Association of Recess Provision With Accelerometer-Measured Physical Activity and Sedentary Time in a Representative Sample of 6- to 11-Year-Old Children in the United States

PURPOSE

To assess the association between the amount of recess provision and children's accelerometer-measured physical activity (PA) levels.

METHODS

Parents/guardians of 6- to 11-year-olds (n = 451) in the 2012 National Youth Fitness Survey reported recess provision, categorized as low (10-15 min; 31.9%), medium (16-30 min; 48.0%), or high (>30 min; 20.1%). Children wore a wrist-worn accelerometer for 7 days to estimate time spent sedentary, in light PA, and in moderate to vigorous PA using 2 different cut points for either activity counts or raw acceleration. Outcomes were compared between levels of recess provision while adjusting for covariates and the survey's multistage, probability sampling design.

RESULTS

Children with high recess provision spent less time sedentary, irrespective of type of day (week vs weekend) and engaged in more light or moderate to vigorous PA on weekdays than those with low recess provision. The magnitude and statistical significance of effects differed based on the cut points used to classify PA (eg, 4.7 vs 11.9 additional min·d-1 of moderate to vigorous PA).

CONCLUSIONS

Providing children with >30 minutes of daily recess, which exceeds current recommendations of ≥20 minutes, is associated with more favorable PA levels and not just on school days. Identifying the optimal method for analyzing wrist-worn accelerometer data could clarify the magnitude of this effect.

Exploring Children's Self-Reported Activity Compensation: The REACT Study

PURPOSE

Previous research has focused on device-based measures of activity compensation, with little understanding of how children perceive potential compensatory responses to activity or inactivity, or whether these change after periods of activity or inactivity. The aim of this study was (a) to explore the alignment between children's self-reported usual compensation and compensation recall after experimental conditions and (b) to examine sex differences.

METHODS

In total, 360 children (47% boys) participated in at least one of three experimental conditions over 6 wk: (a) restricted physical activity (PA; indoor play), (b) imposed moderate- to vigorous-intensity PA (MVPA; sports class), and (c) imposed light-intensity PA (LPA; standing lesson). Before the first condition, children reported their "usual compensation" behavior to examples of restricted/imposed PA, and 2-3 d after each experimental condition, they completed a recall measure of their compensation after the condition. Multilevel regression models were conducted to determine whether children's perceptions of "usual compensation" score were associated with recalled compensation score after imposed or restricted PA. Additional models were fitted for sex-specific associations.

RESULTS

Overall and among girls, the usual compensation score was positively associated with the compensatory recall score for the additional MVPA and LPA conditions ( P < 0.0005; e.g., they thought they would usually compensate for additional MVPA and then perceived that they compensated after additional MVPA). A negative association was seen in the restricted activity condition among girls ( P = 0.03). All associations in the boys' analyses were statistically nonsignificant.

CONCLUSIONS

These findings suggest some alignment between children's self-reported usual compensation and compensation recall after imposed changes to routine activity. Future research should consider device-measured comparisons and identify characteristics of children at risk of activity compensation in future interventions.

Test-retest reliability of a measure of perceived activity compensation in primary school children and their parents: a mixed methods study

There is a lack of specific tools for assessing children's activity compensatory responses. This study 1) determined test-retest reliability and internal consistency of survey items assessing children's self-reported and parents' proxy-reported perceived compensatory responses; and 2) described children's and parents' views of potential compensatory mechanisms. Children (n = 55; mean age 10.2 ± 0.9) and their parents (n = 60) completed a survey twice, seven days apart. A sub-sample (17 parents; 13 children) participated in a short, semi-structured interview. Intraclass Correlation Coefficients (ICCs) and Cronbach's alpha assessed absolute agreement and internal consistency. Interviews were analysed via thematic analysis. Seven self- and proxy-reported survey sub-scales had excellent test-retest reliability (ICC ≥ 0.75), three had good (ICC ≥ 0.56) and one fair (ICC = 0.44). All survey items and sub-scales had acceptable internal consistency (alpha >0.67). Thematic analysis identified two overarching themes: awareness of compensation and mechanisms of compensation. After an active day at school, most participants perceived that compensation occurred later that day. Mechanisms of compensation included psychological, physiological, environmental, and interpersonal mechanisms. This reliable survey provides a new tool for assessing children's and their parents' perceptions of activity compensation and may inform future intervention designs. Future research is needed to establish concordance between perceived and device-assessed compensation.

