Active healthy living: prevention of childhood obesity through increased physical activity

Addressing the Challenge: A Review of Effective Prevention Strategies for Childhood Obesity in India

Childhood obesity is a growing public health concern in India, with rising prevalence rates and associated health risks. This review examines effective prevention strategies for addressing this issue. Through a comprehensive analysis of research findings, policy initiatives, and community-based interventions, the review identifies critical components of successful prevention efforts. These include multi-sectoral collaborations, tailored interventions addressing socioeconomic and cultural factors, and the involvement of families and healthcare professionals. The importance of addressing childhood obesity in India is underscored, given its significant impact on health outcomes, healthcare costs, and quality of life. The review concludes with a call to action for stakeholders and policymakers to prioritise prevention efforts, allocate resources, and implement evidence-based interventions to combat childhood obesity effectively. By working together, India can mitigate the adverse effects of childhood obesity and promote a healthier future for its children.

Depression and Anxiety Symptoms and Their Associated Factors Among Chinese Residents After the Lifting of the Dynamic Zero-COVID Policy: A Cross-Sectional Study

Purpose

China lifted its strict zero-Covid approach on December 7, 2022. This study aimed to investigate depression and anxiety symptoms and their associations among Chinese residents after the change in public policy.

Methods

A cross-sectional sample of 925 Chinese residents (726 females and 199 males) was recruited using convenience and snowball sampling approach between 16 and 25 December 2022. Participants completed online questionnaires on basic information, depression, anxiety, COVID-19 related perceptions, and protective behaviors change.

Results

Mild and moderate-to-severe depression symptoms were reported by 35.6% and 19.1% of participants, respectively. Nearly 40% of participants reported mild anxiety and 18.7% reported moderate-to-severe anxiety. Results from multinomial logistic regression analysis indicated that male gender, younger age, the presence of chronic disease, poorer self-rated mental health status, perceived impact, and worry were risk factors for both depression and anxiety, while higher education and protective behaviors change were protective factors. Besides, living with or caring for children (4-6 years), family members or other housemates currently with influenza-like symptoms, and perceived severity were also risk factors for depression.

Conclusion

Our findings provided initial evidence that Chinese residents may face heightened depression and anxiety during the early stage after the policy was released. Furthermore, we identified some vulnerable populations in need of prioritizing mental health assistance and some potentially modifiable factors associated with depression and anxiety, which provides an important guide for developing timely and effective psychological interventions and preparing for future pandemics.

Developing Healthy Lifestyle Behaviors in Early Age-An Intervention Study in Kindergartens

Childhood obesity prevention is a leading public health challenge requiring the adoption of healthy lifestyles at an early age. We examined how the kindergarten environment can promote eating sensibly, drinking water and becoming physically active. The effects of an intervention program among 42 Israeli kindergartens (1048 children, aged 4-6) whose teachers participated in a health education training program were compared to 32 kindergartens (842 children) whose teachers did not undergo this training program. An eight-month intervention program focused on knowledge/mathematical/logical/critical thinking, self-regulation/control acquisition, and sensible decision-making abilities. We hypothesized that nutrition and physical-exercise-oriented intervention programs, combining knowledge/mathematical logical thinking, would positively impact the quality of children's mid-morning snack and water consumption, their ability to express feelings following physical exercise, and the adoption of healthy lifestyles at home. The quality of mid-morning snacks and water consumption were observed in both groups pre- and post-intervention. Qualitative interviews documented children's subjective feelings following physical exercise. A significant improvement (p < 0.001) was observed in the mid-morning snacks composition and in water drinking habits in the intervention group; 80% of children offered a physiological explanation regarding energy expenditure processes following intense physical exercise. In conclusion, kindergarten interventions implemented by trained teachers can promote adoption of health behaviors necessary for obesity prevention.

Association of Playground "Playability" With Physical Activity and Energy Expenditure

INTRODUCTION

Children's physical activity, especially play, is important for healthy physical, social, and psychological development. Playgrounds are public spaces for children, but not all playgrounds are conducive to play and physical activity. We examined "playability," the ability of a space to promote active play, and associations with moderate-to-vigorous physical activity (MVPA) and energy expenditure.

METHODS

This cross-sectional study assessed playground features with the Play Space Audit Tool; we calculated playability scores from audit data, overall and by domain (general amenities, surface, path, and play structure), from playgrounds in 70 parks in Chicago, Illinois, in 2017. We observed 2,712 individuals during the audits and used the System for Observing Play and Recreation in Communities tool to assess MVPA and energy expenditure. We used generalized estimating equation negative binomial regression to calculate incidence rate ratios for MVPA and mixed effects models to calculate energy expenditure (in kcal/kg/min) associated with playability scores.

RESULTS

General amenities and play structure scores were associated with 1.28 (95% CI, 1.08-1.52) and 1.15 (95% CI, 1.00-1.31) times as many individuals (any age) engaged in MVPA, respectively. The general amenities score was significantly associated with 0.51 (95% CI, 0.24-0.79) and 0.42 (95% CI, 0.15-0.68) higher energy expenditure in renovated playgrounds and in all playgrounds, respectively.

CONCLUSION

Overall, general amenities and play structure scores were associated with MVPA and were robust to adjustment for weather, neighborhood socioeconomic characteristics, and crime. These playground playability indices may strengthen future evaluations of community infrastructure for children's physical activity.

Barriers to Participation in a Telemedicine-based, Family-based Behavioral Group Treatment Program for Pediatric Obesity: Qualitative findings from Rural Caregivers

This study examined factors influencing rural caregivers' decision to decline participation in a healthy lifestyle intervention. Eligible caregivers of rural children who declined participation in a healthy lifestyle intervention were interviewed regarding reasons for declining. Inductive thematic analyses were conducted for responses. Caregiver interviews (n=16) resulted in 5 saturated themes: (1) rural families' household schedules prohibit participation, (2) preference for diverse treatment approaches, (3) desire for information across multimedia platforms, and more communication with a point-of-contact, (4) support for an inclusive approach integrated with existing school practices, and (5) caregivers had an understanding of behaviors that promote health.

Physical Activity, Sleep, and Demographic Patterns in Alaska Native Children and Youth Living in Anaktuvuk Pass

Physical activity (PA), sleep, and weight are important factors for youth health. However, data about these factors are unknown in youth living in isolated Alaska Native communities. This study aims to assess PA, sleep, height and weight in elementary through high school students living in Anaktuvuk Pass. Fourteen children (<12) and 24 youths (12-20) volunteered to participate in this study. PA and sleep data were collected with actigraphy. Height and weight were assessed with standard procedures. Demographics were collected via survey. Results show that 10.53% and 18.42% of participants were overweight and obese, respectively. Average bedtime was 00:15 am and wake time 08:23 am. Total sleep time was 498.21 min. Participants averaged 477.64 min in sedentary activity, 297.29 min in light activity, 150.66 min in moderate activity, and 18.05 min in vigorous activity. Adjusted models suggest that high school students engage in significantly more sedentary activity, and significantly less light, moderate, and vigorous activity compared to those in middle and elementary school. All students engaged in less moderate and vigorous activity on the weekend compared to the weekday. Data suggest that as children age they become more sedentary. Future studies should focus on increasing daily PA in high school students while considering other obesogenic factors.

How much did it cost to develop and implement an eHealth intervention for a minority children population that overlapped with the COVID-19 pandemic?

BACKGROUND

eHealth interventions using active video games (AVGs) offer an alternative method to help children exercise, especially during a pandemic where options are limited. There is limited data on costs associated with developing and implementing such interventions.

OBJECTIVES

We quantified the costs of delivering an eHealth RCT intervention among minority children during COVID-19.

METHODS

We categorized the total trial cost into five subcategories: intervention material development, advertising and recruitment, intervention delivery, personnel salaries, and COVID-19-related equipment costs.

