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Contardo Ayala AM, Ridgers ND, Timperio A, Arundell L, Dunstan DW, Hesketh KD, Daly RM, Salmon J. The association between device-measured sitting time and cardiometabolic health risk factors in children. BMC Public Health 2024; 24:1015. [PMID: 38609909 PMCID: PMC11010425 DOI: 10.1186/s12889-024-18495-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND There is limited evidence of the associations between postural-derived sitting time, waist-worn derived sedentary time and children's health and the moderation effect of physical activity (PA). This study examined associations of children's device-measured sitting time with cardiometabolic health risk factors, including moderation by physical activity. METHODS Cross-sectional baseline data from children (mean-age 8.2 ± 0.5 years) in Melbourne, Australia (2010) participating in the TransformUs program were used. Children simultaneously wore an activPAL to assess sitting time and an ActiGraph GT3X to assess sedentary time and physical activity intensity. Cardiometabolic health risk factors included: adiposity (body mass index [BMI], waist circumference [WC]), systolic and diastolic blood pressure (SBP, DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, triglycerides, fasting plasma glucose (FPG), serum insulin, and 25-hydroxyvitaminD (25[OH]D). Linear regression models (n = 71-113) assessed associations between sitting time with each health risk factor, adjusted for different PA intensities (i.e. light [LIPA], moderate-vigorous intensities [MVPA], separately on each model), age, sex, adiposity, and clustering by school. Interaction terms examined moderation. The analyses were repeated using device-measured sedentary time (i.e. ActiGraph GT3X) for comparison. RESULTS Sitting time was positively associated with SBP (b = 0.015; 95%CI: 0.004, 0.026), DBP (b = 0.012; 95%CI:0.004, 0.020), and FPG (b = 0.001; 95%CI: 0.000, 0.000), after adjusting for higher PA intensities. The association between sitting time and insulin (b = 0.003; 95%CI: 0.000, 0.006) was attenuated after adjusting for higher PA intensities. When the models were adjusted for LIPA and MVPA, there was a negative association with LDL (b=-0.001; 95%CI: -0.002, -0.000 and b=-0.001; 95%CI: -0.003, -0.000, respectively). There was a negative association of sedentary time with WCz (b=-0.003; 95%CI: -0.005, 0.000) and BMIz (b=-0.003; 95%CI: -0.006, -0.000) when the models were adjusted by MVPA. Sedentary time was positively associated with triglycerides (b = 0.001; 95%CI: 0.000, 0.001) but attenuated after adjusting for MVPA. No evidence of moderation effects was found. CONCLUSIONS Higher volumes of sitting and sedentary time were associated with some adverse associations on some cardiometabolic health risk factors in children. These associations were more evident when sitting time was the predictor. This suggests that reducing time spent sitting may benefit some cardiometabolic health outcomes, but future experimental research is needed to confirm causal relationships and identify the biological mechanisms that might be involved. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12609000715279.
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Affiliation(s)
- Ana María Contardo Ayala
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Victoria, Australia.
| | - Nicola D Ridgers
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Victoria, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Victoria, Australia
| | - Lauren Arundell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Victoria, Australia
| | - David W Dunstan
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Victoria, Australia
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Victoria, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Victoria, Australia
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Aljahdali AA, Baylin A, Ruiz-Narvaez EA, Kim HM, Cantoral A, Tellez-Rojo MM, Banker M, Peterson KE. Sedentary patterns and cardiometabolic risk factors in Mexican children and adolescents: analysis of longitudinal data. Int J Behav Nutr Phys Act 2022; 19:143. [PMID: 36456985 PMCID: PMC9714228 DOI: 10.1186/s12966-022-01375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 10/28/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Sedentary behavior is a modifiable risk factor for cardiometabolic health; however, the assessment of total sedentary time may not capture youth's highly active and interrupted activity patterns. This study examined the associations between sedentary activity patterns and cardiometabolic risk factors among Mexican youth, who have a disproportionate burden of metabolic diseases, using a repeated measure design out of a longitudinal data. METHODS 570 subjects in the Early Life Exposure in Mexico to ENvironmental Toxicants (ELEMENT) birth cohort, who were followed up to three-time points during adolescence, were included. Bout duration, and frequency and percentages of waking time spent in specific intensities of activity, were quantified using ActiGraph wGT3X-BT wrist accelerometers. Self-reported questionnaires were used to query the usual duration of different sedentary behaviors. Outcomes were fasting lipid profile, markers for glucose homeostasis, anthropometry, and blood pressure. Associations were modeled using linear mixed-effects models, and isotemporal substitution approach was additionally used to assess the effect of replacing objectively assessed sedentary activity with other activity intensities, adjusting for potential confounders. RESULTS Each hour of self-reported screen-based time was positively associated with diastolic blood pressure (mm Hg) [β = 0.30, 95% confidence interval (95% CI) = 0.10, 0.51], and an hour of other sedentary time was associated with log serum glucose (mg/dL) [β = 0.01, 95% CI = 0.004, 0.017]. Substitution models showed that replacing 5% of sedentary time with moderate to vigorous physical activity (MVPA) was associated with lower waist circumference (cm) [β = - 1.35, 95% CI = - 1.91, - 0.79] and log serum triglycerides (mg/dL) [β = - 0.11, 95% CI = - 0.18, - 0.03]. Substituting one uninterrupted sedentary bout with light activity was associated with lower insulin (μIU/mL) [β = - 0.06, 95% CI = - 0.10, - 0.02]. CONCLUSIONS Sedentary time was associated with cardiometabolic risk factors in Mexican youth in a context-specific manner. Replacing sedentary time with higher intensities was associated with improvements in some cardiometabolic markers.
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Affiliation(s)
- Abeer A. Aljahdali
- grid.412125.10000 0001 0619 1117Department of Clinical Nutrition, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.214458.e0000000086837370Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI USA
| | - Ana Baylin
- grid.214458.e0000000086837370Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Epidemiology, University of Michigan, Ann Arbor, MI USA
| | - Edward A. Ruiz-Narvaez
- grid.214458.e0000000086837370Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI USA
| | - Hyungjin Myra Kim
- grid.214458.e0000000086837370Center for Computing, Analytics and Research, University of Michigan, Ann Arbor, MI USA
| | - Alejandra Cantoral
- grid.501731.10000 0004 0484 7567Department of Health, Iberoamerican University, Mexico City, Mexico
| | - Martha M. Tellez-Rojo
- grid.415771.10000 0004 1773 4764Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Margaret Banker
- grid.214458.e0000000086837370Department of Biostatistics, University of Michigan, Ann Arbor, MI USA
| | - Karen E. Peterson
- grid.214458.e0000000086837370Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan, School of Public Health, Ann Arbor, MI 48109-2029 USA
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Smallcombe JW, Biddle GJH, Slater T, Thackray AE, Dunstan DW, Barrett LA, Tolfrey K. Breaking Sitting Time with Physical Activity Increases Energy Expenditure but Does Not Alter Postprandial Metabolism in Girls. Med Sci Sports Exerc 2022; 54:1850-1860. [PMID: 35714076 DOI: 10.1249/mss.0000000000002979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Young people spend a substantial proportion of their time at school sedentary; therefore, this setting represents an important target for interventions aimed at displacing sedentary time with physical activity. This study aimed to examine the postprandial metabolic effects of breaking sedentary time by accumulating walking and repeated bouts of nonambulatory standing during simulated school days in inactive adolescent girls. METHODS Seventeen girls (mean ± SD = 12.8 ± 0.4 yr) completed two 3-d experimental conditions. On days 1 and 2 of the standing + walking (STD-WLK) experimental trial, participants interrupted sedentary time by completing 4 × 10 min bouts of self-paced walking and accumulated 18 × 5 min standing bouts during each simulated school day. On day 3 of STD-WLK, participants attended school as normal with no additional physical activity or standing prescribed. On all 3 d of the control condition (CON), participants attended school as normal with no physical activity intervention. On days 2 and 3 of both STD-WLK and CON, a baseline capillary blood sample was provided to determine fasting [TAG] and [glucose]. Participants then consumed a standardized breakfast (0 h) and lunch (4.7 h), and blood samples were provided postprandially at 2.7, 5.3, and 7.3 h for [TAG] and [glucose]. RESULTS Energy expenditure was 28% (95% confidence interval = 8% to 52%) higher during school hours on day 1 and day 2 during STD-WLK compared with CON (2171 vs 1693 kJ; effect size = 0.89, P = 0.008). However, no reduction of fasting or postprandial [TAG] or [glucose] was observed on day 2 or day 3 ( P ≥ 0.245). CONCLUSIONS Two consecutive days of breaking prolonged sitting with self-paced walking and intermittent standing had no meaningful effect on postprandial metabolism in adolescent girls.
