Objectively measured sedentary behaviour and moderate and vigorous physical activity in different school subjects: a cross-sectional study

Accelerometer-measured sedentary volume and bouts during the segmented school day among Chinese school students

Background

This study examined sedentary volume and bouts of Chinese primary and middle school students during different segments of a school day and determined whether gender and school level are associated with their sedentary volume and bouts.

Methods

A total of 472 students participated in this study. Accelerometers were used to measure the sedentary volume and sedentary bouts of different durations (i.e., 1-4 min, 5-9 min and ≥10 min) during all segments.

Results

The participants spent the majority of their time in sitting (61.7%) and sitting bouts of ≥10 min (37.3%). They spent higher percentages of time in sitting during regular classes (76.7%) and out-of-school time (54.5%), and lower during physical education (PE) classes (32.2%), lunch break (35.4%) and recess (38.0%). The highest proportions of time were in sedentary bouts of ≥10 min during regular classes (50.2%), out-of-school time (28.0%) and lunch break (18.8%), while the greatest percentages occurred in sitting bouts of 1-4 min during PE class (16.4%) and recess (18.6%). Girls and middle school students had higher percentages of sedentary volume than boys and primary school students during most segments. They spent greater proportions of time in sitting bouts of ≥10 min during regular classes, lunch break, and out-of-school time, and higher proportions in sedentary bouts of 1-4 min than boys and primary students during PE classes.

Conclusion

Regular class and out-of-school time were identified as key segments for reducing sedentary volume and breaking up prolonged sitting. Interventions on interrupting prolonged sitting during lunch break should also be explored. Girls and middle school students should receive more attention in future interventions.

Sedentary behavior patterns and the risk of non-communicable diseases and all-cause mortality: A systematic review and meta-analysis

BACKGROUND

The association between sedentary behavior and health-related outcomes has been well established, whereas it is inconclusive whether a sedentary behavior pattern is an additional risk factor for health-related outcomes independent of total sedentary time and physical activity.

OBJECTIVES

To determine sedentary behavior patterns and their association with risks of noncommunicable diseases and all-cause mortality and to assess whether this association is independent of total sedentary time and physical activity.

DESIGN

This was a systematic review and meta-analysis.

METHODS

Studies were obtained by searching the Web of Science Core Collection, PubMed/Medline, the Cochrane Library, Embase, CINAHL, and SPORTDiscus up to April 2023. All observational studies published in English or Chinese were included if they explored sedentary behavior patterns and their association with risks of abdominal obesity, metabolic syndrome, diabetes, cardiovascular disease, cancer, and all-cause mortality among individuals who had never experienced the outcome event before the baseline assessment. Data extraction using a standardized form and quality appraisal using two authoritative tools were then performed. All these steps were completed by two independent reviewers from December 2022 to May 2023. If data were sufficiently homogenous, meta-analyses were performed; otherwise, narrative syntheses were employed. Harvest plots were also used to visually represent the distribution of evidence.

RESULTS

Eighteen studies comprising 11 prospective cohort studies and seven cross-sectional studies were included. The findings suggested that prolonged sedentary time and usual sedentary bout duration were two metrics that reflected the nonlinear dose-response effect of prolonged sedentary behavior patterns. Only extremely high levels of prolonged sedentary behavior patterns significantly increased the risk of adverse health outcomes, independent of physical activity. Whether prolonged sitting was an additional risk factor for adverse health outcomes, independent of total sedentary time, was inconclusive due to an insufficient number of primary studies that included total sedentary time as one of the potential covariates. There was some evidence that supported a sedentary bout that significantly increased the risk of adverse health outcomes was 30-60 min. The threshold of prolonged sedentary time differed with outcomes, and future studies are needed to make this threshold more precise.

CONCLUSION

A prolonged sedentary behavior pattern was associated with increased risks of several major noncommunicable diseases and all-cause mortality. People, especially those who do not reach the recommended level of moderate-to-vigorous physical activity, are encouraged to interrupt sedentary bouts every 30 to 60 min and limit prolonged sedentary time per day as much as possible.

TWEETABLE ABSTRACT

Breaking up consecutive sedentary bouts >30 to 60 min and substituting them with brief bouts of physical activity.

