Patterns and determinants of physical activity in U.S. adolescents

Insights from Multiple Stakeholders Regarding Adolescent Obesity in China: An Exploratory Qualitative Study

With a significant increase in the obesity epidemic in China, addressing adolescent obesity should be highlighted as a priority. The current qualitative study aims to explore the perspectives of key stakeholders regarding adolescent obesity, providing guidance for developing effective obesity interventions for Chinese adolescents. A total of 12 focus group discussions were convened with a range of representative stakeholders including adolescents (n = 37), parents (n = 28), and school staff (n = 21) from sample schools. Semi-structured topic guides were used for data collection. All data were transcribed verbatim and analyzed thematically. From multiple stakeholder perspectives, we finally identified 3 overarching themes (Understanding adolescent obesity, Key healthy lifestyles, and Barriers to obesity prevention practices) and 8 sub-themes. While participants had mixed perceptions of status and prevalence of adolescent obesity, all acknowledged the serious health consequences associated with it. As significant modifiable risk factors, unhealthy diet and physical activity were identified to be prevalent among Chinese teenagers and lead to excessive weight gain. However, a variety of individual, environmental and sociocultural factors hindered the implementation of healthy lifestyles, affecting adolescent obesity prevention and control. Given adolescent obesity is a complex, multifactorial and multilevel public issue, comprehensive lifestyle interventions are recommended that synergistically engage multiple stakeholders across key communities to fight the ongoing obesity epidemic.

Fatigue and Physical Activity Patterns in Children With Inflammatory Bowel Disease

OBJECTIVES

Fatigue is a common symptom in children with inflammatory bowel disease (IBD). Diagnostic tests to evaluate biological causes of fatigue commonly include markers of inflammation and hemoglobin (Hb), yet functional parameters have been inadequately studied in pediatric IBD. In this study, we compared fatigued and non-fatigued children with IBD from both a biological and functional point of view.

METHODS

A cross-sectional study of 104 pediatric IBD patients with mild to moderately active IBD was conducted. Fatigued children were defined as those with a Pediatric Quality of Life Inventory Multidimensional Fatigue Scale z score <-2.0. Non-fatigued children had a z score ≥-2.0. Disease-specific quality of life (measured with IMPACT-III score), C-reactive protein (CRP), fecal calprotectin (FC), hemoglobin z score (Hb z score), and physical activity tests including 6-minute walking distance z score (6MWD z score) and triaxial accelerometry (TA) were evaluated.

RESULTS

Fatigued children (n = 24) had a significant lower IMPACT-III score than non-fatigued children (n = 80). Hb z scores, CRP, FC, and 6MWD z scores were not significantly different between groups. TA was performed in 71 patients. Wear time validation requirements were met in only 31 patients. Fatigued patients spent significant shorter median time in moderate-to-vigorous activity than non-fatigued patients (18.3 vs 37.3 minutes per day, P = 0.008).

CONCLUSION

Biological parameters did not discriminate fatigued from non-fatigued patients. TA possibly distinguishes fatigued from non-fatigued patients; the potential association may provide a target for interventions to combat fatigue and improve quality of life.

Physical Activity Trajectories in Early Childhood: Investigating Personal, Environmental, and Participation Factors

INTRODUCTION/PURPOSE

To determine personal, environmental, and participation factors that predict children's physical activity (PA) trajectories from preschool through to school years.

METHODS

Two hundred seventy-nine children (4.5 ± 0.9 yr, 52% boys) were included in this study. Physical activity was collected via accelerometry at six different timepoints over 6.3 ± 0.6 yr. Time-stable variables were collected at baseline and included child's sex and ethnicity. Time-dependent variables were collected at six timepoints (age, years) and included household income (CAD), parental total PA, parental influence on PA, and parent-reported child's quality of life, child's sleep, and child's amount of weekend outdoor PA. Group-based trajectory modeling was applied to identify trajectories of moderate-to-vigorous PA (MVPA) and total PA (TPA). Multivariable regression analysis identified personal, environmental, and participation factors associated with trajectory membership.

RESULTS

Three trajectories were identified for each of MVPA and TPA. Group 3 in MVPA and TPA expressed the most PA over time, with increased activity from timepoints 1 to 3, and then declining from timepoints 4 to 6. For the group 3 MVPA trajectory, male sex (β estimate, 3.437; P = 0.001) and quality of life (β estimate, 0.513; P < 0.001) were the only significant correlates for group membership. For the group 3 TPA trajectory, male sex (β estimate, 1.970; P = 0.035), greater household income (β estimate, 94.615; P < 0.001), and greater parental total PA (β estimate, 0.574; P = 0.023) increased the probability of belonging to this trajectory group.

CONCLUSIONS

These findings suggest a need for interventions and public health campaigns to increase opportunities for PA engagement in girls starting in the early years. Policies and programs to address financial inequities, positive parental modeling, and improving quality of life are also warranted.

Jumping Rope Improves the Physical Fitness of Preadolescents Aged 10-12 Years: A Meta-Analysis

To systematically review the effects of jumping rope on physical fitness among 10 to 12-year-old preadolescents, and to provide evidence-based support for its use in school physical education curriculum work. The PubMed, Web of Science, SPORTDiscus, ScienceDirect, and CNKI databases were searched for randomized controlled trials that assessed jumping rope and physical fitness among preadolescents aged 10-12 years. Meta-analyses were used to calculate the standardized mean difference (SMD) values and 95% confidence intervals (CI), and subgroup analyses were conducted on intervention duration, frequency and period. A total of 1048 subjects from 15 studies were included. Compared to regular physical education courses, jumping rope did not show a significant advantage in terms of body morphology. In terms of physical function, boys showed greater improvements in vital capacity, and girls showed greater improvements in resting HR. In terms of physical performance, boys showed greater improvements in speed, upper-body strength, lower-body strength, muscular endurance and agility, while girls showed greater improvements in coordination and balance. Boys experienced a minimal improvement in flexibility, while girls did not show a significant difference. Combining the results of the subgroup analyses, the optimal session time, frequency and intervention length of jumping rope for significantly improving the physical fitness of preadolescents were >40 min, 2 times/week and 8-12 weeks, respectively. In conclusion, jumping rope provides small to large benefits over regular physical education for both boys and girls aged 10-12 years in terms of physical function and physical performance indicators other than flexibility, while showing no significant advantage in terms of body morphology. Based on the available research, it is recommended that children aged 10-12 years participate in jump rope sessions for at least 40 minutes once or twice a week for 8-12 weeks to better develop physical fitness.

Rationale and design of a pilot randomized controlled trial to increase moderate-to-vigorous physical activity in preadolescent Latina girls and their mothers

Background

Hispanic/Latina girls have a low prevalence of moderate-intensity physical activity (PA) compared to their male counterparts and non-Hispanic White girls. Mothers influence their children's activity levels by creating and supporting PA opportunities, modeling PA, and reinforcing children's efforts to be physically active. The Conmigo trial will evaluate a mother-daughter intervention to promote PA and examine potential mechanisms of change including mothers' PA, parenting regarding PA, and mother-daughter communication.

Method

This randomized controlled trial examines the feasibility, acceptability, and impact of a 12-week intervention promoting PA in preadolescent Latina girls in San Diego County, CA. Participants (n = 90 dyads) are randomized to the Conmigo PA intervention or to a control group that receive an abbreviated version of the intervention. The intervention was informed by Social Cognitive Theory and Family Systems Theory and emphasize family-level factors to promote PA using an actor-partner model. Mothers and daughters attend weekly 90-min sessions in English or in Spanish via Zoom video conferencing, supported by facilitator follow-ups and WhatsApp supportive chat group for mothers. Objective (accelerometer) and self-report measures at baseline, 3 months, and 6 months capture the frequency and intensity of PA and correlates and predictors of PA. We also examine the impact of the intervention on the bidirectional influence of mother-daughter PA.

Implications

The findings from the Conmigo trial will form the basis of a randomized controlled community trial and will move the field forward in identifying targets of change in preventing chronic disease risk in Hispanic/Latino communities.

Youth-onset type 2 diabetes mellitus: an urgent challenge

The incidence and prevalence of youth-onset type 2 diabetes mellitus (T2DM) and its complications are increasing worldwide. Youth-onset T2DM has been reported in all racial and ethnic groups, but Indigenous peoples and people of colour are disproportionately affected. People with youth-onset T2DM often have a more aggressive clinical course than those with adult-onset T2DM or those with type 1 diabetes mellitus. Moreover, the available treatment options for children and adolescents with T2DM are more limited than for adult patients. Intermediate complications of youth-onset T2DM, such as increased albuminuria, often develop in late childhood or early adulthood, and end-stage complications, including kidney failure, develop in mid-life. The increasing frequency, earlier onset and greater severity of childhood obesity in the past 50 years together with increasingly sedentary lifestyles and an increasing frequency of intrauterine exposure to diabetes are important drivers of the epidemic of youth-onset T2DM. The particularly high risk of the disease in historically disadvantaged populations suggests an important contribution of social and environmental factors, including limited access to high-quality health care, healthy food choices and opportunities for physical activity as well as exposure to stressors including systemic racism and environmental pollutants. Understanding the mechanisms that underlie the development and aggressive clinical course of youth-onset T2DM is key to identifying successful prevention and management strategies.

