The relationship of overweight and obesity to the motor performance of children living in South Africa

Physical Activity, Sedentary Behaviour, Weight Status, and Body Composition among South African Primary Schoolchildren

Background: Over the past decades, childhood overweight has increased in many African countries. We examined the relationship between sedentary behaviour, moderate-to-vigorous physical activity (MVPA), and body composition in South African primary schoolchildren living in peri-urban settings. Methods: MVPA was measured via 7-day accelerometry and body composition via bioelectrical impedance analysis in 1090 learners (49.2% girls, M_age = 8.3 ± 1.4 years). The relationships between MVPA and sedentary behaviour with the various body composition indicators (body fat and fat-free mass [total, truncal, arms, and legs], bone mass, muscle mass, and body water) were tested with mixed linear regressions. Results: The prevalence of overweight and obesity was 9.8% and 6.6%, respectively; 77.1% of the children engaged in ≥60 min of MVPA/day. Girls were more likely to be overweight/obese, to accumulate less than 60 min of MVPA/day, and had significantly higher relative body fat than boys (ps < 0.001). Lower MVPA was associated with a higher likelihood of being overweight/obese, higher relative body fat, and lower relative fat-free mass, bone mass, muscle mass, and body water (ps < 0.001). For lower sedentary behaviour, the associations with body composition pointed in the opposite direction. Conclusions: In this South African setting, girls are a particularly relevant target group for future physical activity interventions to prevent overweight/obesity-related non-communicable diseases in later life.

Health-Related Motor Testing of Children in Primary School: A Systematic Review of Criterion-Referenced Standards

Being physically fit in younger years prevents several diseases in the presence as well as in the life course. Therefore, monitoring physical fitness and motor competence through motor testing is essential for determining developmental status and identifying health-related risks. The main objectives of this systematic review were (1) to identify currently available health-related criterion-referenced standards and cut-off points for physical fitness and motor competence test items, (2) to frame the methodological background on setting health-related criterion-referenced standards and (3) to give implications for a health-related evaluation system for physical fitness and motor competence tests. The electronic data base search (PubMed, Web of Science and SURF) yielded 2062 records in total and identified six empirical studies reporting cut-off points of motor test items for children (7-10 years), as well as 30 methodological papers discussing determination approaches to health-related criterion-referenced standards. Data collection, selection and analyses followed the PRISMA guidelines. Health-related motor test standards need to be gender- and age-specific but should refer to an absolute cut-off point rather than to relative performance in the reference group. Due to the lack of data on health-related criterion referenced standards, receiver-operating-characteristic (ROC) curves provide a tool for the determination of cut-off points and criterion referenced standards for physical fitness and motor competence tests. A standardized approach forms the fundamental base for a globally applicable evaluation of health-related fitness tests.

Influences of persistent overweight on perceptual-motor proficiency of primary school children: the North-West CHILD longitudinal study : Persistent overweight and perceptual-motor proficiency in children

BACKGROUND

Overweight can be a precursor of poor motor execution, negatively impacting the overall development of school-aged children on various levels. This study determined the long-term influences of overweight on perceptual-motor proficiency (PMP) of primary school children in the North-West Province of South Africa.

METHODS

The study, which included 381 participants, formed part of the NW-CHILD longitudinal study from Grade 1 (6.86 years, ± 0.39) in 2010 to Grade 7 (12.9 years, ± 0.38) in 2016. Socioeconomic categories, called quintiles, were used to compare high and low socioeconomic status groups. Overweight was identified when BMI values fell above the 85th percentile, using age- and gender-specific cut-off points. The group was categorised into 4 BMI groups (never overweight, persistent overweight, overweight-to-normal and normal-to-overweight). The Bruininks Oseretsky Test of Motor Proficiency-2 (BOT-2) Short Form and selected composites measuring strength, balance, and running speed and agility were used to assess PMP.

RESULTS

A repeated measures ANOVA analysis indicated specific PMP differences between different BMI groups, but not total motor proficiency (BOT-2 Short Form total) differences. Practical significant group differences (Cohen's d-values) were found in running speed and agility, strength, balance and the BOT-2 total, over seven primary school years. The persistent overweight group showed the poorest performance over time, but also showed deteriorating skills and a gradual widening in perceptual-motor skills performance, compared to the other groups. BMI-related differences in perceptual-motor coordination were also more pronounced in older age groups.

