Objective assessment of childhood adherence to Canadian physical activity guidelines in relation to body composition

Physical Literacy and Resilience in Children and Youth

Background: There is growing interest in the relationship between physical and psychosocial factors related to resilience to better understand the antecedents of health and successful adaptation to challenges in and out of school, and across the lifespan. To further this understanding, a trans-disciplinary approach was used to investigate the association between the multidimensional constructs of physical literacy and resilience in children at a key stage in their development.

Methods: Cross-sectional data were collected from 227 school children aged 9-12 years old from five schools in Winnipeg, Manitoba, Canada. Resilience was measured using the Child and Youth Resilience Measure, and physical literacy through the Physical Literacy Assessment for Youth tools. Data were provided by self-report, surrogate assessors of the child (physical education teachers and parents), and trained assessors for movement skills. These data were analyzed using correlation and logistic regression.

Results: Resilience was significantly correlated with numerous indicators of physical literacy, including movement capacity, confidence, and competence, environmental engagement, and overall perceptions of physical literacy. Regressions indicated that resilience could be predicted by movement confidence and competence, environmental engagement, and overall physical literacy.

Conclusions: The findings of this study, using a constellation of sources, provide foundational evidence for the link between resilience and physical literacy among children, encouraging the importance of physical literacy development in schools. Longitudinal studies are required to further examine this relationship and how these previously unrelated fields may work together for a richer understanding of the interplay between the physical and psychological determinants of well-being.

Top 10 Research Questions Related to Physical Literacy

The term physical literacy is relatively new, and its definition, conceptual underpinning, how it is measured, how to change it, and its relationship with holistic health and wellness across the life span are a few of many foundational issues that lack consensus. At present, there are more questions than answers. The purpose of this article is to highlight 10 important research questions related to physical literacy with the hope of fueling future research activity and debate. Input was sought from international experts and practitioners on priorities and research gaps related to physical literacy. This list was supplemented by personal experience and research priorities identified in published manuscripts. From these various sources, the top 10 research questions related to physical literacy were compiled. Research related to physical literacy is in its infancy, and many important, even fundamental research questions and priorities remain unanswered. Research needs are summarized within 4 themes: monitoring physical literacy, understanding the physical literacy journey, enhancing physical literacy, and the benefits of physical literacy. Specific research questions relate to identifying measurable aspects of physical literacy and how they change across cultures and throughout the life span, as well as understanding the individual and environmental factors that describe the physical literacy journey and are effective targets for interventions. Physical literacy is increasingly recognized as the foundation for a healthy active lifestyle; however, robust research demonstrating its constitution, its relationship with health-related outcomes, and intervention strategies for its improvement remains to be completed.

The Canadian Assessment of Physical Literacy: methods for children in grades 4 to 6 (8 to 12 years)

BACKGROUND

Physical literacy is described as the motivation, confidence, physical competence, knowledge and understanding to value and engage in a physically active lifestyle. As such, it is expected that those who have greater physical literacy would be more likely to obtain the health benefits offered by habitual physical activity. A theoretical model and assessment battery, the Canadian Assessment of Physical Literacy (CAPL), for the assessment of childhood physical literacy had been proposed in theory but validity data were lacking. The purpose of this study was to explore validity evidence for the CAPL among children in grades 4 to 6.

METHODS

CAPL validity was evaluated through three analyses that utilized cross-sectional data obtained through local schools in Eastern Ontario, Canada. A confirmatory factor analysis compared the data to the theoretical model. Patterns of association between self-reported age and gender and the CAPL total and domain scores were examined using regression models. Teacher ratings of participants' knowledge, attitude and physical activity competence were compared to assessment results.

RESULTS

The CAPL was completed by 963 children (55 % female) in grades 4, 5 and 6. Children were 8 to 12 years of age (mean 10.1 years), with 85 % of children approached agreeing to participate. A confirmatory factor analysis using data from 489 children with complete raw scores supported a model with four domains: engagement in physical activity (active and sedentary), physical competence (fitness and motor skill), motivation and confidence, and knowledge and understanding. Raw domain scores followed expected patterns for age and gender, providing evidence for their validity. Interpretive categories, developed from age and gender adjusted normative data, were not associated with age indicating that the CAPL is suitable for use across this age range. Children's gender was associated with the physical competence, motivation and engagement in physical activity domain scores, indicating that further research is required regarding the gender adjustment of the raw CAPL scores. CAPL domain and total scores were statistically significantly associated with teacher ratings of the child's motivation, attitudes, fitness, skill and overall physical activity.

