Longitudinal Trajectories of Children's Physical Activity and Sedentary Behaviors on Weekdays and Weekends

Clustering of diet, physical activity and sedentary behaviour and related physical and mental health outcomes: a systematic review

BACKGROUND

Physical activity (PA), sedentary behaviour (SB) and diet play an important role in the physical and mental health of young people. Understanding how these behaviours cluster, and the impact of clusters on health is important for the development of public health interventions. This review examines the prevalence of clusters of PA, sedentary time, and dietary behaviours, and how clusters relate to physical and mental health indicators among children, adolescents and young adults.

METHODS

Electronic (PubMed, Web of Science and Scopus) and manual searches were conducted for articles that were (i) observational studies including children, adolescents and/or young adults aged 5-24 years, (ii) examined the 'patterning', 'clustering', or 'co-existence' of each of PA, dietary behaviour and SB, and (iii) published in English up to and including July 2022. In addition to information on clustering, data on physical and mental health outcomes were extracted where reported. Included studies were assessed using the Cochrane risk of bias for observational studies. A narrative synthesis was conducted due to high heterogeneity. This review was registered with PROSPERO (CRD42021230976).

RESULTS

Forty-nine cross-sectional studies and four prospective cohort studies from eighteen countries reporting data from 778,415 individual participants were included. A broad range of clusters (n = 172) were found (healthy, unhealthy, and mixed). Mixed clusters were common (n = 98), and clusters of high diet quality, low PA and high SB were more prevalent in girls, while mixed clusters of high PA, high SB and low diet quality were more prevalent in boys. Unhealthy clusters comprising low moderate to vigorous PA, low consumption of fruits and vegetables, and high screen time were prevalent, particularly in those from lower socioeconomic status families. Compared to those with healthy behavioural clusters, those with unhealthy and mixed clusters had a higher adiposity, higher risk of cardiovascular disease, poorer mental health scores, and lower cardiorespiratory fitness.

CONCLUSIONS

PA, SB and diet cluster in healthy, unhealthy and mixed patterns in young people that differ across sociodemographic characteristics. Unhealthy clusters are associated with poorer health outcomes. Intervention strategies targeting un-clustering multiple unhealthy behaviours should be developed and evaluated for their impact on health outcomes.

Weekday and Weekend Physical Activity of Preschool Children in Relation to Selected Socioeconomic Indicators

Physical activity (PA) is as vital for improving the health of young children as it is positively associated with a broad range of psychological, cognitive, and cardio-metabolic outcomes. The aims of this study were to: (1) to assess the level of PA and meeting the WHO recommendations: moderate-to-vigorous physical activity (MVPA) and the number of steps in Polish preschool boys and girls on weekdays and on weekends; (2) to investigate the relationship between selected socioeconomic indicators (self-reported by parents) and PA, including meeting the WHO recommendation for daily MVPA and the number of steps on weekdays and on weekends among Polish preschoolers. Data were collected in the 2017/2018 school year. The study included a total of 522 boys and girls both aged between 5 and 6 years. The ActiGraph GT3X-BT tri-axial accelerometer was used to measure PA. Selected socioeconomic indicators as well as parental body weight and body height were self-reported by parents/caregivers using a questionnaire. In most of the PA indicators analyzed for girls (moderate, vigorous, total MVPA, and steps/day), the averages were higher during the week than during the weekend. Moreover, significantly more boys met the criteria of MVPA, both on weekdays and over the weekend (32.3% boys and 19.2% girls on weekdays and 31.1% boys and 18.1% girls on weekends). Additionally, more boys met the step recommendations, but only on weekends (15.5% boys and 6.6% girls). It was found that if there were two people in a household, there was an almost a three-fold greater chance (adj. OR = 2.94, p = 0.032) of meeting the MVPA criterion with an even stronger association (over fivefold greater chance) in meeting the step recommendation (adj. OR = 5.56, p = 0.033). The differences in the day schedule may potentially contribute with the level of PA in girls. Among the analyzed selected socioeconomic indicators, only the number of people in a household had a significant association on PA.

Weekday and Weekend Differences in Eating Habits, Physical Activity and Screen Time Behavior among a Sample of Primary School Children: The "Seven Days for My Health" Project

BACKGROUND

Healthy eating and active lifestyle habits are essential for a child's development, wellbeing, and health. School setting and family environment play a crucial role in shaping these habits and this could be reflected in different behavior patterns during weekdays and weekends.

