Physical activity assessment in children and adolescents

A Longitudinal Assessment of the Impact of Biological Maturity and Menarche on Adolescents' Organized Sport and Physical Activity Participation

INTRODUCTION

Processes accompanying growth and maturation are known to impact physical activity (PA) participation among adolescents. This study evaluated the longitudinal impact of these processes on organized sport participation and moderate-to-vigorous PA (MVPA) among male and female adolescents.

METHODS

This study used secondary analysis of data from a longitudinal cohort of 6639 adolescents (Age = 12.92 ± 0.81 years; Males = 3302; Females = 3226) collected using confidential, online self-report surveys through the Health4Life Study across 71 secondary schools in Australia from 2019 to 2022. Controlling for age, socioeconomic status, and state, mixed effects regression models assessed the impact of pubertal stage, relative pubertal timing, and period status (female adolescents only) on organized individual and team sports and MVPA participation.

RESULTS

While organized sport and MVPA participation reduced over time for all participants, male and female adolescents responded differently to puberty. Male adolescents showed marginally greater likelihood of participation in organized team sport during early puberty and individual sport during late puberty, but female adolescents significantly reduced individual sport participation during middle, late, and postpubertal stages. Relative pubertal timing did not impact male adolescents, but early maturing female adolescents were significantly less likely to participate in organized team and individual sports. Achieving menarche was linked to lower odds of individual sport participation only.

CONCLUSIONS

Declining PA participation rates suggest that adolescents may need support for maintaining PA. Disparate effects of puberty in male and female adolescents advocate for separate approaches based on their specific characteristics. Future research should explore the impact of specific sport environment characteristics and menstrual cycle experiences on PA.

Assessment of Sport and Physical Recreation Participation for Children and Youth with Disabilities: A Systematic Review

Accurate measurement of participation in sport/physical recreation for children with disabilities is important due to decreased physical activity in this population. This review examines the psychometric properties of relevant assessments. Four databases were searched for studies investigating assessments of participation in sport/physical recreation for children and youth with disabilities. The assessment content was analyzed by the proportion of items relevant to sport/physical recreation and the inclusion of participation elements (attendance or involvement). The evidence quality was evaluated using COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklists and summarized according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Nine assessments (46 papers) met criteria. Only the Children's Assessment of Participation and Enjoyment measured attendance and involvement. Five assessments measured attendance (12-90% items related to sport/physical recreation) and three context-dependent assessments measured involvement. Only the Measure of Experiential Aspects of Participation and Self-reported Experiences of Activity Settings (involvement) were recommended by GRADE. No assessment adequately measured attendance and involvement in sport/physical recreation for children and youth with disabilities. While existing assessments may continue to be used to measure global participation, a comprehensive assessment of sport and physical recreation should be developed with and evaluated for children and youth with disabilities.

Development and Testing of the Observational System for Recording Physical Activity in Children-Toddlers

Background: Direct observation (DO) tools developed for preschoolers have been used to describe toddler physical activity (PA). No DO system created to assess PA levels and the childcare environment of toddlers exists. The purpose of this study was to develop the Observational System for Recording Physical Activity in Children-Toddlers (OSRAC-T) and assess the inter- and intra-rater reliability. Methods: This tool is an extension of the Observational System for Recording Physical Activity in Children-Preschool and uses the same focal child, time sampling system (5-second observation and 25-second recording). Tool content was established through identifying similar research, consulting with experts, and conducting informal observations. A sample of toddlers (12-36 months) was observed and video recorded during childcare. In-person observations were compared to video observations from one coder (intrarater reliability). Video observations (39% of intervals) were coded by two raters to determine interrater reliability. Results: The final instrument included nine categories that described PA level and type, social and environmental contexts, and transition support relevant to toddlers. Observers completed 124 observation sessions (n = 31; 25.5 ± 6.0 months) resulting in 7,757 30-second observation intervals. Interval-by-interval agreement was moderate to high (58.90%-95.30%) for all categories, and interrater reliability was low to moderate (k = 0.28-0.69). Conclusion: The OSRAC-T is a reliable observation system to assess several PA-related behaviors of toddlers. It may be used to better inform early childcare center design, future intervention studies, or to assess correlates or relationships between PA behavior and health outcomes in toddlers.

Healthier Diet and Diet-Related Behaviors Are Associated with Increased Physical Activity and Reduced Sedentary Behavior Among Adolescents in Greece

BACKGROUND/OBJECTIVES

Healthy diet, regular physical activity (PA), and minimizing sedentary behavior (SB) are crucial in promoting adolescents' health and well-being. We assessed adherence to PA and SB recommendations among a representative sample of adolescents and explored their relationship with diet and diet-related behaviors.

METHODS

Data from the Greek arm of the 2017/2018 international Health Behavior in School-Aged Children (HBSC) cross-sectional study were used, including a probability sample of 3357 students (47.6% boys) who were 11, 13, and 15 years old. PA, SB, consumption of food groups/beverages, and diet-related behaviors were self-reported. Multiple logistic regression was used to identify potential associations.

RESULTS

Most students failed to meet PA (83.9%) (i.e., ≥1 h of moderate-to-vigorous physical activity/day) and SB (90.2%) (i.e., ≤2 h of screen time/day) recommendations. Daily consumption of fruit and vegetables compared to consumption at ≤1 day/week was associated with increased adherence to PA recommendations (adjusted Odds Ratio (aOR) = 2.26, 95% Confidence Intervals (CI): 1.62-3.17 for fruit; aOR = 1.35, 95%CI: 1.00-1.82 for vegetables). Eating sweets ≤1 day/week vs. every day was associated with higher adherence to SB recommendations (aOR = 2.41, 95%CI: 1.43-4.04). Poor diet quality was related to lower adherence to PA and SB recommendations. Daily breakfast consumption vs. never and abstaining from eating at fast-food restaurants were associated with better adherence to PA and SB recommendations. Rarely eating in front of screens was associated with substantially higher odds of adhering to SB recommendations (aOR = 5.79, 95%CI: 3.67-9.14).

CONCLUSIONS

Healthier diet/diet-related behaviors were associated with increased PA and reduced SB in this sample of adolescents.

Influence of pre-processing criteria on analysis of accelerometry-based physical activity

BACKGROUND

Accelerometers are widely adopted for physical activity (PA) measurement. Accelerometry data require pre-processing before entering formal statistical analyses. Many pre-processing criteria may influence PA outcomes and the processed sample, impacting results in subsequent statistical analyses.

AIM

To study the implications of pre-processing criteria for accelerometer data on outputs of interest in physical activity studies.

METHODS

We used the ActiGraph hip-worn accelerometry data from 538 adult Latino participants. We studied four most important domains of pre-processing criteria (wear-time, minimum wear-time, intensity level, and modified bouts). We examined the true sample size in pre-processed data, the moderate-to-vigorous physical activity (MVPA) outcome, and regression coefficients of age and gender predicting MVPA.

RESULTS

Many pre-processing criteria have minimum impact to the output of interest. However, requirements for minimum wear-time can have high influence on subsequent analyses for MVPA. High requirements for wear-time (e.g., minimum of 5 days with more than 12 hours of wear-time per day) lead to weakened statistical efficiency in estimating the relationship between potential predictors and the MVPA outcome. Intensity levels using vector magnitude triaxial counts yielded drastically different results than those using conventional vertical axis counts.

CONCLUSION

Moderate changes in minimum wear-time can yield notably different output data and subsequently influence analyses assessing the impacts of interventions on MVPA behaviors. Processed data using vector magnitude and conventional vertical axis counts are not directly comparable. Sensitivity analyses using alternative pre-processing scenarios are highly recommended to verify the robustness of analyses for accelerometry data.

Design of a Freely Accessible Web Application (Instrument for the Measurement of Balance in Primary Education, IMEP) for the Assessment of Static and Dynamic Balance in Children Aged 6-9 Years Based on Force Platforms

Background: The proper development of balance is essential in the acquisition of a correct physical condition, as well as in the evolutionary follow-up at early ages, and its periodic evaluation is very relevant in the educational environment. Objectives: The objective of this research was to design an accessible web application for static and dynamic balance assessment, based on a force platform and motion analysis software. Methods: The Single leg balance test (SLB), Tandem balance test (TBT), and Y balance test (YBT) were performed on a sample of 75 children aged 6 to 9 years. Results: The results show that static balance is more complex at an older age, greater standing height, and with eyes closed (p < 0.001). Regarding the center of pressure (COP), its variability was greater in girls owing to a lower Total Force (TF) at the time of the test (p < 0.05). Parallel observation with the Kinovea software has made it possible to elaborate a scale from 1 to 10 points for integration into an open-access web application (IMEP) to assess static and dynamic balance. Conclusions: The creation of an ad hoc application for primary school teachers and students has been possible by using validated devices obtaining a rating scale, which facilitate the monitoring of students' functional evolution and offers the possibility of scheduling physical education sessions with a preventive approach as well as a focus on improving physical condition.

Should organized sport characteristics be considered as a strategy for meeting physical activity guidelines in children?

BACKGROUND

A clearer understanding of the relationships between specific sport context with overall physical activity (PA) and sedentary time (ST) may contribute to the development of more accurate preventive strategies to increase children's engagement in PA.

PURPOSE

This study aimed to examine how different organized sports contributed to children's daily PA and ST.

