Measuring activity levels of young people: the validity of pedometers

Agreement between the activPAL accelerometer and direct observation during a series of gait and sit-to-stand tasks in people living with cervical dystonia

Background

Accelerometers are commonly used for the assessment of PA; however, these devices have not been validated in people with dystonia who experience movement limitations. To properly understand movement behaviors and deliver accurate exercise prescription in this population, the validity of these devices must be tested.

Objective

This study aimed to validate step count and postural transitions detected by the activPAL accelerometer (AP) against direct observation (DO) during two functional assessments: the 30-s sit-to-stand (30STS) and 6-min usual-pace walk tests. Methods: A total of 11 participants with cervical dystonia (CD) (male/female n = 5/6; mean age = 61 years; BMI = 24 kg/m2) performed the 6-min usual pace walking and 30STS while wearing the activPAL. A trained observer counted steps and observed the number of sit-to-stands.

Results

The average step count detected with AP and DO was 651.8 (218-758) and 654.5 (287-798) respectively. The average transitions detected were 11 (4-16) and 12 (4-17) respectively. Both methods showed good agreement and there was a statistically significant and strong correlation between the two methods, i.e., transitions (r = 0.983, p = 0.0001), and step counts (r = 0.9841, p = 0.0001).

Conclusion

There is a good agreement between activPAL and direct observation for step counts and transitions between sitting and standing in people living with CD.

Physical activity levels, pulmonary function, and MRI in children born extremely preterm: A comparison between children with and without bronchopulmonary dysplasia

INTRODUCTION

Children with a history of bronchopulmonary dysplasia (BPD) may have lower physical activity levels, but evidence to date is mixed. This study compared physical activity levels between children born extremely preterm with and without history of BPD, and examined their associations with pulmonary magnetic resonance imaging (MRI) and pulmonary function test (PFT) indices.

METHODS

This multicentre cross-sectional study included children aged 7-9 years born extremely preterm, with and without BPD. Children wore a pedometer for 1 week, then completed the Physical Activity Questionnaire (PAQ), pulmonary MRI, and PFT. Spearman correlations and multivariable linear regression modeling were performed.

RESULTS

Of 45 children, 28 had a history of moderate-severe BPD. There were no differences in any physical activity outcomes by BPD status. Higher average daily step count and higher average daily moderate-to-vigorous physical activity (MVPA) were each correlated with greater forced vital capacity (r = 0.41 and 0.58), greater MRI lung proton density at full expiration (r = 0.42 and 0.49), and lower lung clearance index (r = -0.50 and -0.41). After adjusting for MRI total proton density and BPD status, a 5% increase in forced expiratory volume at 1 s was associated with 738 (95% CI: 208, 1268) more steps per day and 0.1 (0.0, 0.2) more hours of MVPA, respectively.

CONCLUSION

School-aged children born extremely preterm have similar physical activity levels to their peers, regardless of history of BPD. MRI and PFT measures suggestive of gas trapping and/or airflow obstruction are associated with lower physical activity levels.

Pedometer Efficacy for Clinical Care in Pediatric Cardiology

BACKGROUND

Physical activity is essential to the long-term health of children living with cardiac disease. The simplicity and cost of pedometers make them an attractive alternative to accelerometers for monitoring the physical activity behaviors of these children. This study compared measures obtained from commercial-grade pedometers and accelerometers.

METHODS

Pediatric cardiology outpatients (n = 41, mean age = 8.4 [3.7] y, 61% female) wore a pedometer and accelerometer daily for 1 week. Step counts and minutes of moderate to vigorous physical activity were compared between devices, accounting for age group, sex, and diagnostic severity, using univariate analysis of variance.

RESULTS

While pedometer data were significantly correlated with accelerometers (r > .74, P < .001), measurements obtained were significantly different between devices. Overall, pedometers overestimated physical activity data. The overestimation of moderate to vigorous physical activity was significantly less among adolescents than younger age groups (P < .01, ηp2=.38). For step counts, there was a significant age by sex interaction observed where preschool and adolescent males tended to have greater differences between accelerometer and step count data than females (P < .01, ηp2=.33). Differences between devices were not associated with severity of diagnosis.

CONCLUSIONS

The distribution of pedometers in a pediatric outpatient clinic was feasible, yet the data collected significantly overestimated physical activity, especially among younger children. Practitioners who want to introduce objective measurements as part of their physical activity counseling practice should use pedometers to monitor individual changes in physical activity and consider patient age before administering these devices for clinical care.

Digital Health Technologies in Pediatric Trials

BACKGROUND

Advances in the miniaturization of sensors and other technologies provide opportunities to collect physiological and/or functional data directly from patients participating in clinical trials. The use of such technologies in children is particularly promising. Objective, quantifiable measurements made by these technologies, often on a continuous or frequent basis, may provide more robust data than the episodic reports from caregivers that are used in traditional pediatric trials.

METHODS

We reviewed the pros and cons of these technologies for use in a variety of pediatric diseases, including seizure and neuromuscular disorders, cardiorespiratory diseases, and metabolic disorders.

RESULTS

Correlation between sensor measurements and patient observations or traditional clinical measurements varied depending on the disease being evaluated. There was a notable dearth of reports on the use of digital health technology in pediatric patients. Given the range of sensors and measurements that can be made by DHTs, selection of the design, metrics and types of sensors best suited to disease evaluation presents challenges for adoption of these technologies in clinical trials.

CONCLUSION

Traditional measurements of drug effects are often deficient, particularly in the evaluation of infants and young children. The opportunity to make objective, frequent measurements may increase our power to detect and quantify responses to therapy in these populations. Further research and evaluation are needed to realize the full scientific potential of remote monitoring in pediatric clinical trials.

Bidirectional relationships of physical activity and gross motor skills before and after summer break: Application of a cross-lagged panel model

BACKGROUND

Gross motor skills are postulated to have a bidirectional relationship with physical activity (PA); however, no study has tested this relationship before and after a summer break. The purpose of this study was to examine the bidirectional relationships between school PA and gross motor skills in children before and after a summer break.

METHODS

Participants were a sample of 440 children recruited from 3 low-income schools (age = 8.9 ± 1.2 years, mean ± SD). PA was assessed as average school-day step counts using Yamax DigiWalker pedometers (Yamasa Tokei Keiki, Tokyo, Japan) worn for 5 consecutive school days. Gross motor skills were assessed using the Test for Gross Motor Development, 3rd edition. Data were collected at 2 timepoints: at the end of spring semester (T1) and at the beginning of the subsequent fall semester (T2). An age- and body mass index-adjusted cross-lagged model was employed to relate T1 school step counts with T2 gross motor skills and T1 gross motor skills with T2 school step counts.

RESULTS

T1 gross motor skills significantly predicted T2 school step counts (β = 0.24, 95 % confidence interval (95%CI): 0.08-0.40, p = 0.003); however, T1 school step counts did not predict T2 gross motor skills (β = 0.04, 95%CI: -0.06 to 0.14, p = 0.445). The model explained 35.4% and 15.9% of the variances of T2 gross motor skills and T2 school step counts, respectively. Additional analyses indicated that these relationships were driven primarily by ball skills.

CONCLUSION

The relationship between gross motor skills and school PA was not bidirectional; however, higher gross motor skills, specifically ball skills, predicted higher school PA after a 3-month summer break.

Validity of the Fitbit Ace and Moki Devices for Assessing Steps During Different Walking Conditions in Young Adolescents

PURPOSE

Using wearable monitoring devices is increasingly ubiquitous, including among young people. However, there is limited evidence of the validity of devices which are aimed at children and adolescents. The purpose of this study was to evaluate the validity of Fitbit Ace and Moki monitors in healthy young adolescents.

METHODS

This cross-sectional study included 17 young adolescents (ages 11-13 y) ambulating between 3 different walking conditions (incidental [∼6 min], controlled, and treadmill [each 3 min], while wearing wrist-worn devices [Fitbit Ace, Moki] on each wrist [left and right, respectively]). Data from the devices were compared with observer counts (criterion). Bland-Altman plots and mean absolute percentage errors were computed.

RESULTS

Analyses identified that the Fitbit Ace showed higher levels of bias across conditions compared with the Moki device: (mean difference [SD]; Fitbit Ace: 30.0 [38.0], 3.0 [13.0], and 13.0 [23.0] steps and Moki: 1.0 [19.0], 4.0 [16.0], and 6.0 [14.0] steps, incidental, controlled, and treadmill, respectively). Mean absolute percentage errors ranged from 3.1% to 9.5% for the Fitbit Ace and 3.0% to 4.0% for the Moki device.

