Physical Activity Questionnaire for children and adolescents: English norms and cut-off points

Maternal-child overweight relationship, assessment of maternal perception of child weight status and feeding behaviours

BACKGROUND

Parents play a key role in constructing children' behaviours. We studies maternal-child overweight relationship and compared maternal perception of child weight status and feeding behaviours between groups of normal-weight and overweight children.

METHODS

The cross-sectional study was conducted on 192 girls aged 10-13 years and their mothers. They were divided to two groups of overweight (n = 94) and normal-weight (n = 98) children. Anthropometric characteristics were measured for children and mothers. Logistic regression analysis was used to examine the association between child overweight and tertiles of maternal body mass index (BMI). Maternal perception of child's weight status and her engagement in promoting child's healthy behaviours was assessed.

RESULTS

BMI and waist circumference was significantly higher in children (P < 0.001) and mothers (P < 0.01) of overweight compared to normal-weight group. There was a significant relationship between children's overweight and tertiles of maternal BMI, which remained significant after adjusting for potential confounders. Mothers of overweight children were more concerned for their child's overeating and overweight, and for compelling the child to diet to maintain a desirable weight (P < 0.001). In contrast, mothers of normal-weight children restricted sugar-sweetened drinks (P = 0.008), offered fruit and vegetables (P = 0.035), and helped their children to get enough physical activity (P = 0.022) and night sleep (P = 0.001) more than mothers in other group.

CONCLUSIONS

This study showed a strong relationship between children and mothers' overweight. Despite being more concerned about their child weight status, mothers of overweight children reported behaviours which were less encouraging the children for healthy eating and lifestyle than mothers of normal-weight children.

Patient-Reported Outcomes After Surgically Treated Anterior Horn Tears in the Pediatric Discoid Meniscus

Background

As a subset of symptomatic discoid lateral meniscal (DLM) tears, anterior horn (AH) meniscal tears are not well studied in the pediatric population. There are even fewer studies reporting patient-reported outcomes after surgical treatment of AH tears in DLM.

Purpose

To compare reported outcomes after surgical treatment of DLM tears involving the AH versus other locations in pediatric patients.

Study Design

Cohort study; Level of evidence, 3.

Methods

A retrospective review of prospectively collected patient data between 2013 and 2020 was conducted. Patients aged <18 years who underwent arthroscopic treatment of a symptomatic DLM were included. Pathology was classified as tears of the AH or tears not involving the anterior horn (NAH). Demographic data along with patient-reported outcome scores (Pediatric International Knee Documentation Committee [Pedi-IKDC] and Patient Assessment Questionnaire [PAQ]) were collected preoperatively through 24 months of follow-up.

Results

A total of 41 patients were included (median age, 12.9 years; range, 7-17 years; 32% female, 68% male). The mean follow-up time for was 25 months (range, 8-58 months). There were 17 (41%) patients in the AH group and 24 (59%) patients in the NAH group. Of the AH group, 16 (94%) were treated with meniscal repair (vs menisectomy), while 19 (79%) of the NAH group were treated with meniscal repair. All patients achieved significant pre- to postoperative improvement on both the Pedi-IKDC and the PAQ. At 24-month follow-up, there were no differences between the AH and NAH groups on the Pedi-IKDC (92.51 vs 89.72; P = .18) or the PAQ (2.57 vs 2.61; P = .06).

Conclusion

Patients who underwent meniscal repair for AH DLM reported positive postoperative outcomes.

Four-year longitudinal associations of physical activity, waist circumference, and blood pressure in UK adolescents

BACKGROUND

This study assessed the specific influence of physical activity (PA) and waist circumference (WC) on the 4-year growth trajectory of blood pressure in UK high-school students.

METHODS

Four-year longitudinal monitoring of 1501 adolescents was conducted as part of the EoEHHS. Measurements were taken in Grades (G)7, 9, and 11.

RESULTS

Systolic (SBP) and diastolic blood pressure (DBP) increased over the 4-year period (SBP G7 114.6 ± 8.9 mmHg, G9 118.1 ± 9.7 mmHg, G11 122.8 ± 7.8 mmHg; DBP G7 66.7 ± 6.6 mmHg, G9 68.0 ± 6.4 mmHg, G11 70.0 ± 5.2 mmHg). Baseline WC predicted baseline and growth in SBP, but the strongest contribution to SBP came from changes in WC (β = 0.084, p = 0.002). Baseline PAQ-A score (β = -0.822, p = 0.020) and changes in PAQ-A score (β = -0.650, p = 0.019) were associated with smaller increases in DBP over the 4-year measurement period.

CONCLUSIONS

Baseline and change in WC predicted the growth trajectory of SBP, while baseline and change in PA predicted the growth trajectory of DBP. PA and WC have a prognostic value in predicting changes in blood pressure in adolescents. Increasing PA during adolescence could slow the rise in DBP over time. This is meaningful for future hypertension and CVD risk reduction into adulthood.

IMPACT

Hypertension in adolescents is a growing health problem that is often overlooked. Baseline and changes in waist circumference over a 4-year period predicted development of systolic blood pressure, while baseline and changes in physical activity predicted development of diastolic blood pressure. Physical activity and waist circumference have a prognostic value in predicting changes in blood pressure in adolescents and could be valuable in planning programmes to prevent hypertension in similar communities and reduce the risk of future adult hypertension.

Effects of a school-based karate intervention on academic achievement, psychosocial functioning, and physical fitness: A multi-country cluster randomized controlled trial

PURPOSE

To examine the effects of a school-based karate intervention on academic achievement, psychosocial functioning, and physical fitness in children aged 7-8 years.

METHODS

Twenty schools in 5 different European countries (2 second-grade classrooms per school) participated in a cluster randomized controlled trial (Sport at School trial). Participants were assigned to either a control group, which continued with their habitual physical education lessons, or to an intervention group, which replaced these lessons with a 1-year karate intervention (Karate Mind and Movement program). A total of 721 children (344 girls and 377 boys, 7.4 ± 0.5 years old, mean ± SD) completed the study, of which 333 and 388 were assigned to the control group and intervention group, respectively. Outcomes included academic performance (average grade), psychosocial functioning (Strengths and Difficulties Questionnaire for parents), and different markers of physical fitness (cardiorespiratory fitness, balance, and flexibility).

RESULTS

The intervention provided small but significant benefits compared to the control group for academic achievement (d = 0.16; p = 0.003), conduct problems (d = -0.28; p = 0.003), cardiorespiratory fitness (d = 0.36; p < 0.001), and balance (d = 0.24; p = 0.015). There was a trend towards significant benefits for flexibility (d = 0.24; p = 0.056). No significant benefits were observed for other variables, including psychosocial difficulties, emotional symptoms, hyperactivity/inattention, peer problems, or prosocial behaviour (all p > 0.05).

CONCLUSION

A 1-year school-based karate intervention was effective in improving academic achievement, conduct problems, and physical fitness in primary school children. The results support the inclusion of karate during physical education lessons.

Cut-point values for classifying active children and validity and reliability of physical activity questionnaire for children in Morocco

BACKGROUND

The Physical Activity Questionnaire for Children (PAQ-C) is widely used to assess physical activity in populations; however, there is a lack of information about the psychometric properties (validity and reliability) and about the PAQ-C score meaning in populations from low-middle income countries.

AIMS

The aim of this study is to evaluate the reliability and validity of PAQ-C and to determine the cut-point values of PAQ-C using accelerometry as a reference in a group of Moroccan children.

METHODS

In a sample of 171 children and adolescents aged 8 to 14 years, physical activity was assessed with the GT3X + accelerometer and the PAQ-C. PAQ-C was administered for a second time (retest) after 1 week for a subsample (n = 73). Reliability was analyzed by intraclass correlation coefficient (ICC). The PAQ-C was compared against count per minute CPM and moderate to vigorous intensity PA (MVPA) obtained by accelerometry. Receiver operating curve analyses were performed to assess the performance of PAQ-C in identifying MVPA as measured by accelerometry (reference method).