METHODS

PA was measured for seven days via accelerometers, in 410 children aged 6-10 years (49.8% boys). Of those, 332 (53.0% boys) were engaged in an organized sport and were further considered for statistical analyses. Parents reported children's sport participation (e.g. which sport, number of times per week, duration). The sports were classified into: indoor vs. outdoor; individuals vs. team; combat vs. individual aesthetic vs. racing vs. invasion. Children's height and weight were objectively collected. Multiple one-way analyses of covariance were used to examine the effects of sport characteristics on PA and ST. A linear regression, adjusted for children's sex, age, body mass index and father's educational level, determined the relationship between being involved in multiple PA and sedentary behaviours with Moderate to Vigorous PA (MVPA) levels.

RESULTS

Although engaged in an organized sport, only 30% of the children achieved the PA recommendations. Sport (compared with active commute and active play) was the best contributor to daily MVPA. Outdoor sports (vs. indoor) contributed the most to vigorous PA (VPA) and MVPA. Team sports (vs. individual) were significantly associated with lower ST. Children in combat sports accumulated more VPA and MVPA, while those in racing sports showed a higher ST.

CONCLUSIONS

Sport participation alone does not guarantee children will reach the PA guidelines, and the type of sport can influence children's PA levels. Gender-stereotypes in sports may prevent girls from achieving their 60 minutes of MVPA daily.

Clustering of diet and physical activity behaviours in adolescents across home and school area-level deprivation in Cameroon, South Africa, and Jamaica

BACKGROUND

Adolescence is a crucial period for establishing healthy behaviours that can reduce the risk of noncommunicable diseases. However, limited data exist on the clustering of health-related behaviours, in adolescents from low- and middle-income countries (LMICs). This study examined how diet and physical activity behaviours cluster and how they are influenced by home and school area-level deprivation.

METHODS

The study surveyed 527 adolescents in Yaoundé (Cameroon), Kingston (Jamaica), and Cape Town (South Africa) and grouped them into three categories according to the socioeconomic status (SES) of their homes and school areas (low-low, low-high, and high-high). A k-median algorithm defined three clusters and measured dietary attributes including Dietary Habit Score (DHS), Healthy Food Score (HFS), Nutritional Knowledge Questionnaire (NKQ), moderate-to-vigorous physical activity (MVPA), and sedentary time using validated questionnaires. The clusters were ranked based on their physical activity levels and compared them within each city using statistical tests.

RESULTS

The scores on the NKQ and HFS indicated a poor level of both nutritional knowledge and healthy food consumption across sites. Cluster analysis revealed a consistent pattern of high screen time clustering with lower (less healthy) dietary scores across sites. This pattern was consistent regardless of SES in Kingston, and SES and school socioeconomic areas in Cape Town and Yaoundé.

CONCLUSION

An inverse clustering of sedentary behaviour duration and eating habits remained consistent across different strata for at least two sites, suggesting that interventions to reduce sedentary time could have a ripple effect on multiple NCD risk factors in adolescence.

Identifying data gaps in early childhood physical activity evidence

Childhood physical activity sets the foundation for health. While we know many factors that contribute to physical activity, there are limitations in our knowledge, especially in early childhood. Through our review, we identify gaps in existing datasets to guide future research.

Investigating heart rate responses of children to active travel: a mixed effects modeling analysis

BACKGROUND

The active travel concept has gained recognition as an effective method to enhance physical activity in children's everyday mobility. Yet, there is a notable gap of quantitative evidence on its direct impacts, especially regarding physiological outcomes that can concretely demonstrate its influences on physical intensity and overall health of children.

METHODS

This study investigates the effects of active travel on children, focusing on trip-level physiological responses, specifically heart rate. Through a mixed survey design, we obtained a repeated-measures dataset from a cohort of 73 children (average age 13) across three Austrian secondary schools, each observed for 7 days. By applying mixed effects modelling approach, both fixed and random effects to children's heart rates were explored.

RESULTS

According to results from developed mixed linear models (maximum R2 = 0.22), it revealed a significant positive association between active travel mode(s) engagement and heightened physiological responses (Low, Medium and High active level of trip compare to None: β = 1.81, 5.01 and 8.34, t-value = 4.70, 10.29 and 21.34), indicating that increased usage of active travel modes led to elevated heart rate values. Additionally, subjective perceptions also played an important role in influencing children's physiological responses. Feelings of exhausted, anxiety, and stress contributing to a higher heart rate (β = 14.79, 16.69 and 1.99, t-value = 20.42, 5.67 and 3.0), while unhappiness was associated with a lower heart rate (β = -5.96, t-value = -14.62). Effects of social interactions were also found during the trip. The presence of adults was associated with a calming effect (β = -1.92, t-value = -5.72), whereas solo travel resulted in lower heart rate compared to travel with peers (β = -1.95, t-value = -6.59).

CONCLUSION

Our article innovatively employs mixed survey methods and heart rate data to quantitatively demonstrate the positive association between engagement in active travel modes and heightened physiological responses in children, elucidating the intricate interplay of subjective perceptions and social interactions during trips, thus offering valuable insights into the health implications of active travel at a trip level. Future research will keep on leveraging survey and experimental methods.

24-Hour Movement Behaviors of LGBTQA+ Young People: A Systematic Review

BACKGROUND

The movement behaviors of LGBTQA+ young people, who encounter specific health, and other, challenges are not well understood. This systematic review examines the 24-hour movement behaviors of LGBTQA+ young people compared with population estimates of meeting the 24-hour movement guidelines.

METHODS

Seven electronic databases were searched from inception to January 2024. Observational studies published in English and reporting quantitative data for physical activity, sedentary behavior, or sleep duration for LGBTQA+ individuals <24 years old were included. Data were narratively synthesized for children/adolescents (<18 years) and young adults (18-24 years), guided by the Cochrane Synthesis Without Meta-analysis guidelines.

RESULTS

Fifty-six studies were included; 46 were of "fair" quality and 37 were conducted in the United States. Physical activity, sedentary behavior, and sleep outcomes were reported in 46, 11, and 14 studies, respectively. Ninety unique LGBTQA+ terms were identified. Based on outcomes reported in ≥1 study, and compared to population estimates, LGBTQA+ young people were less likely to meet aerobic physical activity and strength/resistance training guidelines. LGBTQA+ children/adolescents were less likely to meet the sleep guidelines. Young adults demonstrated similar adherence to sleep guidelines as population estimates.

CONCLUSIONS

Overall, our results suggest that LGBTQA+ young people have suboptimal 24-hour movement behaviors; in some cases, worse than population estimates. Utilization of more robust measures of exposure and outcome variables is recommended, with a focus on sleep and sedentary behavior.

Evaluation of the ActiMotus Software to Accurately Classify Postures and Movements in Children Aged 3-14

BACKGROUND

ActiMotus, a thigh-accelerometer-based software used for the classification of postures and movements (PaMs), has shown high accuracy among adults and school-aged children; however, its accuracy among younger children and potential differences between sexes are unknown. This study aimed to evaluate the accuracy of ActiMotus to measure PaMs among children between 3 and 14 years and to assess if this was influenced by the sex or age of children.

METHOD

Forty-eight children attended a structured ~1-hour data collection session at a laboratory. Thigh acceleration was measured using a SENS accelerometer, which was classified into nine PaMs using the ActiMotus software. Human-coded video recordings of the session provided the ground truth.

RESULTS

Based on both F1 scores and balanced accuracy, the highest levels of accuracy were found for lying, sitting, and standing (63.2-88.2%). For walking and running, accuracy measures ranged from 48.0 to 85.8%. The lowest accuracy was observed for classifying stair climbing. We found a higher accuracy for stair climbing among girls compared to boys and for older compared to younger age groups for walking, running, and stair climbing.

CONCLUSIONS

ActiMotus could accurately detect lying, sitting, and standing among children. The software could be improved for classifying walking, running, and stair climbing, particularly among younger children.

Fact or Fiction-Accelerometry Versus Self-Report in Adherence to Pediatric Concussion Protocols: Prospective Longitudinal Cohort Study

Background

Concussion, or mild traumatic brain injury, is a growing public health concern, affecting approximately 1.2% of the population annually. Among children aged 1-17 years, concussion had the highest weighted prevalence compared to other injury types, highlighting the importance of addressing this issue among the youth population.

Objective

This study aimed to assess adherence to Return to Activity (RTA) protocols among youth with concussion and to determine if better adherence affected time to recovery and the rate of reinjury.

Methods

Children and youth (N=139) aged 5-18 years with concussion were recruited. Self-reported symptoms and protocol stage of recovery were monitored every 48 hours until symptom resolution was achieved. Daily accelerometry was assessed with the ActiGraph. Data were collected to evaluate adherence to the RTA protocol based on physical activity cutoff points corresponding to RTA stages. Participants were evaluated using a battery of physical, cognitive, and behavioral measures at recruitment, upon symptom resolution, and 3 months post symptom resolution.

Results

For RTA stage 1, a total of 13% of participants were adherent based on accelerometry, whereas 11% and 34% of participants were adherent for stage 2 and 3, respectively. The median time to symptom resolution was 13 days for participants who were subjectively reported adherent to the RTA protocol and 20 days for those who were subjectively reported as nonadherent (P=.03). No significant agreement was found between self-report of adherence and objective actigraphy adherence to the RTA protocol as well as to other clinical outcomes, such as depression, quality of life, and balance. The rate of reinjury among the entire cohort was 2% (n=3).