Clustering of Activity-Related Behaviors in Relation to Self-Reported Causes of Stress among Pre-Adolescents: Results from a National Epidemiological Study

An epidemiological study was conducted among 1728 10–12-year-old students (55.1% girls) and their parents during 2014–2016 in Greece. This study aimed to identify the dominant clusters of physical activity/sedentariness among preadolescents and investigate their association with self-reported sources of stress. Children’s physical activity levels and sources of stress were evaluated using validated questionnaires that assessed daily hours of activities, both on weekdays and on weekends, including physical activity, screen-based sedentary time, and non-screen-based sedentary time. The k-means algorithm of cluster analysis was applied. Three clusters of children’s physical activity/sedentariness were revealed. Cluster 1 was characterized as “Inactive-Non sedentary”, cluster 2 as “Active –Non-screen sedentary”, and cluster 3 as “Inactive-Sedentary”. Parental needs/expectations were associated with physical activity patterns (p = 0.009), i.e., children assigned to the third and second clusters had 36% and 51% lower odds to be stressed due to parental requirements [(OR for cluster 3 = 0.64, 95% CI = 0.41–0.99), (OR for cluster 2 = 0.49, 95% CI = 0.32–0.76)], compared with their first-cluster counterparts. Considering the need to promote physical activity in early life stages, the identification of these complex activity-related patterns along with their significant interaction with parental expectations as a cause of stress could enhance the effectiveness of targeted behavior change interventions among those parent–child dyads most in need.

Parent and child perceptions of physical activity with type 1 diabetes

INTRODUCTION

Type 1 diabetes (T1D) is a lifelong illness that affects over 2500 children in Ireland. Management involves complex daily regimens including frequent blood glucose monitoring, pharmacotherapy, dietary management, and physical activity (PA). PA is an important modifiable lifestyle factor. Unfortunately, children with T1D remain physically inactive. Children with T1D face disease-specific barriers and facilitators to PA engagement. All aspects of T1D management for children are supported or supervised by parents. Thus, the purpose of this study was to examine parents' and children's perceptions of barriers and facilitators to PA engagement.

RESEARCH DESIGN AND METHODS

43 parent and child dyads participated. Parents completed a self-report survey. Children completed a modified version of the Physical Activity Questionnaire for Children (PAQ-C) that explored habitual PA patterns, perceived facilitators and barriers to PA engagement.

RESULTS

21 females, 22 males and their parents (36 mothers, 7 fathers) participated. 69% of males and 90% of females reported that having diabetes did affect their PA participation. 54% of males and 48% of females were insufficiently active based on their total PAQ-C score (<2.9 and <2.7). 53% of parents reported that their children participated in school physical education. 21% of parents reported that their child did not participate in PA outside of the school setting. 23% of parents reported that they did not feel comfortable with their child participating in strenuous PA. A further 30% of parents reported that they only felt comfortable with their child participating in strenuous PA if supervised. 66% of parents reported their child should be more physically active. 83% of parents reported that having T1D did impact their child's PA level.

CONCLUSIONS

This study demonstrates the potential influence of parents' perceptions on PA engagement in children with T1D. Additional education is needed to support the promotion of PA for children with T1D.

Youth physical activity and the COVID-19 pandemic: A systematic review

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Numerous studies examined youth physical activity (PA) during the COVID-19 pandemic.

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Overall decreases in youth PA were seen during the first 1.5 years of the pandemic.

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There were differences in PA by sub-populations (e.g., age, sex/gender)

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There were also differences in PA by location/type (e.g., outdoor, play)

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Programming and policy should focus on evolving PA promotion for youth.

The purpose of the systematic review was to identify, evaluate, and synthesize evidence from available published literature examining the impact of the coronavirus disease 2019 (COVID-19) pandemic on youth physical activity (PA). A systematic review of the literature was conducted for years 2020–2021. Published articles were searched in eight databases. Inclusion criteria included: availability of full-text, written in English language, and reported quantitative or qualitative results of original or secondary data on PA and COVID-19 related factors among youth (ages 5–17 years). A standard quality assessment tool assessed risk of bias and quality of included articles. The search retrieved 2,899 articles with 51 articles ultimately meeting inclusion criteria. The majority of articles (65 %) investigated change in PA from before to during the pandemic. Most evidence indicated an overall decrease in youth PA levels during the pandemic with differences observed among sub-populations (e.g., age, sex or gender), type, and location. Findings suggest pandemic-related closures hindered PA participation due to a high reliance on school- and sport-based PA. Programmatic strategies (e.g., activity breaks, active curriculum, free online activities/lessons) should include aligning intervention measures and geared towards evolving and ongoing PA promotion based on the latest findings.

Exploring the intersectionality of family SES and gender with psychosocial, behavioural and environmental correlates of physical activity in Dutch adolescents: a cross-sectional study

BACKGROUND

Examining the correlates of adolescent's physical activity (PA) and how they may differ according to the intersection of gender and family socioeconomic status (SES) can support the development of tailored interventions to more effectively promote adolescents' PA. This study explored how the associations between psychosocial, behavioural and environmental factors and adolescent's PA differed according to gender and family SES.

METHODS

This study used data from the Dutch Youth Health Survey 2015. Adolescents (n = 9068) aged 12-19 were included in the study. The associations between psychosocial, behavioural, and environmental factors and PA (days per week engaging in at least one hour of PA) were examined with multilevel linear regression analysis. Potential interactions between these correlates, gender and family SES were explored.

RESULTS

On average, adolescents engaged in at least one hour of PA for 4,2 days per week. Poor self-perceived health, low peer social support, and a weak connection with the environment were all associated with lower PA in adolescents. Daily smoking, cannabis use, risk of problematic gaming and social media use, as well as lack of daily consumption of fruit, vegetables, water and breakfast were associated with lower PA, whereas binge drinking was not. Interactions revealed that poor self-perceived health was associated with lower PA in adolescents from moderate- and high-SES families, but not in low-SES adolescents, whereas cannabis use was only associated with lower PA amongst low-SES adolescents. Low peer social support was associated with lower PA across all groups, but it was most strongly associated with lower PA amongst male adolescents from low-SES families than in other subgroups. Amongst low-SES males, low peer social support was associated with a 1.47 reduction in days engaging in sufficient PA, compared with a 0.69 reduction for high-SES males.

CONCLUSIONS

This study identified several psychosocial, behavioural and environmental factors that can be targeted to potentially increase adolescent's PA. We also found that correlates of PA differed according to the intersection of gender and family SES. Our findings suggest that PA interventions should be tailored according to gender and SES to address the specific needs, barriers and facilitators of different subgroups.

The gendered playing field: Family socioeconomic status and national gender inequality in adolescents' out-of-school physical activity

Research has shown that both gender and family socioeconomic status (SES) are important determinants of adolescents' physical activity (PA). This study expands our current knowledge by exploring the moderating role of family SES on gender differences in adolescents' out-of-school PA. We also examine whether this moderating effect varies across countries with different levels of gender inequality. Based on existing empirical studies and theoretical framework, it is hypothesized that 1) gender differences in out-of-school PA would be smaller among adolescents from higher SES families due to them being more likely to share egalitarian gender norms, and 2) this SES gradient in gender differences in adolescents' out-of-school PA would be more salient in countries with lower levels of gender inequality. A total of 316,657 15-year-old adolescents in 50 countries from the 2015 Programme for International Student Assessment (PISA) survey were analyzed. Our multilevel negative binomial regression models show that the gender gap in out-of-school PA is mitigated among families with higher SES, but this moderating role of family SES is less noticeable in countries with higher levels of national gender inequality. Our findings suggest the importance of egalitarian gender culture at both individual and macro-level in understanding gender disparities in adolescents' PA.