CONCLUSIONS

CAPL offers a comprehensive assessment of engagement in physical activity, physical competence, motivation and confidence, and knowledge and understanding as components of childhood (grades 4 to 6, 8 to 12 years) physical literacy. Monitoring of these measures enhances our understanding of children's physical literacy, and assists with the identification of areas where additional supports are required.

The combined effect of physical activity and sedentary behaviors on a clustered cardio-metabolic risk score: The Helena study

BACKGROUND/OBJECTIVE

Increased physical activity (PA) and decreased sedentary behaviors (SBs) may have beneficial effects on cardio-metabolic risk in adolescents. The aim of this study was to examine the associations between independent/combined effects of PA and SB with individual/clustered cardio-metabolic risk factors.

METHODS

A sample of 769 adolescents (12.5-17.5 years) from the HELENA cross-sectional study (Healthy Lifestyle in Europe by Nutrition in Adolescence) and with valid data on metabolic risk factors were included.

RESULTS

Concerning moderate-to-vigorous-PA (MVPA) and vigorous-PA (VPA), measured with accelerometers, girls tended to do more MVPA (36%) and VPA (114%) than boys. Unadjusted analyses show a positive association between "PA ≥ 60 min/d; SB ≥ 2 h" and the ratio TC/HDL-c (β = 0.27; 95%CI 0.01 to 0.52; p < 0.05), and a negative association between "MVPA ≥ 60 min/d; SB < 2h" with the ∑ 4Skinfolds (β = -0.32; 95%CI -0.61 to -0.02; p<0.05). Moreover, "SB ≥ 2 h/d" was associated with increased cardio-metabolic risk (PR 1.59; 95%CI 1.05 to 2.39; p < 0.05), while "PA ≥ 60 min/d; SB < 2h" had a protective effect against cardio-metabolic risk (PR 0.48; 95%CI 0.25 to 0.91; p < 0.05). After adjustment for potential confounders, a positive association between SB and ∑ 4Skinfolds was shown (β = 0.28; 95%CI 0.04 to 0.53; p < 0.05). Furthermore, VO2max (mL/kg/min) tends to increase in those participants who do higher VPA and less SB (p = 0.042), and there was a protective effect of "VPA ≥ 30 min/d; SB < 2h" against cardio-metabolic risk (PR 0.24; 95%CI 0.07 to 0.85; p < 0.05).

CONCLUSION

The current study suggests that adolescents should be encouraged to decrease sedentary lifestyle and increase physical activity, especially vigorous physical activity, in order to reduce cardio-metabolic risk.

Physical activity and clustered cardiovascular disease risk factors in young children: a cross-sectional study (the IDEFICS study)

BACKGROUND

The relevance of physical activity (PA) for combating cardiovascular disease (CVD) risk in children has been highlighted, but to date there has been no large-scale study analyzing that association in children aged ≤9 years of age. This study sought to evaluate the associations between objectively-measured PA and clustered CVD risk factors in a large sample of European children, and to provide evidence for gender-specific recommendations of PA.

METHODS

Cross-sectional data from a longitudinal study in 16,224 children aged 2 to 9 were collected. Of these, 3,120 (1,016 between 2 to 6 years, 2,104 between 6 to 9 years) had sufficient data for inclusion in the current analyses. Two different age-specific and gender-specific clustered CVD risk scores associated with PA were determined. First, a CVD risk factor (CRF) continuous score was computed using the following variables: systolic blood pressure (SBP), total triglycerides (TG), total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-c) ratio, homeostasis model assessment of insulin resistance (HOMA-IR), and sum of two skinfolds (score CRFs). Secondly, another CVD risk score was obtained for older children containing the score CRFs + the cardiorespiratory fitness variable (termed score CRFs + fit). Data used in the current analysis were derived from the IDEFICS ('Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS') study.

RESULTS

In boys <6 years, the odds ratios (OR) for CVD risk were elevated in the least active quintile of PA (OR: 2.58) compared with the most active quintile as well as the second quintile for vigorous PA (OR: 2.91). Compared with the most active quintile, older children in the first, second and third quintiles had OR for CVD risk score CRFs + fit ranging from OR 2.69 to 5.40 in boys, and from OR 2.85 to 7.05 in girls.

