Physical activity patterns in nonobese and obese children assessed using minute-by-minute accelerometry

Hourly step recommendations to achieve daily goals for working and older adults

BACKGROUND

The widespread use of physical activity trackers enables the collection of high-resolution health data, such as hourly step counts, to evaluate health promotion programmes. We aim to investigate how participants meet their daily step goals.

METHODS

We used 24-h steps data from the National Steps ChallengeTM Season 3, wherein participants were rewarded with vouchers when achieving specified goals of 5000, 7500, and 10,000 steps per day. We extracted data from 3075 participants' including a total of 52,346 participant-days. We modelled the hourly step counts using a two-part model, in which the distribution for step counts was allowed to depend on the sum of step counts up to the previous hour and participant demographics.

RESULTS

Participants have a mean age of 44.2 years (standard deviation = 13.9), and 40.4% are males. We show that on weekdays, the hourly mean step counts among participants aged 60 and above are higher than participants aged 30 to 59 from the start of the day till 6 p.m. We also find that participants who accumulate at least 7000 steps by 7 p.m. are associated with higher success of achieving 10,000 steps.

CONCLUSIONS

We provide recommendations on the hourly targets to achieve daily goals, based on different participants' characteristics. Future studies could experimentally test if prompts and nudges at the recommended times of day could promote reaching step goals.

Association of physical activity, sedentary behavior, diet quality with adiposity: a longitudinal analysis in children categorized by baseline weight status

BACKGROUND/OBJECTIVES

Childhood obesity rates have increased in recent years. The effectiveness of future public health interventions to reduce childhood obesity will be enhanced by a better understanding of behavioral factors that influence adiposity in children as they transition from childhood to adolescence. The purpose of this study was to examine whether initial weight status modifies the longitudinal associations of physical activity, sedentary behavior, and diet quality with changes in adiposity over time.

SUBJECTS/METHODS

A total of 658 children (45% boys) were stratified into 3 groups based on 5th grade BMI percentiles ( < 85th, 85-95th, > 95th) and followed from 5th grade to 6th and/or 7th grade. Study variables, including fat-mass-index (FMI), moderate-to-vigorous physical activity (MVPA), diet quality, and sedentary behavior, were measured at 5th, 6th, and/or 7th grades. Separate growth curve models were conducted within each weight status group to examine the associations between MVPA, sedentary behavior, diet quality and adiposity, operationalized as FMI. All models controlled for sex, maturity offset, race, and parent education.

RESULTS

Of the 658 children, 53% were classified with normal weight at baseline, 18% with overweight, and 29% with obesity. Associations between MVPA, sedentary behavior, diet quality and FMI varied within each weight status group. MVPA was negatively associated with adiposity (FMI) for all weight status groups. Diet quality and sedentary behavior were associated with adiposity only in children with obesity at baseline; neither diet quality nor sedentary behavior was associated with FMI for those with overweight.

CONCLUSIONS

MVPA was negatively associated with adiposity (FMI) in all weight status groups, suggesting that MVPA may protect against higher adiposity. Sedentary behavior and diet quality were associated with adiposity only in children with obesity at baseline; neither sedentary behavior nor diet quality was associated with FMI for children with overweight.

Weight status and meeting the physical activity, sleep, and screen-time guidelines among Texas children: results from a population based, cross-sectional analysis

BACKGROUND

Evidence suggests that the interactive effects of physical activity, screen-time and sleep are stronger than independent effects of these behaviors on pediatric obesity. However, this hypothesis has not been fully examined among samples of young school-aged children. The aim of this study is to determine the association of weight status with meeting the physical activity, screen-time, and sleep guidelines, independently and concurrently, among 2nd grade children.

METHODS

The Texas School Physical Activity and Nutrition Project collected parent-reported physical activity, screen-time, and sleep, and measured body height and weight on a statewide representative weighted sample (n = 320,005) of children. Weighted multivariable logistic regressions were used to assess associations of weight status (classified using age- and sex-specific body weight [kg]/height [m]², based on International Obesity Task Force cutoffs) with meeting the physical activity, screen-time, and sleep guidelines, while controlling for relevant covariates (age, sex, race/ethnicity, comorbidities etc.).

RESULTS

A greater proportion of healthy weight children (9.9%) met the physical activity, screen-time, and sleep guidelines concurrently compared to children who are thin (3.3%), or children with overweight (5.7%), obese (3.5%), and morbid obesity (1.0%). Children who were thin (adjusted odds ratio [aOR]:0.40, 95% confidence interval [CI]: 0.10, 1.50), overweight (aOR = 0.75, CI: 0.33, 1.70), obese (aOR = 0.53, CI: 0.15, 1.81), and morbidly obese (aOR = 0.10, CI: 0.02, 0.28) had lower odds of concurrently meeting the guidelines compared to children with healthy weight.

CONCLUSIONS

Among this representative sample of Texas children, weight status was associated with meeting physical activity, screen-time, and sleep guidelines. Future studies should aim to evaluate causal relations between these behaviors and weight status.

Health related behaviours and physical activity level of hypertensive individuals during COVID-19 pandemic

During the COVID-19 pandemic, all countries implemented lockdown to prevent transmission of coronavirus. The prolonged stay-at-home process created some unfavourable effects like unhealthy lifestyle, physical inactivity and sedentary behaviour especially in patients with cardiovascular risk. Hypertensive individuals are also affected in the pandemic because of limited access to healthcare services, screening, and altered lifestyles. We aimed to investigate physical activity (PA) level, sedentary behaviour, mental health and healthy lifestyle behaviours in patients with hypertension and compare these parameters with healthy controls. This prospective, cross-sectional study included 40 hypertensive and 40 age-sex matched healthy controls. We assessed PA with the International Physical Activity Questionnaire long-form, quality of life with Short-Form 36 (SF-36) questionnaire, anxiety and depression with Hospital Anxiety and Depression Scale (HADS) and lifestyle behaviours with Health-Promoting Lifestyle Profile Scale-II (HPLP-II). Moderate and vigorous PA levels of hypertensives' were statistically lower than healthy controls (P = 0.001; P = 0.003, respectively). Hypertensive patients exhibited lower SF-36 physical function (P = 0.001), energy/vitality (P = 0.042), body pain scores than those of healthy controls (P = 0.007). Although HADS-anxiety, depression scores were similar (P > 0.05), the depression ratio (45%) was more common in the hypertensive group during the lockdown. The main findings are that hypertensive patients have lower PA levels and worse quality of life than healthy controls during the pandemic. In addition, the presence of depression is more common among hypertensive patients. Considering unhealthy lifestyles, governments, and health professionals should take some precautions and plan interventions against physical inactivity. As known, providing regular physical activity is a keystone to fighting against cardiovascular disease.

Physical activity in early childhood: a five-year longitudinal analysis of patterns and correlates

Background

Knowledge on longitudinal patterns and related factors of young children’s physical activity (PA) is still scarce. Therefore, the aim of this study was to examine patterns and changes of accelerometer-measured PA over time in two to six-year-old children. Furthermore, the aim was to investigate if parental PA, socioeconomic status, sex, weight status, and motor skills are related to child PA over time, using prospective cohort data from a clustered randomized controlled trial.

Methods

One hundred and six children (52% girls) and their parents had PA measured yearly from age two to six with an Actigraph GT3X. The actigraph was worn on the non-dominant wrist for one week; anthropometric data and motor skills, as well as background information, was collected simultaneously. The outcome was counts per minute from the vector magnitude, and linear mixed-effect models were used to answer the research questions.

Results

Among the children, accelerometer-measured PA increased on average by 11% per year from two years of age (mean 3170 cpm (3007-3334 95% CI)) onwards to six years of age (mean 4369 cpm (4207-4533 95% CI)). From three years of age, children were more active on weekdays than on weekend days. The rate of difference varied across low, medium, and highly active children (based on tertiles). No significant differences in weekdays/weekend PA among the lowest active children was found. Despite this, they were still significantly less active on weekend days than the most active children. Maternal, but not paternal PA was found to be significantly positively related to child PA over time, with a medium to large effect size. But no significant relationships were found between child PA and sex, weight status, or socioeconomic status.

