Comparison of cardiorespiratory fitness and body mass index between rural and urban youth: findings from the East of England Healthy Hearts Study

[Measurement by accelerometry of physical activity levels in a sample of Spanish adolescents]

OBJECTIVES

To establish the relationship between the level of physical activity (PA) and maximum oxygen consumption (VO2 max.); and to analyze the level of PA and its relationship with sex, place of residence, influence of physical education (PE) classes in PA, and body mass index (BMI) in adolescents.

MATERIALS AND METHODS

89 subjects from the province of Salamanca (Spain), aged 12 to 16 (14±1.18 years), participated in the study; 55.1% (n=49) of the sample were men and 44.9% (n=40) women. The instruments used were: Actigraph GT3X accelerometer, Course Navette Test and Tanita Body Composition Analyzer MC780MA. Information on sex and place of residence was also collected.

RESULTS

Only 18% of the individuals met the minimum PA recommendations set by the World Health Organization (WHO). Males and subjects from urban areas performed greater amounts of physical activity. Subjects with lower BMI and of the male sex had better levels of VO2max. PE classes did not contribute substantially to the total weekly amount of PA.

CONCLUSIONS

These results can be considered relevant to develop specific programs that promote PA and prevent overweight and obesity in adolescents, making emphasis on the female population, people from rural areas and those with higher BMI.

Parent Preferences for Physical Activity in Before and After School Programs in Rural and Suburban Communities: A Discrete Choice Experiment

BACKGROUND

The purpose of this study was to examine and compare parent preferences of before and after school physical activity program components in rural and suburban elementary schools.

METHODS

A discrete choice experiment was conducted to measure parent preferences for components of before/after school programs. A total of 183 parents (age = 37.2 [8.2] y, 155 females) sampled from 15 elementary schools (K-6 grades) in the Western United States took part in the study, half of which were from a rural community (n = 93, 50.8%). Results from the discrete choice experiment were analyzed using hierarchic Bayesian methodology, which estimated utility scores and was used to calculate important scores for program components.

RESULTS

The specific goal of the before/after school program was the strongest determinant of parents' stated choice overall, followed by leaders, time of day, length, and main focus. Learning sports as the physical activity goal was the top-rated attribute. Subgroup analyses revealed discrepancies between suburban and rural parents and parents of boys and girls.

CONCLUSION

This study extends the application of discrete choice experiments to school-based programming, providing a unique way to design empirically based, stakeholder informed school programs, specifically within before and after school settings.

School-based physical activity interventions in rural and urban/suburban communities: A systematic review and meta-analysis

Disparities in physical activity and health outcomes exist between urban and rural youth. School settings can be utilized to promote physical activity in youth regardless of urban-rural status. This systematic review and meta-analysis aimed to assess and compare the effect of rural and urban/suburban school-based physical activity programs on total physical activity in youth. A search of five databases was conducted. A total of 33 studies remained after the exclusion process, 28 of which took place in urban/suburban schools and five of which took place in rural schools. The DerSimonian and Laird random effects model was employed with the estimates of heterogeneity taken from the inverse-variance fixed-effect model. For rural studies, the Hartung-Knapp-Sidak-Jonkman method was used to obtain error estimates. Results from the total sample indicated a significant but small pooled increase in daily physical activity (Hedge's g = 0.12, 95% confidence interval [CI]: 0.06-0.18), which held for interventions conducted in urban/suburban schools (Hedge's g = 0.12, 95% CI: 0.06-0.19). For rural school-based interventions, there was no significant pooled effect (Hedge's g = 0.06, 95% CI: -0.50 to 0.61). This meta-analysis provides evidence that school-based interventions can be marginally effective for increasing daily physical activity in children and adolescents; however, no effect was observed for interventions implemented in rural settings.

Physical Fitness in Upper Austrian Children Living in Urban and Rural Areas: A Cross-Sectional Analysis with More Than 18,000 Children

Physical fitness is an important component in the development and health of children and adolescents. Given the equivocal results of previous research regarding the influence of the living environment on physical fitness, this study examined differences in physical fitness in urban and rural elementary school children in Upper Austria. A total of 18,168 (51% male) children between 6 and 11 years of age participated in anthropometric assessments and completed eight fitness tests that assessed cardiorespiratory endurance, muscular power, speed, agility, flexibility, and ball handling skills during a single test session in the school’s gymnasium. Urban living environment was associated with higher body weight (p = 0.01) and lower physical fitness (p < 0.01), except for flexibility, which was better in urban children (p < 0.01) and upper body strength (no difference), even after accounting for differences in body weight. Furthermore, it was shown that urban–rural differences in physical fitness are more pronounced in normal weight children and that these differences increase with age. These results highlight the potential of the living environment for the promotion of an active lifestyle that enhances physical fitness. The availability of safe spaces that facilitate unstructured and structured physical activity, as well as active transportation provide viable options for the promotion of physical fitness in children.

