Reliability and Validity of the PAQ-C Questionnaire to Assess Physical Activity in Children

Study protocol to examine the effects of acute exercise on motor learning and brain activity in children with developmental coordination disorder (ExLe-Brain-DCD)

INTRODUCTION

Developmental coordination disorder (DCD) is one of the most prevalent pediatric chronic conditions. Without proper intervention, significant delays in motor skill performance and learning may persist until adulthood. Moderate-to-vigorous physical exercise has been proven to improve motor learning (adaptation and consolidation) in children with or without disorders. However, the effect of a short bout of physical exercise on motor adaptation and consolidation in children with DCD has not been examined. Furthermore, the role of perceptual-motor integration and attention as mediators of learning has not been examined via neuroimaging in this population.

OBJECTIVES

Therefore, the primary aims of this project will be to compare children with and without DCD to (a) examine the effect of acute exercise on motor learning (adaptation and consolidation) while performing a rotational visuo-motor adaptation task (rVMA), and (b) explore cortical activation in the dorsolateral- and ventrolateral-prefrontal cortex areas while learning the rVMA task under rest or post-exercise conditions.

METHODS

One hundred twenty children will be recruited (60 DCD, 60 controls) and within-cohort randomly assigned to either exercise (13-minute shuttle run task) or rest prior to performing the rVMA task. Adaptation and consolidation will be evaluated via two error variables and three retention tests (1h, 24h and 7 days post adaptation). Cortical activation will be registered via functional near-infrared spectroscopy (fNIRS) during the baseline, adaptation, and consolidation.

DISCUSSION

We expect to find exercise benefits on motor learning and attention so that children with DCD profiles will be closer to those of children with typical development. The results of this project will provide further evidence to: (a) better characterize children with DCD for the design of educational materials, and (b) establish acute exercise as a potential intervention to improve motor learning and attention.

Examination of Physical Activity Patterns of Children, Reliability and Structural Validity Testing of the Hungarian Version of the PAQ-C Questionnaire

INTRODUCTION

Several studies report on the importance of physical activity (PA) in childhood, which influences attitudes towards health in adulthood. For monitoring PA, trustworthy measurement tools are needed. The study aimed to adapt the Physical Activity Questionnaire for Children (PAQ-C) to the Hungarian language and assess its validity, reliability, and factor structure.

METHODS

A total of 620 children (the average age was 10.62 (SD 2.36)) participated in the cross-sectional study. To assess physical activity, the PAQ-C questionnaire was used. The collected data were analysed using IBM SPSS version 28.0 and IBM SPSS AMOS 29.0 software.

RESULTS

The internal consistency was acceptable (alpha = 0.729) and the test-retest reliability showed acceptable agreement (ICC = 0.772). The confirmatory factor favoured a one-factor structure of the questionnaire. The average PAQ-C score for girls was 2.87 (SD 1.07), and for boys it was 3.00 (SD 1.05), which showed a significant difference (p = 0.005).

DISCUSSION

Based on our findings, our study tested the validity and reliability of the one-factor PAQ-C questionnaire, a valid and reliable measurement tool to test the physical activity patterns of primary school children in a Hungarian sample. Further research is needed to develop physical activity monitoring of Hungarian children.

Effectiveness of a School Drinking Water Promotion and Access Program for Overweight Prevention

BACKGROUND AND OBJECTIVE

Drinking water promotion and access shows promise for preventing weight gain. This study evaluated the impact of Water First, a school-based water promotion and access intervention on changes in overweight.

METHODS

Low-income, ethnically diverse elementary schools in California's Bay Area were cluster-randomized to intervention and control groups. Water First includes classroom lessons, water stations, and schoolwide water promotion over 1 school year. The primary outcome was overweight prevalence (BMI-for-age-and-sex ≥85th percentile). Students (n = 1249) in 56 fourth-grade classes in 18 schools (9 intervention, 9 control) from 2016 to 2019 participated in evaluation at baseline, 7, and 15 months. Data collection was interrupted in 8 additional recruited schools because of coronavirus disease 2019.

RESULTS

Of 1262 students from 18 schools, 1249 (47.4% girls; mean [SD] age, 9.6 [0.4] years; 63.4% Hispanic) were recruited. From baseline to 7 months, there was no significant difference in changes in overweight prevalence in intervention schools (-0.2%) compared to control schools (-0.4%) (adjusted ratio of odds ratios [ORs]: 0.7 [confidence interval (CI): 0.2-2.9] P = 0.68). From baseline to 15-months, increases in overweight prevalence were significantly greater in control schools (3.7%) compared to intervention schools (0.5%). At 15 months, intervention students had a significantly lower change in overweight prevalence (adjusted ratio of ORs: 0.1 [CI: 0.03-0.7] P = .017) compared to control students. There were no intervention effects for obesity prevalence.

CONCLUSIONS

Water First prevented increases in the prevalence of overweight, but not obesity, in elementary school students.

Effects of smartphone addiction on cognitive function and physical activity in middle-school children: a cross-sectional study

Introduction

This study aimed to investigate the effects of smartphone addiction on cognitive function and physical activity in middle-school children.

Methods

A population of 196 children (boys and girls) from middle schools were recruited for this study with an average age of 12.99 ± 0.81 years, a height of 153.86 ± 6.50 meters, a weight of 48.07 ± 7.31 kilograms, and a body mass index of 20.22 ± 2.08 kg/m2. Smartphone addiction was determined using Arabic versions of the Smartphone Addiction Scale-Short Version, and physical activity levels were assessed by a physical activity questionnaire for older children. The working memory and selective attention domains of cognitive function were evaluated using a laptop screen's digital version of the memory automaticity and Flanker tasks, respectively. A one-way MANOVA was conducted to determine the differences in working memory between the smartphone-addicted and non-addicted groups. The relationship between smartphone addiction and physical activity was analyzed using Pearson's chi-squared test.

Results

The cognitive function-attention domain accuracy component showed a statistically significant difference between the groups, with a p-value of 0.05). The reaction time between smartphone-addicted and non-addicted children showed no statistically significant difference (p = 0.817). The relationship between smartphone addiction and physical activity was statistically significant (p < 0.001).

Discussion

The interaction effects between physical activity and smartphone addiction on reaction times showed statistically insignificant (p = 0.25) differences, showing that physical activity's effect on reaction times did not depend on smartphone addiction levels. The non-addicted children had significantly higher physical activity levels than the addicted children, indicating that smartphone addiction reduced physical activity.

Sedentary and physical activity time differs between self-reported ATLS-2 physical activity questionnaire and accelerometer measurements in adolescents and young adults in the United Arab Emirates

BACKGROUND

Most young adults and adolescents in the United Arab Emirates (UAE) do not meet the established internationally recommended physical activity levels per day. The Arab Teen Lifestyle Study (ATLS) physical activity questionnaire has been recommended for measuring self-reported physical activity of Arab adolescents and young adults (aged 14 years to mid-twenties). The first version of the ATLS has been validated with accelerometers and pedometers (r ≤ 0.30). The revised version of the questionnaire (ATLS-2, 2021) needs further validation. The aim of this study was to validate the self-reported subjective sedentary and physical activity time of the ATLS-2 (revised version) physical activity questionnaire with that of Fibion accelerometer-measured data.

METHODS

In this cross-sectional study, 131 healthy adolescents and young adults (aged 20.47 ± 2.16 [mean ± SD] years (range 14-25 years), body mass index 23.09 ± 4.45 (kg/m2) completed the ATLS-2 and wore the Fibion accelerometer for a maximum of 7 days. Participants (n = 131; 81% non-UAE Arabs (n = 106), 13% Asians (n = 17) and 6% Emiratis (n = 8)) with valid ATLS-2 data without missing scores and Fibion data of minimum 10 h/day for at least 3 weekdays and 1 weekend day were analyzed. Concurrent validity between the two methods was assessed by the Spearman rho correlation and Bland-Altman plots.

RESULTS

The questionnaire underestimated sedentary and physical activity time compared to the accelerometer data. Only negligible to weak correlations (r ≤ 0.12; p > 0.05) were found for sitting, walking, cycling, moderate intensity activity, high intensity activity and total activity time. In addition, a proportional/systematic bias was evident in the plots for all but two (walking and moderate intensity activity time) of the outcome measures of interest.

CONCLUSIONS

Overall, self-reported ATLS-2 sedentary and physical activity time had low correlation and agreement with objective Fibion accelerometer measurements in adolescents and young adults in the UAE. Therefore, sedentary and physical activity assessment for these groups should not be limited to self-reported measures.

Behavioral Patterns of Sugary Drink Consumption among African American Adolescents: A Pilot and Feasibility Study Using Ecological Momentary Assessment

BACKGROUND

Sugary drinks (SDs) are the predominant contributors to added sugar intake among adolescents, with the highest intakes reported among African American adolescents. The objective of this pilot study was to examine the feasibility of using mobile phone-based ecological momentary assessment (EMA) to investigate, in real time, behavioral patterns of SD consumption among African American adolescents from low-income households.

METHODS

Adolescents (n = 39, ages 12-17) attended a virtual meeting with a trained research assistant, which involved completion of surveys and training on responding to EMA prompts using a mobile phone application. On the seven subsequent days, adolescents were instructed to respond to researcher-initiated prompts three times daily, which queried their SD intake, location, social context, activities, stress, and mood. They were also asked to complete an analogous self-initiated survey each time they consumed SDs.