CONCLUSIONS

PA is important to protect against clustering of CVD risk factors in young children, being more consistent in those older than 6 years. Healthcare professionals should recommend around 60 and 85 min/day of moderate-to-vigorous PA, including 20 min/day of vigorous PA.

Social influence and adolescent health-related physical activity in structured and unstructured settings: role of channel and type

BACKGROUND

Social influence channels (e.g., parents) and types (e.g., compliance) have each been related to physical activity independently, but little is known about how these two categories of influence may operate in combination.

PURPOSE

This study examined the relationships between various combinations of social influence and physical activity among youth across structured and unstructured settings.

METHODS

Adolescents (N=304), classified as high or low active, reported the social influence combinations they received for being active.

RESULTS

Participants identified three channels and three types of influence associated with being active. For structured activity, compliance with peers and significant others predicted membership in the high active group (values of p< .001). In the unstructured setting, peer compliance (p= .009) and conformity (p= .019) were associated with active group membership.

CONCLUSIONS

These findings reinforce considering both setting, as well as the channel/type combinations of social influence, when examining health-related physical activity.

[Physical activity and obesity]

One reason for the high prevalence of overweight and obesity might be the differences in lifestyle compared to earlier decades, called the "obesogenic environment." With this, the decline in physical activity (PA) in favor of a sedentary lifestyle is assumed to play an important role. Physical activity or inactivity has a major impact on the development of overweight and obesity as well as on certain metabolic disorders. This review summarizes current scientific knowledge regarding the association between PA and overweight/obesity. The term "physical activity" is defined and different methods of its assessment are introduced. In addition, certain methods for the evaluation/operationalization of collected PA data are described. Finally, some epidemiological studies dealing with the associations between PA and overweight/obesity in children/adolescents as well as in adults are presented.

Assessment of a two-year school-based physical activity intervention among 7-9-year-old children

Background

Physical activity (PA) in children has declined in recent decades, highlighting the need for effective intervention programs for school-aged children. The main objective of this study was to assess to what extent PA during and after school hours changed among children who received a progressive two-year long intervention vs. that of children who only received general curriculum-based PA.

Methods

A cluster randomized intervention study was conducted and six elementary schools randomly assigned to serve as control- or intervention schools. All children attending second grade (mean age = 7.4 years - born in 1999) were invited to participate in the fall of 2006 (N = 320, 82% participated), again in 2007 (midpoint) and 2008 (end of intervention). The intervention consisted of multi-component PA-intervention during school hours and was conducted by teachers at each intervention school. PA was assessed by means of accelerometers and subjectively at the intervention schools via teachers' PA log-books.

Results

There was no difference in PA intensity (minutes of moderate-to-vigorous physical activity - min of MVPA) between the two study groups at baseline, but children in the intervention schools were more physically active at moderate-to-vigorous intensity compared to those in control schools after one year of intervention (mean difference of MVPA_log-minutes: 0.61, 95%CI: 0.02, 1.20, p = 0.04). Moreover, the model for minutes of MVPA during school hours, showed a significant three-way interaction between time at mid-point, group and gender (mean difference of MVPA_log-minutes: 1.06, 95%CI: 0.15, 1.97, p = .02), indicating a significantly greater increase among the boys in the intervention schools compared to girls. No difference in PA was detected between the study groups at the end of the study period after two years of intervention.

Conclusions

The results suggest that the objective of increasing PA at school was met after one year of intervention, and it was more pronounced among boys. The lack of increase at the end of the study period suggested that any increase in PA during school may highly depend on both motivation and training of general teachers. Boys may respond better to PA interventions such as the one described in this study.

Health-related fitness in children and adolescents

PURPOSE

The American Physical Therapy Association Section on Pediatrics developed a task force to summarize fitness guidelines for children and adolescents. The purposes of this article were to review components, measurement methods, and consequences of physical fitness, and to summarize evidence-based activity recommendations for youth.

SUMMARY OF KEY POINTS

Health-related fitness is comprised of body composition, flexibility, cardiorespiratory endurance, and muscular strength and endurance. Each of these components is reviewed in terms of definition, assessment, normative values, and recommendations.

CONCLUSIONS

The task force supports the guidelines of the US Department of Health and Human Services, which state that to promote overall health and wellness, youth should participate in 60 minutes or more of physical activity every day.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Physical therapists should apply research relevant to health-related fitness when treating youth. Promoting fitness, health, and wellness in our communities is a responsibility all therapists should assume.

