Sedentary Behaviors in Today's Youth: Approaches to the Prevention and Management of Childhood Obesity: A Scientific Statement From the American Heart Association

Associations of perceived neighbourhood and home environments with sedentary behaviour among adolescents in 14 countries: the IPEN adolescent cross sectional observational study

BACKGROUND

Understanding environmental correlates of sedentary behaviour (SB) among young people is important as such data can identify approaches to limit sedentary time. This paper estimates associations of parent-reported neighbourhood and adolescent-reported home environments with SB among adolescents aged 11-19 years from 14 countries.

METHODS

In the International Physical activity and the Environment Network (IPEN) Adolescent Study (an observational, cross-sectional multi-country study), adolescents wore a triaxial accelerometer for seven days that assessed sedentary time (ST). Adolescents completed survey measures of sedentary behaviour (SB) related to recreational screen time and sitting time in motor vehicles. Parents and adolescents completed surveys assessing neighbourhood and home environments. Accelerometer based ST was available in 3,982 adolescents while survey data were available for 6,302 dyads. We estimated the total and direct effects of each environmental attribute on ST and SB. Sex of the adolescent and city/country were examined as moderators.

RESULTS

The average ST in adolescents from 14 countries ranged from 7.8 to 10.5 h/day. Personal social media was the only significant correlate of total ST across both sexes. With respect to self-reported SB, adolescents accumulated an average of 3.8 h of non-school screen time per day and nearly 40 min of transport-related sitting time. Screen time was associated with all home environment variables, including social media account, as well as land use mix-diversity, traffic safety, and crime safety. Transport-related sitting time was related to land use mix-diversity, recreation facilities, walking facilities, and pedestrian infrastructure, but no home environment variables. City/country and sex were significant moderators of several associations.

CONCLUSIONS

Both home and neighbourhood environment features were related to ST and SB. Having social media accounts emerged as a major contributor towards sedentarism in adolescents.

Ineffective overweight self-management: A study of diagnostic accuracy and etiological relationships

PURPOSE

To evaluate the accuracy of clinical indicators and etiological factors associated with the nursing diagnosis of ineffective overweight self-management among university students.

METHOD

A diagnostic accuracy study with a cross-sectional design was conducted with 108 university students. A latent class analysis model with random effects was used to establish sensitivity and specificity measures of clinical indicators, estimate the prevalence of the diagnosis, and calculate posterior probabilities for the diagnosis. Odds ratios for etiological factors were calculated using univariate logistic regression. The study was approved by the Research Ethics Committee of the responsible institution.

RESULTS

The nursing diagnosis of ineffective overweight self-management had an estimated prevalence of 38.1% in the sample. Sensitive clinical indicators included excessive calorie consumption (0.9514) and dissatisfaction with body image (0.8834). Specific indicators included negative self-perception of health (0.9999), inadequate eating behavior (0.9990), and impaired emotional health (0.8273). A personal history of overweight (OR = 2.78; p-value = 0.018) increased the likelihood of developing ineffective overweight self-management by approximately two and a half times.

CONCLUSION

Ineffective overweight self-management is prevalent among university students and is characterized by two sensitive clinical indicators, three specific indicators, and a population at risk that increases the likelihood of this diagnosis.

IMPLICATIONS FOR NURSING PRACTICE

Accurate clinical indicators and the identification of etiological factors for the diagnosis of ineffective overweight self-management support nurses' clinical reasoning in practice. Moreover, verifying accurate components for diagnosing ineffective overweight self-management contributes to the development of interventions aimed at promoting the health of university students.

Leisure screen time and diabetic retinopathy risk: A Mendelian randomization study

The aim of this study was to investigate whether leisure screen time (LST) increases the risk of diabetic retinopathy (DR) using the Mendelian randomization (MR). This study employed a two-sample MR analysis, utilizing 63 single-nucleotide polymorphisms as instrumental variables (IVs) to assess the causal relationship between LST and the risk of Dr. To ensure the robustness of the results, a multi-effect test was conducted to evaluate the validity of the IVs. Additionally, heterogeneity tests were performed to explore differences among sub-samples. Sensitivity analyses were also conducted to further validate our findings. The impact of LST on the risk of DR was observed in both inverse variance weighted (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.04-1.43, P = 1.38 × 10-2) and weighted median (OR: 1.30, 95% CI: 1.05-1.61, P = 1.46 × 10-2) analyses. However, the MR-Egger method (OR: 0.66, 95% CI: 0.32-1.36, P = .273) did not find an increased risk of DR with increased LST. The pleiotropy test yielded a P-value of P = .09. Heterogeneity tests showed that the Q value for the inverse variance weighted method was 71.39 with a P-value of 0.17, indicating no significant heterogeneity. These results suggest that the IVs might be appropriate, and the analysis results could be robust. A large-scale MR analysis suggests a causal relationship between LST and the risk of Dr.

Validation of the CRAVE-C scale in Chinese adults: a four-study examination of competing motivations for physical activity versus rest

Background

The study aimed to validate the Cravings for Rest and Volitional Energy Expenditure (CRAVE) scale among Chinese adults with different health conditions (healthy control, chronic illnesses, and psychiatric disorders) and skill levels (athletes vs. non-athletes).

Methods

In Study 1, a confirmatory factor analysis (CFA) using the Maximum Likelihood Method (MLM) was performed on a Chinese sample of emerging adults (N = 481) to evaluate the structural validity of the Cravings for Rest and Volitional Energy Expenditure-Chinese version (CRAVE-C). In Study 2, differences in "Move" and "Rest" desires were examined among patients with psychiatric disorders, patients with chronic illnesses, and healthy controls. In study 3, investigated the relationship between cardiorespiratory fitness and exercise motivation using the CRAVE-C (N = 83). In Study 4, the changes in "Move" desire from baseline to post-training were compared between athletes and non-athletes.

Results

Results from Study 1 indicated that the 10-item CRAVE-C showed good fit indices ( Chi2 (34) = 118.769, CFI  = 0.95, TLI = 0.934, SRMR = 0.053, RMSEA = 0.072). "Move" positively correlated with various factors of the Affective Exercise Experiences Questionnaire-Chinese and the Physical Effort Scale-Chinese, while "Rest" correlated negatively. In Study 2, Patients with psychiatric disorders had a significantly higher "Move" desire than healthy controls. Patients with chronic illnesses had a significantly higher "Rest" desire than healthy controls. In Study 3, higher cardiorespiratory fitness was associated with a slight increase in "Move" desire (3.26% ± 37.35%) and a decrease in "Rest" desire (18.94% ± 66.99%). Lower fitness was linked to a significant decline in "Move" desire (-54.61% ± 111.33%) and an increase in "Rest" desire (43.62% ± 63.64%). In Study 4, the athlete group demonstrated a significant increase in "Move" desire from baseline to post-training, whereas the non-athlete group reported a significant decrease in "Move" desire from baseline to post-training.

Conclusion

The 10-item CRAVE-C has good reliability and validity in the Chinese cultural context and can be used among Chinese adults with different health conditions and skill levels.

Lifestyle Interventions in Pediatric Primary Care

Pediatric clinicians should offer guidance on age-appropriate nutrition, physical activity, sleep and screen time for families of children and adolescents with obesity. They should build rapport with families, ask permission before discussing obesity-related health concerns, use preferred terminology, and recommend whole family change. Using principles of shared decision-making, pediatric clinicians and families should set individualized goals for lifestyle changes, prioritizing reducing sugar-sweetened beverage intake, increasing physical activity, and reducing screen time. Families of children and adolescents with obesity should be connected to the highest level of support accessible to and desired by the family, including intensive health behavior and lifestyle treatment programs.

Parent and child opinion on the use of standing desks in the classroom

Objective

Standing desks present a novel approach to reduce sedentary time in the classroom and address cardiovascular risk factors at an early age. In the context of designing a standing desk study, parents and children were surveyed regarding their perceptions and current use of standing desks and other flexible seating.

Methods

Survey administered from January 31st to February 26th, 2024 to a convenience cohort of 50 parent-child pairs presenting for well or acute care at a pediatrics clinic affiliated with an academic institution (Hershey, Pennsylvania, United States). Logistic regression examined parent support of and child willingness to use a standing desk in the classroom.

Results

Parents were primarily non-Hispanic, white females above 40 years of age. Child participants mean age and grade level were 10.5 years and 5th grade respectively. Among parents, 85 % (39/46) were supportive of their child's use of a standing desk in the classroom, with 4 declining to answer. For children, almost half, 48 % (24/50), were willing to use a standing desk. Acceptability decreased for child body mass index (BMI) ≥85th percentile versus BMI <85th percentile (parent acceptability OR = 0.07 [95 % CI: 0.01-0.63; p = 0.018]; child acceptability: OR = 0.13 [95 % CI 0.03-0.51, p = 0.003]).