RESULTS

The total RCT cost was $1,927,807 (Direct: $1,227,903; Indirect: $699,904) with three visits required for each participant. The average cost per participant completing the RCT (79 participants/237 visits) was $24,403 (Direct: $15,543; Indirect: $8860). Due to no-shows and cancellations (198 visits) and dropouts before study completion (61 visits; 56 participants), 496 visits had to be scheduled to ensure complete data collection on 79 participants. If all 496 visits were from participants completing the three-visit protocol, that would correspond to 165 participants, bringing the average cost per participant down to $11,684 (Direct: $7442; Indirect: $4242). Of the subcategories, intervention material development accounted for the largest portion, followed by personnel salaries. While the direct COVID-19-specific cost constituted <1% of the entire budget, the indirect effects were much larger and significantly impacted the trial.

CONCLUSION

RCTs typically involve significant resources, even more so during a pandemic. Future eHealth intervention investigators should budget and plan accordingly to prepare for unexpected costs such as recruitment challenges to increase flexibility while maximizing the intervention efficacy.

Obesity in Children

Child obesity is widely prevalent, and general pediatricians play an important role in identifying and caring for patients with obesity. Appropriate evaluation and treatment require an understanding of the complex etiology of child obesity, its intergenerational transmission, and its epidemiologic trends, including racial/ethnic and socioeconomic disparities. The American Academy of Pediatrics has published screening, evaluation, and treatment guidelines based on the best available evidence. However, gaps in evidence remain, and implementation of evidence-based recommendations can be challenging. It is important to review optimal care in both the primary care and multidisciplinary weight management settings. This allows for timely evaluation and appropriate referrals, with the pediatrician playing a key role in advocating for patients at higher risk. There is also a role for larger-scale prevention and policy measures that would not only aid pediatricians in managing obesity but greatly benefit child health on a population scale.

Changes in frequency of park/playground utilization among children aged 4-59 months in Los Angeles County, California 2008-2020

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Every day and 3–6 d/wk park use rose from 2008 to 2017, and declined in 2020.

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Never park use declined from 2008 (12.2%) to 2017 (8.5%) and rose in 2020 (35.5%).

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Children 24–59 mo had 36% lower every day park use odds in 2020 than 2008.

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Children 24–59 mo had 85–89% lower 3–6 and 1-2d/wk park use odds in 2020 than 2008.

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Children 4–23 mo had similar patterns in park utilization frequency 2008–2020.

Child physical activity and play are critical for healthy development, and parks/playgrounds are important public spaces that provide physical activity/play opportunities. This study was conducted to assess changes in park/playground utilization by Special Supplemental Nutrition Program for Women, Infants and Children (WIC)-participating children from 2008 to 2020, and whether the COVID-19 pandemic was associated with lower park/playground utilization and racial/ethnic disparities in park/playground utilization. Cross-sectional data from the 2008–2020 triennial Los Angeles County WIC Survey (n = 21,886) were used, and analyses stratified by child age (4–23 months, 24–59 months). Odds ratios (OR) and 95 % confidence intervals (CI) for the relationship between year and park/playground utilization frequency were determined from multinomial logistic regression, and racial/ethnic disparities were assessed by interacting year with race/ethnicity. Among children 24–59 months of age, park/playground utilization increased compared to never from 2011 to 2017 compared to 2008 (Every day, 2011–2017: OR [95 % CI]: 2.69 [1.93, 3.75], 4.71 [3.23, 6.86], 10.20 [6.91, 15.06]; 3–6 days/week 2011–2017: 1.54 [1.13, 2.10], 3.11 [2.18, 4.45], 3.94 [2.71, 5.72]; 1–2 days/week, 2014–2017; 1.53 [1.08, 2.18], 1.63 [1.13, 2.37]). Associations reversed in 2020, with 36 % lower odds of every day (OR [95 % CI]: 0.64 [0.48, 0.85]), 85 % lower odds of 3–6 days/week (0.15 [0.11, 0.20]) and 89 % lower odds of 1–2 days/week (0.11 [0.09, 0.15]) park/playground utilization compared to never than in 2008. Park/playground utilization frequency increased from 2008 to 2017, but progress reversed during the COVID-19 pandemic in 2020. Results for children ages 4–23 months were similar. Future public health restrictions to public recreation facilities should consider realistic limitations to potential benefits and the potential for unintended consequences before implementation.

Nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity: An Obesity Medical Association (OMA) Clinical Practice Statement 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details nutritional and activity recommendations for the child with normal weight, overweight, and obesity (Appendix A) with consideration of food insecurity. This CPS is intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices in the normal range and body mass indices greater than or equal to the 85th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA.

Methods

The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors.

Results

This OMA Clinical Practice Statement details nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity. In addition, this CPS addresses nutritional recommendations for complications related to the disease of obesity as well as providing guidance on food insecurity as it impacts children with obesity and their families.

Conclusions

This OMA Clinical Practice Statement on nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity is an overview of current recommendations. These recommendations provide a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.

Motivators and Barriers to Physical Activity among Youth with Sickle Cell Disease: Brief Review

Purpose: Health disparities for minority groups include a low rate of physical activity and underserved urban minority youth with chronic disease are among the least active population segments, as exemplified by sickle cell disease (SCD). “Exercise prescriptions” for youth with chronic diseases need to be evidence based and align with psychologic motivators and barriers. This scoping review sought evidence for psychosocial motivators or barriers to physical activity (PA) in youth with SCD and other chronic disease that could be relevant to SCD. Methods: Five databases were searched for studies on urban minority youth published between 2009 and 2022. Results: Keyword searching yielded no papers on SCD and PA motivation and barriers. Adding health-related quality of life (HRQL) in SCD found eleven relevant papers. Widening the search to chronic disease in minority youth resulted in a total of 49 papers. Three thematic categories and seven sub-themes emerged. PA barriers added by chronic disease include fear of triggering disease complications, negative relationships due to disease limitations on performance in sports, and lack of suitable environment for PA that accommodates the chronic disease. PA motivators are similar for youth without chronic disease: self-efficacy, autonomy, positive relationships with peers and parents and coach/teacher. Conclusion: Direct descriptions of PA motivations and barriers to PA in SCD are limited to fatigue and fear of sickle vaso-occlusive pain. The PA barriers and motivators found for urban youth with chronic disease overlap with themes in healthy adolescents from underserved minorities. Community-based interventions could strengthen PA motivators (self-efficacy, autonomy, positive relationships with peers and parents and coach/teacher) but need disease accommodations to overcome the barriers (fear of triggering disease complications, environmental limitations, and negative relationships). Evidence-based exercise prescriptions might incorporate educational modules to overcome disease stigma and misconceptions. Prospective studies of PA motivators and barriers could improve HRQL in SCD.

Mapping recommended strategies to promote active and healthy lifestyles through physical education classes: a scoping review

Background

Understanding which strategies have been recommended for the promotion of active and healthy lifestyles through physical education (PE) classes can guide PE policies and practice. Therefore, we summarized worldwide recommendations regarding strategies for PE classes that have aimed to promote active and healthy lifestyles among school-aged children and adolescents.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were utilized. A literature search was carried out in June 2020 in eight peer-reviewed literature databases, in addition to searches in institutional and personal libraries. The eligibility criteria included any online document that included recommendations targeting any dimension of PE classes (e.g., policy and environment, curriculum, appropriate instruction, student assessment, and strategies that interact with PE) published since 2000.

Results

In total, 2,408 potentially eligible documents were screened. Of these, 63 were included in the final analysis. The recommended strategies were as follows: six referred to policy and environment (valuing PE, higher frequency and duration of classes, inclusive PE classes, mandatory daily classes, evaluation of PE classes, and qualified teachers), five to curriculum (structure, type of content, cross-cutting themes, and components that improve PE classes), four to appropriate instruction (promotion of physical activities, inclusion of social issues, employment of the use of innovative technologies, and organization of the teaching–learning process), and three to student assessment (understanding human movement concepts, evaluation of contents, and assessment methods to develop an active and healthy lifestyle).

Conclusion

Twenty-one strategies recommended for PE classes linked to five dimensions aimed at different target populations were identified. Over half were linked to the dimensions of policy and environment and appropriate instruction. PE is recommended to be mandatory and valued at all educational levels, with weekly frequency that contributes to an active and healthy lifestyle. This review shows that guaranteeing different experiences beyond sports, improving social inclusion, using innovative technologies, and providing adequate materials and spaces to be important challenges and ways to guide policies, programs, and new research in this field of knowledge.