Physical activity as the main therapeutic tool for metabolic syndrome in childhood

Physical activity (PA) and diet directly influence obesity and metabolic syndrome (MS) as important determinants of body composition. Understanding how PA relates to MS in youth is of great importance, and could offer a common strategy for clinical and public health approaches to control this condition. The underlying disorder of MS is a condition of insulin resistance, and a strong relationship between PA level and insulin sensitivity is clearly ascertained. The type, duration, frequency and intensity of PA affect fuel metabolism, in particular carbohydrate and lipid oxidation. The possible modulation of metabolism because of increased fat oxidation by PA is the basis for both prevention and restoration of insulin resistance and MS in obese children. In daily clinical practice, diet followed by pharmacologic treatment are usually the approaches taken, whereas PA is often considered just a suggestion. Although diet and PA have different effects on body composition, with both contributing to fat loss, only PA increases muscle mass and thus has a direct effect on metabolic function, expressed by changes in cardiovascular risk factors. Therefore, it is important to remember their complementary but different targets in daily clinical practice, such as body weight control for diet and metabolic health for PA. In this review, we have summarized the literature on the relationship between PA and MS in pediatrics. Then, we have analyzed the possibility of using PA for MS treatment, as an alternative to drugs, by discussing the results of intervention studies, reasons for low compliance to PA, related benefits, adherence difficulties and costs. Finally, we have tried to suggest recommendations for a multiple-step PA strategy in children and adolescents at risk for MS, by considering PA as the 'key' player in treatment.

Declines in physical activity and higher systolic blood pressure in adolescence

The authors examined the potential association between changes in the number of moderate-to-vigorous physical activity (MVPA) sessions per week, adiposity, and systolic blood pressure (SBP) during adolescence. SBP and anthropometric factors were assessed biannually (1999/2000, 2002, and 2004) in a cohort of 1,293 Canadian adolescents aged 12-13 years in 1999. Self-reported 7-day recall data on MVPA sessions >or=5 minutes in duration were collected every 3 months over the 5-year period. Estimates of initial level and rate of decline in number of MVPA sessions per week from individual growth models were used as predictors of SBP in linear regression models. A decline of 1 MVPA session per week with each year of age was associated with 0.29-mm Hg and 0.19-mm Hg higher SBPs in girls and boys, respectively, in early adolescence (ages 12.8-15.1 years) and 0.40-mm Hg and 0.18-mm Hg higher SBPs, respectively, in late adolescence (ages 15.2-17.0 years). The associations were not attenuated by changes in body mass index, waist circumference, or skinfold thickness in girls during late adolescence. Although weaker, associations were evident in boys during late adolescence, as well as in both girls and boys during early adolescence. These results support prevention of declines in MVPA during adolescence to prevent higher blood pressure in youth.

Physical activity intensity and risk of overweight and adiposity in children

BACKGROUND

Physical activity recommendations for children focus on duration of activity and underemphasize intensity.

OBJECTIVE

To evaluate the relationship between physical activity (intensity and duration) and the odds of being overweight, >20% body fat and >25% body fat.

METHODS AND PROCEDURES

Body fat, BMI and physical activity (accelerometry) were measured in children (n = 251) aged 8-10 years. Physical activity was quantified as time in moderate physical activity (MPA) and vigorous physical activity (VPA).

RESULTS

Prevalence of overweight and obesity were 18 and 11.6%, respectively. Regression indicated that VPA, not MPA, is associated with body fat (r = 0.35, P < 0.001) and BMI (r = 0.26, P < 0.001). Odds ratio demonstrated a significant impact of MPA and VPA on body composition. Children performing < or =5 min/day of VPA are 4.0 times more likely to have > or =20% body fat (P < 0.001), 2.9 times more likely to have > or =25% body fat (P < 0.05) and 5.2 times more likely to be classified as overweight (P < 0.01) compared to children performing > or =15 min/day. Those performing < or =15 min/day of MPA vs. >45 min/day MPA are at 4.2 increased odds of having > or =20% body fat (P < 0.001), and 3.0 increased odds of having > or =25% (P < 0.01).

DISCUSSION

Lower durations of both MPA and VPA are associated with increased odds of overweight and adiposity. Forty-five minutes of MPA and fifteen minutes of VPA were associated with reduced body fat and BMI. We recommend that these amounts are used to develop minimum physical activity intensity guidelines for the prevention and treatment of obesity.