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Affiliation(s)
| | - Gregory J H Biddle
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UNITED KINGDOM
| | - Tommy Slater
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UNITED KINGDOM
| | | | | | - Laura A Barrett
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UNITED KINGDOM
| | - Keith Tolfrey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UNITED KINGDOM
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Kolb S, Burchartz A, Oriwol D, Schmidt SCE, Woll A, Niessner C. Indicators to Assess Physical Health of Children and Adolescents in Activity Research-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010711. [PMID: 34682457 PMCID: PMC8535832 DOI: 10.3390/ijerph182010711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 12/11/2022]
Abstract
Sufficient physical activity can help promote and maintain health, while its lack can jeopardize it. Since health and physical activity lay their foundation for later life in childhood and adolescence, it is important to examine this relationship from the beginning. Therefore, this scoping review aims to provide an overview of physical health indicators in children and adolescents in research on the effects of physical activity and sedentary behavior. We identified the indicators used to quantify or assess physical health and summarized the methods used to measure these indicators. We systematically searched Scopus, Pubmed, and Web of Science databases for systematic reviews. The search yielded 4595 records from which 32 records were included in the review. The measurements for physical health reported in the reviews contained measures of body composition, cardiometabolic biomarkers, physical fitness, harm/injury, or bone health. Body composition was the most used indicator to assess and evaluate physical health in children, whereas information on harm and injury was barely available. In future research longitudinal studies are mandatory to focus on the prospective relationships between physical activity or sedentary behavior, and physical health.
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Affiliation(s)
- Simon Kolb
- Institute of Sports and Sport Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany; (A.B.); (S.C.E.S.); (A.W.); (C.N.)
- Correspondence:
| | - Alexander Burchartz
- Institute of Sports and Sport Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany; (A.B.); (S.C.E.S.); (A.W.); (C.N.)
| | - Doris Oriwol
- Institute of Movement and Sport, University of Education Karlsruhe, 76133 Karlsruhe, Germany;
| | - Steffen C. E. Schmidt
- Institute of Sports and Sport Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany; (A.B.); (S.C.E.S.); (A.W.); (C.N.)
| | - Alexander Woll
- Institute of Sports and Sport Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany; (A.B.); (S.C.E.S.); (A.W.); (C.N.)
| | - Claudia Niessner
- Institute of Sports and Sport Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany; (A.B.); (S.C.E.S.); (A.W.); (C.N.)
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Quirino NMMDL, Prazeres Filho A, Barbosa AO, Mendonça G, Farias Júnior JCD. Breaks in Sedentary Time and Cardiometabolic Markers in Adolescents. Arq Bras Cardiol 2021; 117:352-362. [PMID: 34495233 PMCID: PMC8395781 DOI: 10.36660/abc.20200047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The interruption of the time spent in sedentary behavior (breaks) has been associated with better levels of cardiometabolic indicators in the adult population, but in adolescents, further investigations are still needed to confirm these findings. OBJECTIVES To analyze the association of the number of breaks per day in sedentary behaviors with cardiometabolic markers and whether it was moderated by nutritional status and excessive time on sedentary behavior in adolescents. METHODS This is a cross-sectional study of 537 adolescents (52.3% girls), aged between 10 and 14 years, enrolled in public schools in the city of João Pessoa, Paraíba state, Brazil. The number of daily breaks (>100 counts/minutes) in sedentary time was measured by Actigraph GT3X+ accelerometers. The following cardiometabolic markers were analyzed: systolic and diastolic blood pressure (mmHg), fasting blood glucose levels, total cholesterol, triglycerides, HDL-c, LDL-c (all in mg/dL) and body mass index (BMI) (kg/m2). Linear regression was used to analyze the association between the number of breaks and cardiometabolic markers and whether this association was moderated by nutritional status and excessive time in sedentary behavior. The significance level of p<0.05 was adopted for all analyses. RESULTS The number of daily breaks was negatively associated with BMI (boys - ß = -0.083; 95%CI: -0.132; -0.034 and girls - ß = -0.115; 95%CI: -0.169; -0.061), but not with the remaining cardiometabolic markers. The number of breaks per day was negatively associated with BMI (ß = -0.069; 95% CI: -0.102; -0.035), but not with the other cardiometabolic markers and this association was not moderated by the adolescents' nutritional status (p=0.221), or by excessive time in sedentary behavior (p=0.176). CONCLUSIONS Including breaks in sedentary time seems to contribute to lower BMI values in adolescents.
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Affiliation(s)
- Natália Maria Mesquita de Lima Quirino
- Faculdades Nova Esperança (FACENE), João Pessoa, PB - Brasil.,Grupo de Estudos e Pesquisas em Epidemiologia da Atividade Física (GEPEAF), João Pessoa, PB - Brasil
| | - Alcides Prazeres Filho
- Grupo de Estudos e Pesquisas em Epidemiologia da Atividade Física (GEPEAF), João Pessoa, PB - Brasil.,Programa Associado de Pós-Graduação em Educação Física (UPE/UFPB), João Pessoa, PB - Brasil
| | - Arthur Oliveira Barbosa
- Grupo de Estudos e Pesquisas em Epidemiologia da Atividade Física (GEPEAF), João Pessoa, PB - Brasil.,Programa Associado de Pós-Graduação em Educação Física (UPE/UFPB), João Pessoa, PB - Brasil
| | - Gerfeson Mendonça
- Grupo de Estudos e Pesquisas em Epidemiologia da Atividade Física (GEPEAF), João Pessoa, PB - Brasil.,Centro Universitário Cesmac, Maceió, AL - Brasil
| | - José Cazuza de Farias Júnior
- Grupo de Estudos e Pesquisas em Epidemiologia da Atividade Física (GEPEAF), João Pessoa, PB - Brasil.,Programa Associado de Pós-Graduação em Educação Física (UPE/UFPB), João Pessoa, PB - Brasil.,Universidade Federal da Paraíba (UFPB), João Pessoa, PB - Brasil
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Parental Factors Related to Physical Activity among Adolescent Men Living in Built and Natural Environment: A Population-Based MOPO Study. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:3234083. [PMID: 34122561 PMCID: PMC8169255 DOI: 10.1155/2021/3234083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 11/20/2020] [Accepted: 05/17/2021] [Indexed: 11/17/2022]
Abstract
Introduction Physical inactivity is a global concern, especially among adolescent men. Little research has been done on the association between parental factors and young adults' physical activity in the context of residential environment. We aimed to reveal what parental factors are associated with physical activity among adolescent men living in built and natural environments. Methods A population-based sample of 1,904 men (mean age = 17.9, SD = 0.7 years) completed a questionnaire regarding physical activity, parental factors, and lifestyle in Northern Finland in 2012 and 2013. Geographical information system methods and dominant land-use type were used to define the residential environment in a 1-kilometer radius buffer zone surrounding each participant's home address. If the residential area included more artificial surfaces, it was defined as a built environment, and areas including more nature were defined as natural environments. Results According to multivariable analyses, a mother's physical activity (OR = 1.9; 95% CI: 1.3-2.8) was positively associated with the physical activity of adolescent men living in built environments, and the father's physical activity was positively associated with the physical activity of adolescent men living in natural environments (2.8; 1.7-4.8). Self-rated health (built 5.9 [4.0-8.7]; natural 5.2 [3.0-9.0]) was positively associated with physical activity level. Those with symptoms of depression were more likely to be physically inactive (built 0.5 [0.3-0.8]; natural 0.3 [0.1-0.6]). Adolescent men were equally physically active regardless of the living environment. Conclusions The level of physical activity of parents, self-rated health, and depressive symptoms should be considered when designing physical activity promotions for adolescent men according to their residential environments.
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Objectively Measured Sedentary Levels and Bouts by Day Type in Australian Young Children. J Phys Act Health 2021; 18:580-586. [PMID: 33837164 DOI: 10.1123/jpah.2020-0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to understand whether a higher number of sedentary bouts (SED bouts) and higher levels of sedentary time (SED time) occur according to different day types (childcare days, nonchildcare weekdays, and weekends) in Australian toddlers (1-2.99 y) and preschoolers (3-5.99 y). METHODS The SED time and bouts were assessed using ActiGraph GT3X+ accelerometers. The sample was composed of 264 toddlers and 343 preschoolers. The SED bouts and time differences were calculated using linear mixed models. RESULTS The toddlers' percentage of SED time was higher on nonchildcare days compared with childcare days (mean difference [MD] = 2.3; 95% confidence interval, 0.7 to 3.9). The toddlers had a higher number of 1- to 4-minute SED bouts on nonchildcare days compared with childcare days. The preschoolers presented higher percentages of SED time during nonchildcare days (MD = 3.1; 95% confidence interval, 1.6 to 4.5) and weekends (MD = 1.9; 95% confidence interval, 0.4 to 3.4) compared with childcare days. The preschoolers presented a higher number of SED bouts (1-4, 5-9, 10-19, and 20-30 min) during nonchildcare days and weekends compared with childcare days. No SED times or bout differences were found between nonchildcare days and weekends, neither SED bouts >30 minutes on toddlers nor on preschoolers. CONCLUSION The SED time and bouts seem to be lower during childcare periods, which means that interventions to reduce sedentary time should consider targeting nonchildcare days and weekends.