Open Science Framework Registration: https://osf.io/harwq/

The impact of nutrition and lifestyle modification on health

The main recommendations from public health entities include healthy diets and physical activity as the main lifestyle factors impacting the development of chronic diseases such as cardiovascular and metabolic diseases, cancer, and even neurological diseases. Randomized clinical trials have been designed to demonstrate those lifestyle modifications can change the pattern of chronic diseases development and progression. Among these, nutrition is one of the most impacting factors. Therefore, nutrition and diets were also included in different randomized clinical trials, and most of them showed a favorable impact of nutrition modification on the participant's health. Nevertheless, study designs were considerably different, and future studies are needed to support nutrition modifications further. The choice of a healthy considered diet, like the Mediterranean diet, was shown to impact chronic diseases, cardiovascular risk, and adult life expectancy mainly due to its anti-inflammatory and antioxidant properties. Furthermore, a high intake of fibers, fruits, and vegetables together with a low intake of fat and energy-dense, processed foods contribute to an inflammation reduction and a more robust immune system leading. Besides these well-known properties, all lifestyle modifications must be personalized according to the availability of foods, geographic localizations, and the healthy status of the patient.

Parental influence on urban adolescents' physical activity experience

As important socializing agents of adolescents, parents may substantially influence adolescents' physical activity but their roles in adolescents' physical activity experience have not been sufficiently studied. Furthermore, there is a dearth of research on potential mechanisms through which parents may promote adolescents' positive physical activity experience. Using a longitudinal sample of 464 urban and primarily Hispanic and African American adolescents, this study examined the impact of parental support on adolescents' physical activity experience. Results of structural equation modeling showed that after controlling for adolescents' gender, body mass index, and perceived overall health, parental support positively affected adolescents' restructuring ability (i.e., ability to construct meaningful and satisfying activities during unpleasant experiences) and intrinsic motivation (i.e., activity participation driven by inherent interest and enjoyment) in physical activity, which in turn positively affected adolescents' physical activity experience. No significant gender differences were found in these relationships. Theoretical and practical implications are discussed.

Momentary associations between stress and physical activity among children using ecological momentary assessment

Chronic and acute stress may have a detrimental effect on children's physical activity. Research on stress as a predictor of children's physical activity has mostly focused on stress between children, rather than how children's within-day variation in stress may predict physical activity. The current study assessed the within- and between-effects of stress on subsequent physical activity in three different time windows using ecological momentary assessment (EMA) and accelerometry. Children (N = 190; M_{Baseline Age} =10.1±0.9, 53% female, 56% self-identified Hispanic/Latino) completed six semi-annual assessment bursts across three years. During each burst, participants responded to up to seven (weekend) or three (weekday) randomly prompted EMA surveys on smartphones for seven days and wore a waist-worn accelerometer. Multi-level structural equation modeling examined within- and between-subjects effects of stress as a predictor of children's subsequent moderate-to-vigorous physical activity (MVPA) in the 15, 30, and 60 minutes following the EMA prompt. Latent variables were created for within- and between-subjects stress were comprised of three EMA stress items. Higher than average levels of stress (within-subjects) significantly predicted lower MVPA in the subsequent 15, 30 and 60 minutes (ps < .05). Between-subjects stress was not significantly associated with subsequent MVPA (ps > .05). Results indicate that elevated momentary stress predicts less subsequent MVPA. These findings suggest that within-day fluctuations in stress may be a barrier for children engaging in physical activity. Childhood physical activity promotion and interventions should consider the role of children's stress, aim to reduce the stress children experience throughout the day, and incorporate stress coping strategies.

Facilitators and Barriers to Access to Pediatric Medical Services in a Community Hospital

Background: Missed medical appointments decrease continuity of medical care, waste resources, and may affect health outcomes. We examined the factors associated with missed children's supervision visits in Eastern Brooklyn, NY, USA. Methods: We surveyed guardians whose children received routine medical care at four pediatric clinics. Participants filled out a questionnaire that queried: demographics, food security, recent relocation, parental support of healthy behaviors, and length of knowing provider. Preexisting disease(s) and missed visits were retrieved from medical records. Regression analyses were used to determine factors that were associated with missing medical appointments. Results: Among 213 families, 33% faced food insecurity and 16.4% reported moving within the past 12 months. Forty percent of children missed at least 1 visit. Food insecurity (adjusted odds ratio [aOR] 2.3, 95% confidence interval [CI 1.0% to 5.2%) and recent relocation (aOR 1.8, 95% CI 1.1-3.4 were associated with missed health supervision visits, whereas greater parental healthy behaviors (aOR 0.5, 95% CI 0.3-0.9) and longer length of knowing provider (aOR 0.8, 95% CI 0.7-1.0) were associated with fewer missed appointments. Conclusion: This study indicates that social inequity may contribute to poor adherence to medical appointments through multiple mechanisms, including food insecurity, lack of social stability, and parental health behaviors. Multidimensional proactive prevention, and reactive tolerance should be considered as opportunities to mitigate the impact of social inequity on health outcomes.

A 3-year longitudinal study of the association of physical activity and sedentary behaviours with childhood obesity in China: The childhood obesity study in China mega-cities

OBJECTIVES

Examine school children's physical activity (PA) and sedentary behaviours (SB) during 2015 to 2017 in China, and study their associations with children's weight status and relevant gender differences.

METHODS

This open cohort study included students from five major cities (Beijing, Shanghai, Xi'an, Nanjing, and Chengdu) across China. Data were collected from students in 2015, 2016, and 2017 (n = 5535) and from their parents and school personnel. Children's weight, height, and waist circumference were measured. SB and PA factors were evaluated using questionnaires. Mixed-effects models examined the relationship between weight status and PA-/SB-associated factors using this longitudinal data.

RESULTS

These children had high rates of obesity (12.4%, 95% CI 11.6%-13.3%) and central obesity (28.1%, 95% CI 26.9%-29.3%) during 2015 to 2017. Boys were more likely to have obesity than girls (16.5% vs 8.4%, respectively) as well as centrally obesity (36.3% vs 19.8%, respectively) and spent more time in screen viewing than girls (hours/week ± SD: 2015, 1.8 ± 2.5 vs 1.5 ± 2.0; 2016, 2.0 ± 2.4 vs 1.8 ± 2.5; 2017, 1.7 ± 2.3 vs 1.4 ± 2.1 hours/week). Those who walked <5 minutes on their average daily walk to school were more likely to have obesity (OR: 1.96, 95% CI 1.03-3.73) than those who spent ≥15 minutes on walking to school. When stratified by gender, this higher risk was only observed in girls (OR: 3.01, 95% CI 1.09-8.35). Children who spent more time in screen viewing were more likely to have obesity (OR: 1.13, 95% CI 1.06-1.21) and have central obesity (OR: 1.05, 95% CI 1.02-1.09). The association for obesity was consistent in boys and girls (boys, OR: 1.15, 95% CI 1.05-1.25; girls, OR: 1.12, 95% CI 1.00-1.24).

CONCLUSIONS

More screen time and less walking time were risk factors for developing obesity in urban Chinese children. The associations varied by gender.

Bi-Directional Associations Between Real-Time Affect and Physical Activity in Weight-Discordant Siblings

Pediatric obesity confers increased risk for a host of negative psychological and physical health consequences and is reliably linked to low levels of physical activity. Affective antecedents and consequences of physical activity are thought to be important for the development and maintenance of such behavior, though research examining these associations in youth across the weight spectrum remains limited.

OBJECTIVE

This study examined bi-directional associations between affect and physical activity (i.e., moderate-to-vigorous physical activity [MVPA] and total activity counts), and the extent to which weight (body mass index z-score [z-BMI]) moderated these associations.

METHODS

Participants were drawn from a prior study of siblings (N = 77; mean age = 15.4 ± 1.4 years) discordant for weight status (39 nonoverweight siblings, 38 siblings with overweight/obesity) who completed ecological momentary assessment (EMA) with accelerometer-assessed physical activity.

