Cycling to School and Body Composition, Physical Fitness, and Metabolic Syndrome in Children and Adolescents

Associations between school-level environment and individual-level factors of walking and cycling to school in Canadian youth

Identifying individual-level and school-level correlates of walking and cycling to school remains a public health priority as only one in four Canadian youth actively travels to school. This study aimed to estimate the prevalence of Canadian youth in grades 6 to 10 who walk, cycle, or use motorised transport to go to school, and to examine if school neighbourhood walkability, neighbourhood-level and individual-level correlates are associated with mode of transportation to school. Data come from the 2017/2018 Health Behaviour in School-aged Children study. The walkability of the schools' neighbourhood was measured using the Canadian Active Living Environments (Can-ALE) index. We observed that only 22.4% and 4.2% of youth walked and cycled to school, respectively. Most (73.4%) used motorised transport to school, including 53.2% of youth who lived less than 5 minutes from school. Schools located in neighbourhoods with higher Can-ALE classes (i.e., higher walkability) were positively associated with walking to school. No statistically significant association between school walkability and cycling to school was observed. Individual-level socioeconomic status (SES) was associated with walking, but not cycling, to school. Conversely, neighbourhood-level SES was associated with cycling, but not with walking, to school. Correlates of walking to school differed from those for cycling to school, suggesting that different approaches to promoting active transportation are needed.

Cardiometabolic risk factors in South American children: A systematic review and meta-analysis

BACKGROUND

Cardiometabolic risk factors (impaired fasting glucose, abdominal obesity, high blood pressure, dyslipidemia) cluster in children, may predict adult disease burden, and are inadequately characterized in South American children.

OBJECTIVES

To quantify the burden of cardiometabolic risk factors in South American children (0-21 years) and identify knowledge gaps.

METHODS

We systematically searched PubMed, Google Scholar, and the Latin American and Caribbean Health Sciences Literature via Virtual Health Library from 2000-2021 in any language. Two independent reviewers screened and extracted all data.

RESULTS

179 studies of 2,181 screened were included representing 10 countries (n = 2,975,261). 12.2% of South American children experienced obesity, 21.9% elevated waist circumference, 3.0% elevated fasting glucose, 18.1% high triglycerides, 29.6% low HDL cholesterol, and 8.6% high blood pressure. Cardiometabolic risk factor definitions varied widely. Chile exhibited the highest prevalence of obesity/overweight, low HDL, and impaired fasting glucose. Ecuador exhibited the highest prevalence of elevated blood pressure. Rural setting (vs. urban or mixed) and indigenous origin protected against most cardiometabolic risk factors.

CONCLUSIONS

South American children experience high rates of obesity, overweight, and dyslipidemia. International consensus on cardiometabolic risk factor definitions for children will lead to improved diagnosis of cardiometabolic risk factors in this population, and future research should ensure inclusion of unreported countries and increased representation of indigenous populations.

Learning to Cycle: Is Velocity a Control Parameter for Children's Cycle Patterns on the Balance Bike?

The balance bike (BB) has been pointed out as being the most efficient learning bicycle due to its inherent stimulation of balance. However, the process of acquiring the control of balance on the BB has not been explored. This study aimed to: (i) categorize the cycle patterns of children on the BB, (ii) compare the cycle patterns in different stages of learning (before and after six sessions of a BB practice program), and (iii) verify whether velocity is a control parameter leading to transitions between different cycle patterns on a BB. The data were collected during the Learning to Cycle program from 12 children aged 6.06 ± 1.25 years. The velocity was measured using an inertial sensor. Seven different movement patterns were captured and categorized through video analysis. After practice, there was an increase in the mean number of different patterns and in the global mean and maximum velocity. These were interpreted as an improvement of the motor competence in the use of the BB. The results obtained support the hypothesis that velocity is a control parameter which leads to the emergence of diverse patterns of behavior. As the speed increased, the amount of foot contact with the ground became less frequent and the locomotor modes that imply that longer flight phases began to emerge.

Investigaciones realizadas en Colombia relacionadas con actividad física y obesidad 2010-2020

Introducción: La obesidad es un problema de salud pública mundial. La actividad física es una herramienta importante de promoción y prevención de este problema. Se desconoce las investigaciones realizadas en Colombia al respecto, lo cual es necesario para implementar políticas públicas eficientes. Objetivo: analizar las investigaciones colombianas encontradas en bases de datos científicas sobre la actividad física y obesidad. Metodología: revisión sistemática de artículos de investigación realizados en Colombia del año 2010 al 2020, en las bases de datos PubMed y SciELO.  Resultados: de 87 artículos encontrados, 23 cumplieron los criterios de inclusión. El 91,3 % publicados en revistas indexadas internacionalmente. 69,5% estudios observacionales, 17,4% ensayos clínicos y 8,7% revisiones sistemáticas. Conclusiones: poca producción en Colombia. La mayoría en revistas indexadas, tuvieron diseño observacional y encontraron asociación entre poca actividad física con sobrepeso/obesidad. Alta prevalencia de sobrepeso/obesidad. Pocos autores fueron profesionales en el área del deporte y el entrenamiento. Introduction: Obesity is a global public health problem. Physical activity and exercise are important tools for promoting and preventing. The research carried out in Colombia in this regard is unknown, which is necessary to implement efficient public policies. Objective: to analyze Colombian research found in scientific databases on physical activity or exercise in overweight and obesity. Methodology: literary review of research articles carried out in Colombia from 2010 to 2020, in the PubMed and SciELO databases. Results: Of 87 articles found, 23 met the inclusion criteria. 91.3% published in internationally indexed journals. 69.5% observational studies, 17.4% clinical trials and 8.7% systematic reviews. Conclusions: little production in Colombia. Most of the indexed journals had an observational design and found an association between little physical activity and overweight/obesity. High prevalence of overweight/obesity. Few authors were professionals in the area of training.

