A Classroom-Based Intervention to Promote Physical Literacy in Children: ALPHYL Study Protocol

Physical literacy is crucial for children's appropriate development and physical, social and mental health. In a school setting, class-based physical activity (PA) interventions are considered to be appropriate programs to foster PA participation and cognitive development. The purpose of this project, named the Active Learning in PHYsical Literacy (ALPHYL) study, was to describe a multicomponent classroom-based physically-active learning randomised control trial (RCT) in primary school children. The main purpose was to promote children's physical literacy, academic achievement and cognitive function. The ALPHYL study is mainly based on physical literacy, active school models and the Supportive, Active, Autonomous, Fair and Enjoyable principles. The ALPHYL is an 8-10-week RCT to be conducted in six primary schools (12 classes) in Valencia (Spain) and its metropolitan area. Schools will be randomly assigned to the intervention or waiting-list control group. After a 30 h in-person training course for teachers and weekly meetings in the three months of resource preparation, the ALPHYL intervention will be conducted in physical education (PE) and non-PE lessons by teachers. The intervention consists of at least three daily sessions of physically active learning in addition to model-based PE teaching. Its feasibility will be evaluated weekly according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. To assess its effectiveness, a pre-test, post-test and retention (8-10 weeks post-intervention) with primary outcomes (i.e., PA level, motor competence, perceived motor competence and PL, motivation, perceived social support, academic achievement and cognitive function), secondary outcomes and covariates will be collected.

Lifestyle Behaviours Profile of Spanish Adolescents Who Actively Commute to School

The aim of this study was to study different ‘healthy profiles’ through the impact of multiple lifestyle behaviours (sleep patterns, screen time and quality diet) on active commuting to school (ACS) in adolescents. Sixteen secondary schools from four Spanish cities were randomly selected. All participants filled in an “Ad-Hoc” questionnaire to measure their mode of commuting and distance from home to school and their lifestyle behaviours. A multivariate logistic regression model was performed to analyse the main predictor variables of ACS. The final sample was 301 adolescents (50.2% girls; mean age ± SD: 14.9 ± 0.48 years). The percentage of ACS was 64.5%. Multiple logistic regressions showed: boys were more active commuters than girls [OR = 2.28 (CI 95%: 1.12−4.64); p = 0.02]; adolescents who lived farther had lower probability to ACS [OR = 0.74 (CI 95%: 0.69−0.80); p < 0.001]; adolescents who met sleep duration recommendations were more likely to ACS [OR = 3.05 (CI 95%: 1.07−8.69); p = 0.04], while with each hour of sleep, the odds of ACS was reduced [OR = 0.51 (CI 95%: 0.30−0.89); p = 0.02]; higher odds were shown to ACS in adolescents who have more adherence to MD [OR = 1.16(CI 95%: 1.00−1.33); p = 0.05]; and habitual breakfast consumption was inversely associated with ACS [OR = 0.41 (CI: 95%: 0.18−0.96); p = 0.04]. ACS was associated with being a boy, living at a shorter distance to school, a daily sleep time ≥ 8 h and presented a higher adherence to MD.

Associations among Active Commuting to School and Prevalence of Obesity in Adolescents: A Systematic Review

Active commuting to school (ACS) seems to be one of the means to increase physical activity (PA) levels in youth, but it is unclear if ACS reduces the prevalence of obesity, protecting and improving their health. Most of the previous research has been conducted on children or youth (i.e., children with adolescents together), and there is a paucity of research in adolescents only. The purpose of this review was to assess the association between ACS with overweight/obesity parameters in adolescents aged 11 to 19 years. We used PubMed, WOS and SPORTDiscus as electronics databases. All steps of the process followed the recommendations of the PRISMA flow-diagram. Fifteen articles (68.18%) found a consistent association between ACS and body composition and seven studies (31.82%) showed no differences in body composition between active and passive commuters to school. Fourteen studies observed that active commuters to school had a more favorable body composition and one study reported that ACS was associated with unfavourable body composition. ACS could be the steppingstone to improve PA promotion in adolescence but whether ACS is associated with improved body composition and prevention of obesity requires further research.