RESULTS

Test-retest reliability was poor with an ICC = (0.48 [0.27; 0.63] for the whole sample, while for the ≥11 year group, the intra-class correlation coefficient was moderate (0.71 [0.42; 0.86]. PAQ-C scores were significantly related to accelerometry-derived metrics of physical activity, CPM (R = 0.29, P < 0.001) and MVPA (R = 0.26, P < 0.001). For the age group ≥11 years, the associations between PAQ-C Scores and CPM and MVPA were stronger, respectively, R = 0.37 (P < 0.001), R = 0.38 (P < 0.0001). We identified that a PAQ-C Score cut-point of 2.33 (95%CI [0.43-0.68]) discriminated adequately between those who met physical activity guidelines and those that did not in the overall sample.

CONCLUSIONS

The PAQ-C is valid and useful to assess population level physical activity in those ≥11 years in Morocco and so might be helpful in population surveillance of physical activity in Moroccan adolescents.

Physical function in children and adolescents pre- and 1-year post-liver transplant

BACKGROUND

Several studies describe poorer motor developmental motor outcomes post-liver transplant (LT) in younger children. Limited studies examine physical function in older children and adolescents pre- and post-LT.

METHODS

Retrospective review of standard of care physical function outcome measures pre- and 1-year post-LT in children ≥6 years at LT. Measures include: 6-minute walk test (6MWT), grip strength, Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) components, Physical Activity Questionnaire (PAQ), and Paediatric Quality of Life Multidimensional Fatigue Scale. Association of medical variables with outcomes was explored.

RESULTS

The study cohort included 23 (8 male, median (interquartile range) age 11.67 (8.25, 13.92) years at LT) participants. Top two primary diagnoses included biliary atresia (30.4%) and fulminant hepatic failure (21.7%). At 1-year post-LT, over one-third (36%) were overweight or obese. Compared with healthy norms, children had significantly lower pre-LT PAQ scores (p = .002), pre- and post-6MWT scores (p < .001) and post-LT BOT-2 strength and agility scores (p < .001). Pre-LT, lower balance scores were associated with abdominal distention/ascites (p = .009) and splenomegaly (p = .017). Lower pre-LT platelet count correlated with poorer balance (r = .532, p = .017) and lower strength and agility scores (r = .446, p = .043). Significant moderate inverse correlations were found between weight/body mass index z-scores and BOT-2 components. Post-LT children continue to demonstrate decreased levels of motor proficiency and functional capacity but report less fatigue and increased physical activity.

CONCLUSIONS

Older children and adolescents undergoing LT are at risk of decreased physical function, highlighting the need for pre- and post-LT rehabilitation to optimize long term outcomes.

Changes in physical activity level of adolescents and its relationship with mental health during regular COVID-19 prevention and control

PURPOSE

This study aimed to analyze the impact of regular prevention and control of COVID-19 on the physical activity level (PAL) of adolescents and the relationship between PAL and mental health.

METHODS

Using the convenience sampling method, two stages of the on-site cross-sectional investigation were conducted in 11 middle schools in Guiyang City in China. There were 1132 participants who completed the Physical Activity Questionnaire for old children (PAQ-C) in October 2020, and 1503 participants who completed the PAQ-C and Mental Health Inventory of Middle-school students (MMHI-60) in October 2021. All participants reported their demographic data. Descriptive, quantitative statistics were used for data analysis. One-way ANOVA was used to explore associations between PAL and mental health.

RESULTS

The results of statistical analysis showed a gradual yearly increase in the PAL of teenagers, and the PAL of male junior middle school students has a significant increase (p < .05); while that of adolescents in Grade 10 significantly decreased (p < .001). There is a statistically significant correlation between adolescents' mental health (except for anxiety) and PAL (p < .05). The overall abnormal rate of mental health was 27.9%; The PAL and the total mean score of mental health had a negative correlation (p < .001). There was a significant difference between mental health scores and corresponding PAL (p < .001). Furthermore, there are statistically significant differences in scores of mental health factors corresponding to varying PAL among junior high school students and male students (p < .05).

CONCLUSIONS

The regular epidemic prevention and control measures had significant adverse effects on the PAL of girls and high school adolescents, especially Grade 10 adolescents. Improving adolescents' PAL can promote their mental health. Interventions based on PAL slightly lower than the level recommended in the physical activity guidelines can bring significant mental health effects.

Differences in Physical Activity Levels between Healthy and Transplanted Children: Who Needs More Tips?

BACKGROUND

Advances in the medical-surgical field have significantly increased the life expectancy of patients undergoing solid organ transplantation but this exposes patients to long-term complications due to chronic therapies and changes in lifestyle. It is known that children affected by pathology tend to be more sedentary and inactivity represents a further risk factor for the onset of non-communicable diseases. The aim of the present study was to compare the lifestyle of two groups of young patients: one group of healthy subjects (HG) and one group of kidney or liver transplant recipients (TG).

METHODS

Patients were asked to complete Physical Activity Questionnaire for Older Children (PAQ-C).

RESULTS

A total of 104 subjects were recruited (50.9% male, mean age 12.8 ± 3.16 years old). No significant differences were observed in the final score between groups when comparing subjects based on health condition (Healthy 2.69 ± 0.65 vs. Transplant Group 2.42 ± 0.88), the intensity of sports activities (Competitive 2.82 ± 0.59 vs. Not Competitive 2.53 ± 0.7) or type of transplant (Liver 2.51 ± 0.91 vs. Kidney 2.16 ± 0.75).

CONCLUSION

The results of this study showed a worrying reality: children are engaged in low levels of physical activity regardless of their health status and in general the level of activity does not reach the recommended values even in the absence of contraindications. So, it is necessary to encourage healthy children to practice more PA and to introduce PA prescriptions for transplanted children to prevent their health from deteriorating due to sedentariness.

Sleep quality, physical activity, screen time, and substance use in children with obesity: associations with obstructive sleep apnea

STUDY OBJECTIVES

The association between obstructive sleep apnea (OSA) and lifestyle habits in children with obesity is largely unknown. This study aimed to determine whether there was an association between lifestyle patterns (sleep quality, physical activity, recreational screen time, and substance use) and OSA presence and severity in children with obesity.

METHODS

This cross-sectional study recruited children with obesity, aged 8-17 years, who were referred to undergo polysomnography. Children completed questionnaires on sleep quality, physical activity, recreational screen time, and substance use. Children also had a diagnostic polysomnography. The association between questionnaire scores and OSA severity, after adjusting for body mass index z-score, age, and sex, was evaluated using negative binomial multiple regression. Correlations were conducted between sleep quality, physical activity, screen time, substance use, and OSA severity.

RESULTS

A total of 100 children were included in the analysis (mean age: 14.3 ± 2.6 years; 44% female; mean body mass index z-score: 2.5 ± 0.4; 65% with OSA). In the adjusted regression analysis, each additional substance-use behavior was associated with a 17% (95% confidence interval: 1%, 36%) increase in OSA severity. Correlations were identified between poorer sleep quality and lower physical activity (r = -.42), poorer sleep quality and more substance-use behaviors (r = .40), and greater physical activity and less substance-use behaviors (r = -.26).

CONCLUSIONS

In children with obesity, more substance-use behaviors were independently associated with greater OSA severity. As there are complex, bidirectional relationships between lifestyle behaviors and OSA severity, interventions need to be comprehensive and multifactorial to ensure successful treatment of OSA and its sequelae in children.

CITATION

Blinder H, Narang I, Chaput J-P, Katz SL; on behalf of the Canadian Sleep and Circadian Network. Sleep quality, physical activity, screen time, and substance use in children with obesity: associations with obstructive sleep apnea. J Clin Sleep Med. 2023;19(3):511-518.

Preliminary Evaluation of Sedentary Lifestyle in Italian Children after Solid Transplant: What Role Could Physical Activity Play in Health? It Is Time to Move

BACKGROUND

Advances in the medical-surgical field have significantly increased survival after solid organ transplantation in the pediatric population. However, these patients are predisposed to the development of long-term complications (e.g., cardiovascular disease). The therapeutic role of physical activity (PA) to counteract these complications is well known. The purpose of the study was to investigate the level of PA in a pediatric population after solid organ transplantation.

METHODS

In the first 4 weeks at the beginning of the school year, the Physical Activity Questionnaire for Older Children and Adolescents was administered to young patients who had previously undergone solid transplants at our institute.

RESULTS

Questionnaires of 49 patients (57.1% female, mean age 13.2 ± 3.5 years) were analyzed and 32.7% of subjects did not perform any exercise during school physical education classes. Only 24% practiced a moderate quantity of exercise in the previous week (2-3 times/week) and 72% engaged in sedentary behaviors during weekends.