Children and adolescents do not compensate for physical activity but do compensate for sedentary behavior

Little is known about behavioral transfer and compensation within and between moderate-to-vigorous physical activity (MVPA) and sedentary behavior. Thus, taking a within-person perspective, this study investigated across 1 week whether (a) children and adolescents compensate for increased MVPA and sedentary behavior with less of the respective behavior the next day and (b) transfer and compensation occur between these behaviors within 1 day and across 2 days. We obtained data from 2676 participants (6–17 years) of the national Motorik-Modul (MoMo) study in Germany. Participants wore an ActiGraph accelerometer (Pensacola, FL, USA) for 7 days. We analyzed within- and between-day associations using hierarchical linear modeling. If youth engaged in 2 h more sedentary behavior than typical on any given day, they engaged in 37.20 min less MVPA the same day (B = −0.31, p < 0.001) as well as in 4.80 min more MVPA (B = 0.04, p < 0.001) and 7.20 min less sedentary behavior (B = −0.06, p < 0.001) the next day. If youth engaged in 1 h more MVPA than typical on any given day, they engaged in 97.80 min less sedentary behavior the same day (B = −1.63, p < 0.001) and in 5.40 min less sedentary behavior the next day (B = −0.09, p < 0.001). No association with next-day MVPA was observed. Our results indicate that children do not compensate for enhanced MVPA but transfer to less sedentary behavior, while more sedentary behavior is compensated with less sedentary behavior and more MVPA the next day. This provides essential information for the design of intervention studies to tackle physical inactivity and sedentary behavior.

School-related sedentary behaviours and indicators of health and well-being among children and youth: a systematic review

BACKGROUND

The purpose of this systematic review was to examine the associations between school-related sedentary behaviours and indicators of health and well-being in children and youth (~ 5-18 years) attending school.

METHODS

This review was conducted to inform the development of School-Related Sedentary Behaviour Recommendations. Peer-reviewed, published, or in-press articles in English were included. Reviews, meta-analyses, and case studies were excluded; all other study designs were eligible. Further, articles had to meet the a priori study criteria for population, intervention, comparator (PROSPERO ID: CRD42021227600). Embase, MEDLINE® ALL, and PsycINFO were searched. Risk of bias was assessed for individual experimental studies using the Cochrane risk of bias assessment tool, and in observational studies based on the GRADE framework and in line with previous systematic reviews examining sedentary behaviours in children. Overall quality of evidence was assessed using the GRADE framework for each outcome category and study design. Results were synthesized narratively, grouped by study design and outcome category. Further, several high-level summaries were conducted to help interpret results.

RESULTS

Evidence was synthesized from 116 reports, including 1,385,038 participants and 1173 extracted associations. More school-related sedentary behaviour was favourably associated with nearly one-third of extracted associations for cognitive (33%) and social-emotional (32%) indicators (e.g., less anxiety), but unfavourably associated with other movement behaviours (e.g., less physical activity) (35%). Active lessons were favourable (72%), compared to more school-related sedentary behaviours, when examining associations for all health and well-being indicators. More homework was favourable across all health and well-being indicators in 4% of extracted associations for primary school children, and 25% of extracted associations for secondary school children. However, ≥2 h/day of homework appeared to be unfavourable for health and well-being. Limitations for synthesized studies included generally low quality of evidence and a lack of studies in South American, African, or low-middle income countries.

CONCLUSIONS

Findings can help inform policy makers, schools, and teachers, regarding the amount of homework assigned and the introduction of active lessons into the classroom to enhance health and well-being of children. More research is needed examining school-related sedentary behaviours and indicators of health and well-being in low- and middle-income countries.

Exploring activity compensation amongst youth and adults: a systematic review

BACKGROUND

Globally, significant efforts have focused on increasing physical activity and reducing sedentary behaviour in youth and adults across a range of settings (e.g., schools, workplaces, community, and home). Despite this, interventions have had varied efficacy and typically have failed to sustain changes in behaviours over time. One explanation that has been put forth to explain the mixed success of interventions is activity compensation. However, little is known about activity compensation, including whether compensation occurs, and perceptions and potential mechanisms of activity compensation. Understanding activity compensation would assist in tailoring and targeting of potential intervention strategies. The primary aim of this review was to synthesise research that has investigated activity compensation in youth and adults. The secondary aim was to identify potential reasons for and/or awareness of compensatory changes that may have occurred.

METHODS

An electronic search of the EBSCOhost (via Academic Search Complete, CINAHL Complete, Education Source, Health Source: Nursing/Academic Edition, PsycINFO, SPORTdiscus with Full Text), MEDLINE Complete, Global Health, EMBASE, Scopus and Web of Science databases up to May 2021 was conducted. Quality assessment of included quantitative studies used a modified compensation-specific McMaster Quality Assessment Tool.