Using open data and open-source software to develop spatial indicators of urban design and transport features for achieving healthy and sustainable cities

Benchmarking and monitoring of urban design and transport features is crucial to achieving local and international health and sustainability goals. However, most urban indicator frameworks use coarse spatial scales that either only allow between-city comparisons, or require expensive, technical, local spatial analyses for within-city comparisons. This study developed a reusable, open-source urban indicator computational framework using open data to enable consistent local and global comparative analyses. We show this framework by calculating spatial indicators-for 25 diverse cities in 19 countries-of urban design and transport features that support health and sustainability. We link these indicators to cities' policy contexts, and identify populations living above and below critical thresholds for physical activity through walking. Efforts to broaden participation in crowdsourcing data and to calculate globally consistent indicators are essential for planning evidence-informed urban interventions, monitoring policy effects, and learning lessons from peer cities to achieve health, equity, and sustainability goals.

Associations between Park and Playground Availability and Proximity and Children's Physical Activity and Body Mass Index: The BEACH Study

A cross-sectional study was designed to evaluate the relationship between the availability and proximity to parks and playgrounds and physical activity (PA). Moreover, the accessibility to parks and playgrounds and its association with active commuting to/from school (ACS) and body mass index (BMI) were analyzed. The sample was composed of children aged 6-12 years old from the BEACH (Built Environment and Active CHildren) study in Valencia, Spain. The availability and proximity to parks and playgrounds were calculated at different buffer sizes (250, 500, 1000 and 1250 m) using geographical information system data. PA out of school was assessed using accelerometers. Sociodemographics and ACS were measured with a parent questionnaire. Objectively measured weight and height were used to calculate BMI. Mixed linear regression analyses were conducted for each exposure variable, adjusting for sociodemographics, neighborhood walkability level, and participant clustering. The number of parks and playgrounds were positively associated with moderate to vigorous PA (MVPA) and total PA (TPA); including light PA and MVPA, during weekdays, in different buffer sizes. A negative relationship between distance to the nearest playground and TPA during weekdays was found. In addition, the number of playgrounds was positively related to ACS in different buffer sizes, whereas park land area was negatively related to the BMI percentile. This study highlights the importance of assessing the availability and proximity to parks and playgrounds in children's neighborhoods when PA behavior and weight status are analyzed. Study findings may help policymakers when targeting interventions to promote health-enhancing behaviors in children.

International evaluation of the Microscale Audit of Pedestrian Streetscapes (MAPS) Global instrument: comparative assessment between local and remote online observers

OBJECTIVES

The use of online imagery by non-local observers to conduct remote, centralized collection of streetscape audit data in international studies has the potential to enhance efficiency of collection and comparability of such data for research on built environments and health. The objectives of the study were to measure (1) the consistency in responses between local in-field observers and non-local remote online observers and (2) the reliability between in-country online observers and non-local remote online observers using the Microscale Audit of Pedestrian Streetscapes Global tool to characterize pedestrian-related features along streets in five countries.

METHODS

Consistency and inter-rater reliability were analyzed between local and non-local observers on a pooled database of 200 routes in five study regions (Melbourne, Australia; Ghent, Belgium; Curitiba, Brazil; Hong Kong, China; and Valencia, Spain) for microscale environmental feature subscales and item-level variables using the intraclass correlation coefficient (ICC).

RESULTS

A local in-field versus remote online comparison had an ICC of 0.75 (95 % CI: 0.68-0.80) for the grand total score. An ICC of 0.91 (95 % CI: 0.88-0.93) was found for the local online versus remote online comparison. Positive subscales yielded stronger results in comparison to negative subscales, except for the similarly poor-performing positive aesthetics/social characteristics.

CONCLUSIONS

This study demonstrated remote audits of microscale built environments using online imagery had good reliability with local in-field audits and excellent reliability with local online audits. Results generally supported remote online environmental audits as comparable to local online audits. This identification of low-cost and efficient data acquisition methods is important for expanding research on microscale built environments and physical activity globally.