CONCLUSIONS

Preliminary data confirmed that young recipients are still far from meeting the minimum indications of the World Health Organization on PA and sedentary behavior. It will be necessary to increase their involvement in PA programs in order not only to increase their life expectancy but also to improve their quality of life.

Parent and child perceptions of physical activity with type 1 diabetes

INTRODUCTION

Type 1 diabetes (T1D) is a lifelong illness that affects over 2500 children in Ireland. Management involves complex daily regimens including frequent blood glucose monitoring, pharmacotherapy, dietary management, and physical activity (PA). PA is an important modifiable lifestyle factor. Unfortunately, children with T1D remain physically inactive. Children with T1D face disease-specific barriers and facilitators to PA engagement. All aspects of T1D management for children are supported or supervised by parents. Thus, the purpose of this study was to examine parents' and children's perceptions of barriers and facilitators to PA engagement.

RESEARCH DESIGN AND METHODS

43 parent and child dyads participated. Parents completed a self-report survey. Children completed a modified version of the Physical Activity Questionnaire for Children (PAQ-C) that explored habitual PA patterns, perceived facilitators and barriers to PA engagement.

RESULTS

21 females, 22 males and their parents (36 mothers, 7 fathers) participated. 69% of males and 90% of females reported that having diabetes did affect their PA participation. 54% of males and 48% of females were insufficiently active based on their total PAQ-C score (<2.9 and <2.7). 53% of parents reported that their children participated in school physical education. 21% of parents reported that their child did not participate in PA outside of the school setting. 23% of parents reported that they did not feel comfortable with their child participating in strenuous PA. A further 30% of parents reported that they only felt comfortable with their child participating in strenuous PA if supervised. 66% of parents reported their child should be more physically active. 83% of parents reported that having T1D did impact their child's PA level.

CONCLUSIONS

This study demonstrates the potential influence of parents' perceptions on PA engagement in children with T1D. Additional education is needed to support the promotion of PA for children with T1D.

24-h movement behaviours in Spanish youth before and after 1-year into the covid-19 pandemic and its relationship to academic performance

Most studies have shown a decline in the adherence to 24-Hour Movement Guidelines because of Covid-19 lockdown. However, there is little evidence regarding changes 1-year after the pandemic in these guidelines and their possible impact on academic performance. The study aims were: (1) to examine the possible changes in 24-Hour Movement Guidelines for youth (i.e., at least 60 min per day of moderate-to-vigorous physical activity, ≤ 2 h per day of recreational screen time, and 9 to 11 h of sleep per day for children and 8 to 10 h for adolescents) before and after 1-year into the Covid-19 pandemic, and (2) to examine the possible changes in the relationship between 24-Hour Movement Behaviours (physical activity, screen time, and sleep duration) and academic performance before and after 1-year into the Covid-19. This is a repeated cross-sectional study in two different samples of young Spanish at different times. Firstly, a total of 844 students (13.12 ± 0.86; 42.7% girls) completed a series of valid and reliable questionnaires about physical activity levels, recreational screen time, sleep duration and academic performance before Covid-19 pandemic (March to June 2018). Secondly, a different sample of 501 students (14.39 ± 1.16; 55.3% girls) completed the same questionnaires 1-year after Covid-19 pandemic (February to March 2021). Adherence to the three 24-Hour Movement Guidelines was significantly lower 1-year after into the Covid-19 pandemic (0.2%) than before the pandemic (3.3%), while adherence to none of these three recommendations was significantly higher 1-year after the Covid-19 pandemic (66.3%) than before the pandemic (28.9%). The positive relationship between physical activity levels and academic performance was no longer significant after 1-year into Covid-19 pandemic (β = − 0.26; p < 0.001). 1-year after Covid-19 pandemic, the relationship between recreational screen time (β = − 0.05; p > 0.05) and sleep duration (β = 0.05; p < 0.001) with academic performance did not change compared to pre-pandemic. The results suggest that 24-Hour Movement Behaviours have worsened among young people 1-year after Covid-19 pandemic compared to pre-pandemic period. Moreover, the physical activity benefits associated in terms of academic performance seem to have disappeared because of the Covid-19 pandemic. Therefore, there is a public health problem that requires priority and coordinated action by schools, policy makers, and researchers to mitigate the adverse effects of the pandemic on 24-Hour Movement Behaviours.

Childhood type 1 diabetes is associated with abnormal bone development

OBJECTIVE

To describe bone mineral density (BMD), bone structure, and fracture prevalence in adolescents with type 1 diabetes (T1D) and explore their associations with glycemic control and microvascular complications.

RESEARCH DESIGN AND METHODS

Cross sectional study of 64 adolescents (38 males) with T1D duration >10 years who underwent dual-energy X-ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT), fracture survey, plantar fascia thickness, and microvascular complications assessment.

RESULTS

Mean age was 16.6 ± 2.1 years, diabetes duration 12.8 ± 2.2 years and HbA1c 8.9 ± 1.7% (74 mmol/mol). Fracture prevalence was 50%. DXA areal BMD (Z-score) was reduced for femoral neck (-0.5 ± 1.3, p = 0.008) and arm (-0.4 ± 1.0, p < 0.001), while total areal BMD and lumbar spine BMD were normal. In pQCT (Z-score), trabecular volumetric BMD (vBMD) was reduced for tibia (-0.4 ± 0.8, p < 0.001) and radius (-0.8 ± 1.4, p < 0.001) whereas cortical vBMD was increased at both sites (tibia: 0.5 ± 0.6, p < 0.001, radius: 0.7 ± 1.5, p < 0.001). Muscle cross-sectional area (CSA) was reduced for upper (-0.6 ± 1.2, p < 0.001) and lower (-0.4 ± 0.7, p < 0.001) limbs. DXA total areal BMD was positively correlated with BMI (p < 0.01) and age at T1D diagnosis (p = 0.04). Lower radial bone CSA, total and lumbar spine BMD were associated with autonomic nerve dysfunction. HbA1c, diabetes duration, fracture history and other microvascular complications were not significantly associated with bone parameters.

CONCLUSIONS

Adolescents with childhood-onset T1D have site-specific bone deficits in upper and lower limbs but normal total and lumbar spine BMD. T1D appears to have differential effects on trabecular and cortical bone compartments. Future longitudinal analysis is warranted to examine whether these changes translate in to increased fracture risk.

Physical activity across days of week, video games, and laptop use are more likely to influence weight gain among Saudi Youth

Purpose

The purpose of this study was to determine the extent and prevalence of daily PA and the sedentary behavior during inactive spare-time among young Saudis and their effect on overweight and obesity.

Methods

A total of 357 students completed all stages of this study. They included 282 boys aged 11.95 ± 0.73 years (213 children aged 11.62 ± 0.506 years and 69 adolescents aged 13.16 ± 0.373 years) and 75 girls (16 children aged 11.94 ± 0.236 years and 59 adolescents aged 13.47 ± 0.626 years). For each participant, height and weight were measured, and BMI was calculated. A questionnaire asking about daily PA and sedentary habits during the previous 7 days was also used. Multiple comparisons were performed to test for differences between groups by sex and age category, and stepwise multiple regression analysis was used to determine which variables significantly affected BMI.

Results

The overall prevalence of overweight and obesity was 17.02 and 28.37% in boys and 9.33 and 0% in girls, respectively. The patterns of PA were changing within elements and between sexes. Both groups of boys were more active than girls during breakfast and lunch periods (p < 0.001 for all). A significant difference in favor of boys was also observed between the two groups of boys and the group of adolescent girls regarding after-school physical activity (p < 0.05 for all). Prepubescent boys reported being generally less active during the previous 7 days than their female counterparts and adolescent peers. Sedentary behaviors did not differ between all groups. Playing video games and using laptops were the parameters significantly associated with BMI.

Conclusions

This study noted that the prevalence of overweight and obesity was more pronounced in boys than in girls. However, boys were more active but had the same degree of sedentary behavior as girls. Physical activity across the days of weekly, video games, and laptop use were the parameters that most affected BMI.

