Age and gender differences in objectively measured physical activity in youth

Financial Literacy and Exercise Behavior: Evidence from Japan

Lack of exercise, which increases the risk of many serious physical and mental illness, has been a common health issue in Japan. Recent studies confirm that financial literacy discourages irrational behavior like gambling and smoking. We therefore investigate how financial literacy, as a rational decision-making instrument, relates to peoples’ exercise behavior in Japan. We hypothesize that financial literacy encourages people to exercise regularly. Using Osaka University’s Preference Parameters Study (PPS) for 2010, we categorized respondents into two groups: those who exercise regularly or at least once a week and those who do not. Our probit estimation results show that financial literacy is positively related with exercise behavior, meaning that financially literate people are more likely to exercise regularly. As the COVID-19 health pandemic seems to exacerbate peoples’ physical inactivity, the results of our study show an alternative approach to encourage exercise. We therefore recommend that governments implement a financial literacy improvement policy to alleviate the lack of exercise.

Handgrip Strength and Vitamin D as Predictors of Liver Fibrosis and Malnutrition in Chronic Hepatitis C Patients

Background

In patients with chronic hepatitis C (CHC), a negative impact of associated malnutrition on both morbidity and mortality was reported. We aimed to elucidate the efficacy of serum liver fibrosis markers (fibronectin (FN), hydroxyproline (Hyp), and hyaluronic acid (HA)) and their respective indices (HA index, Hyp index, and FN index) and vitamin D status in predicting malnutrition associated with liver fibrosis in CHC patients and to investigate their association with the value of current clinical malnutrition assessment tools subjective global assessment (SGA), handgrip strength (HGS), and muscle mass scores (SGA, BMI, MAMC, and HGS).

Materials and Methods

A cross-sectional study was conducted on 80 patients aged 40-60 years with proven viremia, HCV antibodies, HCV-RNA positivity, genotype determinations, and established chronic hepatitis C virus for more than 6 years and 80 control subjects. SGA, HGS, and muscle mass score (MAMC) were estimated in both patients and control subjects. Based on SGA scores, CHC patients were classified into three groups: well nourished (n = 12; SGA-A); mild or moderately malnourished (n = 25; SGA-B); and severely malnourished (n = 43; SGA-C). Liver fibrosis markers, inflammatory indicator α-Fetoprotein (AFP), tumor necrosis factor-alpha (TNF-α), 25-hydroxyvitamin D, and PTH were estimated using immunoassay techniques.

Results

CHC patients with moderate and severe malnutrition SGA scores showed a significant decline in the levels of vitamin D, increased PTH, and lower values of HGS and muscle mass indices compared to well-nourished patients and control subjects. In addition, malnutrition, vitamin D deficiency, and lower values of HGS, MAC, TSF, and MAMC showed significant correlation with liver severity among CHC patients. Liver fibrosis markers Hyp, HA, FN, APRI, HypI, HAI, and FNI as noninvasive biomarkers showed significant correlation with both severity of liver diseases and associated malnutrition, especially in cirrhotic HCV patients (F4) compared to those with significant fibrosis (F2-F3).

Conclusion

The results showed that deficiency in vitamin D levels, HGS, SGA, and muscle mass scores (MAC, MAMC, or TSF) could be used as markers of liver pathogenicity in patients with CHC. In addition, the study concluded that noninvasive biomarkers Hyp, HA, FN, APRI, HypI, HAI, and FNI separately or in association with vitamin D status, HGS, SGA, and muscle mass scores (MAC, MAMC, or TSF) were significantly associated with an incidence of malnutrition between ~70.5% and 89.6% of CHC patients with significant fibrosis and cirrhosis.

Physical activity in children and adolescents with CHD: review from a measurement methodological perspective

AIM

To compile a literature overview of physical activity in children with CHD and to critically evaluate the methodology used for physical activity assessment.

METHODS

A review of the literature was performed using PubMed to identify studies examining accelerometer and subjectively assessed physical activity in children and adolescents with CHD.

RESULT

A total of 15 studies were included (6 studies using subjective measures and 9 articles using accelerometers for the assessment of physical activity). The patients generally failed to meet the recommendations of physical activity. When compared to healthy controls, the results were widely divergent in the subjectively assessed measures and the accelerometer-based studies showed a tendency of no difference in physical activity. Neither subjective methods nor accelerometer-based studies reported any difference in physical activity in general, in relation to the severity of the heart disease.

CONCLUSION

Methodological variation and limitations in the assessment of physical activity largely explain the divergent results and the inability to establish differences in physical activity between children with CHD of different severity and compared to healthy controls. Methodological knowledge and guidelines are provided for improved assessment of physical activity using accelerometers in clinical research.

Objectively Measured Physical Activity Increases Only in Males During a Summer Camp for Obese Children

Childhood obesity is a major public health challenge. Summer camps for children with obesity represent an alternative setting to improve eating and physical activity habits. Here we evaluated if the participation in the camp improves objectively measured physical activity and sedentary behavior and whether there are differences between male and female participants. Twenty-eight children, 13 males and 15 females (body mass index >97° centile, weight excess >30%, Tanner stage I), agreed to participate in an 8-day camp. During the summer camp, children participated in sports-like games and outdoor activities for at least 3 h a day, and the school-camp staff also provided a theoretical nutritional learning plan. Accelerometry-derived physical activity was measured through the SenseWear Mini Armband during a week at home and during the camp experience. Before camping, the participants were far above the minimum daily values of moderate- to vigorous-intensity physical activity (MVPA) to be considered sufficiently active (≥60 min/day), but male participants were more active than females (MVPA: 186.2 ± 94.2, 111.0 ± 64.7; P = 0.020). Male participants increased their MVPA (234.3 ± 114.8, P = 0.020), whereas females not (111.9 ± 52.9, P = 0.020). No difference emerged for the sedentary behavior either before or during the camp. This study suggests that participation in a summer camp for obese children can determine different responses in physical activity levels, depending on the sex of young participants. Thus, summer camps for obese children should put particular attention on female participants, besides reducing sedentary behavior in both males and females.

Volume and accumulation patterns of physical activity and sedentary time: longitudinal changes and tracking from early to late childhood

BACKGROUND

Physical activity (PA) decreases and sedentary time (SED) increases across childhood, with both behaviours tracking. However, no studies have examined how accumulation patterns of PA and SED (i.e., prolonged bouts, frequency of breaks in sedentary time) change and track over time. The aim of this study was to investigate longitudinal changes in and tracking of total volume and accumulation patterns of SED, light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA) among boys and girls.

METHODS

In 2008/09 (T1), children in HAPPY (3-5y; n = 758) in Melbourne, Australia wore ActiGraph GT1M accelerometers to objectively assess SED, LPA, MPA and VPA. This was repeated at age 6-8y (T2; n = 473) and 9-11y (T3; n = 478). Ten pattern variables were computed: bouts of ≥ 5-, ≥ 10-, ≥ 15- and ≥ 20-min for SED, ≥ 1- and ≥ 5-min for LPA, ≥ 1-min for MPA, ≥ 1- and ≥ 5-min for VPA, and breaks in SED (interruptions of > 25 counts 15 s^- 1). Longitudinal mixed models examined changes from T1-3, controlling for T1 age. Generalized estimating equations assessed tracking over the three time points, controlling for T1 age and time between measurements. Analyses were stratified by sex.

RESULTS

Total volume and bouts of SED and SED breaks increased, while total volume and bouts of LPA decreased for both sexes. There was a small decrease in total volume of MPA for girls, but time spent in ≥ 1-min bouts increased for both sexes. Total volume of VPA increased for both sexes, with time spent in ≥ 1-min bouts increasing for boys only. All volume and pattern variables tracked moderately for boys, except for all SED bouts ≥ 15-min, LPA bouts ≥ 5-min and MPA bouts ≥ 1-min (which tracked weakly). For girls, total SED and SED bouts ≥ 1-min tracked strongly, total volume of LPA, MPA and VPA, ≥ 5- and ≥ 10-min SED bouts, and ≥ 1-min LPA and MPA bouts tracked moderately, and SED breaks, all SED bouts ≥ 15 min, LPA bouts ≥ 5 min and all VPA bouts tracked weakly.

CONCLUSIONS

Patterns of SED and PA change from early to late childhood; with the exception of SED breaks and VPA, changes were detrimental. Total volumes and short bouts tended to track more strongly than longer bouts. Interventions to prevent declines in PA and increases in SED are important from early in life.