Conclusions

Overall, adherence to staged protocols post concussion was minimal when assessed with accelerometers, but adherence was higher by self-report. More physical activity restrictions, as specified in the RTA protocol, resulted in lower adherence. Although objective adherence was low, reinjury rate was lower than expected, suggesting a protective effect of being monitored and increased youth awareness of protocols. The results of this study support the move to less restrictive protocols and earlier resumption of daily activities that have since been implemented in more recent protocols.

Influence of Physical Activity, Physical Fitness, Age, Biological Maturity and Anthropometric Variables on the Probability of Suffering Lumbar, Neck and Shoulder Pain in Spanish Adolescents from the Region of Murcia

Background: Back pain in adolescents is a common injury, mainly affecting the lumbar, cervical and sometimes shoulder region. This has been related to various factors, such as lifestyle habits or physical capacity, but no previous research has shown conclusive results. The aims of this study was to analyze the risk of suffering lumbar, neck and shoulder pain according to anthropometric and physical fitness variables, physical activity level, age and biological maturity in adolescents, as well as the influence of sex in the study results. Methods: A descriptive cross-sectional study was performed, including a sample of 2015 adolescents (boys: n = 1006, mean age = 14.41 ± 1.35 years-old; girls: n = 1009, mean age = 14.48 ± 1.41 years-old). The participants underwent an anthropometric evaluation and physical fitness tests were carried out, including a 20 m shuttle run, a counter movement jump, a horizontal jump, a 20 m sprint and push-up tests, followed by the completion of lumbar, neck and shoulder pain questionnaires. Results: Higher values in age and peak height velocity (PHV) showed an increase in the risk of suffering lumbar, neck and shoulder pain (OR = 0.79-1.55; p = 0.000-0.025). The anthropometric variables related to adiposity showed an increase in the risk of suffering back pain, with significant incidence in the lumbar region (OR = 1.32-1.60; p = 0.000); while muscle mass showed a protective effect (OR = 0.59; p = 0.000). Regarding the fitness tests, a better physical fitness seemed to protect adolescents from suffering from the analyzed back pains in the general sample and in the boys sample (OR = 0.56-1.60; p = 0.000), while in the girls sample the influence of the physical fitness was less relevant. Conclusions: Both anthropometry and physical fitness may influence the occurrence of back pain in adolescents, with some variations in their importance according to sex.

Subjective measurement of physical activity and sedentary behaviour in children and adolescents with cerebral palsy: a scoping review

PURPOSE

Physical activity is essential for maintaining overall health. Cost-effective and easily administered outcome instruments are valuable for clinical practice and large-scale population studies. The scoping review aimed to identify and map subjective instruments developed or validated to measure habitual physical activity and/or sedentary behaviour in children and adolescents with cerebral palsy aged 0-18 years across all levels of the GMFCS-E&R.

MATERIALS AND METHODS

This scoping review was conducted in accordance with the JBI methodology for scoping reviews and searched the databases PubMed, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, JBI Database of Systematic Reviews and Implementation Reports, Embase and Pedro to identify articles.

RESULTS

From 288 full-text references, 13 studies met the inclusion criteria. Nine instruments measured habitual physical activity and/or sedentary behaviour in children and adolescents with cerebral palsy aged 18 months to 18 years. Six subjective instruments were tested for ambulatory children, while three instruments were tested in children and adolescents at GMFCS-E&R level I-V.

CONCLUSION AND IMPLICATIONS

Reporting of the psychometric properties were found on reliability in three instruments, while data on validity were reported in all instruments. Further studies assessing the psychometric properties of subjective instruments in the target population are needed.

Microbial Ecology and Metabolism of Emerging Adulthood: Gut Microbiome Insights from a College Freshman Cohort

The human gut microbiome (GM) undergoes dynamic changes throughout life, transitioning from infancy to adulthood. Despite improved understanding over the past years about how genetics, lifestyle, and the external environment impact the GM, limited research has explored the GM's evolution during late-stage adolescence, especially among college students. This study addresses this gap by investigating the longitudinal dynamics of fecal microbial, functional, and metabolomic signatures in a diverse group of first-year, dormitory-housed college students. A total of 485 stool samples from 246 participants were analyzed, identifying four primary GM community types, predominantly led by Bacteroides (66.8% of samples), as well as Blautia and Prevotella. The Prevotella/Bacteroides (P/B) ratio emerged as a robust GM composition indicator, predictively associated with 15 metabolites. Notably, higher P/B ratios correlated negatively with p-cresol sulfate and cholesterol sulfate, implying potential health implications, while positively correlating with kynurenic acid. Distinct GM transition and stability patterns were found from a detailed longitudinal subset of 93 participants over an academic year. Parasutterella and the Ruminococcus gnavus group exhibited positive associations with compositional variability, whereas Faecalibacterium and Eubacterium ventriosum group displayed negative associations, the latter suggesting stabilizing roles in the GM. Most notably, nearly half of the longitudinal cohort experienced GM community shifts, emphasizing long-term GM adaptability. Comparing individuals with stable community types to those undergoing transitions, we observed significant differences in microbial composition and diversity, signifying substantial shifts in the microbiota during transitions. Although diet-related variables contributed to some observed variance, diet did not independently predict the probability of switching between community types within the study's timeframe via multi-state Markov modeling. Furthermore, exploration of stability within dynamic microbiomes among the longitudinal cohort experiencing shifts in community types revealed that microbiome taxa at the genus level exhibited significantly higher total variance than estimated functional and fecal metabolomic features. This suggests tight control of function and metabolism, despite community shifting. Overall, this study highlights the dynamic nature of the late-stage adolescent GM, the role of core taxa, metabolic pathways, the fecal metabolome, and lifestyle and dietary factors, contributing to our understanding of GM assembly and potential health implications during this life phase.

Predicting Adolescents' Leisure-Time Physical Activity Levels: A Three-Wave Prospective Test of the Integrated Model of Self-Determination Theory and the Theory of Planned Behavior

A three-wave prospective study was conducted to provide a better understanding of the ability of the integrated model of self-determination theory (SDT) and the theory of planned behavior (TPB) to predict future physical activity (PA) engagement among adolescents. Nearly 2500 secondary school students from China were recruited to test the hypothesized pathway from autonomous motivation from SDT at baseline (T1) through the constructs of TPB one month later (T2) on leisure-time PA levels of secondary school students three months later (T3). The findings revealed that the structural equation models yielded excellent fit indices with χ2 = 1858.989, df = 257, CFI = 0.936, TLI = 0.926, RMSEA = 0.050 [90% CI = 0.048 to 0.052], and SRMR = 0.032. In particular, autonomous motivation at T1 was positively associated with attitude (R2 = 0.160), subjective norms (R2 = 0.160), and perceived behavioral control (PBC) (R2 = 0.173) at T2 (β = 0.395 to 0.414, p < 0.001) and subsequently associated with intention at T2 (R2 = 0.875, β = 0.112 to 0.478, p < 0.001). T2 intention was positively associated with leisure-time PA levels (R2 = 0.004) at T3. Our findings contribute to a better understanding of the motivational mechanisms and social cognition processes involved in predicting adolescents' leisure-time PA levels among adolescents.

A Semester of Hatha Yoga Has Comparable Effects to Physical Education for Children in Terms of Physical Activity and Psychosocial Indicators

BACKGROUND/OBJECTIVES

As research on yoga with school children is growing, this study investigated the effects a semester of yoga versus physical education on children's physical activity and psychosocial indicators.

METHODS

Physical activity and psychosocial variables were assessed at Time 1 (January/February) and Time 2 (April/May) through self-report surveys (n = 157; 63% female, age: m = 10.38, sd = 0.81 years) for the intervention (Hatha yoga classes) and control groups (standard physical education classes). The intervention group was also observed regarding pedometer and System for Observing Fitness Instruction Time data.

RESULTS

The results revealed a trend towards an increase for the control and a decrease for the intervention group in stress levels. The pedometer results showed a trend towards an increasing number of steps/min. Skill practice had the greatest increase with time dedicated to that activity. The observation results revealed a significant difference in activity from Time 1 to Time 2. The major differences were decreases in sitting and being very active, and an increase in walking.

CONCLUSIONS

Given the observation data and our study design limitations, the study results showed similarities between Hatha yoga and physical education in terms of increasing physical activity levels and psychosocial variables; thus, yoga may be a viable alternative to children's physical education in this regard.

Differences in Objective Physical Activity Between Children With Visual Impairment and Those With Normal Sight

Purpose

To compare objective physical activity (PA) levels of children with visual impairment (VI) and children with normal sight.

Methods

One hundred children with VI and 100 age- and gender-matched normal-sighted peers 7 to 17 years of age wore an ActiGraph for 1 week. Activity count per minute (cpm) was modeled using a series of generalized linear mixed-effects models including vision, age, sex, time of day, and vision by time of day interaction. PA outcomes included mean counts per minute and proportion of time spent on sedentary, light, moderate, and vigorous intensity PA.