Individual responsiveness to a school-based karate intervention: An ancillary analysis of a randomized controlled trial

INTRODUCTION

School-based sport interventions have shown beneficial effects on psychosocial functioning and academic performance in children. However, the inter-individual variability in response to these types of interventions remains unclear. We aimed to determine which children benefit most from a school-based sport intervention.

METHODS

This is an ancillary analysis of a randomized controlled trial assessing the effects of a 1-year school-based karate intervention (versus "traditional" physical education lessons) in children (7-8 years) from twenty schools across five European countries. Outcomes included psychosocial functioning (Strengths and Difficulties Questionnaire [SDQ] for parents) and academic performance (grade point average). Only participants of the intervention group were included in the present ancillary analysis, and were categorized as responders or non-responders for the analyzed outcomes attending to whether improvements surpassed a minimal clinically important difference.

RESULTS

About 388 children (187 girls) from the intervention group completed the study, of which 17% and 46% were considered responders for SDQ and academic performance, respectively. Responders for the SDQ presented higher SDQ scores (i.e., higher psychosocial difficulties) at baseline than non-responders (p < 0.001). Responders for academic performance were mostly males (p = 0.017), with an older age (p = 0.030), and with worse academic performance (p < 0.001) at baseline compared with non-responders, and tended to present higher SDQ scores (p = 0.055). Responders for one outcome obtained greater benefits from the intervention on the other outcome (e.g., responders for SDQ improved academic performance [p < 0.001] compared with non-responders).

CONCLUSIONS

A school-based sport intervention (karate) seems particularly effective for children with psychosocial difficulties and low academic performance.

Quality of life measures and physical activity in childhood systemic lupus erythematosus

Childhood systemic lupus erythematosus (cSLE) is a life-long disease with significant morbidity and mortality, and with associated significant impact on health-related quality of life (HRQOL). Previous literature supports that physical activity has positive impact on HRQOL in patients with chronic diseases, including cSLE. We sought to describe the physical activity of our patients with cSLE and determine the relationship between physical activity, SLE activity, treatment modalities and HRQOL in cSLE. Children ≤18 years of age with cSLE and their parents were enrolled and completed corresponding child and parent Simple Measure of Impact of Lupus Erythematosus in Youngsters^© reports (cSMILEY^© and pSMILEY^©, respectively), and the Physical Activity Questionnaire for Children (PAQ-C) or Adolescents (PAQ-A). Through retrospective chart review, we assessed the SLE Disease Activity Index (SLEDAI) using the SLEDAI-2K assessment tool. Descriptive statistics as well as Pearson's correlation coefficients were performed with the data obtained. Forty-four children and their parents were enrolled; clinical data, SMILEY^© and PAQ-C or PAQ-A scores of cSLE subjects were evaluated. The most frequently reported physical activity modality was walking (61.3%), with mean frequency of 3.7 ± 1.8 days a week, and a median of 3.5 days a week. Although there was no correlation noted between treatment modalities and PAQ-C/PAQ-A, there was weak correlation between SLEDAI and PAQ-C/PAQ-A (Pearson correlation= 0.2, ρ = 0.1, p = 0.9, n = 44). There was a weak correlation between SMILEY total score and PAQ [cSMILEY^© and PAQ-C/PAQ-A combined cohorts (Pearson correlation = 0.2, ρ = 0.3, p = 0.07, n = 44), and modest correlation between pSMILEY^© scores and PAQ-C/PAQ-A combined cohorts (Pearson correlation = 0.3, ρ = 0.3, p = 0.05, n = 44)]. Our study emphasizes the need for larger samples to understand the prognostic value of activity levels and the extent to which increasing physical activity might be linked to improvements in HRQOL in this vulnerable population.

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.

Physical Activity in Paediatric Long QT Syndrome Patients

Background

Physical activity (PA) is important for cardiovascular health as well as social and emotional well-being of children. Patients with long QT syndrome (LQTS) often face PA restrictions and are often prescribed beta-blockers for disease management. The aim of this study was to determine if PA levels were lower in patients with LQTS compared with healthy controls.

Methods

Participants with LQTS from an inherited arrhythmia clinic completed the Physical Activity Questionnaire for Children and Adolescents (PAQ-C/A) and an exercise stress test. PAQ score (a general measure of PA for youth, unitless) and endurance time were compared with healthy controls.

Results

Twenty-three patients with LQTS completed the PAQ and had an exercise stress test within a year of having completed the PAQ. No difference was observed in PAQ scores between LQTS and control groups (LQTS: 2.3 ± 0.15 vs controls: 2.3 ± 0.18; P = 0.78). There was no effect of age on PA in patients with LQTS (P > 0.05), whereas PA significantly decreased in controls with age (eg, 11-12 vs 17-20 years: 3.2 ± 0.07 vs 1.5 ± 0.08, P = 0.005). Endurance time and heart rate at peak exercise were significantly lower in patients with LQTS compared with controls (11 ± 0.5 vs 15 ± 0.5 minutes, P < 0.0001; 169 ± 5 vs 198 ± 2 beats per minute, P < 0.0001).

Conclusions

Despite guideline recommendations restricting PA, risk of sudden cardiac death, and use of beta-blockers, our cohort of patients with LQTS reported similar PA levels as healthy controls.

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.

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.

Is adherence to 24-Hour Movement Guidelines associated with a higher academic achievement among adolescent males and females?

OBJECTIVES

This study aims to examine the independent and combined associations of 24-Hour Movement Guidelines for physical activity, screen time, and sleep duration with academic achievement in adolescent males and females.

DESIGN

Cross-sectional study.

METHODS

1290 Spanish adolescents (565 females), aged 11 to 16 years (13.06 ± 0.84), participated in this study. Self-reported physical activity, screen time, and sleep duration questionnaires were assessed. Academic achievement was calculated as an average score of the adolescents'' grades in first language (Spanish), first foreign language (English), and mathematics subjects. A multiple linear regression model was used to examine the association between meeting 24-Hour Movement Guidelines and academic achievement. Covariates included age, sex, socioeconomic status, body mass index, and cardiorespiratory fitness.

RESULTS

Not meeting any of the three 24-Hour Movement Guidelines was associated with lower academic achievement in the whole sample (p < 0.001). Meeting physical activity and sleep duration guidelines, both independently and together, was associated with higher academic achievement in the whole sample (p < 0.001). Meeting at least two recommendations was associated with higher academic achievement in males (p < 0.01). However, trend analysis revealed that participants who met two or three recommendations had higher academic achievement compared to those who met one or none of these recommendations (p < 0.05). All these results were similar for males and females.

CONCLUSIONS

Our findings suggest the importance of promoting more than one 24-Hour Movement Guidelines, mainly physical activity and sleep duration, which seems to contribute positively to increased academic performance in adolescents.

Impact of COVID-19 lockdown on glycaemic control and lifestyle changes in children and adolescents with type 1 and type 2 diabetes mellitus

AIMS

Malaysia implemented nationwide lockdown from 18th March till 3rd May 2020 to mitigate the spread of coronavirus disease (COVID-19). This study aimed to examine the impact of the lockdown on glycaemic control and lifestyle changes in children and adolescents with type 1 (T1DM) and 2 diabetes mellitus (T2DM) aged less than 18 years old.

METHODS

In this cross-sectional study, interviews and a standardised questionnaire comparing lifestyle changes before and during the lockdown were performed in follow-up clinic visits after the lockdown. Anthropometry measurements and glycated haemoglobin (HbA1c) values were compared 3 months prior and after the lockdown.

RESULTS

Participants were 93 patients with T1DM (11.08 ± 3.47 years) and 30 patients with T2DM (13.81 ± 2.03 years). Male gender, T2DM and pubertal adolescents were found to have a significant deterioration in glycaemic control. A significant increment of HbA1c was observed in patients with T2DM (8.5 ± 0.40 vs 9.9 ± 0.46%), but not in patients with T1DM (8.6 ± 0.28 vs 8.7 ± 0.33%). Contrarily, there was an improved glycaemic control in pre-pubertal T1DM children likely due to parental supervision during home confinement. Weight and BMI SDS increased in T1DM patients but surprisingly reduced in T2DM patients possibly due to worsening diabetes control. Reduced meal frequency mainly due to skipping breakfast, reduced physical activity level scores, increased screen time and sleep duration were observed in both groups.

CONCLUSIONS

Adverse impact on glycaemic control and lifestyle were seen mostly in patients with T2DM and pubertal adolescent boys.