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Júdice PB, Hetherington-Rauth M, Northstone K, Andersen LB, Wedderkopp N, Ekelund U, Sardinha LB. Changes in Physical Activity and Sedentary Patterns on Cardiometabolic Outcomes in the Transition to Adolescence: International Children's Accelerometry Database 2.0. J Pediatr 2020; 225:166-173.e1. [PMID: 32553870 DOI: 10.1016/j.jpeds.2020.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To examine the associations of changes in physical activity and sedentary patterns with changes in cardiometabolic outcomes from childhood to adolescence. STUDY DESIGN Youth from the International Children's Accelerometry Database (n = 1088; 55% girls), aged 8-13 years and followed for ∼4 years, were used in this analysis. Hip-mounted accelerometers were used and all physical activity intensities were expressed as the % of total wear-time. Sedentary time was separated into time spent in bouts <10 minutes and ≥10 minutes. A composite z score for cardiometabolic risk (CMR score) was computed by summing the standardized values for systolic and diastolic blood pressure, triglycerides (TG), low-density lipoprotein cholesterol (LDL-c), and the inverse high-density lipoprotein cholesterol. Multivariate analyses were performed using adjusted linear regression models. RESULTS Increase in sedentary time was unfavorably associated with changes in CMR score (β = 0.021; CI 0.004-0.037), TG (β = 0.003; CI 0.001-0.005), and diastolic blood pressure (β = 0.068; CI 0.009-0.128). Decrease in moderate-to-vigorous physical activity was unfavorably associated with changes in LDL-c (β = -0.009; CI -0.017 to -0.001) and TG (β = -0.007; CI -0.013 to -0.001). Increase in ≥10 minutes sedentary time was unfavorably associated with changes in CMR score (β = 0.017; CI 0.004-0.030), LDL-c (β = 0.003; CI 0.000-0.005), and TG (β = 0.003; CI 0.000-0.004). Decrease in light-intensity physical activity was unfavorably associated with changes in CMR score (β = -0.020; CI = -0.040 to 0.000). CONCLUSIONS More physical activity and less prolonged sedentary time are beneficial for cardiometabolic health in youth transitioning to adolescence.
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Affiliation(s)
- Pedro B Júdice
- Exercise and Health Laboratory, Interdisciplinary Center for the Study of Human Performance, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada - Portugal, Portugal.
| | - Megan Hetherington-Rauth
- Exercise and Health Laboratory, Interdisciplinary Center for the Study of Human Performance, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada - Portugal, Portugal
| | - Kate Northstone
- Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
| | - Lars Bo Andersen
- Faculty of Education, Arts and Sport, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Niels Wedderkopp
- Department of Regional Health Research, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark; Department of Orthopedics, University Hospital of Southwestern Jutland, Esbjerg, Denmark
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Luís B Sardinha
- Exercise and Health Laboratory, Interdisciplinary Center for the Study of Human Performance, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada - Portugal, Portugal
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Calella P, Mancusi C, Pecoraro P, Sensi S, Sorrentino C, Imoletti M, Franzese A, Gallè F, Liguori G, Valerio G. Classroom active breaks: a feasibility study in Southern Italy. Health Promot Int 2020; 35:373-380. [PMID: 31011751 DOI: 10.1093/heapro/daz033] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Patrizia Calella
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Via Medina 40, Naples 80133, Italy
| | - Caterina Mancusi
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Via Medina 40, Naples 80133, Italy
| | - Pierluigi Pecoraro
- Nutrition Unit, Department of Prevention, Local Health Authority Napoli 3 Sud, Via Montedoro 47 - Torre del Greco, Naples, Italy
| | - Serena Sensi
- Nutrition Unit, Department of Prevention, Local Health Authority Napoli 3 Sud, Via Montedoro 47 - Torre del Greco, Naples, Italy
| | - Carmelina Sorrentino
- Nutrition Unit, Department of Prevention, Local Health Authority Napoli 3 Sud, Via Montedoro 47 - Torre del Greco, Naples, Italy
| | - Maria Imoletti
- Nutrition Unit, Department of Prevention, Local Health Authority Napoli 3 Sud, Via Montedoro 47 - Torre del Greco, Naples, Italy
| | - Adriana Franzese
- Section of Pediatrics, Department of Translational Medical Science, University of Naples "Federico II", Via Pansini 5, Naples, Italy
| | - Francesca Gallè
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Via Medina 40, Naples 80133, Italy
| | - Giorgio Liguori
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Via Medina 40, Naples 80133, Italy
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Via Medina 40, Naples 80133, Italy
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Wijndaele K, White T, Andersen LB, Bugge A, Kolle E, Northstone K, Wedderkopp N, Ried-Larsen M, Kriemler S, Page AS, Puder JJ, Reilly JJ, Sardinha LB, van Sluijs EMF, Sharp SJ, Brage S, Ekelund U. Substituting prolonged sedentary time and cardiovascular risk in children and youth: a meta-analysis within the International Children's Accelerometry database (ICAD). Int J Behav Nutr Phys Act 2019; 16:96. [PMID: 31672163 PMCID: PMC6822444 DOI: 10.1186/s12966-019-0858-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Evidence on the association between sitting for extended periods (i.e. prolonged sedentary time (PST)) and cardio-metabolic health is inconsistent in children. We aimed to estimate the differences in cardio-metabolic health associated with substituting PST with non-prolonged sedentary time (non-PST), light (LIPA) or moderate-to-vigorous physical activity (MVPA) in children. METHODS Cross-sectional data from 14 studies (7 countries) in the International Children's Accelerometry Database (ICAD, 1998-2009) was included. Accelerometry in 19,502 participants aged 3-18 years, together with covariate and outcome data, was pooled and harmonized. Iso-temporal substitution in linear regression models provided beta coefficients (95%CI) for substitution of 1 h/day PST (sedentary time accumulated in bouts > 15 min) with non-PST, LIPA or MVPA, for each study, which were meta-analysed. RESULTS Modelling substitution of 1 h/day of PST with non-PST suggested reductions in standardized BMI, but estimates were > 7-fold greater for substitution with MVPA (- 0.44 (- 0.62; - 0.26) SD units). Only reallocation by MVPA was beneficial for waist circumference (- 3.07 (- 4.47; - 1.68) cm), systolic blood pressure (- 1.53 (- 2.42; - 0.65) mmHg) and clustered cardio-metabolic risk (- 0.18 (- 0.3; - 0.1) SD units). For HDL-cholesterol and diastolic blood pressure, substitution with LIPA was beneficial; however, substitution with MVPA showed 5-fold stronger effect estimates (HDL-cholesterol: 0.05 (0.01; 0.10) mmol/l); diastolic blood pressure: - 0.81 (- 1.38; - 0.24) mmHg). CONCLUSIONS Replacement of PST with MVPA may be the preferred scenario for behaviour change, given beneficial associations with a wide range of cardio-metabolic risk factors (including adiposity, HDL-cholesterol, blood pressure and clustered cardio-metabolic risk). Effect estimates are clinically relevant (e.g. an estimated reduction in waist circumference of ≈1.5 cm for 30 min/day replacement). Replacement with LIPA could be beneficial for some of these risk factors, however with substantially lower effect estimates.
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Affiliation(s)
- Katrien Wijndaele
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Addenbrooke's Hospital Hills Road Cambridge, Cambridge, CB2 0QQ, UK.
| | - Thomas White
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Addenbrooke's Hospital Hills Road Cambridge, Cambridge, CB2 0QQ, UK
| | - Lars Bo Andersen
- Faculty of Teacher Education and Sport, Campus Sogndal, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Anna Bugge
- Centre for Research in Childhood Health, Exercise Epidemiology Unit, Department of Sport Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Physiotherapy, University College Copenhagen, Copenhagen, Denmark
| | - Elin Kolle
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Niels Wedderkopp
- Faculty of Teacher Education and Sport, Campus Sogndal, Western Norway University of Applied Sciences, Bergen, Norway
- Centre for Research in Childhood Health, Exercise Epidemiology Unit, Department of Sport Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mathias Ried-Larsen
- Faculty of Teacher Education and Sport, Campus Sogndal, Western Norway University of Applied Sciences, Bergen, Norway
- Centre for Research in Childhood Health, Exercise Epidemiology Unit, Department of Sport Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Susi Kriemler
- Institute of Social and Preventive Medicine, University of Zurich, Zürich, Switzerland
| | - Angie S Page
- Centre for Exercise, Nutrition and health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | | | - John J Reilly
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland
| | - Luis B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Esther M F van Sluijs
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Addenbrooke's Hospital Hills Road Cambridge, Cambridge, CB2 0QQ, UK
- UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Addenbrooke's Hospital Hills Road Cambridge, Cambridge, CB2 0QQ, UK
| | - Søren Brage
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Addenbrooke's Hospital Hills Road Cambridge, Cambridge, CB2 0QQ, UK
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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11
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Barnett TA, Kelly AS, Young DR, Perry CK, Pratt CA, Edwards NM, Rao G, Vos MB. Sedentary Behaviors in Today's Youth: Approaches to the Prevention and Management of Childhood Obesity: A Scientific Statement From the American Heart Association. Circulation 2019; 138:e142-e159. [PMID: 30354382 DOI: 10.1161/cir.0000000000000591] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This scientific statement is about sedentary behavior and its relationship to obesity and other cardiometabolic outcomes in youth. A deleterious effect of sedentary behavior on cardiometabolic health is most notable for screen-based behaviors and adiposity; however, this relation is less apparent for other cardiometabolic outcomes or when sedentary time is measured with objective movement counters or position monitors. Increasing trends of screen time are concerning; the portability of screen-based devices and abundant access to unlimited programming and online content may be leading to new patterns of consumption that are exposing youth to multiple pathways harmful to cardiometabolic health. This American Heart Association scientific statement provides an updated perspective on sedentary behaviors specific to modern youth and their impact on cardiometabolic health and obesity. As we reflect on implications for practice, research, and policy, what emerges is the importance of understanding the context in which sedentary behaviors occur. There is also a need to capture the nature of sedentary behavior more accurately, both quantitatively and qualitatively, especially with respect to recreational screen-based devices. Further evidence is required to better inform public health interventions and to establish detailed quantitative guidelines on specific sedentary behaviors in youth. In the meantime, we suggest that televisions and other recreational screen-based devices be removed from bedrooms and absent during meal times. Daily device-free social interactions and outdoor play should be encouraged. In addition, parents/guardians should be supported to devise and enforce appropriate screen time regulations and to model healthy screen-based behaviors.