Sedentary Patterns and Sit-to-Stand Transitions in Open Learning Spaces and Conventional Classrooms among Primary School Students

Educational reforms worldwide have resulted in schools increasingly incorporating open and flexible classroom designs that may provide possibilities to reduce sedentary behavior among students during lessons. Cross-sectional associations of classroom type on accelerometry assessed sedentary bout durations and sit-to-stand transitions were investigated in 191 third and fifth grade students recruited from one school with open learning spaces and two schools with conventional classrooms. A three-way ANOVA for classroom type, gender and grade level indicated that students in open learning spaces had more 1-to-4-min sedentary bouts (mean difference 1.8 bouts/h, p < 0.001), fewer >10-min sedentary bouts (median 0.20 vs. 0.48 bouts/h, p = 0.004) and more sit-to-stand transitions (mean difference 0.9 STS/h, p = 0.009) than students in conventional learning spaces. Comparisons between schools by grade, which were conducted with a one-way ANCOVA adjusted for gender, indicated that most of the significant differences occurred between schools with different classroom types. There were only small and mostly statistically nonsignificant differences between the two schools with conventional classrooms. In conclusion, open learning spaces may improve children’s sedentary profiles towards shorter sedentary bout durations and facilitate also postural transitions during lessons, which may translate into beneficial health impacts over a longer period.

Design Process and Implementation of Teacher Training Modules in Movement Integration: What Have We Learnt?

Substantial evidence shows that the current level of children’s physical activity (PA) is insufficient. Schools along with academic lessons can offer an effective avenue to increase children’s physical activity and decrease sedentary time. Teacher training in movement integration (MI) has been emphasized as an important strategy in facilitating less sedentary and more physically active lessons. The aim of this study was to explore the design process for developing a teacher training module for MI and its implementation within the comprehensive, school-based, physical activity program. Flexible co-creation methods with teachers were applied. Process evaluation was conducted through individual feedback surveys, observations in schools, evaluating the teacher’s MI mapping timetable, group feedback, and a follow-up study. The two-day module, a practical and flexible approach, ready-to-use resources, allocated time and autonomy for practice, communication with other teachers, and a whole school approach aligned with teachers’ needs are identified as key elements. A follow-up study after the training showed significant changes in teachers’ practices regarding the use of MI in the classroom. The study offers important insights into the design process and its successes and failures. The lessons learnt, a final model of designed seminars, and a toolbox of materials are presented.

The Acute Effects of Standing on Executive Functioning in Vocational Education and Training Students: The Phit2Learn Study

Research suggests that sedentary behavior (SB) is negatively associated with cognitive outcomes. Interrupting prolonged sitting has been shown to improve cognitive functions, including executive functioning (EF), which is important for academic performance. No research has been conducted on the effect of standing on EF in VET students, who make up a large proportion of the adolescent population and who are known to sit more than other students of this age. In this study, we investigated the acute effects of reducing SB by short time standing on EF in vocational education and training (VET) students. In a randomized crossover study, 165 VET students were first taught for 15 min in seated position. After this, they performed while seated the Letter Memory Test for updating, and the Color Shape Test for shifting and inhibition. Students were randomly assigned to a sitting or standing condition. All students were taught again for 15 min and then took the same tests in the condition they were allocated to, respectively, standing or seated. After 1 week, the test procedure was repeated, in which students switched conditions. Mixed model analyses showed no significant effect of sitting or standing on updating, shifting, or inhibition. Also, no significant differences were found for the order of condition on updating, shifting, or inhibition. Our results suggest that 40 min of standing does not significantly influence EF among VET students.

