated with AST in kindergarten and K–6 students. School travel mode was counted using direct observations at elementary schools in the City of Toronto in 2015. Two samples were observed: 1) Kindergarten sample: a random sample of schools with separate kindergarten entrances (n = 26 schools, 1069 children); 2) Kindergarten to grade 6 sample: observations were conducted at arrival locations at 50% of eligible elementary schools for students of all ages (n = 88 schools, 17,224 children). Proportions arriving by different travel modes were compared using Chi-square analysis. Negative binomial regression was conducted to examine the association between school characteristics and AST. AST was lower in the kindergarten compared to the K–6 sample (60% versus 74%, χ² = 91.37, p < 0.001). The predominant sedentary mode for kindergarten students was by vehicle (38%), with < 2% using strollers/wagons. Recent immigrant status was related to higher AST in kindergarten students; higher social disadvantage, crossing guards, school population and collision rates were related to higher AST in the K–6 sample. Factors influencing AST in young students require further investigation to influence the development of healthy active lifestyles at an early age.

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Observational counts of school transportation mode and stroller use was conducted.

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Active school transportation (AST) was less in kindergarten versus all age students.

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< 2% of kindergarten students use strollers for transportation to school.

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School proportion of recent immigrants was related to AST in kindergarten students.

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Higher social disadvantage was most strongly related to AST in all age students.

Physical activity, black carbon exposure and airway inflammation in an urban adolescent cohort

OBJECTIVE

Regular physical activity can improve cardiopulmonary health; however, increased respiratory rates and tidal volumes during activity may increase the effective internal dose of air pollution exposure. Our objective was to investigate the impact of black carbon (BC) measured by personal sampler on the relationship between physical activity and fractional exhaled nitric oxide (FeNO), a marker of airway inflammation. We hypothesized that higher personal BC would attenuate the protective effect of physical activity on airway inflammation.

METHODS

We performed a cross-sectional study nested in a birth cohort of African American and Dominican children living in the Bronx and Northern Manhattan, New York City. Children were recruited based on age (target 9-14 year olds) and presence (n=70) or absence (n=59) of current asthma. Children wore wrist mounted accelerometers for 6 days and were classified as 'active' if they had ≥60min of moderate-to-vigorous activity (MVA) each day and 'non-active' if they had <60min of MVA on any given day, based on CDC guidelines. Personal BC measured using a MicroAeth, was assessed during two 24-h periods, at the beginning and end of physical activity assessment. High BC was defined as the upper tertile of BC measured with personal sampler. FeNO measurements were sampled at the beginning and end of the of physical activity assessment.

RESULTS

In multivariable linear regression models, 'active' children had 25% higher personal BC concentrations (p=0.02) and 20% lower FeNO (p=0.04) compared to 'non-active' children. Among children with high personal BC (n=33), there was no relationship between activity and FeNO (p=1.00). The significant protective relationship between activity and airway inflammation was largely driven by children with lower personal BC (n=96, p=0.04).

CONCLUSIONS

Children that live in an urban environment and are physically active on a daily basis have higher personal exposure to BC. High BC offsets the protective relationship between physical activity and airway inflammation.

A Structured Peer-Mentoring Method for Physical Activity Behavior Change Among Adolescents

Despite national guidelines for regular physical activity, most adolescents are not physically active. Schools serve an estimated 60 million youth and provide an educational environment to meet the current physical activity guidelines. The obesity epidemic and chronic disease comorbidities associated with physical inactivity are not likely to be reversed without a strong contribution from local schools. This article describes how a structured peer-mentoring method provides a feasible, flexible, and tailored means to meet the current guidelines for best practice in a school setting. Structured peer mentoring using trained high school mentors to support behavior change in younger peers is an innovative method to meeting the School Health Guidelines to Promote Healthy Eating and Physical Activity Through structured peer mentoring, adolescents are provided consistent social support in a caring and personalized manner. This support builds skills and competencies enhancing self-efficacy to sustain a lifetime of physical activity behavior.

An Intervention to Increase Physical Activity in Children: A Randomized Controlled Trial With 4-Year-Olds in Preschools

INTRODUCTION

A majority of preschool-aged children spend a significant portion of every weekday in a preschool or child care setting, where they typically participate in limited physical activity. This study determined if an ecologic physical activity intervention in preschools increases children's moderate- to vigorous-intensity physical activity (MVPA).

DESIGN

RCT, with preschool as the unit of randomization and analysis. Child physical activity was measured by accelerometry. Mixed model analysis of covariance with preschool as a random variable was used to test the effects of the intervention on physical activity in the total group and in sex-specific subgroups. Data were collected in 2008-2010 and analyzed in 2012-2014.

SETTING/PARTICIPANTS

Children in 4-year-olds' classrooms in 16 preschools, pair matched and assigned to intervention or control groups.

INTERVENTION

The intervention focused on increasing children's physical activity by changing instructional practices. Researchers trained preschool teachers to engage children in physical activity during (1) structured, teacher-led physical activity opportunities in the classroom; (2) structured and unstructured physical activity opportunities at recess; and (3) physical activity integrated into pre-academic lessons. Research staff encouraged teachers to adapt the intervention to their classrooms.

MAIN OUTCOME MEASURES

Minutes/hour of MVPA during the preschool day.

RESULTS

In an analytic sample of 379 children (188 intervention, 191 control), those in the intervention schools engaged in significantly more MVPA than children in control schools (7.4 and 6.6 minutes/hour, respectively). This difference remained significant after adjusting for parent education and length of the school day (half versus full day). In the sex-specific analyses, the difference was significant for girls (6.8 vs 6.1 minutes/hour of MVPA, respectively) but not for boys (7.9 vs 7.2 minutes/hour, respectively).