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12
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Hashem R, Rey-Lόpez JP, Hamer M, McMunn A, Rowlands A, Whincup PH, Owen CG, Ding D, Powell L, Stamatakis E. Associations between objectively assessed and questionnaire-based sedentary behaviour with body mass index and systolic blood pressure in Kuwaiti adolescents. BMC Res Notes 2019; 12:588. [PMID: 31533859 PMCID: PMC6751576 DOI: 10.1186/s13104-019-4626-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/10/2019] [Indexed: 11/29/2022] Open
Abstract
Objective Kuwait has one of the highest obesity rates in the world. This study examined the associations between sedentary behaviour (objectively measured and self-reported), adiposity and systolic blood pressure in a sample of adolescents residing in Kuwait. Data was obtained from the Study of Health and Activity among adolescents in Kuwait (2012–2013). The sample included a total of 435 adolescents (201 boys). Outcomes were age- and sex specific body mass index Z-scores and systolic blood pressure. Exposures were total sedentary behaviour measured by accelerometry and time spent in some sedentary behaviours (television viewing, video games, computer use and total screen-time). We used multiple linear regression analyses, adjusted for age, governorate, maternal education and physical activity, to examine associations between sedentary behaviour and adiposity and systolic blood pressure. Results Only 2 statistically significant associations were found between sedentary behaviour and the study outcomes: body mass in boys was directly associated with higher sedentary time [β (95% CIs) 0.003 (0.00 to 0.06)]; body mass index was inversely associated with videogames in both sexes [girls: β (95% CIs) − 0.17 (− 0.48 to − 0.04); boys: − 0.24 (− 0.57 to − 0.12)]. In this sample of Kuwaiti adolescents, sedentary behaviour showed limited deleterious associations with adiposity and systolic blood pressure.
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Affiliation(s)
- Rawan Hashem
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Juan Pablo Rey-Lόpez
- Charles Perkins Centre, Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Hamer
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK.,School of Sport Exercise & Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Anne McMunn
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Alex Rowlands
- Diabetes Research Centre, University of Leicester, Leicester, UK.,NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK.,Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - Christopher G Owen
- Population Health Research Institute, St George's University of London, London, UK
| | - Ding Ding
- Charles Perkins Centre, Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Lauren Powell
- Charles Perkins Centre, Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Emmanuel Stamatakis
- Charles Perkins Centre, Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia.
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13
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Agreement Between GT3X Accelerometer and ActivPAL Inclinometer for Estimating and Detecting Changes in Different Contexts of Sedentary Time Among Adolescents. J Phys Act Health 2019; 16:780-784. [DOI: 10.1123/jpah.2018-0178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 04/22/2019] [Accepted: 05/12/2019] [Indexed: 11/18/2022]
Abstract
Background: This investigation aimed to analyze the agreement between the GT3X accelerometer and the ActivPAL inclinometer for estimating and detecting changes in sedentary behavior of different contexts among adolescents. Methods: Secondary data from an intervention using standing desks in the classroom conducted within 2 sixth-grade classes (intervention [n = 22] and control [n = 27]) were used. The intervention took place over 16 weeks, with activity assessments (ActivPAL and GT3X) being performed 7 days before and in the last week of the intervention. Baseline information from both groups was considered for cross-sectional analysis (209 valid days), while data from 20 participants (intervention group) were used for longitudinal analysis. Results: The authors observed that GT3X overestimated sedentary time at school (16.8%), after school (13.5%), and during weekends (7.3%) compared with ActivPAL (P < .05). Outside the school (after school [r = −.188] and on weekends [r = −.260]), there was a trend to higher overestimation among adolescents with less sedentary behavior. Longitudinally, the GT3X was unable to detect changes resulting from an intervention in school hours (ActivPAL = −34.7 min·9 h−1 vs GT3X = +6.7 min·9 h−1; P < .05). Conclusions: The authors conclude that GT3X (cut-point of <100 counts·min−1) overestimated sedentary time of free-living activities and did not detect changes resulting from a classroom standing desk intervention in adolescents.
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14
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Prazeres Filho A, Barbosa AO, Farias Júnior JCD. Tempo e bouts em comportamento sedentário e marcadores cardiometabólicos em adolescentes. REVISTA BRASILEIRA DE CIÊNCIAS DO ESPORTE 2019. [DOI: 10.1016/j.rbce.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Borghese MM, Borgundvaag E, McIsaac MA, Janssen I. Imputing accelerometer nonwear time in children influences estimates of sedentary time and its associations with cardiometabolic risk. Int J Behav Nutr Phys Act 2019; 16:7. [PMID: 30654817 PMCID: PMC6337764 DOI: 10.1186/s12966-019-0770-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/04/2019] [Indexed: 11/22/2022] Open
Abstract
Background A limitation of measuring sedentary time with an accelerometer is device removal. The resulting nonwear time is typically deleted from the data prior to calculating sedentary time. This could impact estimates of sedentary time and its associations with health indicators. We evaluated whether using multiple imputation to replace nonwear accelerometer epochs influences such estimates in children. Methods 452 children (50% male) aged 10–13 were tasked with wearing an accelerometer (15 s epochs) for 7 days. On average, 8% of waking time was classified as nonwear time. Sedentary time was derived from a “nonimputed” dataset using the typical approach of deleting epochs that occurred during nonwear time, as well as from an “imputed” dataset. In the imputed dataset, each nonwear epoch was re-classified as being as sedentary or not using multiple imputation (5 iterations) which was informed by the likelihood of a wear time epoch being classified as sedentary or not using parameter estimates from a logistic regression model. Estimates of sedentary time and associations between sedentary time and health indicators (cardiometabolic risk factor and internalizing mental health symptoms Z-scores) were compared between the nonimputed and imputed datasets. Results On average, sedentary time was 33 min/day higher in the imputed dataset than in the nonimputed dataset (632 vs. 599 min/day). The association between sedentary time and the cardiometabolic risk factor Z-score was stronger in the imputed vs. the nonimputed dataset (β = 0.137 vs. β = 0.092 per 60 min/day change, respectively). These findings were more pronounced among children who had < 7 days with ≥10 h of wear time. Conclusion Researchers should consider using multiple imputation to address accelerometer nonwear time, rather than deleting it, in order to derive more unbiased estimates of sedentary time and its associations with health indicators.
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Affiliation(s)
- M M Borghese
- School of Kinesiology and Health Studies, Queen's University, 28 Division St, Kingston, ON, Canada
| | - E Borgundvaag
- Department of Public Health Sciences, Queen's University, 99 University Avenue, Kingston, Ontario, Canada
| | - M A McIsaac
- Department of Public Health Sciences, Queen's University, 99 University Avenue, Kingston, Ontario, Canada
| | - I Janssen
- School of Kinesiology and Health Studies, Queen's University, 28 Division St, Kingston, ON, Canada.
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16
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Skrede T, Steene-Johannessen J, Anderssen SA, Resaland GK, Ekelund U. The prospective association between objectively measured sedentary time, moderate-to-vigorous physical activity and cardiometabolic risk factors in youth: a systematic review and meta-analysis. Obes Rev 2019; 20:55-74. [PMID: 30270500 DOI: 10.1111/obr.12758] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/11/2018] [Accepted: 08/01/2018] [Indexed: 01/03/2023]
Abstract
Sedentary time and moderate-to-vigorous physical activity (MVPA) may be uniquely related to cardiometabolic health. Excessive sedentary time is suggested as an independent cardiometabolic risk factor, while MVPA is favourably associated with cardiometabolic health. This systematic review and meta-analysis summarizes the evidence on a prospective relationship between objectively measured sedentary time, MVPA and cardiometabolic health indicators in youth. PubMed, Embase, CINAHL, PhyscINFO and SPORTDiscus were systematically searched from January 2000 until April 2018. Studies were included if sedentary time and physical activity were measured objectively and examined associations with body mass index, waist circumference, triglycerides, high-density lipoprotein, insulin, blood pressure or the clustering of these cardiometabolic risk factors. We identified 30 studies, of which 21 were of high quality. No evidence was found for an association between sedentary time and cardiometabolic outcomes. The association between MVPA and individual cardiometabolic risk factors was inconsistent. The meta-analysis for prospective studies found a small but significant effect size between MVPA at baseline and clustered cardiometabolic risk at follow-up (ES -0.014 [95% CI, -0.024 to -0.004]). We conclude that there is no prospective association between sedentary time and cardiometabolic health, while MVPA is beneficially associated with cardiometabolic health in youth.