Step Count Associations Between Adults at Risk of Developing Diabetes and Their Children: The Feel4Diabetes Study

BACKGROUND

Shared risk factors of type 2 diabetes mellitus (T2DM) between parents at risk and their children, such as low physical activity levels, should be addressed to prevent the development of the disease. The aim of this study was to determine the association of objectively measured step counts per day between parents at risk of developing T2DM and their 6- to 10-year-old children.

METHODS

The baseline data from the Feel4Diabetes study were analyzed. Dyads of children and one parent (n = 250, 54.4% girls and 77.6% mothers) from Belgium were included. Step counts per day during 5 consecutive days from parents and their children were objectively measured with ActiGraph accelerometers.

RESULTS

Adjusted linear regression models indicated that parents' and children's step counts were significantly associated during all days (β = 0.245), weekdays (β = 0.205), and weekend days (β = 0.316) (P ≤ .002 in all cases). Specifically, mother-daughter associations during all days and weekend days and father-son step counts during weekdays and when considering all days were significant.

CONCLUSION

There is a positive association between step counts from adults at risk of developing T2DM and their children, especially in the mother-daughter and father-son dyads.

In-School, Out-of-School, and Weekend Physical Activity Levels Vary Across Sociodemographic Subgroups of US Adolescents

BACKGROUND

In response to conflicting findings for activity levels across sociodemographic groups, this study examined differences in adolescents' in-school, out-of-school, and weekend physical activity (PA) by sociodemographic subgroups using representative US data.

METHODS

Data were obtained from the Family Life, Activity, Sun, Health, and Eating study. Multiple regression models compared in-school, out-of-school, and weekend PA by gender and race/ethnicity, and examined potential modification of associations by grade (middle vs high school) and socioeconomic status (lower vs higher).

RESULTS

Final analytic sample was 1413 adolescents (Mean age = 14.5 y, 51.3% female, 64.5% white). Compared with whites, in-school PA was significantly higher among blacks and those classified as other race/ethnicity for middle school (69.8 and 71.0, respectively, vs 66.4 min/d), and among Hispanics for high school (52.7 vs 48.4 min/d). Hispanics' (vs whites') out-of-school PA was significantly lower for middle school (63.7 vs 66.6 min/d), but higher for high school (54.0 vs 51.8 min/d). In-school PA was significantly higher among adolescents of lower (vs higher) socioeconomic status among males and Hispanics (all Ps < .05).

CONCLUSIONS

The relation of race/ethnicity with PA varies by grade and time of day/week. Socioeconomic status findings contradict previously reported findings. Efforts to increase PA based on sociodemographic disparities should consider potential interaction effects.

Youth’s Physical Activity and Fitness from a Rural Environment of an Azores Island

This study aimed to characterize and compare physical activity (PA) and fitness levels by sex in 109 students of a rural environment. The participants were between 15 and 20 years old, from the Santa Maria High School in the Azores’ Santa Maria island. PA levels were assessed by International Physical Activity Questionnaire (IPAQ)-short form. The physical fitness was evaluated by the Fitnessgram battery tests. The sample of this study were physically active, 67.9% were classified with high and moderate PA levels. Regarding the sex comparisons, no significant differences between PA levels were founded. However, males presented higher values of vigorous physical activity, whereas females spent more time in moderate activity, such as walking. Moreover, females had more time in sitting positions during the week and weekend. Regarding the physical fitness levels, males presented significantly higher performances in the upper strength (p < 0.001) and aerobic capacity tests (p < 0.001), whereas females showed higher values in the sit and reach test (p < 0.001), in the trunk lift test (p < 0.005), and in the fat mass values (p < 0.001). It seems reasonable to assume that there is a sociodemographic influence on the PA and physical fitness levels in our sample. We may speculate that rural life provides more opportunities for youth for being physically active than urban life. No differences were founded between sexes for physical activity. However, differences were found between sex for strength, flexibility, cardiorespiratory fitness, and body composition. That might be explained by the biological differences and the type of physical activity habits that each sex use to have in rural environmental.

COVID-19 nationwide lockdown and physical activity profiles among North-western Italian population using the International Physical Activity Questionnaire (IPAQ)

BACKGROUND

The role of physical activity in enhancing health is well recognized. However, in the more industrialized countries, physical activity rates are declining, and the emerging COVID-19 pandemic may amplify this scenario. Thus, this study aimed to report the Italian population's physical activity profile living in the North-western regions during the national lockdown.

METHODS

Physical activity was assessed using the official Italian short form of IPAQ, intended for Social Networking Services (SNS). Participation was voluntary, and people could fill the questionnaire simply by clicking on a specific link.

RESULTS

The final sample size was 612 Italians, male and female, equally distributed (49.1% male and 50.9% female). Data showed a percentage of 15.4% of inactive subjects (MET < 700), 61.8% of moderate-active (MET 700-2500), and 22.9% of active people (MET > 2500). Women were more inactive than men (p < 0.01; 57.4% vs 42.6%). Furthermore, participants were classified into four classes of age: 18-29; 30-44; 45-59; and 60-79. Class 18-29 was prevalent (p < 0.01, 68.3%) and showed higher levels of physical activity (p < 0.05).

CONCLUSIONS

Italians living in North-western regions maintained a moderate amount of physical activity during the quarantine. This behavior should be encouraged, particularly among women that usually appear to be less active than men.

Reduced level of physical activity during COVID-19 pandemic is associated with depression and anxiety levels: an internet-based survey

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has resulted in a strong negative impact on economic and social life worldwide. It has also negatively influenced people's general health and quality of life. The aim of the present study was to study the impact of social distancing on physical activity level, and the association between mood state (depression and anxiety level) or sex with actual physical activity levels, the change in physical activity caused by social distancing period, the adhesion level to social distancing, the adoption time of social distancing, family income and age.

METHODS

A self-administered questionnaire with personal, quarantine, physical activity, and mood state disorders information's was answered by 2140 Brazilians of both sex who were recruited through online advertising.

RESULTS

The physical activity level adopted during the period of social distancing (3.5 ± 0.8) was lower than that the adopted prior to the pandemic period (2.9 ± 1.1, p < 0.001). Thirty percent of the participants presented symptoms of moderate/severe depression and 23.3% displayed moderate/severe anxiety symptoms. A greater presence of symptoms related to anxiety and depression were associated with low physical activity levels, low family monthly income, and younger age. A higher percentage of men who had no mood disorders was observed among those who were very active than among those less active.

CONCLUSION

The COVID-19 pandemic has a negative impact on physical activity. Those who reduced their level of physical activity had the highest levels of mood disorders. Therefore, physical activity programs should be encouraged, while respecting the necessary social distancing to prevent the spread of Severe Acute Respiratory Syndrome Coronavirus 2.

Obesity in young children and its relationship with diagnosis of asthma, vitamin D deficiency, iron deficiency, specific allergies and flat-footedness: A systematic review and meta-analysis

There is evidence that a number of medical conditions and co-morbidities are associated with obesity in young children. This review explored whether there is evidence of associations with other conditions or co-morbidities. Observational studies of young children (mean age < 10 years) were identified using electronic searches of five databases (MEDLINE, Embase, CINAHL, AMED and SPORTDiscus). Of 27 028 studies screened, 41 (comprising 44 comparisons) met the inclusion criteria. These studies provided data on five distinct diseases/conditions: asthma (n = 16), vitamin D deficiency (n = 10), iron deficiency (n = 10), allergies (n = 4) and flat-footedness (n = 4). Thirty-two studies were appropriate for meta-analysis using random-effects models, and revealed obesity was significantly associated with having asthma (OR 1.5, 95% CI 1.3-1.7), vitamin D deficiency (OR 1.9, 95% CI 1.4-2.5) and iron deficiency (OR 2.1, 95% CI 1.4-3.2). Heterogeneity (I2 ) ranged from 57% to 61%. Narrative synthesis was conducted for all studies. There was no evidence of a consistent association between obesity in young children and eczema, dermatitis or rhinitis due to the low number of studies. However, there was an association with flat-footedness. These results have implications for health policy and practice and families. Further research leading to a greater understanding of the associations identified in this review is suggested.