CONCLUSIONS

A flexible ecologic physical activity intervention that trains teachers to provide children with opportunities to be active throughout the school day increased MVPA in preschool children.

Body Composition, Fitness Status, and Health Behaviors Upon Entering College: An Examination of Female College Students From Diverse Populations

Although poor health-related behaviors that impact development of chronic diseases begin much earlier than when actual disease is evident, few studies have examined health behaviors in college students, who may be at an important transitional period where early intervention could prevent development of chronic diseases. The purpose of this study was to examine health-related factors in female college students (N = 61) by race/ethnicity and weight status. We found significant differences in health profiles between non-Hispanic White (White) and African American students, including greater physical fitness and healthier diets among White students. Overweight/obese students had worse health profiles than healthy BMI students. Furthermore, weight status was significantly associated with cardiovascular fitness. This supports a focus on PA promotion for interventions in the period of emerging adulthood, alongside the other healthy behaviors, to elicit improvements in weight status and potential reduction of chronic disease risks.

Reliability and Validity of the Physical Education Activities Scale

BACKGROUND

Measuring adolescent perceptions of physical education (PE) activities is necessary in understanding determinants of school PE activity participation. This study assessed reliability and validity of the Physical Education Activities Scale (PEAS), a 41-item visual analog scale measuring high school adolescent perceptions of school PE activity participation.

METHODS

Adolescents (N = 529) from the Pacific Northwest aged 15-19 in grades 9-12 participated in the study. Construct validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Measurement invariance across sex groups was tested by multiple-group CFA. Internal consistency reliability was analyzed using Cronbach's alpha. Inter-subscale correlations (Pearson's r) were calculated for latent factors and observed subscale scores.

RESULTS

Exploratory factor analysis suggested a 3-factor solution explaining 43.4% of the total variance. Confirmatory factor analysis showed the 3-factor model fit the data adequately (comparative fit index [CFI] = 0.90, Tucker-Lewis index [TLI] = 0.89, root mean squared error of approximation [RMSEA] = 0.063). Factorial invariance was supported. Cronbach's alpha of the total PEAS was α = 0.92, and for subscales α ranged from 0.65 to 0.92. Independent t-tests showed significantly higher mean scores for boys than girls on the total scale and all subscales.

CONCLUSION

Findings provide psychometric support for using the PEAS for examining adolescent's psychosocial and environmental perceptions to participating in PE activities.

Parents' perceptions of preschool activities: exploring outdoor play

RESEARCH FINDINGS

Outdoor play is important for children's health and development, yet many preschool-aged children in childcare settings do not receive the recommended 60 minutes/day of outdoor play. Childcare providers have previously described parent-related barriers to increasing outdoor playtime, including parents not providing appropriate clothing for their children and parents' preference for academics over active play. This study explored parent perceptions and knowledge of outdoor playtime in childcare environments. On average, parents reported wanting their child to spend significantly more time playing outside during a full day of childcare than the recommended minimum. However, over one-half of parents reported that they did not know how much time their child actually spent playing outside and 43% reported that they did not know their childcare center's outdoor play policies.

PRACTICE OR POLICY

Childcare providers may over-perceive parent-related barriers to outdoor play. Parents generally support outdoor play for their preschooler during center-based childcare but are not well informed about outdoor playtime and policies. Encouraging communication between parents and early childhood educators about these topics could lead to more universal support and strategies for promoting outdoor and active play opportunities for children which are important for their health and development.

Sport-based physical activity intervention on body weight in children and adolescents: a meta-analysis

Controversial results reported in past research pertaining to the effectiveness of sport-based physical activity interventions on weight loss. The purpose of this study was to assess the impact of sport-based physical activity intervention on body weight in children and adolescents using a meta-analysis. Academic Search Complete, Education Source, ERIC, Medline, ProQuest, PsycINFO and SportDiscus databases were searched from January 2000 to April 2015. Eighteen studies met following inclusion criteria: sport-based intervention studies; subjects aged 6-18 years; reported body weight; published in peer-reviewed journals written in English. The mean intervention duration was 17.72 weeks. The overall effect size (ES) was 0.52 (Cohen's d (ES) = 0.52, 95% CI = 0.08, 0.95, P = 0.021), using a random effects model. Moderator analyses results showed that the Q statistic for the sport type (individual sport or team sport, Qbetween (Q_b) = 14.52, df = 1, P = 0.001) and diet control (Qbetween (Q_b) = 8.85, df = 1, P = 0.001), explained the heterogeneity of ESs. Our study showed that there was a moderate overall effect of sport-based physical activity intervention on body weight reduction. The team sport type (ES = 1.05, 95% CI = 0.44, 1.66) and diet control group (ES = 0.84, 95% CI = 0.26, 1.41) appeared to be more effective in reducing body weight.

The Use of Narrative as a Treatment Approach for Obesity: A Storied Educational Program Description

INTRODUCTION

Childhood obesity is a health care crisis according to the leading pediatric advocacy groups (National Medical Association, American Academy of Pediatrics, and American Diabetes Association) and the White House. The problem has reached epidemic proportions for all children, but it has an even greater impact on racial minorities. The subject of childhood obesity can lead to a host of medical, psychological, and social problems, including low self-esteem and discrimination.We wrote an interventional children's book and workbook (The Tale of Two Athletes: The Story of Jumper and The Thumper) and developed a three-step intervention based on the narrative. The intervention's purpose is to increase public awareness, reduce stigma, and to help members of underserved communities become more comfortable discussing obesity.