METHODS

We investigated primary school children's lifestyle habits through a cross-sectional analysis of 428 Italian primary school children, with a mean age of 8.99 years (±1.43). Data were collected from May to June 2017 using a weekly diary to assess children's lifestyles.

RESULTS

Children who eat their morning snack and lunch at school three or more times during the weekdays were 5.47 times more likely (95% CI 3.02, 10.2) to consume adequate snacks and 7.79 times more likely (95% CI 4.43, 14.5) to have adequate meals than those who did not.

CONCLUSION

Consumption of vegetables, lunch, and snacks are significantly more adequate during the weekdays as compared to the weekends. Physical activity levels did not differ between weekdays and weekends. Moreover, children spent more time engaged in physical activities than in front of a screen during both the weekdays and the weekends. The present results are good indicators of the importance of the school canteen in defining correct eating habits. Family-based and school-based interventions could represent valuable integrative strategies for promoting a healthy lifestyle in children.

Bidirectional relationships of physical activity and gross motor skills before and after summer break: Application of a cross-lagged panel model

BACKGROUND

Gross motor skills are postulated to have a bidirectional relationship with physical activity (PA); however, no study has tested this relationship before and after a summer break. The purpose of this study was to examine the bidirectional relationships between school PA and gross motor skills in children before and after a summer break.

METHODS

Participants were a sample of 440 children recruited from 3 low-income schools (age = 8.9 ± 1.2 years, mean ± SD). PA was assessed as average school-day step counts using Yamax DigiWalker pedometers (Yamasa Tokei Keiki, Tokyo, Japan) worn for 5 consecutive school days. Gross motor skills were assessed using the Test for Gross Motor Development, 3rd edition. Data were collected at 2 timepoints: at the end of spring semester (T1) and at the beginning of the subsequent fall semester (T2). An age- and body mass index-adjusted cross-lagged model was employed to relate T1 school step counts with T2 gross motor skills and T1 gross motor skills with T2 school step counts.

RESULTS

T1 gross motor skills significantly predicted T2 school step counts (β = 0.24, 95 % confidence interval (95%CI): 0.08-0.40, p = 0.003); however, T1 school step counts did not predict T2 gross motor skills (β = 0.04, 95%CI: -0.06 to 0.14, p = 0.445). The model explained 35.4% and 15.9% of the variances of T2 gross motor skills and T2 school step counts, respectively. Additional analyses indicated that these relationships were driven primarily by ball skills.

CONCLUSION

The relationship between gross motor skills and school PA was not bidirectional; however, higher gross motor skills, specifically ball skills, predicted higher school PA after a 3-month summer break.

Backyard benefits? A cross-sectional study of yard size and greenness and children's physical activity and outdoor play

BACKGROUND

The home environment is the most important location in young children's lives, yet few studies have examined the relationship between the outdoor home environment and child physical activity levels, and even fewer have used objectively measured exposures and outcomes. This study examined relationships between objectively assessed home yard size and greenness, and child physical activity and outdoor play.

METHODS

Data were drawn from the HealthNuts study, a longitudinal study of 5276 children in Melbourne, Australia. We used cross-sectional data from a sample at Wave 3 (2013-2016) when participants were aged 6 years (n = 1648). A sub-sample of 391 children had valid accelerometer data collected from Tri-axial GENEActive accelerometers worn on their non-dominant wrist for 8 consecutive days. Yard area and greenness were calculated using geographic information systems. Objective outcome measures were minutes/day in sedentary, light, and moderate-vigorous physical activity (weekday and weekend separately). Parent-reported outcome measures were minutes/day playing outdoors (weekend and weekday combined). Multi-level regression models (adjusted for child's sex, mother's age at the birth of child, neighbourhood socioeconomic index, maternal education, and maternal ethnicity) estimated effects of yard size and greenness on physical activity.

RESULTS

Data were available on outdoor play for 1648 children and usable accelerometer data for 391. Associations between yard size/greenness and components of physical activity were minimal. For example, during weekdays, yard size was not associated with daily minutes in sedentary behaviour (β: 2.4, 95% CI: - 6.2, 11.0), light physical activity (β: 1.4, 95% CI: - 5.7, 8.5) or MVPA (β: -2.4, 95% CI: - 6.5, 1.7), with similar patterns at weekends. There was no relationship between median annual yard greenness and physical activity or play.