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Affiliation(s)
- T Skrede
- Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - S A Anderssen
- Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - G K Resaland
- Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - U Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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17
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Valerio G, Maffeis C, Saggese G, Ambruzzi MA, Balsamo A, Bellone S, Bergamini M, Bernasconi S, Bona G, Calcaterra V, Canali T, Caroli M, Chiarelli F, Corciulo N, Crinò A, Di Bonito P, Di Pietrantonio V, Di Pietro M, Di Sessa A, Diamanti A, Doria M, Fintini D, Franceschi R, Franzese A, Giussani M, Grugni G, Iafusco D, Iughetti L, Lamborghini A, Licenziati MR, Limauro R, Maltoni G, Manco M, Reggiani LM, Marcovecchio L, Marsciani A, del Giudice EM, Morandi A, Morino G, Moro B, Nobili V, Perrone L, Picca M, Pietrobelli A, Privitera F, Purromuto S, Ragusa L, Ricotti R, Santamaria F, Sartori C, Stilli S, Street ME, Tanas R, Trifiró G, Umano GR, Vania A, Verduci E, Zito E. Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Ital J Pediatr 2018; 44:88. [PMID: 30064525 PMCID: PMC6069785 DOI: 10.1186/s13052-018-0525-6] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/07/2018] [Indexed: 01/06/2023] Open
Abstract
The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.
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Affiliation(s)
- Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, via Medina 40, 80133 Naples, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Giuseppe Saggese
- Department of Pediatrics, University Hospital of Pisa, Pisa, Italy
| | | | - Antonio Balsamo
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Simonetta Bellone
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Sergio Bernasconi
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Parma, Italy
| | - Gianni Bona
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Valeria Calcaterra
- Pediatrics Unit, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Margherita Caroli
- Italian Society for Obesity (SIO), Francavilla Fontana (Brindisi), Italy
| | | | - Nicola Corciulo
- Pediatric Unit, Hospital of Gallipoli, Gallipoli (Lecce), Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, “S. Maria delle Grazie”, Pozzuoli Hospital, Naples, Italy
| | | | - Mario Di Pietro
- Pediatric and Neonatal Unit, “G. Mazzini”Hospital, Teramo, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonella Diamanti
- Artificial Nutrition Unit Bambino Gesù, Children’s Hospital, IRCCS, Rome, Italy
| | - Mattia Doria
- Italian Federation of Pediatricians (FIMP), Venice, Italy
| | - Danilo Fintini
- Endocrinology and Diabetology Unit Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | - Adriana Franzese
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | | | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Giulio Maltoni
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Melania Manco
- Research Area for Multifactorial Diseases, Children’s Hospital Bambino Gesù, Rome, Italy
| | | | | | | | - Emanuele Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona, Italy
| | - Giuseppe Morino
- Nutrition Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | | | - Valerio Nobili
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
- Hepatometabolic Unit, Bambino Gesù Children’s Hospital, IRCSS, Rome, Italy
| | - Laura Perrone
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | | | | | | | | | - Roberta Ricotti
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Francesca Santamaria
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | - Chiara Sartori
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - Maria Elisabeth Street
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Rita Tanas
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Ferrara, Italy
| | | | - Giuseppina Rosaria Umano
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Vania
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Elvira Verduci
- Deparment of Pediatrics, San Paolo Hospital, University of Milan, Milan, Italy
| | - Eugenio Zito
- Department of Social Sciences, University of Naples Federico II, Naples, Italy
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18
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Karatzi K, Moschonis G, Botelli S, Androutsos O, Chrousos GP, Lionis C, Manios Y. Physical activity and sedentary behavior thresholds for identifying childhood hypertension and its phenotypes: The Healthy Growth Study. ACTA ACUST UNITED AC 2018; 12:714-722. [PMID: 30115564 DOI: 10.1016/j.jash.2018.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/18/2018] [Accepted: 07/03/2018] [Indexed: 11/19/2022]
Abstract
Hypertension phenotypes may represent differential pathophysiologic mechanisms and clinical impact, yet they have been poorly investigated. The study aimed to examine the associations of physical activity and sedentary behavior with hypertension phenotypes in a large group of Greek children and to identify thresholds regarding risk of hypertension. This was a cross-sectional study with a regionally representative sample of 2473 schoolchildren aged 9-13 years, with full data on physical activity and sedentary behavior indices, as well as arterial blood pressure measurements, physical examination, and anthropometry. Hypertensive children of both sexes had lower levels of physical activity (steps/d). Hypertensive girls had lower moderate-to-vigorous physical activity (MVPA), whereas hypertensive boys with isolated systolic hypertension (ISH) had more screen time than their normotensive counterparts. Increased levels of physical activity was associated with 33%-54% lower risk of all hypertension phenotypes in both sexes, whereas increased MVPA was associated with 41%-65% lower risk of all phenotypes in girls and with ISH and systolic and diastolic hypertension (SDH) in boys. In boys, higher sedentary time was associated with 11%-13% higher risk for SDH and ISH. Cutoff points of 12,378 steps/d, 47.3 min/d of MVPA, and 2.9 h/d of sedentary behavior were determined for identifying children at increased risk of hypertension. Physical activity is inversely associated with all hypertension phenotypes, whereas sedentary behavior is positively associated with ISH and SDH in boys. More studies should confirm the hypertension-specific cutoff values identified to be used in future prevention programs for childhood hypertension.
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Affiliation(s)
- Kalliopi Karatzi
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University of Athens, Greece
| | - George Moschonis
- Department of Rehabilitation, Nutrition and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Sofia Botelli
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University of Athens, Greece
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University of Athens, Greece
| | - George P Chrousos
- First Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, Aghia Sophia Children's Hospital, Athens, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, Heraklion, University of Crete, Crete, Greece
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University of Athens, Greece.
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19
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Huang WY, Wong SHS, He G, Salmon JO. Isotemporal Substitution Analysis for Sedentary Behavior and Body Mass Index. Med Sci Sports Exerc 2017; 48:2135-2141. [PMID: 27760071 DOI: 10.1249/mss.0000000000001002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study examined the prospective associations of reallocating time spent in different types of sedentary behavior, physical activity, and sleep with body mass index (BMI) in children using isotemporal substitution analysis. METHODS Chinese children in grades 1-3 were recruited to a cohort study in 2009 and were followed up over a 2-yr period. Reports were gathered from the parents on children's sedentary behavior, sleep duration, and sociodemographic variables. The reported sedentary behavior types were then grouped into three categories: screen time (e.g., watching TV), academic-related activities (e.g., doing homework), and other sedentary behaviors (e.g., sitting and talking). Moderate-to-vigorous physical activity (MVPA) and light-intensity physical activity were assessed by ActiGraph accelerometry (ActiGraph, Pensacola, FL). Isotemporal substitution models were performed to examine the effects of time allocation on BMI. RESULTS A total of 672 children (359 boys, mean age at recruitment = 7.6 yr) who had provided valid accelerometer data for at least one assessment time point were included in the analysis. Controlling for covariates and total behavior time, isotemporal substitution models indicated that the displacement of 30 min·d of other sedentary behaviors with equal amounts of screen time (B = 0.12; 95% confidence interval, 0.04-0.20) or academic-related activities (B = 0.13; 95% confidence interval, 0.04-0.21) was associated with higher BMI. Reallocating 30 min·d of MVPA with each of the sedentary behavior variables resulted in increased BMI. CONCLUSIONS The substitution of screen time or academic-related activities with other sedentary behaviors or MVPA was associated with lower BMI in Chinese children.
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Affiliation(s)
- Wendy Yajun Huang
- 1Department of Physical Education, Hong Kong Baptist University, Hong Kong, CHINA; 2Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, CHINA; 3School of Kinesiology and Health, Capital University of Physical Education and Sports, Beijing, CHINA; and 4Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, AUSTRALIA
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20
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Verloigne M, Ridgers ND, Chinapaw M, Altenburg TM, Bere E, Van Lippevelde W, Cardon G, Brug J, De Bourdeaudhuij I. Patterns of objectively measured sedentary time in 10- to 12-year-old Belgian children: an observational study within the ENERGY-project. BMC Pediatr 2017; 17:147. [PMID: 28615079 PMCID: PMC5471712 DOI: 10.1186/s12887-017-0894-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 05/31/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study examined the frequency of and differences in sedentary bouts of different durations and the total time spent in sedentary bouts on a weekday, a weekend day, during school hours, during after-school hours and in the evening period in a sample of 10- to 12-year-old Belgian children. METHODS Accelerometer data were collected as part of the ENERGY-project in Belgium (n = 577, 10.9 ± 0.7 years, 53% girls) in 2011. Differences in total sedentary time, sedentary bouts of 2-5, 5-10, 10-20, 20-30 and ≥30 min and total time accumulated in those bouts were examined on a weekday, a weekend day, during school hours, during after-school hours and in the evening period, using multilevel analyses in MLwiN 2.22. RESULTS More than 60% of the participants' waking time was spent sedentary. Children typically engaged in short sedentary bouts of 2-5 and 5-10 min, which contributed almost 50% towards their total daily sedentary time. Although the differences were very small, children engaged in significantly fewer sedentary bouts of nearly all durations during after-school hours compared to during school hours and in the evening period. Children also engaged in significantly fewer sedentary bouts of 5-10, 10-20, and 20-30 min per hour on a weekend day than on a weekday. CONCLUSIONS Although primary school children spend more than 60% of their waking time sedentary, they generally engaged in short sedentary bouts. Children's sedentary bouts were slightly longer on weekdays, particularly during school hours and in the evening period, although the differences were very small. These results suggest that in this age group, interventions focusing on reducing total sedentary time rather than interrupting prolonged sedentary time are needed.