The Effect of Place of Residence on Physical Fitness and Adherence to Mediterranean Diet in 3⁻5-Year-Old Girls and Boys: Urban vs. Rural

The aim of the present study was to examine the effect of place of residence on physical fitness and adherence to Mediterranean Diet (AMD) in 3–5-year-old children, i.e., whether those who live in urban areas differ than those in rural and whether any difference varied by age. Participants were 363 preschoolers (age 3–5 years old), who performed a series of anthropometric, physical fitness tests and measured their nutritional habits through a 16-item Mediterranean Diet (KIDMED) questionnaire. The main findings of the present study were that (a) boys had better performance in ball bouncing, Medicine Ball Throw Test (MBTT), 25 m sprint, Standing Broad Jump (SBJ), crawling, and shuttle run test (SRT) than girls, and the magnitude of these differences was small; (b) preschoolers in urban residence were taller than those in rural and had better performance in SRT; (c) older preschoolers had larger anthropometric characteristics and better performance than younger preschoolers; (d) the magnitude of the effect of age was larger than the effect of residence; and (e) good AMD was more prevalent in boys than in girls and in 3-year-old participants than in their older peers, but was not related to place of residence. Therefore, these findings identified the need to develop exercise and nutrition intervention programs in preschoolers considering sex, age, and place of residence.

A Method by Which to Assess the Scalability of Field-Based Fitness Tests of Cardiorespiratory Fitness Among Schoolchildren

Previous research has reported the validity and reliability of a range of field-based tests of children’s cardiorespiratory fitness. These two criteria are critical in ensuring the integrity and credibility of data derived through such tests. However, the criterion of scalability has received little attention. Scalability determines the degree to which tests developed on small samples in controlled settings might demonstrate real-world value, and is of increasing interest to policymakers and practitioners. The present paper proposes a method by which the scalability of cardiorespiratory field-based tests suitable for school-aged children might be assessed. We developed an algorithm to estimate scalability based on a six-component model; delivery, evidence of operating at scale, effectiveness, costs, resource requirements and practical implementation. We tested the algorithm on data derived through a systematic review of research that has used relevant fitness tests. A total of 229 studies that had used field based cardiorespiratory fitness tests to measure children’s fitness were identified. Initial analyses indicated that the 5-min run test did not meet accepted criteria for reliability, whilst the 6-min walk test likewise failed to meet the criteria for validity. Of the remainder, a total of 28 studies met the inclusion criteria, 22 reporting the 20-m shuttle-run and seven the 1-mile walk/run. Using the scalability algorithm we demonstrate that the 20-m shuttle run test is substantially more scalable than the 1-mile walk/run test, with tests scoring 34/48 and 25/48, respectively. A comprehensive analysis of scalability was prohibited by the widespread non-reporting of data, for example, those relating to cost-effectiveness. Of all sufficiently valid and reliable candidate tests identified, using our algorithm the 20-m shuttle run test was identified as the most scalable. We hope that the algorithm will prove useful in the examination of scalability in either new data relating to existing tests or in data pertaining to new tests.

Is Olympic inspiration associated with fitness and physical activity in English schoolchildren? A repeated cross-sectional comparison before and 18 months after London 2012

OBJECTIVES

To compare cardiovascular fitness and physical activity of schoolchildren 18 months after London 2012 according to Olympic 'inspiration'.

DESIGN

A cross-sectional comparison between groups of schoolchildren categorised according to self-reported Olympic inspiration and a repeated cross-sectional comparison using data collected pre-2012.

SETTING

Schools within a 50 km radius of the Olympic Park, Stratford, London.

PARTICIPANTS

931 students (10.0-15.9-year-olds) attending 6 schools assessed in 2013 and 2014 (18 (range: 14-20) months after London 2012) and 733 students from the same schools assessed in 2008-2009 (42 (range: 38-46) months before London 2012).