RESULTS

A total of 44 studies met the inclusion criteria (22 = adult populations; 22 = youth populations) and were classified as (1) quantitative (n = 31); (2) combination of quantitative and behavioural (n = 11); (3) behavioural only (n = 1); and (4) qualitative (n = 1). Of the 42 studies that included a quantitative component, 11 (26%) reported compensation occurred. Within the 13 studies examining specific behaviours, 35 behaviours were assessed, and evidence of compensation was inconsistent. Compensation mechanisms included fatigue, time constraints, lack of motivation, drive to be inactive, fear of overexertion, and autonomous motivation.

CONCLUSION

Little evidence of compensation was reported in the included quantitative studies; however, inconsistencies between studies makes comparisons difficult. There was considerable variability in the types of behaviours assessed in quantitative studies, and few studies examined potential compensatory mechanisms. Future research, using compensation specific study designs, methods, and analytic techniques, within different population sub-groups, should address these evidence gaps.

Compensation or Displacement of Physical Activity in Children and Adolescents: A Systematic Review of Empirical Studies

Regular physical activity during childhood and adolescence is associated with health benefits. Consequently, numerous health promotion programs for children and adolescents emphasize the enhancement of physical activity. However, the ActivityStat hypothesis states that increases in physical activity in one domain are compensated for by decreasing physical activity in another domain. Currently, little is known about how physical activity varies in children and adolescents within intervals of one day or multiple days. This systematic review provides an overview of studies that analyzed changes in (overall) physical activity, which were assessed with objective measurements, or compensatory mechanisms caused by increases or decreases in physical activity in a specific domain in children and adolescents. A systematic search of electronic databases (PubMed, Scopus, Web of Science, SportDiscus) was performed with a priori defined inclusion criteria. Two independent researchers screened the literature and identified and rated the methodological quality of the studies. A total of 77 peer-reviewed articles were included that analyzed changes in overall physical activity with multiple methodological approaches resulting in compensation or displacement. Of 40,829 participants, 16,265 indicated compensation associated with physical activity. Subgroup analyses separated by study design, participants, measurement instrument, physical activity context, and intervention duration also showed mixed results toward an indication of compensation. Quality assessment of the included studies revealed that they were of high quality (mean = 0.866). This review provides inconclusive results about compensation in relation to physical activity. A trend toward increased compensation in interventional studies and in interventions of longer duration have been observed.

Potential health-related behaviors for pre-school and school-aged children during COVID-19 lockdown: A narrative review

As a consequence of the COVID-19 pandemic, different measures have been implemented by governments from each affected country. Such measures usually involve restrictions on the movement of citizens, and have had a profound effect on usual activities and timetables. As a result of school closures and strict restrictions regarding going outside home, children have been one of the most disadvantaged population groups during the lockdown period. We therefore aimed to investigate potential health risk behaviors amongst isolated pre-school and school-aged children. We retrieved relevant articles from MEDLINE, Web of Science, PsycInfo, and Scopus databases to describe identified health-related behaviors (i.e. screen exposure, environmental influence, physical activity and fitness, sedentariness, sleep patterns, eating habits, psychological response, body composition, and injuries) in relation to social isolation and social deprivation of children without previous illness or conditions. This review depicts the potential health-related behaviors according to related literature, and put the focus on future short and long-term sequels of social isolation. Socio-affective complications and insufficient physical activity are underscored as two of the main concerns, particularly among socio-economic deprived children. Both issues could be effectively addressed with either adequate parental or community guidance.

Health-Related Behaviors Among School-Aged Children and Adolescents During the Spanish Covid-19 Confinement

In response to the coronavirus disease 2019 (Covid-19) world pandemic, affected countries such as Spain enacted measures comprising compulsory confinement as well as restrictions regarding free movement. Such measures likely influence children's and adolescents' lifestyles. Our study aimed to investigate the impact that the Covid-19 confinement has on health-related behaviors (HRBs) among Spanish children and adolescents. An online survey was administered to 516 parents to collect data about 860 children and adolescents (49.2% girls) aged between 3 and 16 years in relation to physical activity, screen exposure, sleep time, and fruit and vegetable consumption during the Covid-19 confinement. Respectively, t-paired test and t-test between groups served to check differences between HRBs levels before and during the confinement as well as between strict and relaxed confinement. Significant differences were found for a reduction of weekly minutes of physical activity during the confinement (-102.5, SD 159.6) (p < 0.001), an increase of daily hours of screen exposure (2.9, SD 2.1) (p < 0.001), and a reduction of daily fruit and vegetable consumption (-0.2, SD 1.6) (p < 0.001). Sleep time showed a significant difference between strict and relaxed confinement (-0.3, SD 0.1) (p < 0.05), whereas binomial logistic regression adjusted for covariates (age, sex, education of the parents, siblings, current condition, exposure to Covid-19, and previous health risk behavior) showed significantly lower odds for screen exposure risk behavior with relaxed confinement (OR 0.60, 95%CI 0.40-0.91). The present study suggests that Covid-19 confinement reduced physical activity levels, increased both screen exposure and sleep time, and reduced fruit and vegetable consumption. Therefore, most HRBs worsened among this sample of Spanish children and adolescents. Closure of schools, online education, and the lack of policies addressing the conciliation between labor and family life could have played an important role in HRBs worsening among pupils, which might be mitigated with adequate conciliation policies, parental guidance, and community support.

