Tracking of physical activity, fitness, body composition and diet from adolescence to young adulthood: The Young Hearts Project, Northern Ireland

The relationship between attitude toward physical activity and weight gain in children and young adolescence

Introduction

The purpose of this study was to investigate the association between attitudes toward physical activity and weight gain among children and young adolescents with an additional focus on the impact of gender on these attitudes.

Methods

Employing a descriptive survey method, data were systematically gathered via purposive sampling from 11 specific cities in Türkiye, ensuring representation from all seven regions. A total of 3,138 students, aged between 9 and 14 years, participated in this study, with a distribution of 46% girls and 54% boys. To assess the attitudes of children and young adolescents toward physical activity, the Youth Physical Activity Attitude Scale was utilized. Height and body weight measurements were taken to determine the body mass index of participants. SPSS 26.0 software facilitated the statistical analyses, including Pearson correlation analysis to explore relationships between variables. Multivariate Analysis of Variance was employed to evaluate the impact of age, BMI, and gender on attitudes toward physical activity.

Results

Participants classified as normal weight exhibited a more positive attitude towards physical activity compared to their obese and overweight counterparts. Moreover, a significant gender difference emerged, with boys demonstrating significantly higher positive attitudes toward physical activity than girls. However, no significant difference was observed in negative attitudes based on gender. The study also revealed that an escalation in negative attitudes towards physical activity correlated with students being categorized as underweight, overweight, or obese, as opposed to having a normal weight status. Additionally, a statistically significant divergence in both positive and negative attitudes towards physical activity was found based on age. Specifically, the results indicated that students aged 9 and 14 exhibited lower levels of positive attitude when contrasted with their counterparts of different age groups. Conversely, in the domain of negative attitudes, students at the age of 9 scored higher than their peers in other age categories.

Discussion

Attitudes towards physical activity can serve as a convenient indicator and guide for assessing the effectiveness of various practices or interventions aimed at promoting physical activity, with recognition of the significant gender difference in positive attitudes among children and young adolescents.

Longitudinal changes in device-measured physical activity from childhood to young adulthood: the PANCS follow-up study

BACKGROUND

There is a lack of longitudinal studies examining changes in device-measured physical activity and sedentary time from childhood to young adulthood. We aimed to assess changes in device-measured physical activity and sedentary time from childhood, through adolescence, into young adulthood in a Norwegian sample of ostensibly healthy men and women.

METHODS

A longitudinal cohort of 731 Norwegian boys and girls (49% girls) participated at age 9 years (2005-2006) and 15 years (2011-2012), and 258 of these participated again at age 24 years (2019-2021; including the COVID-19 pandemic period). Physical activity and sedentary time were measured using ActiGraph accelerometers. Linear mixed models were used to analyse changes in physical activity and sedentary time and whether low levels of childhood physical activity track, i.e., persist into young adulthood (nchange=721; ntracking=640).

RESULTS

The most prominent change occurred between the ages of 9 to 15 years, with an increase in sedentary time (150 min/day) and less time spent in light (125 min/day), moderate (16 min/day), and vigorous physical activity (8 min/day). Only smaller changes were observed between the ages of 15 and 24 years. Changes in moderate-to-vigorous physical activity from childhood to young adulthood differed between subgroups of sex, tertiles of body mass index at baseline and tertiles of peak oxygen uptake at baseline. While the tracking models indicated low absolute stability of physical activity from childhood to young adulthood, children in the lowest quartiles of moderate-to-vigorous (OR:1.88; 95%CI: 1.23, 2.86) and total physical activity (OR: 1.87; 95%CI: 1.21, 2.87) at age 9 years were almost 90% more likely to be in these quartiles at age 24 years compared to those belonging to the upper three quartiles at baseline.

CONCLUSIONS

We found a substantial reduction in physical activity and increase in time spent sedentary between age 9 and 15 years. Contrary to previous studies, using mainly self-reported physical activity, little change was observed between adolescence and young adulthood. The least active children were more likely to remain the least active adults and could be targeted for early intervention.

Bidirectional associations between adiposity and physical activity: a longitudinal study from pre-puberty to early adulthood

Objective

This study aimed to investigate directional influences in the association between adiposity and physical activity (PA) from pre-puberty to early adulthood.

Methods

In the Calex-study, height, weight, body fat and leisure-time physical activity (LTPA) were measured at age11.2-years, 13.2-years and 18.3-years in 396 Finnish girls. Body fat was measured by dual-energy X-ray absorptiometry, calculating fat mass index (FMI) as total fat mass in kilograms divided by height in meters squared. LTPA level was evaluated using a physical activity questionnaire. In the European Youth Heart Study (EYHS), height, weight and habitual PA were measured at age 9.6-years, 15.7-years and 21.8-years in 399 Danish boys and girls. Habitual PA and sedentary behaviour were assessed with an accelerometer. Directional influences of adiposity and PA were examined using a bivariate cross-lagged path panel model.

Results

The temporal stability of BMI from pre-puberty to early adulthood was higher than the temporal stability of PA or physical inactivity over the same time period both in girls and boys. In the Calex-study, BMI and FMI at age 11.2-years were both directly associated with LTPA at age 13.2-years (β = 0.167, p = 0.005 and β = 0.167, p = 0.005, respectively), whereas FMI at age 13.2-years showed an inverse association with LTPA at age 18.3-years (β = - 0.187, p = 0.048). However, earlier LTPA level was not associated with subsequent BMI or FMI. In the EYHS, no directional association was found for physical inactivity, light-, moderate-, and vigorous-PA with BMI during the follow-up in girls. In boys, BMI at age 15.7-years was directly associated with moderate PA (β = 0.301, p = 0.017) at age 21.8-years, while vigorous PA at age 15.7-years showed inverse associations with BMI at age 21.8-years (β = - 0.185, p = 0.023).

Conclusion

Our study indicates that previous fatness level is a much stronger predictor of future fatness than level of leisure-time or habitual physical activity during adolescence. The directional associations between adiposity and physical activity are not clear during adolescence, and may differ between boys and girls depending on pubertal status.

Exposure to tobacco, alcohol and 'Junk food' content in reality TV programmes broadcast in the UK between August 2019-2020

BACKGROUND

Exposure to alcohol, tobacco and foods high in fat, sugar or salt (HFSS) content in media is a risk factor for smoking, alcohol use and HFSS consumption in young people. We report an analysis of tobacco, alcohol and HFSS content in a sample of reality TV programmes broadcast on TV and video-on-demand services throughout a 1-year period.

METHODS

We used 1-min interval coding to quantify content in all episodes of 20 different reality TV programmes between August 2019 and August 2020 and estimated population exposure to a sample of these programmes using viewing data and UK population estimates.

RESULTS

We coded 13 244 intervals from 264 episodes. Tobacco content appeared in 227 intervals (2%) across 43 episodes (2%), alcohol in 5167 intervals (39%) across 258 episodes (98%) and HFSS in 1752 intervals (13%) across 234 episodes (88%). A sample of 15 series delivered ~157.4 million tobacco, 3.5 billion alcohol and 1.9 billion HFSS gross impressions to the UK population, including 24 000, 12.6 million and 21.4 million, to children, respectively.

CONCLUSION

Tobacco, alcohol and HFSS content are common in reality TV programmes. These programmes deliver exposure to tobacco, alcohol and HFSS imagery, which are a potential driver of tobacco use, alcohol use and HFSS consumption in young people.

A content analysis of 'junk food' content in children's TV programmes: a comparison of UK broadcast TV and video-on-demand services

OBJECTIVES

Exposure to high in fat, sugar or salt (HFSS) food imagery is associated with unhealthy consumption, and subsequently obesity, among young people. We report and compare the results of two content analyses, one of popular children's television channels in the UK and the other of a selection of children's programmes available on video-on-demand (VOD) services.

METHODS

Content analysis of 3 days' worth of programmes on two popular children's television channels broadcast on UK television (CBeebies and Milkshake as well as a sample of children's programmes available on the VOD platforms (Netflix and Amazon Prime) using 1-min interval coding.

RESULTS

In children's television channels, HFSS content was seen in 181 episodes (36%) and in 417 intervals (13%) on terrestrial television, 'Milkshake' had a significantly higher proportion of broadcasts, which contained HFSS content than 'CBeebies'. In VOD platforms, HFSS content was seen in 82 episodes (72% of the total number of episodes), across 459 intervals (19% of the total number of intervals), with no significant difference in the proportion of programmes containing HFSS content between Netflix and Amazon Prime.

CONCLUSIONS

HFSS content is common in both popular UK children's television channels and children programmes on VOD services and is likely having an effect on HFSS consumption in children. Legislative opportunities to prevent this exposure are being missed.