A Longitudinal Examination of Withholding All or Part of School Recess on Children's Physical Activity and Sedentary Behavior: Evidence from a Natural Experiment

School recess is a daily opportunity for school-age students to be physically active. However, in some territories teachers often use recess for other purposes (e.g., children's poor classroom behavior might be punished with reduced time for recess). This study aimed to examine the impact of such practices on children's physical activity (PA) and the relationships between PA, gender, body mass index (BMI), and academic achievement. Forty-six first-grade students from two natural classrooms wore an accelerometer over the course of 6 weeks to measure their metabolic equivalent of task (METs) and sedentary behavior during school recess. Gender, age, BMI, the classroom to which students belonged, and academic achievement were also analyzed in two Generalized Estimating Equations models. Results revealed that boys achieved more METs and spent less time participating in sedentary behavior than girls during recess. Children within a healthy weight range of BMI yielded more METs than underweight and overweight/obese children. Academic achievement was positively associated with the METS and negatively with the sedentary behavior. Finally, withholding all or part of school recess significantly reduced children's PA and extended their sedentary behavior. The literature indicates that school recess plays an important role in promoting numerous children's health outcomes. Therefore, students should not be excluded from participation in all or part of recess.

Relating outdoor play to sedentary behavior and physical activity in youth - results from a cohort study

BACKGROUND

Outdoor play, sedentary behavior (SB), and moderate-to-vigorous physical activity (MVPA) are related to youth's health, however, there are research gaps regarding 1) associations between outdoor play, SB, and MVPA across a broad pediatric age range (6-17 years), and 2) longitudinal associations between outdoor play, SB, and MVPA across childhood and adolescence. Two studies were conducted to address those research gaps: Study 1 aimed to investigate relationships between outdoor play and accelerometer-assessed SB and MVPA in a cross-sectional nationwide sample of children and adolescents in Germany. Study 2 aimed to investigate prospective associations between outdoor play and self-reported screen-time SB and MVPA and in a sample of children with three measurement timepoints across 11 years.

METHODS

Data were obtained of the German national representative Motorik-Modul (MoMo) Study and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). In Study 1, N = 2278 participants (6-17 years) were included with self-reported outdoor play and accelerometer-assessed SB and MVPA. Associations were examined via multiple linear regressions. In Study 2, N = 570 participants (baseline: 4-7 years) were included in the longitudinal analysis with follow-ups six and 11 years later. Screen-time SB (TV watching and PC/Gaming), MVPA, and outdoor play were self-reported. Associations were investigated through a path prediction model.

RESULTS

Study 1 showed that compared to <1 h outdoor play, higher engagement in daily outdoor play was related to lower SB (1-2 h: - 9.75 min/day, P = 0.017; ≥2 h: - 17.78 min/day, P < 0.001) and higher MVPA (≥2 h: + 3.87 min/day, P = 0.001). The cross-sectional relationship between MVPA and outdoor play was moderated by sex (in favor of males) and age (in favor of younger children). Study 2 showed that outdoor play in early childhood negatively predicted PC use/Gaming in later childhood, but was unrelated to MVPA.

CONCLUSION

In Study 1, outdoor play was negatively related to SB cross-sectionally. In Study 2, outdoor play in early childhood was negatively related to PC and Gaming time in later childhood. Thus, providing outdoor play opportunities, especially during early childhood, has potential to prevent SB. Future research should investigate longitudinal relationships using device-based assessments for SB and MVPA.

Moderate-to-Vigorous Physical Activity in Primary School Children: Inactive Lessons Are Dominated by Maths and English

BACKGROUND

A large majority of primary school pupils fail to achieve 30-min of daily, in-school moderate-to-vigorous physical activity (MVPA). The aim of this study was to investigate MVPA accumulation and subject frequency during academic lesson segments and the broader segmented school day.

METHODS

122 children (42.6% boys; 9.9 ± 0.3 years) from six primary schools in North East England, wore uniaxial accelerometers for eight consecutive days. Subject frequency was assessed by teacher diaries. Multilevel models (children nested within schools) examined significant predictors of MVPA across each school-day segment (lesson one, break, lesson two, lunch, lesson three).

RESULTS

Pupils averaged 18.33 ± 8.34 min of in-school MVPA, and 90.2% failed to achieve the in-school 30-min MVPA threshold. Across all school-day segments, MVPA accumulation was typically influenced at the individual level. Lessons one and two-dominated by maths and English-were less active than lesson three. Break and lunch were the most active segments.

CONCLUSION

This study breaks new ground, revealing that MVPA accumulation and subject frequency varies greatly during different academic lessons. Morning lessons were dominated by the inactive delivery of maths and English, whereas afternoon lessons involved a greater array of subject delivery that resulted in marginally higher levels of MVPA.

