An Updated Systematic Review of Childhood Physical Activity Questionnaires

SPLASH Into Fitness: A Swimming-Based Pilot Intervention to Promote Healthful Identities and Behaviors Among Preadolescent Girls

BACKGROUND

Girls' physical activity and healthful eating behaviors decline throughout adolescence. These trajectories may be linked to the underdevelopment of exercise and healthful eater identities. Youth programs might consider prioritizing identity development as an innovative health promotion strategy, especially during the formative preadolescent life stage.

OBJECTIVES

This study examines healthful identities and behaviors among a sample of preadolescent girls who participated in SPLASH, a multicomponent youth program consisting of identity development ("I am an exerciser"; "I am a healthy eater"), physical activity, and healthful eating.

METHODS

SPLASH was piloted in a community-based recreational facility in the Midwest United States. Participants had differing levels of program access: all girls (N = 32, age = 10.6 ± 0.8) attended a 1-week summer day camp, and a subset (n = 16) received supplementary access to a 10-week eHealth program. Using a feasibility framework, we examined SPLASH's (1) preliminary efficacy, (2) implementation, and (3) acceptability.

RESULTS

Girls' exercise identities and behaviors improved following camp participation. At follow-up, those in the camp-plus-eHealth group reported greater improvements in physical activity enjoyment relative to girls in the camp-only group.

CONCLUSIONS

SPLASH is a promising identity-focused health promotion program for preadolescent girls. Community support and family engagement facilitated this pilot study. Programmatic impact should be assessed in additional communities.

Validation of physical activity recall questionnaire and log using doubly-labelled water in Sri Lankan children

BACKGROUND AND OBJECTIVE

Valid and cost-effective approaches are essential to assess physical activity and sedentary behaviours in individuals of all ages. This study aimed to validate a physical activity recall questionnaire (PAR-Q) and a physical activity log against the doubly labelled water (DLW) technique in 11-13-year-old Sri Lankan children.

METHOD

Total energy expenditure (TEE) was determined using the criterion DLW technique (TEEDLW) and physical activity energy expenditure (PAEEDLW) was estimated. Subsequently, physical activity assessment methods were validated in a group of children (n = 79). PAR-Q was adapted from the adolescent physical activity questionnaire and the physical activity log from the Bouchard activity diary. The youth physical activity compendium was used to calculate PAEE from both PAR-Q (PAEEPAR-Q) and activity log (PAEEPALog). Statistical analysis included Pearson's correlation coefficient and Bland-Altman analyses.

RESULTS

Mean age of the study sample was 12.0 ± 0.8 years where the greater proportion were males (51.9%, n = 41). PAEEPAR-Q and PAEEPALog were significantly correlated with the PAEEDLW (r = 0.69 and r = 0.49, p < 0.05). PAR-Q underestimated PAEE by 230.1 ± 1071.1 kJ/day. Physical activity log overestimated PAEE by 14.6 ± 1283.2 kJ/day; for unit increase in the mean of the two measurements, the difference between the measurements increased by 0.48 (R2 = 0.16, p < 0.001).

CONCLUSION

PAR-Q is a valid tool for predicting PAEE in Sri Lankan children whereas the physical activity log was not. Researchers and practitioners can confidently use the PAR-Q to assess physical activity in this population, with potential applications in various research and intervention settings.

Enhancing physical activity levels in 9-11-year-old children of varied genders: strategies leveraging parental exercise consciousness

Objective

This study aimed to explore the predictive associations of parental exercise consciousness with the physical activity (PA) status and characteristics of 9-11-year-old children, in an attempt to identify effective strategies for addressing PA insufficiency in children from a parental standpoint.

Methods

The PA rating scale-3 and the Chinese Civic Exercise Consciousness Questionnaire were used to measure primary school students' PA and their parents' exercise consciousness from 361 families in Tianjin, China. The dimensions of exercise consciousness were cognition and identity (CI), sentiment and intention (SI), attitude and willingness (AW), and rights and responsibilities (RR) dimensions. Descriptive statistics, ANOVA with post-hoc test analysis, correlation analysis, and hierarchical regression analysis were performed.

Results

First, children's PA increased with age, with boys significantly exceeding girls (p < 0.01). Significant gender differences were observed in both PA intensity and frequency (boys higher than girls, p < 0.01), although this was not consistent across age groups. Variations in PA duration and frequency showed significant age-related changes (p < 0.01), whereas intensity showed significant changes at older ages (p < 0.01). Second, we observed moderate to above-average level of parental exercise consciousness, and a significantly positive correlation between parental exercise consciousness and children's PA levels (α = 0.601, p < 0.01); meanwhile, all four dimensions of parental exercise consciousness showed varying degrees of positive correlations with children's PA intensity, duration, and frequency (p < 0.01). Third, stratified linear regression analysis showed the varied predictive associations of the different dimensions of parental exercise consciousness with children's PA intensity, duration, and frequency. SI and AW significantly predictively associated with PA levels across different age groups and genders (p < 0.05).

Conclusion

Age and gender showed crucial associations with children's PA levels, resulting in distinct preferences and behaviors between boys and girls across various age groups. Parental exercise consciousness of exercise positively associated with the intensity, frequency, and overall volume of children's PA. Enhancing parental consciousness of exercise-related emotions, intentions, attitudes, and willingness may effectively associate with enhancements in the intensity, duration, and frequency of their children's PA, ultimately promoting greater engagement in physical exercise among the youth.

Cardiopulmonary Fitness and Physical Activity Among Children and Adolescents With Inherited Cardiac Disease

Importance

Historical restrictions on children with inherited cardiac arrhythmia or cardiomyopathy have been implemented to mitigate the potential risk of sudden death, but these limitations can be detrimental to overall health and cardiopulmonary fitness.

Objectives

To evaluate cardiopulmonary fitness and physical activity among children with inherited cardiac disease and identify the factors associated with maximum oxygen uptake (V̇o2max) in this population.

Design, Setting, and Participants

This cross-sectional, multicenter, prospective controlled study was conducted in 7 tertiary care expert centers for inherited cardiac disease in France from February 1, 2021, to June 20, 2023, with a 2-week follow-up. Participants included 100 children and adolescents aged 6 to 17 years with inherited cardiac arrhythmia or cardiomyopathy who were compared with 107 sex- and age-matched controls.

Main Outcomes and Measures

Maximum oxygen uptake was assessed using cardiopulmonary exercise testing, and results were expressed using pediatric reference z score values. The main determinants of V̇o2max included clinical (New York Heart Association [NYHA] functional class, treatment, echocardiographic, and electrocardiogram variables), functional (cardiopulmonary exercise test parameters), sociodemographic (sex, schooling, and parents' education), and behavioral (physical activity and motivation) characteristics.

Results

A total of 100 patients (mean [SD] age, 12.7 [3.1] years; 52 boys [52.0%]) and 107 controls (mean [SD] age, 11.7 [3.3] years; 54 boys [50.5%]) were included. The V̇o2max was lower in patients than controls, expressed as z scores (mean [SD] score, -1.49 [1.48] vs -0.16 [0.97]; P < .001) or raw values (mean [SD] value, 32.2 [7.9] vs 40.2 [8.5] mL/kg/min; P < .001). Moderate to vigorous physical activity levels were lower in patients than in controls (mean [SD] level, 42.0 [23.6] vs 48.2 [20.4] min/d; P = .009). The final multivariable model explained 80% of the V̇o2max by integrating clinical (lower NYHA functional class, absence of ventricular dilatation, and absence of implantable cardioverter-defibrillator), functional (higher forced vital capacity and ventilatory anaerobic threshold), sociodemographic (male sex, normal progression of schooling, and higher maternal educational level), and behavioral (higher self-reported physical activity and motivation toward physical activity) parameters.

Conclusions and Relevance

This cross-sectional study suggests that levels of cardiopulmonary fitness and physical activity were lower in children and adolescents with inherited cardiac disease than in healthy controls, even after adjusting for use of β-blockers and using modern pediatric reference models. Assessing cardiopulmonary fitness among children with inherited cardiac disease can contribute to engaging in a shared decision-making process for sports participation and preventive interventions, such as early cardiac rehabilitation programs.

The measurement reliability and equivalence of print versus online versions of the Youth Activity Profile

PURPOSE

The Youth Activity Profile (YAP) is a 7-day self-report designed to quantify physical activity and sedentary behaviors among youth. This study evaluated the reliability of the online version of the YAP and equivalence with the paper-based version.

METHOD

A total of 2,490 participants from 17 schools in Iowa and Texas completed the YAP. Each classroom was randomly assigned to complete either the print or online version twice. A variance components model was used to assess the test-retest reliability and equivalence testing was also applied.

RESULTS

Both paper and online versions had similar reliability for the PA estimates in school (ICCprint = 0.69-0.91; ICConline = 0.54-0.84), at home (ICCprint = 0.72-0.83; ICConline = 0.64-0.94), PA at weekend (ICCprint = 0.33-0.72; ICConline = 0.39-0.70), and SB (ICCprint = 0.69-0.90; ICConline = 0.66-0.80). The two versions were statistically equivalent for most YAP items except for recess.

CONCLUSION

The online YAP appears to be a reliable assessment of physical activity and sedentary behavior in youth populations.