RESULTS

SD consumption was reported on 219 of 582 (38%) researcher-initiated surveys and on 135 self-initiated SD consumption surveys, for a total of 354 instances of SD intake over the 7-day assessment period. The majority (69%) of the surveys were completed while at home. SD consumption was reported on 37%, 35%, and 41% of researcher-initiated surveys completed at their home, at the home of a friend or family member, or while in transit, respectively.

CONCLUSIONS

These preliminary data indicate that mobile phone-based EMA is feasible for investigating SD intake behaviors among African American youth from low-income households and support the promise of EMA for investigating SD consumption in this population in larger samples of youth.

Intervention Programme Based on Self-Determination Theory to Promote Extracurricular Physical Activity through Physical Education in Primary School: A Study Protocol

Low levels of physical activity (PA) are a concern among students, producing negative physical, health and mental consequences. This study aims to present a protocol intervention in physical education (PE) based on self-determination theory (SDT) to enhance students’ motivation towards performing PA and increasing their PA levels in their leisure time. This protocol is a convenience study with two allocation arms (intervention group versus control group). SDT-based motivational strategies will be carried out and co-created with PE teachers to increase motivation and out-of-school PA levels. Data collection will be conducted three times: before the intervention, after the intervention (four months after baseline) and at the end of the intervention (retention measurement, seven months after baseline). The measures will assess perceived teacher support for PA, motivation towards PA, intention to be physically active, PA levels, engagement in PE and academic performance. Overall, this intervention programme is expected to increase students’ autonomous motivation for PA and their PA levels in their free time. This intervention might encourage teachers to establish strategies and resources to increase their students’ adaptive outcomes.

Effects of Endurance Exercise Intensities on Autonomic and Metabolic Controls in Children with Obesity: A Feasibility Study Employing Online Exercise Training

Exercise is one of the major determinants of a healthy lifestyle, which is particularly important in childhood and serves as a powerful preventive tool. On the other hand, obesity and arterial hypertension rates are increasing in children, representing a huge risk for developing major cardiovascular and metabolic diseases in adult life. Of fundamental importance is the modality and volume of exercise required to obtain benefits. In this feasibility study, we considered a group of obese children, studied before and after a 12-week online exercise training program, and subdivided the participants into two groups considering the volume of exercise performed (above or below 1200 MET·min/week). This threshold level was applied in two different ways: subdivision A considered the total weekly physical activity volume (considering both time spent walking for at least 10 min consecutively and time spent performing structured exercise) and subdivision B considered only the weekly volume of structured exercise. We assessed autonomic and metabolic control and auxological and lifestyle parameters. We observed that the improved volume of structured exercise was associated with reduced arterial pressure percentile only in subdivision B and an improvement in markers of vagal and metabolic control was evident. Moreover, the 12-week online exercise training program, defined considering individual fitness level and progressively adapted as the goal was reached, proved to be sustainable from an economical and organizational point of view.

Water Security Experiences and Water Intake Among Elementary Students at Low-Income Schools: A Cross-Sectional Study

OBJECTIVE

To examine students' experiences of water security at school and how experiences relate to intake of water from different sources of water at school.

DESIGN/METHODS

In this cross-sectional study, 651 students in grades 3 to 5 in 12 low-income public elementary schools in the San Francisco area completed surveys about their daily intake of water from different sources of water at school, experiences of water security including safety, cleanliness, and taste of water at school, and their demographics. Multivariable linear regressions examined associations between students' water security experiences at school and reported intake from different sources of water at school.

RESULTS

Approximately half of students were Latino (56.1%) and had overweight/obesity (50.4%). Most (74.5%) had some negative water security experience at school. Students drank from the school fountain or water bottle filling station a mean of 1.2 times/day (standard deviation [SD] = 1.4), sinks 0.2 times/day (SD = 0.7), tap water dispensers 0.2 times/day (SD = 0.6), and bottled water 0.5 times/day (SD = 1.0). In multivariable linear regression, students with more negative experiences of school water security drank less frequently from fountains (-0.5 times/day, P value < .001), but more frequently from tap water dispensers (0.1 times/day, P value = .040) and sinks (0.1 times/day, P value = .043), compared to students with no negative perceptions.

CONCLUSIONS

On average, students had negative school water security experiences, which decreased their consumption of water from tap water sources. However, relationships between negative water security experiences and reported water intake appeared to be mitigated by water source. Schools should consider installing more appealing water sources to promote water intake.

Self-Perceived Physical Level and Fitness Performance in Children and Adolescents with Inflammatory Bowel Disease

Background: Inflammatory bowel disease (IBD) patients show a higher risk of developing metabolic and cardiovascular diseases due to the presence of systemic low-grade chronic inflammation. Exercise can improve cardiovascular fitness and modulate the inflammatory processes. We evaluated the physical activity (PA) level and the fitness performance of children and adolescents with IBD. Patients and methods: We considered 54 pediatric patients with IBD (14.6 ± 2.2; 22 M), including CD (n = 27) UC (n = 24) and IBD unclassified (n = 3), and 70 healthy children. In all children, the Physical Activity Questionnaire (PAQ-C) and the International Fitness Enjoyment Scale were self-reported and recorded. Results: PAQ-C showed significant difference in PA levels in patients with IBD compared to controls (p < 0.001). A decrease in general fitness (p = 0.003), cardiorespiratory fitness (p = 0.002), strength (p = 0.01), speed agility (p = 0.003), and flexibility (p = 0.01) were also detected between patients and controls. Speed agility was related to age (p = 0.02) and BMI z-score (p = 0.01), and flexibility to BMI z-score (p = 0.05). We noted a correlation between PA levels and physician global assessment (p = 0.021) and activity disease severity (p = 0.025). Conclusions: A poorer PA level and poor physical competence were found in patients with IBD compared to healthy children and adolescents. Monitored exercise could provide multiple benefits at both physical and psychological levels.

Physical Activity and Related Factors in Pre-Adolescent Southern African Children of Diverse Population Groups

Tailored obesity management includes understanding physical activity (PA) and its context, ideally in childhood before the onset of health risk. This cross-sectional study determined, by sex and population, the PA of Southern African pre-adolescent urban primary school children. PA was measured objectively (step count: pedometer) and subjectively (Physical Activity Questionnaire for Older Children [PAQ-C]), taking confounders (phenotype, school-built environment, and socio-economic environment) into account. Body composition was measured with multifrequency bioelectrical impedance analysis (Seca mBCA). PA was adjusted for phenotypic confounders (body size and composition) using multivariate regression. Sex and population differences in PA were determined with two-way ANOVA. Ninety-four healthy pre-adolescents (60% girls, 52% black) with a similar socio-economic status and access to PA participated. Amidst phenotypic differences, average steps/day in girls (10,212) was lower than in boys (11,433) (p = 0.029), and lower in black (9280) than in white (12,258) (p < 0.001) participants. PAQ-C scores (5-point rating) were lower for girls (2.63) than boys (2.92) (p < 0.001) but higher for black (2.89) than white (2.58) (p < 0.001) participants. Objective and subjective measurements were, however, not significantly (r = −0.02; p = 0.876) related and PAQ-C failed to identify reactive changes in the step count. Objectively measured PA of black participants and of girls was consistently lower than for white participants and boys. Target-group specific interventions should therefore be considered.

Making a HIIT: study protocol for assessing the feasibility and effects of co-designing high-intensity interval training workouts with students and teachers

Background

High-intensity interval training (HIIT) is an effective strategy for improving a variety of health outcomes within the school setting. However, there is limited research on the implementation of school-based HIIT interventions and the integration of HIIT within the Health and Physical Education (HPE) curriculum. The aims of the Making a HIIT study are to: 1) describe the methodology and evaluate the feasibility of co-designing HIIT workouts with students and teachers in HPE; 2) determine the effect of co-designed HIIT workouts on cardiorespiratory and muscular fitness, and executive function; 3) understand the effect of co-design on students’ motivation, enjoyment, and self-efficacy towards the workouts; and 4) evaluate the implementation of the intervention.

Methods

Three schools will participate. Within each school, three different groups will be formed from Year 7 and 8 classes: 1) Co-Designers; 2) HIIT Only; and 3) Control. The study will include two phases. In phase one, Group 1 will co-design HIIT workouts as part of the HPE curriculum using an iterative process with the researcher, teacher, and students as collaborators. This process will be evaluated using student discussions, student surveys, and teacher interviews. In phase two, Groups 1 and 2 will use the co-designed 10-minute HIIT workouts in HPE for 8-weeks. Group 3 (control) will continue their regular HPE lessons. All students will participate in cardiorespiratory fitness, muscular fitness, and executive function assessments before and after the HIIT program or control period. Students will complete questionnaires on their motivation, enjoyment, and self-efficacy of the workouts. Differences between groups will be assessed using linear regressions to account for covariates. Heart rate and rating of perceived exertion will be collected during each HIIT session. The implementation will be evaluated using the Framework for Effective Implementation. Ethical approval was granted by the University of Queensland Human Research Ethics Committee and other relevant bodies.

Discussion

This study will be the first to co-design HIIT workouts with teachers and students within the HPE curriculum. As this study relies on co-design, each HIIT workout will differ, which will add variability between HIIT workouts but increase the ecological validity of the study.