Developing a comprehensive school-based physical activity program with flexible design - from pilot to national program

This article focuses on the process of designing the vital, participatory school-based intervention program aiming to increase the physical activity in schools. The program analyzed is Estonian nationwide comprehensive physical activity program Schools in Motion (SiM) that recently received European Commission's #BeActive Education Award. The program has a good performance in terms of willingness of schools to participate in co-creation of program development, the high interest to join the program and zero dropouts, and strong partnership with ministries which enables to actively participate in policy making. Authors analyze the key elements of the planning, piloting, implementation, and scaling phases of the SiM program and share their lessons learnt in co-working with schools. The difficulties faced during the development process, the strengths and challenges associated with an interdisciplinary approach, and involvement of schools as experts have been addressed.

Association between Physical Activity and Mood States of Children and Adolescents in Social Isolation during the COVID-19 Epidemic

The COVID-19 epidemic adversely affects the lifestyle of people. This study aimed to examine the impacts of social isolation on physical activity (PA) levels and mood states of children and adolescents and to explore the correlation between them during the COVID-19 epidemic. A total of 9979 children and adolescents (11.63 ± 1.23 years old) from Yan’an, China volunteered to participate in this study and completed online questionnaires. PA and mood states were measured by International Physical Activity Questionnaire Short Form (IPAQ-SF) and Profile of Mood States (POMS), respectively. The results showed that the mean of students’ moderate-to-vigorous PA (MVPA) was 23.19 min per day. The total mood disturbance in the moderate and high-level PA groups were significantly lower than those in the low-level PA group (p < 0.05). Additionally, boys and girls had significant differences in PA levels (p < 0.01), and the PA levels of students in different grades were also significantly different (p < 0.01). Meanwhile, boys’ mood states were worse than girls’. The Grade 4 in primary schools had the worst mood states while Grade 5 had the best mood states. The results suggested that the MVPA of students has dropped badly, compared with the results of previous studies investigated in normal times. In addition, the PA level had a significantly positive impact on the mood states of children and adolescents during the COVID-19 epidemic. Sex and grades were factors which affected the PA levels and mood states. This study can help policymakers and healthcare professionals understand PA and mood states of Chinese children and adolescents during the epidemic. We should pay attention to the changes in PA levels and mood states of children and adolescents.

Impacts of a Standing Desk Intervention within an English Primary School Classroom: A Pilot Controlled Trial

Traditional classroom furniture dictates that children predominantly sit during class time. This study evaluated the impact of providing standing desks within a deprived UK primary school setting over 8 months using mixed-method approaches. All children within a Year 5 class (9–10-year-olds, n = 30) received an adjustable sit–stand desk, while another Year 5 class (n = 30) in a nearby school retained traditional furniture as a control classroom. At baseline, 4 months, and 8 months, activPAL monitors (PAL Technologies, Glasgow, UK) were worn for 7 days to provide time spent sitting and standing. Behavior-related mental health, musculoskeletal discomfort surveys, and a cognitive function test battery were also completed at all three timepoints. Intervention experiences from pupils and the teacher were captured using focus groups, interviews, and classroom observations. At both 4 months and 8 months, multi-level models revealed a reduction in class time sitting in the intervention group compared to the control group ((β (95%CI) 4 months −25.3% (−32.3, −18.4); 8 months −19.9% (−27.05, −12.9)). Qualitative data revealed challenges to teaching practicalities and a gradual decline in behavior-related mental health was observed (intervention vs. control: 4 months +5.31 (+2.55, +8.08); 8 months +7.92 (+5.18, +10.66)). Larger trials within similar high-priority settings are required to determine the feasibility and cost-effectiveness of providing standing desks to every child in the classroom.

A good beginning: study protocol for a group-randomized trial to investigate the effects of sit-to-stand desks on academic performance and sedentary time in primary education

BACKGROUND

Sedentary behavior is associated with health risks and academic under-achievement in children. Still, children spend a large part of their waking hours sitting at a desk at school. Recent short-term studies demonstrated the potential of sit-to-stand desks to reduce sitting time in primary education. The program of "A Good Beginning" was conceived to assess the long-term effects of sit-to-stand desks on sitting time in primary education, and to examine how sit-to-stand desks versus regular desks relate to academic performance, and measures of executive functioning, health and wellbeing. The present paper describes the design of this group-randomized trial, which started in 2017 and will be completed in 2019.