RESULTS

Generalized linear mixed models indicated z-BMI moderated trait-level and momentary associations. When adolescents with higher z-BMI reported momentary negative affect, they evidenced less MVPA within the next hour. Across the sample, greater overall activity was associated with lower negative affect. However, at the momentary level, when adolescents with higher (but not lower) z-BMI evidenced greater activity, they reported decreases in negative affect.

CONCLUSIONS

Findings indicate affective experiences surrounding physical activity differ according to z-BMI. Specifically, momentary negative affect may impede momentary MVPA among youth with higher z-BMI. Further research is warranted to elucidate factors influencing these momentary associations and the extent to which these momentary associations prospectively predict weight change.

Physical Activity and Enjoyment in Parent-Child Dyads During Shared Physical Activity

Purpose: The purpose of this study was to compare objectively-measured physical activity (PA) and enjoyment of five shared PAs in parent-child dyads. Method: Thirty-one parent-child dyads (mean±SD; age, parents: 38.0 ± 6.6 years, children: 5.9 ± 1.7 years) completed separate PA sessions, which included five standardized PAs (brisk walking, jumping games, dancing, body-weight exercises, and tag games) in random order for each dyad. Parent and child moderate-to-vigorous PA (MVPA) and accelerometer counts per minute (CPM) were measured using Actigraph GT9X activity monitors. The Visual Analog Scale was used to assess enjoyment of children and parents. Repeated measures ANOVAs and paired t-tests determined differences in PA within and between children and parents for the activities, respectively. Friedman Tests with post hoc Wilcoxon signed-rank tests determined significant differences in enjoyment across the activities for children and parents and Wilcoxon signed-rank tests compared enjoyment between children and parents for each PA. Results: Jumping games resulted in the highest proportion of time spent in MVPA and highest overall CPM for children and parents (p < .05). Compared to parents, children spent proportionally more time in MVPA during jumping games, body-weight exercises, and tag games (all, p < .05). Tag games were the most enjoyable PA for children and parents (p < .05). Children enjoyed body-weight exercises more than parents (p < .05). Conclusions: Future indoor PA programs and research interventions that include parent-child dyads should consider implementing jumping games, body-weight exercises, and tag games during shared PA, which resulted in higher MVPA and enjoyment by both children and parents when compared to walking and dancing.

Rapid component of excess post-exercise oxygen consumption of children of different weight status after playing active video games

BACKGROUND

Excess post-exercise oxygen consumption (EPOC) of children could indicate the potential of an exercise therapy to treat or prevent obesity. However, EPOC as a result of playing active video games (AVG) has been poorly investigated. Therefore, we aimed to investigate the rapid component of EPOC of children with healthy weight and overweight/obesity (according to their BMI percentile) after playing AVGs that feature predominately upper body (UB) and whole-body (WB) movement.

METHODS

Twenty-one children with healthy weight (BMI percentile < 85%) and with overweight/obesity (BMI percentile ≥ 85%) randomly underwent two 10-min AVG sessions (UB and WB). The heart rate (HR), minute ventilation (VE), oxygen consumption (VO2) and carbon dioxide production (VCO2) were recorded during exercise and post-exercise recovery period. For the rapid component of EPOC in each AVG session, measurements were recorded every 15 s for 5-min of post-exercise recovery. The rate of perceived exertion (RPE) was also measured immediately before and after each AVG play.

RESULTS

Children with overweight/obesity had a higher average of absolute VE, VO2, and VCO2 than their healthy-weight counterparts (BMI percentile < 85%; n = 21) during post-exercise recovery. RPE, HR, and HR% were not different between the game sessions and weight groups. Children with overweight/obesity showed a higher absolute VO2 during EPOC than healthy-weight children in both game sessions, but relative VO2 was higher in healthy-weight children during EPOC. No differences were observed for EPOC between UB and WB sessions.

CONCLUSIONS

Children with overweight/obesity had a greater EPOC than healthy-weight children after AVG sessions in terms of absolute oxygen values, whereas healthy-weight children have higher EPOC considering relative VO2 when controlling for body mass. UB and WB AVGs induced a similar EPOC among children with healthy weight and overweight/obesity. As UB and WB AVGs induce the rapid component of EPOC in children regardless their weight status, AVGs could be used as an exercise method to treat and prevent child obesity.

Facets of Impulsivity in Relation to Diet Quality and Physical Activity in Adolescence

Although the construct of impulsivity has generally been found to be associated with obesity and health behaviors in adults, research among adolescents is more limited and studies have yet to elucidate which facets of impulsivity may be most salient with regard to different eating and physical activity behaviors. Therefore, the present cross-sectional study assessed facets of impulsivity, measured by the UPPS-P questionnaire, in relation to health behaviors among adolescents. A sample of 2797 high school students from Los Angeles, California completed self-report measures during the ninth grade. The UPPS-P subscales (i.e., (lack of) premeditation, sensation seeking, (lack of) perseverance, negative urgency, positive urgency) were examined as predictors of unhealthy diet quality (i.e., frequency of consumption of high-fat foods and sweet food and drinks, measured by the National Cancer Institute (NCI) Quick Food Scan) and frequency of vigorous physical activity (measured by the Youth Risk Behavior Surveillance System). Greater sensation seeking, positive urgency, and negative urgency was associated with greater unhealthy diet quality (ps < 0.001). Greater negative urgency and lack of perseverance was associated with less frequent vigorous physical activity, whereas greater sensation seeking, lack of premeditation, and positive urgency was associated with more frequent vigorous physical activity (ps < 0.05). While negative urgency (i.e., impulsivity in the context of negative emotions) was consistently associated with poor health behaviors, other facets of impulsivity may potentiate vigorous physical activity in youth. Together these findings underscore the importance of considering the multidimensional nature of impulsivity in relation to adolescents’ health behaviors and highlight areas for future longitudinal research.

Effects of a 12-Weeks Yoga Intervention on Motor and Cognitive Abilities of Preschool Children

Since early childhood is regarded as an important period of motor and cognitive development, understanding the effects of physical activity on motor abilites and cognitive development in preschool children has major public health implications. This study investigates the effects of a 12 weeks' yoga intervention program on motor and cognitive abilities in preschool children. Preschool children (n = 45; age 5-6 years) attending regular preschool programs were non-randomly assigned to yoga intervention (n = 23; 30 min sessions three times per week) or a control group (n = 22; no additional organized physical activity program). Exercise training for the intervention group included yoga program. Motor abilities (BOT-2 subtests: fine motor integration, manual dexterity, balance and bilateral coordination), and cognitive abilities (School Maturity Test subtests: visual memory, stacking cubes and codes) were assessed before and after the intervention period in both groups. Data were analyzed using repeated-measures ANOVA. Participants in the intervention group improved fine motor integration (p = 0.022), fine motor skills in general (0.029), bilateral coordination (0.000), balance (0.000), and body coordination (0.000). Preschool children's participation in the preschool yoga intervention significantly improved their motor abilities, but not their cognitive abilities.

60 Minutes Per Day in Moderate to Vigorous Physical Activity as a Natural Health Protector in Young Population

The aim of this study was to check whether following the recommendations of the World Health Organization (WHO) concerning physical activity protects children and adolescents against the occurrence of overweight and obesity. A total of 1002 children were included in the analysis. The average age of the studied children was 9.36 years ± 3.52 years. Measurement of height and body mass was performed for every child, followed by physical activity assessment over seven days. In each group analyzed, the overweight and obese children had a shorter time in moderate to vigorous physical activity (MVPA) than the children with normal body mass. Among the children spending < 60 min per day in MVPA, the risk of occurrence of overweight and obesity was greater than among children with physical activity > 60 min per day. It was also shown that the greatest risk of occurrence of body mass disorder was a situation in which the mother’s gestational weight gain (GWG) is over 18 kg and the child does not spend a minimum of 60 min/day in MVPA. Not meeting the recommendation is connected with an increased chance of the occurrence of overweight and obesity. The level of physical activity influences the incidence of overweight and obesity. The children with overweight and obesity spent less time per day in MVPA. An increased body mass in mothers during pregnancy associated with a child’s low level of physical activity increases the risk of the occurrence of overweight and obesity.