Associations between Fat Mass and Fat Free Mass with Physical Fitness in Adolescent Girls: A 3-Year Longitudinal Study

The main purpose of the study was to examine the longitudinal associations between fat mass and fat free mass with health-related physical fitness. Two-hundred and forty 15-year old adolescent girls were measured at the baseline and after a period of 3 years (17 years). Health-related physical fitness included the following tests: (1) explosive power of the lower extremities (standing broad jump); (2) muscle endurance of the trunk (sit-ups in 60 s); (3) flexibility (sit-and-reach test); (4) muscle endurance of the lower extremities (squats in 60 s); (5) aerobic endurance (the 800 m run test); and (6) speed endurance (the 400 m running test). Fat mass and fat free mass were assessed using the bioelectrical impedance method. Longitudinal associations were analyzed with linear mixed model estimates. After adjusting for body mass index, fat mass was negatively associated with standing broad jump (β = −1.13, p < 0.001), sit-ups in 60 s (β = −0.27, p < 0.001), and squats in 60 s (β = −0.27, p < 0001), while positive associations with the 800 m running test (β = 0.02, p < 0.001) and the 400 m running test (β = 0.02, p < 0.001) were observed. On the other hand, fat free mass was positively associated with standing broad jump (β = 1.14, p < 0.001), sit-ups in 60 s (β = 0.28, p < 0.001), and squats in 60 s (β = 0.28, p < 0001), while the 800 m running test (β = −0.02, p < 0.001) and the 400 m running test (β = −0.02, p < 0.001) exhibited negative associations. This study shows that fat mass and fat free mass components are longitudinally, but oppositely associated with health-related physical fitness in adolescent girls.

Tracking of health-related physical fitness in adolescent girls: a 3-year follow-up study

BACKGROUND

Evidence has shown that higher levels of physical fitness (PF) in youth have beneficial effects on adult health-related outcomes. However, the tracking of separate PF components during adolescence has been less studied. Since PF often starts to rapidly decline during adolescence, it is necessary to provide information regarding critical time-point for interventions. This study aimed to analyze the extent of tracking the components of PF through PF tests.

METHODS

In this longitudinal study, we recruited 240 adolescent girls with recoded data at 2 time-points (15 y and 17 y). PF included body composition (fat mass), explosive power of lower extremities (standing broad jump), muscle endurance of the trunk (sit-ups in 60 s), flexibility (sit-and-reach test), muscle endurance of lower extremities (squats in 60 s), aerobic endurance (the 800 m run test) and speed endurance (the 400 m run test). Tracking coefficients were calculated using generalized estimating equations. Tertiles (high, moderate and low) were calculated for each fitness component.

RESULTS

The highest tracking coefficients between the two time-points were found for explosive power of lower extremities (β = 0.98), followed by flexibility (β = 0.89), body composition (β = 0.88), speed endurance (β = 0.86), aerobic endurance (β = 0.75), muscle endurance of lower extremities (β = 0.65), and muscle endurance of the trunk (β = 0.51). Tertile ratings remained stable across the two time-points.

CONCLUSIONS

Moderate to high tracking of PF in adolescent girls suggests that interventions aiming to increase the level of PF should probably begin in early adolescence.

Tracking of physical fitness levels from childhood and adolescence to adulthood: a systematic review and meta-analysis

BACKGROUND

Prospective and large studies indicate that high physical fitness levels during young are beneficial for health during adulthood. The aim of the study was to investigate the tracking of physical fitness components from childhood and/or adolescence to adulthood.

METHODS

Two authors systematically searched MEDLINE and Web of Science electronic databases for relevant articles. Studies with apparently healthy youth aged 6-18 years who track their physical fitness to adulthood were included. Our study carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Correlation coefficients (r) were used as effect size. Random-effects models were used to estimate the pooled effect size. Correlation coefficients were interpreted as follows: <0.30 low stability, 0.30 to 0.60 moderate stability, and >0.60 high stability. Risk of bias of each study was determined by The Quality Assessment Tool for Observational Cohort and Cross-sectional Studies.

RESULTS

Twenty-one prospective studies were included in the meta-analysis (n=6,197 participants at follow-up, 47.4% women). The mean length of follow-up was 20.8 years. Overall, cardiorespiratory fitness (r=0.38; 95% CI: 0.29-0.48; I²=92.7%), muscular strength (r=0.51; 95% CI: 0.43-0.59; I²=87.9%), and muscular endurance (r=0.50; 95% CI: 0.36-0.86; I²=94.5%) show moderate tracking from childhood and/or adolescence to adulthood, independent of test used and length of follow-up. This moderate tracking was slightly stronger in women than in men and from adolescence compared to childhood. Trunk flexibility component, assessed with the sit and reach test, exhibits high stability (r=0.69; 95% CI: 0.58-0.81; I²=92.9%). Interestingly, meta-regression analysis shows positive association between correlation coefficient for flexibility and the length of follow-up (β =0.017; 95% CI: 0.012-0.021).

DISCUSSION

Although the current study found inconsistency between results, the findings suggest that acquiring high physical fitness levels should be targeted already from childhood and adolescence given that low levels of fitness in adulthood are related with several chronic diseases and mortality.

TRIAL REGISTRATION

Registration number CRD42021279143.

Relationships between physical function, body composition and metabolic health in Pacific Island youth

The Pacific Islands Families (PIF) study is a birth cohort study designed to increase knowledge about the growth and development of Pacific children living in Auckland, New Zealand. Adolescence is a critical time of growth and development, yet the roles of physical function and body composition in metabolic health at this life stage are not clear. We aimed to investigate associations between measures of physical function (the 6-minute-walk-test (6MWT)), heart rate changes before and after the 6MWT, handgrip strength, body composition including appendicular skeletal muscle mass (ASMM) measured by dual-energy X-ray absorptiometry and biomarkers of metabolic health from a fasting blood sample.A total of 200 youth (98 girls, 102 boys) aged 14–15 years, from the birth-cohort of children in the Pacific Islands families study were measured. In girls, the proportion of ASMM was lower and fat higher than in boys. Controlling for age, a 1% increase in ASMM predicted a longer walk distance (+6.3, 95%CI 2.2, 10.4 m in girls; +7.1, 95%CI 4.4, 9.1 m in boys) and lower heart rate following the 6MWT. ASMM and fat mass were independently predictive of maximal handgrip strength which was increased by 1.4 (1.0,1.8) kg in girls and 1.7 (1.3, 2.0) kg in boys for each kg increase in ASMM and reduced by 0.23 (0.08, 0.38) kg in girls and 0.26 (0.14, 0.37) kg in boys for each kg increase in fat mass. Lower total cholesterol and LDL were associated with an increase in distance walked in boys only. For each year of age, distance walked was reduced by 34 (15, 53) m in girls and 59 (36,84) m in boys. These findings should be explored further in the context of other influences such as food security, opportunities for physical activity and cultural expectations.

Feasibility of smartphone application- and social media-based intervention on college students' health outcomes: A pilot randomized trial

Objective We evaluated the feasibility of a 10-week program combining a smartphone application and theoretically-based, social media-delivered health education intervention to improve college students' health behaviors and outcomes. Participants: Forty-four college students (32 female; X̅_age=21.6 years) in 2015-2016. Methods: Participants were randomized into one of two groups: (1) experimental: used MapMyFitness smartphone application to log and track physical activity (PA) and participated in a Social Cognitive Theory-based, Facebook-delivered health education intervention; (2) comparison: only included in a separate, but content-identical, Facebook intervention. Our primary outcomes pertained to intervention feasibility while our secondary outcomes reflected health behaviors and outcomes. Results: Intervention interest was high, with retention 95.5%. Experimental participants used MapMyFitness 1.71x/week, with both groups implementing the Facebook-delivered health education tips 1-3x/week. We observed a modest sedentary behavior reduction in the experimental group (-29.2-minutes/day). Additionally, both groups demonstrated slight reductions in weight (experimental:-1.2 kg/comparison:-0.6 kg) and body fat percentage (both groups:-0.8%-decrease). Increased PA-related social support and decreased barriers were observed. Conclusions: A low-burden and well-integrated social media-based intervention is feasible and of interest to college students, possibly improving select health behaviors and outcomes. PA-oriented smartphone application offered limited additional benefit.