Body surveillance prospectively linked with physical activity via body shame in adolescent girls

The socialization of girls to habitually monitor their bodies, via the process of body surveillance, contributes to an increased risk of negative physical and psychological experiences. The present study examined if body surveillance may also contribute to the decrease in physical activity that is observed in girls during adolescence, and if this association is mediated by body shame (operationalized as both experienced and anticipated shame when imagining changes to one's body in the future). Physically active adolescent girls (n = 206) reported body surveillance at baseline, and measures of experienced and anticpated body shame, and physical activity two years later. Body surveillance was indirectly associated with physical activity via the experience and anticipation of body shame. Specifically, the experience of body shame was associated with lower reported engagement in physical activity (b = -0.13, 95 % CI [-0.23, -0.03]), whereas the anticipation of body shame was associated with higher physical activity (b = 0.07, 95 % CI [0.01, 0.15]), possibly for the purpose of appearance management. Due to the opposing directional effects of experienced versus anticipated body shame, it is important to consider both facets of this emotional experience in understanding how vigilant bodily monitoring impacts physical activity engagement in adolescent girls.

Associations among masticatory muscle activity, physical activity and self-reported oral behaviours in adult women

OBJECTIVES

To examine the relationship between masticatory muscle activity (MMA), self-reported oral behaviours (OBs) and overall physical activity (PA) in adult women.

MATERIALS AND METHODS

MMA and PA were assessed by a wearable electromyography (EMG) device and accelerometer respectively, worn over 2 non-consecutive days by 53 women (mean age 27.5 ± 6.4 years). Following the second recording day, self-reported OBs were assessed. MMA was assessed by the number, amplitude and duration of masseter contraction episodes. Masseter muscle EMG outcome measures were number of contraction episodes per hour (CEs/h) and the relative contraction time (RCT%). PA was assessed by time accumulated in moderate to vigorous physical activity (MVPA) and 10-min bouts of MVPA per hour. Data were analysed using mixed model analysis.

RESULTS

MMA in free-living conditions consisted mostly of low-amplitude (<10% maximum voluntary clenching) and short-duration (<10 s) contraction episodes. Masseter CEs/h were not associated with self-reported levels of OB. Masseter CEs/h were positively associated with time accumulated in MVPA (F = 9.9; p = 0.002) and negatively associated with 10-min bouts of MVPA/h (F = 15.8; p <0.001). RCT% was not significantly associated with either.

CONCLUSIONS

Objectively assessed MMA is not associated with self-reported OB in free-moving adult females. Moderate to vigorous exercise and physical inactivity are accompanied with an increase in the number of masseter muscle contractions and thus possibly tooth clenching activity.

CLINICAL RELEVANCE

OB can be influenced by the type and extent of PA. Subjective assessment of MMA by questionnaire and/or interviews may be invalid.

Familial and Parental Predictors of Physical Activity in Late Adolescence: Prospective Analysis over a Two-Year Period

Children’s health behaviors are highly influenced by their parents and family. This study aimed to prospectively evaluate the parental/familial factors associated with physical activity levels (PALs) among older adolescents. The participants were 766 adolescents, who were prospectively observed at baseline (when they were 16 years of age), at first follow-up measurement (FU1; 17 years of age), and second follow-up measurement (FU2; 18 years of age). Sociodemographic factors (age, gender, socioeconomic status, and sport participation) and parental/familial variables were evaluated at baseline. PALs (evidenced by the Physical-Activity Questionnaire-for-Adolescents) were prospectively evidenced at baseline, FU1, and FU2. Factorial analysis of variance for repeated measurements showed a significant decrease in PALs during the study course (F = 83.05, p < 0.001). Sport participation and male gender were significant predictors of PALs at baseline, FU1, and FU2. Logistic regression, controlled for sport participation and male gender, evidenced paternal education as a significant predictor of baseline PALs. Parental conflict was a significant predictor of PALs in all three testing waves. The significant influence of paternal education on the children’s PALs existed from younger adolescence until the age of 17 years. The association between parental conflict and PALs developed in older adolescence. These results should be used in the development of specific and targeted interventions aimed at the improvement of PALs and a reduction of sedentarism in youth.

Why Are Individuals With Diabetes Less Active? The Mediating Role of Physical, Emotional, and Cognitive Factors

BACKGROUND

Despite the key role of physical activity in the management of diabetes, many individuals with diabetes do not engage in the recommended levels of physical activity. However, our knowledge of the mechanisms underlying the relationship between diabetes and physical inactivity is limited.

PURPOSE

To investigate the associations between diabetes and the levels and evolution of physical activity across aging, and to determine whether physical, emotional, and cognitive factors mediate these associations.

METHODS

Data from 105,622 adults aged 50-96 years from the Survey of Health, Ageing and Retirement in Europe (SHARE) were used in adjusted linear mixed models to examine whether diabetes was associated with physical activity levels and variations across aging. The potential mediators were subjective energy, muscle strength, physical and cognitive disability, sleep problems, depressive symptoms, and cognitive functions. The variables were measured up to seven times over a 13-year period.

RESULTS

Individuals with diabetes demonstrated a lower level and a steeper decrease in physical activity across aging than individual without diabetes. Mediators explained ~53% and 94% of the association of diabetes with the level of physical activity and with the linear evolution of physical activity across aging, respectively. All mediators were significantly associated with physical activity. Physical and cognitive disability as well as depressive symptoms were the strongest mediators, while sleep was the lowest one.

CONCLUSIONS

These findings suggest that the etiology of physical inactivity in individuals with diabetes can result from several physical, emotional, and cognitive changes associated with the emergence of this disease.

School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials

OBJECTIVES

To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness.

DESIGN

Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity.

PARTICIPANTS

Data for 6621 children and adolescents aged 4-18 years from 20 trials were included.

MAIN OUTCOME MEASURES

Peak oxygen consumption (VO2Peak mL/kg/min) and minutes of moderate and vigorous physical activity.

RESULTS

Interventions modestly improved students' cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness.

CONCLUSIONS

Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

Testing the Child PROMIS Physical Activity Measurement in Youth Attending a Large Community Event

PURPOSE

The study's purpose was to evaluate the concurrent validity of the Child Patient-Reported Outcomes Measurement Information System (PROMIS) PA with the Youth Activity Profile (YAP) and examine its relationship to PROMIS measures of sedentary behavior and fatigue. The PROMIS Pediatric Activity (PA) measure is a newly developed, valid instrument used to collect data on children's lived experiences of short bouts of moderate to rigorous physical activity.

METHODS

Participants were ages 8 to 20 years attending a state fair. Child PROMIS measures-PA, Sedentary Behavior, and Fatigue-and the YAP were completed on an iPad.

RESULTS

The PROMIS PA and YAP had a positive correlation. The PROMIS PA was not associated with sedentary behavior or fatigue measurements.

CONCLUSION

As expected, the PROMIS PA and YAP measure-related PA constructs, the YAP focuses on energy expended while the PROMIS PA indicates perceived response to activity.

Impact of body mass index and socio-economic status on motor development in children and adolescents

This study assessed the impact of body mass index (BMI) and socioeconomic status (SES) on the Zurich Neuromotor Assessment, second version (ZNA-2), a battery of tests of motor development in typically developing children between 3 and 18 years of age. BMI measurements and international socio-economic index data were taken from the normative sample of the ZNA-2 for 321 children (158 boys, 163 girls) with a median age of 9.3 years. The age- and gender-adjusted motor performance of these children was quantified and grouped into five components: fine, pure, and gross motor tasks, static balance, and contralateral associated movements. A total score was also calculated. The associations of BMI and SES with the motor scores contribute to less than 5.1% of the total variance.Conclusion: The ZNA-2 for motor development is suitable for measuring motor abilities' development as it is largely independent of the BMI of the child and the SES of the family. What is Known: • Typical motor development, as measured with the Zurich Neuromotor Assessment, second edition (ZNA-2), is strongly dependent on age and gender. • The ZNA-2 focusses on motor performance, motor quality and simple motor skills. What is New: • Higher socio-economic status (SES) is associated with slightly better motor performance as measured by the ZNA-2 total score. • In the ZNA-2 less than 5.1% of the variability in motor performance is attributable to the combined effect of body mass index and SES.

Physical activity pattern and its relationship with overweight and obesity in saudi children

Background

Overweight and obesity among children and adolescents are emerging public health problems. Modifiable lifestyle factors such as physical inactivity and eating out are responsible for the increased prevalence of obesity and related health risks.

Objective

To examine physical activity level and weight status among Saudi children in relation to age and gender.

Study design

In a cross-sectional study, 200 apparently healthy Saudi children (118 boys and 82 girls), aged 5–15 years, were enrolled from the Pediatric clinics at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. To determine physical activity level, the International Physical Activity Questionnaire-Short Form-A was used. Anthropometric measurements were taken for all participants.