Path Analysis on Determinants of Childhood Obesity and Associated Risk Factors of Cardiovascular, Renal, and Hepatic Diseases: The CASPIAN-V Study

The interaction between several lifestyle and obesogenic environmental factors is considered as the main underlying factor for the escalating trend of childhood obesity and its adverse consequences. In this study, we assessed the mutual influence of lifestyle habits and body mass index (BMI) as well as risk factors for cardiometabolic, hepatic, and renal disorders to define the causality power of each item. This nationwide cross-sectional study was conducted as the fifth round of a school-based surveillance program. Overall, 14,800 students living in Iran were studied, and blood samples were obtained from 4,200 of them. Demographic factors, anthropometric and biochemical measures were used to define lifestyle-related latent variables as well as cardiac, renal, and hepatic risk indicators. Total, direct, and indirect effects between factors were analyzed using the standardized regression weights for each pathway. Data from 14,274 students (participation rate of 99%) and 3,843 blood samples were included. All of the latent variables had a significant direct effect on BMI, with the most potent effect of unhealthy nutrition (β ≅ 0.63) in boys and girls. BMI has significant direct effects on risk indicators of cardiovascular, renal, and hepatic diseases with the most powerful effect on cardiovascular risk factors (β ≅  − 0.08). The most important predisposing factor for obesity was unhealthy nutrition, whereas increased activity, adequate sleep, and better hygiene had protective roles. BMI shows the strongest association with indicator of cardiovascular diseases. These findings underscore the importance of implementing public health programs for the prevention of chronic noncommunicable diseases.

Physical fitness and its association with overweight among early adolescents in Puducherry, Southern India

Objectives Physical fitness is an important indicator of health and longevity. This can reduce morbidity and mortality of Non-communicable diseases. We aimed to assess the physical fitness among early adolescents and its association with age, gender and obesity. Methods We conducted a cross sectional analytical study in a public school in Puducherry, south India among early adolescents (aged 10-14 years). We assessed the physical fitness components like body composition (body mass index, waist circumference), muscular strength and endurance (hand grip test, curl up test), flexibility (sit and reach test, shoulder stretch test), agility (shuttle run test) and cardio respiratory and endurance (600-yard run test). Results A total of 263 children were included; 141 (54%) were girls. 30 children (11%) were thin and 57 (22%) were either obese or overweight. Overall, median (IQR) right- and left-hand grip strength was 10 (6-14) and 13 (7-18) unit of kg respectively. Median (IQR) curl-ups performed in a minute were 14 (10-20). About 13% of children failed to perform left shoulder stretch. Children aged 12-14 years had higher median (IQR) right hand grip strength [14.5 (12-22) unit of kg] compared to children aged 10 and 11 years [6 (4-12) unit of kg] and this difference was statistically significant (p<0.001). The performance was similar in all tests between boys and girls except for left hand grip strength; boys had higher grip strength compared to girls (p=0.02). In girls, children who belonged to thinner BMI category performed better than obese children in shuttle run test (p=0.03). Conclusion There was a significant difference in physical fitness based on age except in left and right shoulder stretch test. Since the prevalence of overweight/obesity was high in adolescents, creating awareness and enabling environment related to the physical fitness is important.

The Effect of Narrative on Physical Activity via Immersion During Active Video Game Play in Children: Mediation Analysis

BACKGROUND

Active video games (AVGs) can increase physical activity (PA) and help produce higher physiological expenditure. Animated narrative videos (NVs) possess unique immersive and motivational properties. When added to AVGs, they have been found to increase moderate-to-vigorous physical activity (MVPA) as opposed to the original no video condition. However, there is no evidence of whether that was due to the NV or the addition of an animated video to an AVG.

OBJECTIVE

This study aimed to investigate the differential effect of adding an NV versus a nonnarrative video (NNV) to an AVG on PA parameters and physiological responses and to explore the mediating role of immersion.

METHODS

A total of 22 children aged 8 to 12 years were randomly assigned to the NV or NNV condition. They were instructed to play an AVG (on Xbox Kinect) for as long as they wanted. We used accelerometers to estimate the time spent (in minutes) in MVPA. Heart rate (HR) and rate of perceived exertion (RPE) were measured before, during, and after the AVG play session. The participants then reported their experience of narrative immersion via a questionnaire.

RESULTS

The NV group had significantly higher narrative immersion (mean 3.50, SD 0.55 vs mean 2.91, SD 0.59; P=.03) and MVPA (mean 19.46, SD 13.31 vs mean 7.85, SD 5.83; P=.02) than the NNV group. Narrative immersion was positively correlated with MVPA (r=0.52; P=.01) and average HR during AVG (r=0.43; P=.05). Mediation analysis indicated that narrative immersion mediated the effect of NV (NV vs NNV) on MVPA (direct effect: beta=7.51; P=.01). The indirect effect was that NV was positively correlated with the mediator variable narrative immersion (beta=.59; P=.03), which was itself marginally associated with MVPA (beta=6.95; P=.09); when narrative immersion was included in the model, the regression coefficient was attenuated.

CONCLUSIONS

AVG with added narratives elicits more narrative immersion, resulting in more minutes in MVPA. Narrative immersion served as a mediator between NV and MVPA via its elicitation of an elevated HR without increasing RPE. The inclusion of immersive narratives in AVG could be helpful for inducing MVPA, to enhance AVG engagement without additional exertion.

Effects of Neuromuscular Training on Motor Competence and Physical Performance in Young Female Volleyball Players

Although neuromuscular training (NMT) emphasizes injury prevention training, there is little information about its effects on performance in young athletes. This study aimed to investigate the effects of eight-weeks NMT on motor competence and physical performance in 10- to 12-year-old female volleyball players. Sixty-six participants (mean ± SD; 11.05 ± 0.72 years) were randomized into either the NMT group (NTG; n = 32) or control group (CON; n = 34). Sprint on 10-m, modified T-test, plank, vertical jump, and medicine ball throw tests were used to assess the physical performance. The Körperkoordinationstest für Kinder (KTK) was used to assess the subjects’ motor competence. The NMT was performed twice a week during the first 30 min of each regularly scheduled 90-minute volleyball training. Participants in the CON group attended only their regular volleyball training. A significant group x time interaction was found for Motor Quotient KTK (MQKTK) (p < 0.001), KTK lateral jumps (p < 0.001), and KTK shifting platforms (p < 0.01). There was a significant interaction for modified T-test results (p < 0.001) and vertical jump (p = 0.04). No change was observed in both groups for plank performance (p > 0.05). The NMT promoted significant gains in motor competence and physical performance in youth female volleyball players.

Physical Activity Assessment and Counseling in Pediatric Clinical Settings

Physical activity plays an important role in children's cardiovascular health, musculoskeletal health, mental and behavioral health, and physical, social, and cognitive development. Despite the importance in children's lives, pediatricians are unfamiliar with assessment and guidance regarding physical activity in children. With the release of the 2018 Physical Activity Guidelines by the US Department of Health and Human Services, pediatricians play a critical role in encouraging physical activity in children through assessing physical activity and physical literacy; providing guidance toward meeting recommendations by children and their families; advocating for opportunities for physical activity for all children in schools, communities, and hospitals; setting an example and remaining physically active personally; advocating for the use of assessment tools and insurance coverage of physical activity and physical literacy screening; and incorporating physical activity assessment and prescription in medical school curricula.

Self-reported history of concussions is associated with risk factors for suicide completion among high school students

BACKGROUND

Suicide is the third leading cause of death among adolescents. While research has found concussions to be a risk factor for suicide in adults, this relationship is not well studied in nationally representative samples of youth. This study examines the relationship between self-reported history of sports-related concussion and five risk factors for suicide completion.

METHODS

Data were obtained from the 2017 Youth Risk Behavior Surveillance Survey (n=13,353). Multivariate logistic regression models assessed the relationship between self-reported, sports-related concussion and five risk factors for suicide completion. Analyses controlled for sex, race/ethnicity, grade, bullying victimization, and sexual orientation. Subsample analyses were conducted stratified by sex. Interaction models examined biological sex as a possible effect modifier.

