Construct validity and test-retest reliability of the International Fitness Scale (IFIS) in Spanish children aged 9-12 years

Comparison of physical activity and physical fitness in children and adolescents of Chinese Han and Tibet ethnicity

Background

Physical activity (PA) and physical fitness (PF) are important markers of health status in children and adolescents in different ethnicities. In this study, we aimed to compare the PA and PF indicators between Tibetan and Han children and adolescents.

Methods

Children and adolescents of 4-9 grades were recruited in Shigatse (n = 963) and Shanghai (n = 2,525) respectively. The information related to demographic, PA, and PF was collected via a self-reported questionnaire. PA was assessed through the participation of moderate to vigorous PA (MVPA), muscle-strengthening exercise (MSE) and organized sport participation (OSP). PF was estimated using the International Fitness Scale containing components of overall fitness, cardiorespiratory fitness, speed and agility, muscular strength and flexibility.

Results

Han (mean age = 13.45 ± 3.3 years; 49.7% girls) and Tibet (mean age = 13.8 ± 2.5 years; 48.3% girls) children and adolescents from Shanghai and Shigatse completed the questionnaire survey. It was revealed that Tibetan students had higher MVPA, MSE and OSP than children and adolescents of Han ethnicity (p < 0.01, small to medium effect size). A relatively higher percentage of student in Shanghai did not participate in any form of PA. On the other hand, less Tibetan students thought their PF indicators including overall fitness, cardiorespiratory fitness, speed and agility, muscular strength and flexibility were poor or very poor than their counterparts of Han ethnicity (p < 0.01, small to medium effect size).

Conclusion

Tibetan children and adolescents have higher levels of PA and PF in comparison to their Han counterparts. More children and adolescents of Han ethnicity engage in no PA and think their PF indicators were poor.

The International Fitness Scale (IFIS): A valid tool to assess physical fitness in French children

BACKGROUND

The need for monitoring regularly physical fitness in youth is well established for public health issues. The aim of this study was to assess the validity and reliability of the International Fitness Scale questionnaire (IFIS) to assess physical fitness in French children in the school context.

METHODS

A sample of 2 060 children (1054 boys), aged 10.6 ± 0.9 years, participated in the validation study while an independent sample of 366 children (175 boys), aged 9 to 11 years, participated in the assessment of reliability. Physical fitness was measured by a self-report of 5 questions with a 5-point Likert-scale (from very poor to very good) (IFIS), and also measured objectively by 4 field tests: cardiorespiratory fitness, muscular strength, speed/agility and flexibility. For the test-retest reliability assessment, children were instructed to complete the questionnaire twice, 1 week apart.

RESULTS

For all physical fitness components studied, children reporting a good or a very good physical fitness in the IFIS had better results in objective measurements of physical fitness tests compared to children reporting a very poor to an average physical fitness (p<0.001) without or with adjustments for sex, age and weight status. The reliability coefficients were acceptable for all components of physical fitness (0.59-0.72).

CONCLUSIONS

These results suggest that IFIS appears to be a useful instrument for teachers to estimate physical fitness levels of French children, possibly on a large scale.

Comprehensive management of children and adolescents with type 1 diabetes mellitus through personalized physical exercise and education using an mHealth system: The Diactive-1 study protocol

Introduction

The use of new technologies presents an opportunity to promote physical activity, especially among young people with type 1 diabetes (T1DM), who tend to be less active compared to their healthy counterparts. The aim of this study is to investigate the impact of a personalized resistance exercise program, facilitated by the Diactive-1 App, on insulin requirements among children and adolescents diagnosed with T1DM.

Methods and analysis

A minimum of 52 children and adolescents aged 8-18 years, who were diagnosed with T1DM at least 6 months ago, will be randomly assigned to either a group engaging in an individualized resistance exercise program at least 3 times per week over a 24-week period or a waiting-list control group. The primary outcome will be the daily insulin dose requirement. The secondary outcomes will include glycemic control, cardiometabolic profile, body composition, vascular function, physical fitness, 24-hour movement behaviors, diet, and psychological parameters. The usability of the app will also be assessed.

Ethics and dissemination

Ethical approval to conduct this study has been granted by the University Hospital of Navarra Research Board (PI_2020/140). Parents or legal guardians of minors participating in the study will provide written consent, while children and adolescents will sign an assent form to indicate their voluntary agreement. The trial's main findings will be shared through conference presentations, peer-reviewed publications, and communication directly with participating families. This study aims to offer valuable insights into the holistic management of children and adolescents with T1DM by utilizing personalized exercise interventions through an mHealth system.

Trial registration

NCT06048757.

Perceived Quality of Life Is Related to a Healthy Lifestyle and Related Outcomes in Spanish Children and Adolescents: The Physical Activity, Sedentarism, and Obesity in Spanish Study

BACKGROUND

Maintaining a healthy lifestyle is crucial for safeguarding the well-being and quality of life perception, appropriate growth, and development of children and adolescents, while also mitigating the risk of future adult-onset diseases.

OBJECTIVE

To assess associations between perceived quality of life and healthy lifestyle and related outcomes in Spanish children and adolescents.

METHODS

Cross-sectional analysis of 8-16-year-old children and adolescents (n = 3534) were included in the nationwide study of Physical Activity, Sedentarism, and Obesity in Spanish Youth (PASOS). Data were collected through (1) questionnaires on health-related quality of life (HRQoL), healthy lifestyle outcomes (dietary intake, physical fitness, sleep, and screen time), and (2) anthropometric measurements for weight status assessment. Data were analysed by logistic regression, using the health-related quality of life (HRQoL) as the grouping variable.

RESULTS

Participants with a lower HRQoL were those with a lower adherence to the MedDiet and lower achievement of the recommended daily intake of fruit and vegetables. They were also less likely to follow the recommendations for screen time and sleep (with the exception of the weekend) compared to participants with a higher HRQoL. Participants with a lower HRQoL showed a lower healthy weight status and poorer physical fitness than those with a higher HRQoL.

CONCLUSIONS

Healthy eating habits, healthy weight status (normal weight), appropriate sleep time, physical fitness, and limited screen time play a crucial role in the perceived quality of life in children and adolescents.

Associations Between Motor Competence and Physical Activity, Physical Fitness and Psychosocial Characteristics in Adolescents: A Systematic Review and Meta-analysis

BACKGROUND

Motor competence is an integral component of the health and performance of youth. Numerous studies support the hypothesis that motor competence interacts with perceived motor competence and physical fitness during childhood to induce positive (e.g. healthy weight status) or negative (e.g. reduced physical activity engagement) trajectories. Yet, while adolescence is a key period of rapid growth and maturation, no systematic reviews and meta-analyses have examined the association between motor competence and physical activity, physical fitness and psychosocial characteristics solely within adolescents.

OBJECTIVES

This study aimed to (1) analyse the scientific literature evaluating associations between motor competence and physical activity, physical fitness and/or psychosocial characteristics amongst adolescents; (2) evaluate the associations between motor competence and physical activity, physical fitness characteristics and/or psychosocial characteristics amongst adolescents; and (3) investigate the impact of moderator variables (i.e., age, sex, type of motor competence assessment) on the associations.

METHODS

A systematic search of electronic databases was conducted, followed by a qualitative synthesis of study methods. Random-effects meta-analyses were performed to establish the magnitude and orientation of pooled correlation coefficients between motor competence and physical activity, physical fitness and psychosocial characteristics of adolescents, whilst considering potential moderators (i.e., age, sex, type of motor competence assessment).

RESULTS

Sixty-one studies were included, totalling 22,256 adolescents. Twenty-seven different assessments of motor competence were used, with 31 studies utilising product-orientated (i.e. outcome) motor competence assessments. Meta-analyses of 43 studies showed that motor competence was positively associated with physical activity (r = 0.20 to 0.26), some physical fitness characteristics (e.g. muscular strength, cardiovascular endurance; r = 0.03 to 0.60) and psychosocial characteristics (r = 0.07 to 0.34), and inversely associated with weight status (r =  - 0.36 to - 0.10), speed (r =  - 0.31) and agility (r =  - 0.37 to 0.41). Associations with flexibility were unclear.