Attainment of World Health Organization physical activity recommendations by Ecuadorian children: Analysis of social and anthropometrics factors in two distinct populations

Daily adherence to WHO recommended physical activity guidelines has multiple health benefits in children and adolescents. Limited data from low and middle-income countries are available regarding adherence to WHO physical activity recommendations. This study aims to objectively measure physical activity intensities and explore associations with sociodemographic and anthropometric factors related to nonadherence to the WHO minimum physical activity recommendations. Two cross-sectional studies were conducted between 2014 and 2019 in two distinct populations of Ecuador in terms of poverty and residency (Cuenca: 66% live in urban areas, and 38.2% have unsatisfied basic needs; Quininde, 76.4% live in rural areas and 91% have unsatisfied basic needs). Waist-worn accelerometers were used to measure daily physical activity, standardized questionnaires were used to assess sociodemographic variables (age, sex, ethnicity, and socioeconomic status), and anthropometric (weight, height, waist circumference) measurements were taken. Multivariable regression was used to assess the relationship between sociodemographic and anthropometric factors with physical activity in each study population. The study involved 650 participants in Cuenca, with a mean age of 9.1 years (SD 2.9), and 985 children and adolescents in Quinindé, with a mean age of 8.3 years (SD 0.4). In both settings, boys were more likely than girls (Cuenca: adj. OR 3.09, 95% CI 2.17-4.39; Quinindé adj. OR 5.63, 95% CI 4.03-7.85) to achieve the WHO physical activity guidelines. More affluent participants were much less likely to meet this recommendation than their poorer counterparts in both settings. In Cuenca, a higher waist circumference was inversely associated with meeting WHO daily physical activity recommendation (adj. OR 0.96, 95% CI 0.94-0.98), whereas in Quinindé, adherence to WHO guidelines was more likely in non-Mestizo than Mestizo children (adj. OR 1.45, 95% CI 1.02-2.07). The findings suggest that anthropometric differences and sociodemographic disparities influence the attainment of WHO physical activity recommendations in Ecuadorian children.

Characteristics of the Outdoor Environment Affording Physical Activity, Motor Competence, and Social Interactions in Children Aged 3-7 Years: A Systematic Review

Early childhood education (ECE) settings play a crucial role in promoting physical and social development among children aged 3-7 years. This systematic review sought to examine the associations between characteristics of ECE outdoor environments, social interactions, physical activity, and motor competence. The secondary aim examines previously applied methods to capture children's behaviour in the context of their social and physical environment.

METHODS

This review used the PRISMA framework and study quality was assessed using the mixed-methods appraisal tool (MMAT). Keyword searches were conducted in seven databases. Studies were eligible if children were aged 3-7 years in ECE; physical activity, social interactions and/or motor competence were measured; location and/or social context were measured. Results were synthesised using an effect direct plot, a table of associations, and narrative synthesis.

RESULTS

Twenty-three studies from eight countries met the inclusion criteria. Intervention and controlled cross-sectional studies (n = 9) favoured high-quality outdoor environments rich in affordances, portable play equipment, and natural features to increase children's physical activity, social interactions, and cooperative play. Cross-sectional and descriptive studies (n = 14) positively associated open grassy space, portable and fixed equipment, wheeled toys, and paths with physical activity (p < 0.05). Based on limited evidence, playground size and active games in small groups were associated with greater MC.

CONCLUSIONS

The findings highlight the benefit of creating diverse affordance rich outdoor environments in early childhood settings to promote physical and social development. Limitations include variability in study designs and protocols for conducting systematic observations, thus emphasising the need for standardised approaches to future research.

DE-PASS Best Evidence Statement (BESt): Determinants of self-report physical activity and sedentary behaviours in children in settings: A systematic review and meta-analyses

Previous physical activity interventions for children (5-12yrs) have aimed to change determinants associated with self-report physical activity behaviour (PAB) and/or sedentary behaviour (SB), however, the associations between these determinants and PAB/SB in different settings are uncertain. The present study aimed to identify modifiable determinants targeted in previous PAB/SB interventions for children. Intervention effects on the determinants and their associations with self-report PAB/SB were assessed across settings. Search of relevant interventions from pre-defined databases was conducted up to July 2023. Randomized and non-randomized controlled trials with modifiable determinants were included. Data extraction and risk of bias assessments were conducted by two independent researchers. Where data could be pooled, we performed Robust Bayesian meta-analyses. Heterogeneity, publication bias and certainty of evidence were assessed. Fifteen studies were deemed eligible to be included. Thirty-seven unique determinants within four settings were identified-school, family, school with family/home, and community with(out) other settings. Ninety-eight percent of determinants belonged to individual/interpersonal determinant categories. Narratively, intervention effects on student perception of teachers' behaviour (school), self-management, perceived barriers, external motivation, exercise intention, parental modeling on SB (school with family/home) and MVPA expectations (community) were weak to strong, however, corresponding PAB/SB change was not evident. There were negligible effects for all other determinants and the corresponding PAB/SB. Meta-analyses on self-efficacy, attitude, subjective norm and parental practice and PAB/SB in two settings showed weak to strong evidence against intervention effect, while the effect on knowledge could not be determined. Similarly, publication bias and heterogeneity for most analyses could not be ascertained. We found no concrete evidence of association between the modifiable determinants and self-report PAB/SB in any settings. This is presumably due to intervention ineffectiveness. Design of future interventions should consider to follow the systems-based approach and identify determinants unique to the context of a setting, including policy and environmental determinants.

Associations between adherence to 24-hour movement guidelines and socio-emotional competence among preschool children: A cross-sectional study

BACKGROUND

This study investigated the association between adherence to 24-h movement guidelines and socioemotional competence among Chinese preschool children.

METHODS

A total of 1288 parents of Chinese preschoolers (54.64 % boys, 45.36 % girls; Mage = 4.48, SD = 0.97) reported the time their children spent on physical activity (PA), screen time (ST), and sleep duration (SD), and completed questionnaires measuring socioemotional competence. Multiple logistic regression analyses were used to explore the associations between individual and combined measures of PA, ST, and SD, and the risk of low socioemotional competence.

RESULTS

The risk of low socioemotional competence was significantly lower for children aged 4 (odds ratio [OR] = 0.47, 95 % CI: 0.31-0.71), 5 (OR = 0.23, 95 % CI: 0.15-0.35), and 6 (OR = 0.16, 95 % CI: 0.10-0.25) compared to 3-year-olds. Children with a family income level higher than 20,000CNY had a significantly lower risk of low socioemotional competence than those with a family income level not higher than 3000CNY (OR = 0.21, 95 % CI: 0.08-0.59). Urban residency was associated with significantly lower odds of low socioemotional competence than rural residency (OR = 0.41, 95 % CI: 0.21-0.82). Adherence to the PA-only guidelines (OR = 0.45, 95 % CI: 0.22-0.94), SD-only guidelines (OR = 0.25, 95 % CI: 0.08-0.72), ST + SD guidelines (OR = 0.33, 95 % CI: 0.16-0.67), and PA + ST + SD guidelines (OR = 0.36, 95 % CI: 0.18-0.70) were associated with a lower risk of low socioemotional competence. In addition, among boys, only adherence to the PA + ST + SD guidelines (OR = 0.36, 95 % CI: 0.14-0.90) was associated with a lower risk of low socioemotional competence. Among girls, adherence to SD guidelines only (OR = 0.22, 95 % CI: 0.04-0.90), ST + SD guidelines (OR = 0.17, 95 % CI: 0.06-0.49), and PA + ST + SD guidelines (OR = 0.37, 95 % CI: 0.14-0.91) were all associated with a lower risk of low socioemotional competence.

CONCLUSIONS

Adhering to 24-h movement guidelines is crucial for enhancing socioemotional competence in preschool children, especially girls. Interventions should focus on promoting physical activity, reducing screen time, and ensuring adequate sleep.

The association of fructose and fiber consumption and physical activity with non-alcoholic fatty liver disease in children and adolescents: a cross-sectional study

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is emerging as the most prevalent liver disease in overweight and obese children. While no cure exists, dietary and lifestyle modifications have been shown to improve the condition. This study investigates the relationship between fructose and fiber consumption, physical activity, and NAFLD in children.

METHODS

A cross-sectional study was conducted on 378 overweight and obese children aged 6-13 years. NAFLD diagnosis was confirmed via ultrasound, and dietary intake was assessed using a 147-item food frequency questionnaire (FFQ). Physical activity was evaluated using the Modifiable Activity Questionnaire (MAQ). Multivariable logistic regression models were applied to determine the associations.

RESULTS

After excluding 53 participants due to incomplete data, 325 were included in the final analysis. The mean age was 9.2 ± 1.7 years, and 35% had NAFLD. No significant association was found between fructose intake and NAFLD (OR: 0.67, 95% CI: 0.35-1.29, P = 0.221). However, higher intake of legume fiber (OR: 0.48, 95% CI: 0.26-0.90, P = 0.03) and nut fiber (OR: 0.52, 95% CI: 0.28-0.95, P = 0.04) was significantly associated with a reduced risk of NAFLD. Physical activity showed a trend towards reduced NAFLD risk but was not statistically significant after adjustments (OR: 0.53, 95% CI: 0.22-1.04, P = 0.07).

CONCLUSIONS

While fructose intake was not significantly linked to NAFLD in this population, fiber from legumes and nuts appeared protective. Further prospective studies are needed to confirm these findings and clarify the role of physical activity in NAFLD prevention.

Evaluation of the ActiMotus Software to Accurately Classify Postures and Movements in Children Aged 3-14

BACKGROUND

ActiMotus, a thigh-accelerometer-based software used for the classification of postures and movements (PaMs), has shown high accuracy among adults and school-aged children; however, its accuracy among younger children and potential differences between sexes are unknown. This study aimed to evaluate the accuracy of ActiMotus to measure PaMs among children between 3 and 14 years and to assess if this was influenced by the sex or age of children.