RESULTS

Overall, 15.0% of high school students reported a sports-related concussion in the past 12-months. Self-reported, sports-related concussion was significantly associated with greater odds of feeling sad/hopeless (Adj OR: 1.20; 95% CI:1.02-1.42), suicidal ideations (Adj OR: 1.25; 95% CI:1.02-1.55), suicide attempt (Adj OR: 1.60; 95% CI:1.31-1.96), and suicide attempt treated by a doctor/nurse (Adj OR: 2.35; 95% CI:1.68-3.29), adjusting for covariates. Stratified analyses demonstrated differences by sex, however, no direct evidence of effect modification was observed in interaction models.

LIMITATIONS

Data are cross-sectional, prohibiting causal inferences. Measures were assessed via self-report. No pre-concussion measures of mental health.

CONCLUSION

Self-reported sports-related concussion was associated with risk factors for suicide completion. No direct evidence of effect modification was observed but stratified analyses suggest biological sex may impact the observed relationship.

Building a culture of health through research: The role of the physical activity research center

This paper provides brief context for why the physical activity research center was created and how it supports the national movement to build a culture of health.

NASA Mission X Program for Healthy Eating and Active Living among Taiwanese Elementary School Students

PURPOSE

This study assessed the effects of an intervention program adapted from the NASA Mission X (MX) program on children's Healthy Eating Active Living (HEAL) knowledge and behaviors and anthropometry.

METHODS

This clustered randomized control trial recruited 8 elementary schools in remote rural areas of Northern Taiwan. The intervention was the 8-week MX program. All the 3rd and 4th graders were invited to the study (n = 245). Children's weight, height, HEAL knowledge and behaviors were measured pre- and post-intervention.

RESULTS

The intervention group had significantly more improvements than control group in physical activity knowledge score (+0.91 vs. +0.25, p = 0.002), diet knowledge score (+0.62 vs. +0.17, p = 0.044), and score of interests in NASA and space exploration (+0.34 vs. -0.07, p < 0.0001). BMI increased from 18.4 to 18.6 (p < 0.05) for the control group but did not change for the intervention group. The changes in BMI between groups did not differ significantly.

CONCLUSION AND PRACTICE IMPLICATIONS

This randomized controlled trial showed that the NASA MX program was feasible and acceptable among children in Taiwan, and improved children's HEAL knowledge. (ClinicalTrials.gov registration: NCT03355131).

OVERWEIGHT IN SCHOOLCHILDREN AND ASSOCIATION WITH PHYSICAL ACTIVITY AND PARENTAL HABITS

ABSTRACT Introduction: Excess weight in childhood and adolescence is an important health problem that tends to persist in adulthood. Among the causes of this increase there appears to be a consensus on emphasizing physical activity as an excellent strategy to achieve better weight control, and on considering some models of parental practices essential for the acquisition of healthy habits in young people. Objective: To study the role of physical activity (undertaken by children and their parents) in the prevalence of overweight in Spanish schoolchildren. Methods: We studied 1687 schoolchildren aged between 13 and 17 years and 2335 mothers and fathers. The body mass index (BMI) of each child was calculated and information was collected on the physical activity level of the children and the parental physical activity level and BMI. Results: The schoolchildren analyzed have a higher prevalence of excess weight than the national average, significantly associated with age, sex, and excess weight of the mother, showing no significant association with the level of physical activity, but instead with the parental level of physical activity. Discussion: As predictive variables for excess weight in schoolchildren we found sex, age and excess weight of the mother. Conclusion: There is a prevalence of obesity and overweight in the sample of schoolchildren studied, and this is significantly associated with age rather than with physical activity. This prevalence is also significantly associated with the excess weight of the parents and with the level of physical activity of the father, which appears to confirm the influence of family characteristics and household physical activity in excess weight among schoolchildren. Level of Evidence I; Diagnostic studies - Investigating a diagnostic test.

State Physical Education Policy Changes From 2001 to 2016

BACKGROUND

State policies influence the quantity and quality of educational programs delivered in schools. This study examined state physical education policy changes from 2001 to 2016 by analyzing data reported in The Shape of the Nation Report.

METHODS

Policies related to state mandates for physical education, time/credit requirements, assessment and fitness testing requirements, adoption of state standards, and allowance of substitutions were analyzed over 5 editions of the report using repeated measures statistics.

RESULTS

A majority of state physical education-related policies have not changed over the past 15 years despite calls by numerous public health agencies for enhanced physical education in schools. There was, however, a significant increase in the number of states adopting teaching standards and requiring assessment and fitness testing in physical education, mirroring a broader shift in education toward standards, assessment, and accountability.

CONCLUSIONS

Despite improved rigor in physical education through the adoption of standards and assessment practices, physical education continues to be marginalized in schools by a lack of curricular time and inappropriate substitution policies. Stronger policies are needed for physical education to have a substantial impact on school health.

Parenting practices that may encourage and discourage physical activity in preschool-age children of Brazilian immigrant families: A qualitative study

Brazilians are a rapidly increasing Latino immigrant group in the United States (US), yet little research has examined factors influencing physical activity (PA) levels and behaviors of children growing up in Brazilian immigrant families. This information is needed to develop culturally sensitive interventions tailored to this population. Therefore, this qualitative study explored PA parenting practices used by Brazilian immigrant mothers living in the US. Thirty-seven Brazilian immigrant mothers with at least one child between the ages of 2 and 5 years participated in 1of 7 focus group discussions. Thematic analysis identified seven parenting practices that mothers employ that may encourage or facilitate physical activity their preschool-aged children's PA including: 1) modeling PA; 2) engaging and being physically active with child; 3) providing logistic support; 4) encouraging, praising, and offering motivational support; 5) watching, supervising, and teaching children how to engage in PA; 6) monitoring and setting limits to child's screen time; and 7) prompting child to be physically active. In addition, analysis identified four parenting practices that may discourage or inhibit children's PA including: 1) modeling of sedentary behaviors; 2) having rules and restrictions due to safety- and weather-related concerns; 3) limiting child's outdoor time due to parental time constraints; and 4) restricting child's outdoor and play time as punishment. Furthermore, analyses demonstrated that social contextual factors (e.g., income, housing, neighborhood safety, etc.) influence mothers' PA parenting practices and consequently, their children's PA. This is the first qualitative study, to our knowledge, to explore PA parenting practices of Brazilian-born immigrant mothers living in the US. Future research should further explore PA parenting practices of Brazilian immigrant parents including quantifying PA parenting practices that encourage and discourage PA, as well as examining the influence of fathers' PA parenting practices on young children's PA.

Effects of exergaming on motor skill competence, perceived competence, and physical activity in preschool children

BACKGROUND

Few school settings offer opportunities for preschool children to engage in structured physical activity, and only a few studies have been conducted examining exergaming's effectiveness on health outcomes in this age group. This study's purpose, therefore, was to examine a school-based exergaming intervention's effect on preschool children's perceived competence (PC), motor skill competence (MSC), and physical activity versus usual care (recess), as well as to examine gender differences for these outcomes.

METHODS

A total of 65 preschool children from 2 underserved urban schools were assigned to 1 of 2 conditions, with the school as the experimental unit: (1) usual care recess group (8 weeks of 100min of recess/week (5 days × 20 min)) and (2) exergaming intervention group (8 weeks of 100min of exergaming/week (5 days × 20 min) at school). All children underwent identical assessments of PC, MSC, and moderate-to-vigorous physical activity (MVPA) at baseline and at the end of the 8th week.

RESULTS

A significant Group × Time effect was observed for MVPA, F(1, 52) = 4.37, p = 0.04, η p 2  = 0.04, but not for PC, F(1, 52) = 0.83, p = 0.37, η p 2  = 0.02, or MSC, F(1, 52) = 0.02, p = 0.88, η p 2  = 0.00. Specifically, the intervention children displayed significantly greater increased MVPA after 8weeks than the comparison children. Additionally, there was a significant time effect for MSC, F(1, 52) = 15.61, p < 0.01, η p 2  = 0.23, and gender effect for MVPA, F(1, 52) = 5.06, p = 0.02, η p 2  = 0.09. Although all preschoolers' MSC improved across time, boys demonstrated greater MVPA than girls at both time points.

CONCLUSION

Exergaming showed a positive effect in promoting preschool children's MVPA at school and has the potential to enhance PC and MSC. More research with larger sample sizes and longer study durations are warranted.