METHODS

In classrooms and other community settings, a storied education program is presented to students of various ages. Interactive storytelling is the first step: live narration with direct listening and active participation. Didactic information on obesity is shared, including a sociocultural explanation for why the issue is more problematic among racial minorities. The audience is then introduced to the story of Jumper and The Thumper, two larger-than-life characters who experience different outcomes as a result of their choices about diet and exercise. True examples are described during the narration about these two young men, accompanied by cartoons and photographs for visual emphasis.The next step is reading: audience members are provided with a book to reinforce what was learned. Readers are allowed to more closely examine the importance of making healthy choices.Practicing positive behaviors and decision making through games and exercises from the companion workbook is the final step. These activities help children and their families live a healthier lifestyle. The goal is that these three steps, linked to a common narrative, will have a meaningful impact on obesity by creating behavioral change.

RESULTS

Children, parents, and health care professionals have stated their enthusiastic response to the information and message and that they have made positive changes in children's eating and exercise habits. The program has been presented in community forums, churches, medical meetings, and elementary schools in at-risk communities.

CONCLUSION

New strategies must be developed to lead, uplift, and empower through health and wellness education and through community collaboration if we are to change the direction of course toward this devastating condition that affects our most valuable commodity-our children. This community-based educational approach is a means to help recognize and treat obesity in underserved communities.

The impact of long-term school-based physical activity interventions on body mass index of primary school children - a meta-analysis of randomized controlled trials

Background

Physical activity (PA) intervention is a commonly recommended strategy to combat childhood obesity. However, its effectiveness has long been controversial. This paper aims to examine the effectiveness of long-term (≥12 months) school-based PA interventions on body mass index (BMI) in primary school children, who are gaining BMI.

Methods

Original papers were retrieved from PubMed, Google Scholar, the Cochrane Library and Web of Science, published between 1990 and 2015. The inclusion criteria were those research studies that were: randomized controlled trials (RCTs), conducted in primary school settings, had valid data on BMI at baseline and at the final follow up (or on BMI changes), and involved PA intervention that lasted for at least 12 months.

Results

Out of 11,158 potentially eligible articles, 18 papers were included in the analysis, involving 22,381 primary school children with intervention durations ranging from 12 to 72 months. Compared to the control groups, the BMI increment was 2.23 kg/m² less in the intervention groups (p < 0.05). The heterogeneity was high across the studies (99.8 %), but declined after sub-group analyses. The intervention type, intervention duration, and weekly PA intervention time were among the factors leading to the heterogeneity.

Conclusion

Long-term school-based interventions containing PA as a core component appear to be effective in achieving healthier BMI. However, the results should be interpreted with caution due to the high heterogeneity among the studies. More high quality school-based RCTs among diverse populations are needed to improve the homogeneity and to yield a more robust conclusion.

Anticipatory Guidance for Long-Distance Running in Young Athletes

More young children are participating in endurance running events such as full and half marathons, and the safety of these events for children has been heavily debated. There is a paucity of evidence on either side of the debate. However, overuse injuries, stress fractures, as well as the potential for psychologic burnout are legitimate concerns. Parents who are seeking advice from pediatricians about child participation in these endurance events should be made aware of these risks. Young children may participate in endurance running events under close supervision from health professionals, coaches, and parents, with full medical evaluation before initiation of training, throughout training, as well as 6 to 12 months post-race. Special attention should be made to the psychologic well-being of the child, with the participation in running being child-driven, not parent- or coach-driven, and emphasis on enjoyment and fitness, not competition.

Physical activity levels during youth sport practice: does coach training or experience have an influence?

This study examined moderate-to-vigorous physical activity (MVPA) levels in youth during flag football practice and compared youth MVPA in practices led by trained or untrained, and by experienced or inexperienced, coaches. Boys (n = 111, mean age = 7.9 ± 1.2 years) from 14 recreation-level flag football teams wore an accelerometer during two practices. Each team's volunteer head coach reported prior training and coaching experience. Mixed-model team-adjusted means showed the proportion of practice time spent in sedentary (13 ± 1%), MVPA (34 ± 2%) and vigorous (12 ± 1%) activity. Practice contributed ~20 min of MVPA towards public health guidelines. There was no significant difference in percentage time spent in MVPA between teams with trained (mean = 33.3%, 95% CI = 29.4%, 37.2%) and untrained coaches (mean = 35.9%, 95% CI = 25.5%, 42.4%) or between experienced (mean = 34.1%, 95% CI = 30.2%, 38.0%) and inexperienced coaches (mean = 33.8, 95% CI = 27.9%, 39.7%). Although sport provides a setting for youth to accrue MVPA, two-thirds of practice was spent sedentarily or in light activity. Participation in a coach training programme was not associated with higher MVPA. Further research is needed to inform volunteer coach training programmes that provide coaches with skills necessary to increase the percentage of practice time spent in MVPA.

Classroom Standing Desks and Sedentary Behavior: A Systematic Review

CONTEXT

Reducing sedentary behaviors, or time spent sitting, is an important target for health promotion in children. Standing desks in schools may be a feasible, modifiable, and acceptable environmental strategy to this end.

OBJECTIVE

To examine the impact of school-based standing desk interventions on sedentary behavior and physical activity, health-related outcomes, and academic and behavioral outcomes in school-aged children.

DATA SOURCES

Ovid Embase, Medline, PsycINFO, Web of Science, Global Health, and CINAHL.

STUDY SELECTION

Full-text peer-reviewed journal publications written in English; samples of school-aged youth (5-18 years of age); study designs including the same participants at baseline and follow-up; and use of a standing desk as a component of the intervention.

DATA EXTRACTION

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Eight studies satisfied selection criteria and used quasi-experimental (n = 4), randomized controlled trial (n = 3), and pre-post, no control (n = 1) designs. When examined, time spent standing increased in all studies (effect sizes: 0.38-0.71), while sitting time decreased from a range of 59 to 64 minutes (effect sizes: 0.27-0.49). Some studies reported increased physical activity and energy expenditure and improved classroom behavior.

