Charting the physical activity patterns of contemporary children and adolescents

The influence of activity patterns and relative humidity on particle resuspension in classrooms

This paper investigates the impact of children's recess activity patterns on particulate matter (PM) resuspension in indoor environments, highlighting the complex, multi-dimensional nature of these activities and their interaction with environmental parameters. Despite the recognized role of indoor human activity in PM resuspension, research specifically addressing the effects of children's movements has been sparse. Through experimental scenarios that account for the characteristics of student activities, such as movement speed, trajectory, the number of participants, aisle widths, and varying humidity levels, this study uncovers significant differences in PM resuspension rates. It reveals that not only do movement speed and trajectory have a profound impact, but also the interaction between humidity and these factors plays a critical role, especially under lower humidity conditions. Additionally, the study demonstrates how the combination of people density and spatial configurations can significantly influence resuspension rates. The findings offer valuable insights for designing strategies to mitigate particle pollution in classrooms and similar indoor environments.

Defining and reporting activity patterns: a modified Delphi study

BACKGROUND

Despite significant interest in assessing activity patterns in different populations, there has been no consensus concerning the definition and operationalisation of this term. This has limited the comparability, interpretability, and synthesis of study findings to date. The aim of this study was to establish a consensus regarding the way in which activity patterns and activity pattern components are defined and reported.

METHODS

The activity patterns literature was searched to identify experts to be invited to participate and to develop a proposed definition of activity patterns and activity pattern components. A three-round modified Delphi survey was conducted online (November 2021 to May 2022). In Round 1, participants were asked to rate their agreement with a proposed activity patterns definition, which also included six activity pattern components (e.g., activity intensity, activity bout, transitions), six examples of activity patterns (e.g., frequency of postural transitions in discrete time periods) and eight items for reporting activity patterns in future research (n = 21 items). Open-ended questions enabled participants to provide further comments and suggestions for additional items. Consensus was defined a priori as ≥ 80% participants rating their agreement with an item. In Round 2, participants were asked to rate their agreement with 25 items (13 original items, eight amended, and four new). In Round 3, participants rated their agreement with 10 items (five original items, four amended, and one new).

RESULTS

Twenty experts in activity patterns research participated in Round 1, with response rates of 80% and 60% in Rounds 2 and 3, respectively. The proposed activity pattern definition, all activity pattern components definitions, four of the six activity pattern examples, and 10 items in the activity patterns reporting framework achieved consensus. The removal of one activity component item between Rounds 1 and 2 achieved consensus.

CONCLUSION

This modified Delphi study achieved consensus for defining and reporting activity patterns for the first time. This consensus definition enables standardisation of activity patterns terminology, which is important given the significant interest in quantifying how individuals accumulate their physical activity and sedentary behaviour across the lifespan to inform the development of future public health guidelines and interventions efforts.

Multivariate Training Programs during Physical Education Classes in School Context: Theoretical Considerations and Future Perspectives

Physical Education plays a fundamental role in promoting healthy habits and lifestyles, as well as in the development of individual and cognitive skills. To date, several investigations have reported positive effects on indicators of physical fitness, motor proficiency, and creativity as a result of specific training programs during Physical Education classes. However, the effects of multivariate training programs on the improvement of the aforementioned skills remain unclear in the literature. Through this brief review, the benefit of applying multivariate training programs during Physical Education classes on indicators of physical fitness, motor proficiency and creativity was critically analyzed. A narrative approach was applied to summarize the availed research as following: (i) theoretical background; (ii) research gaps/issues; (iii) subject explanation about multivariate training programs in Physical Education; and (iv) practical application and further research. The evidence reported in this regard may be useful for the development of multivariate training programs that simultaneously enable the improvement of indicators of physical fitness, motor proficiency and creativity. However, there is still no consensus in the literature on the best strategies (i.e., type of program, duration, intensity) to enhance motor proficiency and creativity in the context of Physical Education classes using multivariate training programs.

Associations between Motor Competence, Physical Self-Perception and Autonomous Motivation for Physical Activity in Children

Research indicates that children and adolescents gradually participate less in physical activity with age. Several factors are associated with children's physical activity levels, such as motor performance, self-perception of athletic competence and motivation to physical activity. To gain a better understanding of the factors of importance for behavior related to an active lifestyle, the purpose of this study was to investigate the association between motor competence, physical self-perception and autonomous motivation and to examine to what extent this association may vary by sex. The sample consisted of 101 children, whose average age was 11.7 years (SD = 0.57), 53 boys and 48 girls. All subjects were measured on motor competence, physical self-perception and autonomous motivation for physical activity. The results indicate a low positive relationship between motor competence and physical self-perception for the entire sample and among girls. There is also a significant correlation between autonomous motivation and physical self-perception. No significant correlations were found between autonomous motivation and motor competence. The association between physical self-perception and autonomous motivation suggests that psychological factors play an important role in children's participation in physical activity.