CONCLUSION

The Fitbit Ace and Moki devices might not provide acceptable validity under all walking conditions, but the Moki provides more accurate estimates of incidental walking and might therefore be a good choice for free-living research or school-based interventions.

Feasibility and preliminary efficacy of a school-based health and well-being program for adolescent girls

BACKGROUND

The primary aim of this pilot study was to evaluate the feasibility and preliminary efficacy of a school-based health and well-being program (Health and Well-being for Girls: HWBG) on adolescent girls' well-being, mindfulness, screen-time, and physical activity.

METHOD

The HWBG program was evaluated using a group randomized controlled trial (RCT) in one secondary school. A convenience sample of female students in Grade 8 (mean age 14 ± 0.5 years) was recruited for the study (n=4 classes; 89 girls). The 20-week multi-component HWBG program, guided by Self-Determination Theory and Acceptance and Commitment Therapy, was designed and delivered by a member of the research team. Randomization occurred prior to baseline assessments at the class level (n=4 classes) into dose-matched treatment conditions (i.e., two classes received the HWBG intervention and two classes received an alternate elective course as a wait-list control group). Process evaluation measures of recruitment, retention, adherence, and satisfaction were used to determine program feasibility. This study was designed to assess feasibility (primary outcome) and preliminary efficacy (secondary outcomes), rather than effectiveness. Preliminary efficacy of HWBG for improving mental and social health, screen-time, and physical activity were measured and analyzed using linear mixed-models.

RESULTS

"The health and well-being program" targeting adolescent girls was found to be feasible for implementation as an elective course in a secondary school setting. Participants in the HWBG program reported high levels of satisfaction, the majority of lessons (45 out of 50), were implemented as planned and adherence to the planned HWBG program content was very high. Medium positive effects on mental health (d=0.45) and social health (d=0.50) were observed. Small effects were observed for physical activity, and no significant intervention effects were found for levels of recreational screen time. Participant ratings showed high levels of perceived benefit and enjoyment as indicated in the evaluation data (mean rating of 4.44 out of a possible 5.0) when asked whether the program was enjoyable.

CONCLUSION

The study provides preliminary support for HWBG as a potentially feasible and enjoyable program suitable for use with adolescent girls in the secondary school setting. Potential of the study for facilitating improvements in pro-social and psychological well-being is also supported.

TRIAL REGISTRATION

ACTRN12617000157370 . The trial was registered with the Australian New Zealand Clinical Trials Registry.

Interventions Using Wearable Physical Activity Trackers Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis

Importance

Wearable physical activity (PA) trackers, such as accelerometers, fitness trackers, and pedometers, are accessible technologies that may encourage increased PA levels in line with current recommendations. However, whether their use is associated with improvements in PA levels in participants who experience 1 or more cardiometabolic conditions, such as diabetes, prediabetes, obesity, and cardiovascular disease, is unknown.

Objective

To assess the association of interventions using wearable PA trackers (accelerometers, fitness trackers, and pedometers) with PA levels and other health outcomes in adults with cardiometabolic conditions.

Data Sources

For this systematic review and meta-analysis, searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO were performed from January 1, 2000, until December 31, 2020, with no language restriction. A combination of Medical Subject Heading terms and text words of diabetes, obesity, cardiovascular disease, pedometers, accelerometers, and Fitbits were used.

Study Selection

Randomized clinical trials or cluster randomized clinical trials that evaluated the use of wearable PA trackers, such as pedometers, accelerometers, or fitness trackers, were included. Trials were excluded if they assessed the trackers only as measuring tools of PA before and after another intervention, they required participants to be hospitalized, assessors were not blinded to the trackers, or they used a tracker to measure the effect of a pharmacological treatment on PA among individuals.

Data Extraction and Synthesis

The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. A random-effects model was used for the meta-analysis.

Main Outcomes and Measures

The primary outcome was mean difference in PA levels. When the scale was different across studies, standardized mean differences were calculated. Heterogeneity was quantified using the I2 statistic and explored using mixed-effects metaregression.

Results

A total of 38 randomized clinical trials with 4203 participants were eligible in the systematic review; 29 trials evaluated pedometers, and 9 evaluated accelerometers or fitness trackers. Four studies did not provide amenable outcome data, leaving 34 trials (3793 participants) for the meta-analysis. Intervention vs comparator analysis showed a significant association of wearable tracker use with increased PA levels overall (standardized mean difference, 0.72; 95% CI, 0.46-0.97; I2 = 88%; 95% CI, 84.3%-90.8%; P < .001) in studies with short to medium follow-up for median of 15 (range, 12-52) weeks. Multivariable metaregression showed an association between increased PA levels and interventions that involved face-to-face consultations with facilitators (23 studies; β = -0.04; 95% CI, -0.11 to -0.01), included men (23 studies; β = 0.48; 95% CI, 0.01-0.96), and assessed pedometer-based interventions (26 studies; β = 0.20; 95% CI, 0.02-0.32).

Conclusions and Relevance

In this systematic review and meta-analysis, interventions that combined wearable activity trackers with health professional consultations were associated with significant improvements in PA levels among people with cardiometabolic conditions.

Formative Evaluation of a Home-Based Physical Activity Intervention for Adolescent Girls-The HERizon Project: A Randomised Controlled Trial

BACKGROUND

This is a formative evaluation study of the HERizon Project, a home-based multi-component physical activity (PA) intervention for adolescent girls in the UK and Ireland. Although not intended, this study coincided with the initial COVID-19 lockdown restrictions.

METHODS

A total of 42 female participants, aged 13 to 16 years old (mean = 14.2, SD = 1.1), were randomly allocated to: (i) the HERizon group (n = 22) or (ii) the wait-list control group (n = 20). Participants in the six-week HERizon group were asked to complete three PA sessions each week and engage in weekly behaviour change support video calls. The primary outcome measure was self-reported habitual PA. Secondary outcomes measures included cardiorespiratory fitness (20 m shuttle run), muscular strength (standing long jump), muscular endurance (push up test), and psychosocial outcomes (Perceived Competence Scale, Body Appreciation Scale, Self-Esteem Questionnaire, Behavioural Regulation in Exercise Questionnaire). Quantitative and qualitative process evaluation data were also collected. Outcome measures were assessed at baseline and after the six-week intervention.

RESULTS

There was no significant change in habitual PA between groups (LMM group*time interaction: p = 0.767). The HERizon group had significantly increased cardiorespiratory fitness (p = 0.001), muscular endurance (p = 0.022), intrinsic motivation (p = 0.037), and body appreciation (p < 0.003) in comparison to the wait-list control group. All participants in the intervention group completed the intervention and compliance to the intervention was high (participants completed 18 ± 2 sessions).

CONCLUSIONS

Although no change in PA was observed, HERizon resulted in improved physical fitness and psychosocial outcomes. These preliminary findings, alongside positive findings for feasibility and acceptability, highlight potential benefits from the home-based intervention, thus further investigation is warranted.

The effects of standing tutorial meetings on physical activity behavior in undergraduates: A randomized controlled trial

This study explored the effects of using standing desks in tutorial meetings on the physical activity behavior (PAB) of undergraduate students. Standing desks have been introduced to minimize the detrimental health effects of prolonged sedentary behavior (SB). The effectiveness of using standing desks has not been explored among undergraduate students - a population showing high SB. Ninety-six undergraduate students were randomly assigned to a sitting or standing tutorial group that ran for nine weeks, and their PAB was monitored using the activPAL3™ triaxial activity monitor. To check for potential compensatory or other covarying behaviors, the students' PAB was monitored on tutorial and non-tutorial days. PAB monitoring was conducted in week 4-5, and a follow-up measurement was conducted in week 9 to examine longer-term effects. In week 4-5, the stand group (n = 41) showed less SB (β = -0.092, SE = 0.044, 95% CI: -0.179, -0.006) and more moderate-to-vigorous physical activity (β = 0.320, SE = 0.160, 95% CI: 0.004, 0.635) compared to the sit group (n = 36). On tutorial days, the stand group showed more light physical activity (LPA) than the sit group (p < .001, d = 1.04). In week 9, there was an exam on the last day of that week. Nonetheless, the stand group (n = 37) showed less SB (p < .001, d = 0.378) and more LPA (p = .008, d = 0.725), while breaking up prolonged SB more frequently (p = .007, d = 0.696) on the tutorial day compared to the sit group (n = 32). Overall, undergraduates attending standing tutorial meetings showed less SB and more LPA than those attending conventional, seated tutorial meetings. Standing tutorial meetings can contribute to a more active lifestyle for undergraduates.