Results

Central obesity was highly prevalent among adolescents as compared with a higher prevalence of general obesity in children. Physical activity level was significantly higher among adolescent boys than adolescent girls (P<.05). Girls scored almost double the total metabolic equivalent scores. More boys were considered highly active (59% vs. 40%) in contrast with more girls with low physical activity (38% vs. 26%). Among girls, high physical activity score was higher in children than in adolescents (40% vs. 21%) and an increasing number of adolescents were of low physical activity than children (64% vs. 38%). The majority of the study population were spending more than 2 h per day in watching TV and playing electronic games, but a slightly higher number of children showed sedentary behavior than adolescents. Adolescent girls were significantly spending more time watching TV than adolescent boys (P<.01). Significant inverse associations with most anthropometric measures and the time spent in watching TV and doing desk work were demonstrated in both genders.

Conclusion

This study reports significant influence, by age and gender, contributing to physical inactivity and weight status among Saudi children.

Parental and Familial Factors Influencing Physical Activity Levels in Early Adolescence: A Prospective Study

Parental/familial factors are important determinants of the physical activity level (PAL) in children and adolescents, but studies rarely prospectively evaluate their relationships. This study aimed to evaluate the changes in physical activity levels among adolescents from Bosnia and Herzegovina over a two-year period and to determine parental/familial predictors of PAL in early adolescence. A total of 651 participants (50.3% females) were tested at baseline (beginning of high school education; 14 years old on average) and at follow-up (approximately 20 months later). The predictors included sociodemographic characteristics (age, gender) and parental/familial factors (socioeconomic status of the family, maternal and paternal education, conflict with parents, parental absence from home, parental questioning, and parental monitoring). Physical activity levels were evidenced by the Physical Activity Questionnaire for Adolescents (PAQ-A; criterion). Boys were more active than girls, both at baseline (t-test = 3.09, p < 0.001) and at follow-up (t-test = 3.4, p < 0.001). Physical activity level decreased over the observed two-year period (t-test = 16.89, p < 0.001), especially in boys, which is probably a consequence of drop-out from the sport in this period. Logistic regression evidenced parental education as a positive predictor of physical activity level at baseline (OR [95% CI]; 1.38 [1.15–170], 1.35 [1.10–1.65]), and at follow-up (1.35 [1.11–1.69], 1.29 [1.09–1.59], for maternal and paternal education, respectively). Parents with a higher level of education are probably more informed about the importance of physical activity on health status, and thus transfer this information to their children as well. The age from 14 to 16 years is likely a critical period for maintaining physical activity levels in boys, while further studies of a younger age are necessary to evaluate the dynamics of changes in physical activity levels for girls. For maintaining physical activity levels in adolescence, special attention should be paid to children whose parents are less educated, and to inform them of the benefits of an appropriate physical activity level and its necessity for maintaining proper health and growth.

Quantification of physical activity of Malaysian traditional games for school-based intervention among primary school children

OBJECTIVE

Children's physical activity can be increased by integrating game-based activities, such as traditional games, into physical education sessions. However, the level of physical activity of these games has not been quantified. This study aims to quantify the level of intensity for common Malaysian traditional games (i.e. Galah Panjang, Bola Beracun, Polis Sentri, Belalang Belatuk, Ayam Musang, and Baling Tin) among primary school children aged nine to 11 years (N = 30).

METHODS

We used an accelerometer to measure step count, metabolic equivalent task, level of intensity and vector magnitude during 20 min playing sessions. The playing space was standardised for each game to the size of a badminton court (i.e. 13.4 m in length and 6.1 m in width).

RESULTS

The results showed that three traditional Malaysian games, namely Galah Panjang, Bola Beracun and Baling Tin, fulfilled the requirements to be classified as moderate-to vigorous-intensity physical activity in terms of step count, metabolic equivalent task, heart rate and motions in all planes.

CONCLUSION

This study shows that playing traditional games for 20 min can increase physical activity among primary school students.

Symptoms of disordered eating and participation in individual- and team sports: A population-based study of adolescents

AIM

This study aimed to investigate individual and team sports participation across sex, age, and levels of body mass index (BMI). We also wanted to explore how symptoms of disordered eating (DE) were associated with participation in individual and team sports, and to what extent BMI moderated this association.

METHODS

Data stemmed from a large population-based survey of 10,172 Norwegian adolescents aged 16 to 19 years. Self-reported participation in organized team- and individual sports were the dependent variables. Self-reported symptoms of DE using the five-item Eating Disturbance Screening (EDS-5) questionnaire comprised the independent variable. Covariates included sex, age, socioeconomic status, and BMI. We used regression analyses for associations between DE symptoms and sports participation, including the interaction between DE and BMI.

RESULTS

Boys had higher team sports participation compared with girls. Individual and team sports participation varied significantly across BMI levels for each sex. Symptoms of DE were negatively associated with team sports participation (odds ratio [OR] = 0.90, p < 0.001), and were not significantly associated with individual sports participation. BMI scores moderated the association between DE symptoms and individual sports participation (p < 0.005). DE symptoms were associated with higher individual sports participation among individuals with low BMI, and with lower participation among those with high BMI.

CONCLUSIONS

DE symptoms are important correlates of sports participation among adolescents, but the direction of these associations partly differs across the weight spectrum. Promotion of factors that counteract DE is needed alongside efforts to increase physical activity and sports participation in the general adolescent population.

School-based obesity prevention interventions in Latin America: A systematic review

OBJECTIVE

To evaluate the implementation and effectiveness of school-based interventions to prevent obesity conducted in Latin America and provide suggestions for future prevention efforts in countries of the region.

METHODS

Articles published in English, Spanish, and Portuguese between 2000 and 2017 were searched in four online databases (Google Scholar, PubMed, LILACS, and REDALYC). Inclusion criteria were: studies targeting school-aged children and adolescents (6-18 years old), focusing on preventing obesity in a Latin American country using at least one school-based component, reporting at least one obesity-related outcome, comprising controlled or before-and-after design, and including information on intervention components and/or process.

RESULTS

Sixteen studies met the inclusion criteria. Most effective interventions (n = 3) had moderate quality and included multi-component school-based programs to promote health education and parental involvement focused on healthy eating and physical activity behaviors. These studies also presented a better study designs, few limitations for execution, and a minimum duration of six months.

CONCLUSIONS

Evidence-based prevention experiences are important guides for future strategies implemented in the region. Alongside gender differences, an adequate duration, and the combined use of quantitative and qualitative evaluation methods, evidence-based prevention should be considered to provide a clearer and deeper understanding of the true effects of school-based interventions.

How parental socioeconomic status contribute to children's sports participation in China: A cross-sectional study

Socioeconomic status (SES) is an important factor contributing to health inequality. This study aimed to investigate factors that predict junior school students' sports participation, identify the mechanisms underlying transmission of social resources and assess the mediating effects of classmate support and parental involvement on the relationship between parental SES and children's sports participation. 4829 males and 4536 females (mean age = 13.56 years, standard deviation = 0.686 years) participated in the study. Multivariate regression was adopted to analyze the determinants of junior school students' sports participation and multiple mediation analyses were used to analyze the hypothesized model. The results indicated that parental SES is significantly and directly correlated with junior school students' sports participation. In addition, parental SES has a significant indirect effect on sports participation through classmate support and parental involvement. Furthermore, the mediation effect of classmate support on the association between parental SES and sports participation is stronger than that of parental involvement. To promote and facilitate the participation of junior school students', strategies should be developed by government and social workers to strengthen classmate support and parental involvement.

Tracking Children's Physical Activity Patterns across the School Year: A Mixed-Methods Longitudinal Case Study

Despite the breadth of health benefits associated with regular physical activity (PA), many children in the UK are not sufficiently active enough to meet health guidelines, and tend to become less active as they mature into and throughout adolescence. Research has indicated that children's school, home and neighbourhood environments can all significantly influence their opportunities to engage in moderate-to-vigorous physical activity (MVPA). However, less is known about how children's MVPA patterns within these key environments may change across the school year. The current mixed-methods case study aims to explore this issue by tracking key stage 2 (KS2) and key stage 3 (KS3) children's MVPA patterns across the school year. Fifty-eight children (29 boys, 29 girls, KS2 = 34, KS3 = 24) wore an integrated global positioning systems (GPS) and heart rate (HR) monitor over four consecutive days in the first term of school (autumn), before these measurements were repeated in the two remaining school terms (winter-summer). A subsample of children (n = 6-8 per group) were invited to take part in one of six focus groups each term to further explore their PA behaviours and identify the barriers and facilitators to PA. The children's MVPA was significantly lower (p = 0.046) in term 2 (winter/spring term) than during the warmer terms (autumn and summer). All the locations showed reductions in MVPA in term 2, except indoor MVPA, which increased, and MVPA on foot in the neighbourhood, which remained consistent. Focus groups revealed location, friends, and the variety of options to be associated with MVPA, and poor weather, parental permission, and time limitations to be barriers to MVPA. This mixed-methodological, repeated-measures design study highlights differences in the activity patterns and perceptions of children over the school year. Future studies should implement longitudinal, multi-method approaches to gain deeper insight into how children's PA behaviours differ over time. Consequently, this can inform future health policies promoting children's PA throughout the year.