The Effects of Structured Physical Activity Program on Social Interaction and Communication for Children with Autism

The purpose of this study was to investigate the effects of structured physical activity program on social interaction and communication of children with autism spectrum disorder (ASD). Fifty children with ASD from a special school were randomly divided into experimental and control groups. 25 children with ASD were placed in the experimental group, and the other 25 children as the control group participated in regular physical activity. A total of forty-one participants completed the study. A 12-week structured physical activity program was implemented with a total of 24 exercise sessions targeting social interaction and communication of children with ASD, and a quasi-experimental design was used for this study. Data were collected using quantitative and qualitative instruments. SSIS and ABLLS-R results showed that an overall improvement in social skills and social interaction for the experimental group across interim and posttests, F = 8.425, p = 0.001 (p < 0.005), and significant improvements appeared in communication, cooperation, social interaction, and self-control subdomains (p < 0.005). Conversely, no statistically significant differences were found in the control group (p > 0.005). The study concluded that the special structured physical activity program positively influenced social interaction and communication skills of children with ASD, especially in social skills, communication, prompt response, and frequency of expression.

Interventions to promote physical activity for youth with intellectual disabilities

OBJECTIVE

To describe interventions designed to promote physical activity for youth with intellectual disabilities.

MATERIALS AND METHODS

A systematic review of nine databases until January 31, 2015 identified 213 citations. The inclusion criteria were: a) the study sample consisted of youth with intellectual disabilities, b) the study implemented an intervention to initiate, increase, or maintain physical activity, and c) quantitative or qualitative data were used to report the effectiveness of the intervention. Eleven articles from the 213 citations met this criterion.

RESULTS

Nine studies reported significant increases in physical activity behavior.

CONCLUSIONS

Conclusions cannot be made regarding intervention components that impacted outcome variables, if the observed effects were specifically due to the intervention or if interventions could be maintained long-term. To advance the knowledge base in this area, a concerted effort should be made to increase rigor in study conceptualization and research design.

Effects of physical activity on debilitating behaviours in 13- to 20-year-old males with severe autism spectrum disorder

The presented study investigated the extent to which engaging in a therapeutic sporting programme in males with severe autism spectrum disorder (ASD) improves the debilitating behaviours commonly associated with ASD. Furthermore, the views of parents of the autistic participants were assessed concerning the effectiveness of the programme. Participants were eight 13- to 20-year-old males born in the United Kingdom from a school and sports college for pupils with severe learning difficulties. The selection was using volunteer sampling from the “Monday Club” initiative, run by Saracens Sports Foundation in partnership with a local school and specialist sports college. The Gilliam Autism Rating Scale, 3rd edition was administered to identify and measure the severity of ASD behaviours at four time periods namely: at programme entry as the baseline (Time 1, T1), a second time after 8 weeks (Time 2, T2), a third time after 16 weeks (Time 3, T3), and a fourth time post programme (Time 4, T4). The results showed that for the more severe cases of ASD (Autism Index >101) there was no positive change in subscale performance from T1 to T2. For milder cases (Autism Index, 71–100) there were subtle non-significant improvements on the subscale scores from T1 to T2. Of the 6 subscales at T2, emotional responses, cognitive style, and maladaptive speech approached significance at the P=0.05 level. At T3 and T4, there was also no statistically significant improvement in ASD behaviours compared to the baseline for either condition. Finally parents’ were “very satisfied” with their child’s participation in the physical activity programme.

Validation of the Fitbit Zip for monitoring physical activity among free-living adolescents

Background

The widespread availability of affordable consumer-oriented devices for monitoring physical activity offers an appealing option to physical activity researchers, but studies are needed to demonstrate the validity and reliability of these products. To examine the validity of the Fitbit Zip, we recruited three cohorts (N’s = 25, 35, and 27) of middle-school students to wear the Fitbit and the ActiGraph simultaneously for a week. Adolescents were healthy volunteers representing a range of activity levels. Mean daily minutes of MVPA and mean steps per day were compared between the Fitbit Zip and the Actigraph.

Results

The step data for the Fitbit Zip correlated highly with the step data yielded by the ActiGraph (r’s = .72, .92, .96), and the MVPA data for the Fitbit Zip correlated highly with the MVPA data from the ActiGraph (r’s = .67, .79, .94). Bland–Altman plots revealed that the Fitbit Zip overestimated activity in comparison to the ActiGraph, especially for Cohort One, which completed the study before Fitbit modified their algorithms to count as activity only bouts that continued for at least 10 min.

Conclusions

Our data suggest that the Fitbit Zip is a reasonable alternative to the ActiGraph for estimating activity among free-living adolescents. However, data from the Fitbit should not be used interchangeably with data from the ActiGraph, as there is a consistent tendency for the Fitbit to overestimate steps in comparison to the ActiGraph. Also, the findings confirm concern about using for research a consumer-oriented device that does not make public their algorithms.

Physical activity in German adolescents measured by accelerometry and activity diary: introducing a comprehensive approach for data management and preliminary results

INTRODUCTION

Surveillance of physical activity (PA) is increasingly based on accelerometry. However, data management guidelines are lacking. We propose an approach for combining accelerometry and diary based PA information for assessment of PA in adolescents and provide an example of this approach using data from German adolescents.