LIMITATIONS

One-half of the studies had nonrandomized designs, and most were pilot or feasibility studies.

CONCLUSIONS

This initial evidence supports integrating standing desks into the classroom environment; this strategy has the potential to reduce sitting time and increase standing time among elementary schoolchildren. Additional research is needed to determine the impact of standing desks on academic performance and precursors of chronic disease risk.

Physical activity and nutrition education at the school environment aimed at preventing childhood obesity: evidence from systematic reviews

OBJECTIVE

To organize the main findings and list the most frequent recommendations from systematic reviews of interventions developed at the school environment aimed at reducing overweight in children and adolescents.

DATA SOURCE

Searches for systematic reviews available until December 31, 2014 were conducted in five electronic databases: Cochrane, PubMed, SciELO, SPORTDiscus, and Web of Science. Manual search for cross-references were also performed.

SUMMARY OF THE FINDINGS

Of the initial 2139 references, 33 systematic reviews adequately met the inclusion criteria and were included in the descriptive summary. In this set, interventions with periods of time greater than six months in duration (nine reviews), and parental involvement in the content and/or planned actions (six reviews) were identified as the most frequent and effective recommendations. Additionally, it was observed that boys respond more effectively to structural interventions, whereas girls respond to behavioral interventions. None of the included reviews was able to make inferences about the theoretical basis used in interventions as, apparently, those in charge of the interventions disregarded this component in their preparation.

CONCLUSIONS

Although the summary identified evidence with important applications in terms of public health, there are still gaps to be filled in this field of knowledge, such as the effectiveness of different theoretical models, the identification of the best strategies in relation to gender and age of participants and, finally, the identification of moderating variables to maximize the benefits provided by the interventions.

Beyond Physical Activity: The Importance of Play and Nature-Based Play Spaces for Children's Health and Development

The reduction of child obesity continues to be a challenge worldwide. Research indicates that playing outdoors, particularly in natural play spaces, boosts children's physical activity, potentially decreasing childhood obesity. We present evidence that natural play spaces also provide for more diverse forms of play for children of varying ages and competencies. This is crucial because play spaces designed expressly for physical activity may not increase physical activity among less active children. Moreover, when researchers only examine physical activity in play, they overlook the valuable contributions that play makes to other aspects of children's health and development. To enhance research on children and their play environments, we introduce the theory of play affordances. To assist in the creation of more natural play spaces, we describe the Seven Cs, an evidence-based approach for designing children's play spaces that promotes diverse play. We end with some preliminary insights from our current research using the Seven Cs to illustrate the connections between play, nature, and children's healthy development.

Long-term athletic development, part 2: barriers to success and potential solutions

The first installment of this two-part commentary reviewed existing models of long-term athletic development. However, irrespective of the model that is adopted by practitioners, existing structures within competitive youth sports in addition to the prevalence of physical inactivity in a growing number of modern-day youth may serve as potential barriers to the success of any developmental pathway. The second part of this commentary will initially highlight common issues that are likely to impede the success of long-term athletic development programs and then propose solutions that will address the negative impact of such issues.

Adolescent Physical Education Class Participation as a Predictor for Adult Physical Activity

BACKGROUND

The aim of this study was to determine whether engagement in more physical education (PE) classes during one high school year is associated with change in physical activity (PA) from adolescence to young adulthood.

METHODS

Data were from 1774 participants in Waves 2 (high school, 1996) and 4 (young adulthood, 2008) of the National Longitudinal Study of Adolescent to Adult Health. The predictor was number of PE classes/week in high school (daily, some, or none). The outcome was change in moderate-to-vigorous physical activity (ΔMVPA) over the 12-year period. ΔMVPA was based on differences in MVPA scores derived at each wave from responses to a physical activity behavior recall (range, -9 to 9 scale score or -15 to 15 MVPA episodes/week). Multivariable generalized linear models examined the association between PE participation and ΔMVPA, adjusting for sociodemographics, weight status, and school clustering.

RESULTS

In high school, 34.7% participated in daily PE, whereas 50.1% participated in none. Participation in more PE classes was associated with greater MVPA in high school (mean MVPAW2none = 3.11, standard deviation [SD] = 1.99; mean MVPAW2some = 3.70, SD = 2.00; mean MVPAW2daily = 4.31, SD = 1.95; p < 0.0001). Overall, MVPA decreased over the 12 years (median ΔMVPA = -1.0, or 1-2 MVPA episodes/week). MVPA decreased more for males (median ΔMVPAmale = -1.0, interquartile range [IQR] = -3.0 ± 1.0; median ΔMVPAfemale = 0.0, IQR = -2.0 ± 2.0; p < 0.0001) and those who had participated in some/daily PE (median ΔMVPAsome = -1.0, IQR = -3.0 ± 1.0; median ΔMVPAdaily = -1.0, IQR = -3.0 ± 1.0) than those not in PE (median ΔMVPAnone = 0.0, IQR = -2.0 ± 2.0; p < 0.0001). The relationship between PE and ΔMVPA was maintained in multivariable analyses (βsome = -0.58, standard error [SE] = 0.18; p = 0.002; βdaily = -0.93, SE = 0.16; p < 0.001).

CONCLUSIONS

High school PE participation did not prevent declining PA from adolescence to young adulthood.