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Affiliation(s)
- Maïté Verloigne
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium. .,Research Foundation Flanders (FWO), Egmontstraat 5, 1000, Brussel, Belgium.
| | - Nicola D Ridgers
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Burwood, Australia
| | - Mai Chinapaw
- Department of Public and Occupational Health and the EMGO Institute for Health & Care Research, VU Medical Center, Amsterdam, the Netherlands
| | - Teatske M Altenburg
- Department of Public and Occupational Health and the EMGO Institute for Health & Care Research, VU Medical Center, Amsterdam, the Netherlands
| | - Elling Bere
- Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway
| | | | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Johannes Brug
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health & Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
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21
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Biddle SJH, García Bengoechea E, Wiesner G. Sedentary behaviour and adiposity in youth: a systematic review of reviews and analysis of causality. Int J Behav Nutr Phys Act 2017; 14:43. [PMID: 28351363 PMCID: PMC5371200 DOI: 10.1186/s12966-017-0497-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/20/2017] [Indexed: 01/08/2023] Open
Abstract
Background Sedentary behaviour (sitting time) has becoming a very popular topic for research and translation since early studies on TV viewing in children in the 1980s. The most studied area for sedentary behaviour health outcomes has been adiposity in young people. However, the literature is replete with inconsistencies. Methods We conducted a systematic review of systematic reviews and meta-analyses to provide a comprehensive analysis of evidence and state-of-the-art synthesis on whether sedentary behaviours are associated with adiposity in young people, and to what extent any association can be considered ‘causal’. Searches yielded 29 systematic reviews of over 450 separate papers. We analysed results by observational (cross-sectional and longitudinal) and intervention designs. Results Small associations were reported for screen time and adiposity from cross-sectional evidence, but associations were less consistent from longitudinal studies. Studies using objective accelerometer measures of sedentary behaviour yielded null associations. Most studies assessed BMI/BMI-z. Interventions to reduce sedentary behaviour produced modest effects for weight status and adiposity. Accounting for effects from sedentary behaviour reduction alone is difficult as many interventions included additional changes in behaviour, such as physical activity and dietary intake. Analysis of causality guided by the classic Bradford Hill criteria concluded that there is no evidence for a causal association between sedentary behaviour and adiposity in youth, although a small dose-response association exists. Conclusions Associations between sedentary behaviour and adiposity in children and adolescents are small to very small and there is little to no evidence that this association is causal. This remains a complex field with different exposure and outcome measures and research designs. But claims for ‘clear’ associations between sedentary behaviour and adiposity in youth, and certainly for causality, are premature or misguided.
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Affiliation(s)
- Stuart J H Biddle
- Institute of Sport, Exercise & Active Living, Victoria University, Melbourne, Australia. .,Institute for Resilient Regions, University of Southern Queensland, Education City, 37 Sinnathamby Boulevard, Springfield Central, QLD, 4300, Australia.
| | - Enrique García Bengoechea
- Institute of Sport, Exercise & Active Living, Victoria University, Melbourne, Australia.,McGill University, Montreal, Canada
| | - Glen Wiesner
- Institute of Sport, Exercise & Active Living, Victoria University, Melbourne, Australia
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22
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Gallo LC, Roesch SP, McCurley JL, Isasi CR, Sotres-Alvarez D, Delamater AM, Van Horn L, Arredondo EM, Perreira KM, Buelna C, Qi Q, Vidot DC, Carnethon MR. Youth and Caregiver Physical Activity and Sedentary Time: HCHS/SOL Youth. Am J Health Behav 2017; 41:67-75. [PMID: 27935792 DOI: 10.5993/ajhb.41.1.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We examined associations between youth and caregiver moderate/ vigorous physical activity (MVPA) and sedentary (SED) time, using accelerometery, in the Hispanic Community Health Study/Study of Latino Youth (HCHS/ SOL) Youth. METHODS Participants were 623 caregivers and 877 youth 8-16 years old, enrolled in 2012-2014. Associations of youth and caregiver MVPA time, SED time, and meeting MVPA recommendations ( 150 min/week, adults; 420 min/week, youth) were examined in regression models that controlled for sample weights, design effects, and demographic and health covariates. RESULTS Youth whose caregivers met MVPA recommendations were nearly twice as likely to meet these recommendations themselves when compared to youth whose caregivers did not meet MVPA recommendations (OR = 1.9, 95 CI 1.1, 3.3). Youth and caregiver SED time also were significantly related (p .05). A similar pattern of findings was observed in analyses limited to relationships in which the caregiver was a biological parent of the youth (N = 485 caregivers; N = 795 youth). CONCLUSIONS MVPA and SED are correlated within Latino families as observed by statistically significant relationships of youth and caregiver activity. Additional research is needed to understand underlying genetic and environmental factors that explain these findings.
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Affiliation(s)
- Linda C Gallo
- Professor, Department of Psychology, San Diego State University, San Diego, CA
| | - Scott P Roesch
- Professor, Department of Psychology, San Diego State University, San Diego, CA
| | - Jessica L McCurley
- Doctoral Student, SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Carmen R Isasi
- Associate Professor, Department of Epidemiology Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Daniela Sotres-Alvarez
- Research Assistant Professor, Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alan M Delamater
- Professor, Department of Pediatrics, University of Miami, Miami, FL
| | - Linda Van Horn
- Professor, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elva M Arredondo
- Professor, Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Krista M Perreira
- Professor, Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christina Buelna
- Data Analyst, San Diego State University Research Foundation, San Diego, CA
| | - Qibin Qi
- Assistant Professor, Department of Epidemiology Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Denise C Vidot
- Assistant Professor, School of Nursing and Health Studies, University of Miami, Miami, FL
| | - Mercedes R Carnethon
- Professor, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL;,
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23
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Contardo Ayala AM, Salmon J, Timperio A, Sudholz B, Ridgers ND, Sethi P, Dunstan DW. Impact of an 8-Month Trial Using Height-Adjustable Desks on Children's Classroom Sitting Patterns and Markers of Cardio-Metabolic and Musculoskeletal Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121227. [PMID: 27973414 PMCID: PMC5201368 DOI: 10.3390/ijerph13121227] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/30/2016] [Accepted: 12/06/2016] [Indexed: 11/19/2022]
Abstract
During school hours, children can sit for prolonged and unbroken periods of time. This study investigated the impact of an 8-month classroom-based intervention focusing on reducing and breaking-up sitting time on children’s cardio-metabolic risk factors (i.e., body mass index, waist circumference, blood pressure) and perceptions of musculoskeletal discomfort. Two Year-6 classes (24 students per class) in one primary school were assigned to either an intervention or control classroom. The intervention classroom was equipped with height-adjustable desks and the teacher was instructed in the delivery of pedagogical strategies to reduce and break-up sitting in class. The control classroom followed standard practice using traditional furniture. At baseline, and after 8-months, time spent sitting, standing, stepping, and sitting-bouts (occasions of continuous sitting) as well as the frequency of sit-to-stand transitions were obtained from activPAL inclinometers and the time spent in light-intensity physical activity was obtained from ActiGraph accelerometers. Demographics and musculoskeletal characteristics were obtained from a self-report survey. Hierarchical linear mixed models found that during class-time, children’s overall time spent sitting in long bouts (>10 min) were lower and the number of sit-to-stand transitions were higher in the intervention group compared to the control group, while no changes were observed for musculoskeletal pain/discomfort. No significant intervention effects were found for the anthropometrics measures and blood pressure. Height-adjustable desks and pedagogical strategies to reduce/break-up sitting can positively modify classroom sitting patterns in children. Longer interventions, larger and varied sample size may be needed to show health impacts; however, these desks did not increase musculoskeletal pain/discomfort.
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Affiliation(s)
- Ana María Contardo Ayala
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC 3125, Australia.
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC 3125, Australia.
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC 3125, Australia.
| | - Bronwyn Sudholz
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC 3125, Australia.
| | - Nicola D Ridgers
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC 3125, Australia.
| | - Parneet Sethi
- Physical Activity Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia.
| | - David W Dunstan
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC 3125, Australia.
- Physical Activity Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia.
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia.