METHODS

The 15-year-old participants comprised a subsample the GINIplus birth cohort (n = 328, 42.4% male). Data on PA was obtained from hip-worn accelerometers (ActiGraph GT3X) for seven consecutive days, combined with a prospective activity diary. Major aspects of data management were validity of wear time, handling of non-wear time and diary comments. After data cleaning, PA and percentage of adolescents meeting the recommendations for moderate-to-vigorous activity (MVPA) per day were determined.

RESULTS

From the 2224 recorded days 493 days (25%) were invalid, mainly due to uncertainties relating to non-wear time (322 days). Ultimately, 269 of 328 subjects (82%) with valid data for at least three weekdays and one weekend day were included in the analysis. Mean MVPA per day was 39.1 minutes (SD ±25.0), with boys being more active than girls (41.8±21.5 minutes vs. 37.1±27.8 minutes, p<0.001). Accordingly, 24.7% of boys and 17.2% of girls (p<0.01) met the WHO recommendations for PA. School sport accounted for only 6% of weekly MVPA. In fact, most MVPA was performed during leisure time, with the majority of adolescents engaging in ball sports (25.4%) and endurance sports (19.7%). Girls also frequently reported dancing and gymnastics (23%).

CONCLUSION

For assessment of PA in adolescents, collecting both accelerometry and diary-based information is recommended. The diary is vital for the identification of invalid data and non-compliant participants. Preliminary results suggest that four out of five German adolescents do not meet WHO recommendations for PA and that school sport contributes only little to MVPA.

Is a change in mode of travel to school associated with a change in overall physical activity levels in children? Longitudinal results from the SPEEDY study

Background

Children who use active modes of travel (walking or cycling) to school are more physically active than those who use passive (motorised) modes. However, less is known on whether a change in mode of travel to school is associated with a change in children’s physical activity levels. The purpose of this analysis was to investigate the association between change in mode of travel to school and change in overall physical activity levels in children.

Methods

Data from 812 9–10 year old British children (59% girls) who participated in the SPEEDY study were analysed. During the summer terms of 2007 and 2008 participants completed a questionnaire and wore an accelerometer for at least three days. Two-level multiple linear regression models were used to explore the association between change in usual mode of travel to school and change in objectively measured time spent in MVPA.

Results

Compared to children whose reported mode of travel did not change, a change from a passive to an active mode of travel was associated with an increase in daily minutes spent in MVPA (boys: beta 11.59, 95% CI 0.94 to 22.24; girls: beta 11.92, 95% CI 5.00 to 18.84). This increase represented 12% of boys’ and 13% of girls’ total daily time spent in MVPA at follow-up.

Conclusion

This analysis provides further evidence that promoting active travel to school may have a role in contributing to increasing physical activity levels in children.

Physical activity and obesity in children with congenital cardiac disease

BACKGROUND

Children with congenital cardiac disease experience challenges in developing healthy patterns of physical activity due to decreased exercise capacity and parental fear and confusion about what is permissible. The purpose of this study was to describe physical activity habits in children 10-14 years of age with congenital cardiac disease and the relationship of those habits to obesity as defined by body mass index.

METHODS

This cross-sectional study used self-report measures and clinical data to describe the association between physical activity participation and body mass index in 10- to 14-year-old children with congenital cardiac disease. Further, physical activity levels were compared between children who were overweight or obese and those who were not.

RESULTS

Children (n = 84; 51 males; 33 females) reported low rates of physical activity compared to reports on healthy children. Only 9.5% were overweight (body mass index between the 85th and 94th percentile), and alarmingly 26% were obese (body mass index at or above the 95th percentile). Physical activity and body mass index were not significantly correlated (r = -0.11, p = 0.45) and there was no significant difference in mean physical activity (t = 0.67) between children who were overweight or obese and those who were not.

CONCLUSIONS

Children in this study reported low rates of physical activity and a higher obesity rate than was reported in previous studies. However, the two were not significantly correlated. Further research is indicated to determine the specific factors contributing to obesity and to test interventions to combat obesity in children with congenital cardiac disease.

Do children's individual correlates of physical activity differ by home setting?

We investigated whether physical activity (PA) correlates differed for 9-10 year-old British children living in urban, suburban and rural settings. We analysed cross-sectional data on 1653 children (SPEEDY study). Exposure variables were self-reported, whilst PA was measured using Actigraph accelerometers. Data were analysed using multilevel hierarchical regression models, stratified by home setting. PA levels did not differ by home setting. Boys, those of normal weight and those having a preference for PA had higher PA levels in all strata, but additional correlates were identified within each setting. These results highlight the potential importance of tailoring interventions to specific environmental and population strata.