Clustering of longitudinal physical activity trajectories among young females with selection of associated factors

We examined multi-level factors related to the longitudinal physical activity trajectories of adolescent girls to determine the important predictors for physical activity. The Trial of Activity in Adolescent Girls (TAAG) Maryland site recruited participants at age 14 (n = 566) and followed up with these girls at age 17 (n = 553) and age 23 (n = 442). Individual, social factors and perceived environmental factors were assessed by questionnaire; body mass index was measured at age 14 and age 17, and self-reported at age 23. Neighborhood factors were assessed by geographic information systems. The outcome, moderate-to-vigorous physical activity (MVPA) minutes in a day, was assessed from accelerometers. A mixture of linear mixed-effects models with double penalization on fixed effects and random effects was used to identify the intrinsic grouping of participants with similar physical activity trajectory patterns and the most relevant predictors within the groups simultaneously. Three clusters of participants were identified. Two hundred and forty participants were clustered as “maintainers” and had consistently low MVPA over time; 289 participants were clustered as “decreasers” who had decreasing MVPA over time; 39 participants were grouped as “increasers” and had increasing MVPA over time. Each of the three clusters has its own cluster-specific factors identified using the clustering method, indicating that each cluster has unique characteristics.

A Pilot Dance Intervention to Encourage Physical Activity Engagement for Adolescent Girls with Intellectual Disabilities

Adolescent girls with intellectual disabilities (ID) are at risk for low physical activity (PA) participation due to their limited opportunities. Purpose: To evaluate the feasibility and preliminary efficacy of a 12-week dance intervention to promote engagement in moderate-to-vigorous PA (MVPA) and increase cardiorespiratory fitness. Methods: The 12-week intervention included two 75-min weekly dance sessions. Continuous heart-rate (HR) monitoring assessed time spent below/at/above each girl’s target HR zone. Cardiorespiratory fitness was measured by the 6-min walk test (6MWT). Survey items assessed participant enjoyment and participant and parent satisfaction. Results: The mean (SD) age of 18 adolescent girls was 17.3 (2.7) years. Overall, girls attended 88% of sessions and spent 52.3% of each session in MVPA. Mean MVPA was unchanged across the 12 weeks, but the pattern differed across the three sites. We observed a non-significant pre-post increase of 74.6 feet on the 6MWT. Post-intervention surveys indicated that most girls liked the program, perceived improved fitness, and wished to continue dancing. The majority also reported a preference for a girls-only dance program exclusively for those with ID. Conclusion: Our findings suggest that dance is viable for promoting PA for girls with ID. More frequent exercise training is likely needed to improve cardiorespiratory fitness.

An online family-based self-monitoring and goal-setting intervention to improve children’s physical activity: the FRESH feasibility trial and three-arm pilot RCT

Background

Family-based physical activity promotion presents a promising avenue for promoting whole-family physical activity, but high-quality research is lacking.

Objectives

To assess the feasibility, acceptability and preliminary effectiveness of FRESH (Families Reporting Every Step to Health), a child-led online family-based physical activity intervention; and to identify effective and resource-efficient family recruitment strategies.

Design

The project consisted of (1) a randomised feasibility trial, (2) a randomised controlled pilot trial and (3) a systematic review and Delphi study.

Setting

Norfolk/Suffolk counties, UK.

Participants

Families, recruited from schools, workplaces and community settings, were eligible to participate if one child aged 7–11 years and one adult responsible for their care provided written consent; all family members could participate.

Interventions

The FRESH intervention, guided by self-determination theory, targeted whole families and was delivered via an online platform. All family members received pedometers and were given website access to select family step challenges to ‘travel’ to target cities around the world, log steps, and track progress as they virtually globetrotted. Families were randomised to FRESH intervention, pedometer-only or control arm.

Main outcome measures

Physical (e.g. blood pressure), psychosocial (e.g. family functioning) and behavioural (e.g. device-measured family physical activity) measures were collected at baseline and at 8- and 52-week follow-up. A mixed-methods process evaluation assessed the acceptability of the intervention and evaluation.

Data sources review

Systematic search of four databases (Cochrane Library, PubMed, PsycINFO and SCOPUS).

Review methods

Articles were screened in duplicate, and data extraction was fully checked. Academic experts participated in the three-round Delphi study. Data were combined to identify effective and resource-efficient family recruitment strategies.

Inclusion criteria

Included generally healthy school-aged children and at least one adult; intervention attempted to change physical activity, sedentary behaviour, screen use, diet, or prevent overweight/obesity in multiple family members; presented relevant measure of effect in children and adults.

Results

The feasibility study (12 families, 32 participants; 100% retention at 8 weeks) demonstrated the feasibility and acceptability of FRESH, but highlighted that adaptations were required. Of 41 families recruited in the pilot study (149 participants), 98% and 88% were retained at the 8-week and 52-week follow-up, respectively. More children in the FRESH arm self-reported doing more family physical activity, and they thought that FRESH was fun. There were no notable between-group differences in children’s outcomes. Change in moderate to vigorous physical activity at 8 weeks favoured FRESH intervention adults [vs. control: 9.4 minutes/week (95% confidence interval 0.4 to 18.4) vs. pedometer only: 15.3 (95% confidence interval 6.0 to 24.5)], and was stronger in fathers, but this was not maintained. In 49 included studies, apart from recruitment settings and strategies used (reported in 84% and 73% of the studies, respectively), recruitment details were scarce. School-based recruitment was predominant. The Delphi study identified a wide range of recruitment settings and strategies.

Limitations

Recruitment was the main limitation of the FRESH studies; generalisability of the proposed recruitment strategies may be limited.

Conclusions

This study has demonstrated the feasibility and acceptability of the FRESH intervention. However, we failed to recruit the target sample size and were unable to demonstrate a signal of effectiveness. Future research should employ a multifaceted recruitment approach.

Future work

Further refinements to intervention delivery and recruitment methods should be investigated.

Study registration

Current Controlled Trials ISRCTN12789422 and PROSPERO CRD42019140042.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.

Daily Physical Education Linked to Higher Youth Aerobic Fitness Levels: A 4-Year Longitudinal Study

PURPOSE

Physical education (PE) provides opportunities for youth physical activity during the school day, yet daily PE policies remain low. This study investigated whether daily PE was linked to youth aerobic capacity across a 4-year period in Greenville (South Carolina).

METHODS

Youth in grade levels second to eighth at 2 schools providing daily PE and 2 schools that did not provide daily PE participated in the study (N = 466). The 2 schools used as comparisons provided standard PE outlined by South Carolina, which included one 50-minute session per week (elementary) and daily PE for one semester (middle school). Aerobic fitness was measured using the FITNESSGRAM® Progressive Aerobic Cardiovascular Endurance Run test (May 2011-2015). Number of Progressive Aerobic Cardiovascular Endurance Run laps completed, age, gender, ethnicity, body composition, and school attended were included in multilevel linear regression analyses.

RESULTS

Across the sample, aerobic fitness increased with age. Throughout the study, males demonstrated growth in aerobic fitness compared with a slight decline for females (P < .001). Youth participation in daily PE was linked to increases in aerobic fitness compared with youth who did not receive daily PE (P < .001).

CONCLUSIONS

Findings suggest that exposure to daily PE may contribute to increased aerobic fitness in youth.

Physical Activity, Fitness, and Cognitive Performance of Estonian First-Grade Schoolchildren According Their MVPA Level in Kindergarten: A Longitudinal Study

Little is known about the longitudinal trajectories and associations regarding physical activity (PA), physical fitness (PF), and cognitive skills in childhood. Accelerometer-based PA, sedentary behavior (SB), PF, and cognitive skills were measured in Estonian children (n = 147) in kindergarten (6.6 years) and again at school (7.6 years). Children were subgrouped into lower and upper quartiles by their moderate-to-vigorous PA (MVPA) at 6.6 years. Children in the upper quartile had lower SB, higher PA, and greater muscular strength. Attending school, MVPA in the lower quartile improved. In both subgroups, most strength values and cognitive skills improved, while balance deteriorated in first grade. In the upper quartile, a greater MPA at 6.6 years predicted lower perceptual skills at 7.6 years. A greater SB at 6.6 years predicted higher verbal skills, light and moderate PA and MVPA, and lower verbal skills at 7.6 years after taking into account confounding factors such as the child's sex, age, awake wear time (AWT), maternal education, and/or child's sports participation. A vigorous PA at 6.6 years predicted perceptual (in upper quartile) or verbal (in lower quartile) skills at 7.6 years after controlling for similar confounders. No correlation for PF at 6.6 years and cognitive skills at 7.6 years existed; after adjusting for the above-mentioned confounders relative to upper/lower-limb strength, the 4 × 10 m shuttle run results predicted higher perceptual or verbal skills; static balance and cardiorespiratory fitness predicted lower verbal skills. Cardiorespiratory fitness predicted higher perceptual skills after controlling for sex, age, and AWT. Overall, PA and strength were constantly better and SB lower in the upper quartile, yet the lower quartile demonstrated improved MVPA in first grade, and both subgroups increased most components of their strength and cognitive skills in first grade. Higher levels of VPA at kindergarten predicted either better perceptual or verbal skills in first grade after controlling for confounders; the opposite associations were found for other PA levels and cognitive skills in the higher quartile. PF components at kindergarten predicted either superior or inferior cognitive skills in first grade after adjusting for confounders.