Metabolic Syndrome Prevalence among High School First-Year Students: A Cross-Sectional Study in Taiwan

Different types of high schools in Taiwan have the same physical education curriculum. In this cross-sectional study, we investigated the difference in the prevalence of metabolic syndrome between senior and vocational high school students. We retrospectively collected health check-up data from 81,076 first-year senior and 68,863 vocational high school students in Taipei City from 2011 to 2014, including their blood pressure, height, weight, waist circumference, fasting blood glucose, total cholesterol, triglyceride, and HDL-c levels. The prevalence of metabolic syndrome was determined using definitions from the Taiwan Pediatric Association (TPA), International Diabetes Federation (IDF), and de Ferranti et al. The prevalence of metabolic syndrome was 1.73% (senior and vocational high school students: 1.22% and 2.33%, respectively) using TPA criteria, 1.02% (0.69% and 1.40%, respectively) using IDF criteria, and 5.11% (3.92% and 6.51%, respectively) using de Ferranti et al. criteria. The most prevalent risk factors overall were increased blood pressure and central obesity. Given the significantly higher prevalence of metabolic syndrome in vocational school students regardless of the criteria, and that metabolic syndrome causes future adult health risks, the physical education curriculum and health education program in vocational schools should be strengthened to decrease the risk and prevalence of metabolic syndrome.

Associations among Active Commuting to School and Prevalence of Obesity in Adolescents: A Systematic Review

Active commuting to school (ACS) seems to be one of the means to increase physical activity (PA) levels in youth, but it is unclear if ACS reduces the prevalence of obesity, protecting and improving their health. Most of the previous research has been conducted on children or youth (i.e., children with adolescents together), and there is a paucity of research in adolescents only. The purpose of this review was to assess the association between ACS with overweight/obesity parameters in adolescents aged 11 to 19 years. We used PubMed, WOS and SPORTDiscus as electronics databases. All steps of the process followed the recommendations of the PRISMA flow-diagram. Fifteen articles (68.18%) found a consistent association between ACS and body composition and seven studies (31.82%) showed no differences in body composition between active and passive commuters to school. Fourteen studies observed that active commuters to school had a more favorable body composition and one study reported that ACS was associated with unfavourable body composition. ACS could be the steppingstone to improve PA promotion in adolescence but whether ACS is associated with improved body composition and prevention of obesity requires further research.

Walking and cycling, as active transportation, and obesity factors in adolescents from eight countries

BACKGROUND

Evidence has shown that active transportation decreases obesity rates, but considering walking or cycling as separate modes could provide additional information on the health benefits in adolescents. This study aimed to examine the associations between walking and cycling as form active transportation and obesity indicators in Latin American adolescents.

METHODS

Population-based study with 671 adolescents (mean age: 15.9 [standard deviation: 0.8] years) from eight countries participating in the Latin American Study of Nutrition and Health/Estudio Latino Americano Nutrition y Salud (ELANS). Walking and cycling for active transportation were measured using the International Physical Activity Questionnaire long version. Body mass index, waist circumference, neck circumference, and relative fat mass were used as obesity indicators. Associations were estimated using logistic regression models for the pooled data adjusted for country, sex, age, socio-economic levels, race/ethnicity, leisure-time physical activity and energy intake.

RESULTS

Mean time spent walking and cycling was 22.6 (SD: 33.1) and 5.1 (SD: 24.1) min/day, respectively. The median values were 12.8 (IQR: 4.2; 25.7) and 0 (IQR: 0; 6.2) for walking and cycling. Participants reporting ≥ 10 min/week of walking or cycling for active transportation were 84.2% and 15.5%, respectively. Costa Rica (94.3% and 28.6%) showed the highest prevalence for walking and cycling, respectively, while Venezuela (68.3% and 2.4%) showed the lowest prevalence. There was no significant association between walking for active transportation and any obesity indicator. In the overall sample, cycling for ≥ 10 min/week was significantly associated with a lower likelihood of overweight/obesity based on BMI (OR: 0.86; 95%CI: 0.88; 0.94) and waist circumference (OR: 0.90; 95%CI: 0.83; 0.97) adjusted for country, sex, age, socio-economic level, race/ethnicity, leisure-time physical activity and energy intake compared to cycling for < 10 min/week. There were no significant associations between cycling for active transportation and neck circumference as well as relative fat mass.

CONCLUSIONS

Cycling for active transportation was negatively associated with obesity indicators, especially body mass index and waist circumference. Programs for promoting cycling for active transportation could be a feasible strategy to tackle the high obesity rates in adolescents in Latin America.

TRIAL REGISTRATION

ClinicalTrials.Gov NCT02226627. Retrospectively registered on August 27, 2014.

The Effect of a School-Based Intervention on Children’s Cycling Knowledge, Mode of Commuting and Perceived Barriers: A Randomized Controlled Trial

The low rates of active commuting to/from school in Spain, especially by bike, and the wide range of cycling interventions in the literature show that this is a necessary research subject. The aims of this study were: (1) to assess the feasibility of a school-based cycling intervention program for adolescents, (2) to analyse the effectiveness of a school-based cycling intervention program on the rates of cycling and other forms of active commuting to/from school (ACS), and perceived barriers to active commuting in adolescents. A total of 122 adolescents from Granada, Jaén and Valencia (Spain) participated in the study. The cycling intervention group participated in a school-based intervention program to promote cycling to school during Physical Education (PE) sessions in order to analyse the changes in the dependent variables at baseline and follow up of the intervention. Wilcoxon, Signs and McNemar tests were undertaken. The association of the intervention program with commuting behaviour, and perceived barriers to commuting, were analysed by binary logistic regression. There were improvements in knowledge at follow-up and the cycling skill scores were medium-low. The rates of cycling to school and active commuting to/from school did not change, and only the “built environment (walk)” barrier increased in the cycling group at follow-up. School-based interventions may be feasibly effective tools to increase ACS behaviour, but it is necessary to implement a longer period and continue testing further school-based cycling interventions.