Impact Acceleration During Prolonged Running While Wearing Conventional Versus Minimalist Shoes

Purpose: In recent years a sub-group of minimalist runners have emerged who aim to perform physical exercise more naturally in an attempt to reduce running-related injuries. Here we aimed to determine the effect that running with minimalist footwear in a prolonged run has on foot-impact accelerations. Method: Seventeen runners ran with minimalist and conventional shoes (MS and CS, respectively) in two separate sessions; the participants had experience with both footwear types. We measured the length and frequency of each stride, as well as the tibial and head impact acceleration every 5 minutes during a prolonged run (30 minutes at 80% of each individual's maximum aerobic speed). Results: There were significant differences in the acceleration rate in the tibia (CS: 516.1 ± 238.47 G/s and MS: 786.6 ± 238.45 G/s; p = .009) and head (CS: 73.3 ± 23.65 G/s and MS: 120.7 ± 44.13 G/s; p = .000). Our data indicate that the type of footwear increased the stride frequency and decreased length and that the impact acceleration is increased with MS compared to CS (p < .05 in both cases). However, the effect of prolonged run was not significantly different between CS and MS (p < .05). Conclusions: The peak tibia acceleration and headtibia acceleration rate indicate that the use of MS may be related to a higher risk of injury. These differences remained independently of the runners' fatigue state.

Active commuting to school among 36,781 Spanish children and adolescents: A temporal trend study

This study examines trends in the rates of active commuting to school (ACS) in Spanish children (n = 18 343; 8.93 ± 1.68) and adolescents (n = 18 438; 14.11 ± 1.58) aged 6-18 years from 2010 to 2017. Given the study period included the economic crisis in Spain (2008-2013), the second aim of this study was to compare ACS rates during and after the economic crisis. Data were obtained from 28 studies conducted across Spain. The overall trends in ACS were evaluated using multilevel logistic regression analysis. Among Spanish children and adolescents, the rates of ACS to school ranged around 60% between 2010 and 2017. The rates of ACS in Spanish youth did not change significantly during the 2010-2017 period, except a sporadic increase in the rate of ACS in adolescents in 2012-2013. No significant association between the ACS and the economic crisis time period in youth was found. As conclusion, the ACS remains stable in Spain during the last decade, which is a promising result regarding the evidenced decreasing trend in many countries. Further educational and policy strategies are important to continue promoting this behavior in children and adolescents in the long term.

Reliability of streetscape audits comparing on-street and online observations: MAPS-Global in 5 countries

BACKGROUND

Microscale environmental features are usually evaluated using direct on-street observations. This study assessed inter-rater reliability of the Microscale Audit of Pedestrian Streetscapes, Global version (MAPS-Global), in an international context, comparing on-street with more efficient online observation methods in five countries with varying levels of walkability.

METHODS

Data were collected along likely walking routes of study participants, from residential starting points toward commercial clusters in Melbourne (Australia), Ghent (Belgium), Curitiba (Brazil), Hong Kong (China), and Valencia (Spain). In-person on the street and online using Google Street View audits were carried out by two independent trained raters in each city. The final sample included 349 routes, 1228 street segments, 799 crossings, and 16 cul-de-sacs. Inter-rater reliability analyses were performed using Kappa statistics or Intraclass Correlation Coefficients (ICC).

RESULTS

Overall mean assessment times were the same for on-street and online evaluations (22 ± 12 min). Only a few subscales had Kappa or ICC values < 0.70, with aesthetic and social environment variables having the lowest overall reliability values, though still in the "good to excellent" category. Overall scores for each section (route, segment, crossing) showed good to excellent reliability (ICCs: 0.813, 0.929 and 0.885, respectively), and the MAPS-Global grand score had excellent reliability (ICC: 0.861) between the two methods.

CONCLUSIONS

MAPS-Global is a feasible and reliable instrument that can be used both on-street and online to analyze microscale environmental characteristics in diverse international urban settings.