CONCLUSIONS

Persistent overweight negatively impacts specific motor-proficiency components, while improving weight status can counter these effects, which highlights the importance of timeous intervention to combat obesity at a young age.

Prevalence of overweight and obesity among African primary school learners: a systematic review and meta-analysis

INTRODUCTION

The increasing trend in the global prevalence of childhood overweight and obesity presents a major public health challenge. This study reports the results of a systematic review and meta-analysis to estimate the prevalence of overweight and obesity among primary school learners residing in Africa according to the different body mass index criteria and population level characteristics.

METHODS

A search of multiple databases was conducted to identify relevant research articles published between January 1980 and February 2017. Random effects models were used to pool prevalence data within and across population level characteristics after variance stabilization through arcsine transformation (PROSPERO registration number CRD42016035248).

RESULTS

Data from 45 studies across 15 African countries, and comprising 92,379 and 89,468 participants for overweight and obesity estimates were included. Estimated overweight and obesity prevalence differed significantly across criteria: 10.5% [95% confidence interval, CI: 7.1-14.3] and 6.1% [3.4-9.7] by World Health Organization; 9.5% [6.5-13.0] and 4.0% [2.5-5.9] by International Obesity Task Force; and 11.5% [9.6-13.4] and 6.9% [5.0-9.0] by Centre for Diseases Control, respectively (p = 0.0027 for overweight; p < 0.0001 for obesity). Estimates were mostly higher in urban, and private schools, but generally similar by gender, major geographic regions, publication year and sample size. Substantial heterogeneity in the estimates across and within criteria were not always explained by major study characteristics.

CONCLUSION

Overweight and obesity are prevalent among African primary school learners, particularly those attending urban, and private schools. The results from this meta-analysis could be helpful in making informed decisions on childhood obesity prevention efforts in African countries.

Cross-sectional associations of physical activity and gross motor proficiency with adiposity in South African children of pre-school age

OBJECTIVE

The study aimed to investigate the relationship between physical activity, gross motor skills and adiposity in South African children of pre-school age.

DESIGN

Cross-sectional study.

SETTING

High-income urban, and low-income urban and rural settings in South Africa.

PARTICIPANTS

Children (3-6 years old, n 268) were recruited from urban high-income (n 46), urban low-income (n 91) and rural low-income (n 122) settings. Height and weight were measured to calculate the main outcome variables: BMI and BMI-for-age Z-score (BAZ). Height-for-age and weight-for-age Z-scores were also calculated. Actigraph GT3X+ accelerometers were used to objectively measure physical activity; the Test of Gross Motor Development (Version 2) was used to assess gross motor skills.

RESULTS

More children were overweight/obese and had a higher BAZ from urban low-income settings compared with urban high-income settings and rural low-income settings. Being less physically active was associated with thinness, but not overweight/obesity. Time spent in physical activity at moderate and vigorous intensities was positively associated with BMI and BAZ. Gross motor proficiency was not associated with adiposity in this sample.

CONCLUSIONS

The findings of this research highlight the need for obesity prevention particularly in urban low-income settings, as well as the need to take into consideration the complexity of the relationship between adiposity, physical activity and gross motor skills in South African pre-school children.

Relationship between Body Mass Index, Cardiorespiratory and Musculoskeletal Fitness among South African Adolescent Girls

Background: Cardiorespiratory and musculoskeletal fitness are important health indicators that support optimal physical functioning. Understanding the relationship between body mass index and these health markers may contribute to the development of evidence-based interventions to address obesity-related complications. The relationship between body mass index, cardiorespiratory and musculoskeletal fitness has not been well explored, particularly in female adolescents. The aim of this study was to investigate the association between body mass index, cardiorespiratory and musculoskeletal fitness among South African adolescent girls in low-income communities. Methods: This cross-sectional study included 151 adolescent girls, aged 13⁻16 years. Cardiorespiratory fitness was measured using the 20 m shuttle run test and musculoskeletal fitness was assessed using a variety of field-based tests. Height and weight were measured with standardised procedures and body mass index (BMI) was derived by the formula [BMI = weight (kg)/height (m)²]. Participants were categorised into three BMI groups using the International Obesity Task Force age- and gender-specific cut-off points. Pearson correlations were used to determine the association between body mass index, cardiorespiratory fitness and measures of musculoskeletal fitness at p ≤ 0.05. Results: Overweight and obese girls were found to have lower cardiorespiratory fitness, decreased lower extremity muscular strength, greater grip strength, and more hypermobile joints compared to normal-weight peers. BMI was negatively associated with cardiorespiratory fitness and lower extremity muscular strength. Conclusions: The findings indicate that increased body mass correlates with decreased cardiorespiratory and musculoskeletal fitness. Interventions should be developed to target these important components of physical fitness in this demographic group.