Learning to Cycle: From Training Wheels to Balance Bike

Background: Learning to cycle is an important milestone in a child’s life, so it is important to allow them to explore cycling as soon as possible. The use of a bicycle with training wheels (BTW) for learning to cycling is an old approach practiced worldwide. Most recently, a new approach using the balance bike (BB) has received increased attention, and several entities believe that this could be most efficient. Drawing on the work of Bronfenbrenner (1995) and Newel (1986), this study aimed to analyse the effect of BB’s use on the learning process of cycling independently. Methods: Data were collected in Portugal from an online structured survey between November 2019 and June 2020. Results: A total of 2005 responses were obtained for adults and children (parental response). Results revealed that when the BB’s approach was used, learning age (LA) occurred earlier (M = 4.16 ± 1.34 years) than with the BTW’s approach (M = 5.97 ± 2.16 years) (p < 0.001); or than when there was only the single use of the traditional bicycle (M =7.27 ± 3.74 years) (p < 0.001). Conclusions: Children who used the BB as the first bike had a significantly lower LA than children who did not use it (p < 0.001). To maximize its effects, the BB should be used in the beginning of the learning process.

Helping Children with Obesity "Move Well" To Move More: An Applied Clinical Review

ABSTRACT

Children with obesity experience musculoskeletal pain and reduced physical function and well-being, which collectively impact their fitness, strength, motor skills, and even their ability to undertake simple tasks, like walking and climbing stairs. Disrupting obesity-related disability may be critical to increasing children's physical activity. Thus, barriers to movement should be considered by health practitioners to improve the efficacy of prescribed physical activity. This applied clinical review highlights key subjective and objective findings from a hypothetical case scenario, linking those findings to the research evidence, before exploring strategies to enhance movement and increase physical activity.

An overview of cycling as active transportation and as benefit for health

Active transportation is defined as travelling on foot, by bicycle or other non-motorized means, sometimes in combination with other forms of public transportation, in contrast with the use of motor vehicles. The prevalence of sedentary lifestyle and physical inactivity is a growing epidemic in most developed countries that spread over the last three decades; active transportation may be a promising approach to increase physical activity and reduce the risk of non-communicable diseases improving cardiorespiratory fitness and cardiometabolic health. The health benefits of physical activity in reducing mortality and morbidity have been proved by several publications. Cardiorespiratory fitness can be improved by regular physical activity with an amelioration of insulin sensitivity, blood lipid profile, body composition, inflammation, and blood pressure. Active transportation as a daily physical activity is less expensive compared to motor vehicle use. The advantages are remarkable in terms of contrasting obesity and sedentary lifestyle, decrease motor traffic congestion and mitigate climate change. Massive investments in policies and interventions aimed to increase active transportation are not generally promoted and there are differences in the prevalence of active transportation in the daily routine among different areas. As in the literature several studies as randomized trials or observational studies have been published, with different end-points, in order to investigate if active commuting may be the right answer to improve cardiorespiratory fitness and cardiometabolic health, we aimed to review the available evidences of cycling as an active transportation and to consider its benefits on health.

Mediation role of residential density on the association between perceived environmental factors and active commuting to school in Brazilian adolescents

The objective of this study was to verify whether residential density and connectivity between streets are mediators on the association between perceived environmental factors and active commuting to school (ACS) in Brazilian adolescents. This is a cross-sectional study with a random sample of 1,130 adolescents (52.7% girls) aged between 14 to 20 years, from Porto Alegre, Rio Grande do Sul State, Brazil. Adolescents' self-reported their usual mode of commuting to and from school using a questionnaire and the perceived environmental attributes by Neighborhood Environment Walkability Scale for Youth (NEWS-Y). Residential density and connectivity between streets were measured by gographic information systems (GIS), within 1km road network buffers around the participant's residential address. Regression models were fitted according to mediation analyses procedures. The results showed that residential density is a mediator on the association between ACS and perceived environmental factors, including land-use mix diversity (IE = 0.114; 95%CI: 0.130, 0.311; 32% mediation), neighborhood recreation facilities (IE = 0.064; 95%CI: 0.034, 0.105; 15% mediation), and access to services (IE = 0.045; 95%CI: 0.006, 0.104; 14% mediation). Connectivity between streets did not correlate with ACS, thus it was not tested in the mediation model. In conclusion, residential density is a mediator on the relationship between perceived environmental factors and ACS.

Learning to Cycle: Are Physical Activity and Birth Order Related to the Age of Learning How to Ride a Bicycle?

The present article aimed to verify whether the age at which children learn to ride a bicycle is related to their physical activity or birth order. Data were collected from an online structured survey between November 2019 and June 2020. A total of 8614 responses were obtained from 22 countries. The results reveal significant differences in learning age depending on the frequency of physical activity (F(5, 7235) = 35.12, p < 0.001, ηp² = 0.24). People who engaged in physical activity less than twice a month learned to cycle later (M = 7.5 ± 5.3 years) than people who engaged in physical activity on a daily basis (M = 5.7 ± 2.2 years) (p < 0.001). There were also significant differences in learning age according to birth order (F(2, 3008) = 7.31, p = 0.00, ηp² = 0.005). Only children had the highest learning age (M = 5.5 ± 2.4 years), whereas those who were born last had the lowest, (M = 5.1 ± 1.9 years) (p = 0.013). Creating opportunities for children to be engaged in play and physical activity and social modulation through their older siblings seem to be key conditions to encourage children to learn how to ride a bicycle from a young age and to foster their motor development.