Effects of exercise training on bone mineral density and some health-related outcomes in HIV conditions: A randomized controlled trial

INTRODUCTION

Human Immunodeficiency Virus (HIV) infection remains prevalent co-morbidity, and among fracture patients. Few studies have investigated the role of exercise interventions in preventing bone demineralization in people who have fractures and HIV. If exercise exposed, HIV-infected individuals may experience improved bone health outcomes (BMD), function, quality of life (QoL). The study will aim to assess the impact of home based exercises on bone mineral density, functional capacity, QoL, and some serological markers of health in HIV infection among Nigerians and South Africans.

METHODS AND DESIGN

The study is an assessor-blinded randomized controlled trial. Patients managed with internal and external fixation for femoral shaft fracture at the study sites will be recruited to participate in the study. The participants will be recruited 2 weeks post-discharge at the follow-up clinic with the orthopaedic surgeon. The study population will consist of all persons with femoral fracture and HIV-positive and negative (HIV-positive medically confirmed) aged 18 to 60 years attending the above-named health facilities. For the HIV-positive participants, a documented positive HIV result, as well as a history of being followed-up at the HIV treatment and care center. A developed home based exercise programme will be implemented in the experimental group while the control group continues with the usual rehabilitation programme. The primary outcome measures will be function, gait, bone mineral density, physical activity, and QoL.

DISCUSSION

The proposed trial will compare the effect of a home-based physical exercise-training programme in the management of femoral fracture to the usual physiotherapy management programmes with specific outcomes of bone mineral density, function, and inflammatory markers.

TRIAL REGISTRATION

The study was prospectively registered with the Pan African Clinical Trials Registry (Reference number - PACTR201910562118957) on October 21, 2019. (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9425).

The Relationship between Obesity and Physical Activity of Children in the Spotlight of Their Parents' Excessive Body Weight

Background: The study reveals the relationships between daily physical activity (PA) and the prevalence of obesity in family members separated according to the participation of their offspring in organized leisure-time physical activity (OLTPA), and answers the question of whether the participation of children in OLTPA is associated with a lower prevalence of obesity in offspring with respect to parental PA and body weight level. Methods: The cross-sectional study included 1493 parent-child dyads (915/578 mother/father-child aged 4–16 years) from Czechia selected by two-stage stratified random sampling with complete data on body weight status and weekly PA gathered over a regular school week between 2013 and 2019. Results: The children who participated in OLTPA ≥ three times a week had a significantly lower (p < 0.005) prevalence of obesity than the children without participation in OLTPA (5.0% vs. 11.1%). Even in the case of overweight/obese mothers/fathers, the children with OLTPA ≥ three times a week had a significantly lower (p < 0.002) prevalence of obesity than the children without OLTPA (6.7%/4.2% vs. 14.9%/10.7%). Conclusions: The cumulative effect of regular participation in OLTPA and a child’s own PA is a stronger alleviator of children’s obesity than their parents’ risk of overweight/obesity.

Parent-child dyads and nuclear family association in pedometer-assessed physical activity: A cross-sectional study of 4-to-16-year-old Czech children

The main aim of this study is to examine familial aggregation in pedometer-assessed physical activity (PA) and proxy-reported screen time (ST) with estimating which of the parents' lifestyle indicators help their offspring achieve step count (SC) recommendations under daily life conditions. The analysis included 773 parent-child dyads (591 mother-child, 182 father-child) and 511 nuclear family triads (mother-father-child) with data ambulatory PA monitored with a Yamax pedometer during a regular school/working week during the spring and autumn between 2013 and 2019. Based on Logistic regression analysis, an achievement of 10,000 steps a day by the mothers significantly (p < 0.001) increases the odds ratio of their children reaching the recommended daily SC in the parent-child dyads. Obesity/overweight of mothers (fathers) significantly (p < 0.05) increases (reduces) the chance of their children reaching the recommended daily SC in the analysis of the nuclear family triads. For both overweight/obese and non-overweight children, the odds of reaching the recommended daily SC are significantly (p < 0.05) increased by their regular participation (≥ twice per week) in organised leisure-time PA (analysis of the nuclear family triads) and non-excessive entertainment ST (≤2 h per day) in the mother-child and nuclear family triads. Despite the different mother-/father-child behavioural associations, SC of parents are positively associated with SC of their children (Linear regression analysis). The involvement of children in regular participation in organised leisure activities (at least twice a week) and limiting their excessive entertainment ST might be important factors contributing to the achievement of the recommended daily SC by children.

Physical activity and sedentary behaviour in the Middle East and North Africa: An overview of systematic reviews and meta-analysis

To support the global strategy to reduce risk factors for obesity, we synthesized the evidence on physical activity (PA) and sedentary behaviour in the Middle East and North Africa (MENA) region. Our systematic overview included seven systematic reviews reporting 229 primary studies. The meta-analysis included 125 prevalence measures from 20 MENA countries. After 2000, 50.8% of adults (ranging from 13.2% in Sudan to 94.9% in Jordan) and 25.6% of youth (ranging from 8.3% in Egypt to 51.0% in Lebanon) were sufficiently active. Limited data on PA behaviours is available for MENA countries, with the exception of Gulf Cooperation Council countries. The meta-regression identified gender and geographical coverage among youth, and the PA measurement as predictors of PA prevalence for both adults and youth. Our analysis suggests a significant PA prevalence increase among adults over the last two decades. The inconsistency in sedentary behaviour measurement is related to the absence of standardized guidelines for its quantification and interpretation. The global epidemic of insufficient PA is prevalent in MENA. Lower PA participation among youth and specifically females should be addressed by focused lifestyle interventions. The recognition of sedentary behaviour as a public health issue in the region remains unclear. Additional data on PA behaviours is needed from low- and middle-income countries in the region.

Academic Schedule and Day-to-Day Variations in Sedentary Behavior and Physical Activity of University Students

Students starting at university tend to adopt unhealthy behaviors. With students expected to sit during classes, their academic schedule may be responsible for their activity patterns. The aim of the current study was to investigate the relationship between university students’ academic schedule and day-to-day variations in sedentary behavior (SB) and physical activity (PA). The activity of 317 first-year undergraduate students (mean age 19.6 ± 1.4 years, 69.4% female, 30.0% male, and 0.6% other) was measured with the activPAL3™ triaxial monitor for seven consecutive days. Each class hour was found to be associated with 9.0 additional minutes of SB (95% CI [4.9, 13.1]), 54 additional seconds of moderate-to-vigorous PA (MVPA; 95% CI [12, 96]), and 12.2 min less time in bed (95% CI [−16.6, −7.8]). Active SB ratio (total duration of SB bouts < 30 min divided by total SB duration) decreased by 0.011 per hour of class scheduled for the students (95% CI [−0.016, −0.006]). Light PA (LPA) was not significantly associated with class duration. Students tend to cycle more on days with classes. Seated transportation was not significantly related to whether the students had classes or not. Overall, the academic schedule is associated with SB and PA in students.

Physically active children with epilepsy have good objective sleep duration and efficiency despite subjective reports of fatigue and sleep problems

OBJECTIVE

The aim of this study was to longitudinally characterize in children with epilepsy the objective and subjective sleep quality and the relationship between increased physical activity and sleep as well as measures of psychosocial well-being.

METHODS

Baseline physical activity and sleep were established in children with epilepsy over four weeks, prior to a 12-week exercise intervention (weekly meeting with exercise counselor). Participants continuously wore a wrist pedometer (Fitbit Flex®) to capture daily number of steps, sleep efficiency, and total sleep time. The Early Childhood Epilepsy Severity Scale (E-Chess) assessed baseline epilepsy severity. Subjective sleep quality (Children's Sleep Habits Questionnaire, CSHQ), quality of life (KIDSCREEN-27; Pediatric Quality of Life Inventory, PedsQL™, 4.0 Core), fatigue (PedsQL™ Multidimensional Fatigue Scale), depression (Children's Depression Inventory-Short), and anxiety (Multidimensional Anxiety Scale for Children) were assessed pre- and post-interventions.