Effects of a school-based karate intervention on academic achievement, psychosocial functioning, and physical fitness: A multi-country cluster randomized controlled trial

PURPOSE

To examine the effects of a school-based karate intervention on academic achievement, psychosocial functioning, and physical fitness in children aged 7-8 years.

METHODS

Twenty schools in 5 different European countries (2 second-grade classrooms per school) participated in a cluster randomized controlled trial (Sport at School trial). Participants were assigned to either a control group, which continued with their habitual physical education lessons, or to an intervention group, which replaced these lessons with a 1-year karate intervention (Karate Mind and Movement program). A total of 721 children (344 girls and 377 boys, 7.4 ± 0.5 years old, mean ± standard deviation) completed the study, of which 333 and 388 were assigned to the control group and intervention group, respectively. Outcomes included academic performance (average grade), psychosocial functioning (Strengths and Difficulties Questionnaire for parents), and different markers of physical fitness (cardiorespiratory fitness, balance, and flexibility).

RESULTS

The intervention provided small but significant benefits compared to the control group for academic achievement (d = 0.16; p = 0.003), conduct problems (d = -0.28; p = 0.003), cardiorespiratory fitness (d = 0.36; p < 0.001), and balance (d = 0.24; p = 0.015). There was a trend towards significant benefits for flexibility (d = 0.24; p = 0.056). No significant benefits were observed for other variables, including psychosocial difficulties, emotional symptoms, hyperactivity/inattention, peer problems, or prosocial behavior (all p > 0.05).

CONCLUSION

A 1-year school-based karate intervention was effective in improving academic achievement, conduct problems, and physical fitness in primary school children. The results support the inclusion of karate during physical education lessons.

Vitamin D supplementation reduces serum lipids of children with hypertriacylglycerolemia: A randomized, triple-masked, placebo-controlled crossover trial

OBJECTIVES

This study aimed to evaluate the effect of cholecalciferol supplementation on the body composition and metabolic profile of children with hypertriacylglycerolemia.

METHODS

This is a randomized, triple-masked, placebo-controlled, crossover trial of 44 Brazilian children with hypertriacylglycerolemia, age 4 to 11 y. The sample included eutrophic and overweight/obese children according to body mass index for age, with sufficient and insufficient vitamin D basal levels. The intervention lasted 34 wk, with two periods of 12 wk each separated by a 10-wk washout. The two groups, supplemented and placebo, received five drops of cholecalciferol (equivalent to 1000 international unit/d) and five drops of sunflower oil, respectively, daily for 12 wk. Sociodemographic, economic, sunscreen use, percentage of body surface area daily exposed to sun, physical activity, anthropometry (body mass and height), body composition (waist circumference, body fat percentage, fat-free mass, triceps, and subscapular skinfolds), biochemical profile (25-hydroxyvitamin D, fasting glucose, and lipid fractions), blood pressure, and food intake data were collected.

RESULTS

Of the 44 children who concluded the study, 56.80% were female, 54.50% were of brown race, 81.82% had sufficient serum 25-hydroxyvitamin D (≥75 nmol/L), and 50.00% were overweight/obese according to body mass index for age. There was a reduction in serum total cholesterol (P < 0.001), low-density lipoprotein cholesterol (P < 0.001), nonhigh-density lipoprotein cholesterol (P < 0.001), total cholesterol/high-density lipoprotein cholesterol (P = 0.001), and low/high-density lipoprotein cholesterol ratios (P < 0.001) in the supplemented group compared with the placebo group.

CONCLUSIONS

Cholecalciferol supplementation improved the lipid profile of children with hypertriacylglycerolemia without altering body composition.

Vitamin D is not associated with body composition and metabolic profile among Brazilian children with 25-hydroxyvitamin D ≥ 75 nmol/L: A cross-sectional study

BACKGROUND AND AIMS

The association of vitamin D with cardiovascular disease risk factors among children remains inconclusive, and there is a lack of studies that evaluate children with optimal serum 25-hydroxyvitamin D [25(OH)D]. Thus, this study aimed to analyze the relationship between serum 25(OH)D and body composition and metabolic profile among Brazilian children with sufficient serum 25(OH)D.

METHODS AND RESULTS

A cross-sectional study was conducted with 88 Brazilian children aged 4-11 years. Self-reported race, physical activity, anthropometry (body mass and height), body composition (waist circumference, body fat percentage, fat free mass, triceps and subscapular skinfolds), biochemical profile [lipid fractions, fasting glucose and 25(OH)D] and blood pressure data were collected. No difference was found in sex, self-reported race, physical activity, age, anthropometry, body composition, biochemical parameters and blood pressure between children with 25(OH)D 75-99 and ≥ 100 nmol/L. In addition, there was no association between serum vitamin D and body composition and metabolic profile.

CONCLUSIONS

Serum 25(OH)D was not associated with body composition and metabolic profile among Brazilian children with sufficient serum 25(OH)D. Further studies among children with serum levels ≥ 75 nmol/L are needed to confirm this finding.

Rapid component of excess post-exercise oxygen consumption of children of different weight status after playing active video games

BACKGROUND

Excess post-exercise oxygen consumption (EPOC) of children could indicate the potential of an exercise therapy to treat or prevent obesity. However, EPOC as a result of playing active video games (AVG) has been poorly investigated. Therefore, we aimed to investigate the rapid component of EPOC of children with healthy weight and overweight/obesity (according to their BMI percentile) after playing AVGs that feature predominately upper body (UB) and whole-body (WB) movement.

METHODS

Twenty-one children with healthy weight (BMI percentile < 85%) and with overweight/obesity (BMI percentile ≥ 85%) randomly underwent two 10-min AVG sessions (UB and WB). The heart rate (HR), minute ventilation (VE), oxygen consumption (VO2) and carbon dioxide production (VCO2) were recorded during exercise and post-exercise recovery period. For the rapid component of EPOC in each AVG session, measurements were recorded every 15 s for 5-min of post-exercise recovery. The rate of perceived exertion (RPE) was also measured immediately before and after each AVG play.

RESULTS

Children with overweight/obesity had a higher average of absolute VE, VO2, and VCO2 than their healthy-weight counterparts (BMI percentile < 85%; n = 21) during post-exercise recovery. RPE, HR, and HR% were not different between the game sessions and weight groups. Children with overweight/obesity showed a higher absolute VO2 during EPOC than healthy-weight children in both game sessions, but relative VO2 was higher in healthy-weight children during EPOC. No differences were observed for EPOC between UB and WB sessions.

CONCLUSIONS

Children with overweight/obesity had a greater EPOC than healthy-weight children after AVG sessions in terms of absolute oxygen values, whereas healthy-weight children have higher EPOC considering relative VO2 when controlling for body mass. UB and WB AVGs induced a similar EPOC among children with healthy weight and overweight/obesity. As UB and WB AVGs induce the rapid component of EPOC in children regardless their weight status, AVGs could be used as an exercise method to treat and prevent child obesity.

A multi-method exploration into the social networks of young teenagers and their physical activity behavior

Background

There is a need for novel interventions to target inadequate levels of adolescent physical activity behavior. Previous research indicates that better understanding of the processes by which social networks influence physical activity behavior in adolescents may be useful to enhance intervention design.

Methods

This study used a multi-methods approach to aid our understanding about the role of social networks for adolescent physical activity behavior. The quantitative phase of data collection was analyzed using a three-step linear regression model using cross-sectional data from the WiSe study (n = 529 participants, 48.6% female, mean age 14.38 years (SD 0.32)). A demographically reflective sub-sample of schools were invited to take part in the qualitative phase, which involved focus group discussions. Thematic analysis was used to explore findings from the quantitative phase in greater depth, and identify other themes pertaining to the association between social networks and physical activity behavior.

Results

Males’ physical activity behavior was predicted by their friend group (0.46, p = 0.007) whereas females’ physical activity was predicted by their best friend (0.21, p = 0.03). The three main findings that were uncovered by the regression analysis were explored during the qualitative phase: 1) friends have similar physical activity behaviors; 2) friendship social networks may influence differently early adolescent male and female physical activity behavior; 3) popularity and sociability were not associated with physical activity behavior. Two additional themes emerged from the analysis of focus group data: 4) social norms and 5) external factors that may impact the relationship between adolescent physical activity behavior and social networks.