Levels of Physical Fitness and Weight Status in Children and Adolescents: A Comparison between China and Japan

This study compared the physical fitness level and weight status of children and adolescents in China and Japan. Children and adolescents aged 7–18 years were recruited (China: n = 5660; Japan: n = 5660). Physical fitness was assessed using seven core items—grip strength, 30-s sit-ups, standing long jump, sit-and-reach, 20-s repeated straddling, 20-m shuttle run test, and 50-m dash. A physical fitness index (PFI) was calculated by adding all items’ Z-scores. We conducted comparisons of PFI and its distribution, each physical fitness item, and weight status for individuals from China and Japan across all ages. The PFI was lower in China than in Japan for all age groups, with an especially large difference at age 18 years for boys (a difference of 9.05) and girls (a difference of 9.10) (p < 0.001). The same result was seen for the seven items. The PFI distribution for children and adolescents was more disperse among those in Japan than among those in China. Obesity prevalence was 2.84 times higher in China than in Japan. An inverted U-shaped relationship was observed between physical fitness and nutritional status. Children and adolescents showed markedly lower physical fitness and higher obesity prevalence in China than in Japan.

Psychometric Characteristics of a Commuting-to-School Behaviour Questionnaire for Families

The purposes of this study were: (a) to describe the patterns of modes of commuting to school (children) and to work (parents) separated by gender and age, (b) to validate the questions on children’s mode of commuting to and from school according to their parents, and (c) to analyse the reliability of a family questionnaire focused on commuting to school behaviours. A total of 611 parents (mean age: 43.28 ± 6.25 years old) from Granada (Spain) completed “Family commuting-to-school behaviour” questionnaire in two sessions separated by 14 days, (2016 and 2018). The validation between family and children’s questions was assessed using the Kappa and Spearman correlation coefficients, and the test–retest reliability within the family questions was assessed using the Kappa and the weighted Kappa. The children’s modes of commuting to school (mean age: 11.44 ± 2.77 years old) were mainly passive (57.7% to school) while parents’ modes of commuting to work were mainly active (71.6%). The validity of the mode of commuting was significant with high Kappa and Spearman coefficients. The test–retest reliability presented a good agreement for the mode of commuting to school in children, distance and time to school, and the mode of commuting to work in parents, while the questions on acceptable distance to walk or cycle to school showed a moderate to good agreement. The “Family commuting-to-school behaviour” questionnaire could be a useful tool to assess the mode of commuting of children, distance and time to school for researchers and practitioners.

Relationship of Handgrip Strength to Metabolic Syndrome Among Korean Adolescents 10-18 Years of Age: Results from the Korean National Health and Nutrition Examination Survey 2014-18

Introduction: Handgrip strength (HGS), a simple, convenient, and economic measurement of muscle strength, is known to be related to metabolic syndrome (MetS) in adults. This relationship in adolescents, however, has not been widely examined. this study investigated the relationship of MetS (as defined by the International Diabetes Federation [IDF]'s criteria) to HGS in Korean adolescents. Materials and Methods: This cross-sectional study analyzed data on 2802 adolescents 10-18 years of age from the Korean National Health and Nutrition Examination Survey (KNHANES) 2014-18, which had measured and recorded HGS, body mass index, and other parameters relevant to MetS. Normalized HGS was defined as the sum of the maximum HGS from both hands normalized per weight. Complex sample multivariate logistic regression analyses were performed to investigate the relationship between HGS and MetS. Results: The risk of MetS decreased with increasing sex-specific quartile of normalized HGS in both boys and girls after adjustment for age (P_trend < 0.001). Higher HGS was associated with lower odds of having MetS, such that for every 5% increase of normalized HGS, the odds were decreased by factors of 0.79 (0.73-0.85) and 0.67 (0.59-0.77) for boys and girls, respectively, after age adjustment. Conclusions: This population-based, nationally representative study suggests that higher HGS is associated with lower risk of MetS in Korean adolescents regardless of sex.

Prevalence and factors associated with active transportation to school for adolescents

OBJECTIVE:

To verify the prevalence and factors associated with active transportation to school (ATS) among Brazilian adolescents attending public schools.

METHODS:

Crossectional study with a representative sample of 1,984 adolescents (55.9% girls). Sociodemographic variables included were: gender, age, parental schooling, and socioeconomic status. Psychosocial factors included were: social support from parents and friends for physical activity. Walking, cycling, or skateboarding to school were considered models of active transportation. Binary logistic regression models verified sociodemographic and psychosocial factors association with ATS, adopting p < 0.05.

RESULTS:

The prevalence of active transportation to school was 37.7% (16.2% boys and 21.5% girls). For boys, ATS was associated with: social support from parents in practicing physical activity together as a family (OR = 1.57; 95%CI 1.09–2.25), giving them rides (OR = 1.56; 95%CI 1.04–2.32), and remarking their good performance on it (OR = 1.73; CI95 1.08–2.76); as well as the social support from friends in practicing physical activity together (OR = 2.23; 95%CI 1.35–3.69). For girls, the likelihood of using ATS increased with age (OR = 1.43; 95%CI 1.06–1.92) and having friends who practice physical activity together with them (OR = 1.48, 95%CI 1.04–2.10).

CONCLUSION:

Age and social support for physical activity were associated with ATS. Parents who practice together, give rides, and remark on physical activities increase the likelihood of adolescent boys using ATS. Social support from friends to physical activity increased the likelihood of both genders using ATS.