Sport injuries: a review of outcomes

Injuries can counter the beneficial aspects related to sports activities if an athlete is unable to continue to participate because of residual effects of injury. We provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries. A systematic computerized literature search was conducted on following databases were accessed: PubMed, Medline, Cochrane, CINAHL and Embase databases. At a young age, injury to the physis can result in limb deformities and leg-length discrepancy. Weight-bearing joints including the hip, knee and ankle are at risk of developing osteoarthritis (OA) in former athletes, after injury or in the presence of malalignment, especially in association with high impact sport. Knee injury is a risk factor for OA. Ankle ligament injuries in athletes result in incomplete recovery (up to 40% at 6 months), and OA in the long term (latency period more than 25 years). Spine pathologies are associated more commonly with certain sports (e.g. wrestling, heavy-weight lifting, gymnastics, tennis, soccer). Evolution in arthroscopy allows more accurate assessment of hip, ankle, shoulder, elbow and wrist intra-articular post-traumatic pathologies, and possibly more successful management. Few well-conducted studies are available to establish the long-term follow-up of former athletes. To assess whether benefits from sports participation outweigh the risks, future research should involve questionnaires regarding the health-related quality of life in former athletes, to be compared with the general population.

The effects of aerobic exercise on academic engagement in young children with autism spectrum disorder

PURPOSE

To determine whether participation in aerobic exercise before classroom activities improves academic engagement and reduces stereotypic behaviors in young children with autism spectrum disorder.

METHODS

This study employed a within-subjects crossover design, using a treatment condition (aerobic exercise) and a control condition, across 4 classrooms. The treatment condition included 15 minutes of running/jogging followed by a classroom task. The control condition included a classroom task not preceded by exercise. The number of stereotypic behaviors, percentage of on-task behavior, and correct/incorrect responses were measured. The Wilcoxon signed rank test was used to compare differences between conditions.

RESULTS

Statistically significant improvements were found in correct responding following exercise (P < .05). No significant differences were found for on-task behavior or stereotypic behaviors.

CONCLUSIONS

Consistent with findings in older children, these results indicate that aerobic exercise prior to classroom activities may improve academic responding in young children with autism spectrum disorder.

The contribution of active play to the physical activity of primary school children

OBJECTIVE

To examine associations between active play and the physical activity of 10- to 11-year-old children.

METHOD

Cross-sectional study of 747, 10- tot11-year-olds, conducted between February 2008 and March 2009 in Bristol, UK. Mean minutes of moderate to vigorous physical activity (MVPA) and mean activity levels (counts per minute, CPM) were assessed by accelerometer. Frequency of active play was self-reported.

RESULTS

Regression models indicated that frequent active play (5 or more days per week) was associated with mean daily activity levels (CPM) (girls: p=<0.01; boys: p=<0.01), but was only associated with mean daily MVPA for girls (p=<0.01). For leisure-time physical activity, active play was associated with children's CPM (girls: p=0.02; boys: p=<0.01) and MVPA (girls: p=<0.01; boys: p=0.03) on weekdays after school, but was only associated with weekend day CPM for boys (p=<0.01).

CONCLUSION

Active play is associated with children's physical activity with after-school potentially being a critical period. Strategies to promote active play may prove to be a successful means of increasing children's physical activity.

Physical activity and adolescents: an exploratory randomized controlled trial investigating the influence of affective and instrumental text messages

OBJECTIVE

The present study attempts to develop and pilot the feasibility and efficacy of a novel intervention using affective messages as a strategy to increase physical activity (PA) levels in adolescents. Design An exploratory pilot randomized control trial was used to compare behaviour change over 2 weeks. A modified form of the International Physical Activity Questionnaire was used to assess PA behaviour. A total of 120 adolescents (16-19 years) from 4 sixth forms in West Yorkshire completed the field-based study.

METHOD

Participants were randomly assigned to one of three experimental conditions, or the control condition (N=28). Participants in experimental conditions received 1 short messaging service (SMS) text message per day over the 2 weeks, which included manipulations of either affective beliefs (enjoyable/unenjoyable; N=31), instrumental beliefs (beneficial/harmful; N=30), or a combination of these (N=31). Control participants received one SMS text message per week. Outcomes were measured at baseline and at the end of the 2 week intervention.

RESULTS

PA levels increased by the equivalent of 31.5  minutes of moderate (four metabolic equivalent) activity per week during the study. Main effects of condition (p=.049), and current physical activity level (p=.002) were identified, along with a significant interaction between condition and current activity level (p=.006). However, when the sample was split at baseline into active and inactive participants, a main effect of condition remained for inactive participants only (p=.001). Post hoc analysis revealed that inactive participants who received messages targeting affective beliefs increased their activity levels significantly more than the instrumental (p=.012), combined (p=.002), and control groups (p=.018).

CONCLUSION

Strategies based on affective associations may be more effective for increasing PA levels in inactive individuals.

Using activity diaries to measure children's and adolescents' compliance with activity restrictions after mild traumatic brain injury

PURPOSE

To examine the extent to which children and adolescents with a mild traumatic brain injury (MTBI) comply with the activity restrictions received upon discharge from a pediatric trauma center.

PARTICIPANTS

Thirty-four children with MTBI (aged 8-16 years) and 34 control children matched for age, sex, and premorbid level of physical activity.