Conclusions

PA increased on average with 11% per year, similarly for boys and girls. From three years of age children were more active during weekdays than weekend days. These results indicate that child PA benefits from active stimulation by parents and care takers already from early ages. It is important to identify attributes of possible intervention designs for weekend days for families with young children as well as characterize the least active children.

Trial registration

Early STOPP was prospectively registered in the clinical trials registry: clinicaltrials.gov, ID NCT01198847

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01289-x.

Effects of Movement Behaviors on Overall Health and Appetite Control: Current Evidence and Perspectives in Children and Adolescents

PURPOSE OF REVIEW

To present the definitions and recommendations for movement behaviors in children and adolescents, including physical activity (PA), sedentary behaviors (SB), and sleep, and to provide an overview regarding their impact on health and obesity outcomes from childhood to adulthood, as well as interactions with appetite control.

RECENT FINDINGS

PA represents a variable proportion of daily energy expenditure and one can be active with high SB or vice versa. Studies have described movements across the whole day on a continuum from sleep to SB to varying intensities of PA. More PA, less SB (e.g., less screen time) and longer sleep are positively associated with indicators of physical health (e.g., lower BMI, adiposity, cardiometabolic risk) and cognitive development (e.g., motor skills, academic achievement). However, less than 10% of children currently meet recommendations for all three movement behaviors. Movement behaviors, adiposity, and related cardiometabolic diseases in childhood track into adolescence and adulthood. Furthermore, low PA/high SB profiles are associated with increased energy intake. Recent studies investigating energy balance regulation showed that desirable movement behavior profiles are associated with better appetite control and improved eating habits. Early identification of behavioral phenotypes and a comprehensive approach addressing all key behaviors that directly affect energy balance will allow for individual strategies to prevent or treat obesity and its comorbidities. Investigating exercise as a potential "corrector" of impaired appetite control offers a promising weight management approach.

A Longitudinal Examination of Withholding All or Part of School Recess on Children's Physical Activity and Sedentary Behavior: Evidence from a Natural Experiment

School recess is a daily opportunity for school-age students to be physically active. However, in some territories teachers often use recess for other purposes (e.g., children's poor classroom behavior might be punished with reduced time for recess). This study aimed to examine the impact of such practices on children's physical activity (PA) and the relationships between PA, gender, body mass index (BMI), and academic achievement. Forty-six first-grade students from two natural classrooms wore an accelerometer over the course of 6 weeks to measure their metabolic equivalent of task (METs) and sedentary behavior during school recess. Gender, age, BMI, the classroom to which students belonged, and academic achievement were also analyzed in two Generalized Estimating Equations models. Results revealed that boys achieved more METs and spent less time participating in sedentary behavior than girls during recess. Children within a healthy weight range of BMI yielded more METs than underweight and overweight/obese children. Academic achievement was positively associated with the METS and negatively with the sedentary behavior. Finally, withholding all or part of school recess significantly reduced children's PA and extended their sedentary behavior. The literature indicates that school recess plays an important role in promoting numerous children's health outcomes. Therefore, students should not be excluded from participation in all or part of recess.

Objectively measured physical activity and sedentary time in children with overweight, obesity and morbid obesity: a cross-sectional analysis

Background

Limited physical activity (PA) and a high level of sedentary time (ST) are associated with childhood obesity and are a target for intervention. This study aimed to assess objectively measured PA and ST in Dutch children across weight categories, age groups and sex.

Methods

202 children with overweight, obesity and morbid obesity (55% girls, 12 ± 3y of age, BMI z-score + 3.15 ± 0.73), referred to the Centre for Overweight Adolescents and Children’s Healthcare (COACH, Maastricht UMC+) were included. PA (total PA, light PA and moderate to vigorous PA (MVPA)) and ST were measured with the GT3X Actigraph accelerometer. Wear time validation was set to include at least four days, 480 min/day, including one weekend day.

Results

PA levels in children with morbid obesity were higher compared to children with obesity, also after correction for age and sex (corrected difference (B) 118 counts per minute (cpm), p = .006). ST was lower in children with morbid obesity compared to children with obesity (B − 51 min/day, p = .018). Girls performed significantly less MVPA than boys (B − 11 min/day, p < .001) and for each year increase of age, children performed less PA (B − 46 cpm, p < .001) and ST increased (B 18 min/day, p < .001).

Conclusion

PA and ST is different in subgroups of children with overweight, obesity and morbid obesity, depending on sex, age and overweight severity. In particular, children with obesity perform less PA and more ST compared to children with morbid obesity. Future research could explore the preferences and needs for PA and ST in children in the different weight categories.

Trial registration

The trial is registered with Clinicaltrials.govNCT02091544 at March 19, 2014.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11555-5.

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.

Bi-directional prospective associations between sedentary time, physical activity and adiposity in 10-year old Norwegian children

There is an adverse cross-sectional association between sedentary time, physical activity (PA) and adiposity, but weak and inconsistent estimates raise question to the direction of associations. The present study aims to examine whether the prospective association between sedentary time, different PA intensities and indicators of adiposity is bi-directional. The Active Smarter Kids Study obtained data from 869 ten-year-old children with valid measurements for sedentary time, PA, and adiposity at baseline and follow-up. Time spent sedentary and PA was measured by accelerometry, adiposity was assessed by three different measures: body mass index (BMI), waist circumference (WC) and sum of four skinfolds (S4SF). Neither overall PA nor time spent sedentary predicted lower BMI or WC at follow-up, but the time spent in moderate-and-vigorous PA (MVPA) and vigorous PA (VPA) predicted lower S4SF at follow-up among boys (MVPA β - 0.066 [95% CI -0.105, -0.027] p = 0.001). Baseline BMI and WC predicted less overall PA, MVPA and VPA in boys. All adiposity measures predicted more time spent sedentary at follow-up in boys. The results suggest that overall PA and sedentary time do not predict future adiposity. Baseline adiposity may rather predict more sedentary time and less higher intensity activity.

Obesity, the new childhood disability? An umbrella review on the association between adiposity and physical function

The adverse physical impacts of childhood obesity are increasingly being recognized. The objective of this study is to examine relationships between physical function and adiposity in youth. An umbrella review searched seven databases from inception to May 2019 for systematic reviews examining associations between adiposity and physical function in 0-20-year-olds. Findings were synthesized using the International Classification of Functioning, Disability and Health Framework and NHMRC FORM. Seventeen of 21 systematic reviews reported impairments to body function, including cardiorespiratory fitness (CRF), muscle function, balance/coordination, gait biomechanics, pain and injury. Six reviews reported activity restrictions in motor skills, running speed/agility and functional mobility, and two found inverse associations between adiposity and physical health-related quality of life (p-HRQOL). Some causal relationships indicated that adiposity inversely predicted p-HRQOL/CRF and CRF/muscle function inversely predicted adiposity. Assessments of physical function were heterogeneous and impacts on participation in life situations meaningful to the individual were largely unknown. Substantial evidence associates childhood overweight/obesity with reduced physical function. Associations were mainly cross-sectional, with causative evidence for some outcomes. Comprehensive physical function assessments by qualified health professionals are needed, along with targeted interventions to address deficits. Research should further examine causality of relationships, underlying mechanisms and participation challenges in real-life contexts.