Results

Data of 83 children with VI and 77 normal-sighted peers were included. Mean counts per minute were lower in children with VI (P < 0.001), especially during and after school. Children with VI were less sedentary (55%; 95% confidence interval [CI], 53-57) than children with normal sight before school (62%; 95% CI, 60-64) and over weekends: children with VI, 41% (95% CI, 39-43); children with normal sight, 45% (95% CI, 43-47). Yet, children with VI were more sedentary during school (36%; 95% CI, 34-37) compared with children with normal sight (30%; 95% CI, 29-32). They also spent more time performing light PA and less time performing moderate PA at school and vigorous PA across all periods of day (P < 0.001).

Conclusions

Children with VI participated in light and moderate PA but did not perform as much vigorous PA as children with normal sight, especially during school hours.

Translational Relevance

There is a need to promote more intense PA programs in schools tailored for children with VI.

Machine learning prediction of pulmonary oxygen uptake from muscle oxygen in cycling

The purpose of this study was to test whether a machine learning model can accurately predict VO2 across different exercise intensities by combining muscle oxygen (MO2) with heart rate (HR). Twenty young highly trained athletes performed the following tests: a ramp incremental exercise, three submaximal constant intensity exercises, and three severe intensity exhaustive exercises. A Machine Learning model was trained to predict VO2, with model inputs including heart rate, MO2 in the left (LM) and right legs (RM). All models demonstrated equivalent results, with the accuracy of predicting VO2 at different exercise intensities varying among different models. The LM+RM+HR model performed the best across all intensities, with low bias in predicted VO2 for all intensity exercises (0.08 ml/kg/min, 95% limits of agreement: -5.64 to 5.81), and a very strong correlation (r = 0.94, p < 0.001) with measured VO2. Furthermore, the accuracy of predicting VO2 using LM+HR or RM+HR was higher than using LM+RM, and higher than the accuracy of predicting VO2 using LM, RM, or HR alone. This study demonstrates the potential of a machine learning model combining MO2 and HR to predict VO2 with minimal bias, achieving accurate predictions of VO2 for different intensity levels of exercise.

Exercise Intensity and Activity Energy Expenditure of Professional Golf Players in Official Competitive Setting

BACKGROUND

Research regarding the physical needs of professional golf players is lacking. With advances in wearable technology, it has become easier to analyze physiological responses such as heart rate (HR) to determine activity energy expenditure (AEE). The purpose of the study was to evaluate exercise intensity (EI) and AEE during 4 consecutive tournament's golf rounds using a popular wrist-based HR monitoring.

HYPOTHESIS

Wearable systems for HR monitoring can be used to provide an accurate estimate of energy expenditure.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

A total of 20 male professional golfers participated in the study. Each player was monitored during an official tournament consisting of 4 rounds of 18 holes. EI and AEE were determined using HR wrist monitoring (Whoop Strap 2.0). We calculated the percentage of HRmax (%HRmax) and the percentage of HRres (%HRres) and the AEE in kcal/min using Keytel's formula.

RESULTS

The calculated mean %HRmax and %HRres for the study population were 56.4% ± 1.8% and 40.5% ± 2.6%, respectively. Considering American College of Sports Medicine guidelines, these average percentages correspond to a moderate EI. The average caloric expenditure was 5.4 ± 0.4 kcal/min and 1555.8 ± 157.8 kcal per round considering an average golf round duration of 288.3 ± 19.5 minutes.

CONCLUSION

A professional player's golf round is moderate physical activity. The AEE of this activity was equal to 5.4 cal/min, which is moderate energy consumption.

CLINICAL RELEVANCE

These data could help golf coaches and conditioning coaches to have a better understanding of the load placed on golfers during tournaments.

New Insights Into Accelerometer-Measured Habitual Physical Activity and Sedentary Time During Early Recovery in Pediatric Concussion

PURPOSE

Concussion management is shifting away from a rest-is-best approach, as data now suggest that exercise-is-medicine for this mild brain injury. Despite this, we have limited data on habitual physical activity following concussion. Therefore, our objective was to quantify accelerometer-measured physical activity and sedentary time in children with concussion (within the first month of injury) and healthy controls. We hypothesized that children with concussion would be less active than their healthy peers.

METHODS

We performed a secondary analysis of prospectively collected accelerometer data. Our sample included children with concussion (n = 60, 31 females) and historical controls (n = 60) matched for age, sex, and season of accelerometer wear.

RESULTS

Children with concussion were significantly more sedentary than controls (mean difference [MD], 38.3 min/d, P = .006), and spent less time performing light physical activity (MD, -19.5 min/d, P = .008), moderate physical activity (MD, -9.8 min/d, P < .001), and vigorous physical activity (MD, -12.0 min/d, P < .001); these differences were observed from 8:00 AM to 9:00 PM. Sex-specific analyses identified that girls with concussion were less active and more sedentary than both boys with concussion (P = .010) and healthy girls (P < .010).

CONCLUSION

There is an activity deficit observed within the first month of pediatric concussion. Physical activity guidelines should address this while considering sex effects.

Health-Related Physical Fitness Evaluation in HIV-Diagnosed Children and Adolescents: A Scoping Review

BACKGROUND

Health-related physical fitness has been widely used to investigate the adverse effects of HIV infection/ART in children and adolescents. However, methods/protocols and cut-points applied for investigating health-related physical fitness are not clear. The aim of this scoping review was to map the literature to identify gaps in knowledge regarding the methods/protocols and cut-points.

METHODS

A scoping review, following the Joana Briggs Institute (JBI) guidelines, was conducted through ten major databases. Search followed the PCC strategy to construct block of terms related to population (children and adolescents), concept (health-related physical fitness components) and context (HIV infection).

RESULTS

The search resulted in 7545 studies. After duplicate removal, titles and abstracts reading and full text assessment, 246 studies were included in the scoping review. Body composition was the most investigated component (n = 244), followed by muscular strength/endurance (n = 23), cardiorespiratory fitness (n = 15) and flexibility (n = 4). The World Health Organization growth curves, and nationals' surveys were the most reference values applied to classify body composition (n = 149), followed by internal cut-points (n = 30) and cut-points developed through small populations (n = 16). Cardiorespiratory fitness was classified through cut-points from three different assessment batteries, as well as cut-points developed through studies with small populations, muscular strength/endurance and flexibility were classified through the same cut-points from five different assessment batteries.

CONCLUSIONS

The research on muscular strength/endurance, cardiorespiratory fitness and flexibility has been scarcely explored. The lack of studies that investigated method usability as well as reference values was evidenced.

Development and validation of a smartwatch algorithm for differentiating physical activity intensity in health monitoring

To develop and validate a machine learning based algorithm to estimate physical activity (PA) intensity using the smartwatch with the capacity to record PA and determine outdoor state. Two groups of participants, including 24 adults (13 males) and 18 children (9 boys), completed a sequential activity trial. During each trial, participants wore a smartwatch, and energy expenditure was measured using indirect calorimetry as gold standard. The support vector machine algorithm and the least squares regression model were applied for the metabolic equivalent (MET) estimation using raw data derived from the smartwatch. Exercise intensity was categorized based on MET values into sedentary activity (SED), light activity (LPA), moderate activity (MPA), and vigorous activity (VPA). The classification accuracy was evaluated using area under the ROC curve (AUC). The METs estimation accuracy were assessed via the mean absolute error (MAE), the correlation coefficient, Bland-Altman plots, and intraclass correlation (ICC). A total of 24 adults aged 21-34 years and 18 children aged 9-13 years participated in the study, yielding 1790 and 1246 data points for adults and children respectively for model building and validation. For adults, the AUC for classifying SED, MVPA, and VPA were 0.96, 0.88, and 0.86, respectively. The MAE between true METs and estimated METs was 0.75 METs. The correlation coefficient and ICC were 0.87 (p < 0.001) and 0.89, respectively. For children, comparable levels of accuracy were demonstrated, with the AUC for SED, MVPA, and VPA being 0.98, 0.89, and 0.85, respectively. The MAE between true METs and estimated METs was 0.80 METs. The correlation coefficient and ICC were 0.79 (p < 0.001) and 0.84, respectively. The developed model successfully estimated PA intensity with high accuracy in both adults and children. The application of this model enables independent investigation of PA intensity, facilitating research in health monitoring and potentially in areas such as myopia prevention and control.

Energy Expenditure Prediction from Accelerometry Data Using Long Short-Term Memory Recurrent Neural Networks

The accurate estimation of energy expenditure from simple objective accelerometry measurements provides a valuable method for investigating the effect of physical activity (PA) interventions or population surveillance. Methods have been evaluated previously, but none utilize the temporal aspects of the accelerometry data. In this study, we investigated the energy expenditure prediction from acceleration measured at the subjects' hip, wrist, thigh, and back using recurrent neural networks utilizing temporal elements of the data. The acceleration was measured in children (N = 33) performing a standardized activity protocol in their natural environment. The energy expenditure was modelled using Multiple Linear Regression (MLR), stacked long short-term memory (LSTM) networks, and combined convolutional neural networks (CNN) and LSTM. The correlation and mean absolute percentage error (MAPE) were 0.76 and 19.9% for the MLR, 0.882 and 0.879 and 14.22% for the LSTM, and, with the combined LSTM-CNN, the best performance of 0.883 and 13.9% was achieved. The prediction error for vigorous intensities was significantly different (p < 0.01) from those of the other intensity domains: sedentary, light, and moderate. Utilizing the temporal elements of movement significantly improves energy expenditure prediction accuracy compared to other conventional approaches, but the prediction error for vigorous intensities requires further investigation.