METHOD

Forty-eight children attended a structured ~1-hour data collection session at a laboratory. Thigh acceleration was measured using a SENS accelerometer, which was classified into nine PaMs using the ActiMotus software. Human-coded video recordings of the session provided the ground truth.

RESULTS

Based on both F1 scores and balanced accuracy, the highest levels of accuracy were found for lying, sitting, and standing (63.2-88.2%). For walking and running, accuracy measures ranged from 48.0 to 85.8%. The lowest accuracy was observed for classifying stair climbing. We found a higher accuracy for stair climbing among girls compared to boys and for older compared to younger age groups for walking, running, and stair climbing.

CONCLUSIONS

ActiMotus could accurately detect lying, sitting, and standing among children. The software could be improved for classifying walking, running, and stair climbing, particularly among younger children.

The feasibility, acceptability and potential efficacy of a parental text message and social media program on children's vegetable consumption and movement behaviours: A pilot randomised controlled trial

ISSUE ADDRESSED

Australian children fall short of meeting the dietary, physical activity and sedentary behaviour guidelines. This study aimed to test the feasibility, acceptability and potential efficacy of a parental text message and social media program on, primarily, their school-aged children's vegetable consumption and movement behaviours, and, secondarily, their own.

METHODS

Between August and November 2022, we conducted a two-armed randomised controlled trial with 242 parents/caregivers of primary school-aged children in New South Wales. The 'Adventure & Veg' intervention ran for 8 weeks, promoting vegetable eating behaviours, local outdoor physical activity opportunities and ideas for reducing screen time. Feasibility and acceptability were assessed via recruitment and retention data, intervention metrics and self-reported participant data. Vegetable intake and movement behaviour data were collected via online-surveys and effect sizes were examined.

RESULTS

Most participants reported that they enjoyed receiving the text messages (88%) and the delivery frequency was acceptable (94%). Limitations to Facebook as a delivery platform were reported. The majority of participants used the text messages to influence the vegetable eating (65%) and movement (77%) behaviours of their child. Significant effects were observed among intervention child participants compared with control for mean daily vegetable consumption (0.45 serves, CI: .19; .71, p = .001, d = .5); weekly vegetable variety (1.85, CI: .25; 3.45, p < .001, d = .6); and weekly physical activity variety (.64 CI: .09; 1.19, p = .022, d = .3). Parents in the intervention group increased their daily vegetable intake by .44 serves (CI: .11; .78, p = .01, d = .4).

CONCLUSIONS

A parental text message and social media program has potential to support children's vegetable intake and movement behaviours. Further research is required to explore different online delivery methods to promote local outdoor activity options. SO WHAT?: The Adventure & Veg program holds promise as a stand-alone health promotion intervention or as a useful adjunct to current family or school-based healthy lifestyle programs.

Looking Beyond the Number of Repetitions: An Observational Cross-Sectional Study on Calf Raise Test Outcomes in Children Aged 10-17 Years

AIMS

The calf raise test (CRT) assesses plantarflexor strength and endurance, but normative data for children are scarce. Furthermore, contradictions exist on which factors are associated with total repetitions, with repetitions being the only metric considered. We quantified three of the main CRT outcomes (repetitions, total work, and peak height) in children 10-17 years and explored their relationship with various factors.

METHODS

Healthy children (n = 165, 50.3% female) completed single-legged calf raises on a 10° incline, once on each leg. Test outcomes were extracted using the valid and reliable Calf Raise application.

RESULTS

CRT outcomes were not significantly different between legs (p ≥ .19). The only covariates significantly associated with outcomes based on stepwise quantile regressions were body mass index centile for repetitions, meeting physical activity recommendations for total work and peak height, and age for total work. Outcomes did not significantly differ based on sex or maturation. Median values were around 26 for repetitions, 640-1460 J for total work (age dependent), and 10.1 cm for peak height for children meeting physical activity recommendations.

CONCLUSION

Children who were older, had lower body mass indices, and were more active exhibited superior CRT outcomes. Meeting physical activity recommendations appears beneficial for plantarflexor function and should continue to be prioritized in children.

Subjective measurement of physical activity and sedentary behaviour in children and adolescents with cerebral palsy: a scoping review

PURPOSE

Physical activity is essential for maintaining overall health. Cost-effective and easily administered outcome instruments are valuable for clinical practice and large-scale population studies. The scoping review aimed to identify and map subjective instruments developed or validated to measure habitual physical activity and/or sedentary behaviour in children and adolescents with cerebral palsy aged 0-18 years across all levels of the GMFCS-E&R.

MATERIALS AND METHODS

This scoping review was conducted in accordance with the JBI methodology for scoping reviews and searched the databases PubMed, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, JBI Database of Systematic Reviews and Implementation Reports, Embase and Pedro to identify articles.

RESULTS

From 288 full-text references, 13 studies met the inclusion criteria. Nine instruments measured habitual physical activity and/or sedentary behaviour in children and adolescents with cerebral palsy aged 18 months to 18 years. Six subjective instruments were tested for ambulatory children, while three instruments were tested in children and adolescents at GMFCS-E&R level I-V.

CONCLUSION AND IMPLICATIONS

Reporting of the psychometric properties were found on reliability in three instruments, while data on validity were reported in all instruments. Further studies assessing the psychometric properties of subjective instruments in the target population are needed.

Associations of family socioeconomic indicators and physical activity of primary school-aged children: a systematic review

BACKGROUND

Family socioeconomic indicators (education, occupation, and household income) are key determinants influencing children's physical activity (PA). This study aims to systematically review the current research about the association between family socioeconomic indicators and PA among primary school-aged children and to quantify the distribution of reported associations by childs' and parents' sex and according to analysis and assessment methods.

METHODS

A systematic literature research in multiple scientific databases (MEDLINE via PubMed, Web of Science, ScienceDirect, SPORTDiscus and ERIC) was performed for literature published between 1st January 2010 and 31st March 2022. Only studies reporting statistical associations between an SES indicator of at least one parent (education, occupation, income, or an SES index) and different types and intensities of PA in primary school-aged children (6 to 12 years) were included in the analysis. The distributions of the reported associations were evaluated across and differentiated by sub-group analysis of assessment methods (objectively measured vs. self-reported PA) and analysis methods (univariate vs. multivariate models).

RESULTS

Overall, 93 studies reported in 77 publications were included in this review. Most of the studies were conducted in Europe and used self-reports (questionnaires) to assess PA. Most studies used only a single SES indicator (commonly maternal education), and only two studies calculated an SES index. The majority of the studies focused on moderate-to-vigorous physical activity (MVPA), total physical activity (TPA), and organized physical activity (OPA). Results showed predominantly positive associations between SES indicators and OPA. In contrast, results regarding different intensities of daily PA (TPA, LPA, MPA, MVPA, VPA, LTPA) were heterogeneous, with overwhelmingly no associations.

CONCLUSION

Overall, the results expand the knowledge about the association between family socioeconomic indicators and children's PA and disprove the hypothesis of a clear positive association. However, large multicenter studies are lacking using a real SES index as a predictor and analyzing gender-specific multivariate models.

Development and validation of the Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ) in 14 countries: study protocol

INTRODUCTION

Global surveillance of physical activity (PA) of children and adolescents with questionnaires is limited by the use of instruments developed in high-income countries (HICs) lacking sociocultural adaptation, especially in low- and middle-income countries (LMICs); under-representation of some PA domains; and omission of active play, an important source of PA. Addressing these limitations would help improve international comparisons, and facilitate the cross-fertilisation of ideas to promote PA. We aim to develop and assess the reliability and validity of the app-based Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ) among 8-17 years old in 14 LMICs and HICs representing all continents; and generate the 'first available data' on active play in most participating countries.

METHODS AND ANALYSIS

Our study involves eight stages: (1) systematic review of psychometric properties of existing PA questionnaires for children and adolescents; (2) development of the GAC-PAQ (first version); (3) content validity assessment with global experts; (4) cognitive interviews with children/adolescents and parents in all 14 countries; (5) development of a revised GAC-PAQ; (6) development and adaptation of the questionnaire app (application); (7) pilot-test of the app-based GAC-PAQ; and, (8) main study with a stratified, sex-balanced and urban/rural-balanced sample of 500 children/adolescents and one of their parents/guardians per country. Participants will complete the GAC-PAQ twice to assess 1-week test-retest reliability and wear an ActiGraph wGT3X-BT accelerometer for 9 days to test concurrent validity. To assess convergent validity, subsamples (50 adolescents/country) will simultaneously complete the PA module from existing international surveys.

ETHICS AND DISSEMINATION

Approvals from research ethics boards and relevant organisations will be obtained in all participating countries. We anticipate that the GAC-PAQ will facilitate global surveillance of PA in children/adolescents. Our project includes a robust knowledge translation strategy sensitive to social determinants of health to inform inclusive surveillance and PA interventions globally.

Differences in Objective Physical Activity Between Children With Visual Impairment and Those With Normal Sight

Purpose

To compare objective physical activity (PA) levels of children with visual impairment (VI) and children with normal sight.

Methods

One hundred children with VI and 100 age- and gender-matched normal-sighted peers 7 to 17 years of age wore an ActiGraph for 1 week. Activity count per minute (cpm) was modeled using a series of generalized linear mixed-effects models including vision, age, sex, time of day, and vision by time of day interaction. PA outcomes included mean counts per minute and proportion of time spent on sedentary, light, moderate, and vigorous intensity PA.