Testing the Youth Physical Activity Promotion Model during the COVID-19 Pandemic, with Partial Least Squares Second-Order Latent Constructs

We tested the Youth Physical Activity Promotion (YPAP) framework on Romanian students in order to identify actionable determinants to support participation in physical activity. Our sample consisted of 665 responses to an online survey, with participants aged 18-23 (mean = 19 years); 70% were women. We used the partial least squares algorithm to estimate the relationships between students' behavior and possible predictors during the COVID-19 pandemic. Our results indicate that all the theoretical dimensions of YPAP (predisposing, enabling and reinforcing) have a positive and significant impact on physical activity, with two mediating mechanisms expressed as predisposing factors: able and worth. Unlike previous research, we used second-order latent constructs, unveiling a particular structure for the enabling dimension that only includes sport competence, fitness and skills, but not the environmental factors.

Daily Physical Activity in Children and Adolescents with Low Lumbar and Sacral Level Myelomeningocele

PURPOSE

Children with low lumbar and sacral level myelomeningocele are expected to be community ambulators. However, they do not always meet the expected ambulation level by the time they reach adulthood. The purpose of this study is to investigate daily activity energy expenditure and physical activity levels of these patients in daily routine.

MATERIALS AND METHODS

20 patients and 20 healthy peers were included in this case-control study. Omnidirectional accelerometer monitor was used for assessing activity energy expenditure, and daily durations spent in sedentary, light activity, and moderate to vigorous physical activity levels (NCT04186338).

RESULTS

Mean activity energy expenditure and moderate to vigorous physical activity duration were significantly lower in the patient group, while age was positively correlated with sedentary time and negatively correlated with light activity time.

CONCLUSIONS

In patients with myelomeningocele, increasing daily activity energy expenditure and moderate to vigorous physical activity and, especially as age progresses, decreasing the sedentary behavior may assist in providing the expected ambulation level. These patients should be encouraged to partake in regular exercise programs.

Factors That Influence Participation in Physical Activity in School-Aged Children and Adolescents: A Systematic Review from the Social Ecological Model Perspective

High prevalence of physical inactivity and obesity in children and adolescents has become a global problem. This systematic review aimed to examine the existing literature regarding the factors that influence participation in physical activity (PA) in children and adolescents with reference to the social ecological model (SEM) proposed by McLeroy et al. (1988). The SEM provides a framework under which the influencing factors are categorized into five levels: intrapersonal, interpersonal, organizational, community, and public policy. A systematic search of relevant literature published before July 2020 was conducted through Ebsco, ProQuest, PubMed Central, Scopus, and Web of Science. A total of fourteen studies met the inclusion criteria. The selected articles were all of high quality as assessed using the Mixed Methods Appraisal Tool (2018). The results indicated that gender, age, ethnicity, and self-concept were the most common influencing factors at the intrapersonal level. At the interpersonal and organization levels, supports from friends, parents, and teachers were positive predictors of students' PA participation. Accessibility of facilities and safe neighborhoods was a crucial factor that influenced children and adolescents' participation in PA at the community level. Future studies on the effective types of policies or practices that could successfully promote facilities' accessibility and improve neighborhood safety are required. The outcomes of this systematic review are expected to inform practice and support the development and implementation of sound policies for the promotion of PA participation in children or adolescents from a comprehensive social ecological viewpoint.

A whole family-based physical activity promotion intervention: findings from the families reporting every step to health (FRESH) pilot randomised controlled trial

Introduction

This study assessed the feasibility and acceptability of FRESH (Families Reporting Every Step to Health), a theory-based child-led family physical activity (PA) intervention delivered online. We also assessed the preliminary effectiveness of the intervention on outcomes of interest and whether pre-specified criteria were met to progress to a full-scale definitive trial.

Methods

In a three-armed randomised pilot trial, 41 families (with a 7–11-year-old index child) were allocated to a: ‘family’ (FAM), ‘pedometer-only’ (PED), or a no-treatment control (CON) arm. The FAM arm received access to the FRESH website, allowing participants to select step challenges to ‘travel’ to target cities around the world, log their steps, and track progress as families virtually globetrot. FAM and PED arms also received family sets of pedometers. All family members could participate in the evaluation. Physical (e.g., fitness, blood pressure), psychosocial (e.g., social support), behavioural (e.g., objectively-measured PA), and economic (e.g., expenditure for PA) data were collected at baseline, 8- and 52-weeks.

Results

At 8- and 52-weeks, 98 and 88% of families were retained, respectively. Most children liked participating in the study (> 90%) and thought it was fun (> 80%). Compared to the PED (45%) and CON (39%) arms, a higher percentage of children in the FAM (81%) arm reported doing more activities with their family. Adults agreed that FRESH encouraged their family do more PA and made their family more aware of the amount of PA they do. No notable between-group differences were found for childrens’ minutes in moderate-to-vigorous PA. Sizeable changes of 9.4 (95%CI: 0.4, 18.4) and 15.3 (95%CI: 6.0, 24.5) minutes in moderate-to-vigorous PA was found for adults in the FAM group compared to those in the PED or CON groups, respectively. No other notable differences were found.

Conclusion

This study demonstrates feasibility and acceptability of the FRESH intervention. All progression criteria were at least partially satisfied. However, we failed to recruit the target sample size and did not find a signal of effectiveness on PA particularly long-term or in children. Further refinements are required to progress to a full-scale trial.

Trial registration

This study was prospectively registered (ISRCTN12789422) on 16/03/2016.

Determinants of health and well-being in adolescents : Review of sex differences with a focus on boys

A wide variety of variables determine health and well-being in adolescence. How these variables may differ in relation to gender or sex is often not clear. In addition, research on sex differences often focuses on females rather than males. This review gives an overview on the literature with respect to possible gender/sex-specific determinants and correlates of health and well-being in adolescent boys. The search strategy used the approach of a narrative review, which led to 17 papers being included. The data synthesis employed a qualitative and descriptive analysis approach. We found sex differences in three categories: clinical symptoms, health and well-being, and risk behavior. The results show a variety of determinants that lead to sex differences in health outcomes, such as peer relations, social economic status, physical activity and coping styles. Strengths and limitations of the literature and implications for future research are discussed.

Network Effects on Adolescents' Perceived Barriers to Physical Activity

BACKGROUND

Adolescent physical activity (PA) is widely linked to positive health outcomes. Unfortunately, 80% of adolescents do not meet recommendations, which may be due to perceived barriers to PA. Peer interactions significantly affect adolescent PA behaviors. This study aims to analyze distribution of PA barriers throughout adolescent friendship networks and barriers' associations with PA.

METHODS

Adolescents (N = 383, mean = 10.77 y, SD = 1.30 y, 51.4% male) reported frequency of experiencing PA barriers (body related, social, fitness, convenience, and resource) and names of their friends. Average steps and minutes of moderate- to vigorous-intensity PA per day were measured using accelerometers. Linear network autocorrelation models determined if friends perceived barriers similarly when compared with nonfriends and analyzed relationships between barriers and objective PA measures while controlling for network effects.

RESULTS

Moderate- to vigorous-intensity PA, steps per day, body-related barriers, and social barriers displayed significant network effects, suggesting significant association with the scores of their friends. Average steps per day were significantly associated with age, sex, and social barriers, while inversely associated with fitness barriers.

CONCLUSIONS

This research suggests adolescents' perceived PA barriers are significantly associated with those of their friends. Researchers and practitioners aiming to reduce barriers to PA among adolescents may wish to assess peer reinforcing effects.

The effect of tobacco policies on youth physical activity

Our research examines the effects of tobacco policies on teenagers' physical activity. Smoking and physical activity are both strategies for weight management, and exercise may be a way to reduce some of the ill effects of smoking. These different links suggest that cigarette taxes could either increase or decrease physical activity. We explore this relationship using repeated cross-sectional 1991-2017 data from the national and state Youth Risk Behavior Surveillance System (YRBSS), combined with state-level policies and controls. Our smoking participation results confirm past work; cigarette taxes have a negative effect on smoking that has waned in recent years. The estimated effects of cigarette taxes on physical activity echo those of smoking; cigarette taxes decrease physical activity and, like smoking, these effects have waned recently. However, one likely avenue - sports participation - is unaffected. These results suggest that increased cigarette taxes lead to modest declines in teen physical activity, a finding consistent with youth using exercise to compensate for the health effects of smoking.

Physical activity attitudes among adolescents in Bangladesh

OBJECTIVES

The purpose of this study was to examine physical activity (PA) attitudes among adolescents in Bangladesh and their associations with sociodemographic, lifestyle and activity-related factors.