Conclusions

Most parents and children are amenable to use of a standing desk in the classroom. Additional information for children with elevated BMI and their parents may be required to address reservations about standing. This study was limited by its small sample size, which may not generalize to other populations.

Relationships Between Measures of the Physical Activity-Related Built Environment and Excess Weight in Preschoolers: A Retrospective, Population-Level Cohort Study

Background: The built environment can impact health outcomes. Our purpose was to examine relationships between built environment variables related to physical activity and excess weight in preschoolers. Methods: In this retrospective, population-level study of 4- to 6-year-olds, anthropometric measurements were taken between 2009 and 2017 in Calgary and Edmonton, Alberta, Canada. Based on BMI z-scores (BMIz), children were classified as normal weight (-2 ≤ BMIz <1) or excess weight (BMIz ≥1; overweight and obesity). Physical activity-related built environment variables were calculated (distances to nearest playground, major park, school; street intersection density; number of playgrounds and major parks within an 800 m buffer zone). Binomial logistic regression models estimated associations between physical activity-related built environment variables and excess weight. Results: Our analysis included 140,368 participants (females: n = 69,454; Calgary: n = 84,101). For Calgary, adjusted odds ratios (aORs) showed the odds of excess weight increased 1% for every 100-intersection increase [1.010 (1.006-1.015); p < 0.0001] and 13.6% when there were ≥4 playgrounds (vs. 0 or 1) within an 800 m buffer zone [1.136 (1.037-1.243); p = 0.0059]. For Edmonton, aORs revealed lower odds of excess weight for every 100 m increase in distances between residences to nearest major park [0.991 (0.986-0.996); p = 0.0005] and school [0.992 (0.990-0.995); p < 0.0001]. The odds of excess weight decreased as the number of major parks within the 800 m buffer zone increased from 0 to 1 [0.943 (0.896-0.992); p = 0.023] and from 0 to ≥3 [0.879 (0.773-0.999); p = 0.048]. Conclusion: The physical activity-related built environment was associated with excess weight in preschoolers, although relationships varied between cities that differed demographically and geographically.

Exploring the Link Between Early Technology Exposure and Developmental Milestones in Childhood

Background This study examined the relationship between touchscreen exposure and developmental outcomes in early childhood using the Ages and Stages Questionnaire, Third Edition (ASQ-3), a widely-used developmental screening tool. Methods During a well-child visit, parents of 51 children aged 18-36 months completed the ASQ-3 and a survey on their child's touchscreen habits (timing of introduction, daily usage duration, independent use, engagement in creative activities). Medical records were reviewed for developmental diagnoses and health conditions. Analysis One-way analysis of variances (ANOVAs) examined differences in ASQ-3 domain scores (problem-solving, personal-social, communication, gross motor, fine motor) based on the age of touchscreen introduction and average daily usage time. Independent t-tests compared scores between groups defined by independent touchscreen use and creative activity engagement. Effect sizes were calculated for significant differences. Results In the problem-solving domain, children introduced to touchscreens before 12 months of age scored significantly higher than those introduced later, with a statistical significance of p<0.05 and an effect size of d=0.45. However, there were no significant differences in scores based on the duration of daily touchscreen usage. In the personal-social domain, children introduced to touchscreens at 12 months or later scored significantly higher than those introduced before 12 months, with a significance of p<0.05 and an effect size of d=0.51. Moderate daily usage of 30-90 minutes was associated with higher scores compared to lower usage of less than 30 minutes or higher usage of more than 90 minutes (p<0.05). Additionally, children who used touchscreens independently had significantly higher scores, with a significance of p<0.01 and an effect size of d=0.76. Those who engaged in activities such as coloring or crafting also had significantly higher scores, with a significance of p<0.01 and an effect size of d=0.82. In other domains, such as communication, gross motor, and fine motor, no significant effects of touchscreen exposure were observed. Discussion Earlier touchscreen introduction may facilitate problem-solving skills like experimentation and cognitive flexibility through interactive digital play. However, excessive touchscreen use (greater than 90 minutes per day) before 12 months could interfere with pivotal social-emotional learning from real-world interactions, impeding personal-social development. Moderate, supervised touchscreen exposure combined with creative hands-on activities appears optimal for fostering strong personal-social competencies like cooperation and emotional understanding during the toddler years. Conclusion Timing, duration, context, and content of touchscreen experiences in early childhood relate differently to specific developmental domains. Guidelines should consider these nuances to support overall healthy child development in our digital world. Larger longitudinal studies using multi-method assessments are needed.

The Effects of the LiiNK Intervention on Physical Activity and Obesity Rates among Children

BACKGROUND

Obesity and inactivity among children are at an all-time high and have been steadily increasing in prevalence over the last thirty years. The school environment provides the ideal setting for reaching a large number of children across diverse populations in order to reverse these trends. However, there are many inconsistent results yielded by school-based physical activity interventions due to implementation length, time for activities, and the use of structured physical activities. The LiiNK Project® is a whole-child intervention addressing these gaps by providing children 45-60 min of recess (unstructured, outdoor play) in their schools daily, while the control children are allowed to engage in recess for 30 min daily. The purpose of this study was to compare the physical activity intensity and obesity rates of third- and fourth-grade children participating in the LiiNK intervention, which provides 60 min of recess for third graders and 45 min for fourth graders, to those in a control group allowed 30 min of daily recess.

METHODS

The children were 8-10 years old (M = 9.2; 52% females and 48% males). The intervention children comprised 90 third graders and 100 fourth graders, and the control children comprised 101 third graders and 92 fourth graders. Physical activity levels were monitored using accelerometers to assess sedentary, light, and moderate-to-vigorous physical activity (MVPA). Obesity rates were evaluated using bio-electrical impedance analysis (BIA), in which body fat percentage is calculated based on normative values using age and sex in the equation.

RESULTS

The third-grade intervention children engaged in 13 more MVPA minutes and took 900 more steps daily than their control counterparts, and also presented a greater proportion of overweight children transitioning to a healthy weight status from the fall to the spring semester. Conversely, the fourth-grade control children increased their activity by 500 steps and 15 more MVPA minutes daily. Despite this, the intervention children overall demonstrated a reduction in body fat percentage, while the control children demonstrated an increase in body fat percentage.

CONCLUSIONS

Ultimately, 60 min of unstructured, outdoor play in schools provides children the best opportunity to engage in MVPA, which may positively impact body fat percentages, offering a potential strategy for combatting childhood obesity in school settings.

Active Child, Accomplished Youth: Middle Childhood Active Leisure Fuels Academic Success by Emerging Adulthood

Background/Objectives: Physical activity is an important protective factor throughout life. However, little research has observed the associations between the practice of physical activity and academic success longitudinally, and none have done so with a pan-Canadian sample. This article aims to examine the prospective associations between active leisure in middle childhood and academic achievement in emerging adulthood, for both boys and girls, beyond several family factors. Methods: Participants are 2775 children from the National Longitudinal Study on Children and Youth (NLSCY) aged between 12 and 20 years. Active leisure was self-reported by children at age 12 years regarding their weekly organized sport, artistic sport, and unstructured physical activity participation outside of school hours. Academic success was measured by self-reported school average at age 18 years and the obtention of high school diploma at age 20 years. Results: Girls who engaged in more organized or artistic sports at age 12 years had better academic results at age 18 years (respectively β = -0.082, p < 0.01; β = -0.228, p < 0.001). Both boys and girls who partook in more organized sports at age 12 years were more likely to graduate from high school by age 20 years (respectively β = -0.146, p < 0.001; β = -0.071, p < 0.05). However, girls who engaged in more unstructured physical activity at age 12 years had lower academic achievement at age 18 years (β = 0.077, p < 0.001). Conclusions: Policy makers should aim to reduce the many barriers to an active lifestyle in childhood. Parents should be encouraged to lead their children to go play outside with friends to allow them to fully reap the benefits of an active lifestyle from a young age.

Accelerometer-based sedentary time and physical activity from childhood through young adulthood with progressive cardiac changes: a 13-year longitudinal study

AIMS

Longitudinal evidence on the relationship of sedentary time (ST), light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) with changes in cardiac structure and function in the paediatric population is scarce. This evidence is clinically important due to the impact ST can have on the long-term prognosis of healthy young population in the lifetime continuum. This prospective observational study examined the relationships of cumulative ST, LPA, and MVPA from childhood with longitudinal changes in cardiac structure and function.

