The Preschool Activity, Technology, Health, Adiposity, Behaviour and Cognition (PATH-ABC) cohort study: rationale and design

Compliance with the 24-hour movement behavior guidelines and the impact of sleep methods among toddler, preschool, and school-aged children enrolled in the Guelph Family Health Study

Canadian movement guidelines focused on physical activity (PA), sleep, and screen time support childhood development and reduce the risk of chronic disease. Accelerometers are often used to capture these behaviors; however, they are limited in their ability to record daytime sleep due to potential misclassification.

OBJECTIVES

The objectives of this study were to 1) determine the prevalence of children enrolled in the Guelph Family Health Study who met the guidelines and to 2) compare the impact of different sleep measurement methods.

DESIGN/METHODS

Toddlers (1.5-<3 years; n = 128; valid data for all movement behaviors, n = 70), preschoolers (3-<5 years; n = 143; valid data for all movement behaviors, n = 104), and school-aged (5-<6 years; n = 49; valid data for all movement behaviors, n = 31) children were included. Screen time and sleep habits were obtained through parental report and published normative data. PA and sleep were recorded using accelerometers (wGT3X-BT ActiGraph; right hip).

RESULTS

It was found that 66 % of toddler, 44 % of preschool, and 63 % of school-aged children met the screen time guidelines. Further, 63 % of toddler, 98 % of preschooler, and 80 % of school-aged children met PA guidelines. Sleep guideline compliance ranged from 3 % to 83 % in toddler, 27 % to 92 % in preschooler, and 32 % to 90 % in school-aged children. These proportions were found to be significantly different (Cochran's Q and McNemar's tests).

CONCLUSIONS

Nearly all children met PA guidelines. In contrast, less than half to two-thirds met screen time guidelines. Compliance with sleep guidelines varied substantially with measurement method, highlighting the need for standardization.

Fundamental Movement Skills and Physical Activity of 3-4-Year-Old Children within Early Childhood Centers in New Zealand

We sought to describe and explore relationships between fundamental movement skills (FMS) and level of physical activity (PA; light-, medium-, vigorous, and kCal/hour) in preschool children, aged 3–4-years-old, across four early childhood education (ECE) settings. Children’s FMS were assessed using the Test for Gross Motor Development-2 (TGMD-2; n = 81) and PA via accelerometers (S = 53). Eighty-four children participated, with 50 in both assessments. The TGMD-2 showed as the children got older, their locomotor skills (p < 0.001, r = 0.512) and object control motor skills (p < 0.001, r = 0.383) improved. Accelerometry showed children were primarily inactive at ECE (78.3% of the time). There were significant correlations between kCal/hour and light (p < 0.001, r = −0.688), moderate (p < 0.001, r = 0.599) and vigorous (p < 0.001, r_s = 0.707) activity, and between gross motor quotient and locomotor (p < 0.001, r = 0.798) and object control (p < 0.001, r = 0.367) skills. No correlation was observed between gross motor quotient and kCal/hour. To conclude, children in this cohort were primarily inactive during ECE center hours. Moreover, gross motor quotient was significantly correlated to locomotor and object control skills.

Longitudinal differences in levels and bouts of sedentary time by different day types among Australian toddlers and pre-schoolers

The aim of the present study was to characterize sedentary time (ST) and sedentary bouts among young children, across a typical week and by day type (childcare days, non-childcare days and weekends), over a 12-month period.ST % (ST/accelerometer wear time*100) and number of sedentary bouts/hours were assessed using accelerometers at two time-points 12-months apart in 153 toddlers and 74 pre-schoolers. Differences between baseline and follow-up according to the whole week and the different day types were calculated using linear mixed models with adjustment for age, sex, socio-economic status and zBMI.During the weekend, toddlers had more 20-30 min/h sedentary bouts at follow-up than at baseline (MD: 0.03). In pre-schoolers, ST % (MD:-8.4), the number of 1-4 min/h (MD:-1.45), 5-9 min/h (MD: -0.46) and 10-19 min/h sedentary bouts (MD:-0.11) were lower at baseline, compared to follow-up, on non-childcare days; as were the number of 5-9 min/h sedentary bouts on weekends (MD:0.40). P < 0.05 for all.This study found that longer sedentary bouts (20-30 min/h) tended to decrease among toddlers and pre-schoolers, whereas ST and shorter sedentary bouts increased over 12-months, particularly among pre-schoolers on non-childcare weekdays. Non-childcare days, and home environment may be targeted for intervention to reduce ST and sedentary bouts among pre-schoolers.

Global effect of COVID-19 pandemic on physical activity, sedentary behaviour and sleep among 3- to 5-year-old children: a longitudinal study of 14 countries

BACKGROUND

The restrictions associated with the 2020 COVID-19 pandemic has resulted in changes to young children's daily routines and habits. The impact on their participation in movement behaviours (physical activity, sedentary screen time and sleep) is unknown. This international longitudinal study compared young children's movement behaviours before and during the COVID-19 pandemic.