Association between sociodemographic, dietary, and substance use factors and accelerometer-measured 24-hour movement behaviours in Brazilian adolescents

Sociodemographic factors and lifestyle behaviours were evidenced as correlates of self-reported 24-hour movement behaviours in high-income settings. However, it is unclear how these relations occur in a middle-income country setting, with unique cultural and social characteristics. This study aimed to examine the association between sociodemographic, dietary, and substance use factors with accelerometer-measured 24-hour movement behaviours in Brazilian adolescents. Information on sex, age, socioeconomic status (SES), family structure, dietary behaviours, and history of substance use were collected by a questionnaire. Sleep duration, sedentary behaviour, and light- and moderate-to-vigorous physical activity (LPA and MVPA) were measured using wrist-worn accelerometers. On average, females slept more (β = 21.09, 95%CI 13.18; 28.98), engaged in more LPA (β = 17.60, 95%CI 8.50; 27.13), and engaged in less sedentary behaviour (β = -16.82, 95%CI -30.01; -4.30) and MVPA (β = -4.76, 95%CI -7.48; -1.96) than males. Age and sedentary behaviour were positively associated (β = 8.60, 95%CI 2.53; 14.64). Unprocessed foods were positively related to LPA (β = 2.21, 95%CI 0.55; 3.92), whereas processed foods were positively related to sedentary behaviour (β = 3.73, 95%CI 0.03; 7.38) and inversely related to MVPA (β = -0.89, 95%CI -1.68; -0.10). Family structure, SES, and substance use factors were not significantly associated with any 24-hour movement behaviour.Conclusions: Sex, age, and dietary behaviours, unlike SES or substance use, were associated with 24-hour movement behaviours in this sample of Brazilian adolescents and are important factors to consider in interventions, policies, and practice. What is Known: • The 24-hour movement behaviours are composed of sleep, sedentary behaviour, and physical activity and are important determinants of health. • Most adolescents do not engage in adequate levels of physical activity, sedentary behaviour, and sleep, and there is a need to better understand factors related to these behaviours. What is New: • Sex, age, and dietary behaviours were associated with the 24-hour movement behaviours. • No associations were found between socioeconomic status and substance use with the 24-hour movement behaviours.

Physiological and Lifestyle Factors Associated With Abnormal Blood Pressure in Adolescents Before and After a School-Based Wellness Program in Michigan: A Report From Project Healthy Schools

PURPOSE

Hypertension (HTN) is associated with increased cardiovascular risk and unhealthy lifestyles in adults. However, data on both physiological and lifestyle factors associated with abnormal blood pressure (BP) in adolescents, as well as the effectiveness of interventions in improving these factors among adolescents with abnormal BP, is scarce.

METHODS

Students enrolled in a middle-school-based wellness program, Project Healthy Schools (PHS), between 2005-2016 were eligible. Three systolic (SBP) and diastolic (DBP) BP measurements were taken pre-PHS and post-PHS; averages of the final two were analyzed. Students were grouped by baseline BP: abnormal BP (≥90th percentile for SBP and/or DBP, or ≥120/80 mmHg) or normal BP (<90th percentile for SBP and/or DBP, or <120/80 mmHg). Demographics, physiologic measures, and health behaviors were compared between groups pre- and post-PHS.

RESULTS

Of 2,865 students, 812 (28.3%) had abnormal BP. Median SBP was 119 mmHg in abnormal BP students and 103 mmHg in normal BP students (p < .001). Females were less likely to have abnormal BP than males (48.4% vs. 51.6%, p < .01). Pre-PHS, abnormal BP students were more likely to be overweight (62.3% vs. 28.2%, p < .001) or obese (38.9% vs. 11.3%, p < .001) than normal BP students. Their total cholesterol, triglycerides, random glucose, resting, and recovery heart rates were also higher, and they had worse dietary and sedentary habits. Post-PHS, abnormal BP students demonstrated greater reduction in SBP (-4.0 vs. 2.8 mmHg, p < .001) and DBP (-3.3 vs. .8 mmHg, p < .001) than normal BP students.

CONCLUSIONS

Abnormal BP was prevalent and associated with worse cardiometabolic health parameters and behaviors at baseline. Abnormal BP students demonstrated significant improvements in BP post-PHS, suggesting school-based programs may be effective as nonpharmacological lifestyle interventions in this population.

Sex-dependent effects of forced exercise in the body composition of adolescent rats

Determining the body composition during adolescence can predict diseases such as obesity, diabetes, and metabolic syndromes later in life; and physical activity became an effective way to restore changes in body composition. However, current available literature assessing the body composition before, during and after adolescence in female and male rodents by in vivo techniques is scarce. Thus, by using computerized tomography, we aimed to define the baseline of the weight and body composition during the adolescence and young adulthood of female and male Sprague-Dawley rats (on P30, P60 and P90) under standard diet. Then, we determined the effect of 18 days of forced exercise on the body weight and composition during the early adolescence (P27-45). The highest percentual increments in weight, body volume and relative adipose contents occurred during the female and male adolescence. Forced running during the early adolescence decreased weight, body volume and relative adipose delta and increment values in males only. The adolescence of rats is a period of drastic body composition changes, where exercise interventions have sex-dependent effects. These results support a model that could open new research windows in the field of adolescent obesity.

The Associations Between Physical Performance and Anthropometric Characteristics in Obese and Non-obese Schoolchild Handball Players

This study investigated the relationship of body fat and fitness measures in schoolchild handball players. Twenty-eight young male handball players from handball first youth league volunteered for the present investigation (age: 10.9 ± 0.72 years; body mass: 54.8 ± 22.9 kg; height: 1.48 ± 0.10 m; body fat: 27.6 ± 9.23%). Measures included the Yo-Yo Intermittent Recovery Test level 1 (Yo-Yo IR1), jumping ability [squat and counter-movement jumps (SJ, CMJ)], and sprint tests (10 m, 15 m). Anthropometry was assessed by body mass, body mass index (BMI), and fat percentage (%BF). The power of the upper limb was measured as the total distance thrown overhead using a 2 kg medicine ball. Intrarater reliability for all parameters showed a coefficient of variation (CV) below 10% and an intraclass correlation coefficient (ICC) above 0.75. All ICC were excellent (ICC ≥ 0.96). Reliability as shown by the CV differed between 1.0 (sprint 15 m) and 5.6 (sprint 10 m). With the exception of medicine ball throw, we found significant differences between non-obese and obese in all performance parameters. The differences ranged from η _p ² = 0.47 (sprint 10 m) to η _p ² = 0.09 (medicine ball throw). The two-step-linear regression analysis using the predictors body height and body weight (step 1) and body fat (step 2) showed a marked increase of explained variance by adding body fat. The largest r² changes were calculated for sprint 10 m (0.54), CMJ (0.49), and sprint 15 m (0.42). The lowest influence of the predictors was observed for medicine ball throw (step 1: r ² = 0.03, step 2: r ² = 0.07). With the exception of sprint parameters (β-coefficient sprint 10 m: -0.74; β-coefficient sprint 20: -0.66), a decrease of %BF leads to a higher performance in all parameters. %BF in youth handball players should be an important concern for practitioners working in this team sport in contrast to the frequently used BMI. It seems sensible and appropriate to engage very young children in physical activities such as team handball in order to improve their physical fitness. Decrease in% body fat could be considered both as a training and nutritional target to enhance and optimize sport performance-related outcomes.

Association between physical activity, screen time activities, diet patterns and daytime sleepiness in a sample of Brazilian adolescents

OBJECTIVE

To examine the association between physical activity, screen time, eating habits and daytime sleepiness among Brazilian adolescents.

METHODS

Adolescents from three high schools (n = 876, 49.8% female, 16.4 ± 1.2 years) participated in this cross-sectional survey. Variables related to lifestyle behaviors (ie, physical activity, screen time, eating habits, sleep duration) were collected through an online questionnaire. Daytime sleepiness was assessed using the Pediatric Daytime Sleepiness Scale (PDSS). Excessive daytime sleepiness was defined as a PDSS score ≥20.

RESULTS

The average PDSS score was 18.9 (SD ± 4.8) points and 46.8% of adolescents were classified as having excessive daytime sleepiness. Physical activity was inversely associated with PDSS score (β = -0.29, 95% CI -0.47; -0.11). Consuming processed foods frequently (β = 1.16, 95% CI 0.85; 1.47) and using social media (β = 0.22, 95% CI 0.14; 0.30) were positively associated with PDSS score. Similar findings were observed for the odds of excessive daytime sleepiness. Physical activity was inversely associated (OR = 0.91, 95% CI 0.84; 0.99), while frequent consumption of processed foods (OR = 1.55, 95% CI 1.33; 1.82) and using social media (OR = 1.13, 95% CI 1.02; 1.24) were positively associated with excessive daytime sleepiness.

CONCLUSIONS

Lower physical activity level, a higher consumption processed foods, and higher social media use were associated with daytime sleepiness in this sample of Brazilian adolescents.