RESULTS

Our cohort of 22 children with epilepsy aged 8-14 years was similarly active to peers (11,271 ± 3189 mean steps per day) and displayed normal sleeping patterns (mean sleep efficiency: 87.4% ± 3.08 and mean total sleep time: 521 ± 30.4). Epilepsy severity assessed by E-Chess was low to moderate (median baseline E-Chess score of 6, interquartile range: 5-7). Study outcomes did not change with the intervention. Older children and those with lower baseline activity were more likely to increase their activity during the intervention. Changes in physical activity were not associated with changes in sleep outcomes when accounting for age, sex, and baseline E-Chess score. Subjective sleep quality marginally improved with the intervention (CSHQ total score: 44.5 ± 5.8 at baseline and 41.6 ± 7.2 at the end of study, p = 0.05). Quality of life, fatigue, depression, and anxiety did not change with the intervention (p = 0.55, 0.60, 0.12, and 0.69, respectively).

SIGNIFICANCE

Children with epilepsy who are as active as peers without epilepsy have good objective measures of sleep despite self-reported fatigue and parent-reported sleep problems. The physical activity of initially less active and older children with epilepsy may benefit from an exercise counseling intervention.

Come together, play, be active: Physical activity engagement of school-age children at Play Streets in four diverse rural communities in the U.S

Across the U.S., Play Streets - temporary street closures creating safe places for play for a few hours- are being implemented in urban areas during summer. Play Streets have never been implemented or evaluated in rural communities but have the potential to address challenges residents face accessing safe physical activity opportunities in these areas. Community organizations in four diverse low-income rural communities (selected to represent African American, American Indian, Latino, or White, non-Hispanic populations) received mini-grants in 2017 to implement four, three-hour Play Streets during the summer focusing on school-aged children in elementary-to-middle school. Physical activity was measured using Digi-walker (Yamax-SW200) pedometers and the System for Observing Play and Recreation in Communities (SOPARC/iSOPARC). Sixteen Play Streets were implemented in rural Maryland, North Carolina, Oklahoma, and Texas communities during June-September 2017. A total of 370 children (mean age = 8.81 years [SD = 2.75]; 55.0% female) wore pedometers across all 16 Play Streets (μ = 23.13 [SD = 8.59] children/Play Street). School-aged children with complete data (n = 353) wore pedometers for an average of 92.97 min (SD = 60.12) and accrued a mean of 42.08 steps/min (SD = 17.27), with no significant differences between boys (μ = 43.82, SD = 15.76) and girls (μ = 40.66, SD = 18.34). iSOPARC observations revealed no significant differences in child activity by sex; however, male teens were more active than female teens. Most adults were sedentary during Play Streets according to pedometer and iSOPARC data. Children in diverse rural communities are physically active at Play Streets. Play Streets are a promising intervention for promoting active play among children that lack safe opportunities to be active.

The Choice of Pedometer Impacts on Daily Step Counts in Primary School Children under Free-Living Conditions

Background: We examined whether daily step counts under free-living conditions differed among four types of pedometers used by primary school children. Methods: In Study one, we compared the Yamax SW-200 (widely used in research) and the Kenz Lifecorder (accelerometer-based pedometer) in 30 children (6–12 years). In Study two, after confirming good correlation between these devices, we used Kenz Lifecorder as the criterion device and compared it with the Yamasa EX-200 (pants pocket-type pedometer) and the Omron Active style Pro (accelerometer-based pedometer) among 48 (7–12 years) or 108 children (7–12 years). Results: In Study one, comparable mean step counts between pedometers were observed. The correlation was strong (r = 0.91); the average difference between these two pedometers was +4.5%. In Study two, the average differences between Kenz Lifecorder and Yamasa EX-200 and Kenz Lifecorder and Omron Active style Pro were −7.9% and −18.2%, respectively, and those were not significantly equivalent according to the two one-sided-tests method. The correlations between Yamasa or Omron Active style Pro and Lifecorder were moderate and strong, respectively. Conclusions: The choice of pedometer had a substantial impact on step counts. A consensus on the appropriate pedometer for quantifying daily step counts is needed for evidence-based recommendations for health promotion.

Physical activity participation according to the pyramidal, sensory, and cerebellar functional systems in multiple sclerosis

The objective of the study was to examine the differences in physical activity participation with the pyramidal, cerebellar, and sensory functional systems in people with multiple sclerosis (PwMS). This cross-sectional study included 289 PwMS with a median EDSS of 2.0 (range 0-6.5) and a mean disease duration of 6.8 (SD = 8.4) years. The Godin leisure-time exercise questionnaire (GLTEQ) assessed physical activity participation. The sample was divided into seven groups according to the pyramidal, cerebellar, and sensory functional system scores derived from the EDSS data. Additionally, PwMS were divided into three physical activity subgroups (active, moderately active, and insufficiently active). Furthermore, PwMS were categorized into four levels of disability based on their global Expanded Disability Status Scale (EDSS) score [very mild (0-1.5), mild (2.0-3.5), moderate (4.0-5.5), and severe (6.0-6.5)]. In the physical activity subgroups, 159 (55.0%) were classified as insufficiently active, 59 (20.4%) as moderately active, and 71 (24.6%) as active. Pyramidal, cerebellar, and sensory impairments were demonstrated in 134 (46.4%), 73 (25.3%), and 85 (29.4%) patients, respectively. No differences were found for the GLTEQ scores for all seven functional system groups (P value = 0.168). As for the EDSS disability subgroups, the percentage of active patients (moderately at least) were 60%, 45.8%, 36.5%, and 15.4%, for the very mild, mild, moderate, and severe subgroups, respectively. This study found that participation in leisure-time physical activity is independent from the pyramidal, cerebellar, and sensory functional systems in PwMS.

Accelerometer- and Pedometer-Based Physical Activity Interventions Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis

Importance

Accelerometers and pedometers are accessible technologies that could have a role in encouraging physical activity (PA) in line with current recommendations. However, there is no solid evidence of their association with PA in participants with 1 or more cardiometabolic conditions such as diabetes, prediabetes, obesity, and cardiovascular disease.

Objectives

To assess the association of accelerometer- and pedometer-based interventions with increased activity and other improved health outcomes in adults with cardiometabolic conditions and to examine characteristics of the studies that could influence the association of both interventions in improving PA.

Data Sources

Records from MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and PsycINFO were searched from inception until August 2018 with no language restriction.

Study Selection

Randomized clinical trials or cluster randomized clinical trials evaluating the use of wearable technology devices such as pedometers and accelerometers as motivating and monitoring tools for increasing PA were included. After removing duplicates, the searches retrieved 5762 references. Following abstract and title screening of 1439 references and full-text screening of 107 studies, 36 studies met inclusion criteria.

Data Extraction and Synthesis

Mean difference in PA was assessed by random-effects meta-analysis. Where the scale was different across studies, the standardized mean difference was used instead. Heterogeneity was quantified using the I2 statistic and explored using mixed-effects metaregression. This study was registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

Main Outcomes and Measures

The primary outcome was objectively measured PA in the short to medium term (postintervention to 8 months' follow-up).

Results

Thirty-six randomized clinical trials (20 using accelerometers and 16 using pedometers) involving 5208 participants were eligible for review. Meta-analysis involving 32 of these trials (4856 participants) showed medium improvements in PA: accelerometers and pedometers combined vs comparator showed a small significant increase in PA overall (standardized mean difference, 0.39 [95% CI, 0.28-0.51]; I2 = 60% [95% CI, 41%-73%]) in studies of short to medium follow-up over a mean (SD) of 32 (28.6) weeks. Multivariable metaregression showed improved association with PA for complex interventions that involved face-to-face consultation sessions with facilitators (β = 0.36; 95% CI, 0.17-0.55; P < .001) and pedometer-based interventions (β = 0.30; 95% CI, 0.08-0.52; P = .002).

Conclusions and Relevance

In this study, complex accelerometer- and pedometer-based interventions led to significant small to medium improvements in PA levels of people with cardiometabolic conditions. However, longer-term trials are needed to assess their performance over time. This study found no evidence that simple self-monitored interventions using either pedometers or accelerometers are associated with improvements in PA.

Computer Vision-Based Unobtrusive Physical Activity Monitoring in School by Room-Level Physical Activity Estimation: A Method Proposition

As sedentary lifestyles and childhood obesity are becoming more prevalent, research in the field of physical activity (PA) has gained much momentum. Monitoring the PA of children and adolescents is crucial for ascertaining and understanding the phenomena that facilitate and hinder PA in order to develop effective interventions for promoting physically active habits. Popular individual-level measures are sensitive to social desirability bias and subject reactivity. Intrusiveness of these methods, especially when studying children, also limits the possible duration of monitoring and assumes strict submission to human research ethics requirements and vigilance in personal data protection. Meanwhile, growth in computational capacity has enabled computer vision researchers to successfully use deep learning algorithms for real-time behaviour analysis such as action recognition. This work analyzes the weaknesses of existing methods used in PA research; gives an overview of relevant advances in video-based action recognition methods; and proposes the outline of a novel action intensity classifier utilizing sensor-supervised learning for estimating ambient PA. The proposed method, if applied as a distributed privacy-preserving sensor system, is argued to be useful for monitoring the spatio-temporal distribution of PA in schools over long periods and assessing the efficiency of school-based PA interventions.