METHODS

Parents of children aged 3-5 years, from 14 countries (8 low- and middle-income countries, LMICs) completed surveys to assess changes in movement behaviours and how these changes were associated with the COVID-19 pandemic. Surveys were completed in the 12 months up to March 2020 and again between May and June 2020 (at the height of restrictions). Physical activity (PA), sedentary screen time (SST) and sleep were assessed via parent survey. At Time 2, COVID-19 factors including level of restriction, environmental conditions, and parental stress were measured. Compliance with the World Health Organizations (WHO) Global guidelines for PA (180 min/day [≥60 min moderate- vigorous PA]), SST (≤1 h/day) and sleep (10-13 h/day) for children under 5 years of age, was determined.

RESULTS

Nine hundred- forty-eight parents completed the survey at both time points. Children from LMICs were more likely to meet the PA (Adjusted Odds Ratio [AdjOR] = 2.0, 95%Confidence Interval [CI] 1.0,3.8) and SST (AdjOR = 2.2, 95%CI 1.2,3.9) guidelines than their high-income country (HIC) counterparts. Children who could go outside during COVID-19 were more likely to meet all WHO Global guidelines (AdjOR = 3.3, 95%CI 1.1,9.8) than those who were not. Children of parents with higher compared to lower stress were less likely to meet all three guidelines (AdjOR = 0.5, 95%CI 0.3,0.9).

CONCLUSION

PA and SST levels of children from LMICs have been less impacted by COVID-19 than in HICs. Ensuring children can access an outdoor space, and supporting parents' mental health are important prerequisites for enabling pre-schoolers to practice healthy movement behaviours and meet the Global guidelines.

Objectively Measured Sedentary Levels and Bouts by Day Type in Australian Young Children

BACKGROUND

This study aimed to understand whether a higher number of sedentary bouts (SED bouts) and higher levels of sedentary time (SED time) occur according to different day types (childcare days, nonchildcare weekdays, and weekends) in Australian toddlers (1-2.99 y) and preschoolers (3-5.99 y).

METHODS

The SED time and bouts were assessed using ActiGraph GT3X+ accelerometers. The sample was composed of 264 toddlers and 343 preschoolers. The SED bouts and time differences were calculated using linear mixed models.

RESULTS

The toddlers' percentage of SED time was higher on nonchildcare days compared with childcare days (mean difference [MD] = 2.3; 95% confidence interval, 0.7 to 3.9). The toddlers had a higher number of 1- to 4-minute SED bouts on nonchildcare days compared with childcare days. The preschoolers presented higher percentages of SED time during nonchildcare days (MD = 3.1; 95% confidence interval, 1.6 to 4.5) and weekends (MD = 1.9; 95% confidence interval, 0.4 to 3.4) compared with childcare days. The preschoolers presented a higher number of SED bouts (1-4, 5-9, 10-19, and 20-30 min) during nonchildcare days and weekends compared with childcare days. No SED times or bout differences were found between nonchildcare days and weekends, neither SED bouts >30 minutes on toddlers nor on preschoolers.

CONCLUSION

The SED time and bouts seem to be lower during childcare periods, which means that interventions to reduce sedentary time should consider targeting nonchildcare days and weekends.

Cross-Sectional Associations of Application Use and Media Program Viewing with Cognitive and Psychosocial Development in Preschoolers

Executive functions and psychosocial health during childhood are positively associated with health and developmental outcomes into adulthood. Electronic media use has been reported to adversely affect health and development in children; however, what remains unclear is whether contemporary media behaviors, such as electronic application (app) use, exerts similar effects on health and development. We investigated the associations of electronic media use (program viewing and app use) with cognitive and psychosocial development in preschoolers. Parents of preschool children (n = 247, 4.2 ± 0.6 years) reported the time their child spent using electronic media. Direct assessment of the children’s executive functions (working memory, inhibition, and shifting) and educator-reported psychosocial difficulties were also collected. Associations were examined using linear regression adjustments for covariates and preschool clustering. Small, but significant, negative associations were observed for total electronic media use (b = −0.001; 95% CI: −0.003, −0.000; p = 0.026) and program viewing (b = −0.002; 95% CI: −0.003, −0.000; p = 0.033) with children’s visual–spatial working memory. However, high-dose app users demonstrated higher phonological working memory scores compared to non-users (MD = 0.31; 95% CI: 0.04, 0.58; p = 0.025). Similarly, compared to non-users, low-dose app users displayed statistically significantly fewer total difficulties (MD = −1.67; 95% CI: −3.31, −0.02; p = 0.047). No associations were evident for high-dose app users and the remaining outcomes. The results may suggest that attempts to reduce program viewing while promoting moderate levels of app use may exert positive influences on children’s executive functions and psychosocial development.