Results

Data of 83 children with VI and 77 normal-sighted peers were included. Mean counts per minute were lower in children with VI (P < 0.001), especially during and after school. Children with VI were less sedentary (55%; 95% confidence interval [CI], 53-57) than children with normal sight before school (62%; 95% CI, 60-64) and over weekends: children with VI, 41% (95% CI, 39-43); children with normal sight, 45% (95% CI, 43-47). Yet, children with VI were more sedentary during school (36%; 95% CI, 34-37) compared with children with normal sight (30%; 95% CI, 29-32). They also spent more time performing light PA and less time performing moderate PA at school and vigorous PA across all periods of day (P < 0.001).

Conclusions

Children with VI participated in light and moderate PA but did not perform as much vigorous PA as children with normal sight, especially during school hours.

Translational Relevance

There is a need to promote more intense PA programs in schools tailored for children with VI.

Financial Incentives for Physical Activity and Sports Participation in Young People

Physical inactivity is a global health problem. Childhood is an opportune time to establish healthy physical activity behaviors, including the participation in organized physical activity, such as sports. We hypothesize that financial incentives can improve young people's participation in physical activity and sports. The design of the incentive and the context in which it operates are crucial to its success.

Exercise identity and physical activity behavior during late adolescence: A four wave cross-lagged panel model

Research has shown that physical activity behavior tends to decline across adolescence before stabilizing in adulthood. Identifying salient factors underlying these behavioral changes is therefore imperative for informing intervention development. This study explored the temporal nature of the relationship between exercise identity and physical activity behavior during the transition out of high school. An analysis of data from the Application of integrated Approaches to understanding Physical activity during the Transition to emerging adulthood (ADAPT) prospective cohort study was conducted, involving 1451 Canadian adolescents (Mage = 15.93 ± 0.53 years; 52.4% female). Participants completed the International Physical Activity Questionnaire-Short Form to report weekly moderate-to-vigorous physical activity and an abbreviated version of the Exercise Identity Scale yearly for four years beginning in Grade 11. A four-wave cross-lagged panel model was used to test bi-directional associations between exercise identity and physical activity behavior. Significant auto-regressive effects for exercise identity and physical activity were observed across all four time points. Significant positive cross-lagged paths were observed for exercise identity predicting future physical activity at all time points; however, none of the cross-lagged paths with physical activity predicting future exercise identity were significant. Collectively, these findings support existing theory that emphasizes the role that identity plays in physical activity behavior. Interventions seeking to attenuate the physical activity declines typically observed during the transition to emerging adulthood should therefore consider adopting behavior change techniques that target identity, as it appears to be an important psychological determinant underlying future physical activity engagement.

Development and psychometric testing of a questionnaire for the Korea Youth risk behavior survey to assess physical activity behaviors

BACKGROUND

Physical activity is essential for physical, mental, and cognitive health. Providing evidence to develop better public health policies to encourage increased physical activity is crucial. Therefore, we developed an in-depth survey as part of the Korea Youth Risk Behavior Survey to assess the current status and determinants of physical activity among Korean adolescents.

METHODS

We developed an initial version of the questionnaire based on a review of validated questionnaires, recent trends and emerging issues related to adolescent physical activity, and the national public health agenda pertaining to health promotion. Content validity was confirmed by a panel of 10 experts. Face validity was confirmed through focus group interviews with 12 first-year middle school students. The test-retest reliability of the questionnaire was evaluated by administering it twice, approximately two weeks apart, to a sample of 360 middle and high school students. Additionally, the frequency or average number of responses was analyzed in a sample of 600 students who participated in the initial test-retest reliability evaluation of the questionnaire developed in this study.

RESULTS

Through item pool generation and content and face validity test, the final 15 questionnaire items were developed across five themes: levels of physical activity, school sports club activities, transportation-related physical activity, physical activity-promoting environments, and factors mediating physical activity. The test-retest reliability ranged from fair to substantial. Results from the newly developed survey reveal that only a minority of adolescents engage in sufficient physical activity, with only 17.2% and 21.5% participating in vigorous and moderate-intensity activities, respectively, for at least five days per week. Among school-based activities, 44.3% of students do not participate in school sports clubs due to reasons including absence of clubs and disinterest in exercise. The major motivators for physical activity are personal enjoyment and health benefits, whereas preferences for other leisure activities and academic pressures are the predominant barriers.

CONCLUSIONS

This study developed valid and reliable in-depth survey items to assess physical activity among Korean youths. It will hopefully enhance our understanding of adolescent physical activity, offering essential preliminary evidence to inform the development of public health strategies aimed at promoting adolescent health.

Malnutrition, sarcopenia, and frailty assessment in pediatric transplantation

Nutrition assessment can be challenging in children with end-stage organ disease and in those requiring an organ transplant. The effect of poor nutrition status can exert long-lasting effects on children with end-stage organ disease requiring transplantation. Malnutrition, sarcopenia, and frailty are conditions that require provision of optimal nutrition to prevent or support the treatment of these conditions. Unfortunately, the literature on the assessment of malnutrition, sarcopenia, and frailty in pediatric end-stage organ disease is scarce, thus leading to confusion on how to effectively identify them. Recently, the addition of a variety of validated nutrition and functional assessment techniques has assisted with appropriate assessment of these conditions. The objective of this narrative review is to provide an overview of the current literature for pediatric assessment of malnutrition, sarcopenia, and frailty in the setting of solid organ transplantation and provide practicing nutrition clinicians a solid foundation for learning how to effectively assess these conditions with the current literature available.

Dose-response associations of Monitor-Independent Movement Summary with health-related fitness in youth

The purpose of this study was to determine the dose-response associations between Monitor-Independent Movement Summary (MIMS) units and health-related fitness in youth. The sample comprised US children and adolescents who participated in the 2012 National Youth Fitness Survey (NNYFS; N = 1158, 48.9% female). Health-related fitness domains were assessed using tests of cardiorespiratory endurance (timed maximal and graded treadmill tests), muscular strength (modified pull-up and grip tests), and muscular endurance (plank test). Movement data were collected using wrist-worn ActiGraph accelerometers with raw data processed using MIMS and the calculated metrics of average MIMS/day, Peak 60-min MIMS, and Peak 30-min MIMS. Weighted regression models examined linear associations between MIMS metrics and fitness test scores. Nonlinear associations were examined using weighted spline models with knots placed at the 10th, 50th, and 90th percentiles. Models were adjusted for covariates and fit was examined using the coefficient of determination (R2 ). The strongest adjusted linear relationships included a positive association between MIMS/day (per every 1000 units) and maximal endurance times (b = 5.5 s, p < 0.001) and between Peak 60-min MIMS (per every 10 units) and estimated aerobic capacity (b = 1.7 mL/kg/min, p < 0.001), modified pull-ups (b = 0.7 reps, p < 0.001), and plank test scores (b = 5.0 s, p < 0.001). Linear spline models had slightly higher R2 values (R2 range = 16.9%-74.8%) compared to linear models (R2 range = 15.0%-74.5%). The relationship between MIMS metrics and fitness test scores was best modeled as piecewise linear functions. Although all MIMS metrics associated with cardiorespiratory endurance, Peak 60-min MIMS showed stronger associations with tests of muscular strength and endurance.

Levels of Physical Activity at Age 10 Years and Brain Morphology Changes From Ages 10 to 14 Years

Importance

Physical activity may promote healthy brain development in children, but previous research was predominantly cross-sectional and included small samples, providing limited knowledge.

Objective

To investigate the longitudinal associations of physical activity with brain morphology changes.

Design, Setting, and Participants

A 4-year longitudinal population-based cohort study in Rotterdam, the Netherlands, embedded in Generation R, a cohort from fetal life onward. From the women enrolled during pregnancy, children who had repeated measures of brain structure at ages 10 (range 8 to 12) years and 14 (range 13 to 15) years were included. Data were collected from March 2013 to November 2015 (baseline) and from October 2016 to January 2020 (follow-up). Data were analyzed from April to December 2022.

Exposure

At age 10 years, both the child and their primary caregiver reported the child's levels of physical activity with regard to sport participation, outdoor play, and total physical activity. Primary analyses were based on an average multi-informant report.

Main outcomes and measures

Brain morphology was quantified by magnetic resonance imaging. Hypothesized regions of interest were the bilateral amygdala and hippocampal volumes. Global brain measures were studied to test the specificity of the hypothesis.

Results

Data were available for 1088 children (566 girls [52%]; 693 [64%] Dutch). Their mean (SD) age at baseline was 10.1 (0.6) years. For amygdala volume change, positive associations with multi-informant reports of total physical activity (β = 2.6; 95% CI, 0.3-4.9) were found. Total physical activity was associated with hippocampal volume increases only when reported by the child (β = 3.1; 95% CI, 0.4-5.8). No robust associations with global brain measures were found.

Conclusions and relevance

In this cohort study of 1088 children, more physical activity at 10 years was consistently associated with an increase in amygdala volume in children aged 10 to 14 years. Physical activity and increases in hippocampal volume were found using child reports of physical activity only. These findings suggest physical activity in late childhood was prospectively associated with volumetric changes in specific subcortical structures, but not to global brain development, from late childhood to early adolescence. These findings may inform the design of future public health interventions to best facilitate neurodevelopment with physical activity.

Co-design and content validity of the movement measurement in the early years (MoveMEY) tool for assessing movement behaviour of pre-school aged children

BACKGROUND

Movement behaviours (physical activity, sedentary behaviour, and sleep) are important for pre-school children's health and development. Currently, no tools with appropriate content validity exist that concurrently capture these movement behaviours in young children. The aim of this study was to co-design and assess the content validity of a novel tool to concurrently measure movement behaviours in pre-school aged children (aged 3-4 years).