Cardiorespiratory fitness, physical activity, sedentary behavior, and circulating white blood cells in US youth

The white blood cell (WBC) provides a clue to the presence of illness. Cardiorespiratory fitness (CRF) and physical activity levels are negatively associated with circulating total WBC counts in adults. To date, only a scarce number of studies have investigated these associations among youths. The aim was to elucidate the relationship between CRF and accelerometer-assessed physical activity and sedentary behavior with WBC counts and subfraction concentrations of particular WBC (neutrophils, lymphocytes, monocytes, basophils, and eosinophils) in a large representative national sample of US children and adolescents. Participants accumulating 60 min/day or more of moderate-to-vigorous physical activity (MVPA) were considered active or inactive otherwise. Participants were also categorized into low, average, and high CRF level. The final sample consisted of 1623 children and adolescents (11.9 years old) from 2003 to 2006 cycle and 2624 (14.5 years old) from 1999 to 2004 cycle. CRF was inversely associated with total WBC and segmented neutrophils concentration in both sexes, and MVPA only in boys. Further, active children and adolescents had higher odds of a normal range of WBC count in boys (Odds Ratio [OR] = 1.41 95% CI, 1.02 to 2.34) and girls (OR = 3.52 95% CI, 1.01 to 12.23). In conclusion, our observations indicate that interventions targeting CRF and MVPA could strength the immune system of children and adolescents.

Association between exercise and health-related quality of life and medical resource use in elderly people with diabetes: a cross-sectional population-based study

BACKGROUND

Exercise improves glycemic control and functional capacity in elderly people with diabetes; however, its effect on health-related quality of life (HRQoL) and medical resource use remains unclear. This study aims to clarify the effect of exercise.

METHODS

Using the data from National Health and Nutrition Examination Survey between 2007 and 2016, we identified 1572 elderly people with diabetes for this cross-sectional population-based study. Demographic characteristics, health conditions, comorbidities, HRQoL, and medical resource were compared among four groups (no exercise, low-intensity exercise, moderate-intensity exercise, and high-intensity exercise).

RESULTS

The mean age of all participants was between 71.5 and 73.3 years. Male participants with higher education performed more exercise than their counterparts. The moderate- and high-intensity groups reported better general health condition than the no exercise group. Depression and worse health were more common in the no exercise group. Participants in the moderate-intensity exercise group had lower risk for depression than those in the no exercise group (adjusted odds ratio: 0.13, 95% confidence interval: 0.02-0.92) after adjusting for demographic characteristics, health conditions, and comorbidities, whereas participants in the low- and high-intensity exercise did not have a lower risk. The no exercise group had the highest proportions of emergency, hospitalization, and total healthcare visits.

CONCLUSIONS

Exercise is associated with better HRQoL, and lack of exercise is associated with higher medical resource use in elderly people with diabetes. Encouraging exercise is recommended in this population.

Physical Activity Trajectories among Persons of Turkish Descent Living in Germany-A Cohort Study

Physical activity (PA) behavior is increasingly described as trajectories taking changes over a longer period into account. Little is known, however, about predictors of those trajectories among migrant populations. Therefore, the aim of the present cohort study was to describe changes of PA over six years and to explore migration-related and other predictors for different PA trajectories in adults of Turkish descent living in Berlin. At baseline (2011/2012) and after six years, sociodemographics, health behavior, and medical information were assessed. Four PA trajectories were defined using data of weekly PA from baseline and follow-up: "inactive", "decreasing", "increasing", and "stable active". Multivariable regression analyses were performed in order to determine predictors for the "stable active" trajectory, and results were presented as adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). In this analysis, 197 people (60.9% women, mean age ± standard deviation 49.9 ± 12.8 years) were included. A total of 77.7% were first-generation migrants, and 50.5% had Turkish citizenship. The four PA trajectories differed regarding citizenship, preferred questionnaire language, and marital status. "Stable active" trajectory membership was predicted by educational level (high vs. low: aOR 4.20, 95%CI [1.10; 16.00]), citizenship (German or dual vs. Turkish only: 3.60 [1.20; 10.86]), preferred questionnaire language (German vs. Turkish: 3.35 [1.05; 10.66]), and BMI (overweight vs. normal weight: 0.28 [0.08; 0.99]). In our study, migration-related factors only partially predicted trajectory membership, however, persons with citizenship of their country of origin and/or with poor language skills should be particularly considered when planning PA prevention programs.

Probability of myopia in children with high refined carbohydrates consumption in France

BACKGROUND

Evaluate risk factors for paediatric myopia in a contemporary French cohort taking into account consumption of refined carbohydrates (starches and sugars).

METHODS

An epidemiological cross-sectional study was conducted between May 2017 and May 2018. Two hundred sixty-four children aged 4 to 18 years attending the Centre Hospitalier Universitaire Gui de Chauliac in Montpellier were recruited. Ophthalmologic or optometric cycloplegic refraction were measured. Evaluated risk factors for myopia were collected, including family history of myopia, outdoor time, reading time, screen time, physical activity, and consumption of refined carbohydrates. Association between the probability of at least one eye showing myopia (defined as < 0 D) and frequency of refined carbohydrates consumption adjusted for risk factors and control factors was tested.

RESULTS

Overall, 86/264 (32.6%) children investigated showed myopia in at least one eye. We included 180 children exhibiting refraction < 3 D in both eyes: 88 (48.9%) girls and 92 (51.1%) boys. The consumption of refined carbohydrates significantly increased the probability of myopia for girls (odds ratio [OR] = 1.07; 95% confidence interval [CI], 1.02-1.13; P = 0.009) but decreased it for boys (OR = 0.94; 95% CI, 0.89-0.98; P = 0.011). The probability of myopia was marginally increased with increased screen time (OR = 2.32; 95% CI, 0.94-6.47; P = 0.083). Outdoor time seemed marginally protective (OR = 0.74; 95% CI, 0.54-1.01; P = 0.057).

CONCLUSION

Refined carbohydrates consumption could be associated with child myopia, with increased probability for girls and unexpected reduced probability for boys, possibly due to the fact that frequency of carbohydrates consumption do not really capture boy's chronic hyperglycemia, boys being more physically active than girls at all ages. Some known risk/protective factors of myopia were marginally significant: screen time (risk) and outdoor time (protective). This study reinforces the belief that modifiable risk factors for myopia could be targets for future public health actions.

Comprehensive School Physical Activity Programming and Health Behavior Knowledge

No study to date has examined the effect of a multicomponent school-based physical activity program on health behavior knowledge in a large sample of low-income children from the US. The purpose of this study was to explore the change in physical activity and nutrition knowledge during a Comprehensive School Physical Activity Program (CSPAP) in children. Participants were a convenience sample of 789 children recruited from the 4th to 6th grades from five low-income Title I schools located within the Mountain West Region of the US. Students completed two questionnaires consisting of a physical activity and a nutrition knowledge assessment. Questionnaires were administered at baseline before the commencement of CSPAP and at a 36-week follow-up. Data were analyzed using a 3 × 2 × 2 doubly MANOVA test. Physical activity knowledge scores significantly improved from pretest to posttest during the intervention (p = 0.045, Cohen's d = 0.18). Grade level modified the time effects, with older children in grades 5 and 6 displaying greater improvements in physical activity knowledge than younger children in grade 4 (p = 0.044, Cohen's d = 0.33). There were no significant improvements in nutrition knowledge scores during the CSPAP (p = 0.150). These findings demonstrate that improvements in physical activity knowledge can occur during a multicomponent school-based intervention. Improvements in physical activity knowledge may translate to improvements in habitual physical activity behaviors and positively influence children's health outcomes, especially in older children.