Trial registration

ACTRN, ACTRN12622000534785, Registered 5 April 2022 – Retrospectively registered, https://www.anzctr.org.au/ACTRN12622000534785.aspx

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03440-w.

Effects of an Online Supervised Exercise Training in Children with Obesity during the COVID-19 Pandemic

COVID-19 restrictions have dramatically reduced the active lifestyle and physical activity (PA) levels in the whole population, a situation that can contribute to weight gain and to develop obesity. To improve physical fitness (PF) in children with obesity during COVID-19 restrictions, sport specialists started to deliver physical training through tele-exercise. For these reasons, the aim of this study was to evaluate the effects of a 12-week online supervised training program in children with obesity on different PF components and PA levels. We enrolled a total of 40 Caucasian children (9 F/31 M; aged 11 ± 1.9 years) with obesity. The data collection consisted of a series of anthropometric measures, the PAQ-C questionnaire, and PF tests, valid and reliable tools to assess PF in children. We used a Wilcoxon’s t-test and a Student’s t-test, as appropriate, to assess the differences before and after the training protocol. A total of 37 patients completed the training protocol and were considered in the analysis. Our results show an improvement in all the PF tests, a reduction in the BMI z-score, the waist circumference, and in the waist-to-height ratio, and an increased PA level. In conclusion, the results of our study show that an online supervised training program is effective to promote PA, improving PF and reducing the BMI z-score in children with obesity.

Validation of a Parent-Reported Physical Activity Questionnaire by Accelerometry in European Children Aged from 6 to 12 Years Old

Validated physical activity (PA) questionnaires are crucial for collecting information in large epidemiological studies during childhood. Thus, this study analyzed the validity of a parent-reported PA questionnaire based on the Children’s Leisure Activities Study Survey by accelerometry in European children aged from 6 to 12 years old. We used data from 230 children of the Human Early-Life Exposome and Infancia y Medio Ambiente projects. Mean differences between moderate-to-vigorous PA (MVPA) reported by the questionnaire and the accelerometer were calculated (min/day), and its associated factors were explored by multiple robust linear regression. The agreement between methods was examined using a Bland−Altman plot. The concurrent validity of assessing MVPA was analyzed by cohort-adjusted Spearman’s partial correlations. ROC curve analysis was also used to explore the questionnaire’s capability to identify active children based on the World Health Organization guidelines. A moderate correlation was found between parent-reported and accelerometer MVPA (rho = 0.41, p < 0.001). The child’s sex (girl) was statistically associated with the mean MVPA difference between methods. However, this questionnaire accurately identified physically active children (area under the curve = 83.8% and 82.7% for boys and girls, cut-points = 68.6 and 45.4 min/day in MVPA, respectively). Consequently, this questionnaire is suitable for classifying active children in order to monitor public health interventions regarding PA.

Do Physical Fitness and Executive Function Mediate the Relationship between Physical Activity and Academic Achievement? An Examination Using Structural Equation Modelling

Background: Physical activity health benefits are widely known. However, the association between physical activity, physical fitness, executive function, and academic performance need further investigation. Additionally, one of the literature gaps reveals scarce and mixed findings on what mediators of physical activity may affect academic achievement. Purpose: This investigation aims to provide knowledge about the mediation role of physical fitness and executive function in the association of physical activity with academic achievement in a cohort of Spanish schoolchildren using a structural equation modelling approach. Methods: The data for this cross-sectional study were collected from a convenience sample of children from Spain (Balearic Islands) aged between 9 and 13 years. Physical activity levels were self-reported with the Physical Activity Questionnaire for Children; physical fitness was assessed using the International Fitness Scale; executive function was assessed with the Trail Making Test, and children’s achievements were collected from the school records. Structural equation modelling was used to explore the relationship between physical activity, physical fitness, executive function, and academic achievement. Findings: Statistically significant positive direct associations were observed between physical activity and physical fitness (β = 0.46, 95% CI [0.29, 0.64]), physical fitness and executive function (β = 0.28, 95% CI [0.04, 0.52]), and executive function and academic achievement (β = 0.46, 95% CI [0.28, 0.65]), while adjusting for the confounding effects of sex and body mass index. Furthermore, indirect associations were observed between physical activity and executive function mediated by physical fitness (β = 0.13, bias-corrected 95% CI [0.02, 0.31]) and between physical fitness and academic achievement through executive function (β = 0.13, bias-corrected 95% CI [0.03, 0.32]). Conclusions: This investigation adds to the literature with evidence supporting the idea that regular PA leads to improvements in physical fitness and may support cognitive skills and academic performance in children.

Balance performance analysis after the COVID-19 quarantine in children aged between 8 and 12 years old: Longitudinal study

BACKGROUND

Corona Virus Disease 2019 (COVID-19) has caused great changes in daily activities, especially in children. In Spain, to avoid infections, a home quarantine was declared, which caused a drastic reduction in daily or weekly physical activity in children.

OBJECTIVE

to analyse the balance performance after the COVID-19-induced quarantine on children's balance, through the use of balance tests, considering the type of sport practiced.

METHODS

an observational and longitudinal study was carried out with a sample size of 150 healthy children (69 boys and 81 girls) with a mean age of 10.02 ± 1.15 years. Postural control was evaluated under different equilibrium conditions before and after the quarantine period. Two data collections using the Gyko system were compared, with a difference of 8 months between them. In addition, the influence of foot type and physical activity was analysed.

RESULTS

After the quarantine, statistically significant differences were found in terms of balance results, which were worse than before (p < 0.05). Postural control was not influenced by the type of sport practiced (i.e., individual, collective and / or not practicing sport), nor by the surface which the test was performed (p > 0.05). Physically active children (i.e., individual and / or collective sport) presented worse results than physically inactive children. A statistically significant impairment in terms of balance was demonstrated in children who performed high and moderate physical activity (p < 0.05).

CONCLUSIONS

After the quarantine period, a significant reduction in balance performance was found in children. The findings suggest that regular physical activity benefits postural control. Loss of balance does not differ in postural stability by the type of sport practised. Postural stability is not influenced by the type of footprint after the period of physical inactivity. Postural control is influenced in children with a great level of physical activity.

The Cut-Off Value for Classifying Active Italian Children Using the Corresponding National Version of the Physical Activity Questionnaire

The present study aimed to determine a cut-off value following the filling in of a questionnaire (PAQ-C-It) to identify active Italian children. One-hundred-twenty-nine primary school children (5 Piedmont schools; 47.3% female; mean age = 10 ± 1 years) wore an accelerometer (Actigraph wGT3X-BT) to objectively quantify individual moderate-to-vigorous physical activity during one week. Afterwards, the PAQ-C-It was filled in by participants. A ROC curve procedure was applied to obtain an active/non-active cut-off point. Spearman’s correlation coefficient was also applied to establish the relationship between the two parameters. According to the ROC analysis, the PAQ-C-It cut-off point value is identifiable at >2.75 to indicate active children (area under the curve = 0.62; standard error = 0.05; p = 0.025; coefficient intervals = 0.518−0.716; sensitivity = 0.592, specificity = 0.382), determining that 65 participants (55%) were non-active (mean PAQ-C-It value = 2.3 ± 0.4; active mean PAQ-C-It value = 3.3 ± 0.4). Spearman’s correlation coefficient results were significant but with a small effect size (rho = 0.214; p = 0.008). In conclusion, the present results suggest that the PAQ-C-It can be cautiously used as tool to practically classify active Italian children because of a non-solid relationship between respective accelerometer data and MVPA daily data.

Skipping breakfast and excess weight among young people: the moderator role of moderate-to-vigorous physical activity

The present study aimed to test whether the daily minutes of moderate-to-vigorous physical activity (MVPA) engaged moderate the relationship between breakfast status and excess weight (i.e., overweight and/or obesity) in a Spanish sample of young people. A cross-sectional study involving a total sample of 2890 Spanish schoolchildren (46% girls) aged 6-17 years (M = 12.3 ± 2.6) was conducted. To determine the habit of having breakfast, a dichotomous item about breakfast status (yes/no) from the Mediterranean Diet Quality Index for children and teenagers (KIDMED) was used. Physical Activity Questionnaire for Older Children and the Physical Activity Questionnaire for Adolescents were fulfilled to offer an estimation of the minutes of MVPA that individuals had in the last seven days. Body mass index (BMI) was converted into z-scores and, therefore, excess weight status (i.e., overweight and/or obesity) was established according to World Health Organization criteria for sex and age. Skipping breakfast was positively related with BMI (z-score) and excess weight. Moderation analyses suggested that daily MVPA minutes moderated the association between skipping breakfast and BMI (boys: β =  - 0.175; girls: β =  - 0.073) or the excess weight (boys: OR = 1.10; CI 95%, 1.02 to 1.07; girls: OR = 1.14; CI 95%, 1.04 to 1.24), meaning that physical activity of sufficient intensity seems to reduce the effect of skipping breakfast on the body weight status of young people.

CONCLUSION

Our results indicate that promotion of having breakfast should be accompanied by daily MVPA, as young participants who have breakfast and with higher daily MVPA seem to be more likely to have no excess weight.

WHAT IS KNOWN

• Some of the well-studied factors associated with childhood obesity have been skipping breakfast and insufficient physical activity. • Some studies have pointed out the association between having breakfast and both body mass index and physical activity level, in isolation.