STUDY DESIGN

Cross-sectional study.

METHODS

A total of 781 students (52% female; mean age 14.3 years, SD 1.1) from eight secondary schools in Dhaka, Bangladesh, completed a written questionnaire. Exploratory factor analysis was used to derive positive and negative PA attitude measures. Generalized estimating equations were used to examine the associations.

RESULTS

The most frequent positive attitudes were PA would 'get or keep me in shape' (81%) and 'be fun' (73%). Common negative attitudes were PA 'would make me hot and sweaty' (51%) and 'is hard work' (42%). Multivariable analysis showed that positive PA attitudes were more likely among adolescents who had physical education classes, adolescents involved in school sports, adolescents who ate fresh fruit and vegetables daily, and adolescents who had breakfast regularly. Negative PA attitudes were more likely among girls, adolescents who slept ≤8 h/night, and adolescents who were overweight or obese; and were less common among adolescents who ate fresh fruit and vegetables daily.

CONCLUSIONS

This study suggests that PA interventions for adolescents should highlight benefits for being in shape and having fun as key components of positive PA attitudes; and address negative attitudes of PA being hot and hard work. Specific strategies may be needed to address negative PA attitudes among girls, adolescents who are overweight or obese, and adolescents with insufficient sleep.

Physical activity level in Korean adults: the Korea National Health and Nutrition Examination Survey 2017

OBJECTIVES

This study investigated physical activity (PA) participation based on demographic, physical, and psychological variables in Korean adults.

METHODS

Participants were divided into four groups (combined, aerobic only, resistance only, and neither) based on meeting the PA guidelines using moderate and vigorous PA time and resistance exercise frequency from the Korea National Health and Nutrition Examination Survey 2017. The association between meeting the PA guidelines and demographic, medical, fitness, lifestyle, and psychological variables were analyzed using complex samples crosstabs and a general linear model.

RESULTS

Of the 5,820 Korean adults, 66.0% did not meet any of the guidelines. Among demographic factors, sex, age, marital status, income, education level, occupation, and employment status were associated with meeting the PA guidelines. Chronic disease prevalence, weight, waist circumference, body mass index, diastolic blood pressure, glucose, high-density lipoprotein and triglyceride levels, hand-grip strength, resting heart rate, and family history of chronic disease in the medical and fitness variables; frequency of drinking and eating breakfast, total calorie, water, protein, and fat intake in the lifestyle variables; and perceived stress, depression, suicidal thoughts, and quality of life in the psychological variables were associated with meeting PA guidelines.

CONCLUSIONS

Most Korean adults participate in insufficient PA. Moreover, individuals who are socially underprivileged, have low-income or poor physical and mental health conditions participated in relatively less PA. Our findings suggest that government and individual efforts are required to increase PA and resolve health inequality in Korean adults.

Parents' participation in physical activity predicts maintenance of some, but not all, types of physical activity in offspring during early adolescence: A prospective longitudinal study

PURPOSE

We aimed to examine the longitudinal associations between parents' and youth's participation in physical activity (PA).

METHODS

One hundred and ninety youth completed self-administered questionnaires 3 times per year from 2011 to 2015, and their parents completed an interviewer-administered questionnaire during a telephone interview once in 2011-2012. Data on youth's and parents' activities were classified as interdependent or coactive/independent.

RESULTS

Youth with one or both parents who participated in interdependent activities were more likely to maintain participation in interdependent activities (hazard ratio (HR) = 3.63; 95% confidence interval (CI) = 1.30-10.17). Youth's sustained participation in coactive/independent activities was not associated with parents' participation in coactive/independent activities (HR = 0.97; 95%CI = 0.46-2.06).

CONCLUSION

Longitudinal associations between parents' and youth's participation in PA differed across type of PA. Encouraging parents' participation in interdependent activities may promote sustained participation in interdependent activities in youth.

The influence of depression status on weekly exercise in children ages 6 to 17 years

Exercise has been found to be an effective treatment for mild to moderate depression. The purpose of this study is to explore the relationship between depression status and weekly exercise in children ages 6 to 17 years stratifying by age and sex using a large nationally representative sample. The study data (n = 65,059) came from the 2011-12 National Survey of Children's Health. Depression categories were current, former, and no history of diagnosed depression. Exercise categories were exercising ≤6 days a week and 7 days a week. Multivariable regression stratified by age and by sex was conducted on the weighted survey data. Among children age 6 to 17, 95.2% were never depressed, 2.1% were formerly depressed, and 2.8% were currently depressed and 28.0% exercised daily. Currently depressed children had 0.75 (95% CI 0.56, 1.00) times and formerly depressed children had 1.09 (95% CI 0.76, 1.57) times the adjusted odds of exercising daily compared to never depressed children. Stratified separately by sex and by age, females and children age 12 to 17 with current depression had 0.63 (95% CI 0.42, 0.94) and 0.48 (95% CI 0.35, 0.66) times the adjusted odds of exercising daily compared to their counterparts with no depression. This study indicates a significant difference in daily exercise habits between currently depressed children age 12 to 17 and females compared to their never depressed counterparts. Healthcare workers should be aware of the possible heightened risk of physical inactivity for depressed female children and children age 12 to 17.

Determinants of Diet and Physical Activity in Malaysian Adolescents: A Systematic Review

The increased prevalence of unhealthy eating habits and sedentary lifestyles among Malaysian adolescents has become a public health concern. The aim of this systematic review was to summarize evidence from observational studies related to diet and physical activity (PA) among Malaysian adolescents (13–18 years) and to recognize the associations between determinants of diet and PA and diet and PA behaviours. A systematic search for observational studies published from August 1990 through August 2017 was conducted via PubMed, Science Direct, Cochrane and Web of Science. A total of 18 studies met the inclusion criteria; these were independently extracted by two reviewers. Gender and ethnicity were the most commonly studied correlates of diet and PA; males were more physically active and they tended to have poorer diet quality and higher energy and macronutrient intakes in comparison to females; Malay adolescents had a lower diet quality and Chinese adolescents spent less time in PA compared to other ethnicities. However, the significance of these associations was often small or inconsistent. This review highlights the lack of longitudinal observational studies but summarizes the best available evidence for policymakers and public health practitioners to improve the diet and the level of PA in Malaysian adolescents.

Impact of troop leader training on the implementation of physical activity opportunities in Girl Scout troop meetings

Girl Scouts (GS) is a setting with large reach to target increased moderate-to-vigorous physical activity (MVPA) in girls. The Scouting Nutrition and Activity Program (SNAP) increased MVPA during intervention troop meetings; therefore, further examination of implementation of SNAP components is warranted to determine the processes contributing to intervention success. The purpose of this study is to examine variability in implementation of an active recreation (AR) policy into GS troop meetings. Troop leaders (n = 7) were randomized to receive SNAP, an intervention training on implementing a policy promoting AR, or a standard control. Meetings (seven meetings/troop) were observed, and girls in attendance (n = 76, 9-13 years, mean ± SD = 10.51 ± 1.19 years) wore ActiGraph GT1M accelerometers. Two observers attended each meeting and recorded start/stop points of AR time segments, as well as other tasks (i.e., opening/closing, snack, and Girl Scout curriculum [GSC]). Time-segmented accelerometer data were analyzed using Evenson cut points and paired with observation data. Researchers observed 181 segments (mean/day ± SD = 3.77 ± 1.24). Intervention troops implemented more AR segments/day (mean/day = 0.86; 95% CI = 0.62-1.09) than control troops (mean/day = 0.18; 95% CI = 0.00-0.39). A greater percentage of time (%time) was spent in MVPA during AR segments (mean = 10.99; 95% CI = 7.16-14.82) compared with GSC segments (mean = 0.73; 95% CI = 0.00-4.10), opening/closing (mean = 3.96; 95% CI = 0.54-7.38), and snack (mean = 0.74; 95% CI = 0.00-4.10) segments, and during opening/closing segments compared with GSC and snack segments. Intervention troops implemented more AR segments than control troops. Troop meeting patterns of PA were influenced by task. Adding time segments conducive to PA could increase the %time spent in MVPA during GS troop meetings.