Objectively measured sedentary behaviour in overweight and obese prepubertal children: challenging the school

Sedentary lifestyle is associated with unfavourable health outcomes; however, few studies have analysed the daily fluctuations of sedentary behaviour in children. The aim was to characterise sedentary behaviour in low active, overweight/obese prepubertal children and to examine whether there were daily, age- or gender-based differences. In this observational study free-living movement was measured by accelerometry for one week. Eighty-eight low active, overweight/obese children (8- to 12-year-olds) were included. Analysis was conducted for weekends, weekdays, school time and non-school time on weekdays. Participants spent half of their waking hours engaged in sedentary behaviour (48.1%). Short sedentary bouts (1-4 min) accounted for 86% of sedentary time. Sedentary time was similar on weekends and non-school time, while it was highest during school time. Interventions for the management of childhood obesity should include strategies for shifting sedentary time to physical activity on weekends and non-school time and implementing more activity-permissive classroom lessons.

A Systematic Review of Children's Physical Activity Patterns: Concept, Operational Definitions, Instruments, Statistical Analyses, and Health Implications

Despite the widespread use of the expression “physical activity pattern” (PAP), there apparently is no general consensus regarding its definition. This systematic review aimed to examine available research focussing on (1) definitions of PAP, (2) instruments/techniques used to describe PAP, (3) statistical approaches used to analyse PAP, and (4) implications of PAP on children’s health. A systematic review of the available literature was done to identify studies published up to October 2019, and 76 studies were eligible. None of the studies presented a formal definition of PAP; a wide range of instruments were used to investigate children’s PAP, and most of the revised studies did not explicitly present a formal statistical model to define PAP. Twenty-four papers purported to examine associations between PAP and health indicators. The review highlights no consensus on a clear PAP definition whatever the instrument used to capture it, and we did not find any agreement regarding how best to analyse PAP. We suggest that PAP should be used when targeting the investigation of similarities/dissimilarities, as well as stabilities and/or changes in children’s PA at an intra-personal level. In sum, PAP should be used to best describe individual streams of behaviours, and not exclusively PA levels/intensities.

Patterns and correlates of objectively measured physical activity in 3-year-old children

Background

To increase the knowledge about physical activity (PA) patterns and correlates among children under the age of 4, there is a need for study’s using objective measurements. The aim of this study was therefore to investigate if objectively measured PA among 3-year-old children differed between day of week and time of day and whether it correlated to child weight status and sex as well as parental weight status and education.

Methods

Totally 61 children (51% girls) aged 3, participating in Early Stockholm Obesity Prevention Project were included. PA was measured with a tri-axial accelerometer (ActiGraph GT3X+) worn on the non-dominant wrist for one week. The main outcome was average PA expressed as counts per minute from the vector magnitude. PA and demographics/family-related factors were collected at baseline and at age 3. To analyze the results simple linear regression, ANOVA and paired t-tests were performed.

Results

The mean number of valid days was 6.7 per child. The children were more active on weekdays than weekends (p < 0.01) and the hourly pattern differed over the day with children being most active midmorning and midafternoon (p = 0.0001). Children to parents with low education were more active (p = 0.01) than those with highly educated parents. No differences in PA by child weight status, sex nor parental weight status were found.

Conclusions

PA in 3-year-old children was lower during weekends than weekdays and varied over the day. Boys and girls had similar PA patterns, these patterns were independent of child or parental weight status. Children to parents with low education were more active than their counterparts. The fact that PA differed between weekdays and weekends indicates that PA might be affectable in 3-year-old children.

Why are children different in their moderate-to-vigorous physical activity levels? A multilevel analysis

OBJECTIVE

Children's differences in moderate-to-vigorous physical activity levels are not at random. This study investigates the relevance of individual- and school-level characteristics in explaining these differences.

METHODS

In total, 307 children (154 girls) aged 5-10 years, from 19 Portuguese schools, were sampled. Height and weight were measured, and body mass index was calculated. Time spent in moderate-to-vigorous physical activity was measured by accelerometry. Gross motor coordination was assessed with the KörperkoordinationsTest für Kinder battery and socio-economic status was obtained via the school social support system. School characteristics were obtained with an objective school audit. A multilevel analysis was used as implemented in Stata 15.

RESULTS

Schools explained 18.2% of the total variance in moderate-to-vigorous physical activity, with the remainder being ascribed to children's distinct characteristics. Boys were more active (β=29.59±11.52, p<0.05), and having higher gross motor coordination levels (β=0.11±0.04, p<0.05) was positively associated with daily moderate-to-vigorous physical activity, whereas being older (β=-5.00±1.57, p<0.05) and having higher socio-economic status (β=-7.89±3.12, p<0.05) were negatively related with moderate-to-vigorous physical activity. From the school-level correlates, only playground dimension was significantly associated with moderate-to-vigorous physical activity levels. Children from schools with medium (40m2 to 69m2) and large playground dimensions (≥70m2) were less active than children with smaller playground dimensions (10m2 to 39m2).

CONCLUSIONS

Variation in school children's moderate-to-vigorous physical activity is mostly explained by their individual characteristics; school characteristics also play a role but to a smaller degree. Future intervention programs to change this behavior should be more personalized, emphasizing mostly individual-level characteristics.

Exploring Energy Expenditure and Body Movement of Exergaming in Children of Different Weight Status

PURPOSE

This study examined differences in energy expenditure and bodily movement among children of different weight status during exergames that varied in mode and intensity.

METHODS

Fifty-seven 8- to 12-year-old children including overweight/obesity (n = 28) and normal weight (n = 29) played three 10-minute interval Xbox One exergames (Fruit Ninja, Kung-Fu, and Shape Up) categorized based on predominantly upper-, whole-, or lower-limb movement, respectively. The authors measured bodily movement through accelerometry and obtained energy expenditure and metabolic equivalent (MET) via indirect calorimetry.

RESULTS

Energy expended during gameplay was the highest in Shape Up (P < .01) and higher in Kung-Fu than Fruit Ninja (P < .01). Absolute energy expenditure was significantly higher in overweight/obese children (P < .01), but not when controlling for body mass across 3 exergames (P > .05). Based on the MET cut-points, overweight/obese children spent more time at light intensity (<3 METs) for Fruit Ninja (P < .05) and Shape Up (P < .01), but less time at vigorous intensity (≥6 METs) for Kung-Fu (P < .01) and Shape Up (P < .01). Lower-limb movements during Shape Up were less in overweight/obese children (P = .03).

CONCLUSION

Although children in both groups expended similar energy relative to their body mass during gameplay, overweight/obese children spent more time at light intensity but less time at vigorous intensity with fewer movements especially while playing a lower limb-controlled exergame.

Physical fitness and activity, metabolic profile, adipokines and endothelial function in children

OBJECTIVES

The prevalence of obesity is increasing. The aim of this study was to investigate if there is endothelial dysfunction in children with normal or excess weight, and whether the metabolic profile, adipokines, and endothelial dysfunction would be more strongly associated with physical fitness or with physical activity levels.

METHOD

Cross-sectional study involving children aged 5-12 years. The evaluation included venous occlusion plethysmography, serum levels of adiponectin, leptin and insulin, lipid profile, physical activity score (PAQ-C questionnaire), and physical fitness evaluation (Yo-Yo test).

RESULTS

A total of 62 children participated in this study. Based on the body mass index, 27 were eutrophic, 10 overweight and 25 obese. Triglycerides, LDL cholesterol, HOMA-IR, and leptin were higher in the obese and excess-weight groups compared to the eutrophic group (p<0.01). HDL cholesterol and adiponectin levels were higher in the eutrophic group compared to the obese and excess-weight groups (p<0.01). Flow-mediated vasodilation after hyperemia was higher in the eutrophic group in comparison to obese and excess-weight subjects (p<0.05). There was no difference in the physical activity levels among groups measured by PAQ-C. The Yo-Yo test was significantly associated with HDL cholesterol (rho=-0.41; p=0.01), and this association remained after adjusting for body mass index z-score (rho=0.28; p=0.03).

CONCLUSION

This study showed that endothelial dysfunction is already present in obese children, suggesting a predisposition to atherosclerotic disease. Moreover, HDL cholesterol levels were correlated with physical fitness, regardless of body mass index.