Feasibility and Reliability of a Questionnaire to Assess the Mode, Frequency, Distance and Time of Commuting to and from School: The PACO Study

Active commuting to and from school has several health implications. Self-reporting is the most common assessment tool, but there is a high heterogeneity of questionnaires in the scientific literature. The purpose of this study was to analyse the feasibility and reliability of the Spanish "New Version of Mode and Frequency of Commuting To and From School" questionnaire in children and adolescents. A total of 635 children (5-12 years old) and 362 adolescents (12-18 years old) filled out the questionnaire twice (14 days apart). Feasibility was evaluated using an observational checklist. The test-retest reliability of the "New Version of Mode and Frequency of Commuting To and From School" questionnaire and the distance and time to school were examined using the kappa and weight kappa coefficient (κ). No misunderstanding of questions was reported. The time to complete the questionnaire was 15 ± 3.62 and 9 ± 2.26 min for children and adolescents, respectively. The questionnaire showed substantial and almost perfect kappa coefficients for the overall six items (k = 0.61-0.94) in children and adolescents. The "New Version of Mode and Frequency of Commuting To and From School" questionnaire is a feasible and reliable questionnaire in Spanish children and adolescents.

Like Mother, like Son: Physical Activity, Commuting, and Associated Demographic Factors

A mother’s healthy conduct may lead to the healthy conduct of their children. Thus, this study aimed to verify the role of demographic factors in the relationship between mothers’ physical activity (PA) and commuting to work with children and adolescent’s PA and commuting to school. This cross-sectional study comprised 1421 children and adolescents aged 6 to 17 years and 1421 mothers, from Brazil. PA, commuting, socioeconomic status (SES), skin color/ethnicity, and living area were evaluated by questionnaire. Logistic binary regression models were used. Results indicated that mothers’ PA and commuting were associated with children and adolescent’s PA and commuting to school in crude and adjusted models. Considering the role of the demographic factors, an association was only observed for girls in the relationship between mother’s PA with children’s PA. In adolescents, an association was observed in both high/low SES, boys/girls, and rural/urban areas. Regarding children and adolescent active commuting to school, there was an association with mothers commuting. All demographic factors were strongly associated, except for rural areas. Therefore, mothers’ PA as well as commuting to work are associated with children and adolescent’s PA and commuting to school. Sex, living area, and SES are the related demographic factors.

Relationship between the average slope in the active commuting to and from school and fitness in adolescents: the mediator role of fatness

Active commuting to and from school (ACS) has been recognized as a potential tool to improve physical fitness. Thus, this study aims to test the relationships between the average slope in the ACS and physical fitness, as well as to verify the mediator role of fatness in the relationship between average slope and physical fitness. A total of 257 participants, 137 boys and 120 girls, from 22 schools belonged to first and second High School grades participated in this study. Based on self-reported measure and Google Earth, participants were grouped into the active commuter (number of trips was ≥5, and the time of the trip was ≥15 min), mixed commuter (number of weekly trips was <5, and the time spent on the trip was <15 min) and passive commuter groups (those who reported traveling regularly by car, motorcycle, or bus). Specifically, in the active commuter group, a positive association between the average slope in the ACS with fatness was found, which in turn was positively related to strength lower limbs and cardiorrespiratory fitness. The average slope was not significantly associated with physical fitness indicators. Furtheremore, fatness did not mediate the relathionship between average slope and physical fitness. This research concluded positive associations between average slope and the body fat in the ACS. The tendency of findings signal that the average slope should be taken into account along with the distance, time and frequency of the active commuting.

Changes in and the mediating role of physical activity in relation to active school transport, fitness and adiposity among Spanish youth: the UP&DOWN longitudinal study

Background

Longitudinal changes in child and adolescent active school transport (AST), and the mediating role of different intensities of daily physical activity (PA) levels in relation to AST and physical fitness and adiposity indicators is unclear. This study aimed to: 1) describe longitudinal changes in AST, light PA (LPA), moderate- to vigorous-intensity PA (MVPA), physical fitness and adiposity indicators over three time-points; and 2) investigate the mediating role of LPA and MVPA levels on associations between AST and physical fitness and adiposity indicators over three time-points among children and adolescents.

Methods

This longitudinal study comprised 1646 Spanish children and adolescents (48.8% girls, mean age 12.5 years ±2.5) at baseline, recruited from schools in Cádiz and Madrid. Mode of commuting to school was self-reported at baseline (T0, 2011–12), 1-year (T1) and 2-year follow-up (T2). PA was assessed using accelerometers. Handgrip strength, standing long jump and cardiorespiratory fitness (CRF) assessed physical fitness. Height, weight, body mass index, waist circumference, and triceps and subscapular skinfold thickness were measured. Multilevel linear regression analyses assessed changes in AST, PA levels, physical fitness and adiposity indicators over three time-points (T0-T1-T2). Additionally, longitudinal path analysis (n = 453; mean age [years] 12.6 ± 2.4) was used to test the mediating effects of LPA and MVPA levels on the association between AST and physical fitness and adiposity indicators.

Results

Multilevel analyses observed decreases in LPA between T0-T1 (β = − 11.27; p < 0.001) and T0-T2 (β = − 16.27; p < 0.001) and decreases in MVPA between T0-T2 (β = − 4.51; p = 0.011). Moreover, changes over time showed increases in handgrip between T0-T1 (β = 0.78; p = 0.028) and T0-T2 (β = 0.81; p = 0.046).

Path analyses showed that AST was directly positively associated with MVPA at T1 (all, β ≈ 0.33; p < 0.001). MVPA at T1 mediated associations between AST and CRF at T2 (β = 0.20; p = 0.040), but not the other outcomes. LPA did not mediate any associations.