Can behavioral strategies increase physical activity and influence depressive symptoms and quality of life among children with epilepsy? Results of a randomized controlled trial

PURPOSE

This study examined whether increasing physical activity (PA) through 6 months of behavioral counseling positively influenced depressive symptoms and quality of life (QoL) over 12 months among children with epilepsy (CWE).

METHODS

A longitudinal multisite randomized controlled trial (RCT) was conducted with 8-14-year-old children with active epilepsy. Participants wore a pedometer to track daily PA and completed 3 measures at 4 time points to examine depressive symptoms and QoL. Stratified by site and activity level, participants were randomized to an intervention or control group. The 6-month intervention included 11 behavioral counseling sessions targeting self-regulation of PA. To assess the associations among PA, depression scores, and QoL, primary analysis involved mixed-effects models.

RESULTS

We recruited 122 CWE, of whom 115 were randomized (M_age = 11 ± 2; 50% female) and included in the analysis. The intervention did not increase PA in the treatment compared with the control group. No differences were found between groups over time during the subsequent 6 months, where PA decreased among all participants. Results did not show differences between the groups and over time for measures of depressive symptoms and QoL.

SIGNIFICANCE

The intervention did not improve or sustain PA levels over 12 months. Both groups demonstrated declines in PA over one year, but there were no changes in depression scores or QoL. As most participants were already nearly reaching the Canadian average of step counts of children their age, with a baseline daily step count of over 9000, there may be a challenge for further increasing PA over a longer period.

Ambulatory activity interacts with common risk factors for osteoarthritis to modify increases in MRI-detected osteophytes

OBJECTIVE

To investigate the longitudinal association between objectively measured ambulatory activity (AA) and knee MRI-detected osteophytes (OPs), and to test whether this relationship was modified by common risk factors for OA including sex, obesity, disease severity and knee injury history.

METHODS

408 community-dwelling adults aged 51-81 years were assessed at baseline and 2.7 years. T1-weighted fat-suppressed MRI was used to evaluate knee OPs at both time points. AA was assessed at baseline by pedometers and categorized as: less active (≤7499 steps per day), moderately active (7500-9999 steps per day) and highly active (≥10,000 steps per day).

RESULTS

Statistically significant interactions were detected between knee OA risk factors and AA on increases in MRI-detected OPs (all P < 0.05). In stratified analyses, being moderately active, compared to being less active, was protective against an increase in MRI-detected OPs (score change of ≥1) in females (relative risk (RR) = 0.42, 95%CI, 0.25-0.70, P < 0.01), those who were obese (RR = 0.50, 95%CI, 0.30-0.83, P < 0.01), those with radiographic OA (ROA) (RR = 0.68, 95%CI, 0.47-0.97, P = 0.02) and those with a history of knee injury (RR = 0.27, 95%CI, 0.08-0.88, P = 0.02) in almost every knee compartment, after adjustment for confounders. No statistically significant associations were found in males, non-obese, non-ROA or non-injury groups.

CONCLUSIONS

Being moderately active is protective against an increase in MRI-detected OPs in females, those with ROA, those who are obese and those with a history of knee injury. These findings suggest that being moderately active is beneficial for individuals who are at higher risk of knee OA.

Evaluation of a pilot school-based physical activity challenge for primary students

Issue addressed Physical inactivity and sedentary behaviour among children are growing public health concerns. The Culture Health Communities Activity Challenge (hereafter known as the Challenge) is a school-based pedometer program in which classes compete to achieve the highest class average daily steps in an 8-week period. The Challenge aims to encourage physical activity in primary school students, with a focus on engaging Aboriginal students. The program was piloted in 15 classes in New South Wales in 2014. Methods The evaluation aimed to explore students' and teachers' experiences of the Challenge, and assess its impact on the students' physical activity levels. Data sources were a pre- and post-intervention survey of students' physical activity levels and sedentary time (n=209), qualitative interviews with teachers (n=11) and discussions with 10 classes. Results Fifteen Year 5 and 6 classes comprising 318 students participated. Fifty percent of participants were girls, the average age was 11 years and the majority (57%) were Aboriginal students. Participation in the Challenge was associated with a slight but statistically significant increase in students' physical activity levels (P<0.05), and a significant decrease in weekend screen time (P<0.05). However, when stratified by Aboriginality these changes were not statistically significant for Aboriginal students. Qualitative feedback from teachers and students indicated high levels of engagement and satisfaction with the Challenge. Teachers and students reported positive impacts, including increased motivation to be physically active, and improved student attendance and engagement in class activities and teamwork. Conclusions Participation in the Challenge was associated with increased physical activity and decreased screen time for some students. Students and teachers also reported a range of positive social and educational outcomes. So what? The findings highlight the importance of primary schools as a setting for health promotion activities, and demonstrate that school-based physical activity programs can be engaging and appropriate for classes with high proportions of Aboriginal students.

Changes in school-day step counts during a physical activity for Lent intervention: a cluster randomized crossover trial of the Savior's Sandals

Background

Participation in regular physical activity (PA) has many health benefits for school-aged children. However, only about 20% of children worldwide meet recommendations for being sufficiently active. Children spend many hours per day at school and schools have a mandate for promoting PA. Private religious schools could serve as a novel source for religious-themed PA interventions.

Methods

We randomly allocated 2 clusters of 2 Catholic middle (grades 6–8) schools/cluster to a 2-week no treatment/4-week intervention crossover trial to determine the effects of a 20-day Lenten-themed PA intervention on 187 students’ pedometer steps taken at school. Specifically, students independently progressed through a workbook (Savior’s Sandals) that depicted and informed about 11 locations in the Holy Land where Jesus lived, visited, and/or ministered, and included Scripturally-based questions about each place for students to answer. In all, students would accumulate 110,000 steps if they completed the workbook virtual journey. General linear mixed models with restricted maximum likelihood estimation to compensate for missing data were used to compute the intervention effects on mean daily steps.

Results

There were significant main effects for the intervention overall and by school and grade level. Follow-up tests isolated that a single school (Mean_diff = + 2156 steps/day) and grade 6 students (Mean_diff = + 1678 steps/day) across all four schools experienced the greatest treatment effects.

Conclusions

Religious-themed PA interventions can be effective; however, specific adjustments may be needed to optimize the intervention’s effectiveness for a broader population of students.

Trial registration

Current Controlled Trials ISRCTN10273669. Retrospectively registered 23 Oct 2018.

Fear of falling, not falls, impacts leisure-time physical activity in people with multiple sclerosis

BACKGROUND

There is a consensus that physical activity is imperative for people with MS (PwMS). However, regardless of the benefits, many PwMS do not participate in any meaningful physical activity.

AIM

To examine the relationship between leisure-time physical activity with clinical characteristics and common symptoms in PwMS.

METHODS

The sample included 190 PwMS (107 women), mean age 40.8 (S.D = 13.1) and mean disease duration of 6.4 (SD = 8.3) years since diagnosis. Outcome measures included the Godin Leisure-Time Exercise Questionnaire (GLTEQ), Four Square Step Test (FSST), 2-Minute Walk test (2 mWT), Timed Up and Go test (TUG), Timed 25-Foot Walk test (T25FW), fall status, Falls Efficacy Scale International (FES-I), Modified Fatigue Impact Scale (MFIS), walking speed and the Multiple Sclerosis Walking Scale self-reported questionnaire (MSWS-12).

RESULTS

Eighty-six PwMS were classified as active (GLTEQ = 31.6 (S.D = 16.7); 104 were insufficiently active (GLTEQ = 3.0 (S.D = 4.3). Insufficiently active PwMS demonstrated a slower walking speed, elevated fatigue, more concerns of falling and additional walking difficulties compared to active PwMS. Non-significant differences between groups were observed in the TUG, 2 mWT, FSST, T25FWT and fall status. According to the linear regression, by utilizing the FES-I we observed a 12.2% variance related to leisure-time physical activity. The independent variables: EDSS, MSWS-12, fatigue and walking speed were non-significant.