MAIN MEASURE

Activity diary documenting the exact level of activity during 3 consecutive days during the 1st, 4th, and 12th week post-MTBI (corresponding time intervals for controls) and the Physical Activity Questionnaire.

RESULTS

Fifteen pairs of children (MTBI + control) completed the diaries for all 3 assessment times (77% participation rate among consecutive admissions and 44% compliance rate with diary completion). Although some children engaged in activities before the end of the 4-week restriction period, the majority of the children followed the recommendations they received. Children with MTBI maintained a lower level of energy expenditure at the 1- and 4-week evaluations than did the noninjured children, but not at the 12-week evaluation.

CONCLUSION

Children with MTBI usually comply with the activity restrictions they receive upon discharge from the hospital.

Effects of a 6-week circuit training intervention on body esteem and body mass index in British primary school children

Research examining the impact of physical activity on children's body image has been limited and equivocal. The current researchers examined the effect of 6-week circuit-based training on body esteem and body mass index (BMI) in 68 British children (34 boys and 34 girls, aged 10-11 years, 16% overweight, 7% obese). The Body Esteem Scale for Children (BES-C) was administered to both the intervention group and control group, pre, post and 6 weeks post the intervention. BMI was directly assessed from height and body mass pre- and post-intervention. The results of this study revealed that, as compared to the control group, participation in 6-week circuit training significantly improved body esteem scores post-intervention. However, these scores were not sustained 6 weeks post-intervention. The improvement in body esteem scores from pre- to post-intervention was greater for girls as compared to boys. Additionally, BMI decreased significantly in the intervention group compared to the control group.

Are preschool children active enough? Objectively measured physical activity levels

The present study aimed to describe accelerometer-based physical activity levels in 4- and 5-year-old children (N = 76) on 2 weekdays and 2 weekend days. The children were sedentary for 9.6 hr (85%) daily, while they engaged in moderate to vigorous physical activity (MVPA) for 34 min (5%). Only 7% of the children engaged in MVPA for 60 min per day, and only 26% reached the standard of 120 min of total activity. Their engagement in MVPA did not significantly differ between weekend and weekdays. Mean activity counts and minutes in MVPA did not differ between genders. Physical activity levels in this sample of preschool children were far lower than recommended.

Physical activity for youth with disabilities: a critical need in an underserved population

The recommended amount of daily physical activity for youth is 60 minutes a day, most days of the week. Youth with disabilities are not achieving this target and are significantly less active and more obese than their non-disabled peers. The combination of the health risks associated with physical inactivity and obesity presents a serious health concern in this population. While there is a small amount of research on interventions aimed at improving fitness among youth with disabilities, the majority of these studies were conducted in clinical settings where most or all of the common barriers to participation were eliminated (e.g. transportation, lack of knowledgeable staff, adaptation of programmes and/or facilities to child's needs). One of the most important challenges for paediatric rehabilitation and healthcare professionals is finding ways to increase physical activity and fitness among youth with disabilities in community-based settings. The use of information technology (IT) to customize physical activity programmes for youth with disabilities offers a promising approach to addressing this important health issue in the future.

Skeletal complications after bone marrow transplant in childhood

Childhood cancer survivors are a growing population with special medical needs. It is projected that 66% of these survivors will have at least 1 adverse health effect and 33% will have a severe, chronic, or lethal health disorder. The Institute of Medicine (2003) has recognized the skeletal system to be at risk for long-term complications from treatment for childhood cancer. Bone marrow transplant is frequently used to treat childhood malignancies and is known to cause skeletal complications. Complex mechanisms contribute to skeletal outcomes after bone marrow transplant, all of which can affect optimal physical functioning. Nurses have taken an important role in providing clinical care and conducting research for this population. A thorough understanding of the mechanisms involved in skeletal complications can help the nurse provide state-of-the-art care and design studies to promote optimal results for bone marrow transplant survivors. This article reviews the literature on skeletal complications associated with allogeneic bone marrow transplant and identifies incidence, etiology, symptoms, monitoring, and treatment of specific complications.

Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials

OBJECTIVE

To review the published literature on the effectiveness of interventions to promote physical activity in children and adolescents.

DESIGN

Systematic review.

DATA SOURCES

Literature search using PubMed, SCOPUS, Psychlit, Ovid Medline, Sportdiscus, and Embase up to December 2006. Review methods Two independent reviewers assessed studies against the following inclusion criteria: controlled trial, comparison of intervention to promote physical activity with no intervention control condition, participants younger than 18 years, and reported statistical analyses of a physical activity outcome measure. Levels of evidence, accounting for methodological quality, were assessed for three types of intervention, five settings, and three target populations.

RESULTS

The literature search identified 57 studies: 33 aimed at children and 24 at adolescents. Twenty four studies were of high methodological quality, including 13 studies in children. Interventions that were found to be effective achieved increases ranging from an additional 2.6 minutes of physical education related physical activity to 283 minutes per week of overall physical activity. Among children, limited evidence for an effect was found for interventions targeting children from low socioeconomic populations, and environmental interventions. Strong evidence was found that school based interventions with involvement of the family or community and multicomponent interventions can increase physical activity in adolescents.