WHAT IS NEW

• Daily minutes of moderate-to-vigorous physical activity moderate the association between skipping breakfast and excess weight. • Breakfast promotion as a healthy eating habit should be accompanied by increases in moderate-to-vigorous physical activity, since participants who have breakfast and with higher moderate-to-vigorous physical activity seem to be more likely to have no excess weight.

The Effect of Incorporating an Exergame Application in a Multidisciplinary Weight Management Program on Physical Activity and Fitness Indices in Children with Overweight and Obesity

Children with overweight/obese (OW/OB) have low physical activity (PA) levels and excessive daily screen times. Although access to personal smartphones may complicate restricting sedentary screen time, these devices may be used to promote PA and improve fitness. Therefore, we aim to examine the impact of incorporating an exergame application (APP) into an existing weight management program on BMI, physical activity, fitness levels, and attitude toward PA among OW/OB children. Seventy-nine children (51% girls), median age 10 years, completed an established 5-month weight management program. The intervention included structured PA sessions (2/week), nutritional, and behavioral counseling. An exergame app was installed on the smartphones of the intervention group (APP, n = 32). BMI, physical fitness, PA level, and attitudes toward PA were assessed before and after the intervention. BMI decreased (p < 0.0001) in both groups by 0.67 kg/m2 (Q1, Q3: −1.36–0.12). There were improvements in more fitness components in the APP group than controls, with significantly greater improvements in aerobic fitness (p = 0.038), speed and agility (p = 0.01), and leg strength endurance (p = 0.05) compared to controls. PA levels increased similarly in both groups during the intervention period. The incorporation of an exergame application leads to more significant improvements in fitness components. These findings support the use of exergame apps to improve fitness in OW/OB children.

The Effect of an 8-Week Aerobic Dance Program on Executive Function in Children

In the current study, we examined the effect of an aerobic dance program as part of physical education (PE) classes on aspects of primary school children's executive functions (EFs) (inhibition, working memory, and cognitive flexibility). Participants were 41 children (21 boys and 20 girls; M age =10.30, SD = 0.50 years, M height = 134.09, SD= 3.9 cm; M weight = 35.61, SD = 7.85 kg) who were divided into an experimental group (EG) and a no-PE control group (CG). The EG followed an aerobic dance intervention as part of their PE program (45 minute sessions two days per week over eight weeks). Participants in both groups performed EF tests before and after the intervention period to evaluate their mental flexibility, inhibition, and working memory. A two-way mixed model repeated measures ANOVA revealed a significant effect of the aerobic dance program on participants' cognitive flexibility (i.e., on Trails Making Tests _B-A times and committed errors) (p <0.001), and on Stroop measures of inhibition (corrected number of words and corrected errors) (p <0.001 and p <0.01, respectively), with post-hoc analyses showing an improved performance by the EG in working memory (digit recall score) from pre-test to post-test and in comparsion to the CG (p < 0.001). Thus, this 8-week aerobic dance program promoted EF development among primary school children.

Self-reported physical activity and lack of association with health-related quality of life in a pediatric solid-organ transplant population

BACKGROUND

Physical activity (PA) has been shown to have benefits, including improving health-related quality of life (HRQOL). However, there are few and conflicting studies assessing PA and its relationship with HRQOL in a pediatric solid-organ transplant (SOT) population. The aim of this study was to assess whether overall HRQOL was associated with PA and to determine whether that association was independent of other baseline and contemporaneous clinical and demographic indicators.

METHODS

A retrospective cross-sectional review was performed on 55 pediatric transplant patients (13 heart, 27 kidney, and 15 liver transplant). PA was measured by PAQ-C/PAQ-A, and HRQOL was measured using PedsQL. Demographics, baseline, and contemporaneous data were collected.

RESULTS

There were no significant differences in baseline and contemporaneous characteristics between heart, kidney, and liver transplant recipients. SOT recipients were 15.0 (11.0-18.0) years old at completion of surveys. Median PAQ score was 2.3 (1.6-3.2), PedsQL total score was 77 (65-91), and PedsQL physical functioning score was 88 (72-97). The PedsQL total score was not significantly associated with PAQ score. The PAQ score was significantly associated with physical functioning subscore of the PedsQL (r = 0.37, p < 0.01). Higher physical functioning score was associated with time since transplant (r = 0.29, p = 0.031).

CONCLUSION

Our SOT cohort has a HRQOL similar to other chronic conditions and higher than previous reported HRQOL in pediatric SOT populations. Higher levels of PA and longer time since transplant are associated with higher physical functioning scores.

Asthma control is not associated with physical activity level in children with asthma during regular follow-up

OBJECTIVE

Engagement in physical activity (PA) is one of the important aims of long-term asthma treatment. The objective of this study is to evaluate whether improvement of asthma control is associated with enhanced PA during regular follow-up in children with asthma.

METHODS

Children, 6-18 years, with asthma were eligible for inclusion when their asthma was uncontrolled at a regular follow-up visit. Participants completed a seven-day recall questionnaire to assess engagement in different physical activities (Physical Activity Questionnaires for Children) at baseline and at the time asthma control was achieved according to predefined criteria. They were also instructed to wear an accelerometer (Actigraph^TM GT1M) for seven consecutive days at these timepoints.

RESULTS

Thirty children (21 boys), aged 10.5 (2.9) years, with uncontrolled asthma were included. After a median (IQR) follow up time of 163 (94-253) days PA was assessed again. Accelerometer obtained moderate vigorous PA (median (IQR) 56 (43-66) versus 53 (35-63) minutes) as well as self-reported PA (median (IQR) PAQ score 7.4 (5.9-10.1) versus 7.2 (6.5-11.0)) were not significantly different at the time of uncontrolled and controlled asthma. Moderate vigorous PA increased in 46.2%, was comparable in 23.1%, and decreased in 30.7% of patients, respectively. Self-reported PA increased in 19.0%, was comparable in 52.4%, and decreased in 28.6% of patients, respectively.

CONCLUSIONS

Based on the results of this study we conclude that asthma control is not associated with self-reported and accelerometer obtained level of physical activity during regular follow-up in children with asthma.

Can the Childhood Physical Activity Questionnaire Be Used to Identify Physical Activity Levels in Children With Asthma?

Objective: Children with asthma who are physically active have a better quality of life, emphasizing the importance of activity monitoring and promotion in daily life. The validity of self-reported activity measurements has been questioned in pediatric populations. In this study, we aim to compare the Physical Activity Questionnaire for Children (PAQ-C) with objectively measured PA using accelerometry. Design: In this comparison study, the pooled dataset of two cross-sectional studies was used, which prospectively home-monitored PA using the alternative self-report PAQ-C questionnaire as well as with the criterion standard accelerometry (Actigraph wGT3X-BT and GT1M). Participants:Ninety children with pediatrician-diagnosed asthma participated in the study. Main Outcome Measures:Correlation coefficients were calculated to determine the relation between the PAQ-C and accelerometer data. The predictive value of the PAQ-C in differentiating between achieving and failing the recommended daily level of moderate-to-vigorous activity (MVPA) was evaluated with receiver operator characteristic (ROC) analysis. Results: The results showed weak to moderate correlations of the PAQ-C with the accelerometer data (r = 0.29-0.47). A PAQ-C cutoff of 3.09 showed the best performance on predicting whether the recommended level of MVPA was achieved. With this cutoff, 21 of the 39 children that did achieve their daily MVPA level (53.8% sensitivity) and 33 of the 46 children that did fail their daily MVPA level (71.7% specificity) were correctly classified. A PAQ-C score of 3.5 revealed a negative predictive value of 100% for assessing physical inactivity. Conclusion: This study revealed a weak relation between the PAQ-C and PA assessed with accelerometry. However, a PAQ-C score of 3.5 or higher might be used as a low-cost and easy-to-use PA screening tool for ruling out physical inactivity in a portion of the pediatric asthma population. Clinical Trial Registration: Netherlands Trial Register: Trial NL6087.

Results of the Italian project 'GiochiAMO' to improve nutrition and PA among children

BACKGROUND

Prevalence of overweight and obesity during childhood is still elevated in high-income countries. GiochiAMO is a health promotion program that uses knowledge-based education and games to teach healthy nutrition and physical activity among children (6-8 years old).

METHODS

This study was a single arm field trial. Second and third grade classes of primary school attended an oral presentation about nutrition and physical activity and then were involved in three game sessions. Two multiple-choice questionnaires were administered at the beginning and at the end of the trail. The following scores were measured: nutrition behavior score (NTs), physical activity behavior score (PAs) and delta score (Ds). Wilcoxon, T-test and Mann Whitney were used to perform the univariate analysis.

RESULTS

A total number of 74 and 76 children participated in the physical activity and nutrition interventions. NTs was 4.17 (SD: 2.23) before and 5.03 (SD: 2.79) after the intervention (P = 0.005). PAs was 27.4 (SD: 9.6) before and 30.5 (SD: 10.7) after the intervention (P = 0.003). No significant differences were obtained comparing males and females for all scores. Ds was 0.86 for nutrition and 3.1 for physical activity. Univariate analysis of Delta scores obtained no significant differences.

CONCLUSIONS

The present results confirm the effectiveness of 'GiochiAMO' to change nutrition and physical activity behavior.