Physical activity and its correlates in a pediatric solid-organ transplant population

PA has been shown to have benefits in SOT patients. Studies assessing physical activity levels and its correlates in a pediatric solid-organ transplant population are limited. The aim of this study was to assess PA levels and identify baseline and contemporaneous factors that contribute to PA in a pediatric SOT population. A retrospective cross-sectional review was performed on 58 pediatric transplant patients (16 heart, 29 kidney, and 13 liver transplant). PA was measured by PAQ-C or PAQ-A. Demographics, baseline, and contemporaneous factors were collected. There were no significant differences in baseline and contemporaneous characteristics between heart, kidney, and liver transplant recipients. SOT recipients were 15.2 [12.3-17.3] years old at time of completing the PAQ. Median PAQ score was 2.2 [1.7-2.9]. There were no significant differences in PAQ scores between organ transplant type or between genders. Lower PAQ score was associated with sensory disability (9 vs 49 without disability; P = <.01) and age at time of completing the PAQ (r = -.50, P = <.01). These results suggest that older age at time of completing the PAQ and presence of sensory disability may influence PA levels in the pediatric SOT population.

School and Family Environment is Positively Associated with Extracurricular Physical Activity Practice among 8 to 16 Years Old School Boys and Girls

Extracurricular physical activity in children and adolescents can help achieve compliance with the World Health Organization (WHO) recommendations for physical activity. The purpose of this study was to evaluate factors in school and family environments of children and adolescents in Spain that could be related to the practice of extracurricular physical activity. Multistage random cluster sampling was conducted to include 128 schools with the participation of 10,096 students between the ages of 7 and 16. Participants completed the survey of sports habits designed by the National Sports Council. The results revealed a higher participation in extracurricular sports activities among boys (OR: 1.67 (1.5–1.9)) and students in primary education (up to 12 years old) (OR: 1.8 (1.7–2.0)). Likewise, a statistically significant relationship (p < 0.005) was observed between families where another family member practiced sports and lower number of screen time hours, improved academic performance, and better self-perceived health. Participation of children and adolescents in extracurricular sports activities seems to be associated with their immediate environment. It is therefore essential to emphasize the importance of establishing physical activity habits from an early age in family and school environments.

Dance Programs for School-Age Individuals With Disabilities: A Systematic Review

The purpose of this systematic review was to examine published research literature pertaining to dance programs for school-age individuals with disabilities by describing study characteristics and major findings. Electronic database searches were conducted to identify relevant articles published between January 2008 and August 2018. Sixteen articles met all inclusion criteria, and extracted data from the articles included major findings, study design characteristics (e.g., sample size), and dance program characteristics (e.g., location of program). The methodological quality of each study was assessed using the Crowe Critical Appraisal Tool. Major findings expand on previous reviews on dance by including school-age individuals with disabilities. The critical appraisal of the articles demonstrates a gap in study design rigor between studies. Future research should aim to specify sampling strategies, use theories to frame the impact of dance programs, and provide a thorough description of ethical processes and dance classes.

Effectiveness and cost-effectiveness of the GoActive intervention to increase physical activity among UK adolescents: A cluster randomised controlled trial

BACKGROUND

Less than 20% of adolescents globally meet recommended levels of physical activity, and not meeting these recommended levels is associated with social disadvantage and rising disease risk. The determinants of physical activity in adolescents are multilevel and poorly understood, but the school's social environment likely plays an important role. We conducted a cluster randomised controlled trial to assess the effectiveness of a school-based programme (GoActive) to increase moderate-to-vigorous physical activity (MVPA) among adolescents.

METHODS AND FINDINGS

Non-fee-paying, co-educational schools including Year 9 students in the UK counties of Cambridgeshire and Essex were eligible for inclusion. Within participating schools (n = 16), all Year 9 students were eligible and invited to participate. Participants were 2,862 13- to 14-year-olds (84% of eligible students). After baseline assessment, schools were computer-randomised, stratified by school-level pupil premium funding (below/above county-specific median) and county (control: 8 schools, 1,319 participants, mean [SD] participants per school n = 165 [62]; intervention: 8 schools, 1,543 participants, n = 193 [43]). Measurement staff were blinded to allocation. The iteratively developed, feasibility-tested 12-week intervention, aligned with self-determination theory, trained older adolescent mentors and in-class peer-leaders to encourage classes to conduct 2 new weekly activities. Students and classes gained points and rewards for engaging in any activity in or out of school. The primary outcome was average daily minutes of accelerometer-assessed MVPA at 10-month follow-up; a mixed-methods process evaluation evaluated implementation. Of 2,862 recruited participants (52.1% male), 2,167 (76%) attended 10-month follow-up measurements; we analysed the primary outcome for 1,874 participants (65.5%). At 10 months, there was a mean (SD) decrease in MVPA of 8.3 (19.3) minutes in the control group and 10.4 (22.7) minutes in the intervention group (baseline-adjusted difference [95% confidence interval] -1.91 minutes [-5.53 to 1.70], p = 0.316). The programme cost £13 per student compared with control; it was not cost-effective. Overall, 62.9% of students and 87.3% of mentors reported that GoActive was fun. Teachers and mentors commented that their roles in programme delivery were unclear. Implementation fidelity was low. The main methodological limitation of this study was the relatively affluent and ethnically homogeneous sample.

CONCLUSIONS

In this study, we observed that a rigorously developed school-based intervention was no more effective than standard school practice at preventing declines in adolescent physical activity. Interdisciplinary research is required to understand educational-setting-specific implementation challenges. School leaders and authorities should be realistic about expectations of the effect of school-based physical activity promotion strategies implemented at scale.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN31583496.

Active Breaks: A Pilot and Feasibility Study to Evaluate the Effectiveness of Physical Activity Levels in a School Based Intervention in an Italian Primary School

Background: The school gives access to children, regardless of age, ethnicity, gender and socio-economic class and can be identified as the key environment in which to promote children’s physical activity (PA). The guidelines of the European Union recommend accumulating at least 10-min bouts of PA to reach the daily 60 min. Active breaks (ABs) led by teachers inside the classroom represent a good strategy to promote PA. The aim of this pilot and feasibility study was to evaluate the feasibility and effectiveness in terms of PA level of an AB programme in children aged 8–9 years attending primary school. Methods: A pre-post quasi-experimental pilot and feasibility study was performed in two primary school classes, one of which was assigned to a 14-week AB intervention (AB group) and the other to the control group (CG). At baseline and at follow-up, children were monitored for sedentary and motor activity during an entire week using ActiGraph Accelerometer (ActiLife6 wGT3X-BT). The satisfaction of children and teachers was assessed by self-administered questionnaires. Results: In the pre-post comparison, AB group (n = 16) showed a reduction in the minutes spent in weekly sedentary activity (−168.7 min, p > 0.05), an increase in the number of step counts (+14,026.9, p < 0.05) and in time spent in moderate to vigorous PA (MVPA): weekly MVPA: +64.4 min, daily MVPA: +8.05 min, percentage of MVPA: +0.70%. On the contrary, CG showed a worsening in all variables. ANCOVA analysis, after adjusting for baseline values, showed significant differences between the AB group and CG for time spent in MVPA, percentage of MVPA and step counts. The satisfaction of children and teachers was good. Teachers were able to adapt the AB protocol to the needs of the school curriculum, thus confirming the feasibility of the AB programme. Conclusions: This pilot and feasibility study showed the feasibility and effectiveness of the AB protocol and represented the basis for a future controlled trial.

Developing Empirical Decision Points to Improve the Timing of Adaptive Digital Health Physical Activity Interventions in Youth: Survival Analysis

Background

Current digital health interventions primarily use interventionist-defined rules to guide the timing of intervention delivery. As new temporally dense data sets become available, it is possible to make decisions about the intervention timing empirically.

Objective

This study aimed to explore the timing of physical activity among youth to inform decision points (eg, timing of support) for future digital physical activity interventions.

Methods

This study comprised 113 adolescents aged between 13 and 18 years (mean age 14.64, SD 1.48 years) who wore an accelerometer for 20 days. Multilevel survival analyses were used to estimate the most likely time of day (via odds ratios and hazard probabilities) when adolescents accumulated their average physical activity. The interacting effects of physical activity timing and moderating variables were calculated by entering predictors, such as gender, sports participation, and school day, into the model as main effects and tested for interactions with the time of day to determine conditional main effects of these predictors.