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24
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HUANG WENDYYAJUN, WONG STEPHENHEUNGSANG, HE GANG, SALMON JO. Isotemporal Substitution Analysis for Sedentary Behavior and Body Mass Index. Med Sci Sports Exerc 2016. [DOI: 10.1249/mss.0000000000001002 pmid: 27760071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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25
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van Ekris E, Altenburg TM, Singh AS, Proper KI, Heymans MW, Chinapaw MJM. An evidence-update on the prospective relationship between childhood sedentary behaviour and biomedical health indicators: a systematic review and meta-analysis. Obes Rev 2016; 17:833-49. [PMID: 27256486 DOI: 10.1111/obr.12426] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/06/2016] [Accepted: 04/18/2016] [Indexed: 12/01/2022]
Abstract
Evidence for adverse health effects of excessive sedentary behaviour in children is predominantly based on cross-sectional studies, measuring TV viewing as proxy for sedentary behaviour. This systematic review and meta-analysis summarizes the evidence on the prospective relationship between childhood sedentary behaviour and biomedical health indicators, overall and stratified by type of sedentary behaviour (TV viewing, computer use/games, screen time and objective sedentary time). PubMed, EMBASE, PsycINFO and Cochrane were systematically searched till January 2015. Methodological quality of all included studies was scored, and a best evidence synthesis was applied. We included 109 studies of which 19 were of high quality. We found moderate-to-strong evidence for a relationship of overall sedentary time with some anthropometrics (overweight/obesity, weight-for-height), one cardiometabolic biomarker (HDL-cholesterol) and some fitness indicators (fitness, being unfit). For other health indicators, we found no convincing evidence because of inconsistent or non-significant findings. The evidence varied by type of sedentary behaviour. The meta-analysis indicated that each additional baseline hour of TV viewing (β = 0.01, 95%CI = [-0.002; 0.02]) or computer use (β = 0.00, 95%CI = [-0.004; 0.01]) per day was not significantly related with BMI at follow-up. We conclude that the evidence for a prospective relationship between childhood sedentary behaviour and biomedical health is in general unconvincing.
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Affiliation(s)
- E van Ekris
- Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - T M Altenburg
- Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - A S Singh
- Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - K I Proper
- Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - M W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - M J M Chinapaw
- Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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26
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van Loo CMT, Okely AD, Batterham MJ, Hinkley T, Ekelund U, Brage S, Reilly JJ, Jones RA, Janssen X, Cliff DP. Validation of thigh-based accelerometer estimates of postural allocation in 5-12 year-olds. J Sci Med Sport 2016; 20:273-277. [PMID: 27566897 PMCID: PMC5361055 DOI: 10.1016/j.jsams.2016.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/15/2016] [Accepted: 08/05/2016] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To validate activPAL3™ (AP3) for classifying postural allocation, estimating time spent in postures and examining the number of breaks in sedentary behaviour (SB) in 5-12 year-olds. DESIGN Laboratory-based validation study. METHODS Fifty-seven children completed 15 sedentary, light- and moderate-to-vigorous intensity activities. Direct observation (DO) was used as the criterion measure. The accuracy of AP3 was examined using a confusion matrix, equivalence testing, Bland-Altman procedures and a paired t-test for 5-8y and 9-12y. RESULTS Sensitivity of AP3 was 86.8%, 82.5% and 85.3% for sitting/lying, standing, and stepping, respectively, in 5-8y and 95.3%, 81.5% and 85.1%, respectively, in 9-12y. Time estimates of AP3 were equivalent to DO for sitting/lying in 9-12y and stepping in all ages, but not for sitting/lying in 5-12y and standing in all ages. Underestimation of sitting/lying time was smaller in 9-12y (1.4%, limits of agreement [LoA]: -13.8 to 11.1%) compared to 5-8y (12.6%, LoA: -39.8 to 14.7%). Underestimation for stepping time was small (5-8y: 6.5%, LoA: -18.3 to 5.3%; 9-12y: 7.6%, LoA: -16.8 to 1.6%). Considerable overestimation was found for standing (5-8y: 36.8%, LoA: -16.3 to 89.8%; 9-12y: 19.3%, LoA: -1.6 to 36.9%). SB breaks were significantly overestimated (5-8y: 53.2%, 9-12y: 28.3%, p<0.001). CONCLUSIONS AP3 showed acceptable accuracy for classifying postures, however estimates of time spent standing were consistently overestimated and individual error was considerable. Estimates of sitting/lying were more accurate for 9-12y. Stepping time was accurately estimated for all ages. SB breaks were significantly overestimated, although the absolute difference was larger in 5-8y. Surveillance applications of AP3 would be acceptable, however, individual level applications might be less accurate.
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Affiliation(s)
- Christiana M T van Loo
- Early Start Research Institute and Illawarra Health and Medical Research Institute, Faculty of Social Sciences, University of Wollongong, Australia.
| | - Anthony D Okely
- Early Start Research Institute and Illawarra Health and Medical Research Institute, Faculty of Social Sciences, University of Wollongong, Australia
| | - Marijka J Batterham
- School of Mathematics and Applied Statistics, University of Wollongong, Australia
| | - Trina Hinkley
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences
| | - Ulf Ekelund
- Norwegian School of Sports Sciences, Norway; MRC Epidemiology Unit, University of Cambridge, United Kingdom
| | - Søren Brage
- MRC Epidemiology Unit, University of Cambridge, United Kingdom
| | - John J Reilly
- University of Strathclyde, School of Psychological Sciences and Health, Scotland
| | - Rachel A Jones
- Early Start Research Institute and Illawarra Health and Medical Research Institute, Faculty of Social Sciences, University of Wollongong, Australia
| | - Xanne Janssen
- University of Strathclyde, School of Psychological Sciences and Health, Scotland
| | - Dylan P Cliff
- Early Start Research Institute and Illawarra Health and Medical Research Institute, Faculty of Social Sciences, University of Wollongong, Australia
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27
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Huus K, Åkerman L, Raustorp A, Ludvigsson J. Physical Activity, Blood Glucose and C-Peptide in Healthy School-Children, a Longitudinal Study. PLoS One 2016; 11:e0156401. [PMID: 27270732 PMCID: PMC4896630 DOI: 10.1371/journal.pone.0156401] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 05/15/2016] [Indexed: 11/24/2022] Open
Abstract
Aim To further elucidate the relationship between physical activity and several risk factors for development of diabetes (glucose, C-peptide and obesity) over time. Methods A prospective longitudinal study where physical activity was measured on 199 children from Kalmar and Linköping at age 8, and the same 107 children from Linköping again at age 12. Anthropometric data was collected and blood was analyzed for C-peptide and f-glucose. The children in the study were representative for the general Swedish child population, and on an average lean. Results High physical activity was related to lower C-peptide at age 8 and 12. This correlation was especially pronounced in boys, who also were more physically active than girls at both time points. The association seen at 8 years of age was similar at age 12 in most children. Children with higher BMI Z-Score had a higher fasting C-peptide (age 12) but linear regression showed that children with more steps per day were less likely to have a higher fasting C-peptide irrespective of BMI. Longitudinal follow-up showed that a decrease in physical activity increased insulin resistance and β-cell load. Conclusions Already in young children, physical activity improves insulin sensitivity and decreases the need of C-peptide over time. This seems to become even more pronounced with increasing age when children are followed longitudinally. Low physical activity increases the load on insulin producing β-cells, might increase the risk for both type 1- and 2 diabetes.
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Affiliation(s)
- Karina Huus
- CHILD research group, Department of Nursing, School of Health and Welfare, SE- 551 11 Jönköping, Sweden
- * E-mail:
| | - Linda Åkerman
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, SE- 58185 Linköping, Sweden
| | - Anders Raustorp
- Linnaeus University, School of Sport Sciences, SE-39182 Kalmar, Sweden
- Department of Nutrition and Sport Sciences, University of Gothenburg, SE-40530 Gothenburg, Sweden
| | - Johnny Ludvigsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, SE- 58185 Linköping, Sweden
- Pediatric Clinic, Östergötland, County Council, SE -58185 Linköping, Sweden
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28
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Cliff DP, Hesketh KD, Vella SA, Hinkley T, Tsiros MD, Ridgers ND, Carver A, Veitch J, Parrish AM, Hardy LL, Plotnikoff RC, Okely AD, Salmon J, Lubans DR. Objectively measured sedentary behaviour and health and development in children and adolescents: systematic review and meta-analysis. Obes Rev 2016; 17:330-44. [PMID: 26914664 DOI: 10.1111/obr.12371] [Citation(s) in RCA: 191] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/27/2015] [Accepted: 12/14/2015] [Indexed: 12/24/2022]
Abstract
Sedentary behaviour has emerged as a unique determinant of health in adults. Studies in children and adolescents have been less consistent. We reviewed the evidence to determine if the total volume and patterns (i.e. breaks and bouts) of objectively measured sedentary behaviour were associated with adverse health outcomes in young people, independent of moderate-intensity to vigorous-intensity physical activity. Four electronic databases (EMBASE MEDLINE, Ovid EMBASE, PubMed and Scopus) were searched (up to 12 November 2015) to retrieve studies among 2- to 18-year-olds, which used cross-sectional, longitudinal or experimental designs, and examined associations with health outcomes (adiposity, cardio-metabolic, fitness, respiratory, bone/musculoskeletal, psychosocial, cognition/academic achievement, gross motor development and other outcomes). Based on 88 eligible observational studies, level of evidence grading and quantitative meta-analyses indicated that there is limited available evidence that the total volume or patterns of sedentary behaviour are associated with health in children and adolescents when accounting for moderate-intensity to vigorous-intensity physical activity or focusing on studies with low risk of bias. Quality evidence from studies with robust designs and methods, objective measures of sitting, examining associations for various health outcomes, is needed to better understand if the overall volume or patterns of sedentary behaviour are independent determinants of health in children and adolescents.