Variations in Central Adiposity, Cardiovascular Fitness, and Objectively Measured Physical Activity According to Weight Status in Children (9-11 Years)

The purpose of this study was twofold: first, to compare the central adiposity (CA), cardiovascular fitness (CF), and physical activity (PA) in children with different weight status, and second, to determine the associations between moderate to vigorous physical activity (MVPA) and measures of adiposity [CA and body mass index (BMI)] and CF. A sample of 244 children (boys = 120 and girls = 124), 9.7-10.8 years of age (10.3 ± 0.3 years), was measured for stature, body mass, waist circumferences, and 20-m multi-stage fitness test. PA was recorded with ankle mounted accelerometer. BMI groups were used to classify children as underweight (UW), normal weight (NW), and overweight (OW). The prevalence of being OW was 21.7 and 25% in boys and girls, respectively. Only 5.3% of the participants were found to accumulate recommended amount (≥60 min/day) of MVPA. Boys were significantly outperformed girls in terms of CF. Moreover, they were significantly more engaged in moderate and vigorous physical activities than girls. Regardless of gender, results indicated that OW children had significantly higher values in all anthropometric parameters and lower level of CF than their UW and NW counterparts. In girls, OW children were found to accrue less time engaging in MVPA than the children in UW and NW groups. In boys, OW children were found to accrue less time engaging in vigorous activities than UW and NW children. Results also showed that there were no significant differences between UW and NW girls and boys in respect to CF. Besides, UW girls were found to accrue more time engaging in MVPA than NW girls. MVPA was found to be significantly and negatively correlated with BMI and waist circumference and significantly and positively correlated with CF in both boys and girls. These discrepancies and associations highlight the considerable influences of MVPA on weight status and CF in children.

Predicting physical activity among urban adolescent girls: A test of the health promotion model

The purpose of this study was to test hypothesized relationships of the health promotion model (HPM) as a means of predicting moderate-to-vigorous physical activity (MVPA) among urban, adolescent girls. A secondary analysis of baseline data from a group randomized controlled trial was conducted. The study involved eight urban schools in the Midwestern United States. The sample included girls (N = 517) in the 5th-8th grades. Data were collected on age, body mass index, pubertal status, enjoyment, self-efficacy, social support, options for physical activity (PA), and commitment to PA. MVPA was measured via accelerometers worn by the girls for 7 days. Structural equation modeling was used to analyze study aims. Mean age of the sample was 11.8 years (standard deviation [SD] = 1.0). Girls attained an average of 3.0 (SD = 1.2) minutes per hour of MVPA. Self-efficacy had a positive direct (β = .337; p < .001) and total effect (β = .310; p < .001) on MVPA. Social support and options for PA were not significant predictors of commitment to PA or MVPA. Commitment to PA had a negative but nonsignificant effect (β = -.056; p = .357) on MVPA. The model predicted 10.1% of the variance in MVPA with 9.6% of the variance predicted by self-efficacy. Limitations include lack of longitudinal analysis and inability to generalize the results to other populations such as boys. PA self-efficacy continues to emerge as a significant predictor of MVPA in the HPM. Continued theory testing is needed to better understand the correlates and determinants of PA among adolescent girls before designing theory-based interventions to promote PA.

Accelerometer activity tracking in horses and the effect of pasture management on time budget

BACKGROUND

Accelerometry is an accepted means of quantifying human physical activity. Quantitative physical activity tracking could be beneficial for studies into equine health and disease prevention, for example in relation to obesity management.

OBJECTIVES

Validate accelerometer use in grazing horses, determine between-day repeatability, and assess the effects of pasture size on time budget (i.e. duration in each activity category).

STUDY DESIGN

Proof of concept.

METHODS

Accelerometers (ActiGraph) were positioned at the poll. Horses underwent 5 min of observed activity in three categories: standing, grazing and ambulating. Receiver-operating characteristic curve analysis, used on ten second data epochs, calculated cut points between the activities. A 20-day study was then undertaken on 6 horses at pasture. Time in each category (per day) was deduced; a Mann Whitney U test was performed to compare standard vs. small paddock and day vs. night turn out.

RESULTS

Cut-off values with the optimum sensitivity (94.7-97.7%) and specificity (94.7-96.8%) were found to be <127.6 counts for standing, 127.6-702.7 counts for grazing and >702.7 counts for ambulating. Repeatability was analysed descriptively: Median (IQR) of the between-day difference in minutes standing, grazing and ambulating were 46.9 (21.3-87.9), 77.3 (40.2-124.5) and 15.6 (6.8-40.2) respectively. Median times standing and ambulating were significantly different between standard and small paddocks: standing: 8.7 vs. 10.3 h (P<0.001); ambulating: 55.7 vs. 39.6 min (P = 0.002). There was no significant difference in the median time spent grazing. There were significant differences between day and night: standing: 32.95% vs. 50.97% (P = 0.001), grazing: 60.81% vs. 46.77% (P<0.001) and ambulating: 4.57% vs. 2.40% (P<0.001).

MAIN LIMITATIONS

Small sample size and lack of cross-validation of cut-off points on independent, 'unseen' data.

CONCLUSIONS

Accelerometry can differentiate standing, grazing and ambulating in horses. Our proof-of-concept study demonstrates modifying pasture size influences activity budgets; opening avenues into studying obesity management.

Relationship Between Obesity, Physical Activity, and Cardiorespiratory Fitness Levels in Children and Adolescents in Bosnia and Herzegovina: An Analysis of Gender Differences

This study aimed to examine: (i) the level of physical activity (PA), obesity indices and cardiorespiratory fitness (CRF) among boys and girls in primary school, and (ii) to determine the association of obesity indices and PA with CRF for the total number of participants, and then separately for boys and girls. 753 sixth to ninth grade girls and boys aged 10-14 years took part in this cross-sectional study. The PA was assessed by the "Physical Activity Questionnaire - Children" and CRF was assessed by the Maximal multistage a 20 m shuttle run test. Body mass index (BMI), waist circumferences (WC), and waist to height ratio (WHtR) were considered as obesity indices. Multiple linear regression analyses were performed to explore correlates of CRF. The results obtained showed the prevalence of general overweight and obesity was 25.5% in our sample which was lower than that in the regional estimate (e.g., ∼28%) for Eastern Europe. Among all participants, CRF was associated with male sex, older age, a lower WC percentile, higher WHtR, and higher level of PA. The model accounted for 24% of the variance. CRF was associated with older age and higher level of PA among girls and boys. Lower WC percentile was a significant determinant of CRF among boys. In conclusion, general overweight/obesity was not independently associated with CRF. Those with better CRF were more likely to be male and older, had a higher level of PA and lower central adiposity. These findings emphasize the importance of supporting school age children to take a part in programmed physical activity regardless of their body composition.

Off-Training Levels of Physical Activity and Sedentary Behavior in Young Athletes: Preliminary Results during a Typical Week

The level of physical activity (PA) and sedentary behavior (SED) off-training of young athletes may reveal the quality of recovery from training and highlight health related issues. Thus, the aim was to identify and describe young athletes' PA and SED off-training, according to daily life activities. Eight athletes (15.7 ± 2 years, 1.72 ± 0.6 m height, 62.9 ± 10.2 kg) of a sport talent program wore on their waist a tri-axial accelerometer (ActiGraph^® wGT9X-link, Shalimar, FL, USA) at 30 Hz for 15 consecutive days, and reported their schedule. A two-step cluster analysis classified three groups according to sedentary PA and MVPA. The Sedentary (56.9%), presented the highest sedentary PA (mean [CI], 37.37 [36.45⁻38.29] min/hour); The Hazardous (19.4%) had the lowest values of sedentary and MVPA (10.07 [9.41⁻10.36] min/hour and 8.67 [7.64⁻9.70] min/hour, respectively). Balanced (23.7%) had the highest MVPA (28.61 [27.16⁻30.07] min/hour). Sedentary had the lowest count of home time associated (20%) and higher school (26%) time when compared to the Hazardous (13%). The Balanced showed the highest count of school (61%) and home time (47%). Different profiles for young athletes revealed alarming behavior in the associations with sedentary PA, sitting and SED breaks, which may influence performance and health.