METHODS AND RESULTS

This is a secondary analysis from the Avon Longitudinal Study of Parents and Children, UK birth cohort of 1682 children aged 11 years. Participants who had at least one follow-up timepoints accelerometer-measured ST, LPA, and MVPA over a period of 13 years and repeated echocardiography-measured cardiac structure and function at ages 17- and 24-year clinic visit were included. Left ventricular mass indexed for height2.7 (LVMI2.7) and left ventricular (LV) diastolic function from mitral E/A ratio (LVDF) were computed. Among 1682 children (mean [SD] age, 11.75 [0.24] years; 1054 [62.7%] females), the cumulative one-min/day increase in ST from ages 11 to 24 years was associated with progressively increased LVMI2.7 {effect estimate 0.002 g/m2.7 [confidence interval (CI) 0.001-0.003], P < 0.001}, irrespective of sex, obesity, and hypertensive status. Cumulative one-min/day increase in LPA was associated with a decreased LVMI2.7 (-0.005 g/m2.7 [-0.006 to -0.003], P < 0.0001) but an increased LVDF. Cumulative one-minute/day increase in MVPA was associated with progressively increased LVMI2.7 (0.003 g/m2.7 [0.001-0.006], P = 0.015).

CONCLUSION

ST contributed +40% to the 7-year increase in cardiac mass, MVPA increased cardiac mass by +5%, but LPA reduced cardiac mass by -49%. Increased ST may have long-term pathologic effects on cardiac structure and function during growth from childhood through young adulthood; however, engaging in LPA may enhance cardiac health in the young population.

Neighborhood environments underpin screen time intervention success in children: Evidence from a study of greenspace and community programming across 130 US communities

The goal of this study was to understand how neighborhood greenspace access may support or hinder the effectiveness of community programs and policies (CPPs) aimed at reducing racial and ethnic inequities in screen time among 4598 US children. We found higher CPP intensity was significantly associated with fewer screen time behaviors in high greenspace neighborhoods, but not neighborhoods with low or moderate greenspace. Moreover, there were significant differences in greenspace access by neighborhood-level race and ethnicity. Implementing CPPs without regard for racial and ethnic greenspace inequities may be an underlying cause in the perpetuation of inequities in childhood screen time.

Association between sedentary behavior, screen time and metabolic syndrome among Chinese children and adolescents

BACKGROUND

The aim of the study was to investigate the relationship between sedentary behavior, screen time and MetS among Chinese children and adolescents aged 7-17 years. Data was obtained from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016-2017.

METHODS

Data on sedentary time, screen time, and MetS indicators were obtained through physical and health questionnaires, anthropometric measurements, and clinical examinations. MetS was defined according to the Cook's criteria. Wilcoxon rank sum test and chi-square test were applied for comparisons of measurement data and counting data, respectively. The relationship between sedentary time, screen time, and MetS and its components was analyzed using a multivariate logistic regression model.

RESULTS

The prevalence of MetS among 7-17-year-old students in 2016-2017 was 5.45%. Compared to those with low sedentary behavior, in high sedentary behavior groups, the prevalence of abdominal obesity, high TG, low HDL-C, and MetS was high in boys, and the prevalence of abdominal obesity, high TG, hyperglycemia, and MetS was high in girls. Moreover, for those who reported ≥ 3 h/day of screen time, the prevalence of abdominal obesity, low HDL-C, and MetS was higher in boys, and the prevalence of abdominal obesity and MetS was higher in girls. After adjusting for confounding variables, the risks of abdominal obesity, high TG, low HDL-C, and MetS were higher in high-level sedentary time group, and the risks of abdominal obesity and MetS were 1.15 and 1.14 times higher for those who spent ≥ 3 h/day on screen time, respectively.

CONCLUSIONS

This study shows that high levels of sedentary time and screen time were associated with an increased likelihood of MetS among Chinese children and adolescents aged 7-17 years. Reducing sedentary behavior and screen time may contribute to the prevention of metabolic diseases.

Measurement Method Options to Investigate Digital Screen Technology Use by Children and Adolescents: A Narrative Review

The role and potential impact of digital screen technology in the lives of children is heavily debated. Current evidence is limited by the weakness of measures typically used to characterise screen use, predominantly proxy- or self-reports with known inaccuracy and bias. However, robust and detailed evidence is needed to provide practical trustworthy guidance to families and professionals working with families. The purpose of this paper is to support researchers to select measurement method(s) that will provide robust and detailed evidence. The paper outlines the challenges in measuring contemporary screen use by children, using a child-technology interaction model to organise considerations. A range of different methods used to measure digital screen technology use in children and adolescents (i.e., questionnaires, diaries, electronically prompted sampling, direct observation, fixed room cameras, wearable/portable cameras, audio recorders, screen-device onboard logging, remote digital trace logging and proximity logging) are described along with examples of their use and constructs typically measured as well as a summary of the advantages and disadvantages of each method. A checklist and worked examples are provided to support researchers determining the best methods or combination of methods for a research project.

Movement behaviour typologies and their associations with adiposity indicators in children and adolescents: a latent profile analysis of 24-h compositional data

OBJECTIVES

Growing evidence supports the important role of 24-hour movement behaviours (MB) in preventing childhood obesity. However, research to understand the heterogeneity and variability of MB among individuals and what kind of typologies of individuals are at risk of developing obesity is lacking. To bridge this gap, this study identified typologies of 24-hour MB in children and adolescents and investigated their associations with adiposity indicators.

METHODS

In this cross-sectional study, 374 children and 317 adolescents from the Czech Republic wore wrist-worn accelerometers for seven consecutive days. Time spent in moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary behaviour (SB), and sleep was quantified using raw accelerometery data. Adiposity indicators included body mass index (BMI) z-score, fat mass percentage (FM%), fat mass index (FMI), and visceral adipose tissue (VAT). Bias-adjusted latent profile analysis was used on the 24-hour MB data to identify MB typologies and their associations with adiposity indicators. The models were adjusted for potential confounders. The identified typologies were labelled to reflect the behavioural profiles of bees to aid interpretability for the general public.

RESULTS

Two typologies were identified in children: highly active Workers characterised by high levels of MVPA and LPA, and inactive Queens characterised by low levels of MVPA and LPA, high levels of SB and longer sleep duration compared to Workers. In adolescents, an additional typology labelled as Drones was characterised by median levels of MVPA, LPA, SB and longest sleep duration. After controlling for covariates, we found that children labelled as Queens were associated with 1.38 times higher FM%, 1.43 times higher FMI, and 1.67 times higher VAT than Workers. In adolescents, Drones had 1.14 times higher FM% and Queens had 1.36 higher VAT in comparison with Workers, respectively.

CONCLUSION

Our study highlights the importance of promoting active lifestyles in children and adolescents to potentially reduce adiposity. These findings can provide insights for interventions aimed at promoting healthy MB and preventing childhood obesity.

Independent and Combined Associations of Physical Activity and Screen Time With Biomarkers of Inflammation in Children and Adolescents With Overweight/Obesity

PURPOSE

Inflammation regulation is important for obesity management and prevention of obesity-related diseases. This cross-sectional study aimed to analyze the independent and combined associations of physical activity and screen time with biomarkers of inflammation in children and adolescents with overweight/obesity.

METHOD

A total of 1289 children and adolescents with overweight/obesity were included from the 2015 to 2018 National Health and Nutrition Examination Survey. Multivariable linear regressions were conducted for the association analyses.

RESULTS

For the independent associations, a negative dose-dependent relationship was demonstrated between physical activity and inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) in adolescents with overweight/obesity (P < .001) but not children; screen time was not associated with hsCRP in both children and adolescents. No significant association was found between physical activity or screen time with other inflammatory biomarkers. For the combined associations, there was an interaction between physical activity and screen time on hsCRP in adolescents with overweight/obesity (P = .014). In addition, the negative association between physical activity and hsCRP was greater in boys compared with girls and in Hispanic and non-Hispanic Black individuals compared with non-Hispanic White individuals.

CONCLUSION

This study demonstrated a combined association of physical activity and screen time with inflammatory biomarker hsCRP in adolescents with overweight/obesity.

Physical activity on prescription for children with obesity: a focus group study exploring experiences in paediatric healthcare

Background

Insufficient physical activity is a growing public health concern and is closely linked to obesity in both adults and children. Swedish physical activity on prescription (PAP) is effective in increasing physical activity levels in adults, but knowledge about how PAP is used in paediatric healthcare is lacking. Therefore, this study aimed to explore experiences of working with PAP for children with obesity amongst paediatric staff and managers.

Methods

Seven focus group discussions with 26 participants from paediatric outpatient clinics in western Sweden were conducted. Data were analysed both inductively and deductively, framed by the Normalization Process Theory's four core constructs: coherence, cognitive participation, collective action, and reflexive monitoring.

Results

The PAP work for children with obesity was experienced to be about helping children to become physically active, and less about losing weight. Identified barriers for using PAP were the non-uniform nature of the work and a perceived lack of guidelines. Collaboration with physiotherapists and physical activity organisers outside the organisation was identified as an important facilitator. An important contextual factor for implementing PAP is the collaboration between paediatric clinics and physical activity organisers. In the transition between these stakeholders, maintaining a family-centred approach when working with PAP was experienced as challenging.