METHODS

We followed four distinct steps to develop and assess the content validity of Movement Measurement in the Early Years (MoveMEY): (1) We conducted an extensive literature search, to identify pre-existing proxy measurement tools (questionnaires and diaries) to inform the design of a novel tool, which aimed to effectively capture movement behaviour guidelines of pre-school aged children. (2) We facilitated focus group discussions with parents and carers of pre-school aged children (n = 11) and (3) a qualitative survey with free text responses was completed by topic relevant researchers (n = 6), to co-design the measurement tool. (4) We assessed the content validity of the developed tool, MoveMEY, through interviews with parents of pre-school aged children (n = 12) following piloting of the tool.

RESULTS

We developed an initial version of MoveMEY based on the format of an existing questionnaire and by mapping the content of questions to the guidelines. Co-design of MoveMEY resulted in changes to the format (e.g. short questionnaire to a seven-day diary) and content (e.g. inclusion of 'general information' questions on illness, disabilities and sleep disturbances; question on screen time before bed). Content validity assessment demonstrated that the items of MoveMEY were relevant and comprehensive for the assessment of children's movement behaviours. MoveMEY was felt to be comprehensible, however, parental suggestions were implemented to finalise and improve MoveMEY (e.g. adding examples to questions aiming to detect moderate to vigorous physical activity).

CONCLUSION

MoveMEY is the first co-designed measurement tool that has relevance for assessing the movement behaviour guidelines of pre-school aged children. Parent/carer and topic relevant researcher involvement throughout the development process resulted in a seven-day daily reported activity diary that is comprehensive of children's movement behaviours and comprehensible to parents and carers.

Convergent Validity of the Patient Reported Outcome Measurement Information System-Pediatric Physical Activity Instrument (PROMIS®-PA) with Wearable Devices in Adolescents

The study was conducted mainly to examine the convergent validity of the Patient Reported Outcome Measurement Information System-Pediatric Physical Activity instrument (PROMIS^®®®-PA) with step counts from wearable devices and another validated self-reported outcome measure. As a secondary aim, we explored the effect of different recall time frames (7-day, end-of-day [EoD], and ecological momentary assessment [EMA] time frames during the day) in terms of their feasibility and associations with each other and with step counts. This was a prospective cohort study that examined the associations between measures of PA in school-age children and adolescents (n = 84, aged 10-20). The participants wore Fitbit devices for 7 consecutive days, and then completed the 7-day-recall PROMIS-PA short form and Youth Activity Profile (YAP). Additional analyses were completed in a sub-sample (n = 25, aged 11-18 years) using the PROMIS-PA for the EMA at five intervals during the day (shorter form) and at the EoD. In the total sample, the PROMIS-PA results showed positive moderate correlations with the YAP and average daily steps (r = 0.533, p < 0.001 and r = 0.346, p = 0.002, respectively). In the sub-sample, the 7-day PROMIS-PA was highly correlated with the averaged EMA or EoD ratings for the week, and moderately correlated with the daily step counts. These findings support the validity of the PROMIS-PA as a measure of self-reported physical activity. Adolescents demonstrated higher compliance rates and preference for the 7-day recall and EoD assessments compared to more frequent EMA reporting.

COVID-19 induced changes in physical activity patterns, screen time and sleep among Swedish adolescents - a cohort study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic had a huge impact on daily life, even in countries such as Sweden where the restrictions were relatively mild. This paper assesses the effects of the COVID-19 pandemic restrictions on physical activity (PA) patterns, screen time, and sleep among Swedish adolescents. The exposures explored include gender, parental education, anthropometrics, and cardiovascular fitness (CVF).

METHODS

Cohort data were collected from September 26th to December 6th, 2019, and from April 12th to June 9th, 2021. Participants were 13-14 years-old (7th graders) at baseline with 585 participating at both baseline and follow-up. At both baseline and follow-up PA and sedentary time were measured with accelerometers, and sleep and screen time with questionnaires. The exposure variables (gender, parental education, anthropometrics and CVF) were collected at baseline. Multilevel linear regression analyses were performed.

RESULTS

Moderate-to-vigorous-physical activity (MVPA) remained unchanged while light physical activity (LiPA) decreased and sedentary time increased. Sleep duration decreased and screen time increased. Girls, adolescents with overweight/obesity (BMI and percent body fat), and those with lower CVF at baseline had less favourable changes in PA patterns, sleep and screen time.

CONCLUSIONS

Although no significant (α = 0.05) changes were seen in MVPA, both LiPA and sedentary time as well as sleep and screen time changed in unfavourable ways. More intense activities are often organised and seem to have withstood the pandemic, while less intense activities decreased. Some groups were more vulnerable and will need directed intervention in the post-pandemic period as well as when future pandemics hit.

Questionnaires Measuring Physical Activity in Clinical Pediatric Populations: A Systematic Review

PURPOSE

Regular physical activity (PA) is a cornerstone therapy for many childhood chronic health conditions, and questionnaires offer a simple method for monitoring PA and identifying children who do not meet clinical practice guidelines. The purpose of this systematic review is to determine which questionnaires are most efficacious for assessing PA in children with chronic health conditions.

METHODS

Systematic literature searches were conducted through ProQuest, MEDLINE, Scopus, and SPORTDiscus from January 2010 to August 2020 to identify studies that measured PA with a validated questionnaire in children and adolescents aged 3-18 years old with chronic health conditions. In eligible studies, the validity and reliability of questionnaires were identified, and the modified COnsensus-based Standards for the selection of health status Measurement INstruments checklist and Grading of Recommendations, Assessment, Development, and Evaluations were used to assess the quality and strength of evidence and risk of bias.

RESULTS

Four thousand four hundred and seventy-eight references were extracted, and 10 articles were included for review. From 10 eligible studies, 6 questionnaires were identified, none of which adequately measure PA in clinical pediatric populations.

CONCLUSION

Questionnaires to adequately measure PA in children with chronic conditions are lacking. This compromises the identification of those who do not meet PA guidelines, limiting the opportunity to identify and address factors contributing to low PA levels.

Temporal patterns of sleep and eating among children during school closure in Japan due to COVID-19 pandemic: associations with lifestyle behaviours and dietary intake

OBJECTIVE

To identify temporal patterns of sleep and eating among school-age children during school closure due to the COVID-19 pandemic and to examine their associations with lifestyle behaviours and dietary intake.

DESIGN

In this cross-sectional study, questionnaires were used to assess sleep and eating times, lifestyle behaviours and dietary intake during school closure. Latent class analysis was performed to identify temporal patterns of sleep and eating based on self-reported clock times for wake-up, going to bed and eating meals. Lifestyle behaviours and dietary intake were compared between latent classes.

SETTING

Forty-eight primary and secondary schools in Japan.

PARTICIPANTS

Totally, 6220 children (aged 8-15 years).

RESULTS

Four patterns, labelled 'Very early (20 % of children)', 'Early (24 %)', 'Late (30 %)' and 'Very late (26 %),' were identified and ordered according to the circadian timing. Latter patterns were characterised by later timings of sleep and eating, especially in clock times for wake-up, breakfast and lunch compared with earlier patterns. Children with latter patterns had a less physically active lifestyle, longer screen time (≥4 h/d), shorter study time (<2 h/d) and more frequent skipping of breakfast and lunch than those with earlier patterns. In addition, children with latter patterns had lower intakes of several vitamins, vegetables, fruits, fish and shellfish and dairy products and higher intakes of sugar and confectionaries and sweetened beverages.

CONCLUSION

More than half of the participants had later wake-up, breakfast and lunch during school closure, which was associated with more unfavourable lifestyles and dietary intakes.

Functional impact of pediatric postthrombotic syndrome

BACKGROUND

Postthrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT) in children.

OBJECTIVES

We aimed to assess the impact of pediatric PTS on functioning as assessed by movement ability, mobility, functional disability, and physical activity levels in children after diagnosis of limb DVT.

METHODS

Patients aged 8-21 years in follow-up care after objectively documented limb DVT were prospectively recruited in this cross-sectional study. Measures of functioning (outcomes) included self-reported questionnaires that assessed: 1) movement ability, measured with the Movement Ability Measure-Computer Adaptive Test version; 2) mobility, evaluated with the Computer Adaptive Test version of the Patient-Reported Outcomes Measurement Information System Pediatric Physical Functioning, Mobility domain; 3) functional disability, evaluated with the Functional Disability Inventory; and 4) physical activity levels, evaluated with the Godin Leisure-Time Exercise Questionnaire. The main predictor was PTS severity, which was assessed using the index for the Clinical Assessment of PTS in children. The association between PTS and outcomes was analyzed using linear models.

RESULTS

Eighty-seven patients (median age, 16 years; 25th-75th percentile, 15-18 years; 56% boys) were enrolled. Adjusted for age, sex, and underlying condition, increasing PTS severity was associated with lower current movement ability, a wider gap between current vs preferred movement ability, lower mobility, and slightly higher functional disability scores. There was a nonsignificant effect of PTS severity on moderate-strenuous physical activity.

CONCLUSION

In children, increased PTS severity is associated with lower movement ability and impaired mobility. Reducing the gap between the patients' current vs preferred movement ability is a relevant aspect of PTS management in children.

Associations of physical activity and screen time with adolescent idiopathic scoliosis

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is the most common type of idiopathic scoliosis, affecting approximately 0.61%-6.15% adolescents worldwide. To date, the results on the relationship between moderate-to-vigorous physical activity (MVPA) and AIS were inconsistent, and the association between screen time (ST) and AIS remained unclear. This study aimed to describe MVPA and ST among adolescents, and to explore the independent and joint associations between PA, ST, and AIS.