Longitudinal Associations of Electronic Application Use and Media Program Viewing with Cognitive and Psychosocial Development in Preschoolers

OBJECTIVE

To investigate associations of traditional (program viewing) and contemporary (electronic applications, or apps) electronic media use with preschoolers' executive function and psychosocial development 12 months later.

METHODS

We conducted an analysis of longitudinal data from 185 children (mean age, 4.2 ± 0.6 years). Parents reported children's weekly electronic media use: 1) viewing programs on television or other devices and 2) app and game play using tablets, computers, consoles, or other devices. Direct assessments of children's executive functions (working memory, inhibition, and shifting) and educator-reported psychosocial difficulties were also collected. Linear regression models assessed associations between baseline predictors and developmental outcomes 12 months later, adjusting for covariates, preschool clustering, and baseline levels of predictors.

RESULTS

Higher levels of program viewing at baseline were significantly associated with increases in externalizing behaviors (β = 0.008; 95% confidence interval [CI], 0.002-0.014; P = .010) and total difficulties (β = 0.013; 95% CI, 0.005-0.022; P = .005) at follow-up. High-dose app users (≥30 min/d) had a significantly lower inhibition score (mean difference = -0.04; 95% CI: -0.09 to -0.00; P = .044) at follow-up compared to low-dose app users (1 to 29 min/d).

CONCLUSIONS

Limiting electronic app use to <30 min/d and limiting media program viewing may be positively associated with preschool children's cognitive and psychosocial development.

Non-Invasive Blood Pressure Estimation from ECG Using Machine Learning Techniques

BACKGROUND

Blood pressure (BP) measurements have been used widely in clinical and private environments. Recently, the use of ECG monitors has proliferated; however, they are not enabled with BP estimation. We have developed a method for BP estimation using only electrocardiogram (ECG) signals.

METHODS

Raw ECG data are filtered and segmented, and, following this, a complexity analysis is performed for feature extraction. Then, a machine-learning method is applied, combining a stacking-based classification module and a regression module for building systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) predictive models. In addition, the method allows a probability distribution-based calibration to adapt the models to a particular user.

RESULTS

Using ECG recordings from 51 different subjects, 3129 30-s ECG segments are constructed, and seven features are extracted. Using a train-validation-test evaluation, the method achieves a mean absolute error (MAE) of 8.64 mmHg for SBP, 18.20 mmHg for DBP, and 13.52 mmHg for the MAP prediction. When models are calibrated, the MAE decreases to 7.72 mmHg for SBP, 9.45 mmHg for DBP and 8.13 mmHg for MAP.

CONCLUSION

The experimental results indicate that, when a probability distribution-based calibration is used, the proposed method can achieve results close to those of a certified medical device for BP estimation.

Adherence to 24-Hour Movement Guidelines for the Early Years and associations with social-cognitive development among Australian preschool children

BACKGROUND

The new Australian 24-Hour Movement Guidelines for the Early Years recommend that, for preschoolers, a healthy 24-h includes: i) ≥180 min of physical activity, including ≥60 min of energetic play, ii) ≤1 h of sedentary screen time, and iii) 10-13 h of good quality sleep. Using an Australian sample, this study reports the proportion of preschool children meeting these guidelines and investigates associations with social-cognitive development.

METHODS

Data from 248 preschool children (mean age = 4.2 ± 0.6 years, 57% boys) participating in the PATH-ABC study were analyzed. Children completed direct assessments of physical activity (accelerometry) and social cognition (the Test of Emotional Comprehension (TEC) and Theory of Mind (ToM)). Parents reported on children's screen time and sleep. Children were categorised as meeting/not meeting: i) individual guidelines, ii) combinations of two guidelines, or iii) all three guidelines. Associations were examined using linear regression adjusting for child age, sex, vocabulary, area level socio-economic status and childcare level clustering.

RESULTS

High proportions of children met the physical activity (93.1%) and sleep (88.7%) guidelines, whereas fewer met the screen time guideline (17.3%). Overall, 14.9% of children met all three guidelines. Children meeting the sleep guideline performed better on TEC than those who did not (mean difference [MD] = 1.41; 95% confidence interval (CI) = 0.36, 2.47). Children meeting the sleep and physical activity or sleep and screen time guidelines also performed better on TEC (MD = 1.36; 95% CI = 0.31, 2.41) and ToM (MD = 0.25; 95% CI = -0.002, 0.50; p = 0.05), respectively, than those who did not. Meeting all three guidelines was associated with better ToM performance (MD = 0.28; 95% CI = -0.002, 0.48, p = 0.05), while meeting a larger number of guidelines was associated with better TEC (3 or 2 vs. 1/none, p < 0.02) and ToM performance (3 vs. 2, p = 0.03).

CONCLUSIONS

Strategies to promote adherence to the 24-Hour Movement Behaviour Guidelines for the Early Years among preschool children are warranted. Supporting preschool children to meet all guidelines or more guidelines, particularly the sleep and screen time guidelines, may be beneficial for their social-cognitive development.