Physical Activity Levels of Chilean Children in a National School Intervention Programme. A Quasi-Experimental Study

Background. Recess is a great opportunity to interrupt sedentary behaviour and increase moderate-to-vigorous physical activity (MVPA) in schoolchildren. This quasi-experimental study aimed to compare the levels of physical activity (PA) during the school day of children in a school intervention programme vs. those in a control group, and to determine compliance with MVPA recommendations. Methods. A sample of 154 schoolchildren (6–12 years old) was obtained from several schools (70 with the intervention and 84 controls). This programme was structured with a duration of 90 min/session and performed three times/week. PA levels were recorded with triaxial accelerometers during the school day: during recess, during a PA session or physical education session (PE), and during lunchtime. No pre-intervention evaluation was performed. Results. The MVPA of the control group was higher than that of the intervention group during the first recess (p < 0.001). None of the groups complied with the recommendations for steps during the PA or PE sessions. During the PA session, sedentary time was lower and MVPA was higher, in the intervention group than in the control group. Fifty percent of the children from the intervention group complied with the MVPA recommendations, vs. 22.7% of those in the control group. Conclusions. The schoolchildren in the intervention group performed more MVPA than those in the control group. Future interventions could include other periods, such as recess and lunchtime, which are opportunities for improving the MVPA levels of schoolchildren.

Compensatory changes in physical activity and sedentary time in children and adolescents with cystic fibrosis

Physical activity (PA) is a key element in Cystic Fibrosis (CF) treatment strategies, yet little is known as to whether activity compensation occurs. This study examined whether PA and/or sedentary time on one day were temporally associated with time spent in these intensities the following day in youth with CF. Time spent sedentary and in different PA intensities were objectively-measured for seven consecutive days in 50 youth (22 boys; 12.0 ± 2.7 years); 25 with mild-to-moderate CF and 25 age- and sex-matched controls. Multilevel analyses (day and child) were conducted using generalised linear latent and mixed models. On any given day, every additional 10 minutes spent in sedentary time or moderate-to-vigorous physical activity (MVPA) were associated with 1.9 (95%CI: -3.6 to -1.2) and 12.4 (95%CI: -22.1 to -2.9) minutes less sedentary time the following day, respectively. These temporal associations were also observed when split by group (3.1 vs. 1.9 minutes for healthy and CF, respectively). These findings indicate that youth do not compensate their PA, irrespective of disease status, between days, but may compensate their sedentary time between days. Experimental studies are warranted to fully elucidate whether compensatory responses to PA and sedentary time occur, which is fundamental for informing PA promotion strategies.

Prospective Associations between Weekend Catch-Up Sleep, Physical Activity, and Childhood Obesity

BACKGROUND

Catch-up sleep and low physical activity on weekends have been commonly documented. Preliminary evidence on Chinese children, however, has shown a variety of weekly physical activity patterns. This study examined the prospective associations between weekend catch-up patterns of sleep and physical activity and obesity over a 2-year period in Chinese children.

METHODS

Prospective data from 599 children in the Understand Children's Activity and Nutrition (UCAN) cohort study were analyzed. Weekly patterns of obesogenic behaviors (physical activity and sleep duration) were assessed annually over a 2-year period. Moderate-to-vigorous physical activity (MVPA) and sedentary time were determined by ActiGraph accelerometry. Data on sleep durations and sociodemographic factors were obtained from parental-reported questionnaires. Weekend catch-up sleep and MVPA patterns were calculated and examined in relation to childhood obesity after controlling for sociodemographic variables and sedentary time.

RESULTS

Every additional hour of average weekly sleep duration was associated with a 16% decrease in the odds of obesity (OR: 0.841, 95%CI: 0.709 - 0.999). After adjustment of average sleep duration, weekend sleep catch-up categories showed no association with obesity risk. Over a 2-year period, half of the children demonstrated weekend catch-up MVPA. Weekend catch-up MVPA for less than 20 minutes (OR: 0.473, 95%CI: 0.258 - 0.867) or more than 20 minutes (OR: 0.505, 95%CI: 0.257 - 0.993) were both related to lower risk of obesity.

CONCLUSIONS

Weekend catch-up sleep did not ameliorate the risk of childhood obesity, whereas weekend catch-up MVPA did reduce that risk. More research is needed to explore the factors contributing to these obesogenic behavior patterns.