Thai Preschoolers' movement behaviors outside kindergarten: prevalence of meeting individual and integrated movement guidelines

BACKGROUND

This study aimed to investigate movement behaviors of Thai preschoolers (aged 3-6 years) occurring outside kindergarten in urban areas across Thailand.

METHODS

Surveillance of digital Media in eArLy chiLdhood Questionnaire® was used to collect data from 1051 parents recruited from 12 schools. Descriptive statistics and logistic regressions were applied for data analysis.

RESULTS

Thai preschoolers engaged in physical activity (PA), sedentary screen time, and sleep on weekends significantly more than weekdays with no significant sex differences. Preschoolers met the sleep guidelines the most (62.3%), followed by PA guidelines (48.0%), and screen time (ST) guidelines the least (44.1%). Only 14.6% met the integrated movement guidelines, and 11% met none of the guidelines. Age was positively associated with meeting the PA guidelines, and negatively associated with meeting the sleep and integrated movement guidelines. The number of digital devices at home and geographical region influenced preschoolers in meeting the PA and ST guidelines.

CONCLUSIONS

Thai preschoolers' time spent on all forms of activities outside kindergarten was significantly more on weekends than weekdays with no sex disparity. The prevalence of meeting the integrated movement guidelines was low, and needs to be addressed through comprehensive programs including all forms of activities concurrently.

IMPACT

Thai preschoolers engaged in physical activity (PA), screen time (ST), and sleep on weekends significantly more than weekdays with no significant sex differences. Only 14.6% of preschoolers met the integrated movement guidelines. Age had a significant relationship with meeting the PA, sleep, and integrated movement guidelines. Meeting the PA and ST guidelines in preschoolers was positively associated with the number of digital devices at home. Despite some limitations, this study presented preschoolers' time engaged in the three movement behaviors concurrently, and provided important inputs for development of the national strategic plan to promote PA among Thai children and youth.

Accelerometry-assessed daily physical activity and compliance with recommendations in Spanish children: importance of physical education classes and vigorous intensity

Background

Physical activity (PA) is associated with numerous health benefits. Vigorous PA (VPA) may have a greater impact on public health than lower-intensity PA. The incorporation of a specific recommendation on VPA could complement and improve existing recommendations for average daily moderate-vigorous PA (MVPA). Physical education classes could have a positive impact on children's adherence to average daily physical activity recommendations. The aim was to investigate the association between MVPA and VPA in children, as well as adherence to recommendations, and obesity and the presence of physical education classes.

Methods

A cross-sectional study of physical activity was conducted in a sample of 8 and 9-year-old children in Andalusia (Spain). GENEActiv accelerometers were used, placed on the non-dominant wrist for at least eight consecutive days (24-h protocol). School days with and without physical education class, and weekend days were defined. ROC curves were used to calculate the threshold associated with obesity for average daily MVPA and VPA for recommendations.

Results

A total of 360 schoolchildren were included in the analyses (184 girls). An average of 7.7 (SD 1.4) valid days per participant were evaluated, with 19.9 (SD 10.5) and 11.4 (SD 5.1) minutes of VPA performed by boys and girls respectively. 25.8% of the participants were classified with central obesity. The optimal threshold determined with ROC analysis was 12.5 and 9.5 minutes of average daily VPA for boys and girls, respectively (RecVPA), and 75 minutes of average daily MVPA for both sexes (RecMVPA). The RecVPA showed stronger association with obesity. On school days with physical education class, compared to days without this class, children showed increased VPA and MVPA engagement and better compliance with recommendations, with smaller differences in adherence according to sex or obesity.

Conclusions

On days with physical education class, more physical activity was accumulated at all intensities and greater adherence to the recommendations than on days without this class. VPA had a stronger correlation with the absence of obesity than lower-intensity activity. It was also observed that boys were physically more active and had higher adherence to the recommendations than girls.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Adherence to the WHO recommendation of three weekly days of vigorous intensity activities in children: an accelerometry study of vigorous physical activity bouts

Background

The World Health Organization (WHO) recommends that children and adolescents incorporate vigorous intensity activities (VIAs) at least three days a week. This recommendation has not been sufficiently studied using objective methods, such as accelerometry. Physical education classes and extracurricular sports activities are optimal opportunities for compliance with this recommendation.

Objective

To identify VIAs through bouts of vigorous physical activity (VPA-Bouts) evaluated with accelerometry and, with this, to know the compliance with the recommendation on VIAs.

Methods

A cross-sectional study of the habitual physical activity of 353 children (8-9 years old) was carried out using accelerometry and participation in organized extracurricular sports activities was asked through a questionnaire. School days with and without physical education class, weekends, and the average weekly day were identified, as well as school time and out-of-school time. A VPA-Bout was defined as an interval of at least 60 minutes with a proportion of VPA of at least 16.7% in boys and 12.5% in girls (10.0 and 7.5 minutes/hour of VPA, respectively).

Results

The average daily time in organized extracurricular sports activities declared by questionnaire and the average daily duration of the VPA-Bouts evaluated with accelerometers in the extracurricular period was 21.3 (SD 19.8) and 23.9 (SD 31.2) minutes, respectively, in boys, whereas, in girls it was 20.2 (SD 17.4) and 11.0 (SD 16.9) minutes, respectively. In school time including a physical education class, there was a higher proportion of VPA-Bouts than without these classes (with: 28.6%, without: 2.1%, p < 0.001). Children who reported at least three weekly hours of organized extracurricular sports activities accumulated a higher proportion of school afternoons with VPA-Bouts than those with fewer weekly hours of this type of activities (≥3 hours/week: 27.5%, <3 hours/week: 9.3%, p < 0.001). On the weekend, boys who reported at least three weekly hours of organized extracurricular sports activities performed more VPA-Bouts than those participating in less weekly hours, while in girls no significant differences were observed (weekend; boys, ≥3 hours/week: 26.0%, <3 hours/week: 9.0%, p < 0.001; girls: 8.3%, 8.0%, p = 0.917). Compliance with the recommendation to incorporate VIAs at least three days a week was 23.8%. Children who reported at least three weekly hours of extracurricular sports activities achieved higher compliance than those who reported fewer extracurricular activities (≥3 hours/week: 35.1%, <3 hours/week: 12.7%, p < 0.001). Additionally, boys showed higher compliance rates than girls (boys: 32.9%, girls: 15.3%, p < 0.001).

Conclusion

One in every four children met the WHO recommendation to incorporate VIAs at least three days a week, as evaluated by accelerometry. Physical education classes and extracurricular organized sports activities contributed to compliance with this recommendation.

The prevalence of myopia remains stable under tighter COVID-19 social restriction in preschoolers receiving a school-based eyecare program

PURPOSE

This study investigated the impact of different levels of COVID-19 social restrictions (social distancing in 2020, large-scale home confinement in 2021) on myopia prevalence and behaviours in a preschool population with school-based eyecare programme.

METHODS

Repeated cross-sectional surveys were conducted between August and December in 2019, 2020 and 2021. Children aged 5-6 years received ocular examinations, and questionnaires were answered by caregivers before the day of the examination. The main outcome measures were the changes in after-school time spent on homework, screen-based devices and outdoors. Secondary outcome was the change in myopia prevalence (spherical equivalent [SE] ≤ -0.5 D in either eye after cycloplegia).

RESULTS

A total of 9997 preschoolers were included in the analysis. Under tighter restrictions, more preschoolers spent ≥1 h/day on screen-based devices (42.8% in 2019, 45.2% in 2020, 48.9% in 2021, p < 0.001), and fewer preschoolers spent ≥30 min/day on after-school outdoor activities (49.5% in 2019, 46.0% in 2020, 41.0% in 2021, p < 0.001) on weekdays. A similar trend was found on weekends. While more preschoolers spent ≥2 h/day on screen-based devices (35.3% in 2019, 38.5% in 2020, 43.0% in 2021, p < 0.001), fewer preschoolers spent ≥2 h/day on outdoor activities (41.7% in 2019, 41.7% in 2020, 34.0% in 2021, p < 0.001). The mean SE and myopia prevalence were stable (9.1% in 2019, 10.3% in 2020, 9.4% in 2021, p = 0.707).

CONCLUSION

Our study showed dose-dependent effect of social restrictions on near-work and outdoor behaviours at home. The prevalence of myopia did not increase significantly with short-term cessation of school-based eyecare programmes.

Malnutrition, sarcopenia, and frailty assessment in pediatric transplantation

Nutrition assessment can be challenging in children with end-stage organ disease and in those requiring an organ transplant. The effect of poor nutrition status can exert long-lasting effects on children with end-stage organ disease requiring transplantation. Malnutrition, sarcopenia, and frailty are conditions that require provision of optimal nutrition to prevent or support the treatment of these conditions. Unfortunately, the literature on the assessment of malnutrition, sarcopenia, and frailty in pediatric end-stage organ disease is scarce, thus leading to confusion on how to effectively identify them. Recently, the addition of a variety of validated nutrition and functional assessment techniques has assisted with appropriate assessment of these conditions. The objective of this narrative review is to provide an overview of the current literature for pediatric assessment of malnutrition, sarcopenia, and frailty in the setting of solid organ transplantation and provide practicing nutrition clinicians a solid foundation for learning how to effectively assess these conditions with the current literature available.