Conclusions

PAP is a well-known intervention that is inconsistently used for children with obesity. The intervention should include a family-centred approach for this patient group. It also needs to align better with existing collaborations with other healthcare units as well as with new forms of collaboration with physical activity organisers in the community.

Accumulating Sedentary Time and Physical Activity From Childhood to Adolescence and Cardiac Function in Adolescence

BACKGROUND

Increased physical activity (PA) may mitigate the negative cardiovascular health effects of sedentary behavior in adolescents. However, the relationship of PA and sedentary time from childhood with cardiac function in adolescence remains underexplored. Therefore, we investigated the associations of cumulative sedentary time and PA from childhood to adolescence with cardiac function in adolescence.

METHODS AND RESULTS

Participants were 153 adolescents (69 girls) who were aged 6 to 8 years at baseline, 8 to 10 years at 2-year follow-up, and 15 to 17 years at 8-year follow-up. Cumulative sedentary time and PA exposure between baseline and 2-year follow-up and between baseline and 8-year follow-up were measured using a combined accelerometer and heart rate monitor. Cardiac function was assessed using impedance cardiography at 8-year follow-up. The data were analyzed using linear regression analyses adjusted for age and sex. Cumulative moderate to vigorous PA (standardized regression coefficient [β]=-0.323 [95% CI, -0.527 to -0.119]) and vigorous PA (β=-0.295 [95% CI, -0.508 to -0.083]) from baseline to 8-year follow-up were inversely associated with cardiac work at 8-year follow-up. Conversely, cumulative sedentary time had a positive association (β=0.245 [95% CI, 0.092-0.398]). Cumulative vigorous PA from baseline to 8-year follow-up was inversely associated with cardiac work index at 8-year follow-up (β=-0.218 [95% CI, -0.436 to 0.000]).

CONCLUSIONS

Higher levels of sedentary time and lower levels of PA during childhood were associated with higher cardiac work in adolescence, highlighting the importance of increasing PA and reducing sedentary time from childhood.

The Ongoing Impact of COVID-19 on Pediatric Obesity

In the developed world, pediatric obesity (PO) has been a major health concern since the last century, and this condition may lead to detrimental life-long physical and mental comorbidities. Currently, its prevalence has increased in low- and middle-income countries and in many high-income countries. Thus, the provision of effective and tailored care for children and their families has become vital. The social consequences of the COVID-19 pandemic are known everywhere, and among these, it has been argued that the COVID-19 pandemic has had a major impact on PO. Overall, the growth of PO over the last decade has been enhanced by the pandemic. During the COVID-19 pandemic, children, adolescents and young adults gained weight as the pediatric population dealt with sedentary lifestyles and changes in food habits. In this review, we want to highlight the impact that the COVID-19 pandemic had on PO.

Comparison of Performance in the Six-Minute Walk Test (6MWT) between Overweight/Obese and Normal-Weight Children and Association with Haemodynamic Parameters: A Cross-Sectional Study in Four Primary Schools

Physical activity plays a pivotal role in preventing obesity and cardiovascular risks. The six-minute walk test (6MWT) is a tool to assess functional capacity and predict cardiovascular events. The aim of this cross-sectional study was to compare the performance and haemodynamic parameters before and after a 6MWT between obese/overweight vs. normal-weight children (average age 8.7 ± 0.7 years) participating in a project involving four primary schools in South Verona (Italy). Validated questionnaires for physical activity and diet, as well as blood drops, were collected. Overweight or obese children (OW&OB; n = 100) covered a shorter 6MWT distance compared to normal-weight children (NW, n = 194). At the test's conclusion, the OW&OB group exhibited a higher Rate Pulse Product (RPP = Systolic Blood Pressure × Heart Rate) as compared to the NW. Body Mass Index, waist-to-height ratio, fat mass by electrical impedance, and trans fatty acids showed direct correlations with pre and post-test haemodynamic parameters, such as RPP, and inverse correlations with oxygen saturation. OW&OB children demonstrated lower performance in this low-intensity exercise test, along with an elevated haemodynamic response. Excess fat in childhood can be considered a risk factor for haemodynamic stress, with potential deleterious consequences later in life. Efforts should be initiated early to break this cycle.

Sitting vs. standing: an urgent need to rebalance our world

During their activities of daily living, humans run, walk, stand, sit and lie down. Recent changes in our environment have favored sedentary behavior over more physically active behavior to such a degree that our health is in danger. Here, we sought to address the problem of excessive time spent seated from various theoretical viewpoints, including postural control, human factors engineering, human history and health psychology. If nothing is done now, the high prevalence of sitting will continue to increase. We make a case for the standing position by demonstrating that spending more time upright can mitigate the physiological and psychological problems associated with excessive sitting without lowering task performance and productivity. The psychological literature even highlights potential benefits of performing certain tasks in the standing position. We propose a number of recommendations on spending more time (but not too much) in the standing position and on more active, nonambulatory behaviors. There is a need to inform people about (i) harmful consequences of excessive sitting and (ii) benefits of spending more time performing active, nonambulatory behaviors. One clear benefit is to reduce detrimental health consequences of excessive sitting and to provide potential additional benefits in terms of productivity and performance.

Longitudinal Mediating Effect of Fat Mass and Lipids on Sedentary Time, Light PA, and MVPA with Inflammation in Youth

CONTEXT

Inflammation has been associated with atherosclerosis and metabolic disorders in youth. Preventing inflammation through exposure to different accelerometer-based movement behaviors has not been longitudinally examined.

OBJECTIVE

This work aimed to examine the mediating role of fat mass, lipids, and insulin resistance on the associations of cumulative sedentary time (ST), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) with inflammation.

METHODS

From the Avon Longitudinal Study of Parents and Children, United Kingdom, 792 children with data on at least 2 time-point measures of accelerometer-based ST, LPA, and MVPA during age 11, 15, and 24 years follow-up clinic visits with complete high-sensitivity C-reactive protein (hsCRP) measures at age 15, 17, and 24 years were studied. Mediating associations were examined using structural equation models. When the magnitude of the association between the exposure and outcome is increased after including a third variable, suppression occurred but mediation if decreased.

RESULTS

Among 792 (58% female; mean [SD] age at baseline, 11.7 [0.2] years), ST increased, LPA decreased, and MVPA had a U-shaped increase while hsCRP increased during 13-year follow-up. Insulin resistance partly suppressed (23.5% suppression) the positive associations of ST with hsCRP among participants who were overweight/obese. Fat mass partly mediated (30% mediation) the negative associations of LPA with hsCRP. Fat mass had a 77% mediation effect on the negative associations of MVPA with hsCRP.

CONCLUSION

ST worsens inflammation, but increased LPA had a 2-fold inflammatory-lowering effect and was more resistant to the attenuating effect of fat mass compared with MVPA, and hence should be targeted in future interventions.

Adolescent sedentary behavior and body composition in early adulthood: results from a cohort study

BACKGROUND

This study investigates the cross-sectional and prospective associations between accelerometer-measured sedentary behavior and body composition from adolescence to early adulthood.

METHODS

Data from the Santiago Longitudinal Study were analyzed (n = 212). Sedentary time was measured at age 16 years, and body composition (body mass index [BMI], waist circumference, waist-to-height ratio [WHtR], fat mass percentage, and lean mass percentage) was examined at both age 16 and 23 years. Adjusted linear regression models estimated associations between sedentary time, sedentary bout duration, and body composition, overall and by sex.

RESULTS

In all analyses, mean sedentary bout duration was not associated with body composition. In cross-sectional analyses, more sedentary time during adolescence was significantly associated with lower BMI, waist circumference, WHtR, fat mass percentage, and higher lean mass percentage (p < 0.05). One standard deviation increase in daily sedentary time was prospectively associated with lower body mass index (β = -1.22 kg/m2, 95% CI: -2.02, -0.42), waist circumference (β = -2.39 cm, 95% CI: -4.03, -0.75), and WHtR (β = -0.014, 95% CI: -0.024, -0.004). Sedentary time at 16 years was not associated with changes in body composition from 16 to 23 years.

CONCLUSIONS

Sedentary behavior in adolescence is not adversely associated with body composition profiles in early adulthood.

IMPACT

Little is known about the effect of device-measured sedentary behavior on body composition during the transition from adolescence to early adulthood. Among participants in the Santiago Longitudinal Study, more accelerometer-measured sedentary time during adolescence was associated with lower BMI, waist circumference, and waist-to-height ratio in early adulthood though point estimates were generally small in magnitude. Sedentary behavior in adolescence was not detrimentally associated with healthy body composition profiles in early adulthood. Public health interventions aimed at reducing obesity rates could consider other behaviors, such as physical activity and healthy diet, instead of sitting time.