PRIMARY OUTCOME MEASURES

Self-reported Olympic inspiration; cardiorespiratory fitness ([Formula: see text] mL/kg/min) assessed using the 20 m shuttle-run and self-reported physical activity.

SECONDARY OUTCOMES MEASURES

Differences in [Formula: see text] before and after London 2012.

RESULTS

53% of children reported being inspired to try new sports or activities. Compared with those not inspired by the Games, [Formula: see text] was higher in boys (d=0.43) and girls (d=0.27), who continued to participate in activities at 18(14-20) months. This 45% of sample was also more physically active (boys, d=0.23; girls, d=0.38) than those not or only briefly inspired to participate in activities (boys, d=0.24; girls, d=0.21). Compared with pre-2012 values, [Formula: see text] was lower post-2012 in boys (d=0.37) and in girls (d=0.38).

CONCLUSIONS

High levels of inspiration to participate in new activities reported following London 2012 and positive associations with fitness are encouraging. We cannot discount the possibility that inspired participants may have already been fitter and more active pre-2012. These associations must be interpreted in the context of the significant declines in fitness shown by our repeated cross-sectional comparison. Olympic host countries should employ longitudinal monitoring using objectively measured fitness and physical activity to provide evidence of health-related legacy.

Trajectories of childhood weight gain: the relative importance of local environment versus individual social and early life factors

OBJECTIVE

To determine the association between local environmental factors with child weight status in a longitudinal study, using a semi-parametric, group-based method, while also considering social and early life factors.

METHODS

Standardized, directly measured BMI from 4-10 y of age, and group-based trajectory modeling (PROC TRAJ) were used to estimate developmental trajectories of weight change in a Québec birth cohort (n = 1,566). Associations between the weight trajectories and living location, social cohesion, disorder, and material and social deprivation were estimated after controlling for social and early life factors.

RESULTS

FOUR WEIGHT TRAJECTORY GROUPS WERE ESTIMATED: low-increasing (9.7%); low-medium, accelerating (36.2%); medium-high, increasing (43.0%); and high-stable (11.1%). In the low-increasing and medium-high trajectory groups, living in a semi-urban area was inversely related to weight, while living in a rural area was positively related to weight in the high-stable group. Disorder was inversely related to weight in the low-increasing group only. Other important risk factors for high-stable weight included obesity status of the mother, smoking during pregnancy, and overeating behaviors.

CONCLUSIONS

In this study, associations between local environment factors and weight differed by trajectory group. Early life factors appear to play a more consistent role in weight status. Further work is needed to determine the influence of place on child weight.

Comparisons between inverted body mass index and body mass index as proxies for body fatness and risk factors for metabolic risk and cardiorespiratory fitness in Portuguese adolescents

OBJECTIVES

To compare inverted body mass index (iBMI, cm(2) /kg) and body mass index (BMI, kg/m(2) ) as predictors of body fatness, metabolic risk, and cardiovascular fitness in adolescents.

METHODS

A cross-sectional school-based study was conducted on 445 Portuguese adolescents (252 girls and 193 boys) aged 10-17 years. Height and body mass were assessed to determine iBMI and BMI, percent body fatness was determined from skinfold measures (tricep, subscapular) using the Slaughter et al. (1988: Hum Biol 60: 709-723) regression equation and cardiorespiratory fitness (CRF) was assessed using the 20-m shuttle run test. Capillary blood sampling was used to determine: Total cholesterol, triglycerides, high, and low density lipoprotein. These were combined with measures of systolic blood pressure and waist circumference as z-scores. Metabolic risk (MRS) was constructed by summing the z-scores.

RESULTS

iBMI and BMI were both significantly related to percent body fatness, CRF and MRS (all P = 0.005 or better). BMI was not normally distributed (P = 0.0001), whereas iBMI was (P > 0.05). Regression analysis identified that iBMI and BMI, both alongside for age, were significant predictors of percent body fatness, CRF and MRS (all P = 0.005 or better). Compared with BMI, iBMI was a similar predictor of CRF, MRS and body fatness.

CONCLUSIONS

iBMI offers a biologically sound alternative to BMI to assess the effect of weight status on MRS and CRF in adolescents and allows appropriate use of parametrical statistical techniques without changing the conclusions drawn from such data.