Comparison of accelerometer measured levels of physical activity and sedentary time between obese and non-obese children and adolescents: a systematic review

Background

Obesity has been hypothesized to be associated with reduced moderate-to-vigorous physical activity (MVPA) and increased sedentary time (ST). It is important to assess whether, and the extent to which, levels of MVPA and ST are suboptimal among children and adolescents with obesity. The primary objective of this study was to examine accelerometer-measured time spent in MVPA and ST of children and adolescents with obesity, compared with MVPA recommendations, and with non-obese peers.

Methods

An extensive search was carried out in Medline, Cochrane library, EMBASE, SPORTDiscus, and CINAHL, from 2000 to 2015. Study selection and appraisal: studies with accelerometer-measured MVPA and/or ST (at least 3 days and 6 h/day) in free-living obese children and adolescents (0 to 19 years) were included. Study quality was assessed formally. Meta-analyses were planned for all outcomes but were precluded due to the high levels of heterogeneity across studies. Therefore, narrative syntheses were employed for all the outcomes.

Results

Out of 1503 records, 26 studies were eligible (n = 14,739 participants; n = 3523 with obesity); 6/26 studies involved children aged 0 to 9 years and 18/26 involved adolescents aged 10.1 to19 years. In the participants with obesity, the time spent in MVPA was consistently below the recommended 60 min/day and ST was generally high regardless of the participant’s age and gender. Comparison with controls suggested that the time spent in MVPA was significantly lower in children and adolescents with obesity, though differences were relatively small. Levels of MVPA in the obese and non-obese were consistently below recommendations. There were no marked differences in ST between obese and non-obese peers.

Conclusions

MVPA in children and adolescents with obesity tends to be well below international recommendations. Substantial effort is likely to be required to achieve the recommended levels of MVPA among obese individuals in obesity treatment interventions.

This systematic review has been registered on PROSPERO (International Database of Prospective Register Systematic Reviews; registration number CRD42015026882).

Electronic supplementary material

The online version of this article (10.1186/s12887-018-1031-0) contains supplementary material, which is available to authorized users.

Randomised controlled trial evaluating the effectiveness and cost-effectiveness of 'Families for Health', a family-based childhood obesity treatment intervention delivered in a community setting for ages 6 to 11 years

BACKGROUND

Effective programmes to help children manage their weight are required. 'Families for Health' focuses on a parenting approach, designed to help parents develop their parenting skills to support lifestyle change within the family. Families for Health version 1 showed sustained reductions in mean body mass index (BMI) z-score after 2 years in a pilot project.

OBJECTIVE

The aim was to evaluate its effectiveness and cost-effectiveness in a randomised controlled trial (RCT).

DESIGN

The trial was a multicentre, investigator-blind RCT, with a parallel economic and process evaluation, with follow-up at 3 and 12 months. Randomisation was by family unit, using a 1 : 1 allocation by telephone registration, stratified by three sites, with a target of 120 families.

SETTING

Three sites in the West Midlands, England, UK.

PARTICIPANTS

Children aged 6-11 years who were overweight (≥ 91st centile BMI) or obese (≥ 98th centile BMI), and their parents/carers. Recruitment was via referral or self-referral.

INTERVENTIONS

Families for Health version 2 is a 10-week, family-based community programme with parallel groups for parents and children, addressing parenting, lifestyle, social and emotional development. Usual care was the treatment for childhood obesity provided within each locality.

MAIN OUTCOME MEASURES

Joint primary outcome measures were change in children's BMI z-score and incremental cost per quality-adjusted life-year (QALY) gained at 12 months' follow-up (QALYs were calculated using the European Quality of Life-5 Dimensions Youth version). Secondary outcome measures included changes in children's waist circumference, percentage body fat, physical activity, fruit/vegetable consumption and quality of life. Parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style were also assessed. The process evaluation documented recruitment, reach, dose delivered, dose received and fidelity, using mixed methods.

RESULTS

The study recruited 115 families (128 children; 63 boys and 65 girls), with 56 families randomised to the Families for Health arm and 59 to the 'usual-care' control arm. There was 80% retention of families at 3 months (Families for Health, 46 families; usual care, 46 families) and 72% retention at 12 months (Families for Health, 44 families; usual care, 39 families). The change in BMI z-score at 12 months was not significantly different in the Families for Health arm and the usual-care arm [0.114, 95% confidence interval (CI) -0.001 to 0.229; p = 0.053]. However, within-group analysis showed that the BMI z-score was significantly reduced in the usual-care arm (-0.118, 95% CI -0.203 to -0.034; p = 0.007), but not in the Families for Health arm (-0.005, 95% CI -0.085 to 0.078; p = 0.907). There was only one significant difference between groups for secondary outcomes. The economic evaluation, taking a NHS and Personal Social Services perspective, showed that mean costs 12 months post randomisation were significantly higher for Families for Health than for usual care (£998 vs. £548; p < 0.001). The mean incremental cost-effectiveness of Families for Health was estimated at £552,175 per QALY gained. The probability that the Families for Health programme is cost-effective did not exceed 40% across a range of thresholds. The process evaluation demonstrated that the programme was implemented, as planned, to the intended population and any adjustments did not deviate widely from the handbook. Many families waited more than 3 months to receive the intervention. Facilitators', parents' and children's experiences of Families for Health were largely positive and there were no adverse events. Further analysis could explore why some children show a clinically significant benefit while others have a worse outcome.

CONCLUSIONS

Families for Health was neither effective nor cost-effective for the management of obesity in children aged 6-11 years, in comparison with usual care. Further exploration of the wide range of responses in BMI z-score in children following the Families for Health and usual-care interventions is warranted, focusing on children who had a clinically significant benefit and those who showed a worse outcome with treatment. Further research could focus on the role of parents in the prevention of obesity, rather than treatment.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN45032201.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 1. See the NIHR Journals Library website for further project information.

Low-intensity vibration increases cartilage thickness in obese mice

Obesity is associated with an elevated risk of osteoarthritis (OA). We examined here whether high fat diet administered in young mice, compromised the attainment of articular cartilage thickness. Further, we sought to determine if low-intensity vibration (LIV) could protect the retention of articular cartilage in a mouse model of diet-induced obesity. Five-week-old, male, C57BL/6 mice were separated into three groups (n = 10): Regular diet (RD), High fat diet (HF), and HF + LIV (HFv; 90 Hz, 0.2g, 30 min/d, 5 d/w) administered for 6 weeks. Additionally, an extended HF diet study was run for 6 months (LIV at 15 m/d). Articular cartilage and subchondral bone morphology, and sulfated GAG content were quantified using contrast agent enhanced μCT and histology. Gene expression within femoral condyles was quantified using real-time polymerase chain reaction. Contrary to our hypothesis, HF cartilage thickness was not statistically different from RD. However, LIV increased cartilage thickness compared to HF, and the elevated thickness was maintained when diet and LIV were extended into adulthood. RT-PCR analysis showed a reduction of aggrecan expression with high fat diet, while application of LIV reduced the expression of degradative MMP-13. Further, long-term HF diet resulted in subchondral bone thickening, compared to RD, providing early evidence of OA pathology-LIV suppressed the thickening, such that levels were not significantly different from RD. These data suggest that dynamic loading, via LIV, protected the retention of cartilage thickness, potentially resulting in joint surfaces better suited to endure the risks of elevated loading that parallel obesity. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:751-759, 2018.

Bidirectional association between weight status and motor skills in adolescents : A 4-year longitudinal study

BACKGROUND

Despite considerable efforts the prevalence of overweight and obesity in youth remains high. Poor motor skills have been associated with increased body weight but there is still limited information on the longitudinal association of these health parameters.

AIM

This study examined the prospective association between motor skills and body weight in 10- to 14-year-old youth.