METHODS

Children of two grade-three groups (age 8-9) following regular primary education in Leiden, The Netherlands, were recruited. A coin toss determined which group is the experimental group; the other group is the control group. All children in the experimental group received sit-to-stand desks. They are invited and motivated to reduce sedentary time at school, however, it is their own choice to sit or stand. Children in the control group use regular desks. Otherwise, both groups receive regular treatment. Outcomes are assessed at baseline (T0) and at five follow-up sessions (T1-T5) alternately in winter and summer seasons over three academic years. Primary outcome measures are academic performance, and the proportion of sitting time at school, measured with a 3D accelerometer. Secondary outcome measures are a number of measures related to executive functioning (e.g., N-back task for working memory), health (e.g., height and weight for BMI), and wellbeing (e.g., KIDSCREEN-52 for Quality of Life).

DISCUSSION

A Good Beginning is a two-and-a-half-year research program, which aims to provide a better understanding of the long-term effects of sit-to-stand desks on sedentary time at school and the relation between sitting time reduction and academic performance, executive functioning, health and wellbeing. The findings may serve as useful information for policy making and practical decision making for school and classroom environments.

TRIAL REGISTRATION

The program of "A Good Beginning" is registered at the Netherlands Trial Register (NTR, https://www.trialregister.nl), number NL6166, registration date 24 November 2016.

Supplemental education in early childhood may be associated with professional achievement

OBJECTIVES

To investigate which extracurricular lessons medical doctors and medical students received in early childhood and to compare the results to a similarly aged representative sample.

METHODS

This retrospective questionnaire-based study investigated the prevalence of supplemental early education, along with professional outcomes later in life. The study compared two samples: First, as a proxy for "professional success", medical students and residents (n = 147) were asked to recall which extracurricular lessons they had taken when pre-school aged. This was contrasted to a control sample representative of the general population in Japan. Included extracurricular lessons were: "keyboard/piano", "Japanese calligraphy", "abacus use", "swimming", and "foreign language." Frequencies were compared and tested using contingency tables and the Chi-squared test. P-values < 0.05 were considered significant.

RESULTS

The control sample reported a lower rate (32.7%) of extracurricular activities than medical students did (51.6%, χ²_{(df=1, n=147)} = 13.5, p < 0.001). The proportion of medical students receiving keyboard lessons during their pre-school years was significantly higher (43.5%) than that of the general population (9.1%, χ²_{(df=1, n=147)} = 65.2, p < 0.001). Similar, but less robust, results were observed with Japanese calligraphy (11.5% vs. 3.1%, χ²_{(df=1, n=147)}=11.3, p=0.001), abacus use (4.1% vs. 0.4%, χ²_{(df=1, n=147)} = 7.4, p=0.007), and swimming (33.3% vs. 22.0%, χ²_{(df=1, n=147)} = 6.1, p = 0.013).

CONCLUSIONS

Our results suggest that, in Japan, early supplementary education, including keyboard lessons, is associated with professional success later in life. Future research is warranted to elucidate whether there is a causal link between early extracurricular education and professional outcomes.

Longitudinal Changes in Sitting Patterns, Physical Activity, and Health Outcomes in Adolescents

This study examined two-year changes in patterns of activity and associations with body mass index (BMI) and waist circumference (WC) among adolescents. Inclinometers (activPAL) assessed sitting, sitting bouts, standing, stepping, and breaks from sitting. ActiGraph-accelerometers assessed sedentary time (SED), light-intensity physical activity (LIPA, stratified as low- and high-LIPA), and moderate-to-vigorous physical activity (MVPA). Anthropometric measures were objectively assessed at baseline and self-reported at follow-up. Data from 324 and 67 participants were obtained at baseline and follow-up, respectively. Multilevel mixed-effects linear regression models examined changes over time, and associations between baseline values and BMI and WC at follow-up. There were significant increases in BMI (0.6 kg/m²) and durations of prolonged sitting (26.4 min/day) and SED (52 min/day), and significant decreases in stepping (−19 min/day), LIPA (−33 min/day), low-LIPA (−26 min/day), high-LIPA (−6.3 min/day), MVPA (−19 min/day), and the number of breaks/day (−8). High baseline sitting time was associated (p = 0.086) with higher BMI at follow-up. There were no significant associations between baseline sitting, prolonged sitting, LIPA, or MVPA with WC. Although changes in daily activity patterns were not in a favourable direction, there were no clear associations with BMI or WC. Research with larger sample sizes and more time points is needed.