Psycho-Social Factors in Patients with Cardiovascular Disease Attending a Family-Centred Prevention and Rehabilitation Programme: EUROACTION Model in Spain

BACKGROUND

Coronary heart disease (CHD) persists as the leading cause of death worldwide. Cardiovascular prevention and rehabilitation (CVPR) has an interdisciplinary focus, and includes not only in physiological components, but it also addresses psycho-social factors.

METHODS

The study analysed the Spanish psycho-social data collected during the EUROACTION study. In Spain, two hospitals were randomised in the Valencia community. Coronary patients were prospectively and consecutively identified in both hospitals. The intervention hospital carried out a 16-week CVPR programme, which aimed to assess illness perceptions and establish healthy behaviours in patients and their partners.

RESULTS

Illness perceptions were significantly and inversely associated with anxiety and depression. Low levels of anxiety were associated with better self-management of total cholesterol (p = 0.004) and low-density lipoprotein-cholesterol (p = 0.004). There was concordance at one year among patients and partners who participated in the programme related to anxiety (p < 0.001), fruit consumption (p < 0.001), and vegetable consumption (p < 0.001).

CONCLUSIONS

The EUROACTION study emphasised the importance of assessing psycho-social factors in a CVPR programme and the inclusion of family as support in patients' changes in behaviour.

The Role of Preschool Hours in Achieving Physical Activity Recommendations for Preschoolers

Research on physical activity (PA) in different educational settings could elucidate which interventions promote a healthy school lifestyle in early childhood education (ECE). The aims of this study were: (a) to analyse the PA levels of preschoolers during school hours, as well as the rate of compliance with specific recommendations on total PA (TPA) and moderate-vigorous PA (MVPA); (b) to examine the role of structured movement sessions and recess time in the MVPA levels during school hours; (c) to evaluate the sociodemographic correlates of preschoolers and the school environment on MVPA behaviour during school hours. PA was evaluated with Actigraph accelerometers. Our main findings were that: (a) preschoolers engaged in very little TPA and MVPA during school hours; (b) children showed significantly higher MVPA levels on days with versus without structured movement sessions, and the contribution of the structured sessions to MVPA was significantly higher than that of recess time; (c) gender and age were associated with PA, and a high density of young children on the playground was associated with high levels of vigorous PA, whereas in the classroom, high density was associated with more sedentary behaviour. Structured PA could reduce the gap in achieving international recommendations.

Different neighborhood walkability indexes for active commuting to school are necessary for urban and rural children and adolescents

BACKGROUND

Literature focusing on youth has reported limited evidence and non-conclusive associations between neighborhood walkability measures and active commuting to and from school (ACS). Moreover, there is a lack of studies evaluating both macro- and micro-scale environmental factors of the neighborhood when ACS is analyzed. Likewise, most studies on built environment attributes and ACS focus on urban areas, whereas there is a lack of studies analyzing rural residential locations. Moreover, the relationship between built environment attributes and ACS may differ in children and adolescents. Hence, this study aimed to develop walkability indexes in relation to ACS for urban and rural children and adolescents, including both macro- and micro-scale school-neighborhood factors.

METHODS

A cross-sectional study of 4593 participants from Spain with a mean age of 12.2 (SD 3.6) years was carried out. Macro-scale environmental factors were evaluated using geographic information system data, and micro-scale factors were measured using observational procedures. Socio-demographic characteristics and ACS were assessed with a questionnaire. Several linear regression models were conducted, including all the possible combinations of six or less built environment factors in order to find the best walkability index.

RESULTS

Analyses showed that intersection density, number of four-way intersections, and residential density were positively related to ACS in urban participants, but negatively in rural participants. In rural children, positive streetscape characteristics, number of regulated crossings, traffic calming features, traffic lanes, and parking street buffers were also negatively related to ACS. In urban participants, other different factors were positively related to ACS: number of regulated crossings, positive streetscape characteristics, or crossing quality. Land use mix acted as a positive predictor only in urban adolescents. Distance to the school was a negative predictor on all the walkability indexes. However, aesthetic and social characteristics were not included in any of the indexes.