METHODS

Body weight, height and motor skills, assessed via the German motor test 16-18 (Deutscher Motorik Test, DMT6-18), were measured in 213 middle school students (57% male) every year over a 4‑year period. Club sports participation and migration status were assessed via a questionnaire.

RESULTS

Besides an inverse cross-sectional association between body weight and motor skills, excess body weight was associated with impaired development of motor skills (p < 0.05). Furthermore, weight loss was associated with enhanced motor development and allowed previously overweight students to catch up with their normal weight peers. High motor skills at baseline also reduced the odds of becoming overweight/obese during the observation period. These results were independent of club sports participation.

CONCLUSION

There is a bidirectional, synergistic association between body weight and motor skills. Facilitating the development of motor skills in children and adolescents may therefore be a viable intervention strategy targeting weight management and physical activity in youth.

Using functional data analysis to understand daily activity levels and patterns in primary school-aged children: Cross-sectional analysis of a UK-wide study

Background

Temporal characterisation of physical activity in children is required for effective strategies to increase physical activity (PA). Evidence regarding determinants of physical activity in childhood and their time-dependent patterns remain inconclusive. We used functional data analysis (FDA) to model temporal profiles of daily activity, measured objectively using accelerometers, to identify diurnal and seasonal PA patterns in a nationally representative sample of primary school-aged UK children. We hypothesised that PA levels would be lower in girls than boys at play times and after school, higher in children participating in social forms of exercise (such as sport or play), and lower among those not walking to school.

Methods

Children participating in the UK-wide Millennium Cohort Study wore an Actigraph GT1M accelerometer for seven consecutive days during waking hours. We modelled 6,497 daily PA profiles from singleton children (3,176 boys; mean age: 7.5 years) by means of splines, and used functional analysis of variance to examine the cross-sectional relation of time and place of measurement, demographic and behavioural characteristics to smoothed PA profiles.

Results

Diurnal and time-specific patterns of activity showed significant variation by sex, ethnicity, UK country and season of measurement; girls were markedly less active than boys during school break times than boys, and children of Indian ethnicity were significantly less active during school hours (9:30–12:00). Social activities such as sport clubs, playing with friends were associated with higher level of PA in afternoon (15:00–17:30) and early evenings (17:30–19:30). Lower PA levels between 8:30–9:30 and 17:30–19:30 were associated with mode of travel to and from school, and number of cars in regular use in the household.

Conclusion

Diminished PA in primary school aged children is temporally patterned and related to modifiable behavioural factors. FDA can be used to inform and evaluate public health policies to promote childhood PA.

School-time physical activity among Arab elementary school children in Qatar

Background

Recent data from a self-administered questionnaire show that approximately 75% of school children in Qatar do not meet the daily recommended levels of physical activity (PA). Since children spend half of their waking hours in school, it is important to understand when and how much PA children accumulate during the school day. This study aimed to objectively assess school-time PA among elementary school children in Qatar and to determine association of PA with age, gender, body mass index (BMI) status, or day of the week.

Methods

A cross-sectional epidemiological study was conducted in four randomly selected elementary schools in Qatar. Two classes representing grade 1 children (age 5) and grade 4 children (age 9) were randomly selected within each school. A total of 183 elementary school children (86 boys and 97 girls) ages 6–12 years participated in this study. PA was assessed using a three-axial accelerometer (ActiGraph® wGT3X-BT). Participants wore accelerometers on their non-dominant wrist at school (7:00 a.m. to 1:00 p.m.) for five consecutive school days during the week. A cutoff points of 818 counts per 5 s was classified as moderate-to-vigorous physical activity (MVPA).

Results

The average duration of MVPA in our study was 28.2 ± 13.5 min per day. Only 39% of participated children reach the recommended school-based MVPA of 30 min or more per day. Students spent on average 58.1 ± 8.4% of school time on sedentary activities. MVPA of boys and girls was similar in age 5 while girls age 9 were less active (23.7 ± 1.5 min/day) than boys of the same age (42.7 ± 1.8 min/day), ES = 0.269, P < 0.001. Neither overweight children nor children at risk for being overweight showed any differences in physical activity parameters when compared to children of normal weight. Our results showed, percentage of MVPA on the first (7.7 ± 5.1%) and last (7.1 ± 4.1%) day of the week was generally lower compared to other weekdays (P < 0.001).

Conclusion

This was the first study to objectively assess PA during school hours among elementary school-children in Qatar. This study found that many of school children do not perform sufficient time being physically active at school. All students in two age categories (age 5 and age 9) spend the majority of school time engaged in sedentary activities. The low participation of girls age 9 in MVPA is a cause for concern and need to be addressed.

Different consecutive training protocols to design an intervention program for overweight youth: a controlled study

OBJECTIVE

To find the optimal exercise program to be recommended in reducing adiposity and promoting long-term physical activity adherence in a sample of overweight adolescents.

METHODS

Forty-five overweight adolescents were randomly divided into three exercise groups, to perform two phases of physical activity as follows: in the first phase, the first group performed a 16-week moderate-intensity resistance training (RT), the second group performed a 16-week high-intensity RT, and the third group performed a 16-week aerobic training (AT); in the second phase, all groups performed a 6-week AT. Anthropometric body composition and fitness measures were considered as outcome measures.

RESULTS

After the second protocol, both RT groups showed a significant improvement in percentage of fat mass (F_2,76 = 5.843; p = 0.004; h² = 0.133) and free fat mass (F_2,76 = 6.254; p = 0.003; h² = 0.141), and in fitness tests (p < 0.01). The VO₂max values of the RT groups were significantly higher than those of the AT group (F_2,38 = 4.264; p = 0.021; h² = 0.183). The rate of adherence to exercise was an average of 94% in both RT groups, whereas in the AT group, it was 83%. During the 12-week post-intervention follow-up, the number of participants who continued to perform physical activities was significantly higher in both the RT groups than in the AT group (p < 0.05).

CONCLUSION

The present study provides preliminary evidence that moderate-to-intense RT, followed by AT, can be an effective treatment for overweight adolescents, and the positive effects are maintained even after 12 weeks of follow-up.

Sedentary Behavior During School Recess in Southern Brazil

The aim of this study was to assess sedentary behavior during school recess in Brazilian boys and girls. The study included 455 students (233 boys and 222 girls), aged 8 to 17 years, enrolled in a public school in the city of Londrina, Brazil. All data was collected using questionnaires. Logistic regression with odds ratio and confidence interval (95%) was used to measure the relationship between sedentary behavior and sex, age, weight, screen time, and economic status. There was a high prevalence (40.7%) of sedentary behavior in this sample, with girls (aged 8 to 17 years) more likely than boys (54.5% vs. 27.5%, respectively) and older students (13-17 years) more likely than younger students (8-12 years) to engage in sedentary behavior (49.6% vs. 30.1%, respectively). These findings, and their broad implications for health and for interventions to increase physical activity, are discussed in light of past literature.

Impact of imposed exercise on energy intake in children at risk for overweight

Background

Exercise not only has a direct effect on energy balance through energy expenditure (EE), but also has an indirect effect through its impact on energy intake (EI). This study examined the effects of acute exercise on daily ad libitum EI in children at risk for becoming overweight due to family history.

Methods

Twenty healthy-weight children (ages 9–12 years, 12 male/8 female) with at least one overweight biological parent (body mass index ≥ 25 kg/m²) participated. Children reported to the laboratory for one baseline and two experimental visits (EX = exercise, SED = sedentary) each separated by 1 week in a randomized crossover design. Two hours into the EX day session, children exercised at 70 % estimated VO_2max for 30 min on a cycle ergometer. Objective EI (kcal) was measured at a standard breakfast (~285 kcal) and ad libitum lunch, snack and dinner. Meals were identical on the EX and SED days. Activity-related EE (kcal) was estimated with accelerometers worn on the non-dominant wrist and ankle. Relative EI (kcal) was computed as the difference between Total EI and Activity-related EE for each testing day. Paired t-tests were performed to test differences in Total EI, Activity-related EE and Relative EI between the EX and SED days.