Parents' Perceptions and Adherence to Children's Diet and Activity Recommendations: the 2008 Feeding Infants and Toddlers Study

INTRODUCTION

Solving the childhood obesity problem will require strategies for changes in policy, the environment, the community, and the family. Filling the data gap for children younger than 4 years could facilitate interventions aimed at this critical age group. The objective of this study was to describe parents' and caregivers' perceptions of the healthfulness of their young child's diet and body weight and to assess their adherence to the American Academy of Pediatrics' 5-2-1-0 recommendations.

METHODS

We conducted a descriptive analysis of parents' and caregivers' survey data for 887 infants younger than 12 months, 925 toddlers aged 12 to 23.9 months, and 1,461 preschoolers aged 24 to 47.9 months. Data were from the national, cross-sectional 2008 Feeding Infants and Toddlers Study (FITS).

RESULTS

Most parents considered their child's weight to be about right but were more likely to think their child was underweight (8%-9%) than overweight (2%-3%). Most parents thought their child consumed enough fruits and vegetables: however, only 30% of preschoolers met the recommendation for 5 daily servings. Only 2% of toddlers met the recommendation for no screen time, whereas 79% of preschoolers met the recommendation to limit daily screen time to 2 hours or less. About 56% of toddlers and 71% of preschoolers met the recommendation of at least 1 hour of daily outdoor play. About 56% of toddlers and 52% of preschoolers met the recommendation to limit consumption of sugar-sweetened beverages.

CONCLUSION

The FITS 2008 findings underscore the ongoing need for research on policies and strategies to prevent childhood obesity from infancy through preschool. Health care providers can play a vital role because they are an important and early point of contact for parents.

The effects of school physical education grants on obesity, fitness, and academic achievement

OBJECTIVE

Foundations and governments fund a number of programs that provide grants to improve school physical education or other forms of school-based physical activity. The effects of these grant programs are unknown. We evaluate the effects of Texas Fitness Now, a program in which the state of Texas granted $37 million to improve physical education in high-poverty middle schools over the 4 school years from 2007-08 to 2010-11. The stated goals of Texas Fitness Now were to reduce obesity, increase fitness, and raise academic achievement.

METHOD

We summarize how Texas Fitness Now funds were spent and estimate the impact of Texas Fitness Now using a fixed-effects longitudinal model that exploits changes in schools' eligibility over time. Changes in eligibility occurred when eligibility expanded to new schools after year 2 and when the program was terminated after year 4.

RESULTS

Most Texas Fitness Now funds were spent on sports and fitness equipment. Smaller amounts were spent on anti-obesity curricula. Texas Fitness Now improved strength and flexibility, especially among girls, but it did not improve BMI or academic achievement, and it had mixed effects on aerobic capacity. The fitness benefits were not lost in the year after the program ended, perhaps because schools kept the equipment that they had bought during their years of eligibility.

CONCLUSION

The results of Texas Fitness Now were typical for an intervention that relied almost exclusively on physical activity. Programs that improve BMI as well as fitness tend to have a more fully developed nutrition component.

Parents' perception of stroller use in young children: a qualitative study

BACKGROUND

Despite their wide usage, it has recently been suggested that stroller use may reduce physical activity levels of young children. However, there have been no studies on stroller use as it relates to physical activity outcomes. The objectives of this study were to understand the context of stroller use for young children and parents' perceptions of the relationship between stroller use and their children's physical activity.

METHODS

Parents of children 1 to 5 years of age were recruited through two sites of TARGet Kids!, a primary-care, practice-based research network in Toronto, Canada. Fourteen semi-structured interviews were conducted. Interviews were audio recorded and transcribed verbatim and two independent reviewers conducted thematic analysis. A number of strategies were employed to ensure the trustworthiness of the data.

RESULTS

Parents discussed reasons for stroller use (i.e., transportation; storage; leisure; supervision/confinement; parent physical activity; and sleep), factors that influence the decision to use a stroller (i.e., caregiver choice; convenience, timing, distance; family lifestyle; and child preference), and perceived impact of stroller use on physical activity (i.e., most parents did not recognize a connection between stroller use and physical activity).

CONCLUSION

This study provides a context for researchers and policy makers to consider when developing stroller related physical activity guidelines for young children.

Community-identified strategies to increase physical activity during elementary school recess on an American Indian reservation: A pilot study

The aim of this study was to determine the effect of an 8-week recess intervention on physical activity levels in children attending elementary school on an American Indian reservation during fall 2013. Physical activity was measured with direct observation in three zones on the playground. Lines were painted on existing pavement in zone 1. Zone 2 had permanent playground equipment and was unchanged. Zone 3 contained fields where bi-weekly facilitators led activities and provided equipment. Pre- to post-changes during recess in sedentary, moderate physical activity, moderate-to-vigorous, and vigorous physical activities were compared within zones. Females physical activity increased in Zone 1 (moderate: 100% increase; moderate-to-vigorous: 83%; vigorous: 74%, p < 0.01 for all) and Zone 3 (moderate: 54% increase, p < 0.01; moderate-to-vigorous: 48%, p < 0.01; vigorous: 40%, p < 0.05). Male sedentary activity decreased in Zone 2 (161%, p < 0.01). Physical activity changes in Zone 3 were not dependent upon the presence of a facilitator. Simple and low-cost strategies were effective at increasing recess physical activity in females. The findings also suggest that providing children games that are led by a facilitator is not necessary to increase physical activity as long as proper equipment is provided.

Prevalence of Compliance with a New Physical Activity Guideline for Preschool-Age Children

BACKGROUND

Four expert panels from Australia, Canada, the United Kingdom, and the United States issued physical activity (PA) recommendations for young children that are quite similar. The aim of this study was to determine compliance with the new PA guideline (defined as ≥15 min/hr of total PA) in two independent samples of preschool children.