Profiles of Physical Fitness Risk Behaviours in School Adolescents from the ASSO Project: A Latent Class Analysis

The aim of the present investigation was to describe profiles of adolescents’ fitness level, identify latent classes of fitness-related risk behaviours, and describe their sociodemographic and environmental predictors. In total, 883 adolescents (16.4 ± 1.4 years; 167.3 ± 10.4 cm; 62.8 ± 13.5 kg; 62.2% males) were assessed for personal and lifestyle information and for physical fitness components. Eleven possible fitness determinants and seven predictors were included. Latent class analysis (LCA) was used to determine fitness-related risk behaviours. Logistic regressions predicted class membership and assessed associations with fitness levels and fitness components. Five latent classes were recognised: 1—virtuous, 30.7% of respondents; 2—low physical activity/sport, 18.8%; 3—incorrect alcohol/food habits, 25.8%; 4—health risk/overweight, 15.9%; 5—malaise/diseases, 8.8%. Sex, age, parents’ overweightness/obesity and education, and school type predicted most classes significantly. Compared to class 1, class 2 had higher odds of having all poor fitness components except upper body maximal strength; class 4 had higher risk of low muscular endurance; and class 5 was likely to have lower maximal strength, muscular endurance, and speed/agility. Educating adolescents to reach a sufficient practice of PA/sport could help decreasing the risk of low health-related fitness more than discouraging them from using alcohol, addressing proper food behaviours and habits, and helping them understand their psychophysical malaise symptoms.

Relationships between adolescent body mass index, physical activity, and sensory-processing patterns: Relations entre l'indice de masse corporelle, l'activité physique et les schèmes d'intégration sensorielle des adolescents

BACKGROUND

Trends show a significant decline with adolescent physical activity (PA). Knowledge regarding how sensory-processing patterns and body mass index (BMI) relate to adolescents' PA participation is scarce.

PURPOSE

This study investigated if relationships exist between adolescent BMI, sensory processing, and PA participation.

METHOD

This correlational study collected data from 141 adolescents who completed the Adolescent/Adult Sensory Profile and the Physical Activity Questionnaire-Adolescent. Their BMIs were calculated using self-reported age, height, and weight. The data were analyzed using descriptive statistics and two-tailed Spearman's rank correlation coefficients.

FINDINGS

Adolescents with different sensory-processing patterns reported participation in both similar and distinct PAs. Participation in PA and BMI shared no significant correlation. Sensory sensitivity and BMI total ( r_s = -.171, p = .044) and BMI percentile ( r_s = -.191, p = .024) demonstrated significant correlations. Analysis revealed a correlation between sensory seeking patterns and PA ( r_s = .224, p = .008) as well as correlations among sensory quadrants and participation in specific PAs.

IMPLICATIONS

Occupational therapists should consider an adolescent's sensory preferences when recommending PA interventions.

Physical Activity Intensity Among Adolescents and Association With Parent-Adolescent Relationship and Well-Being

Participation in physical activity (PA) provides young people significant health benefits, including improved well-being. However, large percentages of children and adolescents do not meet the recommendations for PA. Given that PA patterns are established during childhood and adolescence, and evolve within the context of the family, the current study explores the relationship between perceived parent–adolescent relationships and adolescents’ PA levels, body mass index (BMI), and subjective well-being. The study was conducted in Israel, and the sample included 233 participants (126 girls, 107 boys) aged 13 to 18 years.

Participants self-reported the following measures: demographic information, BMI, the Godin-Shephard Leisure-Time Physical Activity Questionnaire, the Personal Well-Being Index, and parent–adolescent relationship. The data were analyzed using Pearson analyses, t tests, and regressions. A clear difference emerged in strenuous PA activity by sex [t(₂₂₃) = 2.1, p < .01]; the average strenuous PA was greater for boys (M = 3.9, SD = 2.4) than for girls (M = 1.8, SD = .2.4). Furthermore, different predictors of strenuous PA by sex were found: for boys, parent–adolescent relationship was a significant predictor; for girls, subjective well-being was a predictor. The findings can shed light on the need for different intervention programs for adolescent boys and girls to increase their involvement in PA.

Developmental Trends and Determinants of Physical Activity From Adolescence to Adulthood Differ by Ethnicity/Race and Sex

BACKGROUND

Interventions to raise population physical activity generally show modest effects; one possible reason is that trends and determinants of moderate to vigorous physical activity (MVPA) differ between population subgroups. This study examined differences in trends and determinants of reported MVPA by ethnicity/race and sex in a 15-year longitudinal study.

METHODS

Participants (n = 2092) in the Project Eating and Activity in Teens and Young Adults study were surveyed on MVPA behavior and potential determinants from adolescence to young adulthood. Generalized estimating equations were used to model age trends in MVPA and associations with determinants.

RESULTS

Mean MVPA declined by 2.1 hours per week over 15 years of follow-up from adolescence to young adulthood. Asian males reported the lowest levels of MVPA at each age. Nonwhite females reported less MVPA than white females at each age. The association of body mass index (BMI) with MVPA differed by sex and ethnicity/race. Asian males and females showed lower levels of MVPA at both low and high BMI.

CONCLUSIONS

Interventions to increase MVPA may need to begin earlier among Asian men and nonwhite women than among other groups. Asian adolescents with lower BMI show lower MVPA and may benefit from additional intervention efforts compared with Asian adolescents with normal BMI.

Less screen time and more frequent vigorous physical activity is associated with lower risk of reporting negative mental health symptoms among Icelandic adolescents

Objective

Few studies have explored the potential interrelated associations of screen time and physical activity with mental health in youth, particularly using objective methods. We examined cross-sectional associations of these variables among Icelandic adolescents, using objective and subjective measurements of physical activity.

Methods

Data were collected in the spring of 2015 from 315 tenth grade students (mean age 15.8 years) in six elementary schools in metropolitan Reykjavík, Iceland. Participants reported, via questionnaire, on demographics, weekly frequency of vigorous physical activity, daily hours of screen time and mental health status (symptoms of depression, anxiety and somatic complaints, self-esteem and life satisfaction). Total physical activity was measured over one week with wrist-worn accelerometers. Body composition was determined by DXA-scanning. Poisson regression analysis was used to explore independent and interactive associations of screen time and physical activity with mental health variables, adjusting for gender, body fat percentage and maternal education.

Results

Less screen time (below the group median of 5.3 h/day) and more frequent vigorous physical activity (≥4x/week) were each associated with reporting fewer symptoms of depression, anxiety, low self-esteem, and life dissatisfaction. No significant associations were observed between objectively measured physical activity and mental health outcomes. Interactive regression analysis showed that the group reporting both less screen time and more frequent vigorous physical activity had the lowest risk of reporting symptoms of depression, anxiety, low self-esteem, and life dissatisfaction.

Conclusions

Reports of less screen time and more frequent vigorous physical activity were associated with lower risk of reporting mental health problems among Icelandic adolescents. Those who reported a combination of engaging in less screen time and more frequent vigorous physical activity had the lowest risk, suggesting a synergistic relationship between the two behaviors on mental health outcomes. Our results support guiding youth towards more active and less sedentary/screen-based lifestyle.

Percepción de barreras para la práctica del ejercicio físico en adolescentes gallegos

El presente trabajo tiene como objetivo identificar las barreras que dificultan la práctica del ejercicio físico en la adolescencia. Para ello, se llevó a cabo un estudio descriptivo y transversal con 342 estudiantes de Educación Secundaria Obligatoria y Bachillerato (M=15.02±1.86), a través del Autoinforme de Barreras para la Práctica del Ejercicio Físico (ABPEF). Los resultados obtenidos muestran como principales barreras que dificultan la práctica del ejercicio físico, las obligaciones o falta de tiempo y la fatiga o pereza. Por el contrario, las barreras con menor peso serían la imagen corporal o ansiedad física-social y el ambiente o las instalaciones.

Psychosocial vulnerability underlying four common unhealthy behaviours in 15-16-year-old Swedish adolescents: a cross-sectional study

Background

Factors that influence unhealthy behaviours in adolescents may have different impacts in different sociocultural settings. There is lack of research on the association between psychosocial vulnerability and unhealthy behaviours in adolescents, particularly outside the United States. The aim was to investigate both direct and indirect relationships between psychosocial conditions (subjective well-being, social relationships and self-esteem) and four health-related behaviours (smoking, alcohol consumption, meal frequency and physical activity) in Swedish adolescents aged 15–16 years. Socio-demographic variables (socio-economic status, gender and age) were also investigated.

Methods

To study these associations, a hypothesised model was tested using structural equation modelling. In the hypothesised model, interrelated psychosocial conditions (low well-being, poor social relationships and low self-esteem) and socio-demographic factors (low self-perceived socio-economic status, being female and higher age) together represented a vulnerability underlying smoking, alcohol consumption, irregular meal frequency and low level of physical activity. In this cross-sectional study, self-report questionnaires were used to collect data from 492 adolescents.

Results

Hypothesised pathways between psychosocial conditions, socio-demographic factors and the four unhealthy behaviours were confirmed. Low well-being was strongly associated with unhealthy behaviours, and poor social relationships showed a strong indirect association with the unhealthy behaviours. Low self-esteem, low self-perceived socio-economic status and female gender were also vulnerability factors for the unhealthy behaviours.