CONCLUSIONS

The results of this systematic review and meta-analysis support the hypothesised interactions of motor competence with physical activity (positive), physical fitness (positive except for weight status, speed and agility) and psychosocial characteristics (positive) in adolescence. However, methodological approaches vary considerably (e.g. variety of motor competence assessments utilised), with limitations of the current literature including an inadequate assessment of motor competence, a lack of longitudinal observations and a failure to account for biological maturation. Future research assessing associations between motor competence and physical activity, physical fitness and psychosocial characteristics of adolescents should include longitudinal observations of a combined motor competence assessment (i.e. process and product) and account for biological maturation. Improved evaluation using these recommendations could provide more accurate data, leading to more targeted interventions to improve adolescents' physical and psychosocial outcomes.

CLINICAL TRIAL REGISTRATION

CRD42021233441 (PROSPERO ID).

Influence of Parental Perception of Child's Physical Fitness on Body Image Satisfaction in Spanish Preschool Children

It is well known that poor physical fitness is an exponential risk factor in the increase in chronic diseases, not only physical but also psychological. Even in childhood, a critical period of development, the perception of physical fitness plays a fundamental role in the individual's self-concept of body image.

AIM

To find out how self-perceived physical fitness influences self-perceived body image in preschoolers.

METHODS

475 preschool pupils were recruited in the schools of Extremadura (Spain). They were administered a sociodemographic questionnaire, the Preschool Physical Fitness Index (IFIS) and the Preschool Body Scale (PBS).

FINDINGS

Significant correlations (p < 0.05) were observed between body dissatisfaction and perceived physical fitness (IFIS), being higher in girls. In terms of variables, general fitness (<0.001), cardio-respiratory fitness (<0.001), muscular strength (<0.001), speed/agility (<0.001) and balance (<0.001) have a negative, medium and significant association with body dissatisfaction in girls; however, this association was lower in the case of boys.

CONCLUSIONS

The influence of physical fitness had a clear impact on self-perceived body image. With better findings on self-perceived physical fitness variables (IFIS) there was less body dissatisfaction (PBS), especially in the female sex. The results also showed that parents who perceived their children to be in poorer physical condition had higher body dissatisfaction. Therefore, it would be interesting for the context involved, particularly parents, to implement strategies to improve positive body image through the promotion of physical education and physical fitness at an early age.

Analysis of Self-Perceived Physical Fitness of Physical Education Students in Public Schools in Extremadura (Spain)

Adolescence is a stage of crucial physiological and psychological changes within the individual's life cycle, where fitness work is important. With self-perception being crucial in relation to adolescent health and well-being, a positive perception of fitness is directly related to increased practice or higher level of physical activity (PA). Thus, the aims were: (1) to analyze, with the Visual Analogue Fitness Perception Scale for Adolescents (FP VAS A), the self-perceived physical fitness (PF) of high school students, (2) to investigate if there are differences according to sex and school location, and (3) to study the correlations between the items of the FP VAS A with age and body mass index (BMI). For this purpose, a cross-sectional study was designed with a total of 961 participants, 48.8% boys and 51.2% girls in secondary education, where 31.9% studied in rural schools and 68.1% in urban schools. The FP VAS A scale was used to assess self-reported PF. Regarding the results, there were statistically significant differences between sexes (p < 0.001), with boys showing higher scores than girls in all the items of the FP VAS A scale, with the exception of global flexibility. Inverse, mean and significant correlations were established between BMI and self-perceived overall PF (r = -0.202; p < 0.001), cardiorespiratory endurance (r = -0.226; p < 0.001) and movement speed (r = -0.268; p < 0.001). Between age and self-perceived cardiorespiratory endurance (r = -0.138; p < 0.001) an inverse, mean and significant correlation was also observed. In conclusion, boys showed a better self-perception of PF than girls for all physical abilities, with the exception of flexibility. School location was not shown to influence students' self-perceived PF. In addition, most of the self-perceived PF abilities for overall fitness correlated inversely with BMI.

Utility of a Physical Fitness Score in Screening for Chronic Diseases

We developed a new Physical Score (PS) consisting of comprehensive physical fitness indicators and elucidated the association between the resultant PS and metabolic diseases, i.e., diabetes, hypertension, dyslipidemia, fatty liver, and metabolic syndrome (MetS), among Japanese. Analyzed were 49,850 persons (30,039 men) aged 30 to 69 y who underwent physical fitness tests. Principal component analysis was performed on the correlation matrix of the physical fitness test results (relative grip strength, single-leg balance with eyes closed, and forward bending) according to sex and age. We defined the PS as the first principal component score. A formula was developed for various age groups comprised of men and women from 30 to 69 years of age from which the PS for each age and sex was calculated. The PS for both men and women was normally distributed with a value of 0 ± 1.15-1.16. Multivariate logistic regression analysis showed that the risk of metabolic diseases increased approximately 1.1-1.6 times per each 1-point reduction in the PS. The association between PS and MetS was particularly strong in that a 1-point reduction in the PS increased the risk of MetS by 1.54 times (95% confidence interval 1.46 to 1.62) in men and by 1.21 times (1.15 to 1.28) in women. The association between a lower PS and disease risk was stronger in younger men for fatty liver and in older men for MetS. Conversely, in women, the association between a lower PS and disease risk was stronger in older women for fatty liver and in younger women for MetS. For diabetes, hypertension, and dyslipidemia, the change in the impact of PS reductions across age groups was small. The PS is a useful and simple non-invasive tool for screening Japanese people for metabolic diseases.

[Translation and cultural adaptation of the Exercise Fear Avoidance Scale for Chilean older adults]

OBJECTIVE

To translate and culturally adapt the Exercise Fear Avoidance Scale (EFAS) Into Spanish for Chilean older adults.

MATERIALS AND METHODS

Double direct translation with harmonization, back translation and analysis of text comprehensibility through cognitive interviews. A sample of 20 older adults between the ages of 63 and 83 participated in the cognitive interview process.

RESULTS

All items were assessed as clear and understandable. Using the paraphrasing and inquiry techniques, 3 items (out of 16) were adapted to achieve better understanding. Two of these adaptations consisted in replacing one concept with another, as the latter was more used in the Chilean context, and making a non-literal translation, since the literal one was too complex for the elderly to understand.

CONCLUSIONS

A Spanish version of the EFAS was obtained, which proved to be understandable and adapted for its use with Chilean older adults.

Physical Fitness Perception and Physical Education Enjoyment in 11- to 12-Year-Old Children

Childhood motor competence plays a fundamental role in long-term adherence to physical activity. Enjoyment levels and self-perception of physical fitness increase motivation, commitment, and participation in physical activity. The objective of this study was to assess the body mass index (BMI), weight percentile, health status, physical fitness, and enjoyment levels of physical activity. A sample of 138 persons, of whom 67 were males and 71 females, with a mean BMI of 20.04 (2.35) answered the questionnaires Physical Activity Enjoyment Scale and the International Fitness Scale−self-report of physical fitness in young people. Tests were administered to measure functional fitness and anthropometric characteristics. Statistical analysis included calculation of Cronbach’s alpha, ANOVA and Pearson’s bivariate test correlations. The data indicate the reliability of the International Fitness Scale. No significant differences by gender were observed for the Physical Activity Enjoyment Scale. The BMI showed that significant positive correlations with 20 m sprint scores (p < 0.001, r = 0.367) and significant negative correlations with 6-minute lap scores (p < 0.001, r = −0.360) could be caused by an older physiological age. The overall physical fitness level of the children was medium-high, with most of the children enjoying physical education classes and slightly higher enjoyment values for males 40.88 (5.42) than females 40.31 (6.16).

Associations of sport participation, muscle-strengthening exercise and active commuting with self-reported physical fitness in school-aged children

Background

Numerous studies suggest a positive association between physical activity and physical fitness in schoolchildren. However, little is known about some neglected forms of physical activity and their associations with physical fitness. This study was conducted via a self-reported questionnaire, owing to the COVID-19 pandemic in many regions in China.