METHODS

We conducted a cross-sectional study of children attending preschools in Columbia, South Carolina. A total of 286 children in one sample and 337 children in a second sample participated. The main outcome of interest was total PA (sum of light, moderate, and vigorous intensity activity) measured by accelerometry. Compliance with the PA guideline was determined for both samples. Separately for each sample, mixed logistic models were used to determine whether there were differences in compliance with the PA guideline between groups based on sex, race/ethnicity, parent education, and weight status, controlling for preschool.

RESULTS

Total PA was 14.5 and 15.2 min/hr in the first and second samples, respectively. The prevalence of meeting the PA guideline was 41.6% and 50.2% in the first and second samples, respectively. In both samples, more males than females met the guideline (53.5% vs. 33.5% and 57.6% vs. 45.9%) in the first and second samples, respectively (p<0.05).

CONCLUSIONS

Approximately one half of children in two independent samples met the guideline for PA in young children. Policies and practices designed to increase PA among preschool children are needed, given that most children are not meeting this PA guideline.

Child development and pediatric sport and recreational injuries by age

CONTEXT

In 2010, 8.6 million children were treated for unintentional injuries in American emergency departments. Child engagement in sports and recreation offers many health benefits but also exposure to injury risks. In this analysis, we consider possible developmental risk factors in a review of age, sex, and incidence of 39 sport and recreational injuries.

OBJECTIVE

To assess (1) how the incidence of 39 sport and recreational injuries changed through each year of child and adolescent development, ages 1 to 18 years, and (2) sex differences. Design : Descriptive epidemiology study.

SETTING

Emergency department visits across the United States, as reported in the 2001-2008 National Electronic Injury Surveillance System database.

PATIENTS OR OTHER PARTICIPANTS

Data represent population-wide emergency department visits in the United States. Main Outcome Measure(s) : Pediatric sport- and recreation-related injuries requiring treatment in hospital emergency departments.

RESULTS

Almost 37 pediatric sport or recreational injuries are treated hourly in the United States. The incidence of sport- and recreation-related injuries peaks at widely different ages. Team-sport injuries tend to peak in the middle teen years, playground injuries peak in the early elementary ages and then drop off slowly, and bicycling injuries peak in the preteen years but are a common cause of injury throughout childhood and adolescence. Bowling injuries peaked at the earliest age (4 years), and injuries linked to camping and personal watercraft peaked at the oldest age (18 years). The 5 most common causes of sport and recreational injuries across development, in order, were basketball, football, bicycling, playgrounds, and soccer. Sex disparities were common in the incidence of pediatric sport and recreational injuries.

CONCLUSIONS

Both biological and sociocultural factors likely influence the developmental aspects of pediatric sport and recreational injury risk. Biologically, changes in perception, cognition, and motor control might influence injury risk. Socioculturally, decisions must be made about which sport and recreational activities to engage in and how much risk taking occurs while engaging in those activities. Understanding the developmental aspects of injury data trends allows preventionists to target education at specific groups.

The Role of the Pediatrician in Primary Prevention of Obesity

The adoption of healthful lifestyles by individuals and families can result in a reduction in many chronic diseases and conditions of which obesity is the most prevalent. Obesity prevention, in addition to treatment, is an important public health priority. This clinical report describes the rationale for pediatricians to be an integral part of the obesity-prevention effort. In addition, the 2012 Institute of Medicine report "Accelerating Progress in Obesity Prevention" includes health care providers as a crucial component of successful weight control. Research on obesity prevention in the pediatric care setting as well as evidence-informed practical approaches and targets for prevention are reviewed. Pediatricians should use a longitudinal, developmentally appropriate life-course approach to help identify children early on the path to obesity and base prevention efforts on family dynamics and reduction in high-risk dietary and activity behaviors. They should promote a diet free of sugar-sweetened beverages, of fewer foods with high caloric density, and of increased intake of fruits and vegetables. It is also important to promote a lifestyle with reduced sedentary behavior and with 60 minutes of daily moderate to vigorous physical activity. This report also identifies important gaps in evidence that need to be filled by future research.

Household factors, family behavior patterns, and adherence to dietary and physical activity guidelines among children at risk for obesity

OBJECTIVE

To describe the proportion of children adhering to recommended physical activity and dietary guidelines, and examine demographic and household correlates of guideline adherence.

DESIGN

Cross-sectional (pre-randomization) data from a behavioral intervention trial designed to prevent unhealthy weight gain in children.

PARTICIPANTS

A total of 421 children (aged 5-10 years) at risk for obesity (body mass index percentile, 70-95).

MAIN OUTCOMES MEASURED

Physical activity (accelerometry), screen time (parent survey), and fruit and vegetable and sugar-sweetened beverage intake (24-hour dietary recall).

ANALYSIS

Proportions meeting guidelines were calculated. Logistic regression examined associations between demographic and household factors and whether children met recommended guidelines for (1) physical activity (≥ 60 min/d), (2) screen time (≤ 2 h/d), (3) fruit and vegetable intake (≥ 5 servings/d), and (4) sugar-sweetened beverage avoidance.

RESULTS

Few children met more than 1 guideline. Only 2% met all 4 recommended guidelines and 19% met none. Each guideline had unique sociodemographic and domain-specific household predictors (ie, availability of certain foods and beverages, media, and active play and exercise equipment).

CONCLUSIONS AND IMPLICATIONS

Families equipped to promote healthy child behavior patterns in 1 activity or dietary domain may not be in others. Results have implications for the development of interventions to affect children's weight-related behaviors and growth trajectories.