METHODS

A frequency-matched case-control study based on the 2021 Chinese School-based Scoliosis Screening Program in Shenzhen city, south China, was conducted. The research involved 494 AIS patients (aged 9-17 years) and 994 sex- and age-matched healthy controls. MVPA and ST were measured using a self-administered questionnaire. Logistic regression models estimated associations between PA, ST, and AIS.

RESULTS

Compared to subjects meeting the recommended 60-min daily of MVPA, adolescents reporting daily MVPA time less than 60 min had 1.76 times higher odds of experiencing AIS (95% CI: 1.32-2.35) and adolescents reporting daily MVPA in inactive status had 2.14 times higher odds of experiencing AIS (95% CI: 1.51-3.03). Moreover, participants reporting ST for 2 hours or more had 3.40 times higher odds of AIS compared with those reporting ST less than 2 hours (95% CI: 2.35-4.93). When compared with the adolescents reporting both ST and MVPA meeting the guidelines recommended times (ST < 2 h and MVPA ≥ 60 min/day), those reporting both ST ≥ 2 h and MVPA in inactive status are 8.84 times more likely to develop AIS (95% CI: 3.99-19.61).

CONCLUSIONS

This study reported that the insufficient MVPA, especially MVPA in inactive status, and excessive ST were risk factors for AIS. Additionally, the joint effects of insufficient MVPA and excessive ST probably increase the risk of AIS.

What happened among Japanese children from school closure due to COVID-19 after school re-opening? Changes in sleep habits and dietary intake

The present study aimed to (1) examine the changes in sleep habits and dietary intake among school-aged children after the school re-opening from a 3-month closure (without school lunch) due to the COVID-19 pandemic, and (2) examine whether the changes differ between those with different temporal patterns of sleep and eating during school closure, namely, 'Very early', 'Early', 'Late' and 'Very late'. The latter patterns were characterised by later timings of wake up, breakfast and lunch. Questionnaires were answered twice by 4084 children (aged 8-15 years), themselves and/or their parents: first in June 2020 (for assessing lifestyle during school closure) and second, from July 2020 to February 2021 (for assessing lifestyle after school opening). After school re-opening, the participants' wake-up time became an hour earlier (95 % CI 1⋅0, 1⋅1) and sleep duration got 0⋅94 h shorter (95 % CI 0⋅91, 0⋅97) than during school closure. An increase in dietary intake was observed for thiamine, vitamin B6, potassium, fruits and dairy products, and a decrease was observed for sugars (as foods) and confectioneries and sweetened beverages, despite small effect sizes (Cohen's d: 0⋅20-0⋅30). Significant changes in wake-up time, sleep duration and sweetened beverage intake were observed among children with the latter temporal patterns. Thus, children wake up earlier and sleep for shorter durations after school re-opening than during school closure; however, changes in dietary intake were generally insignificant. Dietary intake among school-aged children in Japan during school closure (without school lunch) might not be worse than that during school days with universal school lunch.

Questionnaires Measuring 24-Hour Movement Behaviors in Childhood and Adolescence: Content Description and Measurement Properties-A Systematic Review

BACKGROUND

We aim to systematically review the literature on measurement properties of self- and proxy-reported questionnaires measuring 24-hour movement behaviors in children and adolescents.

METHODS

PubMed, PsycINFO, SPORTDiscus, and EMBASE were searched until June 2021. Studies were included if the sample size for validity studies had 50 participants (minimum) and included, at least, both validity and test-retest reliability results of questionnaires. The review followed an adaptation of the Consensus-based Standards for the selection of health Measurement INstruments guidelines, to evaluate the quality of measurements properties of the questionnaires (content, convergent and criterion validity, reliability, measurement error, and responsiveness), as well as the risk of bias of each measurement property.

RESULTS

This review included 29 studies, describing 37 questionnaires. Sixty-eight percent showed "adequate" content validity. None of the questionnaires showed overall "adequate" criterion validity, and the risk of bias was "very low" for 92%. One questionnaire showed "adequate" convergent validity, and 73% of the studies were classified with a "high risk of bias." Seven questionnaires showed "adequate" reliability, and 27.3% of the studies were rated with a "very low risk of bias." None of the questionnaires showed "adequate" criterion validity and reliability, simultaneously.

CONCLUSIONS

Existing questionnaires have insufficient measurement properties, and none considered the 24-hour movement behavior paradigm. These results highlight the need for better questionnaires of movement behavior combinations, to improve the monitoring and surveillance systems of 24-hour movement behaviors in this population.

Physical Activity Levels in Brazilian Adolescents: A Secular Trend Study (2007-2017/18)

Only a small proportion of Brazilian adolescents practice sufficient physical activity (PA). However, it is not clear whether this proportion has been decreasing over time. This study aimed to examine the 10-year trends of sufficient PA in adolescents and to investigate differences by sex and age. Using a standard protocol, we compared two cross-sectional cohorts of adolescents aged 15 to 18 years, recruited in 2007 (n = 1040) and in 2017/18 (n = 978). Using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), the adolescents reported moderate-to-vigorous PA (MVPA) performed in the last seven days. Sufficient PA was defined as engaging in at least 60 min/day of MVPA. In the subgroups, investigated by sex or age, there was an increase in the prevalence of sufficient PA. Overall, sufficient PA declined by 28.1% from 2007 to 2017/18. Boys in 2007 were more active than their 2017/18 peers, and this was equally observed in girls in 2007 compared to those in 2017/18. The findings show decreasing secular trends in sufficient PA in the investigated adolescents. Not only are public health authorities in Brazil witnessing an escalation of insufficient PA, but they are also losing ground with the most active adolescents.

Non-exercise activity thermogenesis in the workplace: The office is on fire

From the second half of the previous century, there has been a shift toward occupations largely composed of desk-based behaviors. This, inevitably, has led to a workload reduction and a consequent lower energy expenditure. On this point, small increments of the non-exercise activity thermogenesis (NEAT) could be the rationale to reach health benefits over a prolonged period. Different published researches suggest solutions to reverse sitting time and new alternative workstations have been thought to increase total physical activity. Therefore, the purpose of this narrative review is to summarize the current state of the research regarding the "NEAT approach" to weight-gain prevention in work environments. This review analyzes the main evidence regarding new alternative workstations such as standing, walking workstations, seated pedal, and gymnastic balls to replace a standard office chair.

Relations among parent-reported physical activity and interoception in children

BACKGROUND

Interoception is the sense of one's internal body and emotional state; it plays a critical role in guiding self-regulatory behaviors. Physical activity (PA) can support interoceptive processes, but limited research has examined the association in children. This study explored the relations among parent-reported PA and several interoceptive domains in children aged 3 - 10 years old.

METHODS

Baseline data were analyzed from a cluster-randomized controlled study examining a yoga intervention (N = 122). Parents completed a questionnaire that included the Caregiver Questionnaire for Interoceptive Awareness, Second Edition (CQIA-2) and two measures of PA, the PROMIS Parent-Proxy Short Form (PROMIS-PA) and the adapted Burdette Proxy Report (aBPR-PA). Psychometrics of the CQIA-2 subscales were assessed and then used in subsequent analyses to examine the association between PA and interoceptive sensibility.

RESULTS

Seventy percent of the surveys were completed by mothers (30% by fathers), and their children (56% female, M_age = 5.81 ± 1.7 years) were predominately white. Across all children, PA had a significant positive relationship with interoceptive domains related to emotion and physical energy (p < 0.01). Children who met the PROMIS-PA "good" cutoff had a clearer sense of emotion and physical energy (F(2,115) = 4.30, p = 0.016, R² = 0.070), compared to children who did not. Children's age predicted interoceptive sensibility of illness and toileting needs (F(1,116) = 14.16, p < 0.001, R² = 0.109).

CONCLUSION

Children with higher PA levels were perceived to have better interoceptive sensibility of emotion and physical energy. Children's age was predictive of interoceptive domains representing the awareness of illness and toileting needs. Future work should consider incorporating direct measures of PA and child-reported interoceptive sensibility. A better understanding of their relationship will likely help guide the design of more effective interventions for health behavior development.

Analysis of Association between Adolescents' Food Habits and Body Mass Change in a Population-Based Sample: Diet and Activity of Youth during COVID-19 (DAY-19) Study

The COVID-19 pandemic may have contributed to food habit changes, including some negative ones that may increase the risk of overweight and obesity. The aim of the study was to analyze the association between adolescents' food habits, body mass change, as well as physical activity level in a population-based sample within the Diet and Activity of Youth during COVID-19 (DAY-19) Study. The DAY-19 Study was conducted in a cohort of 1333 students (aged 10-16 years) recruited in schools after stratified random quota sampling of primary schools (sampling counties within voivodeships and schools within counties) in June 2020. The food habits were assessed for the period of the COVID-19 pandemic and the period before the COVID-19 pandemic while using Adolescent Food Habits Checklist (AFHC). The body mass changes were assessed based on body weight and height for the period of the COVID-19 pandemic and the period before the COVID-19 pandemic while using Polish growth reference values. The physical activity changes were assessed based on the subjective assessment of adolescents. It was stated that for female adolescents declaring body mass gain during the COVID-19 pandemic the highest AFHC purchase scores (healthy purchase habits) (p < 0.0001) were accompanied by the lowest AFHC consumption score (unhealthy consumption habits) (p < 0.0001), as well as for female adolescents declaring physical activity decrease during the COVID-19 pandemic the highest AFHC purchase scores (healthy purchase habits) were observed (p = 0.0333). It was stated that for male adolescents declaring physical activity increased during the COVID-19 pandemic, the highest AFHC consumption scores (healthy consumption habits) were observed (p = 0.0003). In the case of a majority of participants, the general food habits were unchanged, which was observed mainly for food habits associated with food preparation. More food habits changes associated with the COVID-19 pandemic resulting in body mass changes were observed in females than in male adolescents. Body mass gain during the COVID-19 pandemic in adolescents may have resulted from unhealthy consumption habits, accompanied by decreased physical activity, in spite of the fact that this sub-group presented healthy purchase habits, which was observed especially for female adolescents.