Healthy weight and overweight adolescents with type 1 diabetes mellitus do not meet recommendations for daily physical activity and sleep

AIMS

Physical activity (PA) plays an important role in the prevention of cardiovascular disease (CVD), particularly in individuals with type 1 diabetes mellitus (T1DM) who are at increased risk. Our aim was to determine levels of moderate-to-vigorous physical activity (MVPA), sedentary behaviour and sleep in adolescents with T1DM, and identify barriers to PA.

METHODS

Participants aged 12-18 with T1DM wore an accelerometer and continuous glucose monitor for 24 h over 7-days. Data was processed into PA metrics and sleep. Pearson correlations were used to test associations between MVPA and metabolic measures. Barriers to PA were measured using a questionnaire.

RESULTS

Thirty-seven adolescents provided valid accelerometer data. Mean daily MVPA was 44.0 min [SD 17.6] with 16.2% achieving the guideline of ≥ 60 min/day. Participants had 11 h [SD 1.2] of sedentary behaviour and 7.6 h [SD 1.5] of sleep/day. There was no difference in MVPA in overweight or obese (53.8%) vs. healthy weight (44.2%) adolescents (45.0 min [SD 16.6] vs. 43.1 min [SD 18.8]). Only 39.6% reported one or more diabetes specific barrier to PA.

CONCLUSION

Adolescents with T1DM engage in insufficient MVPA and sleep, irrespective of body weight status, suggesting the need for targeted interventions.

Decreasing Sedentary Behaviors in Youth to Prevent and Manage Childhood Obesity: Is It Realistic?

PURPOSE OF REVIEW

Decreasing sedentary behaviors has been proposed as one approach to reduce the rate of obesity in youth. This review summarizes the contemporary literature examining the efficacy of these interventions in the school and community along with an additional focus on the role of socioeconomic status in these interventions.

RECENT FINDINGS

Studies that focus on decreasing sedentary behavior have utilized a wide variety of strategies in a number of settings. The effects of these interventions are often hindered by non-standard outcome measures, study infidelity, and subjective measures of sedentary time. However, interventions that incorporate engaged stakeholders and include younger subjects appear to be the most likely to succeed. Promising interventions to decrease sedentary behaviors have been shown in recent clinical trials; however, replicating and sustaining these results is challenging. From the available literature, school-based interventions have the potential of reaching the largest group of children. In contrast, interventions in younger children, particularly those with invested parents, seem to be the most effective.

Associations of accelerometer-based sedentary time, light physical activity and moderate-to-vigorous physical activity with resting cardiac structure and function in adolescents according to sex, fat mass, lean mass, BMI, and hypertensive status

BACKGROUND

This study examined the independent relationships of device-based measured sedentary time (ST) and physical activity (PA) in relation to cardiac structural and functional geometry among adolescents.

METHODS

From the Avon Longitudinal Study of Parents and Children, UK birth cohort, 530 (50% female) adolescents aged 17 years had complete ST, PA, cardiac, and covariate measures. Echocardiography cardiac measures were left ventricular mass indexed for height2.7 (LVMI2.7 ), relative wall thickness, LV diastolic function (LVDF), and LV filling pressure (LVFP). Overweight/obesity and elevated systolic/BP hypertension were categorized as body mass index >24.99 kg/m2 and ≥130 mmHg, respectively. Data were analyzed with linear regression models adjusting for cardiometabolic factors and lifestyle factors.

RESULTS

The prevalence of overweight/obesity in males and females was 17.9% and 24.5%, respectively. The prevalence of elevated systolic BP/hypertension was 11.6% in males and 1.1% among females. The average ST was 484 ± 78 min/day, light PA was 274 ± 62 min/day, and moderate-to-vigorous PA (MVPA) was 41 ± 24 min/day, among females. Average ST, LPA, and MVPA were 468 ± 87 min/day, 293 ± 70 min/day, and 56 ± 30 min/day, respectively, among males. Higher ST was associated with higher LVMI2.7 (standardized β = 0.16; p = 0.01) among females, but higher ST was associated with lower LVDF in males (β = -0.14; p = 0.04). Higher ST and MVPA were associated with higher LVMI2.7 in the total cohort, normal weight, and overweight/obese adolescents. Light PA was associated with higher LVDF in the total cohort and normotensives and lower LVFP among adolescents with high lean mass.

CONCLUSIONS

Higher ST and MVPA were associated with higher LVMI; however, ST-associated LVMI increase was threefold higher than MVPA-associated LVMI increase. Higher LPA was associated with better cardiac function. Reducing ST and increasing LPA may attenuate the risk of altered cardiac structure and function in adolescents.

Childhood Obesity and Cardiovascular Disease Risk

PURPOSE OF REVIEW

The global epidemic of youth-onset obesity is tightly linked to the rising burden of cardiometabolic disease across the lifespan. While the link between childhood obesity and cardiovascular disease is established, this contemporary review summarizes recent and novel advances in this field that elucidate the mechanisms and impact of this public health issue.

RECENT FINDINGS

The review highlights the emerging data supporting the relationship between childhood adverse events, social determinants of health, and systemic and institutional systems as etiological factors. We also provide updates on new screening and treatment approaches including updated nutrition and dietary guidelines and benchmarks for pediatric obesity screening, novel pharmacological agents for pediatric obesity and type 2 diabetes such as glucagon-like 1 peptide receptor agonists, and we discuss the long-term safety and efficacy data on surgical management of pediatric obesity. The global burden of pediatric obesity continues to rise and is associated with accelerated and early vascular aging especially in youth with obesity and type 2 diabetes. Socio-ecological determinants of risk mediate and moderate the relationship of childhood obesity with cardiometabolic disease. Recognizing the importance of neighborhood level influences as etiological factors in the development of cardiovascular disease is critical for designing effective policies and interventions. Novel surgical and pharmacological interventions are effective pediatric weight-loss interventions, but future research is needed to assess whether these agents, within a socio-ecological framework, will be associated with abatement of the pediatric obesity epidemic and related increased cardiovascular disease risk.

Effects of School Nurse-Led Interventions in Collaboration with Kinesiologists in Promoting Physical Activity and Reducing Sedentary Behaviors in Children and Adolescents: A Systematic Review

The World Health Organization (WHO) recommends that schools adopt a whole-school strategy for healthy behaviors involving different health professionals. The present systematic review aimed to evaluate the efficacy of nurse-led interventions in collaboration with kinesiologists on physical activity and lifestyle behaviors' outcomes in school settings. The protocol was registered in PROSPERO (ID: CRD42022343410). The primary research study was developed through the PICOS question: children and adolescence 6-18 years (P); school nurse-led interventions in promoting physical activity (PA) and reducing sedentary behaviors (I); usual lessons, no intervention focusing on PA (C); PA levels, sedentary behaviors, and healthy lifestyle behaviors (O); experimental or observational study with original primary data and full-text studies written in English (S). Seven studies were included. Interventions were heterogeneous: besides physical activities carried out in all studies, the interventions were based on different health models and strategies (counselling, face-to-face motivation, education). Five out of seven articles investigated PA levels or their related behaviors using questionnaires, and two used ActiGraph accelerometers. Lifestyle behaviors were assessed with heterogeneous methods. Five out of seven articles showed an improvement in at least one outcome after the interventions, whereas two papers showed a statistically non-significant improvement. In conclusion, school interventions involving nurses, also in association with other professionals such as kinesiologists, can be effective in reducing sedentary behaviors and improving healthy lifestyles in children and adolescents.

Effects of a Theory-Based, Multicomponent eHealth Intervention for Obesity Prevention in Young Children from Low-Income Families: A Pilot Randomized Controlled Study

The purpose of this study was to evaluate a theory-based, multicomponent eHealth intervention aimed at improving child health behaviors and parental psychosocial attributes and feeding practices. A pilot randomized controlled trial was conducted among 73 parents with children (1-3 years). Intervention group participants (IG, n = 37) received theory-based educational videos, cooking tutorials, and text messages with key information for a total of 8 weeks. Control group participants (CG, n = 36) received a booklet about general nutrition recommendations for children. A parent-administered questionnaire was used for data collection at baseline and post-intervention. Linear models were performed using R version 4.1.1. for data analysis. Children in the IG significantly increased their daily intake of fruit (ΔΔ = 0.89 servings, p = 0.00057) and vegetables (ΔΔ = 0.60 servings, p = 0.0037) and decreased use of screen time (ΔΔ = -33.87 min, p = 0.026), compared to the CG. Parents in the IG improved significantly more than the CG in self-efficacy (p = 0.0068) and comprehensive feeding practices (p = 0.0069). There were no significant differences between the study groups for changes in child outcomes, such as physical activity and sedentary behaviors, and parental nutrition knowledge and attitudes.