Results

Across all meals, Total EI was not statistically different between the EX and SED days (t = 1.8, p = 0.09). Activity-related EE was greater on the EX day compared to the SED day (t = 10.1, p < 0.001). By design, this difference was predominantly driven by activity during the morning (t = 20.4, p < 0.001). Because children consumed a similar number of kcal on each day, but had greater Activity-related EE on the EX day, Relative EI was lower (t = −5.15, p < 0.001) for the EX day (1636 ± 456 kcal) relative to the SED day (1862 ± 426 kcal).

Conclusions

Imposed exercise was effective in reducing Relative EI compared to being sedentary. Morning exercise may help children at risk for becoming overweight to better regulate their energy balance within the course of a day.

The Role of Active Video-Accompanied Exercises in Improvement of the Obese State in Children: A Prospective Study from Turkey

OBJECTIVE

The aim of this study was to determine the effects of active video games and music-accompanied aerobic and callisthenic exercises on body mass index (BMI), body fat ratio, physical performance tests, psychosocial status, and self-respect in overweight and obese adolescents.

METHODS

Fifty (21 males and 29 females) slightly overweight and obese participants with no chronic disorder and of an average age of 12.16±0.99 years were included in the study. The percentile values for BMI, triceps skinfold thickness, waist circumference measurements, and physical performance tests were evaluated. The effects of obesity on psychological wellness were evaluated using the depression scale for children (DSC) and the Piers-Harris Children's Self-Concept Scale for self-esteem. Following these evaluations, the participants were subjected to an exercise program in five groups of 10 people, 3 days a week for a duration of 8 weeks. Each exercise session lasted 45 minutes. Participants were re-evaluated at the end of the exercise program. The data collected both before and after the exercise program were analyzed using the SPSS 18.0 program.

RESULTS

According to BMI reference values, 28% of the 50 participants (n=14; 6 males and 8 females) were assessed to be overweight and 72% to be obese (n=36; 15 males and 21 females). Following the exercise program, 14% of the participants (n=7; 3 males and 4 females) were assessed as normal, 46% (n=23; 14 males and 9 female) as slightly overweight, and 40% (n=20; 4 male and 16 female) as obese. It was determined that the decrease in BMI values (p<0.05) was higher in male participants than in female participants and that the frequency of obesity was higher in the females. A statistically significant decrease in BMI values was found after the exercise program (p<0.01). Following the exercise program, statistically significant differences have also been observed in the self-esteem (p<0.01), psychological wellness (p=0.025), triceps skinfold thickness, as well as in waist circumference and BMI values of the participants compared to the pre-exercise phase (p<0.01).

CONCLUSION

An exercise program applied with active video games was found to have positive effects on the obese state as well as on the psychosocial status and self-esteem of obese individuals, indicating that exercise and physical activity have an important role in improvement of the obese state in childhood as well as having positive contributions to self-esteem and psychological wellness state.

Correlation of Body Mass Index and Physical Activity Among 7- to 11-Year Children at Zahedan, Iran

Background:

Childhood obesity is currently one of the major concerns in pediatric field. In recent literature, correlation of obesity with some behavioral factors such as physical activity (PA) received attention.

Objective:

The purpose of this study was to determine the relationship between body mass index (BMI) and PA.

Materials and Methods:

This cross-sectional study was carried out in 2012 on 548 randomly selected 7- to 11-year schoolchildren from Zahedan, Iran. The underweight, normal weight, overweight, and obesity status were all based on BMI percentiles for age and sex. Moderate to vigorous PA during the previous 7 days was assessed by a modified version of the Physical Activity Questionnaire for Children.

Results:

The prevalence of underweight, normal weight, overweight, and obesity among the participants was 18.3%, 47.9%, 11.8%, and 22.1%, respectively. Overweight and obesity were significantly higher among girls than boys. Mean PA score in participants was 2.4 ± 0.5. The results showed the PA score was significantly higher among boys than girls. The PA score had a significant association with BMI ( P = .018), and it was greater in normal participants than in obese participants.

Conclusion:

On the basis of observed data and due to the impact of PA on BMI as an indicator of nutritional status and health, teaching children to have better nutrition and lifestyle changes is very important. Therefore, more studies should focus on childhood obesity prevention programs to prevent nonoverweight children from becoming overweight or obese in the future.

Effectiveness of after-school interventions at increasing moderate-to-vigorous physical activity levels in 5- to 18-year olds: a systematic review and meta-analysis

AIM

Physical activity in children improves cardiovascular, mental, metabolic and skeletal health. Many children fail to meet the national recommendation of at least 60 min per day of moderate-to-vigorous physical activity (MVPA). After-school programmes provide an opportunity to engage children in physical activity. This systematic review and meta-analysis examine the effectiveness of after-school interventions at increasing MVPA levels in children and adolescents.

DESIGN

Systematic review and meta-analyses.

DATA SOURCES

A literature search was conducted using MEDLINE, EMBASE and PsychINFO databases from January 1950 to April 2015.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Inclusion criteria-Population: participants aged 5-18 years.

INTERVENTION

an after-school programme in a school-based setting as the main component of an intervention to increase physical activity levels.

OUTCOMES

individual-level measure of time spent in MVPA.

STUDY DESIGN

quasi-experimental, pilot, non-randomised or randomised trials.

EXCLUSION CRITERIA

conference abstracts, unpublished articles, dissertations and non-English language papers.

RESULTS

1387 records were identified through database searching. After removal of duplicates, there were 748 records. 15 articles met the inclusion criteria for the systematic review. 6 studies were eligible for meta-analysis and the pooled intervention effect at end point follow-up was 4.84 min/day of MVPA (95% CI -0.94 to 10.61). The effectiveness of after-school interventions varied considerably and comparisons between studies limited by different methodological study designs. Subgroup analyses within a small minority of studies revealed significant benefits in overweight/obese children and boys. There was a lack of convincing evidence that interventions based on theories of behaviour change were more effective than those with no underlying theory.

CONCLUSIONS

After-school physical activity interventions to date have had mixed effectiveness on increasing MVPA levels. More robust evaluations of extracurricular physical activity interventions are required, particularly studies that use objective assessment of physical activity.

Lean adolescents achieve higher intensities but not higher energy expenditure while playing active video games compared with obese ones

BACKGROUND

While decreased physical activity and increased sedentary behaviours are incriminated for their role in the progression of obesity, active video games (AVG) may offer a new alternative to increase energy expenditure in youth. This study is the first to examine the effect of a 1-h AVG play on lean and obese adolescents' energy expenditure.

METHODS

Body composition and aerobic fitness were assessed in 19 obese and 12 lean adolescent boys (12-15 years old). Participants performed a 1-h AVG session (Kinect Sports technology) while wearing a portable indirect calorimeter (K4b2) to assess their energy expenditure and heart rate.

RESULTS

Body weight (91.0 ± 9.5 vs. 58.5 ± 12.4 kg), body mass index (32.2 ± 3.1 vs. 20.3 ± 1.6 kg m(-2) ) and body fat (38.1 ± 2.7 vs. 13.4 ± 3.9%) were significantly higher in obese adolescents (P < 0.001). Absolute energy expenditure was significantly higher in obese (P < 0.05) but not when corrected for body composition. Maximal heart rate reached during AVG was significantly higher in lean adolescents (190 ± 25 vs. 183 ± 28 bpm, P < 0.05). Time spent between 3 and 6 METs (Metabolic Equivalent Task) was not different between groups but time spent above 6 METs was higher in lean adolescents (P < 0.05).

CONCLUSION

Although lean and obese adolescent boys experienced similar energy expenditure relative to their body size during a 1-h Kinect AVG session, lean adolescents spent more time in moderate-to-vigorous physical activity.