CONCLUSION

Some evidence was found for potentially effective strategies to increase children's levels of physical activity. For adolescents, multicomponent interventions and interventions that included both school and family or community involvement have the potential to make important differences to levels of physical activity and should be promoted. A lack of high quality evaluations hampers conclusions concerning effectiveness, especially among children.

Pedometer determined physical activity levels in primary school children from central England

OBJECTIVE

To assess ambulatory physical activity in school children from central England, to examine any variation in activity between weekdays and weekends and to determine the percentage of children meeting recently identified cut-off steps/day for health.

METHOD

208 British primary school children (101 boys and 107 girls, mean age 9.3+/-0.9 years) from central England wore a sealed pedometer for 4 consecutive days (2 weekend and 2 weekdays) during 2006 from which daily step counts were determined. Data were collected over winter, spring and summer terms. Repeated measures analysis of variance was used to examine potential time (weekend versus weekday), gender and age differences in steps/day.

RESULTS

Children attained significantly higher mean steps/day during weekdays than weekends (p<0.001), and boys attained significantly higher mean steps/day than girls (p<0.05). Mean steps/day values were 13,827 (38,201) and 10,334 (4436) for weekdays and weekends and 12,263 (3789) and 11,748 (3310) for boys and girls respectively. 28.7% of boys and 46.7% of girls met or exceeded the BMI referenced cut-offs for health.

CONCLUSION

Physical activity was greater during weekdays compared to weekends and boys were more active than girls but the majority of children did not meet the health-related cut-off points.

The Children's Computerized Physical Activity Reporter

The objectives of this three-phased study were to design and evaluate the usability of a computerized questionnaire, The Children's Computerized Physical Activity Reporter, designed with and for middle school children's self-report of physical activity. Study design was qualitative, descriptive, and collaborative, framed in a usability engineering model, with 22 participating children (grades 6-8; mean age, 12.5 years; range, 11-15 years) of three ethnic backgrounds. In Phase 1, children's understanding of physical activity and needs for reporting were determined, which were then translated in Phase 2 to the design features and content of the questionnaire; content validity, readability, and algorithm reliability were completed. Phase 3 involved children's evaluation of the questionnaire's usability (ease of use, efficiency, and aesthetics). The children all liked the questionnaire but identified several usability issues within instructions and reports. Working collaboratively with children was highly effective in ascertaining their understanding of physical activity and their self-reporting needs. Thus, the questionnaire's design was created from children's understanding of physical activity and their needs for recalling activities. The development of the questionnaire and its usability evaluation contribute to understanding children's physical activity and to the importance of designing for usability. Additional research is needed to ascertain reliability and validity of data derived from its use and to explore its usefulness in clinical or research venues.

Determinants of sufficient daily activity in Australian primary school children

AIMS

Australian guidelines recommend that children participate in at least one hour of physical activity every day. We aimed to measure physical activity participation in a random sample of Australian primary school children and to determine the biological, behavioural, environmental and social influences associated with insufficient daily activity.

METHOD

We analysed the following cross-section data from a randomly selected sample of children (N=518) aged 5 to 12 years: age, gender, socioeconmic status (SES) indicators, family size, home play equipment availability, transport method to school, and estimated time per week in physical and sedentary activity. Logistic regression analysis was performed to determine variables that were associated with insufficient (<60 minutes) daily activity.

RESULTS

Seventy-six children (15% of the cohort) failed to meet the minimum activity recommendations of 60 minutes of daily activity. These children were significantly less likely to walk or cycle to school (adjusted odds ratio (OR) 0.43; 95% CI=0.24-0.77) or participate in organised sports or activity (OR 0.42; 95% CI=0.28-0.64) and were more likely to spend in excess of 2 hours a day watching television of using a computer for entertainment (OR 2.10 (1.16-3.78). Age, gender, SES and family size were not significantly associated with insufficient activity.

CONCLUSION

There exists a significant proportion of the paediatric population who are insufficiently active. Interventions to encourage increased activity in this sub-group may be successful if they seek to alter sedentary behaviour (namely television use) and method of transportation to and from school.