Conclusions

Vulnerability for four common unhealthy behaviours was found in Swedish adolescents. This study presents the interrelationships of psychosocial and socio-demographic factors and how they were related with unhealthy behaviours. The results bring new insight into how psychosocial factors are related to unhealthy behaviours in adolescents living in northern Europe.

Electronic supplementary material

The online version of this article (10.1186/s40359-017-0209-9) contains supplementary material, which is available to authorized users.

Low muscle mass is associated with cardiometabolic risk regardless of nutritional status in adolescents: A cross-sectional study in a Chilean birth cohort

BACKGROUND

Increased cardiometabolic risk (CMR) is documented in obese and non-obese adolescents with low muscular fitness. However, the association of low muscle mass (LMM) with CMR, independent of weight status, has not been examined. We analyzed the relationship of LMM with CMR in adolescents, regardless of their weight status.

MATERIALS AND METHODS

Observational study in 660 adolescents. BMI, waist circumference (WC), arterial blood pressures (ABP) were measured. Total fat mass (TFM), total lean tissue (TLT), and appendicular skeletal muscle mass (ASM) were estimated (DXA). Fasting lipid profile, glucose, and insulin were measured. HOMA-IR was estimated. Metabolic Syndrome (MetS) was diagnosed (AHA/NHLBI/IDF). ROC analysis was performed to find the optimal cutoffs of TLT percentage for MetS diagnosis. Values below these cutoffs defined LMM. ANCOVA examined the association of LMM with selected cardiometabolic biomarkers.

RESULTS

In both sexes, TLT showed better sensitivity and specificity than ASM for MetS diagnosis. In males and females, TLT of 66.1% and 56.3%, respectively, were the optimal cutoff for MetS diagnosis. In the sample, 17.3% of males and 23.7% of females had LMM. In both sexes, adolescents with LMM had significantly higher values of WC, ABP, TG, TC/HDL, HOMA-IR, and MetS z-score than non-LMM participants. Adolescents with LMM, regardless nutritional status, had significantly increased values of MetS z-score, ABP, TG, TC/HDL-chol, and HOMA-IR than non-obese non-LMM adolescents. Adolescents having both obesity and LMM had the unhealthiest CMR profile.

CONCLUSION

In adolescents, LMM was associated with higher CMR, regardless of nutritional status. In obese adolescents, LMM increased obesity-associated CMR.

The Modifying Effects of Race/Ethnicity and Socioeconomic Status on the Change in Physical Activity From Elementary to Middle School

PURPOSE

Youth physical activity (PA) levels differ by race/ethnicity and socioeconomic status (SES). It is well established that various multilevel factors may influence changes in PA. The present study examined whether the association between the change in individual, interpersonal, and environmental factors and the change in PA is modified by race/ethnicity or SES.

METHODS

This study followed 643 youths and their parents from suburban and rural South Carolina participating in the Transitions and Activity Changes in Kids (TRACK) Study in 2008-2009 and 2010-2011. We assessed total PA in youth using accelerometry and categorized youth and parent survey data into blocks based on the socioecological model. Multivariate regression growth curve models evaluated whether the association between change in independent variables and change in PA was modified by race/ethnicity or SES.

RESULTS

PA declined from fifth to seventh grade among all racial/ethnic and SES groups. Associations between the range of variables and change in PA were modified by race/ethnicity but not SES. Blacks did not share any common predictors of change in PA with whites or Hispanics. However, child-reported number of active friends was associated with total PA, and enjoyment of PA was associated with change in PA among both whites and Hispanics. Significant interactions by time varied by racial/ethnic group.

CONCLUSIONS

The factors that influence changes in youth PA vary by race/ethnicity but not SES. These findings reinforce the complex nature of addressing PA behavior in diverse samples and further support the need for culturally appropriate interventions to promote PA in youth.

Longitudinal physical activity trajectories from childhood to adulthood and their determinants: The Young Finns Study

Determining lifelong physical activity (PA) trajectories and their determinants is essential to promote a physically active lifestyle throughout the life-course. We aimed to identify PA trajectories from childhood to midlife and their determinants in a longitudinal population-based cohort. This study is a part of the Cardiovascular Risk in Young Finns Study. From 1980, a population-based cohort (N = 3596; 1764 boys/1832 girls, age 3-18 years) has been followed up for 31 years. PA indices were formed based on self-reported data (between age 9-49 years) on frequency, duration, and intensity of leisure (during childhood) or high-intensity (at later age) PA and on sports club participation/competitions. PA trajectories were analyzed using group-based trajectory modeling. Childhood (age 12 years), young adulthood (age 24 years), and early midlife (age 37 years) determinants were analyzed. Five PA trajectories were identified: persistently active (6.6%), decreasingly active (13.9%), increasingly active (13.5%), persistently low active (51.4%, reference group), persistently inactive (14.6%). In childhood, rural residential area (OR 0.45, 95% CI 0.21-0.96) and high academic performance (OR 2.18; 95% CI 1.58-3.00) associated with persistently active group. In early midlife, smoking (OR 1.66; 95% CI 1.07-2.58) associated with persistently inactive group, regular alcohol drinking (OR 2.91; 95% CI 1.12-7.55) with persistently active group and having children (OR 2.07; 95% CI 1.27-3.38) with decreasingly active group. High adulthood education associated with both decreasingly (OR 1.87; 95% CI 1.05-3.35) and increasingly (OR 2.09; 95% CI 1.19-3.68) active groups. We identified five PA trajectories from childhood into midlife. Most prominent determinants were academic achievement, education, having children and health habits (i.e. smoking/alcohol use).

Investigating the Physical Activity Behaviors of Canadian Adults Over Time: Multilevel Sex and Age Group Trajectories Across 2 Decades

BACKGROUND

This study explores changes in the leisure-time physical activities of Canadian adults over time.

METHODS

Using representative panel data from the National Population Health Survey, multilevel analyses of 13,933 respondents aged 18 and older were performed to assess both overall and individual leisure-time physical activity trajectories from 1994 to 2011 and the extent to which these trajectories differ by sex and age groups.

RESULTS

With the exception of those aged 65 and older, there is evidence that as Canadians age their overall levels of physical activity increase over time. However, increases in overall physical activity levels are mainly due to increases in walking, gardening, and home exercise. Increases in these 3 activities in particular compensate for declines in engagement levels over time in most other activities.

CONCLUSIONS

As the demographic shift to an older Canadian population continues, evidence of increasing overall physical activity levels across most age groups in Canada gives reason for optimism.

Perceived barriers to leisure-time physical activity and associated factors in adolescents

The objective of this study was to identify the prevalence of perceived barriers to leisure-time physical activity in teenagers and to examine the possible association of these barriers with leisure-time physical inactivity. This cross-sectional study was conducted in 2011 and a representative sample of 1,409 high school students from public schools in the city of Londrina/Paraná was selected through multistage sampling. For data collection, the adolescents completed a questionnaire. The relationship between leisure-time physical inactivity (<300 minutes/week) and perceived barriers was analyzed by calculating the prevalence ratio (PR) in Poisson regression models. "Lack of friends company" was the most prevalent barrier for both girls (75.8%) and boys (58.7%). "Feel lazy" for girls (PR: 1.21; CI 95%: 1.08 to 1.36) and "prefer to do other things" for the boys (PR: 1.48; CI 95%: 1.01 to 2.15) were the barriers most strongly associated with leisure-time physical inactivity. For both genders, a strong dose-response relationship was observed between the number of perceived barriers and leisure-time physical inactivity. The perception of barriers was associated with a higher prevalence of leisure-time physical inactivity in adolescents and should therefore be considered in actions for promoting physical activity in this population.The objective of this study was to identify the prevalence of perceived barriers to leisure-time physical activity in teenagers and to examine the possible association of these barriers with leisure-time physical inactivity. This cross-sectional study was conducted in 2011 and a representative sample of 1,409 high school students from public schools in the city of Londrina/Paraná was selected through multistage sampling. For data collection, the adolescents completed a questionnaire. The relationship between leisure-time physical inactivity (<300 minutes/week) and perceived barriers was analyzed by calculating the prevalence ratio (PR) in Poisson regression models. "Lack of friends company" was the most prevalent barrier for both girls (75.8%) and boys (58.7%). "Feel lazy" for girls (PR: 1.21; CI 95%: 1.08 to 1.36) and "prefer to do other things" for the boys (PR: 1.48; CI 95%: 1.01 to 2.15) were the barriers most strongly associated with leisure-time physical inactivity. For both genders, a strong dose-response relationship was observed between the number of perceived barriers and leisure-time physical inactivity. The perception of barriers was associated with a higher prevalence of leisure-time physical inactivity in adolescents and should therefore be considered in actions for promoting physical activity in this population.