Validity, reliability, and calibration of the physical activity unit 7 item screener (PAU-7S) at population scale

BACKGROUND

Validation of self-reported tools, such as physical activity (PA) questionnaires, is crucial. The aim of this study was to determine test-retest reliability, internal consistency, and the concurrent, construct, and predictive validity of the short semi-quantitative Physical Activity Unit 7 item Screener (PAU-7S), using accelerometry as the reference measurement. The effect of linear calibration on PAU-7S validity was tested.

METHODS

A randomized sample of 321 healthy children aged 8-16 years (149 boys, 172 girls) from the nationwide representative PASOS study completed the PAU-7S before and after wearing an accelerometer for at least 7 consecutive days. Weight, height, and waist circumference were measured. Cronbach alpha was calculated for internal consistency. Test-retest reliability was determined by intra-class correlation (ICC). Concurrent validity was assessed by ICC and Spearman correlation coefficient between moderate to vigorous PA (MVPA) derived by the PAU-7S and by accelerometer. Concordance between both methods was analyzed by absolute agreement, weighted kappa, and Bland-Altman statistics. Multiple linear regression models were fitted for construct validity and predictive validity was determined by leave-one-out cross-validation.

RESULTS

The PAU-7S overestimated MVPA by 18%, compared to accelerometers (106.5 ± 77.0 vs 95.2 ± 33.2 min/day, respectively). A Cronbach alpha of 0.76 showed an acceptable internal consistency of the PAU-7S. Test-retest reliability was good (ICC 0.71 p < 0.001). Spearman correlation and ICC coefficients of MVPA derived by the PAU-7S and accelerometers increased from 0.31 to 0.62 and 0.20 to 0.62, respectively, after calibration of the PAU-7S. Between-methods concordance improved from a weighted kappa of 0.24 to 0.50 after calibration. A slight reduction in ICC, from 0.62 to 0.60, yielded good predictive validity. Multiple linear regression models showed an inverse association of MVPA with standardized body mass index (β - 0.162; p < 0.077) and waist to height ratio (β - 0.010; p < 0.014). All validity dimensions were somewhat stronger in boys compared to girls.

CONCLUSION

The PAU-7S shows a good test-retest reliability and acceptable internal consistency. All dimensions of validity increased from poor/fair to moderate/good after calibration. The PAU-7S is a valid instrument for measuring MVPA in children and adolescents.

TRIAL REGISTRATION

Trial registration number ISRCTN34251612 .

Description and comparison of physical activity from self-reports and accelerometry among primary school children in Kilimanjaro, Tanzania: a pilot study

Background: Self-reports are commonly used to assess physical activity in children. Existing self-reports for physical activity have not been validated for primary school children in Tanzania. To understand if primary school children can accurately report their physical activity, we examined the validity of self-reported physical activity against accelerometer measured physical activity. Methods: A community-based cross-sectional study was conducted from May to July 2018. We conveniently selected four primary schools in Moshi municipal and Moshi rural districts in Kilimanjaro, Tanzania. From these districts, 51 children aged 9 - 11 years were randomly selected. A self-reported questionnaire was used to collect physical activity-related variables. Children wore accelerometers for seven consecutive days to capture physical activity movements. Spearman's rank test and Bland Altman plots were used for assessing validity and agreement between self-reports and accelerometer moderate to vigorous physical activity (MVPA). Results: The study participants' mean age was 10 (SD=0.8) years, and 32 (63%) were girls. A significant positive correlation was found between self-reports and accelerometer MVPA (rho=0.36, p=0.009). The mean total of weekday minutes in MVPA from accelerometers was higher than from self-reports, 408 (SD = 66) versus 261 (SD = 179). Conclusions: This study found a significant positive correlation between self-reports and accelerometers. Self-reports are prone to errors due to recall bias, which interferes with their validity. More research is needed to develop better self-reported measures with specific activities that children can easily remember. Also, researchers should carefully consider the inherent limitations in the validity of self-reports.

Description and comparison of physical activity from self-reports and accelerometry among primary school children in Kilimanjaro, Tanzania: a pilot study

Background: Self-reports are commonly used to assess physical activity in children. Existing self-reports for physical activity have not been validated for primary school children in Tanzania. To understand if primary school children can accurately report their physical activity, we examined the validity of self-reported physical activity against accelerometer measured physical activity. Methods: A community-based cross-sectional study was conducted from May to July 2018. We conveniently selected four primary schools in Moshi municipal and Moshi rural districts in Kilimanjaro, Tanzania. From these districts, 51 children aged 9 - 11 years were randomly selected. A self-reported questionnaire was used to collect physical activity-related variables. Children wore accelerometers for seven consecutive days to capture physical activity movements. Spearman's rank test and Bland Altman plots were used for assessing validity and agreement between self-reports and accelerometer moderate to vigorous physical activity (MVPA). Results: The study participants' mean age was 10 (SD=0.8) years, and 32 (63%) were girls. A significant positive correlation was found between self-reports and accelerometer MVPA (rho=0.36, p=0.009). The mean total of weekday minutes in MVPA from accelerometers was higher than from self-reports, 408 (SD = 66) versus 261 (SD = 179). Conclusions: This study found a significant positive correlation between self-reports and accelerometers. Self-reports are prone to errors due to recall bias, which interferes with their validity. More research is needed to develop better self-reported measures with specific activities that children can easily remember. Also, researchers should carefully consider the inherent limitations in the validity of self-reports.

Subjective versus Objective Measure of Physical Activity: A Systematic Review and Meta-Analysis of the Convergent Validity of the Physical Activity Questionnaire for Children (PAQ-C)

This study aimed to highlight the relationship between moderate-to-vigorous physical activity (MVPA) as assessed by accelerometer devices and the Physical Activity Questionnaire for Children (PAQ-C) to estimate the convergent validity of the questionnaire. A systematic review and a meta-analysis were applied by collecting pertinent studies (PubMed, Web of Science, PsycINFO, and SCOPUS) from 1997 until November 2020. The relationship between PAQ-C and MVPA scores was estimated considering correlation coefficients such as the effect size. Fisher’s transformation was used to convert each correlation coefficient into an approximately normal distribution. The pooled correlations between PAQ-C and MVPA scores were measured by r values after converting the Fisher’s z values back into correlation coefficients for presentation. A total of 13 studies were included in the meta-analysis, and a random effects model was adopted. The pooled correlation between PAQ-C and MVPA scores was significant but with a moderate effect size (r = 0.34 [0.29, 0.39], Z = 15.00, p < 0.001). No heterogeneity among the studies was observed (I² < 25%). In conclusion, the results highlighted a moderate relationship (around 0.30–0.40) between PAQ-C and accelerometer measurements. These results suggested to concurrently administer both tools to reach a more comprehensive description of children’s PA, in terms of quality and quantity.

Description and comparison of physical activity from self-reports and accelerometry among primary school children in Kilimanjaro, Tanzania: a pilot study

Background: Self-reports are commonly used to assess physical activity in children. Existing self-reports for physical activity have not been validated for use among primary school children in, Tanzania. In order to understand if primary school children can accurately report their physical activity, we examined the validity of self-reported physical activity against accelerometer measured physical activity. Methods: A community based cross-sectional study was conducted from May to July, 2018. Four primary schools were conveniently selected in Moshi municipal and Moshi rural districts in Kilimanjaro, Tanzania and from these 51 children aged 9 - 11 years were randomly selected. Self-reported questionnaire was used to collect physical activity related variables. In addition, children wore accelerometers for seven consecutive days to capture physical activity movements. Spearman's rank test and Bland Altman plots were used for assessing validity and agreement between self-reports and accelerometer moderate to vigorous physical activity (MVPA). Results: The mean age of the study participants was 10 (SD=0.8) years and 32 (63%) were girls. A positive significant correlation was found between self-reports and accelerometer MVPA (rho=0.36, p=0.009). Accelerometer had higher mean MVPA 408 (SD = 66) compared to self-reports 261 (SD = 179). Children who reported walking to school had higher MVPA for both accelerometer and self- reports compared to children who use other means of transport to school, e.g. school buses (p < 0.001). Conclusions: This study found a positive significant correlation between self-reports and accelerometers. Self-reports are prone to errors due to recall bias, and this interferes their validity. More research is needed to develop better self-reported measures with specific activities which can easily be recalled by children. Also, researchers have to be aware of self-reports validity limitation.

Adaptation and validation of the Physical Activity Questionnaire for Older Children (PAQ-C) among Czech children

The study aimed to adapt the standardized Physical Activity Questionnaire for Older Children (PAQ-C) into the Czech language and assess its psychometric properties. A forwards-and-backwards translation method was carried out to prepare the Czech PAQ-C version (PAQ-C/CZ), followed by adjustments based on socio-cultural aspects. In the next phase, participants (n = 169) wore accelerometers for seven days. On the 8th day, participants completed the PAQ-C/CZ in school so that it was possible to determine the concurrent validity (correlation between the accelerometer and PAQ-C/CZ data, Spearman’s r), internal consistency (Cronbach’s alpha), item/scale properties (corrected item-total correlations, CITCs), and factor structure (exploratory factor analysis, EFA) for PAQ-C/CZ. In the last phase, participants (n = 63) completed the PAQ-C/CZ twice on two consecutive school days in the morning to determine the test-retest reliability (intraclass correlation coefficient, ICC; independent sample T-test). The PAQ-C/CZ indicated moderate internal consistency (alpha = 0.77), acceptable item/scale properties (CITCs = 0.29–0.61), and good test-retest reliability (ICC = 0.73–0.94). The EFA findings suggested a single factor model (factor load = 0.32–0.73) for PAQ-C/CZ, with items 2, 3, and 4 contributing low to the total score. Results on concurrent validity showed low but significant association (r = 0.28, p < 0.05) between accelerometer and PAQ-C/CZ data. Considering the study results, the PAQ-C/CZ can be recommended as a tool for moderate-to-vigorous physical activity assessment in large-sample research studies only, but with an emphasis on the interpretation of the correct results.