Prevalence of asthma symptoms and association with obesity, sedentary lifestyle and sociodemographic factors: data from the Hellenic National Action Plan for the assessment, prevention and treatment of childhood obesity (MIS301205)

Objectives: To evaluate the prevalence of asthma symptoms in a representative sample of Greek schoolchildren and to evaluate its association with overweight/obesity as well as other socioeconomic, demographic, and lifestyle factors. Methods: This is a cross-sectional study conducted from 10/2012 to 12/2013 on a pre-selected, representative elementary school cohort. Parents completed standardized questionnaires evaluating among others socioeconomic and sedentary activity habits. Students were measured with high sensitivity methods. Socioeconomic status (SES) index (range: 0-13) was calculated on years of parental education, rented versus owned residence, size of residence evaluated as meters squared per person (m²/person), and number of vehicles. Asthma was defined according to the approved Greek version of the International Study on Allergies and Asthma in Childhood (ISAAC) criteria. Results: The prevalence of any asthma symptoms was documented in 31% of population. The odds of presenting any asthma symptoms decreased with increase in age (odds ratio: 0.96, 95% CI: 0.94-0.98) and increased with overweight (odds ratio: 1.13, 95% CI: 1.03-1.25), obesity (odds ratio: 1.27, 95% CI: 1.11-1.46) and sedentary lifestyle. Conclusion: This is the first representative survey of prevalence of asthma symptoms in children and adolescents in Greece indicating its continuous increase. A strong association between presence of asthma symptoms and obesity and sedentary activities was documented irrespectively of socioeconomic and regional factors. The findings stress the importance of public health policies toward obesity prevention and enhancement of physical activities in pediatric populations.

Lifestyle Medicine: The Health Promoting Power of Daily Habits and Practices

There is no longer any serious doubt that daily habits and actions profoundly affect both short-term and long-term health and quality of life. This concept is supported by literally thousands of research articles and incorporated in multiple evidence-based guidelines for the prevention and/or treatment of chronic metabolic diseases. The study of how habits and actions affect both prevention and treatment of diseases has coalesced around the concept of "lifestyle medicine." The purpose of this review is to provide an up-to-date summary of many of the modalities fundamental to lifestyle medicine, including physical activity, proper nutrition, weight management, and cigarette smoking cessation. This review will also focus specifically on how these modalities are employed both in the prevention and treatment of chronic diseases including coronary heart disease, diabetes, obesity, and cancer. The review concludes with a Call to Action challenging the medical community to embrace the modalities of lifestyle medicine in the daily practice of medicine.

Message framing and counseling of parents on children's physical activity - an experimental study

How messages are framed (gain or loss frame) modulate the effect of health information on physical activity level in adults. The role of framing of health information messages to parents about their child's physical activity is unknown.

Adult participants (parents) were randomized to see a video that either emphasized the benefits of physical activity (gain frame) or the risks of physical inactivity (loss frame) in children. The primary outcome was the change in the reported level of physical activity for their children between baseline and two-week follow-up.

92 individuals participated in the study and we obtained follow-up data for 48 participants (20 gain frame and 28 loss frame). Using a generalized linear model, we found that the frame presented to parents significantly influenced the trajectory of their child's physical activity (p = 0.03), with the loss frame condition resulting in more favorable trajectory. Both the willingness to pay for organized physical activities and the perceived barriers to physical activity were similar between the two intervention groups.

The change in the reported level of activity of the child over a two-week period was significantly different whether parents were exposed to a loss frame or a gain frame video message.

Peer mentor versus teacher delivery of a physical activity program on the effects of BMI and daily activity: protocol of a school-based group randomized controlled trial in Appalachia

BACKGROUND

Rural Appalachian populations have poorer health and fewer positive health-related behaviors compared to other United States populations. Appalachians are the most sedentary U.S. population and teens are particularly sedentary. Obesity prevention through improving physical activity is a top priority in Rural Healthy People 2020. Obesity prevalence among Appalachian teens exceeds the national rates of 13.9% and has consistently been greater than 26%. Organized sports has not been effective at improving daily physical activity or health outcomes for Appalachian teens. The purpose of this study is to test the efficacy of a 10-week school-based intervention in promoting self-regulation of physical activity among adolescents not participating in organized sports. By using accelerometers, our study will measure both sedentary time and planned exercise during waking hours.

METHODS

The design for this four-year study is a group-randomized controlled trial (G-RCT). We will recruit high schools in 3 waves, with 4 in Wave 1, 8 in Wave 2, and 8 in Wave 3, for a total of 20 schools. For each wave of schools, we will randomly assign half of the schools to each condition--intervention (peer-to-peer mentoring [MBA]) and comparison (teacher-led [PBA])--for a total of 10 schools in each of the two conditions by study's end. We will collect data at baseline (T₁), 3 months post intervention (T₂), and 6 months post intervention (T₃). Linear Mixed Models (LMMs) and Generalized Linear Mixed Models (GLMMs) will be used to test the main hypotheses. Power for this study was based the primary analysis comparing BMI outcomes at T₂ between the groups, adjusting for baseline BMI values.

DISCUSSION

This study provides age-appropriate lifestyle education and skill building. Peer-to-peer mentoring by local high school students and school-based tailored support strengthens sustainable behavioral change. Focusing on unique healthy-lifestyle challenges prevalent in low-resource areas such as Appalachia such as overcoming environmental, social, and psychological barriers may improve adherence to physical activity. Serving as role models, peer mentors may improve their own lifestyle behaviors, providing a dual intervention.

TRIAL REGISTRATION

NCT02329262 .

Pediatric Playground-Related Injuries Treated in Hospital Emergency Departments in the United States

This study analyzed pediatric playground-related injuries data from the National Electronic Injury Surveillance System. An estimated 5 025 440 children <18 years were treated in US emergency departments for playground-related injuries during 1990-2012, averaging 218 497 children annually. The average patient age was 6.5 years. The overall annual injury rate declined during 1990-2007 ( P < .001) and then increased during 2007-2012 ( P < .001). The climbing equipment-related injury rate remained constant during 1990-2009 and then increased during 2007-2012 ( P = .014). The concussion/closed head injury rate increased during 1990-2008 ( P < .002) with the rate almost doubling from 2008-2012 ( P < .001). Falls accounted for 76.7% of all injuries and 87.7% of injuries to the upper extremities. Injuries resulted in hospitalization for 4.3% of patients. Despite current playground safety standards and guidelines, a large number of playground-related injuries continue to occur. Revised impact attenuation criteria for playground surfacing materials should be implemented and evaluated to more adequately prevent fall-related upper extremity fractures.

Parental Education and Pre-School Children's Objectively Measured Sedentary Time: The Role of Co-Participation in Physical Activity

Parental co-participation in physical activity (PA) may be a beneficial parenting practice for diminishing children's sedentary time (ST). Less information is available, however, on the explanatory role of co-participation in PA regarding parental educational differences in children's ST. Preschool-aged children (N = 864, mean age 4.8, 52% boys) with their parents participated in a cross-sectional DAGIS (Increased Health and Wellbeing in Pre-schools) study between years 2015 and 2016. Children (N = 821) wore an accelerometer for one week. Parents were informed of their educational background, and the frequency of visits with their child in nature, to parks or playgrounds, their own yard, and indoor sport facilities (N = 808). Testing the associations required multiple regression analyses. Parents with a low educational background reported more frequent visits with their child to their own yard, and these visits were associated with children's lower ST. More highly educated parents co-visited indoor sport facilities more frequently, although this did not have a significant association with children's ST. More frequent visits in nature were associated with a lower ST at weekends, regardless of educational background. Future health promotion strategies should inform parents that frequent co-participation in PA, for example, in one's own yard, is beneficial for lowering children's ST.

Association of Anthropometric and Lifestyle Parameters with Fitness Levels in Greek Schoolchildren: Results from the EYZHN Program

Objective

The aim of the study was to evaluate physical fitness (PF) and identify its anthropometric and lifestyle determinants in a sample of Greek schoolchildren.

Methods

The study sample consisted of 335,810 schoolchildren (♂: 51.3%, 6–18 years old). Students’ anthropometric parameters and PF levels—assessed via the Eurofit test battery—were measured by trained physical education teachers and evaluated according to the available norms, while their lifestyle habits were assessed through a questionnaire.