Purpose

This study explores the associations between participating in sports, muscle-strengthening exercises, and active commuting with self-reported physical fitness assessed by the International Fitness Scale (IFIS).

Methods

A total of 3,807 study participants (ages 11–17) from 12 public schools in South-eastern China were recruited, with 2,407 providing valid data on variables for analysis. Study participants were asked to self-report their sociodemographic factors (i.e., sex, grade, age), participation in sports (never, 1–3 times per month, 1–2 times per week, and 3 or more times per week), muscle-strengthening exercise (0–7 days) and active commuting (0–5 days). Generalized linear models were used to explore the associations between sports participation, muscle-strengthening exercise, and active commuting with self-reported physical fitness (comprising general physical fitness, cardiorespiratory fitness, muscular strength, speed and agility, and flexibility). A total of 2,407 children and adolescents with a mean age of 13.82 (±2.1) years were included in the study's final analysis.

Results

The study found no significant association between active commuting and physical fitness. Regarding participating in sports and muscle-strengthening exercises, positive, significant associations were found, which showed that a higher frequency of participating in sports and more participation in muscle-strengthening exercises are associated with improved physical fitness.

Conclusion

This study offered evidence on the roles of some aspects of physical activity in physical fitness. To promote health in children and adolescents, they should be encouraged to participate in more sports and engage in muscle-strengthening exercises.

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.

Reliability of International Fitness Scale (IFIS) in Chinese Children and Adolescents

Background and Objectives: It has previously been shown that the International Fitness Scale (IFIS) is a reliable and valid instrument when used in numerous regions and subgroups, but it remains to be determined whether the IFIS is a reliable instrument for use with Chinese children and adolescents. If the reliability of the IFIS can be verified, populational surveillance and monitoring of physical fitness (PF) can easily be conducted. This study aimed to test the reliability of the IFIS when used with Chinese children and adolescents. Methods: The convenience sampling method was used to recruit study participants. In total, 974 school-aged children and adolescents between 11 and 17 years of age were recruited from three cities in Southeast China: Shanghai, Nanjing and Wuxi. The study participants self-reported demographic data, including age (in years) and sex (boy or girl). The participants completed the questionnaire twice within a two-week interval. Results: A response rate of 95.9% resulted in a sample of 934 participants (13.7 ± 1.5 years, 47.4% girls) with valid data. On average, the participants were 13.7 ± 1.5 years of age. The test–retest weighted kappa coefficients for overall fitness, cardiorespiratory fitness, muscle fitness, speed and agility and flexibility were 0.52 (Std. errs. = 0.02), 0.51 (Std. errs. = 0.02), 0.60 (Std. errs. = 0.02), 0.55 (Std. errs. = 0.02) and 0.55 (Std. errs. = 0.02), respectively. Conclusions: The International Fitness Scale was found to have moderate reliability in the assessment of (self-reported) physical fitness in Chinese children and adolescents. In the future, the validity of the IFIS should be urgently tested in Chinese subgroup populations.

Association of Physical Fitness, Screen Time, and Sleep Hygiene According to the Waist-to-Height Ratio in Children and Adolescents from the Extreme South of Chile

Objective: To analyze the perception of physical fitness, screen time, and self-reported sleep hygiene in children and adolescents (CA) from the extreme south of Chile and its associations with waist-to-height ratio (WtHr). Material and methods: An observational cross-sectional study was conducted in a sample of 594 schoolchildren from 5th to 8th grade of primary education, belonging to municipal educational establishments in the Magallanes region, Chile. Cardiorespiratory fitness was assessed through the 20-m shuttle run test, muscle strength through handgrip and the standing broad jump test, physical fitness perception through the International Fitness Scale, and central obesity through the waist-to-height index. In addition, sleep hygiene and screen time were measured. Results: More than 92% of CA spent more than two hours a day watching or using screens. In addition, CA with excess central adiposity had a lower perception of physical fitness, and lower muscle strength and cardiorespiratory fitness compared to CA with normal values of adiposity. Conclusions: CA of the present study spent a high number of hours watching or using screens and had poor sleep quality. In addition, excessive central adiposity was associated with lower physical fitness.

Independent and Combined Association of Lifestyle Behaviours and Physical Fitness with Body Weight Status in Schoolchildren

(1) Background: Lifestyle behaviours and physical fitness play a critical role in the development of childhood obesity. It has been demonstrated in this study that self-reported physical fitness is representative of a healthy lifestyle and thus is associated with a lower incidence of overweight/obesity. The objective of this study was to analyse the independent and combined association of lifestyles (physical activity, screen time, diet and hours of sleep) and self-reported physical fitness with body weight in schoolchildren. (2) Methods: This study performed a descriptive and cross-sectional analysis. The study sample consisted of 864 schoolchildren between 8−9 years old from 26 schools of the province of Cádiz. To measure lifestyles and self-reported physical fitness, questionnaires were administered to both schoolchildren and families. To obtain the body weight status, the children were measured by body mass index (BMI). To verify the influence of lifestyles and self-reported physical fitness on the body weight status of schoolchildren, a combined score of lifestyles and self-reported physical fitness was calculated. (3) Results: Schoolchildren who followed healthier lifestyles and presented good physical fitness had a better body weight status (p < 0.001). Schoolchildren who had less healthful lifestyles and bad physical fitness had a 10.34 times higher risk of being overweight or obese (p = 0.004). (4) Conclusions: It has been shown that there is an independent and combined association between lifestyles and physical fitness on the body weight of the schoolchildren. We have suggested strategies to get children to adopt healthy lifestyles and good physical fitness to maintain a healthy body weight and prevent obesity.

Validity and Reliability of the International FItness Scale (IFIS) in preschool children

OBJECTIVES

Examine the validity and reliability of parent-reported International FItness Scale (IFIS) in preschool-age children.

METHOD

A cross-sectional study of 3051 Spanish preschoolers (3-5 years). Fitness was measured by PREFIT fitness test battery and reported by parents using an adapted version of the IFIS. Waist circumference was evaluated, and the waist-to-height ratio (WHtR) was calculated. Seventy-six parents of randomly selected schoolchildren completed the IFIS twice (two weeks apart) for a reliability assessment.

RESULTS

ANCOVA, adjusted for sex, age and WHtR, showed that preschoolers who were scored by their parents as having average-to-very good fitness had better levels of measured physical fitness than those preschoolers who were classified as having "very poor/poor" fitness levels (18.1laps to 22.1laps vs 15.6laps for cardiorespiratory fitness; 6.6 kg to 7.5 kg vs 5.3 kg for muscular fitness-handgrip-; 71.7 cm to 76.4 cm vs 62.0 cm for muscular fitness-standing long jump-; 17.2s to 16.2s vs 18.2s for speed/agility; and 11.2s to 15.6s vs 8.7s for balance; p < 0.001). The weighted kappa for concordance between parent-reported fitness levels and objective assessment was poor (κ ≤0.18 for all fitness measures). Overall, the mean values of the abdominal adiposity indicators were significantly lower in high-level fitness categories reported by parents than in low-level fitness categories (p < 0.05). The test-retest reliability of IFIS items ranged from 0.46 to 0.62.

CONCLUSIONS

The reliability of the parent-reported IFIS are acceptable, but the concordance between parents reported and objectively measures fitness levels is poor, suggesting that parents' responses may not be able to correctly classify preschoolers according to their fitness level.

Effectiveness of a 12-Week Multi-Component Training Program with and without Transcranial Direct-Current Stimulation (tDCS) on Balance to Prevent Falls in Community-Dwelling Older Adults: A Study Protocol

Simple Summary

Falls in community-dwelling individuals aged over 65 produce serious outcomes such as disability, morbidity, and mortality, as well as high healthcare costs. This research aims to assess whether a multicomponent training programme (McTP) combined with a transcranial direct-current stimulation device (tDCS), Halo Sport, produces improvements in balance and other gait-related parameters. Therefore, this study intends to test the efficacy of adding a tCDS device to an McTP in order to prevent falls in older adults by testing the safety, efficacy, and effectiveness of its implementation in care resources for the elderly.