Conclusions

The investigation of the interplay between the findings from each phase of the inquiry indicated that social networks influence in different ways and to different degrees the physical activity of adolescent males and females. In turn, these insights point to the need for a systematic tailoring process for the development and implementation of physical activity behavior interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-10081-0.

Physical activity assessment in children and adolescents with juvenile idiopathic arthritis compared with controls

OBJECTIVE

We aimed to assess physical activity (PA) in children with juvenile idiopathic arthritis (JIA) compared with healthy peers and to determine factors influencing PA level.

METHODS

This was a cross-sectional study of the measured level of PA in children with JIA, compared with age- and gender-matched healthy schoolchildren. PA was estimated using a physical activity questionnaire for children and for adolescents (cPAQ/aPAQ). Disease activity was evaluated with the Juvenile Arthritis Disease Activity Score (JADAS). Functional ability was assessed with the Childhood Health Assessment Questionnaire (CHAQ).

RESULTS

A total of 55 children with JIA and 55 healthy control schoolchildren were included. Children with JIA had significantly lower levels of PA compared with their healthy peers as assessed with the cPAQ/aPAQ (P=0.0121). In total, 76% of the JIA group spent the day sleeping and sitting, which was significantly higher compared with the reference group (P=0.001 and P=0.055, respectively). Low PA level was associated with systemic JIA (P=0.002, OR=2.123), polyarticular JIA with positive rheumatoid factor (P=0.001, OR=2.014), JADAS-27≥6 (P=0.001, OR=2.524), patients undergoing treatment (P=0.001, OR=1.271), and higher CHAQ (P=0.002, OR=2.461).

CONCLUSION

Children with JIA were less physically active than their healthy peers and less active than recommended for general health.

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.

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.

The dose-response association between V̇O2peak and self-reported physical activity in children

BACKGROUND

Previous research into the association between aerobic fitness and physical activity in children is equivocal. However, previous research has always assumed that such an association was linear. This study sought to characterize the dose-response association between physical activity and aerobic fitness and to assess whether this association is linear or curvilinear and varies by sex, age and weight status.

METHODS

Physical activity (assess using the Physical Activity Questionnaire), aerobic fitness (20 m shuttle-run), BMI, screen-time and socio-demographic data were collected at ages 12, 14 and 16 years in (n = 1422) volunteers from 9 English schools. Multilevel-regression modelling was used to analyse the longitudinal data.

RESULTS

The analysis identified a significant inverted "u-shaped" association between VO₂max and PAQ. This relationship remained having controlling for the influences of sex, age and weight status. Daily screen time >4 hours and deprivation were also associated with being less fit (P < 0.01).

CONCLUSIONS

This longitudinal study suggests that the dose-response relationship between PA and aerobic fitness in children is curvilinear. The health benefits of PA are greater in less active children and that sedentary and less active children should be encouraged to engage in PA rather than more active children to increase existing levels of PA.

Modeling the dose-response rate/associations between VO2max and self-reported Physical Activity Questionnaire in children and adolescents

Background

This study sought to explore the dose-response rate/association between aerobic fitness (VO2max) and self-reported physical activity (PA) and to assess whether this association varies by sex, age, and weight status.

Methods

VO2max was assessed using the 20-m shuttle-run test. PA was assessed using the Physical Activity Questionnaire (PAQ) for Adolescents (aged >11 years, PAQ-A) or for Children (aged ≤11 years, PAQ-C). The associations between VO2max and PAQ were analyzed using analysis of covariance (ANCOVA), adopting PAQ and PAQ2 as covariates but allowing the intercepts and slope parameters of PAQ and PAQ2 to vary with the categorical variables sex, age group, and weight status.

Results

ANCOVA identified a curvilinear association between VO2max and PAQ, with positive linear PAQ terms that varied for both sex and weight status but with a negative PAQ2 term of -0.39 (95% confidence interval (CI): -0.57 to -0.21) that was common for all groups in regard to age, sex, and weight status. These curvilinear (inverted U) associations suggest that the benefits of increasing PA (same dose) on VO2max is greater when children report lower levels of PA compared to children who report higher levels of PA. These dose-response rates were also steeper for boys and were steeper for lean children compared to overweight/obese children.

Conclusion

Health practitioners should be aware that encouraging greater PA (same dose) in inactive and underweight children will result in greater gains in VO2max (response) compared with their active and overweight/obese counterparts.

Supporting Our Lifelong Engagement: Mothers and Teens Exercising (SOLE MATES); a feasibility trial

This study aimed to examine the feasibility of the Supporting Our Lifelong Engagement; Mothers and Teens Exercising (SOLE MATES) program. SOLE MATES, a single-arm six-week feasibility trial, comprised six face-to-face sessions. Participants were mothers (n = 27) with daughters (n = 31) aged 12-16 years. Data were collected in Ireland between January 2018 and March 2018. Feasibility benchmarks examined recruitment, data collection, acceptability, resources and participant responses. The primary outcome was daughters' step counts, measured via sealed pedometer for seven consecutive days at baseline and six weeks. Secondary outcomes included mothers' step counts, measures of communication, co-participation in activity, health-related quality of life and parenting practices. Feasibility benchmarks were reached or exceeded, except for retention. Eligibility rates were 93.4%, and baseline activity levels were low. Program content, measures and facilitators were acceptable, demonstrated through a mean score of 4.14 (SD 0.3) on a 5-point Likert Scale. Daily steps increased in mothers (2,875 increase, p = .009) and daughters (1,393 increase, p = .007). Positive feasibility metrics demonstrated the program's appeal. Participant responses for outcome measures also indicated program success. However, the relatively homogenous sample and relatively poor initial participation rate were study limitations. The intervention should be evaluated in a randomized controlled trial.

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.

‘No one ever asked us’: a feasibility study assessing the co-creation of a physical activity programme with adolescent girls

Background:

Globally, the poor activity level of adolescent girls is a public health concern. Little research has involved adolescents in the design of interventions. This study assessed the feasibility of involving girls in the co-creation of an activity programme.

Methods:

Thirty-one students (15–17 years old) were recruited from a post-primary school. The Behaviour Change Wheel guided intervention design, providing insights into participants’ capability, opportunity and motivation for change. Step counts and self-reported physical activity levels were recorded pre- and post-intervention. Feasibility benchmarks assessed recruitment, data collection, acceptability and adherence.

Results:

Activity and educational sessions were delivered for six weeks during physical education class. Average attendance was 87% (benchmark = 80%). Eligibility was 61% (benchmark = 60%). There was a 100% retention rate (benchmark = 90%). All participants ( n = 31) completed baseline measures and 71% ( n = 22) completed post-measures. 54% ( n = 17) of students completed pedometer measurements, with 32% ( n = 10) having complete data. Average daily steps were 13,121 pre-intervention and 14,128 post-intervention ( p > 0.05). Data collection was feasible, receiving a mean score > 4/5 (benchmark > 3.5/5).

Conclusions:

The Behaviour Change Wheel can be used to co-create an activity programme with adolescent girls. Predetermined benchmarks, except for pedometer recordings, were reached or exceeded, providing evidence for the need of a randomised controlled trial to test effectiveness.

Prevalence and correlates of overweight and obesity among school children in an urban district in Ghana

Background

There is limited data on risk factors associated with childhood overweight and obesity in Ghanaian school children. Therefore, the aim of this study was to assess the prevalence of overweight and obesity and associated risk factors in Ghanaian school children.

Methods

Data for this study were obtained from a cross-sectional survey of 543 children aged 8 and 11 years, attending private and public primary schools in the Adentan Municipality of Greater Accra Region, Ghana. Anthropometric, dietary, physical activity, sedentary behaviours, sleep duration and socio-demographic data were collected. BMI-for-age Z-scores were used to classify children as overweight/obesity. Multivariable logistic regressions were used to assess the determinants of overweight and obesity.

Results

The overall prevalence of overweight/obesity was 16.4%. Children living in middle (OR = 1.88; 95% CI = 1.01–3.50) and high socioeconomic status (SES) households (2.58; 1.41–4.70) had increased odds of being overweight or obese compared to those living in low SES household. Attending private school (2.44; 1.39–4.29) and watching television for more than 2 h each day (1.72; 1.05–2.82) were significantly associated with increased likelihood of overweight and obesity. Children who slept for more than 9 h a night (0.53; 0.31–0.88) and walked or cycled to school (0.51; 0.31–0.82) had lower odds of being overweight or obese.