Calibration and validation of physical behaviour cut-points using wrist-worn ActiGraphs for children and adolescents: A systematic review

OBJECTIVES

To review cut-points calibrated and independently validated from wrist-worn ActiGraph accelerometers to measure moderate to vigorous physical activity (MVPA) and time spent sedentary (SED) in children and adolescents.

DESIGN

Systematic literature review.

METHODS

Five databases were searched for relevant cut-point calibration and independent validation studies relating to wrist worn ActiGraphs in children and adolescents from inception through 30 April 2022. Extracted data included: country of publication; study name; population; device model; wear location; sampling frequency; epoch length; activity protocol; criterion method and definitions used to classify PA intensity; statistical methods for calibration; statistical methods for validation/cross-validation; and MVPA and SED outcome.

RESULTS

Fourteen calibration studies and seven independent validation studies were identified. Calibrated cut-points for MVPA vector magnitude counts ranged from 7065 to 9204 counts per minute (cpm) and 63.5 to 201 milli-gravitational units (mg). For SED, calibrated cut-points ranged from <2556 cpm to 4350 cpm and 30.8 to 48.1 mg. Classification accuracy values determined by independent validation studies varied, with kappa values ranging from 0.31 to 0.60 and area under the curve statistics ranging from 0.51 to 0.84 for MVPA and kappa values ranging from 0.31 to 0.44 and area under the curve statistics ranging from 0.70 to 0.85 for SED.

CONCLUSIONS

The results of this systematic literature review support the use of the Crouter and colleagues cut-points for the measurement of MVPA and SED for children and adolescents aged 6-12 years. Further work is required to independently validate cut-points developed in younger children and older adolescents.

Physical Activity in Work and Leisure Time during Pregnancy, and Its Influence on Maternal Health and Perinatal Outcomes

BACKGROUND

Physical inactivity during pregnancy has been shown to be linked to an increased risk of complications. However, during pregnancy, doubts arise about what type, intensity and frequency of physical activity are most recommended.

OBJECTIVE

Our main objective was to know the level of physical activity (PA) and sedentary lifestyle in a representative sample of pregnant women in Málaga, one of the most populated cities in Spain. Also, we aimed to find out the effects of PA on obstetric and perinatal outcomes and on the mental health of pregnant women, differentiated according to PA intensity and domain.

METHODS

Five hundred and forty full-term pregnant women who had their obstetric checks in the maternity ward of the Regional University Hospital of Málaga were recruited through consecutive sampling. Participants answered a questionnaire that included the WHO Global Physical Activity Questionnaire (GPAQ), the Edinburgh Depression Scale (EDS), the Generalized Anxiety Disorder Scale (GAD-7) and some other sociodemographic and health-related questions. Subsequently, information about perinatal outcomes was obtained after birth.

RESULTS

Only 50.8% of women followed the WHO recommendations on activity. We found a high proportion of obese pregnant women and a direct effect of a sedentary lifestyle on the rate of cesarean sections and vulvovaginal tears in spontaneous births, as well as on the mental health of future mothers. Women's age, the number of children, BMI at the beginning of pregnancy and leisure time physical activity (LTPA) explained anxiety scores, and age, LTPA, BMI at the end of pregnancy and intense work-related physical activity (WTPA) predicted depression scores.

CONCLUSIONS

LTPA improves obstetric outcomes, helping to reduce the rate of cesarean sections and vulvovaginal tears, as well as reducing prenatal anxiety and depression.

Development and content validity of an application to assess 24-hour movement behaviors in 0-4-year-old children involving end-users and key stakeholders: the My Little Moves app

BACKGROUND

Recently, research focus has shifted to the combination of all 24-h movement behaviors (physical activity, sedentary behavior and sleep) instead of each behavior separately. Yet, no reliable and valid proxy-report tools exist to assess all these behaviors in 0-4-year-old children. By involving end-users (parents) and key stakeholders (researchers, professionals working with young children), this mixed-methods study aimed to 1) develop a mobile application (app)-based proxy-report tool to assess 24-h movement behaviors in 0-4-year-olds, and 2) examine its content validity.

METHODS

First, we used concept mapping to identify activities 0-4-year-olds engage in. Parents (n = 58) and professionals working with young children (n = 21) generated a list of activities, sorted related activities, and rated the frequency children perform these activities. Second, using multidimensional scaling and cluster analysis, we created activity categories based on the sorted activities of the participants. Third, we developed the My Little Moves app in collaboration with a software developer. Finally, we examined the content validity of the app with parents (n = 14) and researchers (n = 6) using focus groups and individual interviews.

RESULTS

The app has a time-use format in which parents proxy-report the activities of their child, using eight activity categories: personal care, eating/drinking, active transport, passive transport, playing, screen use, sitting/lying calmly, and sleeping. Categories are clarified by providing examples of children's activities. Additionally, 1-4 follow-up questions collect information on intensity (e.g., active or calm), posture, and/or context (e.g., location) of the activity. Parents and researchers considered filling in the app as feasible, taking 10-30 min per day. The activity categories were considered comprehensive, but alternative examples for several activity categories were suggested to increase the comprehensibility and relevance. Some follow-up questions were considered less relevant. These suggestions were adopted in the second version of the My Little Moves app.

CONCLUSIONS

Involving end-users and key stakeholders in the development of the My Little Moves app resulted in a tailored tool to assess 24-h movement behaviors in 0-4-year-olds with adequate content validity. Future studies are needed to evaluate other measurement properties of the app.

Fitbit's accuracy to measure short bouts of stepping and sedentary behaviour: validation, sensitivity and specificity study

Objective

This study aims to assess the suitability of Fitbit devices for real-time physical activity (PA) and sedentary behaviour (SB) monitoring in the context of just-in-time adaptive interventions (JITAIs) and event-based ecological momentary assessment (EMA) studies.

Methods

Thirty-seven adults (18-65 years) and 32 older adults (65+) from Belgium and the Czech Republic wore four devices simultaneously for 3 days: two Fitbit models on the wrist, an ActiGraph GT3X+ at the hip and an ActivPAL at the thigh. Accuracy measures included mean (absolute) error and mean (absolute) percentage error. Concurrent validity was assessed using Lin's concordance correlation coefficient and Bland-Altman analyses. Fitbit's sensitivity and specificity for detecting stepping events across different thresholds and durations were calculated compared to ActiGraph, while ROC curve analyses identified optimal Fitbit thresholds for detecting sedentary events according to ActivPAL.

Results

Fitbits demonstrated validity in measuring steps on a short time scale compared to ActiGraph. Except for stepping above 120 steps/min in older adults, both Fitbit models detected stepping bouts in adults and older adults with sensitivities and specificities exceeding 87% and 97%, respectively. Optimal cut-off values for identifying prolonged sitting bouts achieved sensitivities and specificities greater than 93% and 89%, respectively.

Conclusions

This study provides practical insights into using Fitbit devices in JITAIs and event-based EMA studies among adults and older adults. Fitbits' reasonable accuracy in detecting short bouts of stepping and SB makes them suitable for triggering JITAI prompts or EMA questionnaires following a PA or SB event of interest.

The Relationship of the PROMIS® Pediatric Physical Activity Measure with Cardiorespiratory Fitness

A The PROMIS® Pediatric Physical Activity (PA) measure is a new instrument with established validity that measures a child self-report on short bouts of moderate to rigorous physical activity. The purpose of this study was to explore the relationship of the PROMIS® Pediatric PA item bank with cardiorespiratory fitness and self-efficacy. The study was conducted at the Minnesota State Fair. Youth ages 8 to 18 years completed the PROMIS® Pediatric PA and the Self-Efficacy for PA measures on an iPad. Participants performed 3-min step test with heart rates measured 1 min posttest. Participants (N = 182) were 53% female. The PROMIS® Pediatric PA had a weak, significant negative correlation with the step test measurement (r = -0.23, p = 0.001) and a weak, significant positive correlation with self-efficacy (r = 0.27, p < 0.001). Measurements did not differ between groups by sex or age group (school-age and adolescent). Youth who were obese had significantly higher heart rates post step test (p = 0.004); BMI percentile groups did not differ in other measures. Self-report of PA and the physiologic measure of heart rate are from two related but different physical fitness domains which supports their significant but weak relationship.

Gut microbiome diversity, variability, and latent community types compared with shifts in body weight during the freshman year of college in dormitory-housed adolescents

Significant human gut microbiome changes during adolescence suggest that microbial community evolution occurs throughout important developmental periods including the transition to college, a typical life phase of weight gain. In this observational longitudinal study of 139 college freshmen living in on-campus dormitories, we tracked changes in the gut microbiome via 16S amplicon sequencing and body weight across a single academic year. Participants were grouped by weight change categories of gain (WG), loss (WL), and maintenance (WM). Upon assessment of the community structure, unweighted and weighted UniFrac metrics revealed significant shifts with substantial variation explained by individual effects within weight change categories. Genera that positively contributed to these associations with weight change included Bacteroides, Blautia, and Bifidobacterium in WG participants and Prevotella and Faecalibacterium in WL and WM participants. Moreover, the Prevotella/Bacteroides ratio was significantly different by weight change category, with WL participants displaying an increased ratio. Importantly, these genera did not display co-dominance nor ease of transition between Prevotella- and Bacteroides-dominated states. We further assessed the overall taxonomic variation, noting the increased stability of the WL compared to the WG microbiome. Finally, we found 30 latent community structures within the microbiome with significant associations with waist circumference, sleep, and dietary factors, with alcohol consumption chief among them. Our findings highlight the high level of individual variation and the importance of initial gut microbiome community structure in college students during a period of major lifestyle changes. Further work is needed to confirm these findings and explore mechanistic relationships between gut microbes and weight change in free-living individuals.