Results

In all applied PF tests, students’ performance was negatively associated with the presence of obesity and central obesity, defined through international criteria for body mass index and waist to height ratio, respectively. According to multiple logistic regression analysis, the presence of overweight/obesity [odds ratio (OR): 4.43, 95% confidence interval (CI): 3.98–4.93], low adherence to the MD (KIDMED ≤ 3) (OR: 1.27, 95% CI: 1.09–1.48), and increased time spent in sedentary activities (>2 h per day) (OR: 1.16, 95% CI: 1.03–1.29) were positively associated with poor PF, after adjusting for age and sex. In contrast, for every 1 day increase in the weekly frequency of engagement in athletic activity, the probability of poor PF decreased by 26% (OR: 0.74, 95% CI: 0.72–0.77). In a similar model, the presence of central obesity emerged as an even stronger possible predictor of poor PF (OR: 5.20, 95% CI: 4.66–5.78), compared to the presence of general obesity.

Conclusion

Higher general or abdominal adiposity, as well as the adoption of a low-quality diet and a sedentary lifestyle, is strongly associated with low PF levels during childhood.

Examining Influences of Parenting Styles and Practices on Physical Activity and Sedentary Behaviors in Latino Children in the United States: Integrative Review

BACKGROUND

Research indicates that parents influence their children's physical activity (PA) and sedentary behaviors (SB) through their parenting styles and practices.

OBJECTIVE

The objectives of this paper were to evaluate existing research examining the associations between parenting styles, parenting practices, and PA and SB among Latino children aged between 2 and 12 years, highlight limitations of the existing research, and generate suggestions for future research.

METHODS

The method of this integrative review was informed by methods developed by Whittemore and Knafl, which allow for the inclusion of qualitative, quantitative, and mixed-methods studies. Using the Preferred Reporting Items for Systematic Reviews Meta-Analyses guidelines, five electronic academic databases (PubMed, SPORTDiscus, PsycINFO, PsycARTICLES, and CINAHL) were searched for peer-reviewed, full-text papers published in English. Of the 641 unique citations identified, 67 full-text papers were retrieved, and 16 were selected for review.

RESULTS

The majority of the 16 reviewed studies were conducted with predominantly Mexican American or Mexican immigrant samples, and only 1 study examined the association between parenting styles and Latino children's PA and SB. Most (n=15) reviewed studies assessed the influence of parenting practices on children's PA and SB, and they provide good evidence that parenting practices such as offering verbal encouragement, prompting the child to be physically active, providing logistic support, engaging and being involved in PA, monitoring, and offering reinforcement and rewards encourage, facilitate, or increase children's PA. The examined studies also provide evidence that parenting practices, such as setting rules and implementing PA restrictions due to safety concerns, weather, and using psychological control discourage, hinder, or decrease children's PA.

CONCLUSIONS

Because this review found a very small number of studies examining the relationship between parenting styles and Latino children's PA and SB, additional research is needed. Given that the majority of reviewed studies were conducted with predominantly Mexican American or Mexican immigrant samples, additional research examining parenting styles, parenting practices, and PA and SB among multiethnic Latino groups is needed to design interventions tailored to the needs of this ethnically diverse population group.

Trends in Attitudes and Practice Patterns of Physical Therapists in Addressing Childhood Obesity in Schools

PURPOSE

This study investigated trends in attitudes of school physical therapists about intervention for childhood obesity.

METHODS

A survey was developed to quantify attitudes. Two cases investigated the influence of attitudes on choices in treatment frequency. Factor analysis further delineated reasons for treatment frequency recommendations.

RESULTS

Attitudes did not change. Variability in responses decreased. Personal characteristics had evolving influence. In 2008, the perception of the PT's role in childhood obesity intervention had a greater influence on the choice to treat, but in 2015 the perception of the seriousness had a bigger effect on that decision.

DISCUSSION

Changing demographics of the therapists, increasing prevalence of obesity, and recent attention to the problem may have contributed to the trends.

CONCLUSION

There is no consensus as to the role of school physical therapy with intervention for obesity, but influential variables are emerging and practice patterns are evolving.

Pediatric Obesity Algorithm: A Practical Approach to Obesity Diagnosis and Management

Childhood obesity is a growing global health problem. Despite the highest rates of childhood obesity in the United States and other developed countries over the last 30 years, there is still no clear treatment strategy. Practitioners often do not know where to turn to find guidance on managing the nearly one third of their population who present for medical care either with obesity that coexists with other medical problems or because of obesity. The Pediatric Obesity Algorithm is an evidence based roadmap for the diagnosis and management of children with obesity. In this article, we summarize topics from the Pediatric Obesity Algorithm pertaining to pediatric obesity diagnosis, evaluation, and management including assessment, differential diagnosis, review of systems, diagnostic work up, physical exam, age specific management, comorbidities, use of medications and surgery, and medication associated weight gain. Identifying and treating children with obesity as early as possible is important, as is identifying comorbid conditions. Earlier and more comprehensive management through resources such as the Pediatric Obesity Algorithm serve to help guide health care practitioners with a practical and evidence based approach to the diagnosis and management of children with obesity, and provide families with the tools needed for a healthy future.

The Physical Activity Environment and Academic Achievement in Massachusetts Schoolchildren

BACKGROUND

A supportive school-based physical activity environment (PAE) is integral to children's physical activity behaviors, but less understood is its association with academic achievement. We aimed to assess the association between PAE and academic performance and whether a stronger relationship exists in lower-income schools (LIS) compared to middle-income schools (MIS).

METHODS

Schoolchildren (grades 3rd to 5th) were recruited from 17 Massachusetts public schools. Schools were classified based on geographic characteristics and free/reduced-price lunch (FRPL) eligibility (LIS = 7, Median FRPL = 86%; MIS = 10, Median FRPL = 20%). PAE was measured using a 10-item survey. Mixed-effects logistic regression models were used to examine associations between PAE and scoring Advanced/Proficient on standardized Math and English Language Arts (ELA) tests.

RESULTS

Demographic characteristics differed between LIS (N = 278, 5% non-Hispanic white) and MIS (N = 297, 73% non-Hispanic white). In LIS, PAE was associated with Math (odds ratio = 5.40, 95% CI = 2.52-11.54 p < .001), but not ELA test scores (p > .05). There was no relationship between PAE and MIS test scores (p > .05). Schooltime moderate-to-vigorous physical activity was not associated with test scores (p > .05).

CONCLUSIONS

A beneficial relationship exists between a high-PAE and test scores among LIS children, suggesting that the PAE may be associated with a more supportive environment and may be more fundamentally important for lower-income students.

Impact of commuting exposure to traffic-related air pollution on cognitive development in children walking to school

A few studies have found associations between the exposure to traffic-related air pollution at school and/or home and cognitive development. The impact on cognitive development of the exposure to air pollutants during commuting has not been explored. We aimed to assess the role of the exposure to traffic-related air pollutants during walking commute to school on cognitive development of children. We performed a longitudinal study of children (n = 1,234, aged 7-10 y) from 39 schools in Barcelona (Catalonia, Spain) who commuted by foot to school. Children were tested four times during a 12-month follow-up to characterize their developmental trajectories of working memory (d' of the three-back numbers test) and inattentiveness (hit reaction time standard error of the Attention Network Test). Average particulate matter ≤2.5 μm (PM_2.5), Black Carbon (BC) and NO₂ concentrations were estimated using Land Use Regression for the shortest walking route to school. Differences in cognitive growth were evaluated by linear mixed effects models with age-by-pollutant interaction terms. Exposure to PM_2.5 and BC from the commutes by foot was associated with a reduction in the growth of working memory (an interquartile range increase in PM_2.5 and BC concentrations decreased the annual growth of working memory by 5.4 (95% CI [-10.2, -0.6]) and 4.6 (95% CI [-9.0, -0.1]) points, respectively). The findings for NO₂ were not conclusive and none of the pollutants were associated with inattentiveness. Efforts should be made to implement pedestrian school pathways through low traffic streets in order to increase security and minimize children's exposure to air pollutants.