CONCLUSION

In our study of young children residing in higher socio-economic areas of Melbourne yard characteristics did not appear to have a major impact on children's physical activity. Larger studies with greater variation in yard characteristics and identification of activity location are needed to better understand the importance of home outdoor spaces and guide sustainable city planning.

Changes in Physical Fitness during Summer Months and the School Year in Austrian Elementary School Children-A 4-Year Longitudinal Study

Even though physical fitness is an important component in children's health and well-being, there has been a decline in physical fitness over the last several decades. The present study examined potential differences in the development of physical fitness during the academic year and summer vacation in Austrian elementary-school children. A total of 214 children (52.3% boys) completed the German motor test in the fall (after summer vacation) and spring (prior to summer vacation) of every grade throughout their elementary school years. This resulted in eight assessments of cardio-respiratory endurance, muscular fitness, flexibility, speed, agility, and balance over a 4-year period. As expected, physical fitness increased with age but the improvement in cardio-respiratory endurance and muscular fitness was more pronounced during summer vacation (p < 0.01), while the improvement in speed was more pronounced during the academic year (p < 0.01). These results indicate an influence of weather conditions on health-enhancing physical activity in addition to structural and social support. Particularly in geographical regions with cold winters and shorter days, health-enhancing physical activity may be limited. Accordingly, schools need to provide additional opportunities to ensure an adequate amount of physical activity that stimulates the development of physical fitness.

Children's moderate-to-vigorous physical activity on weekdays versus weekend days: a multi-country analysis

Purpose

The Structured Days Hypothesis (SDH) posits that children’s behaviors associated with obesity – such as physical activity – are more favorable on days that contain more ‘structure’ (i.e., a pre-planned, segmented, and adult-supervised environment) such as school weekdays, compared to days with less structure, such as weekend days. The purpose of this study was to compare children’s moderate-to-vigorous physical activity (MVPA) levels on weekdays versus weekend days using a large, multi-country, accelerometer-measured physical activity dataset.

Methods

Data were received from the International Children’s Accelerometer Database (ICAD) July 2019. The ICAD inclusion criteria for a valid day of wear, only non-intervention data (e.g., baseline intervention data), children with at least 1 weekday and 1 weekend day, and ICAD studies with data collected exclusively during school months, were included for analyses. Mixed effects models accounting for the nested nature of the data (i.e., days within children) assessed MVPA minutes per day (min/day MVPA) differences between weekdays and weekend days by region/country, adjusted for age, sex, and total wear time. Separate meta-analytical models explored differences by age and country/region for sex and child weight-status.

Results/findings

Valid data from 15 studies representing 5794 children (61% female, 10.7 ± 2.1 yrs., 24% with overweight/obesity) and 35,263 days of valid accelerometer data from 5 distinct countries/regions were used. Boys and girls accumulated 12.6 min/day (95% CI: 9.0, 16.2) and 9.4 min/day (95% CI: 7.2, 11.6) more MVPA on weekdays versus weekend days, respectively. Children from mainland Europe had the largest differences (17.1 min/day more MVPA on weekdays versus weekend days, 95% CI: 15.3, 19.0) compared to the other countries/regions. Children who were classified as overweight/obese or normal weight/underweight accumulated 9.5 min/day (95% CI: 6.9, 12.2) and 10.9 min/day (95% CI: 8.3, 13.5) of additional MVPA on weekdays versus weekend days, respectively.

Conclusions

Children from multiple countries/regions accumulated significantly more MVPA on weekdays versus weekend days during school months. This finding aligns with the SDH and warrants future intervention studies to prioritize less-structured days, such as weekend days, and to consider providing opportunities for all children to access additional opportunities to be active.

Do Adolescents Who Meet Physical Activity Recommendations on Weekdays Also Meet Them on Weekends? A Cross-Sectional Study in Colombia

The purpose of this study was to examine whether Colombian adolescents fulfill physical activity (PA) recommendations by type of day depending on several variables. A cross-sectional study was carried out on a sample of 2624 adolescents from Neiva (Colombia) using the Seven Day PA Recall and the Family Affluence Scale II self-reported questionnaires. Statistical analyses were performed to find any differences by gender, socioeconomic status, PA recommendations accomplishment, participation in organized and non-organized PA, parents' involvement in sport, and adolescents' academic achievement, and to determine the probability of complying with the PA guidelines. Only 12.3% of the participants met the PA recommendations on weekdays and weekends. Girls maintained their (in)active patterns during the week more than boys (84.4% vs. 70.7%, respectively), while more boys than girls changed them according to the type of day (25.3% vs. 19.6%). Participation in organized sports was the predictor variable with the highest probability of both boys and girls complying with the PA recommendations on weekdays. Non-organized activities were more likely to make girls more active on weekends. In conclusion, a wider offer of organized and non-competitive PA over the weekend and broader sports schedules should be provided to youth in Neiva.