Clustering Patterns of Physical Fitness, Physical Activity, Sedentary, and Dietary Behavior among School Children

Background: Some healthy lifestyle behaviors may have a greater impact on childhood obesity in combination, compared to the independent effects of those behaviors in an isolated manner. The present study aimed to identify the different healthy lifestyle patterns of children according to their physical fitness, physical activity (PA) patterns, screen time, and adherence to the Mediterranean Diet, as well as to examine the association between anthropometric indicators and the membership to a certain cluster. Methods: A final sample of 353 Spanish school children (45.9% females) from the Region of Murcia (Spain) was included in this study (aged 6-13). First, we conducted a hierarchical cluster analysis using Ward's method; based on squared Euclidean distances. Second, we used the k-means cluster analysis to get the final cluster solution. Results: Three different clusters were established: Cluster 1 [high cardiorespiratory fitness (CRF), PA, and Mediterranean Diet], Cluster 2 (low CRF, PA, and Mediterranean Diet + high muscular strength), and Cluster 3 (low physical fitness and PA). Cluster 3 had negative values in all the health-related variables analyzed. Regarding the anthropometric parameters analyzed (BMI, tri-ponderal mass index, waist-to-height ratio, and body fat percentage), Cluster 3 presented the highest values in all anthropometric parameters than the other two clusters (p < 0.001), while Cluster 1 showed the lowest values. Conclusions: The study has identified three clusters respect to health-related variables with the higher prevalence in the cluster established as the unhealthiest lifestyle. Also, cluster classification is associated to obesity indicators such as BMI, tri-ponderal mass index, waist-to-height ratio, and body fat percentage.

Towards a Functional Approach to the Assessment of Daily Life Physical Activity in Children: Are the PAQ-C and Fitbit Flex-2 Technically Adequate?

Considering the need for functional physical activity (PA) measures in PA settings, this study sought to determine the technical adequacy of the Physical Activity Questionnaire for Older Children (PAQ-C) and the Fitbit Flex-2, two instruments with promising features for wide use, using the Actigraph GT3X+ accelerometer as the criterion reference. A total of 218 Greek children (94 boys, 124 girls; mean age = 10.99 ± 1.52 years) volunteered to join in. Participants wore the PA trackers for seven days and completed the PAQ-C. Moreover, a sub-group (n = 60) recompleted the PAQ-C after a week. Results revealed acceptable internal consistency and excellent test-retest reliability for the PAQ-C. Regarding concurrent validity, weak to moderate correlations with PA parameters recorded by the GT3X+ were revealed for the total PAQ-C and were excellent for the Flex-2, while a Bland-Altman plot indicated good agreement. Finally, in alignment with relevant literature, significant gender, but no age, differences were found in participants' PA records in all the tools applied. The above results support the use of the PAQ-C and the Fitbit Flex-2 in children. Considering that they shed light into different parameters of children's habitual PA, their combined utilisation, providing comprehensive information, is strongly recommended.

Relationship Between the Practice of Physical Activity and Physical Fitness in Physical Education Students: The Integrated Regulation As a Mediating Variable

The practice of physical activity (PA) contributes to the prevention of chronic diseases such as obesity, metabolic syndrome or cardiovascular diseases, being also directly related to the individual’s physical fitness. Therefore, it is necessary to measure and monitoring the levels of PA in childhood and adolescence, since it may be useful to describe their current health status and the association with physical fitness, as well as to reveal putative consequences in the future. Within the educational field, it has been shown that physical education (PE) classes are a favorable context for the creation of healthy physical-sports habits and self-determined motivation could be a key for explaining the level of PA practice. For this reason, the purpose of this research was to study the mediating role of integrated regulation (IR) on the relationship between PA and physical fitness in children and adolescents. A total of 325 students between 11 and 14 years old participated in the study. The level of PA was estimated through the specific Physical Activity Questionnaire for Children (PAQ-C), while motivation and IR were measured by using the Perceived Locus of Causality scale (PLOC-2). In addition, physical fitness was measured through the Eurofit fitness battery of tests, composed of three body composition measures and seven tests of different physical capacities. The physical fitness score showed no differences when genders were compared. After regression analysis, the resulting models revealed a good adjustment and correlation between PA practice and physical fitness (β = 0.173; p < 0.001), being established through the macro Process that this relationship is partially conditioned by the IR (β = 0.122; p = 0.03). ROC curve analysis estimated the score of 5.88 as a cut-off point to discriminate between levels of IR for students, classified as physically active or not (AUC = 0.67; p < 0.001). The conclusions from these main and other complementary analyses reporting complete mediations, suggest that the IR could be decisive in predicting and explaining the relationship between the practice of PA and physical fitness at these ages, highlighting its importance for a greater adherence to the practice.

Validation of self-reported physical activity by accelerometry among primary school children in Kilimanjaro, Tanzania: a pilot study

Background: Self-reports are commonly used to assess physical activity in children.  Existing self-reports for physical activity have not been validated for use among primary school children in Kilimanjaro, Tanzania. In order to understand if primary school children can accurately report their physical activity, we examined the validity of self-reported physical activity against accelerometer measured physical activity. Methods: A community based cross-sectional study was conducted from May to July, 2018 among four primary schools in Moshi municipal and Moshi rural districts, Kilimanjaro, Tanzania.  A total of 51 primary school children aged 9-11 years were enrolled using a simple random sampling technique. A self-reported questionnaire was used to collect physical activity related variables. In addition, children wore accelerometers for seven consecutive days to capture physical activity movements. Spearman's rank test and Bland Altman plots were used for assessing validity and agreement between self-reports and accelerometer moderate to vigorous physical activity (MVPA). Results: The mean age of the study participants was 10 (SD=0.8) years. Majority of the study participants were female 32 (63%). A moderate, positive correlation was found between self-reports and accelerometer MVPA (rho=0.36, p=0.009). Accelerometer had higher MVPA compared to self-reports. Children who reported walking to school had higher MVPA for both accelerometer and self- reports compared to children who use other means of transport to school, e.g. school buses (p < 0.001). Conclusions: This study found the moderate positive correlation between self-reports and accelerometers. Self-reports are prone to errors due to recall bias, and this interferes their validity.  More research is needed to develop better self-reported measures with specific activities which can easily be recalled by children. Also, researchers have to be aware of self-reports validity limitation.

Influence of Adiposity on Physical Activity in Schoolchildren: The Moderator Role of Adherence to the Mediterranean Diet

Background: Studies were performed in order to determine the existing relationship between body composition and both physical activity (PA) levels and food habits. Nevertheless, no study has yet examined if the association between adiposity and PA in children is moderated by adherence to the Mediterranean diet (MD). Methods: the cross-sectional and associative analysis involved a total of 370 children (55.1% boys) aged 6–13, from six different schools from the Murcia region of Spain. Results: The different values of moderator [adherence to the MD expressed as a Mediterranean Diet Quality Index (KIDMED) score] are shown by the slope and the different areas of significance. The first area was shown below ≤3.8, indicating that the unfavorable influence of excess of adiposity on PA could be intensified for children in this area. The second area was a significant positive area was shown above ≥9.3, expressing that the unfavorable influence of adiposity could be reduced for those who were above this estimation point. Conclusion: Our findings reveal that the adverse effects of excess adiposity on PA can be moderated by adherence to the MD among schoolchildren.

The Relationship Between Physical Activity and Executive Functions Among Youth in Low-Income Urban Schools in the Northeast and Southwest United States

The purpose of this study was to examine if physical activity is related to greater executive functions among youth in poverty. Executive functions (cognitive flexibility, inhibition, and working memory) and physical activity were measured in participants (N = 149) in the fifth to eighth grade from three schools located in high-poverty districts. Pearson correlations revealed a statistically significant correlation between physical activity and cognitive flexibility (r = .18, p < .05). Hierarchical multiple regressions revealed that physical activity significantly improved prediction for cognitive flexibility, R2 = .09, F(6, 142) = 2.26, p = .041, adjusted R2 = .05, above sex, maturity, and school district. A two-way multivariate analysis of covariance revealed statistically significant differences in working memory in more active youth compared with less active but no statistically significant differences in cognitive flexibility or inhibition (p < .05). Greater physical activity is associated with greater working memory among youth in poverty.