"Not just another Wii training": a graded Wii protocol to increase physical fitness in adolescent girls with probable developmental coordination disorder-a pilot study

Background

Adolescents with low motor competence participate less in physical activity and tend to exhibit decreased physical fitness compared to their peers with high motor competence. It is therefore essential to identify new methods of enhancing physical fitness in this population. Active video games (AVG) have been shown to improve motor performance, yet investigations of its impact on physical fitness are limited. The objective of this study was to examine the impact of the graded Wii protocol in adolescent girls with probable Developmental Coordination Disorder (p-DCD).

Methods

A single-group pre-post design was conducted to assess the impact of a newly developed Wii protocol in adolescent girls attending school in a low income community of Cape Town, South Africa. Sixteen participants (aged 13-16 years) with p-DCD (≤16th percentile on the MABC-2 test) were recruited. Participants received 45 min Wii training for 14 weeks. Outcome measures included the six-minute walk distance and repeated sprint ability. Information on heart rate, enjoyment and perceived exertion ratings were also collected.

Results

Significant improvements in aerobic and anaerobic fitness were observed. The participants reported high enjoyment scores and low perceived exertion ratings. The graded Wii protocol was easily adaptable and required little resources (space, equipment and expertise) to administer.

Conclusions

The findings provide preliminary evidence to support the use of the graded Wii protocol for promoting physical fitness in adolescent girls with p-DCD. Further studies are needed to confirm these results and to validate the clinical efficacy of the protocol in a larger sample with a more robust design.

The efficacy of two activity-based interventions in adolescents with Developmental Coordination Disorder

BACKGROUND

Adolescents with Developmental Coordination Disorder (DCD) usually experience psychomotor difficulties that affect their participation in everyday tasks and sports. Without effective intervention, adolescents show persistent motor deficits through adulthood. It is therefore critical to develop interventions to address the specific needs of this population. Studies evaluating the impact of motor interventions among adolescents with DCD are limited.

AIM

The study evaluated the efficacy of two activity-based motor interventions in female adolescents with DCD.

METHODS AND PROCEDURES

Forty-three female participants (Mean±SD: 14.3±1.1years) were identified as having DCD using the DSM-5 criteria. They were randomly assigned to either Task-oriented Functional Training (TFT) or Wii training. Both groups received 45min training per week for 14 weeks. Outcome measures included isometric muscular strength, motor proficiency, functional performance and participation in activities of daily living (ADL).

OUTCOMES AND RESULTS

At the conclusion of the intervention, the two groups had significant improvement in muscular strength, motor proficiency, running and agility, predilection for physical activity and generalized self-efficacy. However, there was no difference in outcomes for the two interventions.

CONCLUSIONS AND IMPLICATIONS

The findings highlight the potential benefits of activity-based motor interventions in reducing impairments, improving functional performance, and enhancing participation. These results support previous findings on the efficacy of task-oriented interventions and demonstrate the value of these approaches at all levels of functioning.

Relationship between motor proficiency and body composition in 6- to 10-year-old children

AIM

The aim of this study is to examine the relationship between motor skill competence and body composition of 6- to 10-year-old children.

METHODS

Seventy girls and 86 boys participated. Body composition was measured by body mass index and skinfold thickness. Motor proficiency was evaluated through the Bruininks-Oseretsky Test of Motor Proficiency-Short Form, which included measures of gross motor skills and fine motor skills.

RESULTS

Significant associations were found for both sexes between the percentage of body fat and (i) the performance in each gross motor task, (ii) the composite score for gross motor skills and (iii) the motor proficiency score. The percentage of body fat was not significantly associated with the majority of the fine motor skills items and with the respective composite score. Considering body weigh categories, children with normal weight had significantly higher scores than their peers with overweight or with obesity in gross motor skills and in overall motor proficiency.

CONCLUSIONS

Children's motor proficiency is negatively associated with body fat, and normal weight children show better motor competence than those who are overweight or obese. The negative impact of excessive body weight is stronger for gross motor skills that involve dynamic body movements than for stationary object control skills; fine motor skills appear to be relatively independent of the constraints imposed by excessive body weight.