Sedentary Behaviour Among Male Adolescents in Sagamu, Southwest Nigeria

BACKGROUND

Sedentary behaviour (SB) is a leading risk factor for development of non-communicable diseases (NCDs) and associated morbidity worldwide. Several studies have reported a high prevalence of sedentary behaviour among adolescents in developing countries with a male preponderance. The Nigerian male adolescent is similarly faced with lifestyle challenges as his counterparts in other countries.

AIM

This study determined the pattern, knowledge and factors associated with sedentary behaviour among male adolescents in Sagamu, Nigeria.

METHOD

A cross-sectional study was carried out among 330 in-school male adolescents in Sagamu, selected via multi-stage sampling technique. Data were collected using a semi-structured, self-administered questionnaire and analyzed using IBM SPSS version 20. Relevant descriptive and inferential statistics were calculated, with p < .05. Participation was fully voluntary and strict confidentiality was ensured.

RESULT

The mean age of respondents was 15.9 ± 1.4 years; 86.9% of respondents were aged 15-19years. About 94.8% of sedentary respondents had poor knowledge. Over 90% of respondents were sedentary. Screen-based behaviour (79%) contributed more to respondents' pattern of SB while using a tablet or a smart phone (23.6%) singularly contributed the largest to sedentariness. SB was associated with motorized transport (p = .038), smoking (p ≤ .001) and central obesity status (p = .040) but not with socio-demographic characteristics and alcohol intake.

CONCLUSION

Knowledge of SB was poor among respondents. The prevalence of sedentary behaviour was high and associated with central obesity, smoking and motorized transport. School-based interventions including health education, should be initiated to reduce the risk of developing NCDs.

The Effect of Primary School-Based Physical Education Programs: A Systematic Review of Randomized Controlled Trials

The present article aimed to systematically summarize primary school-based intervention programs and their effects evaluated through randomized-controlled trial design. A systematic review of relevant articles was carried out using 4 electronic databases. From a total of 193 studies initially found, 30 were included in the qualitative synthesis. Main results: (1) Intensive interval training or jump/strength exercises may positively influence physical fitness, promoting challenging task, psychological needs, and guided styles to a greater extent; (2) Games that demand more cognitive function seem more beneficial than those based on repetitive aerobic exertion to improve fundamental motor skills; (3) The jumping/strength exercises may cause benefits in bone area and bone mineral density, while flexibility and balance may reduce the risk of muscle injury; and (4) Programming a greater dose of moderate-to-vigorous physical activity seems to be related to positive effects in core executive function and academic performance. Additionally, providing information and involving the social environment may enhance the positive effects.

Physical activity and sedentary behaviour of male adolescents in Indonesia during the COVID-19 pandemic: a mixed-method case study using accelerometers, automated wearable cameras, diaries, and interviews

Background

Previous physical activity and sedentary behaviour studies during the pandemic have largely utilized online surveys, with known limitations including recall bias. Employing both device-based and self-reported measurements may provide a more comprehensive picture of both behaviours. Physical activity and sedentary behaviour research in adolescents is still limited in low- and middle-income countries (LMICs), including Indonesia. Male adolescents had been identified as more active than females but have had a greater decrease in physical activity during the pandemic. The present study aimed to investigate the quantity, temporal patterns, contexts, and biopsychosocial factors of physical activity and sedentary behaviour during the COVID-19 pandemic in a small group of male Indonesian adolescents.

Methods

Male adolescents (n = 5; 14-15 years old) from Yogyakarta wore accelerometers and automated wearable cameras for four days, and completed diaries and interviews in November 2020.

Results

Participants' activity was dominated by light intensity (67% of all physical activity). Sedentary behaviour was high; accelerometer, school days: 456 ± 145 min (78 ± 10% of wear time), non-school days: 344 ± 160 min (79 ± 17% of wear time); camera, school days: 176 ± 101 min (81 ± 46% of wear time), non-school days: 210 ± 165 min (86 ± 67% of wear time). Sedentary behaviour was mainly done during school hours on school days and from late afternoon to evening on non-school days. Screen time was largely for leisure purposes and action games were most favoured. Smartphones were the most used device, mainly used in a solitary context in the bedroom. Non-screen-based sedentary behaviour was consistently low. Interviews suggested that during the pandemic, supporting factors for physical activity are: self-determination, enjoyment, parental support, and physical education; meanwhile, factors influencing screen time are: educational demands, device and internet availability, screen time opportunities, parental control, social facilitators, phone notifications, and emotional state.

Conclusions

Most participants were not able to stay active during the pandemic. Using digital platforms may be beneficial to shift some screen-based sedentary behaviour to 'screen-based' or 'screen-prompted' physical activity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-022-00014-0.

A Multi-Component Educational Intervention for Addressing Levels of Physical Activity and Sedentary Behaviors of Schoolchildren

Physical inactivity and a sedentary lifestyle are risk factors for excess weight and obesity in childhood. It is, therefore, necessary to adopt strategies which can modify these behaviors during childhood, the age at which habits are formed. This study aimed to evaluate the impact of an educational intervention using digital media and face-to-face activities involving children, parents, and the school community on the level of physical activity and sedentary behavior among schoolchildren. This was a secondary analysis of data obtained from a community trial in which students from four primary schools in Mexico City participated. Two schools were assigned to the intervention group (IG) and two to the control group (CG). The intervention lasted 12 months and included a face-to-face component, which involved sessions and workshops for parents and children, as well as visual material for children and a distance component utilizing electronic means (web portal and text messages to mobile phones) for parents. Anthropometric measurements were taken and information was collected on moderate to vigorous physical activity performed by the children and on the time that the schoolchildren spent in front of screens at the beginning of the study and at 6 and 12 months. Information on 201 children from the IG and 167 children from the CG was included in the analysis. At 12 months, the IG showed a mean decrease of 33.4 min/d [95% CI: -53.5 to -13.3] in screen time, while the CG showed an increase of 12.5 min/d [CI 95%: -10.5 to 35.6], p = 0.003. After 12 months of follow-up, applying this educational intervention reduced the time that schoolchildren spent in front of screens. Educational intervention is a feasible and accessible strategy for promoting changes in sedentary behaviors in the school-age population.

Benefits in Cardiac Function from a Remote Exercise Program in Children with Obesity

Physical activity (PA) is a crucial factor in preventing and treating obesity and related complications. In this one-arm pre−post longitudinal prospective study, we evaluated the effects of a 12-week online supervised training program on cardiac morphology, function and blood pressure (BP) in children with obesity. The training program consisted of three sessions per week, each lasting 60 min. Advanced echocardiographic imaging (tissue Doppler and longitudinal strain analysis) was used to detect subclinical changes in heart function. Categorical variables were described as counts and percentages; quantitative variables as the mean and standard deviation (SD) as they were normally distributed (Shapiro−Wilks test). Pre−post comparisons were made with a paired t-test. A total of 27/38 (71%) enrolled patients (18M/9F, 11 ± 2 years) completed the training protocol and were considered in the analysis. At baseline, no hypertensive patient was noted; all echocardiographic variables were within the normal range. After training, we observed a significant reduction in BP parameters, including systolic BP values and Z-score, diastolic BP values, centiles and Z-score, and mean arterial pressure (all p < 0.05). Significant variations in echocardiographic interventricular septum (IVSd) thickness (p = 0.011), IVSd Z-score (p = 0.001), left ventricular (LV) end-diastolic diameter (p = 0.045), LV posterior wall thickness Z-score (p = 0.017), and LV global longitudinal strain (p = 0.016) were detected. No differences in LV diastolic function and right ventricular strain were noted. PA plays a decisive role in improving BP control and has benefits on left ventricle systolic function, representing a strategic approach to limit CV risk. Online exercise could be an excellent method of training in children with obesity.

The effect of different intensity physical activity on cardiovascular metabolic health in obese children and adolescents: An isotemporal substitution model

Objective: This study's purpose was to investigate the effects of different intensities of physical activity on cardiovascular metabolism in obese children and adolescents based on an isochronous replacement model. Methods: A total of 196 obese children and adolescents (mean age, 13.44 ± 1.71 years) who met the inclusion criteria and attended a summer camp from July 2019 to August 2021 were recruited for this study, and all subjects wore a GT3X + triaxial motion accelerometer uniformly around the waist to record physical activity levels. We collected the subjects' height, weight, and cardiovascular risk factors such as waist circumference, hip circumference, fasting lipids, blood pressure, fasting insulin, and fasting glucose before and after 4 weeks of camp and constructed cardiometabolic risk score (CMR-z). We analyzed the effects of different intensities of physical activity on cardiovascular metabolism in obese children using isotemporal substitution model (ISM). Results: After 4 weeks, cardiovascular risk factors such as body weight, waist circumference, triglyceride, and total cholesterol were reduced in adolescents with obesity (p <0.01), and CMR-z was also reduced (p <0.01). ISM analysis revealed that all sedentary behavior (SB) replacement with 10 min of light physical activity (LPA) reduced CMR-z [β = -0.10, 95% CI (-0.20, -0.01)]; 10-min of moderate physical activity (MPA) replacement of SB reduced CMR-z [β = -0.32, 95% CI (-0.63, -0.01)]; 10-min of vigorous physical activity (VPA) replacement of SB reduced CMR-z [β = -0.39, 95% CI (-0.66, -0.12)]. Conclusion: Replacement of SB with 10 min of LPA, MPA, and VPA were all effective in improving cardiovascular risk health, respectively, but MPA or VPA was more effective.