Conclusions

Results from longitudinal path analysis suggest that participation in more AST may help attenuate declines in MVPA that typically occur with age and improve CRF. Therefore, we encourage health authorities to promote AST, as a way to increase MVPA levels and CRF among youth.

Exercise Field Testing in Children: A New Approach for Age-Appropriate Evaluation of Cardiopulmonary Function

Based on the wide range of problems to effectively perform cardiopulmonary testing in young children, this study strives to develop a new cardiopulmonary exercise test for children using a mobile testing device worn in a backpack in order to test children during their natural movement habits, namely, running outdoors. A standard cardiopulmonary exercise ramp test on a cycle ergometer was performed by a group of twenty 7-10-year-old children. The results were compared with a self-paced incremental running test performed using a mobile cardiopulmonary exercise measuring device in an outdoor park. The children were able to reach significantly higher values for most of the cardiopulmonary exercise variables during the outdoor test and higher. Whereas a plateau in [Formula: see text] was reached by 25% of the children during the outdoor test, only 75% were able to reach a reasonable VT2, let alone [Formula: see text], during the bicycle test. The heart rate at VT1, the O₂-pulse, and the OUES were comparable between both tests. OUES was also positively correlated with [Formula: see text] in both tests. Testing children outdoors using a mobile cardiopulmonary exercise unit represents an alternative to standard exercise testing, but without the added problems of exercise equipment like treadmills or bicycles. It allows for individualized exercise testing with the aim of standardized testing durations instead of standardized testing protocols. The running speeds determined during the outdoor tests may then be used to develop age-adapted testing protocols for treadmill testing.

Relationships between area-level socioeconomic status and urbanization with active transportation, independent mobility, outdoor time, and physical activity among Canadian children

Background

Active transportation (AT), independent mobility (IM), and outdoor time are promising ways to increase children’s physical activity. However, in order to create interventions to increase those forms of physical activity, it is important to understand the relationships between area-level socioeconomic status (SES) and type of urbanization with AT, IM, outdoor time, and physical activity, and this was the aim of the study.

Methods

One thousand six hundred ninety-nine children in grades 4 to 6 (mean age: 10.2 ± 1.0 years) from three Canadian regions participated. AT, IM, and outdoor time were assessed using questionnaires and physical activity was measured using the SC-StepRX pedometer. Area-level SES was assessed using the median household income of the census tract in which the school was located and type of urbanization was determined for each school using standardized procedures. Generalized linear and general linear mixed models were used to examine the relationships.

Results

Area-level SES and the type of urbanization were generally not related to AT, IM, or physical activity for either gender. However, we observed that both boys and girls living in lower SES areas had decreased odds of spending > 2 h outdoors on weekend days compared to their peers from higher SES areas. Girls living in suburban or rural areas were more likely to spend > 2 h outdoors on weekdays compared to their urban counterparts.

Conclusions

AT, IM, and physical activity are generally not associated with area-level SES or the type of urbanization in this sample of Canadian children. The finding regarding outdoor time showing that both boys and girls of lower SES areas had decreased odds of spending > 2 h outdoors on weekends compared to their peers from higher SES areas suggest that additional efforts should be implemented to offer outdoor play opportunities in lower SES areas.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7420-y) contains supplementary material, which is available to authorized users.

Assessing and Managing the Metabolic Syndrome in Children and Adolescents

The metabolic syndrome (MetS) is a group of cardiovascular risk factors that are associated with insulin resistance and are driven by underlying factors, including visceral obesity, systemic inflammation, and cellular dysfunction. These risks increasingly begin in childhood and adolescence and are associated with a high likelihood of future chronic disease in adulthood. Efforts should be made at both recognition of this metabolic risk, screening for potential associated Type 2 diabetes, and targeting affected individuals for appropriate treatment with an emphasis on lifestyle modification. Effective interventions have been linked to reductions in MetS-and in adults, reductions in the severity of MetS have been linked to reduced diabetes and cardiovascular disease.

Current therapeutic strategies in treating obesity in children and adolescents - review of the literature

The present paper is a review of current knowledge concerning the most appropriate strategy in the conservative therapy of obese children and adolescents. It presents an account of the combined mode of therapy consisting of behavioral and dietary counseling with appropriate physical activity (also using the support of modern media and devices). The rise in obesity is usually a long-lasting process involving genetic predispositions but also environmental factors which can be modified. The treatment of obesity should be focused on these modified factors and be a lifelong treatment, not merely a short period of exercise or a diet program. Successful therapy depends on the cooperation of the medical team with children and their parents or caregivers.

Differences in Cardiorespiratory Fitness between Chinese and Japanese Children and Adolescents

Background: This study aimed to compare the difference in cardiorespiratory fitness between Chinese and Japanese children and adolescents. Methods: Participants comprised 9025 children and adolescents aged 7–18 years from China and Japan. Cardiorespiratory fitness (CRF) was measured by performance in the 20 m shuttle run test (20mSRT) and estimated maximal oxygen consumption (VO_2max). Differences in CRF between countries were evaluated by t-tests. Centile curves for the 20mSRT and VO_2max values were constructed for Chinese and Japanese children and adolescents, respectively, using the Lambda Mu and Sigma (LMS) method. Results: (1) For most of the age groups, the 20mSRT and VO_2max performances among Chinese participants were lower than among Japanese participants. (2) Japanese children had the most apparent gains in P₁₀, P₅₀, and P₉₀ VO_2max values in primary school; however, they gradually decreased in middle school. For Chinese girls, the P₁₀, P₅₀, and P₉₀ VO_2max values decreased gradually with age. (3) The VO_2max value among Japanese children increased; however, it decreased or remained flat among Chinese children in primary school. Conclusions: CRF among Chinese participants was lower than among Japanese participants while the VO_2max value showed different trends in primary school. Effective measures should be taken to improve CRF among children and adolescents.