Results

On average, the likelihood that a participant would accumulate a typical amount of moderate-to-vigorous physical activity increased and peaked between 6 PM and 8 PM before decreasing sharply after 9 PM. Hazard and survival probabilities suggest that optimal decision points for digital physical activity programs could occur between 5 PM and 8 PM.

Conclusions

Overall, the findings of this study support the idea that the timing of physical activity can be empirically identified and that these markers may be useful as intervention triggers.

Cross-Country Comparisons of Physical Activity and Sedentary Behavior among 5-Year-Old Children

PURPOSE

Previous studies have observed that physical activity (PA) levels tend to be lower in the U.S. population than in many other countries. Within the U.S., PA levels in children are lower in the South than in other regions. Cross-country and interregional differences in PA have not been studied in young children.

METHODS

In an ongoing study of children at genetic risk for Type 1 diabetes, PA was measured by accelerometry in samples of 5-year-old children (n = 2008) from Finland (n = 370), Germany (n = 85), Sweden (n = 706), and the U.S. (n = 847). The U.S. sample was drawn from centers in Washington State, Colorado, and Georgia/Florida. Children wore accelerometers for 7 days, and the data were reduced to daily minutes of light-, moderate- (MPA), vigorous- (VPA), and moderate-to-vigorous- (MVPA) intensity PA and sedentary behavior. Multiple regression was used to compare children across countries and across regions in the U.S, adjusting for wear time, body mass index, and demographic characteristics.

RESULTS

After adjusting for previously mentioned factors, MVPA and MPA were lower in U.S. children than those in Finland and Sweden. Estimates of physical activity were higher in Finland than in other countries, although not all comparisons were significantly different. U.S children spent significantly more time in sedentary behavior than children in Finland (p < 0.0001). Within the U.S., children's PA was consistently lowest in Georgia/Florida and highest in Washington.

CONCLUSIONS

Cross-country differences in PA, previously reported for adults and adolescents, are evident in 5-year-old children. In general, PA levels are lower in U.S. children than their European counterparts, and within the U.S., are lower in Georgia/Florida and Colorado than in Washington. Future studies should be designed to identify the factors that explain these differences.

High Intensity Interval Training (HIIT) Improves Cardiorespiratory Fitness (CRF) in Healthy, Overweight and Obese Adolescents: A Systematic Review and Meta-Analysis of Controlled Studies

Background: High Intensity Interval Training (HIIT) is a sustainable and effective method for improving Cardiorespiratory Fitness (CRF) in adolescents. HIIT is proven to produce equal or greater improvements in CRF when compared to moderate intensity continuous exercise (MICE) in adolescents. Methods: The studies included were considered eligible if: (1) Participants were adolescents (11–18 years old); (2) Examined changes in CRF measured either directly or indirectly; (3) Included a non-exercising control group or MICE comparison group; (4) Participants were matched at enrolment; (5) Reported HIIT protocol information; (6) Provided HIIT intensity. A meta-analysis was conducted to determine the effect of HIIT on CRF. Meta-regression and moderator analyses were performed out to quantitatively examine moderators of protocol design on CRF improvements. Results: HIIT displays a moderate effect to improve CRF (g = 0.86, 95% CI 0.518–1.106, p < 0.001). Neither study duration (weeks), nor total or weekly accumulated HIIT volume (min) displayed any significant moderation effect on pooled improvement on CRF (p > 0.05). Conclusions: HIIT is an effective method to improve CRF in adolescents, irrespective of body composition. Notably, meta regression analysis identified that prolonged high volume HIIT programs are similarly effective to short term low volume HIIT programs. This becomes of particular interest for those involved in school curricula, where short HIIT exercise may provide a pragmatic adjunct to the health benefits of Physical Education (PE) lessons.

Academic Schedule and Day-to-Day Variations in Sedentary Behavior and Physical Activity of University Students

Students starting at university tend to adopt unhealthy behaviors. With students expected to sit during classes, their academic schedule may be responsible for their activity patterns. The aim of the current study was to investigate the relationship between university students’ academic schedule and day-to-day variations in sedentary behavior (SB) and physical activity (PA). The activity of 317 first-year undergraduate students (mean age 19.6 ± 1.4 years, 69.4% female, 30.0% male, and 0.6% other) was measured with the activPAL3™ triaxial monitor for seven consecutive days. Each class hour was found to be associated with 9.0 additional minutes of SB (95% CI [4.9, 13.1]), 54 additional seconds of moderate-to-vigorous PA (MVPA; 95% CI [12, 96]), and 12.2 min less time in bed (95% CI [−16.6, −7.8]). Active SB ratio (total duration of SB bouts < 30 min divided by total SB duration) decreased by 0.011 per hour of class scheduled for the students (95% CI [−0.016, −0.006]). Light PA (LPA) was not significantly associated with class duration. Students tend to cycle more on days with classes. Seated transportation was not significantly related to whether the students had classes or not. Overall, the academic schedule is associated with SB and PA in students.

Associations between Public Transport Accessibility around Homes and Schools and Walking and Cycling among Adolescents

Good public transport accessibility is associated with active travel, but this is under-researched among adolescents. We tested associations between public transport accessibility and active travel among school-going adolescents (12-18 years; n = 1329) from Melbourne, Australia analysing Victorian Integrated Survey of Travel and Activity data. Outcomes included main mode of transport to school and accumulating ≥20 min of active travel over the day. Low and high compared to no public transport accessibility around homes were associated with higher odds of public transport use (low (odds ratio (OR): 1.94 95% confidence interval (CI): 1.28, 2.94) high (OR: 2.86 95% CI: 1.80, 4.53)). Low and high public transport accessibility around homes were also associated with higher prevalence of achieving ≥20 min of active travel (low (prevalence ratio (PR): 1.14 95% CI: 0.97, 1.34) high (PR: 1.31 95% CI: 1.11, 1.54)) compared to none. Public transport accessibility around schools was associated with public transport use (low (OR: 2.13 95% CI: 1.40, 3.24) high (OR: 5.07 95% CI: 3.35, 7.67)) and achieving ≥20 min of active travel (low (PR: 1.18 95% CI: 1.00, 1.38) high (PR: 1.64 95% CI: 1.41, 1.90)). Positive associations were confirmed between public transport accessibility and both outcomes of active travel.

Classroom active breaks: a feasibility study in Southern Italy

Though classroom time has been identified as a contributing factor to sedentary behavior, school has been recognized as the main educational setting providing physical activity (PA) opportunities. The purpose of this study was to develop and evaluate the feasibility of a classroom-based intervention which integrates PA during the school time, and assess its potential effect on reducing inactivity in primary school children. The intervention was performed in a sample of 47 children attending a primary school in the south of Italy and it was structured in two sessions of classroom active breaks (CABs) in three school days a week, shared with and supervised by the teachers. CABs showed an overall potential positive effect on the reduction of inactivity of ∼12 min and an equivalent increase in PA levels, of which 5 min were of moderate/vigorous intensity. Girls showed lower time spent in light and moderate PA and higher amount of inactivity than boys and responded better to the intervention. The satisfaction of children and teachers was high. CABs program is a safe tool to reduce inactivity and increase moderate/vigorous PA. Designing structured exercise breaks adapted in a flexible way to meet the needs of the school curriculum program may increase the feasibility of such PA program in the schools.

Engaging Fathers to Increase Physical Activity in Girls: The "Dads And Daughters Exercising and Empowered" (DADEE) Randomized Controlled Trial

Background

Existing strategies to increase girls' physical activity levels have seen limited success. Fathers may influence their children's physical activity, but often spend more time with their sons and rarely participate in family-based programs.

Purpose

To test a novel program designed to increase the physical activity levels of fathers and their daughters.

Methods

In a two-arm RCT, 115 fathers (29-53 years) and 153 daughters (4-12 years) were randomized to (i) the "Dads And Daughters Exercising and Empowered" (DADEE) program, or (ii) a wait-list control. The 8-week program included weekly educational and practical sessions plus home tasks. Assessments were at baseline, 2 months (postintervention), and 9 months. The primary outcomes were father-daughter physical activity levels (pedometry). Secondary outcomes included screen-time, daughters' fundamental movement skill proficiency (FMS: perceived and objective), and fathers' physical activity parenting practices.