Physical Activity and Screen Viewing Behaviors Among Children Aged 6-9 Years During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic resulted in many restrictions worldwide, including lockdowns and school closures. This may have prevented children from meeting the recommended physical activity (PA) levels and screen time. The aim of this study was to examine the impact of the pandemic on school-age children's PA and screen time in Saudi Arabia.

METHODS

A cross-sectional study where caregivers of children aged 6-9 years living in Saudi Arabia were recruited through convenience sampling to fill out an online survey between July and August 2020. The survey covered demographic information, PAs, and screen time across 3 periods: pre-COVID-19 pandemic, during the COVID-19 lockdown, and the last 7 days preceding the survey during the pandemic where social distancing applied, but no lockdown.

RESULTS

A total of 339 caregivers completed the online survey about their children. The number of active children slightly increased during the lockdown (9.7%) than before COVID-19 and the last days (5.8%); however, the average reported days of PA during the pandemic were fewer than before. The findings indicated that all 3 types of screen time (watch time, screenplay, and device time) were longer during the pandemic (mean [SD]: 9.5 [5.5]) than before the COVID-19 (mean [SD]: 5.8 [5.1]).

CONCLUSION

While the proportion of active children had increased during the lockdown, the COVID-19 pandemic, the COVID-19 pandemic negatively impacted PA days and screen time in school-age children. School-age children in Saudi Arabia were already far from meeting global guidelines even before the pandemic, highlighting this population's need for healthy lifestyle promotion.

Problematic Video Game Use and Mental Health among Spanish Adolescents

Current scientific evidence points to the importance of studying the link between mental health and problematic video game use in adolescents. The aim of this study was to analyse the correlation between gender and stage of adolescence and problematic video game use, as well as to study the correlation between internalizing and externalizing symptomatology, prosocial behaviour and video game use, and the correlation between video gaming and mental health issues in Spanish 12- to 18-year-olds (M = 14.51; SD = 1.57). For this purpose, the Strengths and Difficulties Questionnaire (SDQ) and the Video Game-Related Experiences Questionnaire (VGEQ) were administered to 1448 secondary school students in Extremadura (Spain), of which 50.8% were women and 49.8% men. The results show that (a) males present more problematic video game use, (b) prosocial behaviour negatively correlates with problematic video game use, and (c) mental health issues and problematic video game use correlate in a negative way. However, the stage of adolescence was not seen to have any effect on the problematic video game use. In conclusion, this study points the effects that problematic video game use can have on the mental health of adolescents and the possible protective role that prosocial behaviours can have on the prevention of problematic video game use.

Cardiac Biomarkers in Sports Cardiology

Sustained physical activity induces morphological and functional changes in the cardiovascular system. While mostly physiological, they can also become a trigger for major adverse cardiovascular events, the most severe of which are sudden cardiac arrest and sudden cardiac death. Therefore, any novel method which can help more accurately estimate the cardiovascular risk should be considered for further studying and future implementation in the standard protocols. The study of biomarkers is gaining more and more ground as they have already established their utility in diagnosing ischemic cardiac disease or in evaluating cardiac dysfunction in patients with heart failure. Nowadays, they are being implemented in the screening of apparently healthy individuals for the assessment of the cardiovascular risk. The aim of this paper is to gather published data regarding the measurements of cardiac biomarkers in athletes, i.e., troponins, myoglobin, CK-MB, NT-proBNP, and D-Dimers, and their potential use in the field of sports cardiology.

Is elevated ALT associated with lifestyle risk factors? A population-based survey

Purpose

Given the high prevalence of non-alcoholic fatty liver disease (NAFLD) and the role of Alanine aminotransferase (ALT) in diagnosing liver injury along with the increasing prevalence of lifestyle risk factors, we aimed to evaluate the association between serum ALT level and lifestyle risk factors in a population-based survey.

Methods

This was a population-based study conducted in rural and urban areas of Iran in 2016. Cluster sampling method was applied to enroll a total of 31,050 participants aged ≥ 18. Demographic data, anthropometric measures, and laboratory samples were gathered. Multivariate logistic regression analyses were performed using three different cut-off levels for elevated ALT to assess the relationship between elevated ALT and lifestyle risk factors.

Results

The prevalence of elevated ALT was significantly higher in men with elevated body mass index (BMI), waist-to-hip ratio (WTH), hip circumference, and salt consumption, likewise, in women with higher BMI and WTH. In the multivariate logistic model adjusted for age and sex, high WTH (adjusted odds ratio: 1.73; 95% CI 1.52-1.96), BMI > 25 (1.51; 95% CI 1.29-1.76), hip circumference (1.26; 95% CI 1-1.58), and current smoking (0.67; 95% CI 0.56-0.8) were associated with elevated ALT levels using American cut-off (ALT > 33U/L for male and ALT > 25U/L for female). Only physical measurements (BMI, WTH) but not lifestyle risk factors were related to the increased ALT regardless of the selected cut-offs.

Conclusion

As elevated ALT was associated with several lifestyle risk factors, stewardship programs should be established to modify lifestyle risk factors, such as abdominal obesity and physical inactivity.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-022-01137-6.

Padres Preparados, Jóvenes Saludables: A Randomized Controlled Trial to Test Effects of a Community-Based Intervention on Latino Father's Parenting Practices

Parenting practices have been associated with adolescent lifestyle behaviors and weight status. Evidence is limited regarding the efficacy of interventions to address father influences on adolescent lifestyle behaviors through availability and modeling practices. Therefore, the purpose of this study was to evaluate changes in father parenting practices after Latino families with adolescents participated in the Padres Preparados Jóvenes Saludables (Padres) program. Time-1 (baseline) and Time-2 (post-intervention) data were used from Latino father/adolescent (10-14 years) dyads enrolled in the Padres two-arm (intervention vs. delayed-treatment control group) randomized controlled trial in four community locations. The program had eight weekly, 2.5-h experiential learning sessions on food preparation, parenting practices, nutrition, and physical activity. Two types of parenting practices (role modeling and home food availability) were assessed by father report via questionnaire for each of 7 lifestyle behaviors, for a total of 14 parenting practices. Linear regression mixed models were used to evaluate the intervention effects. A total of 94 father/adolescent dyads completed both Time-1 and Time-2 evaluations. Significant positive intervention effects were found for frequencies of fruit modeling (p = 0.002) and screen time modeling (p = 0.039). Non-significant results were found for the other 12 father parenting practices.

Non-coding RNAs: The link between maternal malnutrition and offspring metabolism

Early life nutrition is associated with the development and metabolism in later life, which is known as the Developmental Origin of Health and Diseases (DOHaD). Epigenetics have been proposed as an important explanation for this link between early life malnutrition and long-term diseases. Non-coding RNAs (ncRNAs) may play a role in this epigenetic programming. The expression of ncRNAs (such as long non-coding RNA H19, microRNA-122, and circular RNA-SETD2) was significantly altered in specific tissues of offspring exposed to maternal malnutrition. Changes in these downstream targets of ncRNAs lead to abnormal development and metabolism. This review aims to summarize the existing knowledge on ncRNAs linking the maternal nutrition condition and offspring metabolic diseases, such as obesity, type 2 diabetes (T2D) and non-alcoholic fatty liver disease (NAFLD).

Physical Literacy of Marginalized Middle School Adolescents in Kansas City Public Schools

PURPOSE

Physical inactivity among adolescents in the United States continues to be a pervasive and growing problem, especially among low income and adolescents of color. Physical literacy is important for adolescents to engage in physical activity. However, few studies have assessed physical literacy among marginalized populations. The purpose of this study is to describe levels of physical literacy among marginalized adolescents in a Midwest City.

METHODS

Data were collected from 169 participants (85 adolescents and 84 parents). Adolescents included in the study were from 4 Kansas City (Missouri) public schools. Univariate statistics were calculated for 3 physical literacy domains (PLAYinventory, PLAYself, and PLAYparent). To assess for differences among groups, the authors conducted a single-factor analysis of variance (1-way analysis of variance).