Do children's expectations about future physical activity predict their physical activity in adulthood?

Background

Much of the population fails to meet recommended physical activity (PA) levels, but there remains considerable individual variation. By understanding drivers of different trajectories, interventions can be better targeted and more effective. One such driver may be a person’s physical activity identity (PAI)—the extent to which a person perceives PA as central to who they are.

Methods

Using survey information and a unique body of essays written at age 11 from the National Child Development Study (N = 10 500), essays mentioning PA were automatically identified using the machine learning technique support vector classification and PA trajectories were estimated using latent class analysis. Analyses tested the extent to which childhood PAI correlated with activity levels from age 23 through 55 and with trajectories across adulthood.

Results

42.2% of males and 33.5% of females mentioned PA in their essays, describing active and/or passive engagement. Active PAI in childhood was correlated with higher levels of activity for men but not women, and was correlated with consistently active PA trajectories for both genders. Passive PAI was not related to PA for either gender.

Conclusions

This study offers a novel approach for analysing large qualitative datasets to assess identity and behaviours. Findings suggest that at as young as 11 years old, the way a young person conceptualizes activity as part of their identity has a lasting association with behaviour. Still, an active identity may require a supportive sociocultural context to manifest in subsequent behaviour.

[Tracking of physical fitness during chilhood: Longitudinal findings from the Diagnoform program]

BACKGROUND

A high level of physical fitness is associated with cardiovascular health in adolescents. We describe change in physical fitness levels assessed at two time points over 3 years.

METHODS

The study presents a longitudinal design, with the first phase data collection at 8 years and the second phase carried out at 11 years. A total of 516 children (254 boys) aged to 7.7±0.4 years (in 2010) and 10.9±0.4 years (in 2010) and 10.9 ± 0.4 years (in 2013) participated to the study. Cardiorespiratory fitness, muscular strength, speed, and agility were assessed in this study. For each physical fitness test, determination of the situation (in terms of percentiles) of each child in 2010 and then in 2013 compared to national standards. The 2010 and 2013 percentiles are then compared using the Wilcoxon signed rank test.

RESULTS

Muscular strength, agility and cardiorespiratory fitness decrease in both sex (p<0.01). A significant decrease was also found for all physical fitness components in normal weight children (p<0.05). For normal weight children in 2010 who became overweight or obese in 2013, there was a significant decrease in scores of cardiorespiratory fitness and agility tests (p<0.05). For overweight children in 2010 becoming from to normal weight status in 2013, only the agility test decreased significantly (p<0.05). Children being overweight or obese in 2010 and remaining in 2013, had a significant decrease in their physical fitness levels (p<0.05).

CONCLUSIONS

Our results indicate that the physical fitness of French youth decrease between childhood and early adolescence. Developing and introducing a health promotion curriculum in the French schools is suggested to improve health and physical fitness.

Associations between Public Transport Accessibility around Homes and Schools and Walking and Cycling among Adolescents

Good public transport accessibility is associated with active travel, but this is under-researched among adolescents. We tested associations between public transport accessibility and active travel among school-going adolescents (12-18 years; n = 1329) from Melbourne, Australia analysing Victorian Integrated Survey of Travel and Activity data. Outcomes included main mode of transport to school and accumulating ≥20 min of active travel over the day. Low and high compared to no public transport accessibility around homes were associated with higher odds of public transport use (low (odds ratio (OR): 1.94 95% confidence interval (CI): 1.28, 2.94) high (OR: 2.86 95% CI: 1.80, 4.53)). Low and high public transport accessibility around homes were also associated with higher prevalence of achieving ≥20 min of active travel (low (prevalence ratio (PR): 1.14 95% CI: 0.97, 1.34) high (PR: 1.31 95% CI: 1.11, 1.54)) compared to none. Public transport accessibility around schools was associated with public transport use (low (OR: 2.13 95% CI: 1.40, 3.24) high (OR: 5.07 95% CI: 3.35, 7.67)) and achieving ≥20 min of active travel (low (PR: 1.18 95% CI: 1.00, 1.38) high (PR: 1.64 95% CI: 1.41, 1.90)). Positive associations were confirmed between public transport accessibility and both outcomes of active travel.

[Association between physical activity level, body mass index and body fat mass in young people of school age in the Wilaya of Marrakesh (Morocco)]

INTRODUCTION

Physical activity is a good indicator of health state and well-being. The purpose of this study is to assess physical activity level and to study its association with body mass index and body fat mass in young people of school age in the Wilaya of Marrakech.

METHODS

A sample of 1173 young people of school age (aged 15- 20 years) was recruited in the city of Marrakech (urban area) and in the Al Haouz Province (rural area). Physical activity level was determined by measuring the energy expenditure compared to the recommended levels of physical activity. Logistic regression was used in the statistical study of these associations.

RESULTS

Forty-one point one percent (41.1%) of respondents were physically active for three hours and more per week, 31.1% practiced less than three hours per week, while 27.3% (41.1% of girls against 14.2% of boys; p < 0.001) do not practice any sport activity in their free time outside the school. Boys were more active than girls (OR = 3.16; p < 0.001). Rural students were more active than urban dwellers (OR = 1.9; p < 0.001). Among girls, passing from the level of "sedentary" lifestyle to the level "very active" lifestyle, the means of body-mass index (BMI) and body fat mass decreased by 1.9 kg/m2 (F = 8.03; p < 0.001) and 6.28% (F = 15.80; p < 0.001) respectively. Among boys, the decrease in BMI was 0.85 kg/m2 (F = 1.17; p = 0.17) and 2.77% (F = 5.15; p = 0.006) in body fat.

CONCLUSION

Physical activity is significantly associated with body fat mass and BMI. Physical activity promotion in young people into their daily activities as well as during their leisure time, is a basic need to cope with the downstream effects of sedentary lifestyle on their health.

Changes and correlations in height from 7 to 69 years of age across the birth years of 1930 to 1989

OBJECTIVES

The aims of this study were to describe changes in height during childhood and to investigate potential changes in the proportion of children attaining final height in childhood and in correlations between child and adult height across birth cohorts.

METHODS

We included 363 059 children (179 906 girls) from the Copenhagen School Health Records Register, who were born between 1930 and 1989, with height measurements at ages 7, 10, or 13 years. Linkages to data resources containing adult height values between ages 18 and 69 years were possible for a subpopulation of 96 133 individuals (23 051 women). Birth years were categorized as 1930 to 1939, 1940 to 1949, and 1950 to 1989. Descriptive height statistics were estimated by birth years and birth cohorts. Height correlations were examined using sex- and age-specific partial Pearson correlation analyses and meta-regression techniques.

RESULTS

Across 60 birth years, mean child heights at age 7 increased by 2.9 cm in girls and 3.0 cm in boys, and adult heights increased as well. The proportions of children attaining final height by age 13 remained low across the birth cohorts; nonetheless, there was a significant increase from 0.7% to 1.5% in girls only (P < .0001). Both child-child and child-adult height correlations were strong and remained relatively stable across birth cohorts.

CONCLUSIONS

Mean child and adult height increased during the study period, but the proportion of children attaining final height at age 13 remained low. Child-child and child-adult height correlations were largely unchanged across birth cohorts.

Longitudinal changes in body composition and waist circumference by self-reported levels of physical activity in leisure among adolescents: the Tromsø study, Fit Futures

BACKGROUND

It is not clear how physical activity affects body composition in adolescents. Physical activity levels are often reduced during this period, and the relative proportion of body fat mass and lean mass undergo natural changes in growing adolescents. We aimed to examine whether self-reported physical activity in leisure time at baseline or change in activity during follow-up affect changes in four measures of body composition; body mass index (kg/m2), waist circumference, fat mass index (fat mass in kg/m2) and lean mass index (lean mass in kg/m2).

METHODS

We used data from the Tromsø Study Fit Futures, which invited all first year students in upper secondary high school in two municipalities in northern Norway in 2010-2011. They were reexamined in 2012-2013. Longitudinal data was available for 292 boys and 354 girls. We used multiple linear regression analyses to assess whether self-reported level of physical activity in leisure time at baseline predicted changes in body composition, and analysis of covariance to assess the effects of change in level of activity during follow-up on change in body composition. All analyses were performed sex-specific, and a p-value of < 0.05 was considered statistically significant.

RESULTS

There were no associations between self-reported leisure time physical activity in the first year of upper secondary high school and changes in any of the considered measure of body composition after 2 years of follow up, with the exception of waist circumference in boys (p = 0.05). In boys, change in fat mass index differed significantly between groups of activity change (p < 0.01), with boys adopting activity or remaining physically active having less increase in fat mass index than the consistently inactive. In girls, change in lean mass index differed significantly between groups of activity change (p = 0.04), with girls adopting physical activity having the highest increase.