Influence of meeting weekday and weekend step count recommendations on weight statusin children

The purpose of this study was to investigate the relationship between meeting step count recommendations during the weekday and weekend and the weight status in school-aged children. A convenience sample of 855 fourth and fifth grade students (9.7 ± 1.0 years) was recruited from 4 elementary schools located in the Western United States. Body Mass Index (BMI) was calculated using standard procedures and then stratified to weight status categories (healthy weight, overweight/obese) using age- and sex-specific percentiles. Step counts were monitored for seven consecutive days using NL-1000 piezoelectric pedometers. A multilevel generalized linear mixed effect model was used to estimate the odds ratios of meeting segmented step counts recommendations and weight status. Students meeting weekday step count recommendations associated with 39% lower odds of overweight/obesity compared to those not meeting any recommendations (P = 0.02). Those meeting both weekday and weekend recommendations associated with 67% lower odds of overweight/obesity compared to children not meeting any recommendations (P = 0.01). Meeting weekend step count recommendations did not associate with weight status. This study supports the positive relationship between segmented step counts and the healthy weight status of school-aged children.

Effect of Children's Weight Status on Physical Activity and Sedentary Behavior during Physical Education, Recess, and After School

Children's body mass index may affect physical activity (PA) participation. Therefore, this study examined the effect of children's weight status on underserved elementary school children's PA and sedentary behavior (SB) throughout the segmented day. Participants were 138 children (X¯age = 8.14 years). Children's height and weight were measured with subsequent classification of children as healthy weight or overweight/obese. Durations of moderate-to-vigorous PA (MVPA), light PA (LPA), and SB during physical education (PE), morning recess, lunch recess, after school, and overall were assessed via accelerometry over three days. Independent t-tests evaluated differences in children's MVPA, LPA, and SB during each daily segment by weight status. Significantly higher MVPA was observed for children of healthy weight status versus children with overweight/obesity during morning recess, t(136) = 2.15, p = 0.03, after school, t(136) = 2.68, p < 0.01, and overall, t(136) = 2.65, p < 0.01. Interestingly, comparisons of children of healthy weight status and children with overweight/obesity's LPA and SB during the after-school segment revealed a trend wherein children with overweight/obesity participated in slightly greater LPA/less SB than children of healthy weight status. Higher MVPA was observed among children of healthy weight versus children with overweight/obesity during most daily segments. Concerted efforts should focus on increasing MVPA among children with overweight/obesity.

Personal, Social, and Environmental Influences on Physical Activity in Groups of Children As Defined by Different Physical Activity Patterns

BACKGROUND

Interventions promoting physical activity (PA) in youth have had limited success, in part because studies with methodological challenges have yielded an incomplete understanding of personal, social, and environmental influences on PA. This study described changes in these factors for subgroups of youth with initially high PA that decreased (Active-Decline) compared with children with initially low PA that decreased (Inactive-Decline) from fifth to ninth grades.

METHODS

Observational, prospective cohort design. Participants (n = 625) were fifth-grade children recruited in 2 school districts and followed from elementary to high school. Students and their parents responded to questionnaires to assess personal, social, and perceived physical environmental factors in the fifth (mean age = 10.5 [.5] y) and ninth (mean age = 14.7 [.6] y) grades. Analyses included a mixed-model 2-way repeated analysis of variances.

RESULTS

Children in the Active-Decline compared with those in the Inactive-Decline group showed a more favorable profile in 6 of 8 personal variables (perceived barriers, self-efficacy, self-schema, enjoyment, competence, and fitness motives) and 4 of 6 social variables (friend support, parent encouragement, parent support, and parent-reported support).

CONCLUSIONS

The results suggest efforts to promote PA should target selected personal, social, and perceived environmental factors beginning before age 10 and continuing through adolescence.