Compliance with the Australian national physical activity guidelines for children: relationship to overweight status

Childhood obesity incidence has increased substantially and it has been argued that decreasing physical activity levels, coinciding with an increase in sedentary behaviours, are responsible. Australian guidelines were published in 2004, recommending that children participate in a minimum of 60 min of physical activity daily and spend no more than 2h a day using electronic media for entertainment. We aimed to compare compliance with these guidelines amongst children of differing weight status. The Childhood Injury Prevention Study (CHIPS) collected data from a randomly selected sample of Brisbane primary and preschool children aged 5-12 years. The following data were available for 518 participants: age, gender, measured height and weight and estimated time per week from a parent-completed 7 days diary in physical activity out of school and sedentary leisure activities including television viewing and computer use. Using age standardised body mass index estimates, approximately 20% of the cohort were overweight. Non-compliance with guidelines was 14.7% for out of school physical activity participation, and 30.9% for excess electronic media entertainment use. There was a 63% increase in the odds of overweight status amongst children who were non-compliant with the electronic entertainment recommendations than those who were compliant (adjusted odds ratio=1.63; 95% CI=1.05-2.54). Female gender and school level socioeconomic category were also independently associated with overweight status. Non-compliance with the minimal physical activity guideline increased the odds of being overweight by 28%, however this difference was not statistically significant. One in seven children from the Greater Brisbane area are at risk for being insufficiently active whilst a third overuse electronic media. Given that overuse of electronic entertainment was positively associated with childhood obesity, these children should be the target of public health campaigns to promote alternative leisure time activities.

Cognitive determinants of energy balance-related behaviours: measurement issues

The burden of disease as a result of overweight and obesity calls for in-depth examination of the main causes of behavioural actions responsible for weight gain. Since weight gain is the result of a positive energy balance, these behavioural actions are referred to as 'energy balance-related behaviours' (EBRBs). In the broadest sense, there are only two EBRBs: food intake and physical activity. However, both diet and physical activity are complex behavioural categories that involve a variety of actions. This article discusses the potential problems and opportunities related to the assessment of cognitive determinants of energy intake and energy expenditure behaviours. We argue for the necessity of studying determinants of EBRBs within an energy balance approach, i.e. focusing on energy input as well as output, instead of only studying dietary change or physical activity behaviour. As a result, however, theoretically sound questionnaires assessing determinants of EBRBs are likely to annoy respondents. It is especially the measurement of the behaviours and the use of belief-based constructs that cause questionnaires to be long, which may lead to low response rates and invalid data. In this article, we propose a careful and systematic consideration of the inclusion or exclusion of measures of cognitive determinants. First, if studies show that an EBRB is strongly influenced by environmental factors and is not or only to a minor extent under intentional control, measurement of cognitions is of little use. Second, only when we have proof that attitudes, norms and perceived behavioural control predict intentions, should we aim to assess the underlying beliefs. Third, since assessment of beliefs results in similar or better prediction than using belief-valuation combinations, we should not 'annoy' respondents with valuation items. Finally, we argue that the traditional paper-and-pencil survey is still the most reliable and practical data collection method. However, pilot studies applying computerised adaptive methods to determinants of EBRBs are encouraged.

Walking to school: incidental physical activity in the daily occupations of Australian children

Children's participation in physical activity is declining, and nowhere is this more apparent than in the incidental activity of walking to school. The aim of this pilot study was to examine the extent to which Australian children walked to and from primary school, and to survey parents to identify factors influencing this behaviour. Parents of 164 students in Grades 1 7 (mean age 9.1 +/- 2.02 years) from a primary school comprising 360 students responded to a questionnaire regarding psychosocial and environmental factors thought to influence the means by which their children went to and from school. Results indicated that parent perception of the importance of physical activity, parents' individual history of transport to school as well as distance from school were the most statistically significant factors determining children's involvement in walking to and from school. The results of this study highlight the attitudes and experiences of parents in determining the extent to which children are involved in non-motorized access to school. Also implicated are organizational policies about geographical school regions. While this study is limited to one school community, further study is recommended with others to better confirm findings by examining socioeconomic, geographic and policy variables. Occupational therapists are challenged to examine ways in which incidental physical activity can be increased in the lives of young children.

It's good to talk: children's views on food and nutrition

OBJECTIVE

To gain an insight into children's views about food and nutrition.

DESIGN

Data were collected in focus group discussions; two focus group sessions were undertaken with each school group.

SETTING

A total of 11 postprimary schools in Northern Ireland and England.

SUBJECTS

In all, 106 children aged 11-12-y-old (n = 52 boys, n = 54 girls).

RESULTS

Focus group transcripts were analysed using qualitative research methodology. Major barriers to healthy eating were taste, appearance of food, filling power, time/effort, cost, choice/availability, risk, rebellion, and body image/weight concerns. The main difference between sexes was in terms of motivating factors for eating well; girls tended to focus primarily on their appearance whereas boys appeared to be more influenced by sport. There was some mention of balance and variety within the focus group discussions, however, in practice, the children had a tendency to categorise foods as either 'good' or 'bad', 'healthy' or 'unhealthy'.

CONCLUSIONS

This study has revealed a number of barriers to, and motivations for, healthy eating, which should be taken into account when planning nutrition intervention strategies aimed at children moving into adolescence. While it may be possible to immediately attempt to address some of the barriers identified in this study, for example, in nutrition education initiatives, other barriers (such as the lack of available, attractive and affordable healthy foods in the school canteen) will prove more difficult to tackle without changes at the policy level. Overall, it appears that health promotion specialists have a major challenge ahead in order to encourage this age group to view healthy eating as an attractive and achievable behaviour.

SPONSORSHIP

Food Standards Agency, London, UK.