Developing Intervention Strategies to Optimise Body Composition in Early Childhood in South Africa

Purpose. The purpose of this research was to collect data to inform intervention strategies to optimise body composition in South African preschool children. Methods. Data were collected in urban and rural settings. Weight status, physical activity, and gross motor skill assessments were conducted with 341 3–6-year-old children, and 55 teachers and parents/caregivers participated in focus groups. Results. Overweight and obesity were a concern in low-income urban settings (14%), but levels of physical activity and gross motor skills were adequate across all settings. Focus group findings from urban and rural settings indicated that teachers would welcome input on leading activities to promote physical activity and gross motor skill development. Teachers and parents/caregivers were also positive about young children being physically active. Recommendations for potential intervention strategies include a teacher-training component, parent/child activity mornings, and a home-based component for parents/caregivers. Conclusion. The findings suggest that an intervention focussed on increasing physical activity and improving gross motor skills per se is largely not required but that contextually relevant physical activity and gross motor skills may still be useful for promoting healthy weight and a vehicle for engaging with teachers and parents/caregivers for promoting other child outcomes, such as cognitive development.

Evidence of an overweight/obesity transition among school-aged children and youth in Sub-Saharan Africa: a systematic review

BACKGROUND

Prevalence of childhood overweight/obesity has increased considerably in recent years. The transition to higher rates of overweight/obesity has been well documented in high income countries; however, consistent or representative data from lower income countries is scarce. It is therefore pertinent to assess if rates of overweight/obesity are also increasing in lower income countries, to inform public health efforts.

OBJECTIVE

This systematic review aimed to investigate the evidence for an overweight/obesity transition occurring in school-aged children and youth in Sub Saharan Africa.

METHODS

Studies were identified by searching the MEDLINE, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases. Studies that used subjective or objective metrics to assess body composition in apparently healthy or population-based samples of children and youth aged 5 to 17 years were included.

RESULTS

A total of 283 articles met the inclusion criteria, and of these, 68 were used for quantitative synthesis. The four regions (West, Central, East, and South) of Sub Saharan Africa were well represented, though only 11 (3.9%) studies were nationally representative. Quantitative synthesis revealed a trend towards increasing proportions of overweight/obesity over time in school-aged children in this region, as well as a persistent problem of underweight. Weighted averages of overweight/obesity and obesity for the entire time period captured were 10.6% and 2.5% respectively. Body composition measures were found to be higher in girls than boys, and higher in urban living and higher socioeconomic status children compared to rural populations or those of lower socioeconomic status.

CONCLUSIONS

This review provides evidence for an overweight/obesity transition in school-aged children in Sub Saharan Africa. The findings of this review serve to describe the region with respect to the growing concern of childhood overweight/obesity, highlight research gaps, and inform interventions.

PROSPERO REGISTRATION NUMBER

CRD42013004399.

Temporal trends and correlates of physical activity, sedentary behaviour, and physical fitness among school-aged children in Sub-Saharan Africa: a systematic review

Recent physical activity (PA) and fitness transitions, identified as behavioural shifts from traditionally active lifestyles to more industralised and sedentary lifestyles, have been observed among school-aged children. There is a wealth of supporting evidence of such behavioural transitions in high income countries; however, a paucity of data on lower income countries exists. These transitions pose a particular threat to the welfare of children by accelerating the onset of chronic diseases. This systematic review investigated the evidence for a PA and fitness transition among Sub-Saharan Africa's school-aged children. Temporal trends and correlates of PA, SB, and fitness were examined. Studies were identified by searching the Medline, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases, and were included if they measured outcomes of interest in apparently healthy samples of children (5‒17 years). A total of 71 articles met the inclusion criteria (40 informed PA, 17 informed SB, and 37 informed fitness). Vast heterogeneity in study methodology complicated analysis of transitions over time and no temporal trends were immediately discernible. However, higher socioeconomic status, urban living, and female children were found to engage in lower levels of PA, higher SB, and performed worse on aerobic fitness measures compared to lower socioeconomic status, rural living, and male children. Data revealed that urbanization was associated with a trend towards decreased PA, increased SB, and decreased aerobic fitness over time. Representative, temporally sequenced data examining a PA and fitness transition are lacking in this region (PROSPERO Registration Number: CRD42013004399).