Parental Support and Objectively Measured Physical Activity in Children: A Yearlong Cluster-Randomized Controlled Efficacy Trial

PURPOSE

We studied whether physical activity (PA) counseling for parents influenced the level of parental support of children's PA and leisure-time PA in children of different levels of initial parental support. We hypothesized that the initial level of parental support would moderate the intervention efficacy.

METHOD

Children (n = 44, M_age = 6.09 ± 1.17 years) and their parents (n = 61) randomly assigned to an intervention group received counseling for 6 months. Children in the control group (n = 47, M_age = 6.12 ± 1.11 years) and their parents (n = 63) did not receive any counseling. Parental support was assessed using the Family Physical Activity Environment Questionnaire, and children's leisure-time PA was recorded using triaxial accelerometers at baseline, at 6 months, and at 12 months. The efficacy of the intervention was tested by linear mixed-effects modeling adjusted for confounding variables (Model 1) and additionally for children's participation in organized PA or sports (Model 2).

RESULTS

Parents within the lowest initial parental support intervention tertile significantly increased their support, and their children's mean level of leisure-time PA significantly improved compared with the corresponding controls during the counseling period. On the other hand, intervention was found to have an unfavorable influence especially in the PA of children of initially highly supportive parents.

CONCLUSION

Targeting PA counseling for parents with low support of their children's PA could contribute to better family-based PA counseling efficacy.

Accelerometer measured levels of moderate-to-vigorous intensity physical activity and sedentary time in children and adolescents with chronic disease: A systematic review and meta-analysis

Context

Moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) are important for child and adolescent health.

Objective

To examine habitual levels of accelerometer measured MVPA and ST in children and adolescents with chronic disease, and how these levels compare with healthy peers.

Methods

Data sources: An extensive search was carried out in Medline, Cochrane library, EMBASE, SPORTDiscus and CINAHL from 2000–2017.

Study selection: Studies with accelerometer-measured MVPA and/or ST (at least 3 days and 6 hours/day to provide estimates of habitual levels) in children 0–19 years of age with chronic diseases but without co-morbidities that would present major impediments to physical activity. In all cases patients were studied while well and clinically stable.

Results

Out of 1592 records, 25 studies were eligible, in four chronic disease categories: cardiovascular disease (7 studies), respiratory disease (7 studies), diabetes (8 studies), and malignancy (3 studies). Patient MVPA was generally below the recommended 60 min/day and ST generally high regardless of the disease condition. Comparison with healthy controls suggested no marked differences in MVPA between controls and patients with cardiovascular disease (1 study, n = 42) and type 1 diabetes (5 studies, n = 400; SMD -0.70, 95% CI -1.89 to 0.48, p = 0.25). In patients with respiratory disease, MVPA was lower in patients than controls (4 studies, n = 470; SMD -0.39, 95% CI -0.80, 0.02, p = 0.06). Meta-analysis indicated significantly lower MVPA in patients with malignancies than in the controls (2 studies, n = 90; SMD -2.2, 95% CI -4.08 to -0.26, p = 0.03). Time spent sedentary was significantly higher in patients in 4/10 studies compared with healthy control groups, significantly lower in 1 study, while 5 studies showed no significant group difference.

Conclusions

MVPA in children/adolescents with chronic disease appear to be well below guideline recommendations, although comparable with activity levels of their healthy peers except for children with malignancies. Tailored and disease appropriate intervention strategies may be needed to increase MVPA and reduce ST in children and adolescents with chronic disease.

Parents' Social Status and Children's Daily Physical Activity: The Role of Familial Socialization and Support

Physical activity is a health relevant factor, particularly in affluent societies where overweight and obesity are increasingly prevalent, even among children. Understanding the development of physical activity patterns in childhood is thus an important issue for health promotion. Following socialization theory, this study describes and explains differences in objectively measured moderate-to-vigorous physical activity (MVPA) in a socially and ethnically mixed sample of 6- to 11-year-old children in Germany. MVPA levels were objectively measured with accelerometers over the course of six consecutive days (Wednesday to Monday). Parents' attitudes and practices as well as the family's socio-economic status (SES) were assessed from the parents via questionnaires. Results indicate that MVPA levels of children vary with gender, but not with age and ethnicity. Moreover, parental SES, parental support for the child's sports activities, parents' own sport activities and the parents' belief in sports' capacities to foster personality development, character building and social integration significantly predict the MVPA level of children. It is concluded that interventions to promote MVPA among children need to take family interactions and lifestyles into account and should address families in socio-economically underprivileged areas.

Activity Levels for Four Years in a Cohort of Urban-Dwelling Adolescent Females

PURPOSE

Evidence suggests that female adolescents and those living in urban environments may have lower physical activity (PA) levels compared with their peers. Yet few studies report PA for urban adolescent females, and there is no consensus regarding potential causes for low PA in this subgroup. We examined PA levels, in a large, diverse cohort of 14- to 17-yr-old urban-dwelling females and assessed the effect of socioeconomic, personal, and neighborhood/environmental factors on PA.

METHODS

One week of time-stamped step count data were collected on 926 girls from the Pittsburgh Girls Study at four annual visits. Valid recordings (worn at least 10 h on 3+ d) were examined and compared with normalized step count values from a U.S. population-representative sample. Relationships between important covariates and average steps per day were examined with regression models.

RESULTS

Adjusted mean ± SD step counts per day at baseline were 5614 ± 2434 after controlling for important covariates with less than 6% of girls achieving at least 10,000 steps per day. The girls from the Pittsburgh Girls Study accrued ~45% of their steps during school hours. Age-specific median step counts per day for study participants were similar to the 25th percentile of U.S. population normalized values and did not significantly change during follow-up. Non-Hispanic African American race/ethnicity was associated with higher average step counts per day; obesity and a recent childbirth were associated with lower average step counts per day.

CONCLUSIONS

Step counts in this cohort of urban adolescent girls were considerably lower than expected for U.S. adolescent females. Targeted efforts to improve PA levels in urban youth should consider the importance of school-based activity while increasing PA opportunities outside of school.

Is There a Relationship Between Perceived Neighborhood Contentedness and Physical Activity in Young Men and Women

The relationship between perceived neighborhood contentedness and physical activity was evaluated in the Add Health study population. Wave I includes 20,745 respondents (collected between 1994 and 1995) and wave II includes 14,738 (71 %) of these same students (collected in 1996). Multinomial logistic regression was used to evaluate this relationship in both wave I and wave II of the sample. Higher levels of Perceived Neighborhood Contentedness were associated with higher reports of physical activity in both males and females and in both waves. For every one-point increment in PNS, males were 1.3 times as likely to report being highly physically active than low (95 % CI 1.23-1.37) in wave 1 and 1.25 times as likely in wave 2 (95 % CI 1.17-1.33). Females were 1.17 (95 % CI 1.12-1.22) times as likely to report being highly active than low and 1.22 times as likely in wave 2 (95 % CI 1.17-1.27) with every one-point increment. PNC appears to be significantly associated with physical activity in adolescents. Involving the community in the development of intervention programs could help to raise the contentedness of adolescents in these communities.

Changes in Moderate-to-Vigorous Physical Activity Among Older Adolescents

OBJECTIVES

Examined patterns and determinants of objectively measured moderate-to-vigorous physical activity (MVPA) over 4 years in US emerging adults.

METHODS

Waves 1 through 4 (W1 [10th grade] to W4 data of a national cohort starting in 2010 (N = 561; 16.19 ± 0.51 years) were used. MVPA was assessed annually from accelerometers; BMI calculated from measured height/weight; and surveys ascertained self-reported physical activity (PA) planning, peer PA , family support, W1 sociodemographics, W4 school status, W4 residence, and W4 employment. Latent growth modeling estimated trajectories in log-transformed duration (minutes/day) of MVPA and associations with covariates.

RESULTS

Less than 9% of participants met the recommended 60+ minutes/day MVPA across W1 through W4. W1 MVPA was greater in males versus females (B = 0.46, P < .001) and Hispanic versus White (B = 0.34, P < .001) participants. Increased BMI change (W1 to W4 slope) was associated with decreased MVPA. MVPA was positively associated with PA planning (W1-W3: B = 0.10, B = 0.06, B = 0.08, Ps < .05), but not with peer PA or family support. Participants attending 4-year college versus not-attending school (B = 0.52, P < .001), and college students living on campus versus at home (B = 0.37, P < .001) were more likely to engage in MVPA at W4. Weekend MVPA remained relatively constant from W1 through W4.

CONCLUSIONS

High-school students engaged in little MVPA and maintained this low level through the transition to adulthood. Emerging adults' MVPA engagement may vary according to social contexts. Those with high BMI may benefit most from interventions to promote MVPA.