CONCLUSIONS

Self-reported leisure time physical activity does not predict changes in body composition in adolescents after 2 years of follow up. Change in the level of physical activity is associated with change in fat mass index in boys and lean mass index in girls.

Tracking of Physical Activity and Sedentary Behavior From Adolescence to Young Adulthood: A Systematic Literature Review

PURPOSE

The transition from adolescence to young adulthood is categorized by substantial changes in one's activity behaviors, which may have important implications for health. To date, no reviews have systematically investigated the evidence of tracking for both physical activity (PA) and sedentary behavior (SB) specifically during this transition period.

METHODS

Web of Science, PubMed, SPORTDiscus, PsycINFO, and CINAHL were searched for articles that examined the tracking of PA and SB in adolescents (aged 9-18 years) through young adulthood (aged 19-25 years) published between the years of 2000 and 2018. Studies were also compared on methodologic quality.

RESULTS

Sixteen studies met the inclusion criteria. The tracking correlations for both the frequency and duration of PA were low-to-moderate. Gender differences were observed in the tracking of PA frequency and duration. Studies that examined the tracking of SB were less frequent, making it difficult to determine how SB tracks from adolescence to young adulthood.

CONCLUSIONS

Generally, PA was shown to track moderately from adolescence through young adulthood. The lack of studies reporting on the tracking of SB indicates that this area should be a target for future research. Future tracking studies should consider appropriate gold-standard objective methodologies and statistical analysis techniques that report fixed outcomes.

Vascular health determinants in children

BACKGROUND

The epidemic of cardiovascular disease (CVD) in the twentieth century generated numerous population-based surveys. These results clearly demonstrate that many factors are causally related to the development of atherosclerosis. Eighty percent of the CVD can be explained by smoking, high blood pressure, deterioration of lipid and glucose metabolism and physical inactivity. CVD is a disease that becomes clinically apparent in adults. However, it is undisputed that this disease develops over a long period of time due to progressive, subclinical changes in the cardiovascular system. The early manifestation of arteriosclerosis correlates with traditional risk factors.

METHODS

This brief report focusses on determinates of vascular health. It describes non-invasive diagnostic methods such as oscillometric analysis of pulse wave velocity (PWV), ultrasound measurement of carotid structure and function as well as brachial endothelial function. Special attention is paid to possible correlations with physical activity, fitness and exercise.

RESULTS

Non-invasive diagnostic methods to determine vascular health are applicable in children. The influence of physical activity and the relationship between aerobic fitness and arterial compliance (AC) remain controversial. First results in young athletes demonstrated an increased carotid intima-media thickness (cIMT), by revealing arterial elasticity. The mechanism and determinants explaining these adaptations have not been fully explained in young healthy athletes.

CONCLUSIONS

Traditional cardiovascular risk factors act early in life and have a major impact on the development of atherosclerosis. The results underline that the prevention strategies and risk factor control should begin in childhood. The emphasis in the present report lied on the determination of vascular health, analyzing arterial structure and function, using non-invasive diagnostic methods. Vascular health and its relation to obesity, hypertension, physical activity and exercise were emphasized. The harmonization of knowledge and methods would greatly increase the comparability of existing results. To further elucidate the clinical relevance, the mechanisms linking arterial structure and compliance function with physical activity, fitness and exercise need further clinical investigation to enhance early preventive intervention strategies.

The prospective association between objectively measured sedentary time, moderate-to-vigorous physical activity and cardiometabolic risk factors in youth: a systematic review and meta-analysis

Sedentary time and moderate-to-vigorous physical activity (MVPA) may be uniquely related to cardiometabolic health. Excessive sedentary time is suggested as an independent cardiometabolic risk factor, while MVPA is favourably associated with cardiometabolic health. This systematic review and meta-analysis summarizes the evidence on a prospective relationship between objectively measured sedentary time, MVPA and cardiometabolic health indicators in youth. PubMed, Embase, CINAHL, PhyscINFO and SPORTDiscus were systematically searched from January 2000 until April 2018. Studies were included if sedentary time and physical activity were measured objectively and examined associations with body mass index, waist circumference, triglycerides, high-density lipoprotein, insulin, blood pressure or the clustering of these cardiometabolic risk factors. We identified 30 studies, of which 21 were of high quality. No evidence was found for an association between sedentary time and cardiometabolic outcomes. The association between MVPA and individual cardiometabolic risk factors was inconsistent. The meta-analysis for prospective studies found a small but significant effect size between MVPA at baseline and clustered cardiometabolic risk at follow-up (ES -0.014 [95% CI, -0.024 to -0.004]). We conclude that there is no prospective association between sedentary time and cardiometabolic health, while MVPA is beneficially associated with cardiometabolic health in youth.

Behavioral Risk Factors of Noncommunicable Diseases Among Medical and Nonmedical Undergraduate Students of Dhaka City, Bangladesh

Background and aims: Behavioral risk factors of noncommunicable diseases (NCDs) are established during early age and continued into adulthood. In Bangladesh, the scenario of NCD risk factors among students was inadequately studied. The aim of this study was to assess and compare the prevalence of behavioral risk factors of NCDs between undergraduate medical and nonmedical students. Methods: This cross-sectional study was conducted among 280 undergraduate students (equal number of students from medical and nonmedical backgrounds). Respondents were selected purposively from 5 purposively-selected institutions. Modified WHO STEPS instrument was used for data collection. Respondents were asked about their behavioral risk factors (tobacco use, insufficient fruit and vegetable intake, inadequate physical activity, and alcohol consumption) by face-to-face interviews. Results: Men students were more in both groups. The mean age of the medical and nonmedical students was 22.1±2.0 and 21.8±1.9 years, respectively. Tobacco use was more among nonmedical students than that among the counterpart (22.1% vs. 15.7%). Medical students were more used to take insufficient fruits and vegetables compared to nonmedical students (97.9% vs. 93.6%). Equal proportions (71.4%) of students in both groups were used to perform inadequate physical activity. Alcohol consumption was observed more among nonmedical students (12.9% vs. 8.6%). Conclusion: Behavioral risk factors of NCDs were remarkable among students of both groups, mainly among nonmedical students.

Student health and well-being in secondary schools: the role of school support staff alongside teaching staff

A growing evidence base indicates that health and educational attainment are synergistic goals. Students' relationships with teachers and other students in the school environment are consistently predictive of a broad range of health and well-being outcomes. Despite the potential importance of relationships between students and a broad range of actors within a school, research tends to reduce 'school staff' to 'teachers'. Previous research has highlighted incongruence between the power imbalance within a teacher-student relationship and the dynamics required to address health and well-being-related issues. To date, there has been no investigation into how the nature of the relationships between students and support staff may differ from those with teaching staff. This article aims to conceptualise the role of support versus teaching staff in promoting health and well-being to understand how school system functioning may affect relationships between school staff and students. Semi-structured interviews were conducted to obtain the perceptions of staff, students and parents within four exploratory case study schools of differing socio-economic status, geographical location and size. In line with the Theory of Health Promoting Schools and Human Functioning, findings demonstrated that the prominence of well-being relies on provision of staffing structures which include a team of support staff to work alongside teaching staff to provide the time and space to deal with issues immediately and build trust and rapport in a one-to-one setting. Further mixed-methods research is required to investigate how staffing structures can facilitate the development of mutually trusting relationships between staff and students.

Investigating the Physical Activity Behaviors of Canadian Adults Over Time: Multilevel Sex and Age Group Trajectories Across 2 Decades

BACKGROUND

This study explores changes in the leisure-time physical activities of Canadian adults over time.

METHODS

Using representative panel data from the National Population Health Survey, multilevel analyses of 13,933 respondents aged 18 and older were performed to assess both overall and individual leisure-time physical activity trajectories from 1994 to 2011 and the extent to which these trajectories differ by sex and age groups.

RESULTS

With the exception of those aged 65 and older, there is evidence that as Canadians age their overall levels of physical activity increase over time. However, increases in overall physical activity levels are mainly due to increases in walking, gardening, and home exercise. Increases in these 3 activities in particular compensate for declines in engagement levels over time in most other activities.

CONCLUSIONS

As the demographic shift to an older Canadian population continues, evidence of increasing overall physical activity levels across most age groups in Canada gives reason for optimism.

Change in physical activity from adolescence to early adulthood: a systematic review and meta-analysis of longitudinal cohort studies

Objective

To systematically review and meta-analyse how physical activity (PA) changes from adolescence to early adulthood (13–30 years).