Parental Support Is Associated with Moderate to Vigorous Physical Activity among Chinese Adolescents through the Availability of Physical Activity Resources in the Home Environment and Autonomous Motivation

This study aimed to use a structural equation model (SEM) to determine the association between parental support and moderate to vigorous physical activity (MVPA) among Chinese adolescents and whether the availability of physical activity (PA) resources in the home environment and autonomous motivation of adolescents mediated the association. Data were collected using questionnaires extracted from the Family Life, Activity, Sun, Health, and Eating (FLASHE) study. A final analytical sample of 3738 adolescents was enrolled. A SEM was performed to evaluate the hypothesized associations. It was found that parental support was not only positively directly but also indirectly associated with MVPA in Chinese boys through the home environment (i.e., availability of PA resources) and the autonomous motivation of adolescents. It is worth noting that the above relationships also exist in Chinese girls, except for the regulatory role of autonomous motivation. These findings suggest that future interventions for increasing adolescents' MVPA should focus on health education for parents to provide more PA resources in the home environment and adequately mobilize children's autonomous motivation.

Translation, Cross-Cultural Adaptation, and Validation of the Persian Version of Thailand Physical Activity Children Survey Questionnaire

Background

According to the importance of physical activity in the child's physical and mental development and cognitive health, developing a valid, reliable, and comprehensive assessment tool for children's physical activity is mandated. The purpose of this study is the translation, cross-cultural adaptation, and validation of the Persian version of the Thailand Physical Activity Children Survey questionnaire to measure the level of physical activity in children aged between 6-9 years in Iran.

Methods

This study consisted of three stages, first, the questionnaire translation into Persian language and modification of the sections according to the Iranian culture, then the evaluation of the questionnaire via a pilot study, and finally, assessing the reliability and validity of the tool. Participants of the pilot study were 250 healthy children, aged 6 to 9 years, meeting eligibility criteria, recruited through a stratified cluster sampling method from schools across Tehran.

Results

The Persian version of the questionnaire demonstrated an acceptable content validity (Content Validity Index between 0.88-1). The test-retest reliability reported the Intra-Class Correlation coefficient in the acceptable range in all sections (between 0.71-1). Cronbach's alpha was reported 0.993, which indicated excellent internal consistency.

Conclusions

According to the acceptable validity and reliability of the Persian version of the Thailand Physical Activity Children Survey for children aged 6-9 years, it is recommended in research and surveillance studies to determine the level of physical activity of children of that age group in Iran.

Validation of a Parent-Reported Physical Activity Questionnaire by Accelerometry in European Children Aged from 6 to 12 Years Old

Validated physical activity (PA) questionnaires are crucial for collecting information in large epidemiological studies during childhood. Thus, this study analyzed the validity of a parent-reported PA questionnaire based on the Children’s Leisure Activities Study Survey by accelerometry in European children aged from 6 to 12 years old. We used data from 230 children of the Human Early-Life Exposome and Infancia y Medio Ambiente projects. Mean differences between moderate-to-vigorous PA (MVPA) reported by the questionnaire and the accelerometer were calculated (min/day), and its associated factors were explored by multiple robust linear regression. The agreement between methods was examined using a Bland−Altman plot. The concurrent validity of assessing MVPA was analyzed by cohort-adjusted Spearman’s partial correlations. ROC curve analysis was also used to explore the questionnaire’s capability to identify active children based on the World Health Organization guidelines. A moderate correlation was found between parent-reported and accelerometer MVPA (rho = 0.41, p < 0.001). The child’s sex (girl) was statistically associated with the mean MVPA difference between methods. However, this questionnaire accurately identified physically active children (area under the curve = 83.8% and 82.7% for boys and girls, cut-points = 68.6 and 45.4 min/day in MVPA, respectively). Consequently, this questionnaire is suitable for classifying active children in order to monitor public health interventions regarding PA.

A Web-Based, Time-Use App To Assess Children's Movement Behaviors: Validation Study of My E-Diary for Activities and Lifestyle (MEDAL)

BACKGROUND

Existing modes of collecting self-reported 24-hour movement information from children, including digital assessments, have not been demonstrated to be of acceptable validity when compared to objective measurements. My E-Diary for Activities and Lifestyle (MEDAL) is an interactive web-based diary developed to collect time-use information from children aged 10 years and older.

OBJECTIVE

This study evaluated the validity of MEDAL for assessing children's movement behaviors by comparing self-reported and accelerometer-measured time spent in movement behavior among children in Singapore aged 10-11 years.

METHODS

Funding for this study was obtained in October 2017, and data were collected between April and August 2020. Participants recorded their daily activities using MEDAL over 2 specified weekdays and 2 weekend days and wore an Actigraph accelerometer on their nondominant wrist throughout the study to objectively assess movement behaviors. Spearman correlation coefficient and intraclass correlation coefficient (ICC) were used to compare the accelerometer measurements and self-reports for each movement behavior. Bland-Altman plots were generated to investigate trends of bias in the self-reports.

RESULTS

Among the participants aged 10-11 years (29/49, 59% boys), we observed that children reported lower light physical activity (LPA) and higher moderate-to-vigorous physical activity (MVPA), inactivity, and night sleep than that measured by the accelerometer. There was a moderate-to-strong correlation between self-reported and accelerometer-measured MVPA (r=0.37; 95% CI 0.20-0.54), inactivity (r=0.36; 95% CI 0.18-0.54), and night sleep (r=0.58; 95% CI 0.43-0.74); the correlation for LPA was poor (r=0.19; 95% CI 0.02-0.36). Agreement was poor for all behaviors (MVPA: ICC=0.24, 95% CI 0.07-0.40; LPA: ICC=0.19, 95% CI 0.01-0.36; inactivity: ICC=0.29, 95% CI 0.11-0.44; night sleep: ICC=0.45, 95% CI 0.29-0.58). There was stronger correlation and agreement on weekdays for inactivity and night sleep; conversely, there was stronger correlation and agreement for MVPA and LPA on weekend days. Finally, based on Bland-Altman plots, we observed that with increasing MVPA, children tended to report higher MVPA than that measured by the accelerometer. There were no clear trends for the other behaviors.

CONCLUSIONS

MEDAL may be used to assess the movement behaviors of children. Based on self-reports, the children are able to estimate their time spent in MVPA, inactivity, and night sleep although actual time spent in these behaviors may differ from accelerometer-derived estimates; self-reported LPA warrant cautious interpretation. Observable differences in reporting accuracy exist between weekdays and weekend days.

Measuring change in adolescent physical activity: Responsiveness of a single item

Self-report measures are frequently used to assess change in physical activity (PA) levels. Given the limited data from adolescent populations, the primary objective of this study was to examine the responsiveness of a single item measure (SIM) of PA for adolescents to detect change in moderate-to-vigorous physical activity (MVPA) using accelerometer data as the reference measure. A secondary objective was to provide further data on the validity of the measure at one point in time. The validity of the SIM to determine the number of days ≥60 minutes of MVPA was based on data from 200 participants (62% female; age: 14.0 ± 1.6 years) and analysis of change was based on data from 177 participants (65% female; age: 14.0 ± 1.6 years). Validity of change in days ≥60 minutes of MVPA was examined through agreement in classification of change between the SIM and accelerometry as the reference measurement and Spearman’s correlation. Cohen’s d and standardised response means were used to assess the responsiveness to change of the measure. The responsiveness of the SIM and accelerometer data were comparable and modest (0.27–0.38). The correlation for change in number of days ≥60 minutes MVPA between the SIM and accelerometery was low (r = 0.11) and the accuracy of the SIM for detecting change, using accelerometry as the reference, was only marginally above chance (53%). Therefore, the adolescent version of the SIM is adequate for assessing PA at a single time point but not recommended for assessing change.

Players at home: Physical activity and quality of life in 12-17 years-old football (soccer) players during the Covid-19 lockdown

BACKGROUND

Aggressive preventive actions were required to face the Covid-19 outbreak. However, from March 2020 on, many healthy youth football players have seen their sporting activities disrupted by the restrictions on outdoor exercise.This study describes physical activity and quality of life during April 2020 lockdown of young people participating in organized football.

METHODS

1163 young football players aged 12-17 years (185 girls) completed a web-based questionnaire including the Youth Physical Activity and the Youth Quality of Life-Short Form Questionnaires; information on lifestyle and football-specific activity were also collected. Differences according to sex, urban/rural context and élite/non-élite club level were tested using a 2 × 2  ×  2 MANOVA (age considered as a covariate).

RESULTS

We found that: (i) on average, exposure to football accounted for 3.2 hours/week, was higher in élite clubs and changed in nature, being mainly performed individually; 19% of participants practiced football <1 hour/week; (ii) only 56% of the participants reported 7 or more hours/week of moderate-to-vigorous physical activity, which decreased with age and changed according to the geographical context; (iii) perceived quality of life was lower in youth playing for non-elite clubs and in older girls; (iv) coaches, rather that official initiatives, were the primary source of football exercises practiced at home.