RESULTS

The sample (N = 169) was primarily Hispanic (48.2% adolescents and 42.9% parents). Sedentary behaviors were self-reported as the highest overall activities adolescents participated in within the past 12 months. The mean physical literacy score for this sample was 71.9 among adolescent reported and 72.7 among parent reported. Analysis of variance of racial and ethnic groups for PLAYself and PLAYparent assessments showed no significant difference in values. Compared with other subscales of both the PLAYparent and PLAYself instrument, parents and adolescents showed a lack of confidence in adolescent's ability to be active in the 4 environments (land, water, ice, and snow).

CONCLUSION

Physical literacy is shown to be important in maintaining physical activity throughout life; given this, it is important to understand how to increase confidence of seasonal specific skills in marginalized adolescents.

Benefits of Physical Activity on Cardiometabolic Diseases in Obese Children and Adolescents

In the past few decades, obesity in the pediatric population has dramatically increased and is common in many countries. Childhood obesity often causes health problems and increases the risk of cardiometabolic diseases such as type 2 diabetes, nonalcohol fatty liver, and cardiovascular diseases. Obesity in young people has been closely associated with environmental, behavioral, and genetic defects, including the availability of high-energy and sugary food and beverages, sedentary behavior, and hereditary factors. Few drugs are currently available to treat obesity in children and adolescents because it is difficult to demonstrate the safety of these drugs on the growth and development of the youth. Lifestyle modifications, such as diet control and physical exercise, are the primary approaches for preventing and treating childhood obesity. Among them, physical activity is a crucial component. This review summarizes the epidemiology, cardiometabolic risk of obesity, therapeutic strategies, and the benefits of exercise on obesity-related chronic diseases in children and adolescents.

A direct observation tool to measure interactions between shade, nature, and children's physical activity: SOPLAY-SN

BACKGROUND

Most physical activity (PA) during school occurs at recess; however, recess PA may be influenced by children's thermal comfort and interaction with nature, neither of which have concurrently been measured reliably in previous studies. This study tests the reliability of SOPLAY-SN, an adaption of the validated System for Observing Play and Leisure Activity in Youth (SOPLAY) to measure Shade and Nature (SN) alongside PA, and associations between children's PA and interaction with shade and nature during recess to highlight the utility of the tool.

METHODS

Interactions with shade and nature were measured using systematic direct observation at two playgrounds (primary-grade = ages 5-8, upper-grade = ages 9-12) during recess at an elementary school in Phoenix, Arizona (USA). Pairs conducted observations over four warm days (primary = 29-34 °C, upper-grade = 32-36 °C) in May 2021 (N = 179 scans). Intraclass correlation coefficients (ICC) were used to calculate inter-rater reliability. Mean counts, frequencies, and Kendall rank correlation coefficient tests were used to assess relations between PA level and interactions with shade and nature.

RESULTS

Reliability was good for sedentary behavior (ICC = 0.98); light PA (LPA; ICC = 0.80) and moderate-to-vigorous PA (MVPA; ICC = 0.94); shade interaction (ICC = 0.95); and nature interaction (ICC = 0.80) and average agreement was good (86% overall PA, 88% shade, 90% nature). Most (60%) primary-grade children were observed in the shade, with 64% under a covered play structure where children were mainly (47%) sedentary. Of the 11% of primary-grade students observed interacting with nature, 90% occurred in a grass field with trees. Among upper-grade children, 23% were observed in the shade with 53% in grass fields where 48% of play was light. Few (7%) upper-grade children were observed interacting with nature, with most instances (76%) in a grass field with trees. Among primary-grade children, shade was correlated with sedentary behavior (τb = 0.63, p < .05); LPA (τb = 0.39, p < .05); MVPA (τb = 0.56, p < .05); and nature interactions with sedentary behavior (τb = 0.16, p < .05). Among upper-grade children, shade was correlated with sedentary behavior (τb = 0.27, p < .05) and LPA (τb = 0.21, p < .05).

CONCLUSIONS

SOPLAY-SN is a reliable tool for measuring children's interaction with shade and nature and participation in PA. Understanding how shade and nature impact movement during recess can inform playground design for children's health and well-being.

Cross-sectional associations between screen time and the selected lifestyle behaviors in adolescents

Background

In adolescents, excessive screen time leads to many adverse health outcomes and is associated with a variety of lifestyle behaviors. This study was conducted to investigate the associations between the two types of screen time and a variety of lifestyle behaviors in American adolescents.

Methods

Based on the Youth Risk Behavior Surveillance System, this cross-sectional study was conducted. With the help of data collectors, participants self-reported screening time, lifestyle behaviors, and demographic data via well-validated tools.

Results

19% and 43.4% of the participants spent more than two hours a day watching television and using the computer, respectively, while the prevalence of physical inactivity and insufficient sleep was 75.1 and 74.4% respectively. Furthermore, 11.9, 7.3, 14.3, and 21.3% of the participants reported skipping fruits, vegetables, breakfast and milk, respectively. Moreover, the prevalence of alcohol and tobacco consumption and sexual activity was 26.8, 5.3, and 23.5% respectively. More than two hours of television time was significantly associated with high risks of fewer frequency for eating fruit (OR = 1.605, 95%CI: 1.308-1.970), vegetables (OR = 1.389, 95%CI: 1.029-1.873), and smoking (OR = 1.465, 95%CI: 1.088-1.972). Computer/video time for more than two hours was significantly associated with high risks of physical inactivity (OR = 1.724, 95%CI: 1.531-1.941), insufficient sleep (OR = 1.354, 95%CI: 1.151-1.592), and not eating fruit (OR = 1.434, 95%CI: 1.179-1.745).

Conclusion

Increased screen time may be associated with specific unhealthy lifestyle behaviors in adolescents. Furthermore, the associations between different types of screen time and various lifestyle behaviors varied.

Endogenous circadian temperature rhythms relate to adolescents' daytime physical activity

Circadian rhythms relate to multiple aspects of health and wellbeing, including physical activity patterns. Susceptible circadian regulation predisposes to circadian misalignment, poor sleep, sleep deprivation, increased sleepiness, and thereby sedentary behavior. Adolescents' circadian regulation is particularly vulnerable, and may lead to sedentary behavior. To investigate which factors associate strongest between physical activity (PA) and circadian behavior, we conducted multimodal circadian rhythm analyses. We investigate how individual characteristics of habitual circadian patterns associate with objectively measured PA. We studied 312 adolescents [70% females) (56% with delayed sleep phase (DSP)], mean age 16.9 years. Circadian period length, temperature mesor (estimated 24 h midline) and amplitude (difference between mesor and peak) were measured using distally attached thermologgers (ibutton 1922L, 3-day-measurement). We additionally utilized algorithm-formed clusters of circadian rhythmicity. Sleep duration, timing, DSP, and PA were measured using actigraphs (GeneActiv Original, 10-day-measurement). We found that continuous circadian period length was not associated with PA, but lower mesor and higher amplitude were consistently associated with higher levels of PA as indicated by mean Metabolic Equivalent (METmean) and moderate-to-vigorous PA (MVPA), even when controlling for sleep duration. Separate circadian clusters formed by an algorithm also reflected distinct patterns of PA accordingly. Late sleepers and those with DSP were less likely to engage in MVPA compared to non-DSP and had more sedentary behavior. Adolescents who engage in higher levels or high-intensity PA have better circadian regulation, as measured by different objective methods including distal temperature measurements as well as actigraphy-measured sleep-wake behavior.

Associations of accelerometer measured school- and non-school based physical activity and sedentary time with body mass index: IPEN Adolescent study

Background

This study examined the strength, shape and direction of associations of accelerometer-assessed overall, school- and non-school-based moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) with BMI among adolescents across the world. Second, we examined whether these associations differed by study site and sex.

Methods

Cross-sectional data from the IPEN Adolescent study, an observational multi-country study, were used. Participants wore an accelerometer for seven days, reported height and weight, and completed a socio-demographic survey. In total, 4852 adolescents (46.6% boys), aged 11–19 years (mean age = 14.6, SD = 1.7 years) were included in the analyses, using generalized additive mixed models.

Results

Adolescents accumulated on average 41.3 (SD = 22.6) min/day of MVPA and 531.8 (SD = 81.1) min/day of ST, and the prevalence of overweight and obesity was 17.2% (IOTF), but these mean values differed by country. Linear negative associations of accelerometer-based MVPA and ST with standardized BMI scores and the likelihood of being overweight/obese were found. School-based ST and non-school-based MVPA were more strongly negatively associated to the outcomes than non-school based ST and school-based MVPA. Study site moderated the associations; adolescent sex did not. No curvilinear associations were found.

Conclusions

This multi-country study confirmed the importance of MVPA as a potential protective factor against overweight/obesity in adolescents. Non-school-based MVPA seemed to be the main driver of these associations. Unexpected results were found for ST, calling for further examination in methodologically sound international studies but using inclinometers or pressure sensors to provide more precise ST measures.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01324-x.