Conclusions

A number of modifiable risk factors were associated with overweight and obesity in this study. Public health strategies to prevent childhood obesity should target reduction in television watching time, promoting active transport to and from school, and increasing sleep duration.

Cross-cultural comparisons of aerobic and muscular fitness in Tanzanian and English youth: An allometric approach

Comparisons of physical fitness measures between children or within group measures over time are potentially confounded by differences in body size. We compared measures of strength (handgrip) and aerobic fitness (running-speed [20m shuttle-run]) of 10.0–15.9 year-olds from Dar es Salaam, Tanzania (n = 977) with schoolchildren from England (n = 1014) matched for age and sex. Differences in fitness were analyzed using general linear models, with allometric scaling for body size (mass and stature) and further adjustments for physical activity. Mean handgrip of Tanzanians was lower than English youth (F = 165.0, P<0.001, η_p² = .079). The difference became trivial when run-speed was scaled for body size (η_p² = .008). Running-speed of the English children was higher than in Tanzanians (F = 16.0, P<0.001, η_p² = .014). Allometric scaling for accentuated this between-county difference in running-speed (η_p² = .019) but when adjusted for physical activity between-country differences in running-speed were trivial (η_p² = .008). These data contradict those studies showing poor muscular fitness in African youth and highlight the need for appropriate scaling techniques to avoid confounding by differences in body size. In contrast to those from rural areas, our sample of contemporary urban Tanzanians were less aerobically fit than European youth. Differences were independent of body size. Lower aerobic fitness of urban Tanzanian youth may be due to reported physical activity levels lower than those of English youth and lower still than previously reported in rural Tanzania.

Prevalence of Overweight and Obesity Among Children and Adolescents With Autism Spectrum Disorder and Associated Risk Factors

Introduction: Prevalence of obesity in Autism Spectrum Disorder (ASD) has been reported to be higher than in the general population. Determining prevalence may help increase awareness of obesity in ASD and potentially lead to initiatives to reduce obesity. In order to understand obesity in ASD children, common risk factors were assessed including physical activity, feeding problems and sleep disturbances. Methods: This is a cross-sectional study performed at the Child Development Center at Universiti Kebangsaan Malaysia Medical Center on 151 ASD children aged 2-18 years. Anthropometric and demographic information were obtained and parents completed three questionnaires; Children Sleep Habits Questionnaire (CSHQ), Physical Activity for Older Children Questionnaire (PAQ-C) and Brief Autism Mealtime Behavior Questionnaire (BAMBI). Results: For ASD children in our sample, the prevalence of overweight (BMI ≥85th to <95th percentiles) was 11.3% and the prevalence of obesity (BMI ≥95th percentile) was 21.9%. The overweight/obese ASD children's median age was higher at 8.5 years (IQR 5.81-10.13) compared to the normal/underweight group of 6.33 years (IQR 4.75-7.7) with a p-value of 0.001. The two groups also differed significantly for maternal BMI and paternal age. The median maternal BMI in the overweight/obese group was 26.05 (IQR 23.35-32.25), statistically significantly higher (p = 0.003) than in the non-overweight/obese group, 24.7 (IQR 21-27.9). The median paternal age of 40 years (IQR 37-44) was statistically significantly higher (p = 0.039) in the overweight/obese group, compared to the median paternal age in the non-overweight/obese group of 38 (IQR 35-42). The male overweight/obese children had median PAQ-C score of 2.44 (IQR 2.00-3.00) vs. 2.89 (IQR 2.35-3.53) in the counterpart group with a p-value of 0.01. Using the multiple linear regression stepwise method, three predictors associated with BMI percentiles reached a statistical level of significance; PAQ-C score in males (p < 0.001), the BAMBI domains of Food Refusal (p = 0.001) and Limited Variety of Food (p = 0.001). Conclusions: The prevalence of obesity and overweight is high among Malaysian ASD children and adolescents. Older child age, high maternal BMI, older paternal age, low physical activity, low likelihood of food refusal and high likelihood of food selectivity were found to be risk factors for high BMI in these children.

Temporal trends in muscular fitness of English 10-year-olds 1998-2014: An allometric approach

OBJECTIVES

To identify temporal trends in muscular fitness of English children using allometric scaling for height and weight to adjust for the influence of body size.

DESIGN

Repeated cross-sectional study.

METHODS

We measured; height, weight, standing broad-jump, handgrip, sit-ups and bent-arm hang in 10-year-old boys and girls from Chelmsford, England in: 2014 (n=306), 2008 (n=304) and 1998 (n=310). Physical activity was (PAQ-C) was assessed in 2008 and 2014. Muscular fitness was allometrically scaled for height and weight. We assessed temporal trends using General Linear Models (fixed factors: wave and sex) and reported effect sizes using partial eta squared (η_P²). We compared percentage change per year 1998-2008 with 2008-2014.

RESULTS

Ten-year-olds in 2014 were taller and heavier than in 2008 and 1998 but there were no differences in BMI. Compared with 2008, physical activity was lower in boys (η_P²=0.012) and girls (η_P²=0.27) assessed in 2014. There were significant main effects of wave for handgrip (η_P²=0.060), sit-ups (η_P²=0.120) and bent-arm hang (η_P²=0.204). Pairwise comparisons showed muscular fitness of both sexes was significantly lower in 2014 than in 1998. From 2008 to 2014 percent change per year in handgrip (1.6%) and sit-ups (3.9%) were greater than for the preceding decade (handgrip 0.6%, sit-ups 2.6%).

CONCLUSIONS

Downward temporal trends in muscular fitness appear independent of secular changes in body size. We found a decrease in self-reported physical activity concurrent with the accelerated declines in fitness from 2008 to 2014. These findings suggest the declines in children are not engaging in physical activities which support development of muscular fitness.

Physical activity experiences in children post-liver transplant: Developing a foundation for rehabilitation interventions

Physical Activity (PA) plays an important role in the physical and psychosocial health of children and is beneficial in the treatment and prevention of comorbidities associated with transplantation. Despite this, PA participation in pediatric liver transplant recipients remains low compared to healthy peers. This qualitative-focused mixed-methods study explored the PA experiences and parental perception of these experiences, including perceived facilitators and barriers to PA in children post-liver transplant. Eighteen participants (9 children [median age 10.8 years] and 9 parents) took part in semi-structured interviews and completed the PedsQL Multidimensional Fatigue Scale and PAQ. Most children reported they were physically active (PAQ median 3.08 [IQR] 2.60-3.51), participating in PA for its enjoyment, regardless of their level of motor proficiency. Levels of fatigue (median 65.28 [IQR] 56.25-90.97) were higher than healthy norms and impacted PA participation in some children. Children and parents perceived PA as central to post-transplant recovery and valued its social and mental health benefits; however, parents struggled with ongoing uncertainty and perceived physical vulnerability of their child. This study indicates the need for continuing PA support and education and provides valuable information for family-centered interventions to increase PA and improve health outcomes in children post-transplant.

Cardiorespiratory fitness and activity explains the obesity-deprivation relationship in children

This study examined the association between obesity and deprivation in English children and whether cardiorespiratory fitness or physical activity (PA) can explain this association. Obesity was assessed using IOTF criteria in 8,398 10-16 year olds. Social deprivation was measured using the Index of Multiple Deprivation (IMD) (subdivided into 3 groups; high, mid and low deprivation). Obesity was analysed using binary logistic regression with stature, age and sex incorporated as confounding variables. Children's fitness levels were assessed using predicted VO2 max (20-metre shuttle run test) and PA was estimated using the PA Questionnaire for Adolescents or Children (PAQ). A strong association was found between obesity and deprivation. When fitness and PA were added to the logistic regression models, increasing levels in both were found to reduce the odds of obesity, although it was only by including fitness into the model that the association between obesity and deprivation disappeared. Including estimated PA into the model was found to be curvilinear. Initial increases in PA increase the odds of obesity. Only by increasing PA to exceed the 71st percentile (PAQ = 3.22) did the odds of being obese start to decline. In order to reduce deprivation inequalities in children's weight-status, health practitioners should focus on increasing cardiorespiratory fitness via physical activity levels in areas of greater deprivation.