The impact of height-adjustable desks and prompts to break-up classroom sitting on adolescents' energy expenditure, adiposity markers and perceived musculoskeletal discomfort

Adolescents spend large amounts of time sitting at school. Little is known about the impact of reducing and breaking-up prolonged sitting during school lessons on adolescents' health. This study aimed to investigate the impact of an intervention to reduce classroom sitting time on adolescents' energy expenditure (EE; kcal/lesson), body mass index (BMI), waist circumference (WC), and musculoskeletal discomfort. A secondary school classroom was equipped with height-adjustable desks, posters promoting the health benefits of and strategies for breaking-up sitting time, and desk stickers reminding students to periodically stand up. Classroom teachers participated in a professional development session. Using a quasi-experimental design, differences between 49 participants who utilised the intervention classroom 2-5 times/week and a comparison group (39 adolescents, matched by year level and subject) who used traditional classrooms, were examined. EE, BMI and WC were objectively measured and musculoskeletal discomfort was self-reported at baseline, 4-weeks, and 17-weeks. Hierarchical linear and multilevel logistic regression-mixed models were used to examine intervention effects, adjusting for baseline values, sex and age. EE was significantly higher at 4-weeks and 17-weeks (29.4 and 37.7 kcal/lesson, respectively), BMI was higher at 4-weeks (0.34 kg/m2), and WC was lower at 4-weeks and 17-weeks (-3.53 and -2.64 cm, respectively) in the intervention compared to the comparison group. No intervention effect was found for musculoskeletal discomfort. Findings provide preliminary indications that these strategies may benefit health among adolescents in the short term. However, extended longer-duration trials are needed to determine longer-term health effects.

Validating Fitbit Zip for monitoring physical activity of children in school: a cross-sectional study

Background

Modern activity trackers, including the Fitbit Zip, enable the measurement of both the step count as well as physical activity (PA) intensities. However, there is a need for field-based validation studies in a variety of populations before using trackers for research. Therefore, the purpose of the current study was to investigate the validity of Fitbit Zip step count, moderate to vigorous physical activity (MVPA) and sedentary minutes, in different school segments in 3rd grade students.

Methods

Third grade students (N = 147, aged 9–10 years) wore a Fitbit Zip and an ActiGraph GT3x-BT accelerometer simultaneously on a belt for five days during school hours. The number of steps, minutes of MVPA and sedentary time during class time, physical education lessons and recess were extracted from both devices using time filters, based on the information from school time tables obtained from class teachers. The validity of the Fitbit Zip in different school segments was assessed using Bland-Altman analysis and Spearman’s correlation.

Results

There was a strong correlation in the number of steps in all in-school segments between the two devices (r = 0.85–0.96, P < 0.001). The Fitbit Zip overestimated the number of steps in all segments, with the greatest overestimation being present in physical education lessons (345 steps). As for PA intensities, the agreement between the two devices in physical education and recess was moderate for MVPA minutes (r = 0.56 and r = 0.72, P < 0.001, respectively) and strong for sedentary time (r = 0.85 and r = 0.87, P < 0.001, respectively). During class time, the correlation was weak for MVPA minutes (r = 0.24, P < 0.001) and moderate for sedentary time (r = 0.57, P < 0.001). For total in-school time, the correlation between the two devices was strong for steps (r = 0.98, P < 0.001), MVPA (r = 0.80, P < 0.001) and sedentary time (r = 0.94, P < 0.001).

Conclusion

In general, the Fitbit Zip can be considered a relatively accurate device for measuring the number of steps, MVPA and sedentary time in students in a school-setting. However, in segments where sedentary time dominates (e.g. academic classes), a research-grade accelerometer should be preferred.