Abstract

Approximately one-third of elderly people aged over 65 who live in the community experience falls every year, with the proportion increasing with age. Moreover, of those who fall, about half will fall again in the following year. The falls’ consequences include disability, morbidity, and mortality. Although many external and internal factors lead to falls, balance issues play a major role. Multi-component training programs (McTP) usually combine balance, strength, cardiorespiratory fitness, and flexibility, with studies reporting multiple benefits on the health-related quality of life. Halo Sport is a transcranial direct-current stimulation (tDCS) device with promising results for gait performance. This study aims to test the effectiveness of the introduction of a tCDS device to an McTP to prevent falls in older adults. The sample will consist of 46 people aged 65 years or older, randomly assigned to experimental (n = 23) and control (n = 23) groups. The experimental group will perform the McTP while wearing tDCS, and the control group will perform McTP without the device, for three sessions per week over 12 weeks. The main measures will provide information about (1) safety, (2) applicability, (3) balance, (4) number of falls, (5) physical fitness, (6) risk of falling, (7) fear of falling, (8) health-related quality of life, and (9) cognitive function. Among the practical implications of this program, it is intended to provide data on its safety and effectiveness to be implemented in different resources as a tool for the prevention of falls.

Changes in children’s self-perceived physical fitness: results from a Physical Education internet-based intervention in COVID-19 school lockdown

Background

Children have a higher chance of decreasing health-related physical fitness during periods of school lockdown due to pandemic situations such as with COVID-19 disease.

Aims

To establish the changes in children’s self-perceived physical fitness (SPPF) during pandemic COVID-19 social distancing in a school lockdown and to describe the individual prevalence of changes in SPPF according to sex.

Methods

It is an intervention study with a convenient sample, 67 children (6–13 years old; 50.7% girls). An intervention occurred according to the Brazilian Base Nacional Comum Curricular (BNCC) and the State Education Secretary orientations for remote Physical Education classes. SPPF was evaluated through a questionnaire (QAPA). Generalized estimative equations (GEE) and the prevalence of changes in individual score delta (Δ) from baseline to follow-up determined the effects.

Results

Positive individual changes in SPPF were observed for 21.2% of girls and 26.4% of boys. Older children presented fewer SPPF total points. There was no interaction between the evaluation period, sex, and age. However, higher baseline SPPF values presented a negative association with the individual SPPF variation (β = − 2.52%; CI 95% − 3.97 to − 1.07; p = 0.001).

Conclusion

A remote Physical Education intervention effectively maintained or even increased individual results of children’s SPPF. Thereby, this study suggests that this kind of initiative should be retained for the duration of social distancing and pandemic conditions to help children maintain an active lifestyle and, consequently, achieve health benefits. Improving intervention effectiveness by focusing on girls seems to be a challenge in this matter.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11332-022-00897-1.

Level of Physical Activity and Its Relationship to Self-Perceived Physical Fitness in Peruvian Adolescents

BACKGROUND

Physical activity and physical fitness play an important role in adolescence. Both are considered to be indicators of the current and future health status of young adults. The main objective of this article was to report the normative values of the Physical Activity Questionnaire for Adolescents (PAQ-A) and the International Fitness Scale (IFIS) instruments in Peruvian school adolescents.

METHODS

A sample of 1229 participants (622 girls and 607 boys) aged between 12 and 17 years was used. The type of study was descriptive-comparative. All measures used were obtained by means of self-administered instruments. The PAQ-A was used to assess the level of physical activity and the IFIS to assess the self-perceived physical fitness level of the adolescents.

RESULTS

It was observed that the PAQ-A questionnaire results obtained from the total sample was 2.34; significantly higher for boys (2.41) compared with girls (2.27). For the IFIS, the total score was 3.07, with boys obtaining 3.13 and girls 2.97.

CONCLUSIONS

It was concluded that there was a direct relationship between the level of PA and self-perceived PF in Peruvian adolescents. Furthermore, adolescent boys were more physically active than girls and they had a better self-perceived PF with the exception of flexibility. Finally, there was a higher weight category involved at the lower level of PA.

Self-reported (IFIS) versus measured physical fitness, and their associations to cardiometabolic risk factors in early pregnancy

Physical fitness is a strong marker of health, but objective fitness measurements are not always feasible. The International FItness Scale (IFIS) for self-reported fitness is a simple-to-use tool with demonstrated validity and reliability; however, validation in pregnancy needs to be confirmed. Also, its association with cardiometabolic health in pregnant women is unknown. Hence, we examined (1) the validity of the IFIS with objectively measured fitness, and (2) the associations of self-reported versus objectively measured cardiorespiratory fitness (CRF) and muscular strength with cardiometabolic risk factors in early pregnancy. Women (n = 303) from the HealthyMoms trial were measured at gestational week 14 for: CRF (6-min walk test); upper-body muscular strength (handgrip strength test); self-reported fitness (IFIS), body composition (air-displacement plethysmography); blood pressure and metabolic parameters (lipids, glucose, insulin). Higher self-reported fitness was associated with better measured fitness (ANOVA overall p < 0.01 for all fitness types), indicating the usefulness of the IFIS in pregnancy. Furthermore, higher self-reported overall fitness and CRF were associated with lower cardiometabolic risk scores (ANOVA p < 0.001), with similar results shown for measured CRF (ANOVA p < 0.001). The findings suggest that IFIS could be useful to stratify pregnant women in appropriate fitness levels on a population-based level where objective measurement is not possible.

Evaluating the reach, effectiveness, adoption, implementation and maintenance of the Resistance Training for Teens program

BACKGROUND

Physical activity guidelines recommend young people engage in regular muscle-strengthening activities (e.g., resistance training [RT]). However, few school-based physical activity interventions have been delivered at-scale or promoted RT. The aim of this study was to evaluate the reach, effectiveness, adoption, implementation and maintenance of the Resistance Training for Teens (RT for Teens) program.

METHODS

Data were collected between August 2015 and October 2020. RE-AIM was operationalized as: (i) Reach: number and characteristics of students estimated to be exposed to the program; (ii) Effectiveness: impact of the program on student-level outcomes measured in a subsample of 750 students from 17 schools; (iii) Adoption: number and representativeness of schools with one or more teachers trained to deliver the program; (iv) Implementation: extent to which the program was delivered as intended; and (v) Maintenance: extent to which the program was sustained in schools.

RESULTS

The estimated program reach was ~ 10,000 students, out of a total student population of ~ 200,000 (~ 5%). Students were from diverse socioeconomic and ethnic backgrounds. Improvements in muscular fitness, RT self-efficacy, perceived cardiorespiratory fitness and flexibility, and participation in muscle-strengthening physical activities were documented. A total of 30 workshops were delivered, involving 468 teachers from 249 schools from diverse geographical regions. Implementation varied considerably, with teachers adapting the program to suit the context of their school and student cohorts. However, RT skill development and the promotion of muscular fitness were the session components delivered most during sessions. Teachers' adherence to the SAAFE (Supportive, Active, Autonomous, Fair and Enjoyable) teaching principles was high. Approximately 30% of teachers (144/476) registered to use the RT for Teens app. At the school-level, 37% (93/249) of schools had at least one registered user (teacher and/or student). A total of 2,336 workouts and 3,116 fitness tests were completed by registered users. Of the 249 schools represented, 51 (20.5%) sent an additional (previously untrained) teacher to a second workshop.

CONCLUSIONS

The RT for Teens program had broad reach and adoption. However, intervention delivery varied considerably across schools and additional support strategies are required to optimize intervention implementation and maintain program delivery over time. Future studies will benefit from the utilization of accepted frameworks, recommendations and guidelines for implementation research.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12621000352808), retrospectively registered 1^st February 2021.