Muscle Strength and Fitness in Pediatric Obesity: a Systematic Review from the European Childhood Obesity Group

The increasing prevalence of paediatric obesity and related metabolic complications has been mainly associated with lower aerobic fitness while less is known regarding potential musculoskeletal impairments. The purpose of the present systematic review was to report the evidence regarding muscular fitness in children and adolescents with obesity. A systematic article search was conducted between November 2014 and June 2015 using MEDLINE, EMBASE, CINAHL psycINFO, SPORTDiscus and SocINDEX. Articles published in English and reporting results on muscle strength and muscular fitness in children and adolescents aged 6 to 18 years were eligible. Of 548 identified titles, 36 studies were included for analyses. While laboratory-based studies described higher absolute muscular fitness in youth with obesity compared with their lean peers, these differences are negated when corrected for body weight and lean mass, then supporting field-based investigations. All interventional studies reviewed led to improved muscular fitness in youth with obesity. Children and adolescents with obesity display impaired muscular fitness compared to healthy-weight peers, which seems mainly due to factors such as excessive body weight and increased inertia of the body. Our analysis also points out the lack of information regarding the role of age, maturation or sex in the current literature and reveals that routinely used field tests analysing overall daily muscular fitness in children with obesity provide satisfactory results when compared to laboratory-based data.

Multidisciplinary residential treatment can improve perceptual-motor function in obese children

AIM

This study evaluated the effects of a 10-month multidisciplinary residential treatment programme on the perceptual-motor function of obese children and compared them to children with a healthy weight.

METHODS

We studied 26 obese Belgian children (10 girls and 16 boys) with a mean age of 10.1 years (±1.4 years), who followed a residential treatment programme consisting of moderate dietary restriction, psychological support and physical activity. The results were compared with 26 healthy weight children matched for age and gender. The anthropometrics and performance of both groups were assessed on two occasions, 10 months apart, based on simple and choice reaction time tasks and a tracking task using a stylus and tablet. Time by body mass index group interactions were investigated using repeated measure ANCOVAs, with age included as a covariate.

RESULTS

No significant interaction effect occurred in either task. In contrast, the obese participants showed a significant improvement in tracking performance over time during the stylus and tablet tests, demonstrating mean deviation from the ideal curve. No difference in performance between baseline and follow-up was observed in the healthy weight controls.

CONCLUSION

Taking part in a multidisciplinary residential treatment programme improved the perceptual-motor function of obese children.

Association between Apolipoprotein E Variants and Obesity-Related Traits in Mexican School Children

BACKGROUND/AIM

Genetic variation in apolipoprotein E (ApoE) has a key role in lipid metabolism. However, its contribution to the amount and distribution of body fat is under investigation. The aim of this study was to analyze the association between genetic variation in ApoE and obesity-related traits in Mexican school children.

MATERIAL AND METHODS

Anthropometric, body composition and physical activity measures were conducted using standard methods in 300 children (177 girls/123 boys) who fulfilled the inclusion criteria. DNA was isolated from saliva. ApoE genotypes were analyzed by allelic discrimination. The association between variation in ApoE and anthropometric and body composition measures was investigated using the General Linear Model.

RESULTS

The mean±SD values for age, body mass index (BMI) and waist circumference (WC) were 9.05±0.80 years, 19.01±3.83 and 67.98±10.97 cm, respectively. Approximately 46% of the participants were overweight or obese. A significant association between ApoE isoforms and WC was found after controlling for age, sex and the percentage of physical activity (p=0.025). Significant main effects were found for vigorous physical activity and light physical activity influencing the adiposity-related BMI (p<0.001) and WC (p=0.044), respectively.

CONCLUSIONS

Variation in ApoE and physical activity intensity were associated with adiposity-related phenotypes in Mexican school children.

Physical activity and sedentary behavior in obese youth

OBJECTIVE

To determine whether directly measured physical activity and sedentary behavior patterns of obese children presenting to a weight-management clinic differs from nationally representative samples of obese and normal-weight children.

STUDY DESIGN

A cross-sectional comparison study of 3 groups of boys and girls between 8 and 18 years (mean, 13.4 years) was performed. A clinical group (n=56) seeking specialized care for obesity was compared with 2 nationally representative samples of children from the Canadian Health Measures Survey (CHMS): (1) body mass index>95th percentile (n=143); and (2) body mass index<85th percentile (n=958).

RESULTS

Obese clinical and obese CHMS boys did not differ in daily moderate-to-vigorous physical activity (MVPA). Both obese groups engaged in less MVPA than normal-weight boys in the CHMS (P<.0006). Compared with normal-weight boys, obese boys had fewer days in which they accrued 60 or 30 minutes of MVPA (P=.006 and .01, respectively). Daily MVPA did not differ among the 3 groups of girls. Light activity in clinical boys was lower than in the normal weight CHMS boys, whereas clinical girls engaged in less light activity than both CHMS comparators. No differences were observed between groups for sedentary behavior.

CONCLUSIONS

Obese youth, whether in clinic or the community, were not more sedentary than their normal-weight CHMS comparators. Although obese youth were less active, overall MVPA was low in all groups. This finding highlights the need for health professionals to target both physical activity and sedentary behavior in all children, rather than focusing on only children with obesity.

Attentional distraction during exercise in overweight and normal-weight boys

The purpose of this study was to investigate the effect of attentional distraction on field running distance and activity intensity during an exercise session in normal-weight and overweight youngsters and to investigate potential mediators. Fifty-three 12–14 yr-old boys participated twice in a 12-min running test and a 20-min exercise session, once with attentional distraction (by listerning to music) and once without distraction (counterbalanced randomised controlled design). At the end of the endurance test running distance was recorded. During the exercise session activity intensity was assessed by accelerometers. After each experiment, rate of perceived exertion (RPE) was estimated and seven questions were asked about how participants experienced the experiment. Both overweight and normal-weight boys ran further during the running test with music (p < 0.05) and this effect was mediated by a decrease in feelings of annoyance. During the exercise session with music, both overweight and normal-weight boys exercised less at low and high intensity and more at moderate and very high intensity (p < 0.01) and this effect was mediated by a decrease in RPE. We can conclude that attentional distraction has a positive effect on running distance on a field endurance test and on activity intensity during an exercise session through different mechanisms in both overweight and normal-weight boys.

Food consumption, physical activity and socio-economic status related to BMI, waist circumference and waist-to-height ratio in adolescents

OBJECTIVE

To examine the association between obesity and food group intakes, physical activity and socio-economic status in adolescents.

DESIGN

A cross-sectional study was carried out in 2008. Cole's cut-off points were used to categorize BMI. Abdominal obesity was defined by a waist circumference at or above the 90th percentile, as well as a waist-to-height ratio at or above 0·500. Diet was evaluated using an FFQ, and the food group consumption was categorized using sex-specific tertiles of each food group amount. Physical activity was assessed via a self-report questionnaire. Socio-economic status was assessed referring to parental education and employment status. Data were analysed separately for girls and boys and the associations among food consumption, physical activity, socio-economic status and BMI, waist circumference and waist-to-height ratio were evaluated using logistic regression analysis, adjusting the results for potential confounders.

SETTING

Public schools in the Azorean Archipelago, Portugal.

SUBJECTS

Adolescents (n 1209) aged 15-18 years.

RESULTS

After adjustment, in boys, higher intake of ready-to-eat cereals was a negative predictor while vegetables were a positive predictor of overweight/obesity and abdominal obesity. Active boys had lower odds of abdominal obesity compared with inactive boys. Boys whose mother showed a low education level had higher odds of abdominal obesity compared with boys whose mother presented a high education level. Concerning girls, higher intake of sweets and pastries was a negative predictor of overweight/obesity and abdominal obesity. Girls in tertile 2 of milk intake had lower odds of abdominal obesity than those in tertile 1. Girls whose father had no relationship with employment displayed higher odds of abdominal obesity compared with girls whose father had high employment status.

CONCLUSIONS

We have found that different measures of obesity have distinct associations with food group intakes, physical activity and socio-economic status.