SIGNIFICANCE

The present findings highlight the impact of concern of falling on physical activity in PwMS. This knowledge may represent an opportunity to improve care and enhance physical activity in the MS population.

Validating Fitbit Zip for monitoring physical activity of children in school: a cross-sectional study

Background

Modern activity trackers, including the Fitbit Zip, enable the measurement of both the step count as well as physical activity (PA) intensities. However, there is a need for field-based validation studies in a variety of populations before using trackers for research. Therefore, the purpose of the current study was to investigate the validity of Fitbit Zip step count, moderate to vigorous physical activity (MVPA) and sedentary minutes, in different school segments in 3rd grade students.

Methods

Third grade students (N = 147, aged 9–10 years) wore a Fitbit Zip and an ActiGraph GT3x-BT accelerometer simultaneously on a belt for five days during school hours. The number of steps, minutes of MVPA and sedentary time during class time, physical education lessons and recess were extracted from both devices using time filters, based on the information from school time tables obtained from class teachers. The validity of the Fitbit Zip in different school segments was assessed using Bland-Altman analysis and Spearman’s correlation.

Results

There was a strong correlation in the number of steps in all in-school segments between the two devices (r = 0.85–0.96, P < 0.001). The Fitbit Zip overestimated the number of steps in all segments, with the greatest overestimation being present in physical education lessons (345 steps). As for PA intensities, the agreement between the two devices in physical education and recess was moderate for MVPA minutes (r = 0.56 and r = 0.72, P < 0.001, respectively) and strong for sedentary time (r = 0.85 and r = 0.87, P < 0.001, respectively). During class time, the correlation was weak for MVPA minutes (r = 0.24, P < 0.001) and moderate for sedentary time (r = 0.57, P < 0.001). For total in-school time, the correlation between the two devices was strong for steps (r = 0.98, P < 0.001), MVPA (r = 0.80, P < 0.001) and sedentary time (r = 0.94, P < 0.001).

Conclusion

In general, the Fitbit Zip can be considered a relatively accurate device for measuring the number of steps, MVPA and sedentary time in students in a school-setting. However, in segments where sedentary time dominates (e.g. academic classes), a research-grade accelerometer should be preferred.

Health-related parental indicators and their association with healthy weight and overweight/obese children's physical activity

Background

Although it is accepted that parents play a key role in forming children’s health behaviours, differences in parent-child physical activity (PA) have not previously been analysed simultaneously in random samples of families with non-overweight and overweight to obese preschool and school-aged children. This study answers the question which of the health-related parental indicators (daily step count (SC), screen time (ST), and weight status and participation in organized leisure-time PA) help their children achieve the step count recommendations.

Methods

A nationally representative sample comprising 834 families including 1564 parent-child dyads who wore the Yamax Digiwalker SW-200 pedometer for at least 8 h a day on at least four weekdays and both weekend days and completed a family log book (anthropometric parameters, SC, and ST). Logistic regression analyses were used to investigate whether parental achievement of the daily SC recommendation (10,000 SC/day), non-excessive ST (< 2 h/day), weight status, and active participation in organized PA were associated with children’s achievement of their daily SC (11,500 SC/day for pre-schoolers and 13,000/11,000 SC/day for school-aged boys/girls).

Results

While living in a family with non-overweight parents helps children achieve the daily SC recommendation (mothers in the model: OR = 3.50, 95% CI = 2.29–5.34, p < 0.001; fathers in the model: OR = 2.41, 95% CI = 1.37–4.26, p < 0.01) regardless of their age category, gender, or ST, for families with overweight/obese children, only the mother’s achievement of the SC recommendations and non-excessive ST significantly (p < 0.05) increase the odds of their children reaching the daily SC recommendation. The active participation of children in organized leisure-time PA increases the odds of all children achieving the daily SC recommendations (OR = 1.80–2.85); however, for overweight/obese children this remains non-significant. The participation of parents in organized leisure-time PA does not have a significant relationship to the odds of their overweight/obese or non-overweight children achieving the daily SC recommendations.

Conclusions

The mother’s health-related behaviours (PA and ST) significantly affect the level of PA of overweight/obese preschool and school-aged children. PA enhancement programmes for overweight/obese children cannot rely solely on the active participation of children in organized leisure-time PA; they also need to take other family-based PA, especially at weekends, into account.

Associations Between Pedometer-Determined Physical Activity and Adiposity in Children and Adolescents: Systematic Review

OBJECTIVE

The present review sought to examine the evidence on the associations between pedometer-determined physical activity and adiposity.

DESIGN

Of 304 potentially eligible articles, 36 were included. A search for observational studies was carried out using Cochrane Library (CENTRAL), the OVID (MEDLINE, Embase, and PsycINFO), EBSCOhost (Sportdiscus), and PEDro database from their commenced to July 2015. Of 304 potentially eligible articles, 36 were included.

RESULTS

Most studies (30/36; 83%) were cross sectional and all used proxies for adiposity, such as body mass index (BMI) or BMI z-score as the outcome measure. Few studies (2/36; 6%) focused on preschool children. There was consistent evidence of negative associations between walking and adiposity; significant negative associations were observed in 72% (26/36) of studies overall.

CONCLUSIONS

The present review supports the hypothesis that higher levels of walking are protective against child and adolescent obesity. However, prospective longitudinal studies are warranted; there is a need for more research on younger children and for more "dose-response" evidence.

Associations between Parental and Friend Social Support and Children's Physical Activity and Time Spent outside Playing

The purpose of this study was to examine the structural validity of a parent and a child questionnaire that assessed parental and friends' influences on children's physical activity and investigate the associations between the derived factors, physical activity, and time spent outside. Children (N = 154, mean age = 11.7) and 144 of their parents completed questionnaires assessing parental and friends' influences on children's physical activity. Children wore a pedometer for six days. Exploratory factor analyses revealed four factors for the parental and five for the child's questionnaire that explained 66.71% and 63.85% of the variance, respectively. Five factors were significantly associated with physical activity and five significantly associated with time spent outside. Higher correlations were revealed between “general friend support,” “friends' activity norms,” and physical activity (r = 0.343 and 0.333 resp., p < 0.001) and between “general friend support” and time spent outside (r = 0.460, p < 0.001). Obtaining information relating to parental and friends' influences on physical activity from both parents and children may provide a more complete picture of influences. Parents and friends seem to influence children's physical activity behavior and time spent outside, but friends' influences may have a stronger impact on children's behaviors.

Social and Environmental Determinants of Child Physical Activity in a Rural Mexican-Origin Community

California's rural agricultural communities face an increased burden of obesity and metabolic disease. The present objective is to define the social and environmental influences to child obesity and physical activity within Mexican-origin communities in California's Central Valley. A range of data (anthropometric, socioeconomic, demographic, cultural and environmental) were collected on more than 650 children enrolled in Niños Sanos, Familia Sana. Physical activity data were gathered from a subsample of children 4-7 years of age (n = 148) via accelerometer. Cross sectional analyses explored the relationship between BMI and physical activity and the influence of numerous social and environmental variables. In this sample 45 % of children were determined to be overweight or obese. Boys had a higher daily average moderate-to-vigorous physical activity than girls (p = 0.008). Chi square analyses showed weight status was associated with activity level in girls (p = 0.03) but not boys. Multivariate regression revealed several social and environmental indicators influenced BMI and physical activity (p = 0.004). In this population of school-age children of Mexican-origin, girls may benefit more from targeted efforts to increase MVPA. Family and community support systems may also boost child participation in physical activities.

Exergaming for Health: A Randomized Study of Community-Based Exergaming Curriculum in Pediatric Weight Management

OBJECTIVE

To evaluate the effectiveness and sustainable impact of a multifaceted community-based weight intervention program for children, including exergaming curriculum.

METHODS

Eighty overweight or obese children, aged 8-12 years, were randomly assigned in a 2:1 ratio to an Exergaming for Health intervention group, comprising both exergaming and classroom curriculum, or to a control group with classroom curriculum alone. Outcome measures included body mass index (BMI), z-score change, and shuttle runs to assess cardiorespiratory endurance.

RESULTS

Fifty-nine participants took part in the intervention and 21 in the control group, with 35 and 13 completing 6-month follow-up, respectively. Twenty-eight intervention children were followed-up at 1 year. At the end of the 6-month intervention, the intervention group reduced its BMI z-score by -0.06 (±0.12) compared to 0 (±0.09) change for the control group; additionally, intervention subjects were two shuttle runs higher than control. However, these differences were not statistically significant (P = 0.07 and P = 0.09, respectively). Over the 6-month period after the program, the intervention group did not have an increase in weight status (BMI z-score change -0.01 [95% confidence interval -0.08 to +0.06], P = 0.76).