Data sources

Seven electronic databases were searched: Medline, Embase, PsycInfo, SCOPUS, ASSIA, SPORTdiscus and Web of Science.

Eligibility criteria for selecting studies

English-language, longitudinal studies (from 01/1980 to 01/2017) assessing PA ≥twice, with the mean age of ≥1 measurement in adolescence (13–19 years) and ≥1 in young adulthood (16–30 years) were included. Where possible, data were converted to moderate-to-vigorous physical activity (MVPA) min/day, and meta-analyses were conducted between weighted mean differences (WMDs) in adolescence and adulthood. Heterogeneity was explored using meta-regression.

Results

Of 67 included studies, 49 were eligible for meta-analysis. PA was lower during adulthood than adolescence WMD (95% CI) −5.2 (−7.3 to –3.1) min/day MVPA over mean (SD) 3.4 (2.6) years; heterogeneity was high (I² >99.0%), and no predictors explained this variation (all p>0.05). When we restricted analysis to studies with data for males (n=29) and females (n=30) separately, there were slightly larger declines in WMD (−6.5 (−10.6 to –2.3) and −5.5 (−8.4 to −2.6) min/day MVPA) (both I² >99.0%). For studies with accelerometer data (n=9), the decline was −7.4 (−11.6 to –3.1) and longer follow-up indicated more of a decline in WMD (95% CI) (−1.9 (−3.6 to –0.2) min/day MVPA), explaining 27.0% of between-study variation. Of 18 studies not eligible for meta-analysis, nine statistically tested change over time: seven showed a decline and two showed no change.

Conclusion

PA declines modestly between adolescence and young adulthood. More objective longitudinal PA data (eg, accelerometry) over this transition would be valuable, as would investigating how PA change is associated with contemporaneous social transitions to better inform PA promotion interventions.

Registration

PROSPERO ref:CRD42015030114.

Longitudinal changes in physical activity, sedentary behavior and body mass index in adolescence: Migrations towards different weight cluster

This study examined longitudinal changes in physical activity, sedentary behavior and body mass index in adolescents, specifically their migrations towards a different weight cluster. A cohort of 755 adolescents participated in a three-year study. A clustering Self-Organized Maps Analysis was performed to visualize changes in subjects' characteristics between the first and second assessment, and how adolescents were grouped. Also a classification tree was used to identify the behavioral characteristics of the groups that changed their weight cluster. Results indicated that boys were more active and less sedentary than girls. Boys were especially keen to technological-based activities while girls preferred social-based activities. A moderate competing effect between sedentary behaviors and physical activities was observed, especially in girls. Overweight and obesity were negatively associated with physical activity, although a small group of overweight/obese adolescents showed a positive relationship with vigorous physical activity. Cluster migrations indicated that 22.66% of adolescents changed their weight cluster to a lower category and none of them moved in the opposite direction. The behavioral characteristics of these adolescents did not support the hypothesis that the change to a lower weight cluster was a consequence of an increase in time devoted to physical activity or a decrease in time spent on sedentary behavior. Physical activity and sedentary behavior does not exert a substantial effect on overweight and obesity. Therefore, there are other ways of changing to a lower-weight status in adolescents apart from those in which physical activity and sedentary behavior are involved.

Self-reported Factors Associated with Engagement in Moderate to Vigorous Physical Activity among Elderly People: A Population-based Study

Background:

Physical activity (PA) typically decreases with aging, especially of moderate to vigorous level, and this change affects health outcomes of older adults. Age-related decline is not evenly distributed across elderly population and is attributed to psychosocial, physical, and environmental determinants.

Methods:

We selected a sample of 1000 elderly people from urban parts of Shiraz in Southern Iran with a two-stage random sampling procedure. Self-reported PA data and correlates of moderate to vigorous activity were collected by interview with the respondents from selected households. Bivariate associations were examined using Chi-square test. Log-binomial regression was used to weigh variables associated with more than light PA.

Results:

Some demographic variables (older age, female sex, lower education level, retirement, and single or widowed status), health problems (lower extremity pain and hypertension), and psychosocial factors (lack of motivation, fear of injury, unsafe roads, and daily life problems) were potential correlates of inadequate PA with bivariate analysis. In log-binomial regression model, lack of motivation (adjusted prevalence ratio [APR] = 2.11, 95% confidence interval [CI]: 1.25–3.56), daily life problems (APR = 1.82, 95% CI: 1.26–2.62), lower educational level (APR = 1.64, 95% CI: 1.08–2.49), unsafe roads (APR = 1.59, 95% CI: 1.02–2.49), and knee pain (APR = 1.68, 95% CI: 1.09–2.58) were associated with lower engagement in moderate to vigorous PA among Iranian older adults.

Conclusions:

Psychosocial attributes considerably influence PA behaviors in older adults. Lower extremity joint pain is a key medical concern. Interventions to promote PA among older adults should be multilevel and particularly targeting personal psychosocial factors.

Change in diet in the period from adolescence to early adulthood: a systematic scoping review of longitudinal studies

BACKGROUND

Late adolescence to early adulthood is a period of lifestyle change and personal development which may influence dietary behaviour. Understanding dietary trajectories across this age range may help in targeting interventions appropriately. This scoping review aimed to assess how longitudinal change in diet is conceptualised and measured between the ages of 13 to 30.

METHODS

We searched Medline, SCOPUS, Embase, PsycInfo (EBSCO), ASSIA, Sportdiscus, and Web of Science Core Collection (January 2016) using search terms combining diet outcomes, longitudinal methods and indicators of adolescent or young adult age. Titles and abstracts were screened and data extracted following published guidelines for scoping reviews. Data were analysed to summarize key data on each study and map availability of longitudinal data on macronutrients and food groups by age of study participants.

RESULTS

We identified 98 papers reporting on 40 studies. Longitudinal dietary data were available on intake of energy, key macronutrients and several food groups, but this data had significant gaps and limitations. Most studies provided only two or three waves of data within the age range of interest and few studies reported data collected beyond the early twenties. A range of dietary assessment methods were used, with greater use of less comprehensive dietary assessment methods among studies reporting food group intakes.

CONCLUSION

Despite limited availability of longitudinal data to aid understanding of dietary trajectories across this age range, this scoping review identified areas with scope for further evidence synthesis. We identified a paucity of longitudinal data continuing into the mid and late twenties, variability in (quality of) dietary assessment methods, and a large variety of macronutrients and food groups studied. Advances in dietary assessment methodologies as well as increased use of social media may facilitate new data collection to further understanding of changing diet across this life stage.

Impact of school policies on non-communicable disease risk factors - a systematic review

BACKGROUND

Globally, non-communicable diseases (NCDs) are identified as one of the leading causes of mortality. NCDs have several modifiable risk factors including unhealthy diet, physical inactivity, tobacco use and alcohol abuse. Schools provide ideal settings for health promotion, but the effectiveness of school policies in the reduction of risk factors for NCD is not clear. This study reviewed the literature on the impact of school policies on major NCD risk factors.

METHODS

A systematic review was conducted to identify, collate and synthesize evidence on the effectiveness of school policies on reduction of NCD risk factors. A search strategy was developed to identify the relevant studies on effectiveness of NCD policies in schools for children between the age of 6 to 18 years in Ovid Medline, EMBASE, and Web of Science. Data extraction was conducted using pre-piloted forms. Studies included in the review were assessed for methodological quality using the Effective Public Health Practice Project (EPHPP) quality assessment tool. A narrative synthesis according to the types of outcomes was conducted to present the evidence on the effectiveness of school policies.

RESULTS

Overall, 27 out of 2633 identified studies were included in the review. School policies were comparatively more effective in reducing unhealthy diet, tobacco use, physical inactivity and inflammatory biomarkers as opposed to anthropometric measures, overweight/obesity, and alcohol use. In total, for 103 outcomes independently evaluated within these studies, 48 outcomes (46%) had significant desirable changes when exposed to the school policies. Based on the quality assessment, 18 studies were categorized as weak, six as moderate and three as having strong methodological quality.

CONCLUSION

Mixed findings were observed concerning effectiveness of school policies in reducing NCD risk factors. The findings demonstrate that schools can be a good setting for initiating positive changes in reducing NCD risk factors, but more research is required with long-term follow up to study the sustainability of such changes.

Stability of physical activity, fitness components and diet quality indices

BACKGROUND

Regular physical activity (PA), a high level of fitness and a high diet quality are positively associated with health. However, information about stability of fitness components and diet quality indices is limited. This study aimed to evaluate stability of those parameters.