Predictors for physical activity in adolescent girls using statistical shrinkage techniques for hierarchical longitudinal mixed effects models

We examined associations among longitudinal, multilevel variables and girls' physical activity to determine the important predictors for physical activity change at different adolescent ages. The Trial of Activity for Adolescent Girls 2 study (Maryland) contributed participants from 8th (2009) to 11th grade (2011) (n=561). Questionnaires were used to obtain demographic, and psychosocial information (individual- and social-level variables); height, weight, and triceps skinfold to assess body composition; interviews and surveys for school-level data; and self-report for neighborhood-level variables. Moderate to vigorous physical activity minutes were assessed from accelerometers. A doubly regularized linear mixed effects model was used for the longitudinal multilevel data to identify the most important covariates for physical activity. Three fixed effects at the individual level and one random effect at the school level were chosen from an initial total of 66 variables, consisting of 47 fixed effects and 19 random effects variables, in additional to the time effect. Self-management strategies, perceived barriers, and social support from friends were the three selected fixed effects, and whether intramural or interscholastic programs were offered in middle school was the selected random effect. Psychosocial factors and friend support, plus a school's physical activity environment, affect adolescent girl's moderate to vigorous physical activity longitudinally.

Prioritizing school intramural and interscholastic programs based on observed physical activity

PURPOSE

To examine which school sports engage children in more physical activity.

DESIGN

Observational, cross-sectional study examining differences between intramural (IM) and interscholastic (IS) sports.

SETTING

Athletic facilities at two schools with IM sports and two schools with IS sports in Wake County, North Carolina.

SUBJECTS

Middle-school children (N = 6735).

MEASURES

Percentage of children observed in sedentary, moderate, and vigorous activity assessed by the System for Observation Play and Leisure Among Youth (SOPLAY). Energy expenditure and physical activity intensity were also estimated by using MET values.

ANALYSIS

T-tests; generalized linear model using cumulative logit link function.

RESULTS

IM sports had higher MET values than IS sports (t = -3.69, p < .001), and IM sports ranked in four of the top five sports in terms of average MET values. Regression models found a significant interaction between school sport delivery model and gender, with boys significantly less physically active in IS programs than boys in IM programs (B = -.447, p < .001) but more physically active (B = .359, p <.001) than girls in IM sports.

CONCLUSION

Regardless of sport type, IM sports generated more physical activity than IS sports among boys but not girls. Soccer, basketball, and track, regardless of school delivery approach, provide the highest physical activity levels. Results suggest that school administrators consider reassessing their programs to more efficiently use diminishing resources to increase students' physical activity levels.

A systematic review of public health-aligned recommendations for preparing physical education teacher candidates

PURPOSE

Since Sallis and McKenzie's seminal article in 1991 outlining physical education's role in public health, increased attention has been given to promoting youth physical activity in schools. The present study systematically reviewed the literature from 1991 to 2013 to identify recommendations for the preparation of physical education teacher candidates (PETCs) from a public health perspective.

METHOD

Eight online databases (e.g., Educational Resources Information Center, Google Scholar) served as data sources for the study. Multiple combinations of key terms (e.g., physical education teacher education [PETE], public health, health-oriented) were used to identify relevant literature meeting search criteria. A content analysis was used to identify 47 distinct recommendations from 25 included articles and to synthesize these recommendations into major areas of focus.

RESULTS

Three major areas of focus were identified: (a) candidate profile (e.g., PETCs should be physically active and fit role models), (b) candidate knowledge (e.g., PETCs should know about behavior change theories), and (c) candidate skills (e.g., PETCs should be able to advocate for school-based physical activity).

CONCLUSION

This review can serve as a blueprint for PETE programs seeking to align professional preparation with public health goals.

Physical activity cut-offs and risk factors for preventing child obesity in Japan

BACKGROUND

There is no official recommendations for physical activity level or steps for preventing and improving child obesity in Japan.

METHODS

Three hundred and two Japanese children aged 9-12 years were recruited wore 3-D speed sensors. Subjects were divided into two groups using the criteria for child obesity in Japan. Body composition was measured on bioelectrical impedance analysis. Physical fitness test was done to evaluate physical strength. Twenty-four hour total steps, energy expenditure, and metabolic equivalents (MET) from Monday to Sunday were consecutively measured. The cut-offs for steps and physical activity level for preventing child obesity were evaluated on receiver operating characteristic curves. Daily life-related risk factors for child obesity were assessed on logistic regression analysis.

RESULTS

In both sexes, body volume; bodyweight, body mass index, fat mass, and percentage body fat in the obese group was significantly higher than in the normal group, but age and height were not different (P < 0.001). Aerobic power, running speed, and explosive strength in the obese group were inferior to those in the normal group (P < 0.001). More than 40 min of 4 MET exercise, defined as moderate-vigorous exercise, and 11,000 steps per day are essential to prevent child obesity. Additionally, >2 h TV viewing per day is a significant risk factor for child obesity (OR, 3.43; 95%CI: 1.27-9.31).

CONCLUSION

Cut-offs for physical activity and potential risk factors for child obesity have been identified. Recommendations for changes to daily lifestyle for school-aged Japanese children are given.

Pediatric hypertension: a growing problem

Hypertension in children and adolescents, once thought to be rare, has been estimated at a current prevalence of between 1% and 5% in the United States. The prevalence of primary hypertension continues to increase with the increasing body mass index of the pediatric population. Who is at risk? If and when to screen? When and how to treat? These controversial questions are important to the physician in primary care practice.