[Physical activity patterns of school adolescents: Validity, reliability and percentiles proposal for their evaluation]

Regular physical activity (PA) during childhood and adolescence is important for the prevention of non-communicable diseases and their risk factors.

OBJECTIVES

To validate a questionnaire for measuring patterns of PA, verify the reliability, comparing the levels of PA aligned with chronological and biological age, and to develop percentile curves to assess PA levels depending on biological maturation.

SUBJECTS AND METHOD

Descriptive cross-sectional study was performed on a sample non-probabilistic quota of 3,176 Chilean adolescents (1685 males and 1491 females), with a mean age range from 10.0 to 18.9 years. An analysis was performed on, weight, standing and sitting height. The biological age through the years of peak growth rate and chronological age in years was determined. Body Mass Index was calculated and a survey of PA was applied. The LMS method was used to develop percentiles.

RESULTS

The values for the confirmatory analysis showed saturations between 0.517 and 0.653. The value of adequacy of Kaiser-Meyer-Olkin (KMO) was 0.879 and with 70.8% of the variance explained. The Cronbach alpha values ranged from 0.81 to 0.86. There were differences between the genders when aligned chronological age. There were no differences when aligned by biological age. Percentiles are proposed to classify the PA of adolescents of both genders according to biological age and sex.

CONCLUSION

The questionnaire used was valid and reliable, plus the PA should be evaluated by biological age. These findings led to the development of percentiles to assess PA according to biological age and gender.

The association between food insecurity and academic achievement in Canadian school-aged children

OBJECTIVE

Education is a crucial social determinant of health. Food insecurity can be detrimental to children's academic achievement, potentially perpetuating a cycle of poverty and food insecurity. We aimed to assess the relationship between food insecurity and academic achievement in Canadian school-aged children.

DESIGN

Cross-sectional study of children and parents. Parents completed the short-form Household Food Security Survey Module and questions about income and education level (socio-economic status). Children completed FFQ. Data were prospectively linked to children's performance on standardized exams written one year later. Mixed-effect logistic regression was employed to assess the relationship between food insecurity and likelihood of meeting academic expectations adjusting for socio-economic status, diet quality and potential confounders.

SETTING

Nova Scotia, Canada in 2011-2012.

SUBJECTS

Students (n 4105) in grade 5 (10-11 years; 2167 girls) and their parents.

RESULTS

Low food security was reported by 9·8 % of households; very low food security by 7·1 % of households. Students from low-income households and reporting poor diet quality were less likely to do well in school. Children who lived in households reporting very low food security had 0·65 times the odds (OR=0·65; 95 % CI 0·44, 0·96) of meeting expectations for reading and 0·62 times the odds (OR=0·62; 95 % CI 0·45, 0·86) of meeting expectations for mathematics.

CONCLUSIONS

Very low household insecurity is associated with poor academic achievement among children in Nova Scotia.

Physical activity evaluation in children with congenital heart disease

Significant advances in the management of children with congenital heart disease (CHD) have resulted in marked improvements in survival and life expectancy. Thus, there is an increased emphasis on promoting physical activity to optimise healthy development and long-term cardiovascular health. Evaluation of physical activity levels as part of ongoing clinical care is recommended to facilitate physical activity counselling and/or exercise prescription. Physical activity is a complex health behaviour that is challenging to evaluate. We provide an overview of techniques for measuring physical activity in children with CHD with a focus on how to do this in the clinical context. Accelerometers are devices that objectively assess intensity and duration of physical activity under free living conditions. They enable evaluation against physical activity guidelines, but are costly and require advanced technical expertise. Pedometers are a simple-to-use and cost-effective alternative, but an outcome metric of daily step count limits classification against guidelines. Commercial wearable activity trackers offer an appealing user experience and can provide valid estimates in children. Furthermore, activity trackers enable remote monitoring of physical activity levels, which may facilitate exercise prescription and activity counselling. Questionnaires are the most cost-effective and time-effective method, but recall error in younger children is a consideration. Routine exercise testing in children with CHD provides important insight into functional status but should not be viewed as a proxy measure of habitual physical activity. Understanding the spectrum and role of physical activity measurement tools is important for clinicians focused on optimising cardiovascular health in children with CHD.

Validity and reliability of the Physical Activity Questionnaire for Children (PAQ-C) and Adolescents (PAQ-A) in individuals with congenital heart disease

OBJECTIVE

To assess the criterion validity, internal consistency, reliability and cut-point for the Physical Activity Questionnaire for Children (PAQ-C) and Adolescents (PAQ-A) in children and adolescents with congenital heart disease-a special population at high cardiovascular risk in whom physical activity has not been extensively evaluated.

METHODS

We included 84 participants (13.6±2.9 yrs, 50% female) with simple (37%), moderate (31%), or severe congenital heart disease (27%), as well as cardiac transplant recipients (6%), from BC Children's Hospital, Canada. They completed the PAQ-C (≤11yrs, n = 28) or-A (≥12yrs, n = 56), and also wore a triaxial accelerometer (GT3X+ or GT9X) over the right hip for 7 days (n = 59 met valid wear time criteria).

RESULTS

Median daily moderate-to-vigorous physical activity was 46.9 minutes per day (IQR 31.6-61.8) and 25% met physical activity guidelines defined as ≥60 minutes of moderate-to-vigorous physical activity per day. Median PAQ-score was 2.6 (IQR 1.9-3.0). PAQ-Scores were significantly related to accelerometry-derived metrics of physical activity (rho = 0.44-0.55, all p<0.01) and sedentary behaviour (rho = -0.53, p<0.001). Internal consistency was high (α = 0.837), as was reliability (stability) of PAQ-Scores over a 4-months period (ICC = 0.73, 95%CI 0.55-0.84; p<0.001). We identified that a PAQ-Score cut-point of 2.87 discriminates between those meeting physical guidelines and those that do not in the combined PAQ-C and-A samples (area under the curve = 0.80 (95%CI 0.67-0.92).

CONCLUSION

Validity and reliability of the PAQ in children and adolescents with CHD was comparable to or stronger than previous studies in healthy children. Therefore, the PAQ may be used to estimate general levels of physical activity in children and adolescents with CHD.

The combined impact of diet, physical activity, sleep and screen time on academic achievement: a prospective study of elementary school students in Nova Scotia, Canada

Background

Few studies have investigated the independent associations of lifestyle behaviors (diet, physical activity, sleep, and screen time) and body weight status with academic achievement. Even fewer have investigated the combined effect of these behaviors on academic achievement. We hypothesize that the combined effect of these behaviors will have a higher impact on academic achievement than any behavior alone, or that of body weight status.

Methods

In 2011, 4253 grade 5 (10–11 years old) students and their parents were surveyed about the child’s diet, physical activity, screen time and sleep. Students’ heights and weights were measured by research assistants. Academic achievement was measured using provincial standardized exams in mathematics, reading and writing, and was expressed as ‘meeting’ or ‘not meeting’ expectations as per standardized criterion. Exams were written 1 year following the measurement of lifestyle behaviors. Lifestyle behaviors were measured with self- and parental proxy reports and expressed as meeting recommendations (yes/no) for each behavior. Mixed effects logistic regression models adjusting for demographic confounders and caloric intake were used to determine the independent and combined associations.

Results

Meeting dietary recommendations was associated with increased likelihood of meeting academic expectations for each of math, reading and writing. Meeting recommendations for screen time and sleep was associated with meeting expectations for writing. For all three subjects, meeting additional lifestyle behavior recommendations was associated with higher likelihood of meeting expectations. Children who met 7–9 lifestyle behavior recommendations had greater than three-times the odds of meeting expectations for reading compared to those who met 0–3 recommendations (OR: 3.07, 95% CI: 2.09, 4.51), and 1.47 and 2.77 times the odds of meeting expectations in mathematics and writing, respectively. Body weight status was not associated with academic achievement.

Conclusions

We found that lifestyle behaviors, not body weight status, are strongly associated with student academic performance. Promoting compliance with established healthy lifestyle recommendations could improve both the health and educational outcomes of school-aged children. School-based health promotion initiatives that target multiple lifestyle behaviors may have a greater effect on academic achievement than those that focus on a single behavior.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0476-0) contains supplementary material, which is available to authorized users.

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.