CONCLUSIONS

Use of exergaming in community pediatric weight management did not improve weight status at the end of programming, and study implementation was limited by small sample and missing data. However, there were clinically promising trends in fitness, screen time, and caloric intake. Weight status of intervention participants did not rebound 6 months after programming. Larger, longer term studies are needed to establish the impact of videogaming interventions.

A cross-sectional study of the relationship between parents' and children's physical activity

BACKGROUND

Though parents' physical activity (PA) is thought to be a predictor of children's PA, findings have been mixed. The purpose of this study was to examine the relationship between pedometer-measured steps/day of parents' and their children and potential moderators of this relationship. We also assessed the parent-child PA relationship as measured by questionnaires.

METHODS

Six-hundred and twelve 7-8 year olds and one of their parents wore Steps Count (SC)-T2 pedometers for four consecutive days. Parents reported their PA from the last seven days and their child's usual PA. Hierarchical linear regressions were used to assess the parent-child PA relationships, controlling for covariates. Gender (parent, child), gender homogeneity, weight status (parent, child), weight status homogeneity, and socioeconomic status (SES) variables (parent education, household income, area-level SES) were tested as potential moderators of this relationship. Partial r's were used as an estimate of effect size.

RESULTS

Parents' steps was significantly related to children's steps (r partial = .24). For every 1,000 step increase in parents' steps, the children took 260 additional steps. None of the tested interactions were found to moderate this relationship. Using questionnaires, a relatively smaller parent-child PA relationship was found (r partial = .14).

CONCLUSION

Physically active parents tend to have physically active children. Interventions designed to get children moving more throughout the day could benefit from including a parent component. Future research should explore the mechanisms by which parents influence their children, and other parent attributes and styles as potential moderators.

Time trends: a ten-year comparison (2005-2015) of pedometer-determined physical activity and obesity in Czech preschool children

BACKGROUND

To explore the time trends (2005-2015) of pedometer-determined weekday and weekend physical activity (PA) and obesity prevalence in 4-7-year-old Czech preschool children and changes in proportion of kindergarten vs. leisure-time PA.

METHODS

The study compared data of two cross-sectional cohorts of preschool children (2005: 92 boys and 84 girls; 2015: 105 boys and 87 girls) in the Czech Republic, using the same measurements and procedures in both cases. PA was monitored by the Yamax Digiwalker SW-200 pedometer for at least eight continuous hours a day over seven consecutive days. Body weight and height were measured using calibrated Tanita scales and anthropometry. The analysis of variance was conducted to examine the gender and cohort effect on step counts. The t-test was used to examine the difference in step counts in kindergarten (or leisure-time) between non-obese and obese children, and the chi-square test compared the prevalence of obesity between 2005 and 2015.

RESULTS

The steps/day (mean ± standard deviation) of preschoolers was significantly higher (p < 0.05) in 2015 (11,739 ± 4,229 steps/day) than in 2005 (10,922 ± 3,181 steps/day); and (p < 0.001) in boys (11,939 ± 3,855 steps/day) than in girls (10,668 ± 3,587 steps/day). In 2015, girls, but not boys, had a significantly (p < 0.01) greater step count on weekdays than in 2005, but not at weekends. A decline of leisure-time step counts on weekdays between 2005 and 2015 in girls (6,8652005 vs. 6,0592015, p < 0.01) and boys (7,8612005 vs. 6,4362015, p < 0.001) is compensated for by the increase of step counts in kindergarten (girls: 3,0582005 vs. 5,3302015, and boys: 4,0032005 vs. 5,9992015, p < 0.001). The prevalence of obesity was not significantly different either in 2005 or 2015 among preschool girls (7.14 % 2005 vs. 9.20 % 2015) or boys (6.52 % 2005 vs. 9.52 % 2015).

CONCLUSION

The steps/day of preschoolers was higher in 2015 than in 2005; this higher level of PA was the result of increased PA in kindergartens over the last ten years, particularly among girls. Thus, the current PA program in kindergartens effectively compensates for the decline in PA in leisure-time of weekdays of non-obese and obese preschoolers compared to 2005 and 2015. Prevalence of obesity among Czech preschool children remains relatively stable between 2005 and 2015.

Psychological distress leads to reduced physical activity and fitness in children: the Australian longitudinal LOOK study

Stress and depression can affect an individual's level of physical activity and fitness, which may place them at risk of developing cardiovascular disease. This study investigates the longitudinal effects of stress and depression on physical activity and cardiorespiratory fitness among youth. Six hundred and seventy-six children, initially aged 8 years, from the LOOK study completed a modified version of the Children's Depression Inventory, the Children's Stress Questionnaire, and objective physical activity and cardiorespiratory fitness assessments on three occasions, every 4 years. Depressive symptoms had a direct effect (longitudinal) on the cardiorespiratory fitness of girls, with a similar trend for boys. In cross-sectional analyses, a child who identified with more symptoms of depression and stress was likely to be less fit and less physically active, which in girls extended to less moderate-to-vigorous physical activity. Our findings, that both physical activity and fitness are impacted by depression and stress may contribute to strategies directed towards achieving enhanced physical activity and reductions in obesity.

Cut-off values for step count and TV viewing time as discriminators of hyperglycaemia in Brazilian children and adolescents

BACKGROUND

The use of step count and TV viewing time to discriminate youngsters with hyperglycaemia is still a matter of debate.

AIM

To establish cut-off values for step count and TV viewing time in children and adolescents using glycaemia as the reference criterion.

SUBJECTS AND METHODS

A cross-sectional study was conducted on 1044 schoolchildren aged 6-18 years from Northeastern Brazil. Daily step counts were assessed with a pedometer over 1 week and TV viewing time by self-report.

RESULTS

The area under the curve (AUC) ranged from 0.52-0.61 for step count and from 0.49-0.65 for TV viewing time. The daily step count with the highest discriminatory power for hyperglycaemia was 13 884 (sensitivity = 77.8; specificity = 51.8) for male children and 12 371 (sensitivity = 55.6; specificity = 55.5) and 11 292 (sensitivity = 57.7; specificity = 48.6) for female children and adolescents respectively. The cut-off for TV viewing time with the highest discriminatory capacity for hyperglycaemia was 3 hours/day (sensitivity = 57.7-77.8; specificity = 48.6-53.2).

CONCLUSION

This study represents the first step for the development of criteria based on cardiometabolic risk factors for step count and TV viewing time in youngsters. However, the present cut-off values have limited practical application because of their poor accuracy and low sensitivity and specificity.

An integrated curriculum approach to increasing habitual physical activity in deprived South Asian children

Integrating physical activity (PA) within a school curriculum is a promising approach for increasing PA in children. To date, no research has examined its effectiveness in increasing the low levels of PA witnessed in deprived South Asian (SA) children. The study aims to ascertain whether an integrated school-based curriculum and pedometer intervention could increase PA in children from deprived SA backgrounds. Following ethical approval and informed consent, 134 deprived SA children (63 boys, 71 girls, control (n = 40, mean age = 11.12 years, SD = 0.32 years) and intervention (n = 94, mean age = 9.48 years, SD = 0.62 years)) from a primary school in England, UK, completed a 6-week integrated PA intervention based on virtually walking from their school (middle of the country) to the coast and back (March-July 2013). Habitual PA was determined at baseline and post 6 weeks intervention for both groups, and determined weekly during the intervention in the experimental group. The results indicated that average daily steps were significantly higher at post 6 weeks compared to baseline for the intervention group (intervention mean change = 8694 steps/day, SD = 7428 steps/day vs. control mean change = -1121 steps/day, SD = 5592 steps/day, 95% CI of difference, 6726-7428 steps/day, P = .001, d = 1.76). In addition, significant decreases in BF% and waist circumference were observed in the intervention group post 6 weeks (mean change for BF% = -4.5%, mean change for WC = -1.7 cm, P = .001). School-based integrated curriculum and pedometer interventions provide a feasible and effective mechanism for increasing habitual PA in primary school children from deprived SA backgrounds.

Measuring Physical Activity of Elementary School Children With Unsealed Pedometers: Compliance, Reliability, and Reactivity

BACKGROUND AND PURPOSE

Evidence of compliance, reliability, and reactivity of using pedometers in children remains inconsistent. This study aimed to examine these aspects of unsealed pedometers.