METHODS

This study includes 652 adults (men=57.56 (10.28) years; women=55.90 (8.34) years at follow-up) who participated in 2002-2004 and returned for follow-up at the Policy Research Centre Leuven in 2012-2014. Minutes sport per day and Physical activity level (PAL) were calculated from the Flemish Physical Activity Computerized Questionnaire. Cardiorespiratory fitness (CRF), morphological fitness (MORF; body mass index and waist circumference) and metabolic fitness (METF) (blood cholesterol and triglycerides) were used as fitness components. Diet quality indices (Healthy Eating Index-2010 (HEI), Diet Quality Index (DQI), Mediterranean Diet Score (MDS)) were calculated from a diet record. Tracking coefficients were calculated using Pearson/Spearman correlation coefficients (rPearson) and intra-class correlation coefficients (rICC).

RESULTS

In both men (rPearson&ICC=0.51) and women (rPearson=0.62 and rICC=0.60) PAL showed good stability, while minutes sport remained stable in women (rPearson&ICC=0.57) but less in men (rPearson&ICC=0.45). Most fitness components remained stable (r⩾0.50) except some METF components in women. In general the diet quality indices and their components were unstable (r<0.50).

CONCLUSIONS

PAL and the majority of the fitness components remained stable, while diet quality was unstable over 10 years. For unstable parameters such as diet quality measurements are needed at both time points in prospective research.

Do Interventions to Increase Walking Work? A Systematic Review of Interventions in Children and Adolescents

Background

Physical activity (PA) levels decline as children move into adolescence, with this decline more notable in girls. As a consequence, many young people are failing to meet current PA guidelines. Walking has been a cornerstone of PA promotion in adults and may provide an effective means of increasing PA levels among younger people.

Objective

Our objective was to conduct a systematic review of interventions aimed at promoting increased levels of walking among children and adolescents.

Methods

Eight electronic databases—CINAHL, Cochrane Library CENTRAL database, EMBASE, Medline OVID, PsycINFO, Scopus, SPORTDiscus and Web of Knowledge—were searched from their inception up to January 2015 using predefined text terms: walking terms AND intervention terms AND population terms AND (physical activity OR exercise). Reference lists of published systematic reviews and original articles included in the review were also screened. Included studies were randomised and non-randomised controlled trials reporting a specific measure of walking levels (self-reported or objective) to assess the effectiveness of interventions aimed at promoting walking in children and adolescents (aged 5–18 years). Only full articles published in English in peer-reviewed journals were included. Risk of bias and behaviour change techniques of included studies were assessed.

Results

Twelve studies were included in this review. The majority of studies assessed interventions delivered within an educational setting, with one study conducted within the family setting. Nine of the included studies reported significant increases in walking in intervention groups versus controls. Commonly employed behaviour change techniques within successful interventions included goals and planning, feedback and monitoring, social support and repetition and substitution.

Conclusions

Walking interventions, particularly those conducted in the school environment, have the potential to increase PA in children and adolescents. Conclusions on which interventions most effectively increased walking behaviours in this population were hindered by the limited number of identified interventions and the short duration of interventions evaluated. The short-term effectiveness of the majority of included studies on levels of walking in this population is promising and further research, particularly within non-educational settings and targeted at sub-groups (e.g. adolescent girls and overweight/obese children and adolescents), is warranted.

Electronic supplementary material

The online version of this article (doi:10.1007/s40279-015-0432-6) contains supplementary material, which is available to authorized users.

Sustainability of the results of a non communicable diseases prevention program among youth in the region of Sousse, Tunisia

INTRODUCTION

Implementation of a healthy lifestyle at an early age is described as a successful intervention to prevent non communicable diseases. However, successful programs are not necessarily sustainable. The purpose of this study was to evaluate a 1-year sustainability of a 3-year comprehensive intervention conducted to promote a healthy lifestyle among schoolchildren.

MATERIALS AND METHODS

A cohort study of 204 schoolchildren enrolled in middle schools was conducted after a quasi-experimental study in the region of Sousse, Tunisia. The survey lasted 1 year. An exposed group (n=105) was selected from the intervention group and the not-exposed group (n=99) was selected from the control group. The exposition was the intervention. The same questionnaire used at pre-intervention and post-intervention was self-administered to collect data about tobacco use, physical activity and eating habits. The biometric measurements were taken by trained medical doctors at schools.

RESULTS

After 1 year of follow-up, none of participants became smokers in the exposed group. However, in the not-exposed group five (5.1%) participants became smokers. The proportion of schoolchildren who experimented with tobacco for the first time increased insignificantly by 2.9% (p=0.77) in the exposed group versus a significant increase by 11.1% (p=0.001) in the not-exposed group. Concerning the recommended physical activity practice, fast food and fried food consumption and overweight, there were no significant changes in the two groups.

CONCLUSION

A 3-year non communicable diseases prevention program has limited sustainable effects among schoolchildren in the short-term. Its repetition or a continued program through multisectoral actions is required.

Developmental differences between boys and girls result in sex-specific physical fitness changes from fourth to fifth grade

To better understand how developmental differences impact performance on a broad selection of common physical fitness measures, we examined changes in boys and girls from fourth to fifth grade. Subjects included 273 boys (age, 9.5 ± 0.6 years; height, 139.86 ± 7.52 cm; mass, 38.00 ± 9.55 kg) and 295 girls (age, 9.6 ± 0.5 years; height, 139.30 ± 7.19 cm; weight, 37.44 ± 9.35 kg). We compared anthropometrics, cardiorespiratory and local muscular endurance, flexibility, power, and strength. A mixed-method analysis of variance was used to compare boys and girls at the 2 time points. Pearson correlation coefficients were used to examine relationships between anthropometric and fitness measurements. Significance was set at p ≤ 0.05. Weight increased significantly (>10%) in both sexes, and girls became significantly taller than boys after growing 4.9% by fifth grade (vs. 3.5%). Both groups improved cardiorespiratory endurance and power, although boys performed better than girls at both time points. Boys were stronger in fourth grade, but girls improved more, leading to similar fifth-grade values. Girls were more flexible in fourth grade, but their significant decreases (∼32.4%) coupled with large improvements in boys (∼105%) resulted in similar fifth-grade scores. Body mass index (BMI) was positively correlated with run time regardless of grade or sex. Power was negatively correlated with BMI and run time in fourth grade. In conclusion, sex-specific differences in physical fitness are apparent before pubescence. Furthermore, this selection of measures reveals sexually dimorphic changes, which likely reflect the onset of puberty in girls. Coaches and teachers should account these developmental differences and their effects on anthropometrics and fitness in boys and girls.

Association between participation in outdoor play and sport at 10 years old with physical activity in adulthood

OBJECTIVE

This study aimed to investigate whether active outdoor play and/or sports at age 10 is associated with sport/physical activity at 32 year follow-up using a birth cohort study.

METHODS

Data were from the 1970 British Cohort Study, a longitudinal observational study. The present paper included data from the age 10 years and age 42 years surveys. At age 10 the participant's mother provided information regarding how often their child played sports, and played outside on streets, parks or playgrounds. At age 42 participants reported frequency of participation in physical activities and sports. Associations between participation in sport/active outdoor play at age 10 years and adult sport/physical activity were investigated using adjusted (gender, fathers socio-occupational class, child's BMI, father's BMI, self-rated health at age 42, assessment of own weight at age 42, participant's education) Cox regression.

RESULTS

Final adjusted Cox regression models showed that participants (n=6458) who often participated in sports at age 10 were significantly more likely to participate in sport/physical activity at age 42 (RR 1.10; 95% CI 1.01 to 1.19). Active outdoor play at age 10 was not associated with participation in sport/physical activity at age 42 (RR 0.99; 95% CI 0.91 to 1.07).

CONCLUSION

Childhood activity interventions might best achieve lasting change by promoting engagement in sport rather than active outdoor play.

Effectiveness of a school based intervention for prevention of non-communicable diseases in middle school children of rural North India: a randomized controlled trial

OBJECTIVE

To assess the effectiveness of a multi-component school based intervention in improving knowledge and behavioral practices regarding diet, physical activity and tobacco use in middle schoolchildren of rural-Ballabgarh, North-India.

METHODS

A total of 40 middle schools were grouped into two, based on geographic proximity and randomly assigned to the intervention or control group in a cluster randomized controlled trial. The target population consisted of 2,348 children studying in 6th and 7th grades in these schools. The intervention consisted of a school component (policies), a classroom component (activities) and a family component [Information Education & Communication (IEC) material]. The main outcome measures were knowledge and behavioral changes in physical activity, diet and tobacco which were self- reported.