Accuracy of perceived physical activity and fitness levels among childhood cancer survivors

BACKGROUND

Childhood cancer survivors do not engage in sufficient physical activity and have low fitness levels. Perceived physical activity and fitness levels may influence survivors' engagement in health behaviours. We aimed to investigate survivors' perceptions of physical activity and fitness levels and identify how accurate their perceptions were. We further explored survivors' attitudes toward physical activity, including perceived importance and desire to increase activity levels.

PROCEDURE

We recruited 116 childhood cancer survivors (8-18 years) and assessed their perceived physical activity levels using a questionnaire and the Godin's Leisure Score Index. Accuracy of their perceptions was established by comparing their perceived physical activity levels with the recommended guidelines. Survivors reported their perceived fitness levels using the International Fitness Scale. We compared survivors' perceptions with their performance on the 6-minute walk test using weighted Cohen's kappa to determine interrater agreement between perceived and objectively measured fitness.

RESULTS

Most survivors did not meet the physical activity guidelines (<420 min/week). One-third incorrectly perceived whether their self-reported physical activity levels were appropriate (84% underestimated, while 16% overestimated). Survivors had average fitness and were inaccurate at perceiving their fitness level. Survivors highly valued the importance of being able to do physical activity, and 89% reported a desire to increase their physical activity.

CONCLUSIONS

Our results reveal that many survivors are not accurate when perceiving their physical activity and fitness levels. Emphasising the need for objective fitness assessments, and patient education in clinical practice may support survivors to accurately perceive their physical activity and fitness levels, thus improving health behaviours.

Self-Reported Physical Fitness in Children and Adolescents with Obesity: A Cross-Sectional Analysis on the Level of Alignment with Multiple Adiposity Indexes

Obesity has been associated with several alterations that could limit physical activity (PA) practice. In pediatrics, some studies have highlighted the importance of enjoyment as a motivation to begin and maintain adherence in PA. Since self-reported physical (SRPF) fitness was related to motivation, the aim of this study was to investigate the existence of differences between SRPF in children with obesity (OB) compared to normal weight (NW). The International Fitness Enjoyment Scale (IFIS) questionnaire was administered to 200 OB and 200 NW children. In all the subjects, height, weight, and BMI and in OB children adiposity indexes including waist circumference (WC), body shape index (ABSI), triponderal mass index (TMI), and fat mass were measured. NW group showed higher IFIS item scores than the OB group (p < 0.01), except in muscular strength. In OB, the anthropometric outcomes were inversely correlated to SRPF outcome except for muscular strength. OB children reported a lower perception of fitness that could limit participation in PA/exercise programs. The evaluation of anthropometric patterns may be useful to prescribe a tailored exercise program considering individual better self-perception outcomes to obtain an optimal PA adherence.

Family-based intervention to prevent childhood obesity among school-age children of low socioeconomic status: study protocol of the FIVALIN project

Background

Childhood obesity represents a global public health crisis: the number of obese children and adolescents (aged 519years) worldwide has risen tenfold in the past four decades. The vast majority of overweight and obese children live in high-income countries, and low socio-economic status (SES) is a significant risk factor. Family Based Interventions (FBI) have demonstrated positive results in preventing obesity, although these results are strongly influenced by SES. Moreover, we still poorly understand how FBI can determine a positive trend in weight status in low-income communities. Therefore, there is an urgent need to define and evaluate innovative and multi-target projects to reduce obesity risk behaviors and health inequalities and the present study aims to present the study protocol of FIVALIN a FBI that pretends to achieve this goal.

Methods

We will conduct a quasi-experimental design within 60 Community Child Centers (CCC) in Barcelona metropolitan area. Each cluster (CCC) will be assigned by convenience to the intervention and control groups. For the whole study, a total of 810 children aged 812years and 600 parents will be recruited during 3 consecutive editions (1st 2019/2020; 2nd 2020/2021; 3rd 2021/2022) of 10months each. The action is a regular multicomponent health-promotion intervention targeting children, families, and CCC. All activities are based on the Motivational Interviewing (MI) approach and will focus on promoting good dietary habits, physical activity, appropriate screen time and sleep duration, and psychological well-being. The control group participate in a unique workshop on general awareness of healthy lifestyles for families. We will perform a comparative analysis of the evolution of weight status, healthy lifestyles, and socioeconomic variables, between the intervention and control groups.

Discussion

There is a need for more evidence on how to target and evaluate holistic interventions in low SES families. Our multi-targeting intervention for obesity prevention tackles risky behaviors that go beyond diet and physical activity (PA). Therefore, future interventions can effectively promote all the behavioral domains that determine trends in the weight status.

Trial registration

ISRCTN Registry: ISRCRN12682870. Registered 9 July 2020. Retrospectively registered.

Protocol version: 30 April 2021, version 5.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02697-x.

Falls Prevention and Quality of Life Improvement by Square Stepping Exercise in People with Parkinson's Disease: Project Report

Parkinson's disease (PD) is a chronic neurodegenerative disorder that affects physical, psychological, and social quality of life. Square Stepping Exercise (SSE) is an effective balance training program to prevent falls and to stimulate cognitive function in the elderly; however, no study has analyzed the effect of SSE in people with PD. The main objective is to investigate whether the application of SSE is safe, applicable, and can improve balance, and is effective in preventing falls, improving cognitive and psychological aspects and thus maximize quality of life in people with PD. Methods/Design: SSE will be performed three times per week for 8 weeks with an additional month follow-up after the intervention. Sixty people with PD will participate, randomly distributed into two groups: experimental group (SSE: n = 30) and control group (Usual care: n = 30). The primary measurements will be: (1) Applicability, (2) Safety, (3) Balance, and (4) Annual number of falls. Secondary measurements will be: (1) Sociodemographic information, (2) Physical condition, (3) Health-related quality of life, (4) Depressive symptoms, (5) Cognitive aspects, (6) Perceived functional social support, and (7) Anticipatory cognition.

A Multimodal Intervention for Prevention of Overweight and Obesity in Schoolchildren. A Protocol Study "PREVIENE-CÁDIZ"

This paper describes the protocol for a study designed to address the high prevalence (40%) of childhood overweight and obesity in the province of Cádiz, Spain, as a reflection of what is happening worldwide. It is widely known that children who suffer from childhood obesity have a higher risk of developing chronic diseases in adulthood. This causes a decrease in the quality of life and an increase in health spending. In this context, it is necessary to intervene promoting healthy lifestyle habits from an early stage. The objective of this project will be to evaluate the effectiveness of a multimodal intervention (individual, school and family) called "PREVIENE-CÁDIZ" [CADIZ-PREVENT]. The intervention will be focused mainly on diet, physical activity, sedentary lifestyle and sleep, to prevent overweight and obesity in schoolchildren from 8 to 9 years old in the province of Cádiz. It will consist of a 10-session education program carried out in the classroom by the teachers. In addition, children will be assigned two workbooks, one to work on in class and the other at home with parents. A workshop aimed at parents will be included to help teach them how to obtain healthier lifestyle habits. The proposed study will involve a quasi-experimental design with a control group.

The effect of an online exercise programme on bone health in paediatric cancer survivors (iBoneFIT): study protocol of a multi-centre randomized controlled trial

BACKGROUND

New approaches on paediatric cancer treatment aim to maintain long-term health. As a result of radiotherapy, chemotherapy or surgery, paediatric cancer survivors tend to suffer from any chronic health condition. Endocrine dysfunction represents one of the most common issues and affects bone health. Exercise is key for bone mass accrual during growth, specifically plyometric jump training. The iBoneFIT study will investigate the effect of a 9-month online exercise programme on bone health in paediatric cancer survivors. This study will also examine the effect of the intervention on body composition, physical fitness, physical activity, calcium intake, vitamin D, blood samples quality of life and mental health.