Cycling is associated with a lower incidence of cardiovascular diseases and death: Part 1 – systematic review of cohort studies with meta-analysis

Objectives

Physical inactivity is a risk factor for cardiovascular disease (CVD). Cycling as a physical activity holds great potential to prevent CVD. We aimed to determine whether cycling reduces the risk of CVD and CVD risk factors and to investigate potential dose-response relationships.

Design

Systematic review and meta-analysis of quantitative studies.

Eligibility criteria for selecting studies

We searched four databases (Web of Science, MEDLINE, SPORTDiscus and Scopus). All quantitative studies, published until August 2017, were included when a general population was investigated, cycling was assessed either in total or as a transportation mode, and CVD incidence, mortality or risk factors were reported. Studies were excluded when they reported continuous outcomes or when cycling and walking were combined in them. We pooled adjusted relative risks (RR) and OR. Heterogeneity was investigated using I.

Results

The search yielded 5174 studies; 21 studies which included 1,069,034 individuals. We found a significantly lower association in combined CVD incidence, mortality and physiological risk factors with total effect estimate 0.78 (95% CI (CI): 0.74–0.82; P<0.001; I2=58%). Separate analyses for CVD incidence, mortality and risk factors showed estimates of RR 0.84 (CI, 0.80 to 0.88; P<0.001; I2=29%), RR 0.83 (CI, 0.76 to 0.90; P<0.001; I2=0%), and OR 0.75 (CI, 0.69 to 0.82; P<0.001; I2=66%), respectively. We found no dose-response relationship or sex-specific difference.

Conclusions

Any form of cycling seems to be associated with lower CVD risk, and thus, we recommend cycling as a health-enhancing physical activity.

Systematic review registration

Prospero CRD42016052421.

Influence of distance, area, and cultural context in active commuting: Continental and insular children

Commuting by walking or cycling is a way to increase physical activity levels. The objective of this article was to determine the modes of commuting to school and the distance and time of the way to school among children from Easter Island and from the mainland (Valparaíso), in Chile. A total of 666 children and adolescents aged 10 to 18 years old (208 from Easter Island and 458 from Valparaíso) participated and completed a valid questionnaire including data about age, gender, usual commuting mode to and from school, distance, and travel time. There are important differences in the mode of commuting between students of Valparaíso and Easter Island. Private transport is more commonly used in Valparaíso than in Easter Island (p<0.001). Furthermore, it was observed that cycling and public transportation are not used as mode of commuting in Valparaíso and Easter Island respectively. Students from Easter Island, who travel more distance and during more time, are more active than students from Valparaíso (going 24.8% and 17.6%; from: 61% and 28.8% respectively). This situation is influenced by the geographic context of the island, the distances from home to school, and the type of commuting, which fosters the level of active commuting. On the other hand, the passive modes of commuting to school are higher in the mainland urban setting of Valparaíso. It is necessary to study the diverse contexts of the Easter Island population, but, for now, the rural setting of Easter Island seems to be associated with a greater level of active commuting to school.

Physical activity in adolescents and children and relationship to metabolic health

PURPOSE OF REVIEW

To summarize the recent developments relating to the role of physical activity in improving insulin resistance and metabolic syndrome in children and adolescents.

RECENT FINDINGS

The current literature strengthens previous findings on the relationship between physical activity and metabolic health in children; suggests a protective role for physical activity in the setting of obesity; examines population-specific findings; addresses specific effects of different modalities of physical activity in improving health; reveals potential mediators in the relationship between physical activity and metabolic health; and suggests new markers of metabolic health that could potentially be used as outcomes in future physical activity studies.

SUMMARY

Recent research generally confirms the role of physical activity in decreasing insulin resistance and metabolic syndrome in children and adolescents. However, the current literature is limited by unstandardized research methods and definitions, and also aggregation of different age groups, genders, and weight status. Future research should address these issues to offer targeted physical activity interventions.

Associations between active commuting to school, sleep duration, and breakfast consumption in Ecuadorian young people

BACKGROUND

Daily behaviours such as active commuting to school (ACS) could be a source of physical activity, contributing to the improvement of youth cardiovascular health, however, the relationship between ACS and other aspects of a youth's health, such as sleep duration and breakfast consumption, require further clarification. The aims of this study were therefore: 1) to analyse the prevalence of modes of commuting to school, sleep duration, and breakfast consumption by age groups and gender, and 2) to analyse the association between ACS, sleep duration recommendations, and breakfast consumption by age groups and gender.

METHOD

This cross-sectional study included 732 school-aged students of low-middle socioeconomic status, categorised into children (10-12 yr), young adolescents (13-15 yr), and older adolescents (16-18 yr). Modes of commuting to/from school, sleep duration, and breakfast consumption were self-reported. Logistic regression models were fitted to examine the association between ACS, sleep duration and breakfast consumption, analysed according to age groups and gender.

RESULTS

The percentage of students meeting sleep duration and daily breakfast recommendations was lowest in older adolescents, and highest in children (6.3% versus 50.8% p < 0.001, and 62.1%, versus 76.8%, p = 0.001, respectively). Young adolescents and girls who met the sleep duration recommendations were more likely to be active commuters than their counterparts (OR = 4.25; 95% CI = 1.81 to 9.92, p = 0.001 and OR = 2.89; 95%CI = 1.01 to 8.27, p = 0.04, respectively).

CONCLUSION

Young adolescents (13-15 yr) and girls who met the sleep duration recommendations during school days displayed a positive association with ACS. There was no association between ACS and breakfast consumption for any of the age groups or gender. Children (10-12 yr) were those that best meet with the adequate sleep duration and breakfast consumption recommendations.