RESULTS

Post-intervention, a significant number of intervention schools adopted the tobacco policy (16/19), physical activity policy (6/19) and healthy food policy (14/19) as compared to the control schools (n = 21). Knowledge about physical activity, diet and tobacco improved significantly in the intervention group as compared to the control group. Proportion of students attending Physical Training (PT) classes for five or more days in a week in the intervention group compared to the control group increased significantly (17.8%; p < 0.01). Proportion of students consuming fruits increased in the intervention group compared to the control group (10%; p < 0.01). Pre-post decrease in the prevalence of current smoking was significantly more in the intervention group as compared to the control group (7.7%; p < 0.01).

CONCLUSIONS

Healthy settings approach for schools is feasible and effective in improving knowledge and behavioral practices of non-communicable diseases (NCD) risk factors in adolescents in rural India.

Long-term predictors of blood pressure among adolescents during an 18-month school-based obesity prevention intervention

PURPOSE

To evaluate the effectiveness of the HEROES (Healthy, Energetic, Ready, Outstanding, Enthusiastic Schools) initiative, a multicomponent school-based obesity prevention intervention based on the Centers for Disease Control and Prevention's coordinated school health approach, on the improvement of blood pressure (BP) and to determine long-term predictors of systolic and diastolic BP changes among high school students who were exposed to the intervention.

METHODS

Biometric and behavioral data from high school students were analyzed at baseline, 6, 12, and 18 months (N = 847, three schools). The attrition rate at 18 months was 26.1%. Sequential generalized estimating equation models were fit to the data using SAS 9.3, taking into account clustering effects within the same school and correlations within repeated measures.

RESULTS

A significant downward trend was observed in systolic BP (p = .0006) and diastolic BP (p < .0001) among the students who were exposed to the HEROES initiative. The prevalence of hypertension decreased from 17.1% at baseline to 12.8% at 6 months (p < .0001), 12.0% at 12 months (p < .0001), and 15.0% (p = .0024) at 18 months. Baseline body mass index, increases in body mass index percentiles, and increases of television-viewing hours were associated with BP increases. Increases in frequencies of eating french fries or chips, skipping breakfast, and consuming supersize meals when eating fast food were predictive of systolic BP changes, not of diastolic BP changes.

CONCLUSIONS

An 18-month multicomponent school-based obesity intervention program may be effectively used to decrease rates of high BP among adolescents.

Dietary patterns and cardiovascular risk factors in adolescents and young adults: the Northern Ireland Young Hearts Project

Dietary pattern (DP) analysis allows examination of the combined effects of nutrients and foods on the markers of CVD. Very few studies have examined these relationships during adolescence or young adulthood. Traditional CVD risk biomarkers were analysed in 12–15-year-olds (n487; Young Hearts (YH)1) and again in the same individuals at 20–25 years of age (n487; YH3). Based on 7 d diet histories, in the present study, DP analysis was performed usinga posterioriprincipal component analysis for the YH3 cohort and thea prioriMediterranean Diet Score (MDS) was calculated for both YH1 and YH3 cohorts. In thea posterioriDP analysis, YH3 participants adhering most closely to the ‘healthy’ DP were found to have lower pulse wave velocity (PWV) and homocysteine concentrations, the ‘sweet tooth’ DP were found to have increased LDL concentrations, systolic blood pressure, and diastolic blood pressure and decreased HDL concentrations, the ‘drinker/social’ DP were found to have lower LDL and homocysteine concentrations, but exhibited a trend towards a higher TAG concentration, and finally the ‘Western’ DP were found to have elevated homocysteine and HDL concentrations. In thea prioridietary score analysis, YH3 participants adhering most closely to the Mediterranean diet were found to exhibit a trend towards a lower PWV. MDS did not track between YH1 and YH3, and nor was there a longitudinal relationship between the change in the MDS and the change in CVD risk biomarkers. In conclusion, cross-sectional analysis revealed that some associations between DP and CVD risk biomarkers were already evident in the young adult population, namely the association between the healthy DP (and the MDS) and PWV; however, no longitudinal associations were observed between these relatively short time periods.

Pedometer determined physical activity and obesity prevalence of Greek children aged 4-6 years

BACKGROUND

Pre-school age is important for developing healthy attitudes towards physical activity (PA). However, research on pre-schoolers' pedometer-determined PA is limited.

AIM

To describe pre-schoolers' ambulatory activity; investigate step count differences in respect to Body Mass Index (BMI) categories and examine the prevalence of obesity.

SUBJECTS AND METHODS

Pre-school aged children (n = 250; 5.5 ± 0.4 years) from Komotini (Greece) wore Omron HJ-720IT-E2 pedometers for 10 consecutive days. Height and weight were measured and BMI was calculated.

RESULTS

Three-way repeated measures ANOVAs revealed that children performed more steps on weekdays than during weekends (p < 0.001) and during leisure time than school (p < 0.001). Significant differences appeared between normal and obese children's counts on weekdays (p < 0.001), weekend days (p < 0.05), during school (p < 0.001), after school (p < 0.005) and in weekly steps (p < 0.005). No gender differences were detected. Moreover, according to a sample t-test analysis, children's daily steps were significantly different from the 10,000 steps/day guideline, while obesity prevalence was 15.6%.

CONCLUSION

School-based ambulatory activity is lower than after school ambulatory activity, independent of BMI-category and gender, although obese children demonstrated fewer steps. Taking into account the high rate of both the obesity prevalence and children not meeting the 10,000 steps/day guideline, the need for preventive policies becomes obvious.

Tracking of weight status and body fatness in Italian children

The prevalence of weight disorders among school-aged children is an increasing phenomenon and it is of great importance to identify the characteristics of individuals at risk of gaining or retaining weight. This study aimed to examine the prevalence of weight disorders and their tracking over a 3-year period in a sample of Italian children. Body mass, body height and selected skinfold thicknesses were assessed in 355 children at the age of 7 and 10 years. Tracking of body mass index (BMI), inverted BMI (iBMI) and skinfold-based body fat were analyzed and the relationships between changes in BMI and body fat were examined. Children presenting with overweight or obesity at 7 years old showed a trend toward lower weight categories at 10 years old. Conversely, a trend to become overweight was observed among normal weight boys, and a trend to become underweight was observed among normal weight girls. BMI, iBMI and body fat showed good levels of tracking, with high correlations between measurements performed at 7 and 10 years of age. Furthermore, BMI and iBMI changes were correlated to body fatness changes. The present study shows the importance of carefully following children's development over time because weight disorders may appear even in previously normal weight children.

Correlates of weight gain in German children attending elementary school

OBJECTIVE

To examine the association of physical fitness, sports participation, physical activity and sedentary behavior as well as dietary patterns and family background with weight gain in non-overweight elementary school children, independent of absolute body weight.

METHODS

Height, weight, and physical fitness were assessed in 1249 (51% male) children in south-west Germany during the fall of 2010 and 2011 (age at baseline: 7.0±0.6years). Based on changes in body mass index percentiles children were classified into a weight loss, constant weight, or weight gain group. Health behavior and family background were assessed via parent questionnaire. Group differences were examined via analysis of variance and multinomial logistic regression.

RESULTS

Weight gain was associated with low physical activity, lack of active transport, and lack of regular breakfast at follow-up. Children in the weight gain category also displayed lower fitness during baseline and follow-up, but differences were more pronounced during follow-up. TV time, migration background or parental education was not associated with weight gain.

CONCLUSION

Ensuring adequate physical activity and high fitness is an important aspect in the prevention of excessive weight gain during childhood. In addition to sports participation active transport should be emphasized in future weight management programs in children.

A systematic review of intervention effects on potential mediators of children's physical activity

Background

Many interventions aiming to increase children’s physical activity have been developed and implemented in a variety of settings, and these interventions have previously been reviewed; however the focus of these reviews tends to be on the intervention effects on physical activity outcomes without consideration of the reasons and pathways leading to intervention success or otherwise.

To systematically review the efficacy of physical activity interventions targeting 5-12 year old children on potential mediators and, where possible, to calculate the size of the intervention effect on the potential mediator.

Methods

A systematic search identified intervention studies that reported outcomes on potential mediators of physical activity among 5-12 year old children. Original research articles published between 1985 and April 2012 were reviewed.

Results

Eighteen potential mediators were identified from 31 studies. Positive effects on cognitive/psychological potential mediators were reported in 15 out of 31 studies. Positive effects on social environmental potential mediators were reported in three out of seven studies, and no effects on the physical environment were reported. Although no studies were identified that performed a mediating analysis, 33 positive intervention effects were found on targeted potential mediators (with effect sizes ranging from small to large) and 73% of the time a positive effect on the physical activity outcome was reported.

Conclusions

Many studies have reported null intervention effects on potential mediators of children’s physical activity; however, it is important that intervention studies statistically examine the mediating effects of interventions so the most effective strategies can be implemented in future programs.