METHODS

A minimum of 116 participants aged 6 to 18 years will be randomized into an intervention (n = 58) or control group (n = 58). The intervention group will receive an online exercise programme and diet counselling on calcium and vitamin D. In addition, five behaviour change techniques and a gamification design will be implemented in order to increase the interest of this non-game programme. The control group will only receive diet counselling. Participants will be assessed on 3 occasions: 1) at baseline; 2) after the 9 months of the intervention; 3) 4 months following the intervention. The primary outcome will be determined by dual energy X-ray absorptiometry (DXA) and the hip structural analysis, trabecular bone score and 3D-DXA softwares. Secondary outcomes will include anthropometry, body composition, physical fitness, physical activity, calcium and vitamin D intake, blood samples, quality of life and mental health.

DISCUSSION

Whether a simple, feasible and short in duration exercise programme can improve bone health has not been examined in paediatric cancer survivors. This article describes the design, rationale and methods of a study intended to test the effect of a rigorous online exercise programme on bone health in paediatric cancer survivors. If successful, the iBoneFIT study will contribute to decrease chronic health conditions in this population and will have a positive impact in the society.

TRIAL REGISTRATION

Prospectively registered in isrctn.com: isrctn61195625 . Registered 2 April 2020.

Gender, Physical Self-Perception and Overall Physical Fitness in Secondary School Students: A Multiple Mediation Model

Background: Physical self-perception is often related with better physical fitness perception in adolescents. Moreover, it is an important social cognitive perspective to provide suitable mental health in this population. However, this relationship is unequal between boys and girls. The physical fitness is a marker of health in young population. The aims of the present study were the following: (1) to compare physical self-perception and self-reported overall physical fitness (OPF) between boys and girls (gender) and body mass index (BMI) status, and (2) to determine the mediating role of all physical self-perception subscales (except physical condition) and BMI status in the link between gender and OPF in adolescent students. Methods: This cross-sectional study consisted of 85 adolescent students of secondary school between 12 and 17 years of age; 41 were boys (M_age = 14.6, SD = 1.7) and 44 were girls (M_age = 14.4, SD = 1.6). Adolescent participants completed all clinical characteristics by body composition measures (age, body weight, body height, and BMI). Physical self-perception was assessed by the physical self-perception profile (PSPP) whereas the international fitness scale (IFIS) was used to predict the self-reported OPF of adolescents in the present study. Results: Gender (boys and girls) differed significantly in all PSPP subscales and OPF, whereas the BMI status (underweight = 19 students, normal weight = 53 students, overweight/obese = 13 students) showed significant differences in all clinical characteristics, physical condition (PSPP), and OPF. A multiple mediation analysis was performed using bias corrected bootstrap. This multiple mediation analysis revealed that all PSPP subscales were significant mediators between gender and OPF: attractive body (p = 0.013), sport competence (p = 0.009), physical strength (p = 0.002), and self-confidence (p = 0.002). The total direct effect of gender on OPF was significant (p = 0.002). Moreover, the multiple mediation estimated a completely standardized indirect of X on Y for attractive body (effect = 0.109), sport competence (effect = 0.066), physical strength (effect = 0.130), and self-confidence (effect = 0.193). Conclusions: These findings contribute to understanding the link between gender and OPF in adolescent students and the mediation of physical self-perception and OPF in this relationship. In addition, strategies focused to improve self-confidence and physical self-perception are necessary in female adolescent students, because boys showed better physical self-perception in all PSPP subscales. Girls are a risk group because they report low physical self-confidence with their respective insecurity feelings and psychological disorders. Thus, personal physical self-perception must be considered as an important social cognitive perspective to provide suitable mental health in children and adolescents.

Reliability of questionnaire The International Fitness Scale: a systematic review and meta-analysis

Objective

To perform a systematic literature review and meta-analysis to investigate the reliability of The International Fitness Scale questionnaire for assessing overall physical fitness and related components.

Methods

PubMed^®, BIREME, SciELO, EMBASE, SPORTDiscus, LILACS and Cochrane databases were searched using the following search terms: “The International Fitness Scale”, “International Fitness Scale” and “IFIS”. Article selection and data extraction were performed according to the following eligibility criteria: reliability and/or validity study of the measure tools of The International Fitness Scale; adoption of the The International Fitness Scale as a reference criterion (gold standard) and being an original article. Quality of the study was considered based on Assessment of Reliability Studies. Data analysis used Kappa coefficient of agreement, Cochran and the Higgins I² test. Sensitivity analysis was conducted using the withdrawal model.

Results

A total of seven articles were included in the analysis. Test-retest reliability coefficients ranged from 0.40 to 0.99, with most studies achieving values ≥0.60, indicative of moderate to substantial reliability.

Conclusion

In spite of appropriate test-retest scores attributed to most reliability indicators, heterogeneity among the studies remained high. Therefore, further studies with low risk of bias are needed to support the reliability of the self-reported The International Fitness Scale.

Doctor, ask your perimenopausal patient about her physical fitness; association of self-reported physical fitness with cardiometabolic and mental health in perimenopausal women: the FLAMENCO project

OBJECTIVE

The aim of this study was to explore the association of self-reported physical fitness (PF) and its components with cardiometabolic and mental health in perimenopausal women.

METHODS

These cross-sectional analyses included 191 participants (53 ± 4 y old) from the FLAMENCO project. Self-reported PF was assessed with the International Fitness Scale (IFIS). Body mass index (BMI), fat mass (FM), waist circumference (WC), systolic and diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDL-C), triglycerides, C-reactive protein (CRP), and glucose were measured. The Beck's Depression Inventory, State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, Life Orientation Test Revised, and Positive and Negative Affect Schedule were used to assess mental health.

RESULTS

After adjusting for potential confounders, greater overall PF was associated with lower BMI, FM, WC (P < 0.001), DBP and CRP, and higher HDL-C (P < 0.05). Cardiorespiratory fitness (CRF), speed-agility, and flexibility were associated with lower BMI, WC, and FM (P < 0.001), and muscle strength (MS) with lower WC and FM (P < 0.05). In addition, CRF, MS, and speed-agility were associated with lower CRP (P < 0.01), and flexibility with enhanced triglycerides and HDL-C (P < 0.05). Overall PF and all its components were associated with lower depression, anxiety, and negative affect (P≤0.01), and greater positive affect (P≤0.05). Overall PF and MS were associated with better sleep quality (P < 0.05), and CRF, MS, and speed-agility with greater optimism (P≤0.05). Finally, overall PF showed evidence of significant association with less pharmaceutical expenditure (B = -7.2, β=-0.145, P = 0.08).

CONCLUSIONS

Self-reported PF was associated with better cardiometabolic and mental health in perimenopausal women. The IFIS might be proposed as an inexpensive, quick, and easy tool in clinical settings.

Relationship between nutrition knowledge, education and other determinants of food intake and lifestyle habits among adolescents from urban and rural secondary schools in Tyrol, Western Austria

Objective:

The aim of this study was to investigate the association of the number of hours of nutrition education and teachers’ qualifications with nutrition knowledge and dietary behaviour in students.

Design:

In this representative cross-sectional study, socio-demographic data, anthropometric measurements, socio-economic status (SES), physical fitness, nutrition knowledge and eating habits were assessed. Differences between groups were tested by χ² and t tests. Multiple linear and logistic regression modelling was used to examine the relationship between demographic characteristics, lifestyle and dietary behaviours, nutrition knowledge, nutrition-trained teachers and number of nutrition lessons.

Setting:

Sixteen secondary schools in urban (n 6) and rural regions (n 10) of Tyrol, Western Austria.

Participants:

Students (n 513) aged 14·2 (sd 0·7) years.

Results:

Higher nutrition knowledge was significantly associated with attending rural school (P = 0·001), having no migration background (P < 0·001), (very) good physical activity behaviour (P = 0·040), non-trained teacher (P = 0·006) but higher number of hours of nutrition education (P = 0·013). Regression models showed that higher nutrition knowledge was independently associated with lower intake of meat and iced tea and higher intake of vegetables and plant-based oils. A higher amount of nutrition education (h/week) was significantly associated with higher intake of dark (wholegrain) bread, lower intake of meat and of energy drinks sweetened with sweeteners.

Conclusions:

Our results suggest that more hours in nutrition education result in higher nutrition knowledge and greater nutrition literacy, which may lead to health-promoting dietary habits. School-based nutrition education can be seen as preventive measure to increase nutritional competences in adolescents independent of their SES.