Determination of cut-off points for the Move4 accelerometer in children aged 8-13 years

BACKGROUND

To assess physical activity (PA) there is a need of objective, valid and reliable measurement methods like accelerometers. Before these devices can be used for research, they need to be calibrated and validated for specific age groups as the locomotion differs between children and adults, for instance. Therefore, the aim of the present study was the calibration and validation of the Move4 accelerometer for children aged 8-13 years.

METHODS

53 normal weighted children (52% boys, 48%girls) aged 8-13 years (mean age = 10.69 ± 1.46, mean BMI = 17.93 kg/m- 2, 60th percentile), wore the Move4 sensor at four different body positions (thigh, hip, wrist and the Move4ecg including heart rate measurement at the chest). They completed nine activities that considered the four activity levels (sedentary behavior (SB), light PA (LPA), moderate PA (MPA) and vigorous PA (VPA)) within a test-retest design. Intensity values were determined using the mean amplitude deviation (MAD) as well as the movement acceleration intensity (MAI) metrics. Determination of activities and energy expenditure was validated using heart rate. After that, cut-off points were determined in Matlab by using the Classification and Regression Trees (CART) method. The agreement for the cut-off points between T1 and T2 was analyzed.

RESULTS

MAD and MAI accelerometer values were lowest when children were lying on the floor and highest when running or doing jumping jacks. The mean correlation coefficient between acceleration values and heart rate was 0.595 (p = 0.01) for MAD metric and 0.611 (p = 0.01) for MAI metric, indicating strong correlations. Further, the MAD cut-off points for SB-LPA are 52.9 mg (hip), 62.4 mg (thigh), 86.4 mg (wrist) and 45.9 mg (chest), for LPA-MPA they are 173.3 mg (hip), 260.7 mg (thigh), 194.4 mg (wrist) and 155.7 mg (chest) and for MPA-VPA the cut-off points are 543.6 mg (hip), 674.5 mg (thigh), 623.4 mg (wrist) and 545.5 mg (chest). Test-retest comparison indicated good values (mean differences = 9.8%).

CONCLUSION

This is the first study investigating cut-off points for children for four different sensor positions using raw accelerometer metrics (MAD/MAI). Sensitivity and specificity revealed good values for all positions. Nevertheless, depending on the sensor position, metric values differ according to the different involvement of the body in various activities. Thus, the sensor position should be carefully chosen depending on the research question of the study.

Moderate-to-vigorous intensity physical activity levels of children with intellectual disability during physical education classes

Background

Physical education (PE) class is an excellent way to improve moderate-to-vigorous intensity physical activity (MVPA). Increasing number of research has explored the children's PA based on movement during PE classes, but data for children with intellectual disability (ID) is still lacking.

Purpose

The purpose of this study was to investigate the current status of MVPA levels of children with ID during PE classes in China, as well as differences of MVPA levels according to gender and grade.

Methods

Accelerometers were used to record MVPA levels of fifty-three children with severe ID from 9 to 16 years of age (mean age: 12.60 ± 1.66 years) during standard PE classes.

Results

The mean time spent in MVPA during PE classes was 8.00 ± 2.10 min, meaning only 22.88% of PE class time was spent in MVPA. As grade levels progresses, time spent in MVPA during PE classes tended to decrease; the fourth-grade children tended to spend more time in MVPA during PE classes compared with the fifth-grade and the sixth-grade (9.15 vs. 7.61 vs. 7.25 min, all p < 0.05). Boys spend significantly more time in MVPA during PE classes than girls; both in the entire sample (9.20 vs. 5.70 min) as well as in each grade (9.76 vs. 6.09 min, 9.35 vs. 5.68 min, 8.31 vs. 5.59 min, all p < 0.05).

Conclusion

Findings from this study indicate that the proportion of PE class spent in the MVPA of children with ID was lower than the 50% recommended by the U.S. Department of Health and Human Services (DHHS) and U.K. Association for Physical Education (AfPE). And the amount of MVPA participation varied by the grade and gender as well as by the activity performed. Therefore, in order to help children with ID achieve MVPA goals, educators need to reevaluate the PE curriculum as well as take due consideration of grade and gender when devising new content.

Positive relationships of character strengths with fitness and physical activity in primary school children

Objective

This study is the first to examine the relationship between character strengths, objective physical fitness, and physical activity in primary school children.

Design

This cross-sectional study was conducted in 2016 and 2017 at a school in Japan. Main Outcome Measures: We obtained informed consent from 236 fourth-grade students; 122 fifth-grade students; and 142 sixth-grade students. After excluding participants with missing data, 473 children (247 boys and 226 girls; aged 9-12 years) with informed consent were included in the study. We measured character strengths, physical fitness, and/or physical activity of fourth- to sixth-grade participants.

Results

Among boys, the total score of physical fitness was significantly associated with perseverance-honesty, courage-ideas, compassion-gratitude, and fairness-care (p < 0.05). Among girls, the total score of physical fitness was significantly associated with perseverance-honesty, courage-ideas, and compassion-gratitude (p < 0.05). Regarding the relationship between character strengths and physical activity, perseverance-honesty was significantly associated with total steps and moderate-to-vigorous physical activity (MVPA), whereas courage ideas were significantly associated with total steps (p < 0.05) in boys. In girls, perseverance-honesty was associated with MVPA (p < 0.05).

Conclusions

Our findings revealed that character strengths are positively associated with objective physical fitness and physical activity in primary-school children.

Children's Physiological and Perceptual Responses to Sports Exergames When Played in Different Positions

Today's children are prone to becoming involved in exergames, but their positions during play have not been sufficiently investigated to determine whether the positions they adopt result in equal responses. The design of this study involved the collection of physiological and perceptual responses (i.e., heart rate (HR), rating of perceived exertion, and enjoyment score) during exergames in three different sports (bowling, tennis, and boxing) with players in different positions (sitting and standing). The participants played each game for 10 min while their HR was recorded. After the gameplay, each perceptual response was retrieved. The results revealed a significant increase in HR above rest during exergaming overall (p < 0.001). Standing gameplay resulted in a significantly higher HR (p < 0.001) than seated gameplay. Compared to tennis and bowling, boxing produced the highest physiological response (p < 0.001) and perceived exertion (p < 0.05) in both positions. The participants perceived all the sports exergames to be enjoyable, as their enjoyment scores did not significantly differ for each game (p > 0.5). For all the variables, no statistically significant differences between genders were identified (p > 0.5). This home-based intervention demonstrated that sports exergames are not only enjoyable; overall, they can provide at least moderately intense physical activity, whether played seated or standing.

OPTIMIZATION AND INDUSTRIALIZATION OF A METABOLIC HOLTER DEVICE AND SOFTWARE DEVELOPMENT

The quantified-self of a person consists in the self-tracking of health and physiological parameters, such as (but not limited to) heart rhythm, energy expenditure, and sleep, using technology and devices such as smartwatches or wristbands, without the need of being supervised by clinicians. The widespread adoption in recent years of wearables, combined with the increased relevance of Internet of Things in healthcare and in exercise equipment, have made self-tracking accessible to a large segment of the population with various performances. In this study, we present the development, optimization, and preliminary validation of a new device aimed to analyze sleep, activity level, and energy expenditure. Based on the results measured with a sensor previously certified (but now out-of-the-market), a machine learning model was trained and validated showing a very satisfying agreement of the results. In order to optimize the software and check the measurement accuracy in vivo, a clinical study on 12 healthy volunteers was performed comparing the results measured by the device with the one obtained by a metabolimeter considered as the gold-standard. The results demonstrated that the device is able to correctly assess energy expenditure, showing a difference lower than 19% of the value given by the gold standard.

Association between Phase Angle and Body Composition of Children and Adolescents Diagnosed with HIV Infection

The aim of the study was to investigate how phase angle (PhA) is associated with subtotal and lumbar spine bone mineral density [BMD], lean soft tissue mass [LSTM], total body fat mass, android and gynoid in children and adolescents with HIV according to sex. A cross-sectional study was conducted in Florianópolis, Brazil, involving 64 children and adolescents vertically transmitted with HIV. Resistance and reactance values were obtained using bioelectrical impedance analysis, and PhA was subsequently calculated. Dual emission X-ray absorptiometry was used to assess body composition. Antiretroviral medication, physical activity (accelerometers) and skeletal maturation (wrist-carpal radiography) were used in the adjusted model. In males, PhA was directly associated with subtotal BMD (βadj: 0.65; R²: 0.38, p < 0.01) and lumbar spine BMD (βadj: 0.53; R²: 0.22, p = 0.01), directly associated with LSTM (βadj: 0.76; R²: 0.46, p < 0.01), and inversely associated with gynoid fat (βadj: -0.47; R²: 0.2, p = 0.01), in adjusted models. In females, PhA was directly associated with subtotal BMD (βadj: 0.46; R²: 0.17, p < 0.01) and lumbar spine BMD (βadj: 0.48; R²: 0.19, p < 0.01). It is concluded that PhA was directly associated with subtotal and regional BMD, LSTM, and inversely with gynoid fat in boys with HIV. In girls, PA was directly associated only with subtotal and regional BMD.