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Affiliation(s)
- D P Cliff
- Early Start Research Institute, Faculty of Social Sciences, School of Education, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - K D Hesketh
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, Burwood, Victoria, Australia
| | - S A Vella
- Early Start Research Institute, Faculty of Social Sciences, School of Education, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - T Hinkley
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, Burwood, Victoria, Australia
| | - M D Tsiros
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - N D Ridgers
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, Burwood, Victoria, Australia
| | - A Carver
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, Burwood, Victoria, Australia.,School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - J Veitch
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, Burwood, Victoria, Australia
| | - A-M Parrish
- Early Start Research Institute, Faculty of Social Sciences, School of Education, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - L L Hardy
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - R C Plotnikoff
- Priority Research Centre for Physical Activity and Nutrition, Faculty of Education and Arts, University of Newcastle, Newcastle, Australia
| | - A D Okely
- Early Start Research Institute, Faculty of Social Sciences, School of Education, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - J Salmon
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, Burwood, Victoria, Australia
| | - D R Lubans
- Priority Research Centre for Physical Activity and Nutrition, Faculty of Education and Arts, University of Newcastle, Newcastle, Australia
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29
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Gammon C, Pfeiffer KA, Kazanis A, Ling J, Robbins LB. Cardiorespiratory fitness in urban adolescent girls: associations with race and pubertal status. J Sports Sci 2016; 35:29-34. [PMID: 26942487 DOI: 10.1080/02640414.2016.1154594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cardiorespiratory fitness affords health benefits to youth. Among females, weight-relative fitness declines during puberty and is lower among African American (AA) than Caucasian girls. Data indicate racial differences in pubertal timing and tempo, yet the interactive influence of puberty and race on fitness, and the role of physical activity (PA) in these associations have not been examined. Thus, independent and interactive associations of race and pubertal development with fitness in adolescent girls, controlling for PA were examined. Girls in grades 5-8 (n = 1011; Caucasian = 25.2%, AA = 52.3%, Other Race group = 22.5%) completed the Pubertal Development Scale (pubertal stage assessment) and Fitnessgram® Progressive Aerobic Cardiovascular Endurance Run (PACER) test (cardiorespiratory fitness assessment). PA was assessed by accelerometry. Bivariate and multivariate analyses were used to examine associations among race, pubertal stage and fitness, controlling for vigorous PA, AA, and pubertally advanced girls demonstrated lower fitness than Caucasian and less mature counterparts. Puberty and race remained significantly associated with fitness after controlling for vigorous PA. The interaction effect of race and puberty on fitness was non-significant. The pubertal influence on fitness is observed among AA adolescents. Associations between fitness and race/puberty appear to be independent of each other and vigorous PA. Pubertally advanced AA girls represent a priority group for fitness interventions.
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Affiliation(s)
- Catherine Gammon
- a Department of Kinesiology , Michigan State University , East Lansing , MI , USA
| | - Karin A Pfeiffer
- a Department of Kinesiology , Michigan State University , East Lansing , MI , USA
| | - Anamaria Kazanis
- b College of Nursing , Michigan State University , East Lansing , MI , USA.,c School of Health Sciences , Oakland University , Rochester , MI , USA
| | - Jiying Ling
- b College of Nursing , Michigan State University , East Lansing , MI , USA
| | - Lorraine B Robbins
- b College of Nursing , Michigan State University , East Lansing , MI , USA
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Stålesen J, Vik FN, Hansen BH, Berntsen S. Comparison of three activity monitors for estimating sedentary time among children. BMC Sports Sci Med Rehabil 2016; 8:2. [PMID: 26855784 PMCID: PMC4743205 DOI: 10.1186/s13102-016-0028-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/29/2016] [Indexed: 11/15/2022]
Abstract
Background Time spent sedentary appears to be associated with several health outcomes in adults, but findings are inconsistent in children. Further, the assessment of sedentary time represents a major challenge. The objectives of the present study were to determine whether 1) ActiGraph GT3X+, ActivPAL and SenseWear Armband Pro3 (SWA) provide comparable estimates of sedentary time in 9–12-year-old children, 2) these devices are valid compared with direct observation, and 3) ActivPAL discriminates between sitting and standing behavior. Methods The sample was 67 children. Data were collected during three consecutive days in November 2012. To test the activity monitors in contexts related to physical and sedentary activities commonly performed by children, the children participated in sessions of activity while sitting (watching television, playing video games and tossing a ball while sitting) and standing (musical chairs, active video gaming and tossing a ball) while wearing three different activity monitors at the same time. All activity sessions were observed by two researchers. Differences between monitors were determined using Friedman’s two-way analysis of variance by rank order. Results Minutes of estimated sedentary time differed across device brands during combined sitting activities: SWA vs. ActiGraph GT3X+ (P = 0.048), SWA vs. ActivPAL, (P < 0.001) and ActiGraph GT3X+ vs. ActivPAL (P = 0.002). Out of 12 min in total of combined recorded sitting activity, SWA reported a median of 6 min (95 % Confidence Interval [CI] = 5.0, 7.0), ActiGraph GT3X+ 7 min (7.0, 8.0) and ActivPAL 10 min (8.6, 10.8) as sedentary time. ActivPAL recorded 3.7 (2.4, 4.0) minutes of the non-sitting activities ‘musical chairs’, 4.0 (4.0, 4.0) minutes in ‘standing ball toss’; and 4.0 (2.7, 4.0) minutes in ‘active video gaming’ as sitting time. Conclusion Recorded sedentary time varied among the monitors GT3X+, SWA and ActivPAL, and misclassification of standing activities as sitting activities were apparent for ActivPAL in certain activities.
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Affiliation(s)
- Jarle Stålesen
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, P.O. Box 422, NO-4604 Kristiansand, Norway
| | - Frøydis Nordgård Vik
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, P.O. Box 422, NO-4604 Kristiansand, Norway
| | | | - Sveinung Berntsen
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, P.O. Box 422, NO-4604 Kristiansand, Norway
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Huang WY, Wong SH. Time use clusters in children and their associations with sociodemographic factors. J Public Health (Oxf) 2015; 38:e106-13. [DOI: 10.1093/pubmed/fdv088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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The combined effect of physical activity and sedentary behaviors on a clustered cardio-metabolic risk score: The Helena study. Int J Cardiol 2015; 186:186-95. [PMID: 25828110 DOI: 10.1016/j.ijcard.2015.03.176] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/09/2015] [Accepted: 03/16/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND/OBJECTIVE Increased physical activity (PA) and decreased sedentary behaviors (SBs) may have beneficial effects on cardio-metabolic risk in adolescents. The aim of this study was to examine the associations between independent/combined effects of PA and SB with individual/clustered cardio-metabolic risk factors. METHODS A sample of 769 adolescents (12.5-17.5 years) from the HELENA cross-sectional study (Healthy Lifestyle in Europe by Nutrition in Adolescence) and with valid data on metabolic risk factors were included. RESULTS Concerning moderate-to-vigorous-PA (MVPA) and vigorous-PA (VPA), measured with accelerometers, girls tended to do more MVPA (36%) and VPA (114%) than boys. Unadjusted analyses show a positive association between "PA ≥ 60 min/d; SB ≥ 2 h" and the ratio TC/HDL-c (β = 0.27; 95%CI 0.01 to 0.52; p < 0.05), and a negative association between "MVPA ≥ 60 min/d; SB < 2h" with the ∑ 4Skinfolds (β = -0.32; 95%CI -0.61 to -0.02; p<0.05). Moreover, "SB ≥ 2 h/d" was associated with increased cardio-metabolic risk (PR 1.59; 95%CI 1.05 to 2.39; p < 0.05), while "PA ≥ 60 min/d; SB < 2h" had a protective effect against cardio-metabolic risk (PR 0.48; 95%CI 0.25 to 0.91; p < 0.05). After adjustment for potential confounders, a positive association between SB and ∑ 4Skinfolds was shown (β = 0.28; 95%CI 0.04 to 0.53; p < 0.05). Furthermore, VO2max (mL/kg/min) tends to increase in those participants who do higher VPA and less SB (p = 0.042), and there was a protective effect of "VPA ≥ 30 min/d; SB < 2h" against cardio-metabolic risk (PR 0.24; 95%CI 0.07 to 0.85; p < 0.05). CONCLUSION The current study suggests that adolescents should be encouraged to decrease sedentary lifestyle and increase physical activity, especially vigorous physical activity, in order to reduce cardio-metabolic risk.
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de Moraes ACF, Carvalho HB, Siani A, Barba G, Veidebaum T, Tornaritis M, Molnar D, Ahrens W, Wirsik N, De Henauw S, Mårild S, Lissner L, Konstabel K, Pitsiladis Y, Moreno LA. Incidence of high blood pressure in children — Effects of physical activity and sedentary behaviors: The IDEFICS study. Int J Cardiol 2015; 180:165-70. [DOI: 10.1016/j.ijcard.2014.11.175] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/23/2014] [Indexed: 11/24/2022]
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