Reliability and Validity of a Questionnaire for Assessing Self-Perceived Health-Related Fitness in Spanish Children

There is a need for developing tools aimed at assessing fitness in children, due to its relationship with health. This study is aimed at testing the reliability and the validity of a questionnaire designed for assessing self-perceived health-related fitness in Spanish children. The questionnaire was created based on the model of physical self-concept developed by Fox and Corbin (1989) who conceived four sub-domains: Sport competence, attractive body, strength and physical condition. A total of 283 children (mean age: 10.80 ± 0.69 years; 45.6% girls) answered the questionnaire twice, in order to determine its test-retest reliability. The results obtained in the International Fitness Scale (IFIS) and on a fitness battery were used to determine its validity evidence based on relations to other variables. Exploratory and factorial analyses were performed to check its validity evidence based on internal structure. The obtained results indicated that the questionnaire showed an accurate validity evidence based on internal structure and a very good test-retest reliability, Intraclass correlation coefficient: .88; 95% CI [.84, .90]. The questionnaire established moderate correlations with the IFIS questionnaire (ρ = -.51 to -.68) and the fitness level showed by the children (ρ = -.53). These findings indicate that the questionnaire can be a useful research tool for assessing self-perceived health-related fitness in children.

International Fitness Scale-IFIS: Validity and association with health-related quality of life in pregnant women

This study aimed (a) to examine the construct validity of the International Fitness Scale (IFIS) to discriminate between different objectively measured physical fitness levels in pregnant women and (b) to assess the extent to which IFIS is able to discriminate between pregnant women with different levels of health-related quality of life (HRQoL). A total of 159 pregnant women were involved in the GESTAtion and FITness project: 106 pregnant women (mean age 32.7, SD 4.4 years) were included. Self-reported physical fitness-that is, cardiorespiratory fitness, muscular strength, flexibility, and overall fitness-was assessed with the IFIS. Physical fitness was objectively measured using the Bruce test, the handgrip strength test and the back-scratch test. The HRQoL was assessed with the 36-item Short Form Health Survey (SF-36). Higher self-reported physical fitness measured with IFIS was associated with higher objectively measured physical fitness (P < .05). There was a linear association so that higher self-reported physical fitness (ie, IFIS; regardless of the fitness component) was related to greater General Health dimension scores (P < .05). Moreover, higher self-reported physical fitness (all components except muscular strength) was associated with better Physical Functioning, lower Bodily Pain and higher Vitality scores (ie, SF-36 components). This linear trend was not seen for objectively measured physical fitness. The results of this study suggest that IFIS might be a useful tool for identifying pregnant women with low or very low physical fitness and with low quality of life health-related. Further research should elucidate whether IFIS can identify women with pregnancy complications before it can be implemented in clinical practice.

Study protocol and rationale of the "Cogni-action project" a cross-sectional and randomized controlled trial about physical activity, brain health, cognition, and educational achievement in schoolchildren

BACKGROUND

Education and health are crucial topics for public policies as both largely determine the future wellbeing of the society. Currently, several studies recognize that physical activity (PA) benefits brain health in children. However, most of these studies have not been carried out in developing countries or lack the transference into the education field. The Cogni-Action Project is divided into two stages, a cross-sectional study and a crossover-randomized trial. The aim of the first part is to establish the associations of PA, sedentarism, and physical fitness with brain structure and function, cognitive performance and academic achievement in Chilean schoolchildren (10-13 years-old). The aim of the second part is to determinate the acute effects of three PA protocols on neuroelectric indices during a working memory and a reading task.

METHODS

PA and sedentarism will be self-reported and objectively-assessed with accelerometers in a representative subsample, whilst physical fitness will be evaluated through the ALPHA fitness test battery. Brain structure and function will be assessed by magnetic resonance imaging (MRI) in a randomized subsample. Cognitive performance will be assessed through the NeuroCognitive Performance Test, and academic achievement by school grades. In the second part 32 adolescents (12-13 year-old) will be cross-over randomized to these condition (i) "Moderate-Intensity Continuous Training" (MICT), (ii) "Cooperative High-Intensity Interval Training" (C-HIIT), and (iii) Sedentary condition. Neuroelectric indices will be measures by electroencephalogram (EEG) and eye-tracking, working memory by n-back task and reading comprehension by a reading task.

DISCUSSION

The main strength of this project is that, to our knowledge, this is the first study analysing the potential association of PA, sedentarism, and physical fitness on brain structure and function, cognitive performance, and academic achievement in a developing country, which presents an important sociocultural gap. For this purpose, this project will use advanced technologies in neuroimaging (MRI), electrophysiology (EEG), and eye-tracking, as well as objective and quality measurements of several physical and cognitive health outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03894241 Date of register: March 28, 2019. Retrospectively Registered.

Is Self-Reported Physical Fitness Useful for Estimating Fitness Levels in Children and Adolescents? A Reliability and Validity Study

Background and objective: The assessment of physical fitness has become a necessary issue in epidemiological studies, since a reduction in fitness is directly associated with early mortality. Therefore, the development of simple, accurate, and inexpensive methods is necessary to measure physical fitness. This study aimed to determine the reliability and validity of the criteria and constructs of the International Fitness Scale (IFIS), Portuguese version, in Brazilian pediatric populations. Methods: A total of 190 children aged 3-10 years and 110 adolescents aged 11-17 years were enrolled in an observational study of reliability and validity. For reliability, the participants completed a questionnaire twice (with an interval of 15 days). To test the criterion validity, we analyzed the agreement between the questionnaire and physical tests (20-m shuttle run test, handgrip strength, standing long jump tests, 4 × 10-m shuttle run test, and back-saver sit and reach test), and the construct validity was estimated by agreement between the questionnaire and high blood pressure. The reliability was analyzed by kappa coefficients. The agreement between the testing and retesting of the questionnaire was evaluated by kappa coefficients. We applied a 2 × 2 table to estimate the specificity, sensitivity, and accuracy of the questionnaire. Results: The mean age of the children was 6.7 years (n = 190), and for the adolescents it was 14.6 years (n = 110). The questionnaire reliability showed an almost perfect score (κ ≥ 0.93 in children and κ ≥ 0.88 in adolescents). The questionnaire showed moderate criterion validity (κ ≥ 0.40 in children and adolescents) as well as moderate construct validity (κ ≥ 0.40) in the components of general conditioning, cardiorespiratory capacity, muscular strength, and speed/agility in children and in the components of cardiorespiratory capacity, muscle strength, and speed/agility in adolescents. The questionnaire was a sensitive method for measuring physical fitness. Conclusions: The Portuguese version of the IFIS is a reliable and valid method for measuring physical fitness in pediatric populations.

School-based physical activity intervention for older adolescents: rationale and study protocol for the Burn 2 Learn cluster randomised controlled trial

INTRODUCTION

This trial aims to investigate the impact of a school-based physical activity programme, involving high-intensity interval training (HIIT), on the physical, mental and cognitive health of senior school students.

METHODS AND ANALYSIS

The Burn 2 Learn (B2L) intervention will be evaluated using a two-arm parallel group cluster randomised controlled trial with allocation occurring at the school level (to treatment or wait-list control). Schools will be recruited in two cohorts from New South Wales, Australia. The trial will aim to recruit ~720 senior school students (aged 16-18 years) from 20 secondary schools (ie, 10 schools per cohort). A range of implementation strategies will be provided to teachers (eg, training, equipment and support) to facilitate the delivery of HIIT sessions during scheduled classes. In phase I and II (3 months each), teachers will facilitate the delivery of at least two HIIT sessions/week during lesson-time. In phase III (6 months), students will be encouraged to complete sessions outside of lesson-time (teachers may continue to facilitate the delivery of B2L sessions during lesson-time). Study outcomes will be assessed at baseline, 6 months (primary end point) and 12 months. Cardiorespiratory fitness (shuttle run test) is the primary outcome. Secondary outcomes include: vigorous physical activity, muscular fitness, cognition and mental health. A subsample of students will (i) provide hair samples to determine their accumulated exposure to stressful events and (ii) undergo multimodal MRI to examine brain structure and function. A process evaluation will be conducted (ie, recruitment, retention, attendance and programme satisfaction).