CONCLUSION

A status of limited physical activity emerged; this might lead to deconditioning and susceptibility to injuries when football could restart. Governing bodies, football Associations and clubs could exploit these results to take informed decisions and support evidence-based interventions during and after the Covid-19 pandemic.

"I Do What I Like": 8- to 10-Year-Old Children's Physical Activity Behavior Is Already Interrelated With Their Automatic Affective Processes

The majority of middle-age children do not meet current physical activity guidelines. There is growing evidence that adults' physical activity is partially influenced by automatic affective processes, which are derived from affective experiences with physical activity. However, little is known about whether these processes are interrelated with children's physical activity level. A prospective design was used to examine whether automatic affective processes assessed by an evaluative priming procedure predict physical activity of children. Physical activity of 48 children (8.71 ± 0.71 years; 65% girls) was measured for 1 week with activity trackers. In a linear regression model, automatic affective processes (β = 0.36) significantly predicted physical activity, accounting for 11.02% of variance. These results indicate that physical-activity-related automatic affective processes are associated with children's physical activity, as has previously been found in adults. This study emphasizes the importance of fostering positive affective experiences associated with physical activity during childhood.

Increased Gaming During COVID-19 Predicts Physical Inactivity Among Youth in Norway-A Two-Wave Longitudinal Cohort Study

Background

A concern for the COVID-19 measures and the potential long-term consequences the measures may have on physical inactivity and gaming among youth.

Objectives

Examine the stability and change in internet and offline gaming and the association with physical inactivity among adolescents in Norway during the pandemic.

Methods

A total of 2940 youth (58% girls) aged 12-19 years participated in an online longitudinal two-wave survey during the first Norwegian national lockdown in April 2020 (t1) and in December 2020 (t2). Gaming behavior and physical activity status were assessed at both time points. Age, gender, and socioeconomic status were included as covariates.

Results

Among boys, 41% reported gaming a lot more and 35% a little more at t1 compared to before the national lockdown. The corresponding numbers for girls were 14 and 23%, respectively. In fully adjusted analysis, a pattern of increased gaming at t1 followed by an additional increase in gaming reported at t2 was associated with physical inactivity at t1 (OR = 2.10, p < 0.01) and t2 (OR = 2.45, p < 0.001). Participants gaming more at t1 followed by a reduction at t2 had higher odds of inactivity at t1 (OR = 1.88, p < 0.01). Youth reporting no gaming at t1 had lower odds for inactivity at this time point (OR = 0.67, p < 0.05).

Conclusions

Increased gaming among many youths and a relationship with physical inactivity was observed during the first phase of the COVID-19 pandemic. To counteract the negative long-term impacts of COVID-19 restrictions, public health initiatives should emphasize the facilitation of physical activity in youth and develop effective strategies to prevent problematic gaming.

A systematic review of proxy-report questionnaires assessing physical activity, sedentary behavior and/or sleep in young children (aged 0-5 years)

BACKGROUND

Accurate proxy-report questionnaires, adapted to the child's developmental stage, are required to monitor 24-h movement behaviors in young children, especially for large samples and low-resource settings.

OBJECTIVES

This review aimed to summarize available studies evaluating measurement properties of proxy-report questionnaires assessing physical activity, sedentary behavior and/or sleep in children aged 0-5 years.

METHODS

Systematic literature searches were carried out in the PubMed, Embase and SPORTDiscus databases, up to January 2021. For physical activity and sedentary behavior questionnaires this is a review update, whereas for sleep questionnaires we included all relevant studies published up to now. Studies had to evaluate at least one of the measurement properties of a proxy-report questionnaire assessing at least duration and/or frequency of physical activity, sedentary behavior and/or sleep in 0- to 5-year-old children. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was used to evaluate the quality of evidence.

RESULTS

Thirty-three studies were included, examining a total of 37 questionnaires. Ten questionnaires were designed for infants, two for toddlers, 11 for preschoolers, and 14 for a broader age range targeting multiple of these age groups. Twenty questionnaires assessed constructs of sleep, four assessed constructs of physical activity, two assessed screen behavior, five assessed constructs of both physical activity and sedentary behavior, and six assessed constructs of all 24-h movement behaviors. Content validity was evaluated for six questionnaires, structural validity for two, internal consistency for three, test-retest reliability for 16, measurement error for one, criterion validity for one, and construct validity for 26 questionnaires. None of the questionnaires were considered sufficiently valid and/or reliable for assessing one or more movement behaviors in 0- to 5-year-old children, and the quality of evidence was mostly low or very low.

CONCLUSIONS

Valid and/or reliable questionnaires assessing 24-h movement behaviors in 0- to 5-year-olds are lacking. High-quality studies are therefore required, to develop proxy-report questionnaires and evaluate their measurement properties.

PROSPERO REGISTRATION NUMBER

CRD42020169268.

Do Fitter Children Better Assess Their Physical Activity with Questionnaire Than Less Fit Children?

Most physical activity (PA) questionnaires assess moderate to vigorous PA (MVPA) describing the physical exertion of individuals that might be influenced by their physical fitness. Therefore, the aim of this study was to determine whether fitter children could better assess their PA with the questionnaire than less fit children. The cross-sectional validation study was conducted with 108 children (60 girls) aged 11 to 14 years, who were divided into three fitness groups based on the results of the 600 m running test. To answer the research question, the agreement between their assessment of PA using the SHAPES questionnaire and the UKK RM42 accelerometer data was analysed. One quarter of the participants achieved at least 60 min of MVPA each day, measured by accelerometer. The average MVPA obtained was 97.8 ± 35.6 min per day, with the high fitness group having a significantly higher value compared with the other groups. Moderate to high validity coefficients were found in the high fitness group (Spearman’s ρ range 0.34–0.70). In contrast, the lower fitness groups had poor to moderate validity for all variables (Spearman’s ρ range 0.03–0.42). These results suggest that the fittest children self-assess their PA with the questionnaire better than less fit children, which may advance new directions for the development and evaluation of PA questionnaires and their usability.

Systematic Review and Meta-Analysis of the Relationship between Actual Exercise Intensity and Rating of Perceived Exertion in the Overweight and Obese Population

The number of overweight (OW) and obese (OB) children, adolescents, and adults has increased globally. Exercise intensity, both actual and perceived, is a significant factor in a variety of health-related investigations and rehabilitation trainings. Despite this, literature on the connection between actual exercise intensity and the rating of perceived exertion (RPE) in overweight and obese populations is lacking. A systematic review, meta-analysis, combined analysis of variance (Brown-Forsythe ANOVA), and Spearman correlation were performed to fill this gap. After preliminary assessments, ten studies were classified as having a low risk of bias and a degree of heterogeneity (I² = 34%; p = 0.05). The RPE scores (F = 0.032; p = 0.859), physiological index (percentage of maximal heart rate (%HR_max) (F = 0.028; p = 0.869), and percentage of maximal oxygen uptake (%VO_2max) (F = 2.434; p = 0.136) demonstrated consistency without being significantly different between the normal weight (NW) and OW/OB groups. The RPE scores varied by age (NW (coefficient values) = 0.677 ***, OW = 0.585 **), as well as by indoor temperature (OW only, coefficient values = 0.422 *), body mass index (NW (coefficient values) = 0.516 **, OW = 0.580 **), and test time (NW only, coefficient values = 0.451 *). We conclude that RPE is appropriate for the following OW and OB people: (1) those who are older than 21.5 (the lowest age in the group of ≥18) years old and younger than 58.6 (the highest age in the group of ≥18) years old, without any other diseases, and (2) those who engage in low-intensity exercise while maintaining a standard indoor temperature. Future studies may address alternative techniques for increasing the reliability of longitudinal comparisons and gender comparisons, as well as investigate other possible confounding factors.

A systematic review of the validity, reliability, and feasibility of measurement tools used to assess the physical activity and sedentary behaviour of pre-school aged children

Physical activity (PA) and sedentary behaviour (SB) of pre-school aged children are associated with important health and developmental outcomes. Accurate measurement of these behaviours in young children is critical for research and practice in this area. The aim of this review was to examine the validity, reliability, and feasibility of measurement tools used to assess PA and SB of pre-school aged children.Searches of electronic databases, and manual searching, were conducted to identify articles that examined the measurement properties (validity, reliability or feasibility) of measurement tools used to examine PA and/or SB of pre-school aged children (3-7 years old). Following screening, data were extracted and risk of bias assessment completed on all included articles.A total of 69 articles, describing 75 individual studies were included. Studies assessed measurement tools for PA (n = 27), SB (n = 5), and both PA and SB (n = 43). Outcome measures of PA and SB differed between studies (e.g. moderate to vigorous activity, step count, posture allocation). Most studies examined the measurement properties of one measurement tool only (n = 65). Measurement tools examined included: calorimetry, direct observation, combined heart rate and accelerometry, heart rate monitors, accelerometers, pedometers, and proxy report (parent, carer or teacher reported) measures (questionnaires or diaries). Studies most frequently assessed the validity (criterion and convergent) (n = 65), face and content validity (n = 2), test-retest reliability (n = 10) and intra-instrument reliability (n = 1) of the measurement tools. Feasibility data was abstracted from 41 studies.Multiple measurement tools used to measure PA and SB in pre-school aged children showed some degree of validity, reliability and feasibility, but often for different purposes. Accelerometers, including the Actigraph (in particular GT3X versions), Actical, ActivPAL and Fitbit (Flex and Zip), and proxy reported measurement tools used in combination may be useful for a range of outcome measures, to measure intensity alongside contextual information.