Health-enhancing physical activity and sedentary behaviour in children and adolescents

We provide a wide-ranging review of health-related physical activity in children and adolescents using a behavioural epidemiology framework. In contrast to many other reviews, we highlight issues associated with true sedentary behaviours alongside physically active behaviours. Specifically, we review the evidence concerning the links between physical activity and cardiovascular disease, overweight and obesity, psychosocial measures, type II diabetes, and skeletal health. Although the evidence is unconvincing at times, several factors lead to the conclusion that promoting physical activity in youth is desirable. A review of the prevalence of physical activity and sedentary behaviours shows that many young people are active, but this declines with age. A substantial number are not adequately active for health benefits and current trends in juvenile obesity are a cause for concern. Prevalence data on sedentary behaviours are less extensive but suggest that total media use by young people has not changed greatly in recent years. Most children and adolescents do not exceed recommended daily hours of TV viewing. Physical activity is unrelated to TV viewing. We also identified the key determinants of physical activity in this age group, highlighting demographic, biological, psychological, behavioural, social and environmental determinants. Interventions were considered for school, family and community environments. Finally, policy recommendations are offered for the education, governmental, sport and recreation, health, and mass media sectors.

The obesity epidemic: prospects for prevention

Some 20-25% of UK adults are obese according to the WHO criterion (BMI >/=30 kg/m(2)). Type 2 diabetes, increasingly recognized as a major complication of overweight and obesity, is beginning to appear in UK adolescents, following the trends in the US. Epidemiological data indicate that the prevalence of overweight and obesity has doubled or tripled in the past few decades in the US, in Europe, and even in many developing countries. Thus obesity is increasingly seen as a public health problem requiring concerted action by both governmental and non-governmental organizations. A sound understanding of the root causes is crucial, if strategies for the prevention and treatment of this epidemic are to be developed. Many epidemiological studies suggest that physical activity at work, school or at leisure has declined to minimal levels, and that sedentary behaviours such as television viewing and computer games have become major pastimes. Thus energy requirements are substantially less than those for recent generations. Further, the food industry produces high-calorie foods which children and adults consume as snack meals, giving a substantial surfeit to their daily energy requirement. In children, a few school-based, preventive intervention trials have shown some promising results. Many negative trials have also been reported, and practical difficulties remain in the widespread implementation of appropriate protocols. Initiatives have been introduced by the government to increase the physical education syllabus in school to a minimum of 2 h/week, and the promotion of fruit and vegetables. Further research is required on the physiological and psychological causes of overweight and obesity in children and adults, and randomized, controlled, school and community-based trials are required to pilot preventative initiatives. Monitoring of the progress in prevention at both organizational and outcome level is required, and also of adverse outcomes such as a rise in the prevalence of eating disorders.

Commuting to school: are children who walk more physically active?

BACKGROUND

The journey to school is an opportunity for increasing children's daily physical activity. However, the contribution that active commuting to school makes to overall physical activity is unknown. This study used objective measurement to investigate the physical activity patterns of children by mode of travel to school.

METHODS

Primary-school children wore an accelerometer programmed to record minute-by-minute physical activity for 7 days and completed a brief questionnaire describing their usual travel to school. The total volume of physical activity and the time spent in activity of at least moderate intensity, as recorded by the accelerometer, was estimated for weekdays and the weekend, and groups of children were compared by mode of transport to school. Data were collected in May/June 2002.

RESULTS

Of the 114 children (59 boys, 55 girls; aged 10.4+/-0.8 years) who took part in the study, those who walked to school (65%) were significantly more active than those who traveled by car (712.0+/-206.7 vs 629.9+/-207.2 accelerometer counts per minute, p=0.05). Analysis by gender indicated that the major differences in physical activity between travel groups were seen only in boys. Hourly activity patterns demonstrated that boys who walked to school were more active after school and throughout the evening than were car users.

CONCLUSIONS

In boys, walking to school was associated with higher physical activity after school and during the evening. Active transport may contribute to a more physically active profile, at least for boys, supporting walk-to-school initiatives to increase children's physical activity.

Assessment of physical activity with a pedometer and its relationship with VO2max among adolescents in Switzerland

OBJECTIVES

In the absence of a gold standard, the assessment of physical activity in children remains difficult. To record physical activity with a pedometer and to examine to what extent it is correlated with VO2max.

METHODS

Survey on physical activity and fitness; 233 Swiss adolescents aged 11 to 15 carried a pedometer (Pedoboy) during seven consecutive days. VO2max was estimated through an endurance shuttle run test.

RESULTS

The physical activity recorded by the pedometer did not vary from one day to the other (p > 0.05). The physical activity was higher among boys than among girls (p < 0.001) and higher among younger adolescents (6th versus 8th grade; p < 0.001). The correlation between physical activity and estimated VO2max was 0.30 (p < 0.01).

CONCLUSIONS

The use of a pedometer to assess physical activity over one entire week is feasible among adolescents. The record provided by the pedometer gives an objective measure of the usual physical activity and, as such, is relatively well correlated with aerobic capacity.