Convergent Validity of the Patient Reported Outcome Measurement Information System-Pediatric Physical Activity Instrument (PROMIS®-PA) with Wearable Devices in Adolescents

The study was conducted mainly to examine the convergent validity of the Patient Reported Outcome Measurement Information System-Pediatric Physical Activity instrument (PROMIS^®®®-PA) with step counts from wearable devices and another validated self-reported outcome measure. As a secondary aim, we explored the effect of different recall time frames (7-day, end-of-day [EoD], and ecological momentary assessment [EMA] time frames during the day) in terms of their feasibility and associations with each other and with step counts. This was a prospective cohort study that examined the associations between measures of PA in school-age children and adolescents (n = 84, aged 10-20). The participants wore Fitbit devices for 7 consecutive days, and then completed the 7-day-recall PROMIS-PA short form and Youth Activity Profile (YAP). Additional analyses were completed in a sub-sample (n = 25, aged 11-18 years) using the PROMIS-PA for the EMA at five intervals during the day (shorter form) and at the EoD. In the total sample, the PROMIS-PA results showed positive moderate correlations with the YAP and average daily steps (r = 0.533, p < 0.001 and r = 0.346, p = 0.002, respectively). In the sub-sample, the 7-day PROMIS-PA was highly correlated with the averaged EMA or EoD ratings for the week, and moderately correlated with the daily step counts. These findings support the validity of the PROMIS-PA as a measure of self-reported physical activity. Adolescents demonstrated higher compliance rates and preference for the 7-day recall and EoD assessments compared to more frequent EMA reporting.

An evaluation of data processing when using the ActiGraph GT3X accelerometer in non-ambulant children and adolescents with cerebral palsy

PURPOSE

To evaluate vertical acceleration, vector magnitude, non-wear time, valid day classifications, and valid period classifications in the data processing phase when using the ActiGraph GT3X accelerometer in non-ambulant children and adolescents with cerebral palsy (CP).

MATERIAL AND METHODS

Accelerometer data retrieved from 33 non-ambulant children and adolescents (4-17 years) with CP were analysed. Comparisons of (i) vertical acceleration versus vector magnitude, (ii) two different non-wear times, (iii) three different settings to classify a day as valid and (iv) two different settings to classify a period as valid were made.

RESULTS AND CONCLUSIONS

Vector magnitude and a non-wear time of at least 90 consecutive minutes statistically significantly increased minutes recorded per day, especially for sedentary time. There was a statistically significant difference in numbers of valid days depending on time criteria set to determine a valid day, whereas there was no statistically significant difference in valid periods using 3 compared to 4 days. This study suggests using the pre-settings in ActiLife; vector magnitude, non-wear time of 90 consecutive minutes, 500 min recorded per day with periods of at least 3 valid days when assessing physical activity objectively by the ActiGraph GT3X accelerometer in non-ambulant children and adolescents with CP.

A Wrinkle in Measuring Time Use for Cognitive Health: How should We Measure Physical Activity, Sedentary Behaviour and Sleep?

One new case of dementia is detected every 4 seconds and no effective drug therapy exists. Effective behavioural strategies to promote healthy cognitive ageing are thus essential. Three behaviours related to cognitive health which we all engage in daily are physical activity, sedentary behaviour and sleep. These time-use activity behaviours are linked to cognitive health in a complex and dynamic relationship not yet fully elucidated. Understanding how each of these behaviours is related to each other and cognitive health will help determine the most practical and effective lifestyle strategies for promoting healthy cognitive ageing. In this review, we discuss methods and analytical approaches to best investigate how these time-use activity behaviours are related to cognitive health. We highlight four key recommendations for examining these relationships such that researchers should include measures which (1) are psychometrically appropriate; (2) can specifically answer the research question; (3) include objective and subjective estimates of the behaviour and (4) choose an analytical method for modelling the relationships of time-use activity behaviours with cognitive health which is appropriate for their research question.

Prediction Equation for Physical Activity Energy Expenditure in 11-13-Year-Old Sri Lankan Children

This study aimed to develop a regression equation to predict physical activity energy expenditure (PAEE) using accelerometry. Children aged 11-13 years were recruited and randomly assigned to validation (n = 54) and cross-validation (n = 25) groups. The doubly labelled water (DLW) technique was used to assess energy expenditure and accelerometers were worn by participants across the same period. A preliminary equation was developed using stepwise multiple regression analysis with sex, height, weight, body mass index, fat-free mass, fat mass and counts per minute (CPM) as independent variables. Goodness-of-fit statistics were used to select the best prediction variables. The PRESS (predicted residual error sum of squares) statistical method was used to validate the final prediction equation. The preliminary equation was cross-validated on an independent group and no significant (p > 0.05) difference was observed in the PAEE estimated from the two methods. Independent variables of the final prediction equation (PAEE = [0.001CPM] - 0.112) accounted for 70.6% of the variance. The new equation developed to predict PAEE from accelerometry was found to be valid for use in Sri Lankan children.

Parental Influence on Child and Adolescent Physical Activity Level: A Meta-Analysis

Parents are often regarded as one of the significant social agents who are important to the participation of physical activity (PA) among children and adolescents. However, within the literature, the relationships between parental influences and child and adolescent PA have been inconclusive and discordant. The purpose of this meta-analysis was to quantify and synthesize the associations between parental social influences (positive parental influence, punishment, and discouragement) and the PA level of children and adolescents. Through a systematic literature search using PsycINFO, Web of Science, PubMed, ProQuest, and SPORTDiscus databases, we identified 112 eligible studies and subsequently extracted 741 effect sizes for our analysis. Multilevel meta-analysis showed that the corrected zero-order correlation of positive parental influence was positive and statistically significant, r = 0.202, SE = 0.014, t = 14.975, p < 0.001, 95% confidence interval (CI) = [0.176, 0.228]. Further moderation analysis also found that this was significantly moderated by parental gender (maternal vs. paternal), respondent of influence measure (parent-reported vs. child-reported), and type of PA measure (subjective vs. objective). The corrected zero-order correlations of negative parental influences (i.e., punishment and discouragement) were not statistically significant, and no significant moderation effects were observed. The findings of our meta-analysis showed that children and adolescents had higher PA levels when their parents supported PA participation by exerting positive social influence. Punishment and discouragement against PA by parents did not appear to be significantly associated with the PA level of children and adolescents. The findings of negative parental social influence were mixed and required further investigations.

The Association Between Adolescent Active Commuting to School and Parent Walking Behavior: The FLASHE Study

PURPOSE

To examine the relationship between adolescent active commuting to school (ACS; walking or biking to/from school) and parent walking activity.

DESIGN

Cross-sectional.

SETTING

US nationwide online surveys.

SAMPLE

1367 parent-adolescent (12-17 years) dyads among the Family Life, Activity, Sun, Health, and Eating (FLASHE) study participants (29.4% response rate).

MEASURES

Online surveys asked about adolescent ACS and parent walking activity in the past week. Adolescents who reported ACS at least once in the past week were categorized as engaging in ACS. Parent walking frequency was categorized into 0-2, 3-5, and 6-7 days.

ANALYSIS

Logistic regression analysis was conducted to compare the probability of adolescent ACS by parent walking activity, adjusted for sociodemographic factors and adolescent-, parent-, and neighborhood-level covariates.

RESULTS

28.5% of adolescents engaged in ACS at least once in the past week. Compared to 0-2 days/week of parent walking activity, ORs for adolescent ACS for 3-5 and 6-7 days/week of parent walking activity were 1.98 (95% CI=1.38-2.87) and 1.81 (1.23-2.68), respectively. In stratified analyses by parent and adolescent sex, father-son dyads presented the strongest association between adolescent ACS and parent walking 3-5 and 6-7 days/week (ORs=4.17 [1.46-11.91] and 3.95 [1.45-10.77], respectively).

CONCLUSIONS

Adolescents with parents who engaged in walking activity ≥3 days/week were more likely to actively commute to school. Parent walking activity may have positive intergenerational effects on adolescent ACS and physical activity.

Physical Activity and Body Image Perception in Adolescents: A Systematic Review

Adolescence represents a vulnerable phase of life for psychological health. The practice of physical activity (PA) appears to have a positive influence on adolescents, increasing self-esteem and producing a more positive body image. A systematic review of published articles over the past 10 years until June 2022 was conducted according to the PRISMA statement employing the electronic databases MEDLINE and Web of Science (639 records) to summarize the literature on the relationship between body image dissatisfaction (BID) and assessed by figural scales and practice of structured and unstructured PA in adolescents (10-18 years), taking into account BMI and/or weight status. All articles were independently reviewed using inclusion/exclusion criteria, retrieved data, and assessed quality with the adapted Newcastle-Ottawa Scale for observational studies. The main finding of interest that emerged from most of the 28 included studies is the negative association between BID and PA during adolescence: as PA increases, BID decreases. However, this updated systematic review also identified some flaws in the existing literature, highlighting the need for high-quality adolescent research using validated figural scales and objective PA assessments. In conclusion, the reviewed studies showed that PA involvement can be efficacious in protecting from body image perception concerns and enhancing body satisfaction. Future interventions should promote structured and unstructured PA during adolescence to improve self-esteem and body image.