Cardiovascular complications of type 2 diabetes in youth

The prevalence of type 2 diabetes mellitus (T2DM) in youth has increased dramatically over the past decades. The literature also suggests that the progression from an impaired glucose tolerance state to established T2DM is more rapid in youth, compared to adults. The presence of significant cardiovascular complications in youth with T2DM, including cardiac, macrovascular, and microvascular remodeling, is another major issue in this younger cohort and poses a significant threat to the healthcare system. However, this issue is only now emerging as a major public health concern, with few data to support optimal treatment targets and strategies to reduce cardiovascular disease (CVD) risk in youth with T2DM. Accordingly, the purpose of this minireview is to better understand the cardiovascular complications in youth with T2DM. We briefly describe the pathophysiology from youth studies, including oxidative stress, inflammation, renin-angiotensin aldosterone system, and epigenetics, which link T2DM and CVD. We also describe the literature concerning the early signs of CVD in youth and potential treatment options to reduce cardiovascular risk.

Can I play?

Physical activity and participation in sports are important for the well being of children and youth and should be encouraged by health care providers. Individuals with chronic diseases are often less active, which can have a negative impact on their health. This article will review the effects of exercise on a few chronic medical conditions including juvenile arthritis, cystic fibrosis, and hypertension. The clinician's role in providing advice about sport participation will also be addressed.

Joint use policies: are they related to adolescent behavior?

OBJECTIVE

Joint use policies (JUP) encourage shared facility use, usually between schools and a city or private organization, for both physical activity-related and non-physical activity-related programs. Little is known about JUP's impact on physical activity (PA). This study examined whether more specific JUPs were associated with increased PA and decreased sedentary behavior (SB) in adolescents.

METHODS

Data on PA, sports participation, and SB were taken from annual cross-sectional nationally representative samples of 51,269 8th, 10th and 12th grade public school students nested in 461 school districts in the US from 2009-2011. JUP measures were constructed using information obtained from corresponding school district JU policies. Multivariable analyses were conducted, controlling for individual demographic and socioeconomic characteristics and clustering at the district level.

RESULTS

Results showed small associations between more specific JUPs and increased PA (IRR 1.01, 95% CI: 1.00, 1.02). Closer examination of specific JUP provisions indicates that specifying what times facilities are available for use was associated with vigorous exercise and prioritizing school or affiliated organizations' use and which spaces were available for use were associated with vigorous exercise and more frequent PA participation, which includes participation in sports or athletics. No associations were found between more specific JUPs and SB.

CONCLUSIONS

JUPS may have small influences on adolescent physical activity behavior. Future longitudinal studies should be conducted to examine the impact of JUPs in conjunction with other physical activity-related policies and environmental changes to determine what impact they have on overall adolescent physical activity and sedentary behavior.

Lifestyle interventions to reduce diabetes and cardiovascular disease risk among children

Diseases once associated with older adulthood, type 2 diabetes and cardiovascular disease, are increasingly diagnosed in children and adolescents. Interventions designed to assist adults in modifying dietary and physical activity habits have been shown to help prevent the development of type 2 diabetes and cardiovascular disease in adults. Given the unfortunate rise in both of these diseases in pediatric populations, it is increasingly important to begin prevention efforts in childhood or prenatally. There is strong empirical support for utilizing lifestyle interventions to prevent these diseases in adults; it is not clear whether the same holds true for pediatric populations. The present review examines lifestyle management efforts to prevent type 2 diabetes and cardiovascular disease in children across socioecological levels. Recommendations are made for expanding the traditional focus of lifestyle interventions from dietary and physical activity behaviors to target additional risks for these diseases such as smoking and depression in youth.

Promoting physical activity through the shared use of school recreational spaces: a policy statement from the American Heart Association

Most Americans are not sufficiently physically active, even though regular physical activity improves health and reduces the risk of many chronic diseases. Those living in rural, non-White, and lower-income communities often have insufficient access to places to be active, which can contribute to their lower level of physical activity. The shared use of school recreational facilities can provide safe and affordable places for communities. Studies suggest that challenges to shared use include additional cost, liability protection, communication among constituencies interested in sharing space, and decision-making about scheduling and space allocation. This American Heart Association policy statement has provided recommendations for federal, state, and local decision-makers to support and expand opportunities for physical activity in communities through the shared use of school spaces.

Physical activity in American schools and body mass index percentile

The international physical inactivity epidemic among children has contributed to child obesity. Schools can be an effective source of physical activity opportunity. A cross-sectional sample of 1306 American children was drawn from the Panel Study of Income Dynamics - Child Development Supplement, 2007. The aim of this study was to determine the role of in-school physical activity on body mass index (BMI) percentile among middle and high school-aged children. Multinomial logistic regression was used to assess the associations between the independent variable, physical activity, and the dependent variable, BMI percentile. After adjusting for covariates, children who had no physical activity during physical education (PE) were much more likely to be obese than normal weight in comparison with those who met the US national requirements (odds ratio = 1.58, confidence interval = 1.14, 2.20). This study suggests that meeting US national guidelines for PE-related physical activity may be effective in preventing obesity.

Shared use of school facilities with community organizations and afterschool physical activity program participation: a cost-benefit assessment

BACKGROUND

Partnerships between school districts and community-based organizations to share school facilities during afterschool hours can be an effective strategy for increasing physical activity. However, the perceived cost of shared use has been noted as an important reason for restricting community access to schools. This study examined shared use of middle school facilities, the amount and type of afterschool physical activity programs provided at middle schools together with the costs of operating the facilities.

METHODS

Afterschool programs were assessed for frequency, duration, and type of structured physical activity programs provided and the number of boys and girls in each program. School operating costs were used to calculate a cost per student and cost per building square foot measure. Data were collected at all 30 middle schools in a large school district over 12 months in 2010-2011.

RESULTS

Policies that permitted more use of school facilities for community-sponsored programs increased participation in afterschool programs without a significant increase in operating expenses.

CONCLUSIONS

These results suggest partnerships between schools and other community agencies to share facilities and create new opportunities for afterschool physical activity programs are a promising health promotion strategy.