METHODS

There were 133 children who wore pedometers for 7 days. A subsample of 50 children completed surveys measuring self-efficacy, enjoyment, parental influence, and environment on Day 1 and 8. Investigator presence and incentives were used to increase compliance.

RESULTS

About 87% of children returned pedometers, with 62% wearing pedometers for 4 days or longer. The intraclass correlation coefficients ranged from .70 to .87, with ICC for 4-day pedometer steps exceeding .80. Wearing pedometers did not change pedometer steps nor alter children's perceptions of self-efficacy, enjoyment, parental influence, and environment significantly.

CONCLUSIONS

Children were compliant wearing pedometers, and there was no reactivity from wearing them.

Classroom-based interdependent group contingencies increase children's physical activity

This study investigated the effects of 2 interdependent group contingencies (individual vs. cumulative classroom goal setting) on the number of pedometer-recorded steps taken per day. Thirty third-grade students in 2 classrooms participated. An ABACX design was conducted in which the X phase referred to a replication of the most successful phase (i.e., B or C). Results indicated that individual goal setting, rather than cumulative classroom goal setting, was more effective in increasing the number of steps taken per day on average. Results suggest that individual feedback may be an important factor in attaining desired results.

Child physical activity levels and associations with modifiable characteristics in centre-based childcare

OBJECTIVE

To describe children's physical activity levels during childcare and associations with modifiable characteristics.

METHODS

A cross-sectional study of 328 preschool children (43% girls; age 3-5 years) and 145 staff from 20 long day care centres in the Hunter Region of NSW, Australia. Pedometers assessed child physical activity levels. Centre characteristics and staff attitudes and behaviours towards children's physical activity were assessed using surveys, interviews and observational audit. Results were analysed using descriptive statistics and linear regression.

RESULTS

Over the measurement period, average step count of children was 15.8 (SD=6.8) steps/minute. Four-year-olds had the highest step counts (16.4, SD=7.1, p=0.03) with no differences by sex. Step counts were significantly higher in centres that had a written physical activity policy (+3.8 steps/minute, p=0.03) and where staff led structured physical activity (+3.7 steps/minute, p<0.001) and joined in active play (+2.9 steps/minute, p=0.06).

CONCLUSIONS

Written physical activity policy, structured staff-led physical activity and staff joining in active play were associated with higher levels of physical activity.

IMPLICATIONS

Childcare physical activity interventions should consider including strategies to encourage written physical activity policies and support structured staff led physical activities.

Parent-child associations in pedometer-determined physical activity and sedentary behaviour on weekdays and weekends in random samples of families in the Czech Republic

This study investigates whether more physically active parents bring up more physically active children and whether parents’ level of physical activity helps children achieve step count recommendations on weekdays and weekends. The participants (388 parents aged 35–45 and their 485 children aged 9–12) were randomly recruited from 21 Czech government-funded primary schools. The participants recorded pedometer step counts for seven days (≥10 h a day) during April–May and September–October of 2013. Logistic regression (Enter method) was used to examine the achievement of the international recommendations of 11,000 steps/day for girls and 13,000 steps/day for boys. The children of fathers and mothers who met the weekend recommendation of 10,000 steps were 5.48 (95% confidence interval: 1.65; 18.19; p < 0.01) and 3.60 times, respectively (95% confidence interval: 1.21; 10.74; p < 0.05) more likely to achieve the international weekend recommendation than the children of less active parents. The children of mothers who reached the weekday pedometer-based step count recommendation were 4.94 times (95% confidence interval: 1.45; 16.82; p < 0.05) more likely to fulfil the step count recommendation on weekdays than the children of less active mothers.

Using Pedometers for Measuring and Increasing Physical Activity in Children and Adolescents

The science and practice of step counting in children (typically aged 6-11 years) and adolescents (typically aged 12-19 years) has evolved rapidly over a relatively brief period with the commercial availability of research-grade pedometers and accelerometers. Recent reviews have summarized considerations for assessing physical activity using pedometers in young people (both children and adolescents), but 3 areas have received little attention: pedometer monitoring protocols, minimal (as opposed to optimal) step counts necessary for maintaining basal levels of health, and appropriate pedometer-based interventions for young people. Therefore, the objective of this review was to evaluate the current evidence and identify future research directions in these areas. The challenges of objective monitoring of physical activity in children and adolescents reinforce the importance of using protocols that minimize participant burden and the potential for tampering/reactivity. Evidence for a sedentary lifestyle cut point is limited; researchers are therefore encouraged to investigate several cut points (ie, <5000, <6000, <7000 steps/d) in children and adolescents to identify the health consequences of very low levels of ambulatory activity. Personalized messages may be necessary for health behavior change in pedometer-based interventions, but there is a need for more high-quality studies to develop the existing evidence base.

Parental perceived neighborhood attributes: associations with active transport and physical activity among 10-12 year old children and the mediating role of independent mobility

BACKGROUND

During the last decades, the use of active travel modes declined in all age groups. Childhood is a critical time to establish lifelong healthy patterns. To develop effective interventions in this age group, insight in the correlates of health behaviors and the possible mediating factors is necessary. Among children, the role of parents may not be overlooked. Therefore, this study aimed to examine the associations of parental perceptions of neighborhood environmental attributes with active transport and total physical activity in 10-12 year old Belgian boys and girls. Furthermore, this study examined the potential mediating effect of independent mobility on these associations.

METHODS

In the present study, 736 10-12 year old children and their parents from 44 elementary schools in Flanders, Belgium, participated. The children were asked to wear an activity monitor and to fill in a survey questioning demographic factors and the Flemish Physical Activity Questionnaire. The parents filled in a survey concerning demographic factors, the child's level of independent mobility and environmental perceptions (Neighborhood Environmental Walkability Scale).

RESULTS

Overall, boys reported more active transport when parents perceived more land use mix diversity, shorter distances to school, good land use mix access, higher residential density and less pleasing neighborhood aesthetics. Higher total physical activity levels were reported when parents perceived shorter distances to school and availability of walking/cycling infrastructure. None of the associations was mediated by independent mobility in boys. Girls reported more active transport when parents perceived higher residential density, more land use mix diversity, shorter distances to school, good land use mix access, available walking/cycling infrastructure and convenient recreational facilities. Girls reported higher total physical activity levels when parents perceived high residential density, good land use mix access, well-maintained and high quality walking/cycling infrastructures and more traffic safety. Independent mobility was found to be an important mediator of these associations in girls.

CONCLUSIONS

Neighborhood environmental interventions to increase children's active transport and physical activity can be effective when combined with awareness raising programs for parents. Furthermore, among girls encouraging independent mobility may contribute to behavior change.

Changes in physical activity during the transition from primary to secondary school in Belgian children: what is the role of the school environment?

BACKGROUND

Key life periods have been associated with changes in physical activity (PA). This study investigated (1) how PA changes when primary school children transfer to secondary school, (2) if school environmental characteristics differ between primary and secondary schools and (3) if changes in school environmental characteristics can predict changes in PA in Belgian schoolchildren. Moderating effects of gender and the baseline level of PA were investigated for the first and third research question.

METHODS

In total, 736 children (10-13 years) of the last year of primary school participated in the first phase of this longitudinal study. Two years later, 502 of these children (68.2%) agreed to participate in the second phase. Accelerometers, pedometers and the Flemish Physical Activity Questionnaire were used to measure PA. School environmental characteristics were reported by the school principals. Cross-classified regression models were conducted to analyze the data.

RESULTS

Self-reported active transport to school and accelerometer weekday moderate to vigorous PA (MVPA) increased after the transition to secondary school while self-reported extracurricular PA and total PA decreased. Pedometer weekday step counts decreased, but this decrease was only apparent among those who achieved the PA guidelines in primary school.Secondary schools scored higher on the school environmental characteristics: provision of sports and PA during lunch break, active schoolyards and playgrounds and health education policy but lower on sports and PA after-school than primary schools. Changes in the school environmental characteristics: active commuting to school, active schoolyards and playgrounds and health education policy resulted in changes in self-reported extracurricular PA, total PA , pedometer/accelerometer determined step counts and accelerometer determined MVPA. Moderating effects were found for baseline PA and gender.

CONCLUSION

PA changed after the transition to secondary school. In general, secondary schools seem more likely to foster strategies to promote PA during school hours than primary schools who seem more likely to foster strategies to promote PA after school. Changes in school environmental characteristics may contribute to changes in PA. Thus, if confirmed in future studies, efforts are needed to implement these components in schools as early as possible to positively affect the change in PA.