Results

Primary outcome data were obtained from 88% of daughters and 90% of fathers at 9 months. Intention-to-treat analyses revealed favorable group-by-time effects for physical activity in daughters (p = .02, d = 0.4) and fathers (p < .001, d = 0.7) at postintervention, which were maintained at 9 months. At postintervention and follow-up, significant effects (p < .05) were also identified for daughters' FMS competence (objective: d = 1.1-1.2; perceived: d = 0.4-0.6), a range of fathers' physical activity parenting practices (d = 0.3-0.8), and screen-time for daughters (d = 0.5-0.8) and fathers (d = 0.4-0.6, postintervention only). Program satisfaction and attendance were very high.

Conclusions

This study provided the first experimental evidence that efforts to increase physical activity behavior in preadolescent girls would benefit from a meaningful engagement of fathers. Clinical Trial information: Australian New Zealand Clinical Trials Registry: ACTRN12615000022561.

Pupils' use of school outdoor play settings across seasons and its relation to sun exposure and physical activity

BACKGROUND

Long outdoor stay may cause hazardous exposure to ultraviolet radiation (UVR) from the sun even at high latitudes as in Sweden (Spring to Autumn). On the other hand, long outdoor stay is a strong predictor of primary school children´s free mobility involving moderate to vigorous physical activity (MVPA). UV-protective outdoor environments enable long outdoor stay. We investigated the concurrent impact of different school outdoor play settings upon pupils´ sun exposure and levels of physical activity across different ages, genders, and seasons.

METHOD

During 1 week each in September, March, and May, UVR exposure and MVPA were measured in pupils aged 7-11 years. Erythemally effective UVR exposure was measured by polysulphone film dosimeters and MVPA by accelerometers. Schoolyard play was recorded on maps, and used areas defined as four play settings (fixed play equipment, paved surfaces, sport fields, and green settings), categorized by season and gender.

RESULTS

During the academic year, sport fields yielded the highest UVR exposures and generated most time in MVPA. In March, time outdoors and minutes in MVPA dropped and UVR exposures were suberythemal at all play settings. In May, green settings and fixed play equipment close to greenery promoted MVPA and protected from solar overexposure during long outdoor stays.

CONCLUSION

More outdoor activities in early spring are recommended. In May, greenery attractive for play could protect against overexposure to UVR and stimulate both girls and boys to vigorous play.

Daily Relations between Social Perceptions and Physical Activity among College Women

OBJECTIVES

There is a need to develop more effective physical activity (PA) promotion programs for college women. Theory and evidence suggest that perceptions of the social environment play a role in college women's PA, though little is known about how these perceptions are associated with PA at the day level. The goal of this study was to examine relations between changes in college women's daily social perceptions and objectively assessed PA over seven days.

DESIGN

Daily diary method.

METHOD

College women (n = 80, M Age = 20, M BMI = 23.1 kg/m2) wore Fitbit wristbands and completed daily self-reports of (1) the quantity and perceived intensity of their social interactions (positive/negative), and (2) the occurrence of social comparisons (based on appearance/health/status) for seven days.

RESULTS

Multilevel models showed daily variability in predictors and outcomes (ps < 0.0001), as well as relations between within-person changes in social perceptions and PA. Increases in negative interactions (particularly those with friends) were consistently associated with decreases in daily PA, whereas increases in positive interactions showed limited relations (srs = -0.22-0.34). Days with health comparisons were days with greater PA for women who had stronger overall interest in comparisons, but were days with less PA for women with weaker overall interest (srs = 0.22-0.33). PA did not differ between days with vs. without appearance comparisons.

CONCLUSIONS

Social perceptions show meaningful day-to-day variability and relations with college women's daily PA, and specific associations may be useful for improving tailored interventions for college women.

Correlates of physical activity in fifth-grade students in Ho Chi Minh City, Vietnam

Studies investigating correlates of physical activity (PA) using objective PA measurements among primary school-aged children are limited in Asia, particularly Vietnam. This study examined psychosocial and environmental factors associated with PA among fifth-grade students in eight primary schools in Ho Chi Minh city, Vietnam. Bivariate analyses showed that for every month increase in students' age, an increase of 66 steps/day (p<0.05) was found; boys had 1442 more steps/day than girls (p<0.001); and students from lower income households had 1169 steps/day less than those from higher income households (p<0.01). For every unit increase in self-efficacy, perceived social influences, intention to be physically active, and parental support for PA, an increase of 220, 200, 522, and 117 steps/day (p<0.01) was found respectively. In multivariable analysis, only intention and parental support for PA remained significant (p<0.01). About 21% of variation in daily steps was explained by demographic characteristics and an additional 13% by psychosocial influences. In conclusion, intention to be physically active and parental support are important factors and should be considered when designing PA interventions in school/community-based settings.

Environmental Mismatch: Do Associations between the Built Environment and Physical Activity among Youth Depend on Concordance with Perceptions?

Without accurate awareness of features within the built environment, the availability of a supportive built environment alone may not be sufficient to influence physical activity levels. We examined the moderating effects of concordance/discordance between selected objective and perceived built environment features in the relationship between objective built environment features and physical activity. Cross-sectional data from 465 youth aged 12–20 years from 18 schools in Melbourne, Australia were used. The relationship between trails and physical activity differed by concordance/discordance. There were positive relationships among those with concordant perceptions, but no significant differences for those with discordant perceptions. At least for trails, environmental interventions designed to enhance physical activity may be less effective if efforts are not made to enhance individuals’ awareness of their environment.

Associations between perceived and actual physical literacy level in Chinese primary school children

Background

The concept of physical literacy (PL) is gaining popularity within public health and physical education circles. However, little is known about the relationship between perceived and actual PL levels among school-aged children. The aim of this study is to explore the associations between perceived and actual levels of PL of primary school students in China.

Methods

A total of 327 children (153 boys and 174 girls) with a mean (SD) age of 10.0 (±1.0) years were included for analysis. PL perceptions were measured using the Perceived Physical Literacy Instrument. Children’s actual level of PL was objectively assessed by the Chinese version of the Canadian Assessment of Physical Literacy, 2nd edition, which consists of four domains: Daily Behavior, Physical Competence, Motivation and Confidence, and Knowledge and Understanding. Pearson’s correlation coefficients were calculated to examine the relationship between students’ perceived and actual PL levels, whereas Multivariate Analysis of Variance (MANOVA) was calculated to investigate the gender, relative age differences, and interaction effect (2 × 4) on perceived and actual PL levels respectively.

Results

Significant correlations were observed between the perceptions and actual PL scores in both boys (r = .46, p < .01) and girls (r = .41, p < .01). Low to moderate significances were shown between each domain of perceived PL and actual PL (from .16 to .49). Further MANOVA results revealed that there were significant gender differences in the Daily Behavior domain of actual PL (F (1, 319) = 30.15, p < .001, Wilks’ Λ = 540.88, η²_partial = .09). Overall, boys had both higher actual PL scores (58.9) and PL perceptions (37.3) than girls. Neither relative age effect nor interaction effect (2 × 4) was observed for the current participants in all the variables.

Conclusions

This study is the first to examine the associations between the perceived and actual levels of PL in Chinese children. Additional studies should explore the importance of children’s perceptions of PL when assessing the actual level of PL in physical education and health settings. Girls should be more encouraged by PE teachers to participate actively in physical activities in the school environment.

Children’s neighbourhood physical environment and early development: an individual child level linked data study

Background

Identification of features of the neighbourhood physical environment that have a causal association with positive child development is important for promoting long-term developmental health. Previous research on these associations have been conducted at the neighbourhood level, and do not account for individual variation in exposure to these features.

Methods

This cross-sectional study utilised de-identified linked administrative data. Neighbourhood features were measured with Geographic Information Systems and identified within a 1600 m service area around the child’s home address. The study population included a random selection of 5024 Western Australian children who participated in the 2012 Australian Early Development Census (AEDC; median age 5 years, 5 months). Multi-level logistic regressions modelled the odds of children scoring in the bottom 10% on the physical, social or emotional AEDC domains as an outcome of neighbourhood features.

Results

After adjustment for individual and neighbourhood sociodemographic factors, lower odds of physical vulnerability were associated with increased neighbourhood residential density, presence of railway station, and higher counts of playgroups and kindergartens. Larger areas of neighbourhood home-yard space were associated with increased odds of physical and social vulnerability. Presence of high-quality green spaces was associated with lower odds of social vulnerability. Increased road traffic exposure was associated with higher odds of social and emotional vulnerability.

Conclusions

The neighbourhood physical environment has a weak but significant association with early childhood development. Future research should consider the interplay between the neighbourhood environment and proximal influences, including parenting attributes and socioeconomic status, and how they influence early child development.