Physical activity and its correlates in a pediatric solid-organ transplant population

PA has been shown to have benefits in SOT patients. Studies assessing physical activity levels and its correlates in a pediatric solid-organ transplant population are limited. The aim of this study was to assess PA levels and identify baseline and contemporaneous factors that contribute to PA in a pediatric SOT population. A retrospective cross-sectional review was performed on 58 pediatric transplant patients (16 heart, 29 kidney, and 13 liver transplant). PA was measured by PAQ-C or PAQ-A. Demographics, baseline, and contemporaneous factors were collected. There were no significant differences in baseline and contemporaneous characteristics between heart, kidney, and liver transplant recipients. SOT recipients were 15.2 [12.3-17.3] years old at time of completing the PAQ. Median PAQ score was 2.2 [1.7-2.9]. There were no significant differences in PAQ scores between organ transplant type or between genders. Lower PAQ score was associated with sensory disability (9 vs 49 without disability; P = <.01) and age at time of completing the PAQ (r = -.50, P = <.01). These results suggest that older age at time of completing the PAQ and presence of sensory disability may influence PA levels in the pediatric SOT population.

Associations of Heart Rate Measures during Physical Education with Academic Performance and Executive Function in Children: A Cross-Sectional Study

The current evidence for a relation between children’s heart rate measures and their academic performance and executive functioning is infancy. Despite several studies observing dose-response effects of physical activity on academic performance and executive function in children, further research using objective measures of the relative intensity of physical activity (e.g., heart rate) is warranted. The present study aimed to inspect associations between heart rate response and various academic performance indicators and executive function domains. A total of 130 schoolchildren between the ages of 9 and 13 years (M = 10.69, SD 0.96 years old; 56.9% boys) participated in a cross-sectional study. Children’s heart rate data were collected through participation in physical education classes using the polar Team^TM hardware and software. One week before heart rate measures, academic performance was obtained from the school records in maths, Spanish language, Catalan language, physical education, and Grade point average. Executive function was measured by two domains, cognitive flexibility with the Trail Making Test and inhibition with the Stroop test. Associations between children’s heart rate data and academic performance and executive function were analyzed using regression models. Academic performance was found to be positively related to four heart rate measures (β range, 0.191 to 0.275; all p < 0.040). Additionally, the hard heart rate intensity level was positively related to two academic indicators (β range, 0.183 to 0.192; all p < 0.044). Three heart rate measures were associated with two cognitive flexibility subdomains (β range, −0.248 to 0.195; all p < 0.043), and three heart rate measures were related to one inhibition subdomain (β range, 0.198 to 0.278; all p < 0.028). The results showed slight associations of heart rate responses during physical education lessons with academic performance but did not clearly indicate associations with executive function. Future experimental studies testing associations between different bouts of intensity levels are needed to disentangle the relationship with brain function during childhood.

Accessing Physical Activity and Health Disparities among Underserved Hispanic Children: The Role of Actual and Perceived Motor Competence

Promoting physical activity (PA) and eliminating health disparities among underserved minority children is a public health priority. The main purpose of this study was to examine the relationship of actual motor competence (a set of object control skills) and perceived motor competence with PA participation and health-related quality of life (HRQoL) among underserved Hispanic children who were born in the U.S. Guided by Stodden et al.’s conceptual model, we tested the direct and indirect effects (mediational model) of actual motor competence on health-related outcomes (PA and HRQoL) through perceived motor competence. Participants were 215 underserved Hispanic children (M_age = 10.55 years, SD = 0.53 [age range 10–12]; 51.6% boys), recruited from four elementary schools in the southwestern U.S., who completed validated questionnaires assessing their perceived motor competence, PA, and HRQoL. Their actual motor skills were assessed using PE Metrics^TM. After examining the associations among the variables, we tested the hypothesized model using structural equation modeling (SEM; AMOS 25). The hypothesized model indicated a good fit (χ²/df = 38.427/24 = 1.60 < 5; non-normed fit index (NFI) = 0.93; comparative fit index (CFI) = 0.968; root mean square error of approximation (RMSEA) = 0.053 [0.016, 0.083]). The effect of actual motor competence on PA and HRQoL was fully mediated by perceived motor competence. The findings demonstrated the mediating role of perceived motor competence between actual motor competence and health-related outcomes (PA and HRQoL) among underserved Hispanic children. The results highlight that actual motor competence significantly predicted underserved Hispanic children’ perceived motor competence, which in turn positively predicted their PA and HRQoL. These findings have significant practical implications for future intervention strategies of randomized clinical trials in schools aimed at promoting PA and HRQoL and eliminating health disparities among underserved Hispanic children.

Development and reliability of questionnaires for the assessment of diet and physical activity behaviors in a multi-country sample in Europe the Feel4Diabetes Study

BACKGROUND

Assessment of diet and physical activity and their determinants still remains a demanding task, especially when the objective is to evaluate the efficacy of lifestyle interventions. In the context of the Feel4Diabetes study (a European community based intervention study in families with school aged children and at high risk of developing diabetes), we aimed to develop questionnaires for the assessment of food-frequency and eating behaviors, and physical activity and sedentary behaviors in both parents and school-aged children and a questionnaire for overall family's energy balance-related behaviors.

METHODS

Questionnaires were developed to be used in 6 countries under standardized harmonization procedures and included questions regarding not only food intake and physical activity, but also questions of their determinants. A reliability study was conducted in 191 pairs of parents and their children (N = 191). Parents completed the questionnaires on two occasions, within a 1-2 week interval. Reliability was tested by the intra-class correlation coefficients (ICC) of test-retest.

RESULTS

Most of the questions in all questionnaires had excellent reliability, assessed as an ICC of > 0.810. Mean ICCs for food-frequency and eating behaviors questionnaires were 0.838 and 0.787, and for physical activity and sedentary behaviors questionnaires were 0.734 and 0.793, in adults and children respectively. Mean ICC for overall family's energy balance-related behaviors and their determinants was 0.659.

CONCLUSION

The developed questionnaires showed acceptable reliability and may be valuable tools in the assessment of children's and parents' behaviors related to diet, physical activity, sedentary behavior and overall energy balance in school- and community-based interventions.

Assessing the effectiveness of a naturally occurring population-level physical activity intervention for children

OBJECTIVES

The aim of the study was to assess the impact of a recreation access pass on grade 5 children's physical activity (PA) levels.

STUDY DESIGN

This is a pre-post evaluation of a population-level community-based intervention.

METHODS

All grade 5 students in (London, Ontario, Canada) were invited to participate in the [ACT-i-Pass] program (G5AP) in May 2014. A total of 643 children completed surveys, that included Physical Activity Questionnaire for Children (PAQ-C), at baseline (October 2014) and 6-month follow-up (April 2015). Difference in the means t-test compared PAQ-C scores between baseline and follow-up for the sample and subgroups. Multiple regression analysis tested associations between change in PAQ-C scores and intrapersonal-, interpersonal-, and physical environment-level variables.

RESULTS

PA increased significantly from baseline to 6-month follow-up. Girls, visible minorities, immigrants, and children with low parental support experienced significant increases in PA. Regression found girls benefitted from the G5AP significantly more than boys, and lower parental support is related to increases in PA.

CONCLUSION

The findings indicate that collaboratively developed, community-based interventions can significantly increase children's PA levels, particularly among subgroups with traditionally lower PA. The pre-post evaluation of this community-based intervention provides useful evidence for developing policies and programs aimed at making population-level improvements in children's PA levels.

An Updated Systematic Review of Childhood Physical Activity Questionnaires

Background and Objective

This review is an update of a previous review published in 2010, and aims to summarize the available studies on the measurement properties of physical activity questionnaires for young people under the age of 18 years.

Methods

Systematic literature searches were carried out using the online PubMed, EMBASE, and SPORTDiscus databases up to 2018. Articles had to evaluate at least one of the measurement properties of a questionnaire measuring at least the duration or frequency of children’s physical activity, and be published in the English language. The standardized COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used for the quality assessment of the studies.

Results

This review yielded 87 articles on 89 different questionnaires. Within the 87 articles, 162 studies were conducted: 103 studies assessed construct validity, 50 assessed test–retest reliability, and nine assessed measurement error. Of these studies, 38% were of poor methodological quality and 49% of fair methodological quality. A questionnaire with acceptable validity was found only for adolescents, i.e., the Greek version of the 3-Day Physical Activity Record. Questionnaires with acceptable test–retest reliability were found in all age categories, i.e., preschoolers, children, and adolescents.

Conclusion

Unfortunately, no questionnaires were identified with conclusive evidence for both acceptable validity and reliability, partly due to the low methodological quality of the studies. This evidence is urgently needed, as current research and practice are using physical activity questionnaires of unknown validity and reliability. Therefore, recommendations for high-quality studies on measurement properties of physical activity questionnaires were formulated in the discussion.

PROSPERO Registration Number

CRD42016038695.

Electronic supplementary material

The online version of this article (10.1007/s40279-018-0987-0) contains supplementary material, which is available to authorized users.