ETHICS AND DISSEMINATION

This study has received approval from the University of Newcastle (H-2016-0424) and the NSW Department of Education (SERAP: 2017116) human research ethics committees.

TRIAL REGISTRATION NUMBER

ACTRN12618000293268; Pre-results.

Continuous cardiometabolic risk score definitions in early childhood: a scoping review

BACKGROUND

Cardiometabolic risk (CMR) in young children has been measured using various approaches, including a continuous summary score that incorporates components such as adiposity, lipids, metabolic factors and blood pressure.

OBJECTIVES

The objective of this study was to comprehensively review definitions of continuous CMR scores in children <10 years of age.

METHODS

A scoping review was conducted using a systematic search of four scientific databases up to June 2016. Inclusion criteria were children <10 years of age and report of a continuous CMR score.

RESULTS

Ninety-one articles were included. Most studies were published from 2007 to 2016 (96%). Nearly all continuous CMR scores (90%) were calculated using the sum or the mean of z-scores, and many articles age-standardized and sex-standardized components within their own population. The mean number of variables included in the risk scores was 5 with a range of 3-11. The most commonly included score components were waist circumference (52%), triglycerides (87%), high-density lipoprotein cholesterol (67%), glucose (43%) and systolic blood pressure (52%).

IMPORTANCE

Continuous CMR scores are emerging frequently in the child health literature and are calculated using numerous methods with diverse components. This heterogeneity limits comparability across studies. A harmonized definition of CMR in childhood is needed.

Making a Case for Cardiorespiratory Fitness Surveillance Among Children and Youth

We review the evidence that supports cardiorespiratory fitness (CRF) as an important indicator of current and future health among school-aged children and youth, independent of physical activity levels. We discuss the merit of CRF measurement for population health surveillance and propose the development of CRF guidelines to help support regional, national, and international surveillance efforts.

Prevalence and correlates of resistance training skill competence in adolescents

The aim of this study is to examine the prevalence and correlates of adolescents' resistance training (RT) skill competence. Participants were 548 adolescents (14.1 ± 0.5 years) from 16 schools in New South Wales, Australia. RT skills were assessed using the Resistance Training Skills Battery. Demographics, BMI, muscular fitness, perceived strength, RT self-efficacy, and motivation for RT were also assessed. The proportion demonstrating "competence" and "near competence" in each of the six RT skills were calculated and sex differences explored. Associations between the combined RT skill score and potential correlates were examined using multi-level linear mixed models. Overall, the prevalence of competence was low (range = 3.3% to 27.9%). Females outperformed males on the squat, lunge and overhead press, whereas males performed better on the push-up (p < .05). Significant associations were seen for a number of correlates, which largely differed by sex. Muscular fitness was moderately and positively associated with RT skills among both males (β = 0.34, 95%CIs = 0.23 to 0.46) and females (β = 0.36, 95%CIs = 0.23 to 0.48). Our findings support a link between RT skills and muscular fitness. Other associations were statistically significant but small in magnitude, and should therefore be interpreted cautiously.

Construct validity and test-retest reliability of the International Fitness Scale (IFIS) in Colombian children and adolescents aged 9-17.9 years: the FUPRECOL study

Background

There is a lack of instruments and studies written in Spanish evaluating physical fitness, impeding the determination of the current status of this important health indicator in the Latin population, especially in Colombia. The aim of the study was two-fold: to examine the validity of the International Fitness Scale (IFIS) with a population-based sample of schoolchildren from Bogota, Colombia and to examine the reliability of the IFIS with children and adolescents from Engativa, Colombia.

Methods

The sample comprised 1,873 Colombian youths (54.5% girls) aged 9–17.9 years. We measured their adiposity markers (waist-to-height ratio, skinfold thickness, percentage of body fat and body mass index), blood pressure, lipids profile, fasting glucose, and physical fitness level (self-reported and measured). A validated cardiometabolic risk index score was also used. An age- and sex-matched subsample of 229 schoolchildren who were not originally included in the sample completed the IFIS twice for reliability purposes.

Results

Our data suggest that both measured and self-reported overall physical fitness levels were inversely associated with percentage of body fat indicators and the cardiometabolic risk index score. Overall, schoolchildren who self-reported “good” or “very good” fitness had better measured fitness levels than those who reported “very poor/poor” fitness (all p < 0.001). The test-retest reliability of the IFIS items was also good, with an average weighted kappa of 0.811.

Discussion

Our findings suggest that self-reported fitness, as assessed by the IFIS, is a valid, reliable, and health-related measure. Furthermore, it can be a good alternative for future use in large studies with Latin schoolchildren from Colombia.

A school-based intervention incorporating smartphone technology to improve health-related fitness among adolescents: rationale and study protocol for the NEAT and ATLAS 2.0 cluster randomised controlled trial and dissemination study

INTRODUCTION

Physical inactivity has been described as a global pandemic. Interventions aimed at developing skills in lifelong physical activities may provide the foundation for an active lifestyle into adulthood. In general, school-based physical activity interventions targeting adolescents have produced modest results and few have been designed to be 'scaled-up' and disseminated. This study aims to: (1) assess the effectiveness of two physical activity promotion programmes (ie, NEAT and ATLAS) that have been modified for scalability; and (2) evaluate the dissemination of these programmes throughout government funded secondary schools.

METHODS AND ANALYSIS

The study will be conducted in two phases. In the first phase (cluster randomised controlled trial), 16 schools will be randomly allocated to the intervention or a usual care control condition. In the second phase, the Reach, Effectiveness, Adoption, Implementation and Maintenance (Re-AIM) framework will be used to guide the design and evaluation of programme dissemination throughout New South Wales (NSW), Australia. In both phases, teachers will be trained to deliver the NEAT and ATLAS programmes, which will include: (1) interactive student seminars; (2) structured physical activity programmes; (3) lunch-time fitness sessions; and (4) web-based smartphone apps. In the cluster RCT, study outcomes will be assessed at baseline, 6 months (primary end point) and 12-months. Muscular fitness will be the primary outcome and secondary outcomes will include: objectively measured body composition, cardiorespiratory fitness, flexibility, resistance training skill competency, physical activity, self-reported recreational screen-time, sleep, sugar-sweetened beverage and junk food snack consumption, self-esteem and well-being.

ETHICS AND DISSEMINATION

This study has received approval from the University of Newcastle (H-2014-0312) and the NSW Department of Education (SERAP: 2012121) human research ethics committees. This study is funded by the Australian Research Council (FT140100399) and the NSW Department of Education.

TRIAL REGISTRATION NUMBER

ACTRN12615000360516; Pre-results.

Fitness in Youth

In this issue, Sacheck and Hall discussed the key findings from the Final Report “Fitness Measures and Health Outcomes in Youth” developed by an expert committee appointed by the Institute of Medicine in 2011 and published in 2012. The findings from this report are more valuable when interpreted together with those from the EU-funded ALPHA project (conducted from 2007 to 2010). The ALPHA project aimed to provide an evidence-based set of valid, reliable, feasible, and safe field-based fitness tests for the assessment of health-related physical fitness in youth to be used in public health monitoring in a comparable way within the European Union and around the globe. The ALPHA team conducted 4 reviews (3 of them systematic reviews) and 11 methodological studies, tested the battery in the school setting, and had several meetings with an international expert board to further discuss the development of the work. The evidence-based ALPHA fitness test battery was finally published in 2011. Several important methodological issues related to fitness assessment and its clinical value mainly derived from this project are discussed in the present article: the ALPHA-fitness test battery; Slaughter’s equations and normalization of fat indicators by height; absolute versus relative muscular strength; physical fitness reference data; health-related fitness cut-points; Self-reported fitness assessment: The International FItness Scale-IFIS; and fitness assessment in preschoolers: The PREFIT project.