Mode of Commuting to School and Its Association with Physical Activity and Sedentary Habits in Young Ecuadorian Students

Active commuting to and from school (ACS) could help to increase daily physical activity levels in youth; however, this association remains unknown in Ecuadorian youth. Thus, the aims of this study were (1) to determine the patterns of commuting to and from school and (2) to analyze the associations between ACS, physical activity (PA), and sedentary habits in Ecuadorian youth. A total of 732 students (65.3% males), aged 10⁻18 years (children = 246, young adolescents = 310, older adolescents = 162) from the central region of Ecuador participated in this study. A self-report questionnaire, including the usual mode and frequency of commuting, distance from home to school (PACO-Questionnaire), and PA and sedentary habits (YAP-Questionnaire), was used. Most of the sample lived ≤2 km from school; however, they were mainly passive commuters (96%). The most common mode of commuting was by car (to school = 43.4%, from school = 31.6%; p < 0.001). Children presented significantly higher scores (0⁻4) in PA outside school and total PA compared with older adolescents (2.20 ± 0.97 vs. 1.97 ± 0.96; p = 0.013 and 2.30 ± 0.76 vs. 2.09 ± 0.74, p = 0.019, respectively), as well as the lowest scores in sedentary habits (1.51 ± 0.65, p < 0.001). PA at school and total PA were positively associated with ACS (OR 3.137; 95% CI, 1.918 to 5.131; p < 0.001, and OR 2.543; 95% CI, 1.428 to 4.527; p = 0.002, respectively). In conclusion, passive modes of transportation were the most frequently used to commute to and from school in young Ecuadorians. PA at school and total PA were positively associated with ACS. Thus, interventions at school setting could be an opportunity to improve PA levels and additionally ACS in youth from the central region of Ecuador.

Metabolic syndrome severity and lifestyle factors among adolescents

The continued rise of pediatric obesity globally has raised concerns for related sequalae. One marker of risk is the metabolic syndrome, a cluster of cardiovascular risk factors that is associated with future cardiovascular disease and type 2 diabetes. MetS has at its core visceral adipocytes exhibiting dysfunction as a result of excess fat content. MetS in children and adolescents is linked to unhealthy lifestyle practices such as sedentary lifestyles and excess consumption calories. As such, the optimal means of addressing MetS is targeting a decrease in adiposity through lifestyle modification, a decrease in MetS following increases in physical activity and improvements in the quality and content of food intake. Efforts remain needed in increasing motivation to these changes and maintaining adherence to avoid long-term sequelae.

Active commuting to and from university, obesity and metabolic syndrome among Colombian university students

Background

There is limited evidence concerning how active commuting (AC) is associated with health benefits in young. The aim of the study was to analyze the relationship between AC to and from campus (walking) and obesity and metabolic syndrome (MetS) in a sample of Colombian university students.

Methods

A total of 784 university students (78.6% women, mean age = 20.1 ± 2.6 years old) participated in the study. The exposure variable was categorized into AC (active walker to campus) and non-AC (non/infrequent active walker to campus: car, motorcycle, or bus) to and from the university on a typical day. MetS was defined in accordance with the updated harmonized criteria of the International Diabetes Federation criteria.

Results

The overall prevalence of MetS was 8.7%, and it was higher in non-AC than AC to campus. The percentage of AC was 65.3%. The commuting distances in this AC from/to university were 83.1%, 13.4% and 3.5% for < 2 km, 2-5 km and > 5 km, respectively. Multiple logistic regressions for predicting unhealthy profile showed that male walking commuters had a lower probability of having obesity [OR = 0.45 (CI 95% 0.25–0.93)], high blood pressure [OR = 0.26 (CI 95% 0.13–0.55)] and low HDL cholesterol [OR = 0.29 (CI 95% 0.14–0.59)] than did passive commuters.

Conclusions

Our results suggest that in young adulthood, a key life-stage for the development of obesity and MetS, AC could be associated with and increasing of daily physical activity levels, thereby promoting better cardiometabolic health.

Current therapeutic strategies in treating obesity in children and adolescents - review of the literature

The present paper is a review of current knowledge concerning the most appropriate strategy in the conservative therapy of obese children and adolescents. It presents an account of the combined mode of therapy consisting of behavioral and dietary counseling with appropriate physical activity (also using the support of modern media and devices). The rise in obesity is usually a long-lasting process involving genetic predispositions but also environmental factors which can be modified. The treatment of obesity should be focused on these modified factors and be a lifelong treatment, not merely a short period of exercise or a diet program. Successful therapy depends on the cooperation of the medical team with children and their parents or caregivers.

Fitness, Fatness and Active School Commuting among Liverpool Schoolchildren

This study investigated differences in health outcomes between active and passive school commuters, and examined associations between parent perceptions of the neighborhood environment and active school commuting (ASC). One hundred-ninety-four children (107 girls), aged 9–10 years from ten primary schools in Liverpool, England, participated in this cross-sectional study. Measures of stature, body mass, waist circumference and cardiorespiratory fitness (CRF) were taken. School commute mode (active/passive) was self-reported and parents completed the neighborhood environment walkability scale for youth. Fifty-three percent of children commuted to school actively. Schoolchildren who lived in more deprived neighborhoods perceived by parents as being highly connected, unaesthetic and having mixed land-use were more likely to commute to school actively (p < 0.05). These children were at greatest risk of being obese and aerobically unfit (p < 0.01). Our results suggest that deprivation may explain the counterintuitive relationship between obesity, CRF and ASC in Liverpool schoolchildren. These findings encourage researchers and policy makers to be equally mindful of the social determinants of health when advocating behavioral and environmental health interventions. Further research exploring contextual factors to ASC, and examining the concurrent effect of ASC and diet on weight status by deprivation is needed.