Enhancing Children's Motor Memory Retention Through Acute Intense Exercise: Effects of Different Exercise Durations

Physical exercise has been proposed as a viable means to stimulate motor learning. Exercise characteristics, including intensity and duration, may play a role in modulating the exercise effect on motor learning. While some evidence exists regarding the benefits of intense and relatively long exercise, little is known about the effect of short exercise bouts on motor learning, especially in children. This study aimed to assess the effect of long versus short intense exercise bouts on the adaptation and consolidation of a rotational visuomotor adaptation task. The participants were 71 healthy children from two sites divided into three groups: long exercise bout (LONG), short exercise bout (SHORT), and no exercise (CON). Children performed a rotated (clockwise 60° rotation) motor task on four different occasions: an adaptation set and 1 h, 24 h, and 7 days delayed retention sets. Exercise bouts were performed prior to the adaptation set. Results showed a group effect during motor adaptation [F(2,68) = 3.160; p = 0.049; η p 2 = 0.087], but no statistical differences were found between groups. Regarding retention tests, both exercise groups (LONG and SHORT) showed superior retention compared to CON group [F(2,68) = 7.102; p = 0.002; η p 2 = 0.175]. No differences were found between exercise groups, indicating similar benefits for the two exercise interventions. Overall, whether the exercise duration was long or short, exercise improved motor memory retention as an estimate of memory consolidation process. The use of short exercise bouts may be suitable to improve children's motor memory consolidation in environments where time constraints exist.

Physical activity of children and adolescents with Charcot-Marie-Tooth neuropathies: A cross-sectional case-controlled study

BACKGROUND

Disability related to the progressive and degenerative neuropathies known collectively as Charcot-Marie-Tooth disease (CMT) affects gait and function, increasing with age and influencing physical activity in adults with CMT. The relationship between CMT-related disability, ambulatory function and physical activity in children and adolescents with CMT is unknown.

METHOD

A cross-sectional case-controlled study of physical activity in 50 children with CMT and age- and gender-matched typically developing (TD) controls [mean age 12.5 (SD 3.9) years]. A 7-day recall questionnaire assessed physical activity; CMT-related disability and gait-related function were measured to explore factors associated with physical activity.

RESULTS

Children with CMT were less active than TD controls (estimated weekly moderate to vigorous physical activity CMT 283.6 (SD 211.6) minutes, TD 315.8 (SD 204.0) minutes; p < 0.001). The children with CMT had moderate disability [CMT Pediatric Scale mean score 17 (SD 8) /44] and reduced ambulatory capacity in a six-minute walk test [CMT 507.7 (SD 137.3) metres, TD 643.3 (74.6) metres; p < 0.001]. Physical activity correlated with greater disability (ρ = -0.56, p < 0.001) and normalised six-minute walk distance (ρ = 0.74, p < 0.001).

CONCLUSIONS

CMT-related disability affects physical activity and gait-related function in children and adolescents with CMT compared to TD peers. Reduced physical activity adversely affects function across the timespan of childhood and adolescence into adulthood in people with CMT.

A qualitative study examining the validity and comprehensibility of physical activity items: developed and tested in children with juvenile idiopathic arthritis

BACKGROUND

Not all physical activity (PA) questionnaires (PAQ) gather information regarding PA intensity, duration, and modes and only a few were developed specifically for children. We assessed children's comprehensibility of items derived from two published PAQs used in children along with three items designed to ascertain PA intensity in order to assess comprehensibility of items and identify response errors. We modified items to create a new PAQ for children (ASCeND). We hypothesized that children would have comprehension difficulties with some original PAQ items and that ASCeND would be easier to comprehend, and would improve recall and reporting of PA.

METHODS

For this qualitative study, we recruited 30 Swedish children [ages 10-16 years; mean age = 13.0 (SD = 1.8)]; median disease activity score = 4.5 (IQR 2.2-9.0); median disease duration = 5.0 (IQR 2.6-10.8) with juvenile idiopathic arthritis (JIA) from a children's hospital-based rheumatology clinic. We conducted cognitive interviews to identify children's comprehension of PAQ items. Interviews were audiotaped, transcribed, and independently analyzed. In phase one, 10 children were interviewed and items modified based on feedback. In phase two, an additional 20 children were interviewed to gather more feedback and further refine the modified items, to create the ASCeND.

RESULTS

The median interview time was 41 min (IQR 36-56). In phase one, 219 comments were generated regarding directions for recording PA duration, and transportation use, walking, dancing, weight-bearing exercise and cardio fitness. Based on feedback we modified the survey layout, clarified directions and collapsed or defined items to reduce redundancy. In phase two, 95 comments were generated. Most comments related to aerobic fitness and strenuous PA. Children had difficulty recalling total walking and other activities per day. Children used the weather on a particular day, sports practice, or gym schedules to recall time performing activities. The most comments regarding comprehension were generated about the 3-item PA intensity survey, suggesting children had problems responding to intensity items.

CONCLUSIONS

The newer layout facilitated recall of directions or efficiency in answering items. The 3-item intensity survey was difficult to answer. Sports-specific items helped children more accurately recall the amount of daily PA. The ASCeND appeared to be easy to answer and to comprehend.

Reliability and validity of the Turkish version of the Physical Activity Questionnaire for Older Children (PAQ-C)

Background/aim

The Physical Activity Questionnaire for Older Children (PAQ-C) is one of the most frequently used questionnaires for evaluating moderate to vigorous levels of physical activity in children. However, a Turkish version of the questionnaire was not available. This study aimed to create a Turkish version of the PAQ-C and examine its psychometric characteristics and factor structure.

Materials and methods

The study was conducted with 784 primary school students (ages 9–14 years). The PAQ-C was examined for content and construct validity and analyzed in terms of reliability. Content validity was evaluated with the content validity index (CVI), construct validity, exploratory factor analysis (EFA) (n = 388), and confirmatory factor analysis (CFA) (n = 396). For reliability analysis, Cronbach’s alpha and the intraclass correlation coefficient (ICC) were calculated. The factor construct was assessed with corrected item total correlations (CITCs).

Results

The CVI for the PAQ-C was 0.95. EFA revealed a two-factor construct of ‘at school’ and ‘extracurricular’. CFA confirmed the two-factor construct. Factor loadings varied between 0.41 and 0.80. Cronbach’s alpha was 0.77 and ICC was 0.91 for the test-retest for the entire sample. All CITCs were >0.20

Conclusion

The PAQ-C is a valid and reliable instrument that can be used for Turkish children

Influence of individual and family factors on physical activity among Saudi girls: a cross-sectional study

BACKGROUND

Physical inactivity is a major public health problem and one of the main causes of noncommunicable diseases among children. The physical activity (PA) of children has been studied extensively in other countries, but not in Saudi Arabia, most especially among school-based girls.

OBJECTIVES

Assess the PA among older Saudi girls (10-15 years old) and determine the influence of various personal and family factors on PA.

DESIGN

Descriptive, cross-sectional study.

SETTING

Primary and middle schools in Riyadh, Saudi Arabia.

SUBJECTS AND METHODS

Using a multi-stage stratified sampling technique, school girls were surveyed using the Physical Activity Questionnaire for Older Children (PAQ-C). Personal and familial factors that influenced PA levels were assessed by multiple regression analysis.

MAIN OUTCOME MEASURES

PA levels of Saudi school girls.

SAMPLE SIZE

464 girls.

RESULTS

The mean (SD) score of the respondents in the PAQ-C was 2.63 (0.57, range=1.27-4.24). The majority of the older children re.ported a moderate level of PA in the last seven days (73.5%), whereas 22.4% and 4.1% of them reported low and high levels of PA, respectively. Employment status of the parents and monthly family income were significant factors that influenced the PA of children.

CONCLUSIONS

The findings reiterate the significance of improving the PA of school girls and the critical role of the family in improving chil.dren's PA. Multisectoral coordination between schools, health agencies, families, and other concerned agencies to plan and implement interventions should help increase the PA of school girls.

LIMITATIONS

The use of self-report may have introduced some levels of social desirability bias. The study was only conducted in a single city.

CONFLICT OF INTEREST

None.

Parental physical activity is associated with objectively measured physical activity in young children in a sex-specific manner: the GECKO Drenthe cohort

Background

Physical activity (PA) is important in combating childhood obesity. Parents, and thus parental PA, could influence PA in young children. We examined whether the time spent at different intensities of PA and the type of parental PA are associated with the PA of children aged 4–7 years, and whether the associations between child-parent pairs were sex-specific.

Methods

All the participants were recruited from the Groningen Expert Center for Kids with Obesity (GECKO) birth cohort (babies born between 1 April 2006 and 1 April 2007 in Drenthe province, the Netherlands) and were aged 4–7 years during measurement. PA in children was measured using the ActiGraph GT3X (worn at least 3 days, ≥10 h per day). PA in parents was assessed using the validated SQUASH questionnaire.

Results

Of the N = 1146 children with valid ActiGraph data and 838 mothers and 814 fathers with valid questionnaire data, 623 child-parent pairs with complete data were analysed. More leisure time PA in mothers was associated with more time spent in moderate-to-vigorous PA (MVPA) in children (Spearman r = 0.079, P < .05). Maternal PA was significantly related to PA in girls, but not boys. More time spent in maternal vigorous PA, in sports activity, and leisure time PA, were all related to higher MVPA in girls (Spearman r = 0.159, r = 0.133 and r = 0.127 respectively, P_all < .05). In fathers, PA levels were predominantly related to PA in sons. High MVPA in fathers was also related to high MVPA in sons (r = 0.132, P < 0.5). Spending more time in light PA was related to more sedentary time and less time in MVPA in sons.

Conclusions

Higher PA in mothers, for instance in leisure activities, is related to higher PA in daughters, and more active fathers are related to more active sons. To support PA in young children, interventions could focus on the PA of the parent of the same sex as the child. Special attention may be needed for families where the parents have sedentary jobs, as children from these families seem to adopt more sedentary behaviour.