CONCLUSIONS

Interventions focusing on improving built environments to increase ACS behavior need to have a better understanding of the walkability components that are specifically relevant to urban or rural samples.

Lipid Profile Results after Cardiovascular Prevention Programme: Euroaction Model in Spain

BACKGROUND

Cardiovascular prevention and rehabilitation programmes (CVPRP) are an established model of care designed to improve risk factor management. They have been successfully implemented in a variety of settings, in patients with coronary heart disease (CHD).

OBJECTIVE

To assess the long term impact of a nurse-coordinated, multidisciplinary, CVPRP in patients with CHD in the reduction of lipid profile and medication prescription in clinical practice.

METHODS

The study used an analytical, experimental, population based, prospective and longitudinal design. In Spain, the study was conducted in the Valencian Community, including two randomized hospitals. Coronary patients were prospectively and consecutively identified in both hospitals. The intervention hospital carried out an 8-week CVPRP.

RESULTS

The proportion of patients achieving improved standards of preventive care increased in the intervention hospital compared with the usual care hospital, mainly regarding LDL-C concentrations. Furthermore, an increased prescription of statins was found in the intervention group. However, there were no statistically significant differences in triglycerides and glucose levels.

CONCLUSION

The EUROACTION nurse-led CVPRP enabled coronary patients to control lipid profile to the European targets. A large proportion of patients were prescribed statin therapy as cardioprotective medication with favorable changes in medication for coronary patients. To improve the potential for cardiovascular prevention, we need local preventive cardiology programmes adapted to the health policy of individual countries.

School Neighbourhood Built Environment Assessment for Adolescents' Active Transport to School: Modification of an Environmental Audit Tool and Protocol (MAPS Global-SN)

School neighbourhood built environments (SN-BE) can influence adolescents' active transport to school habits. Typically, SN-BE assessment has involved micro-scale (i.e., environmental audits) or macro-scale (Geographic Information Systems (GIS)) assessment tools. However, existing environmental audits are time/resource-intensive and not specific to school neighbourhoods, while GIS databases are not generally purposed to include micro-scale data. This study evaluated the inter-rater reliability and feasibility of using a modified audit tool and protocol (Microscale Audit of Pedestrian Streetscapes Global-School Neighbourhood (MAPS Global-SN)) to assess the SN-BE of twelve secondary schools in Dunedin, New Zealand. Correlations between MAPS Global-SN and GIS measures of the SN-BE were also examined. Specifically, MAPS Global-SN audit and GIS spatial analysis (intersection density, residential density, land use mix, walkability) was conducted within a 0.5 km street-network buffer-zone around all twelve schools. Based on investigator and expert consultation, MAPS Global-SN included eight modifications to both auditing processes and items. Inter-rater reliability data was collected from two independent auditors across two schools. The feasibility of a condensed audit protocol (auditing one side of each street segment in the neighbourhood, compared to both sides) was also assessed. Results indicated the modified MAPS Global-SN tool had good to excellent inter-rater reliability and the condensed MAPS Global-SN audit protocol appeared to sufficiently represent the micro-scale SN-BE. Results also highlighted the complementary nature of micro- and macro-scale assessments. Further recommendations for SN-BE assessment are discussed.

Neighborhood Built Environment and Socioeconomic Status are Associated with Active Commuting and Sedentary Behavior, but not with Leisure-Time Physical Activity, in University Students

The role of neighborhood characteristics in promoting physical activity and sedentary behaviors (SB) has not been extensively studied in university students. The study purpose was to analyze the associations of neighborhood built environment and neighborhood socioeconomic status (SES) with active commuting, leisure-time physical activity (LTPA), and SB among university students. This is a cross-sectional study of 308 undergraduate students from two urban universities in Valencia, Spain. Participants' residential neighborhoods were classified according to walkability and SES levels. Walkability was defined as an index of three built environment attributes (i.e., residential density, land-use mix, and street connectivity) based on geographical information system data. Active commuting to and from university (ACU), active commuting in the neighborhood, LTPA, and SB were evaluated through a questionnaire. Mixed model regression analyses were performed. There were no significant SES-walkability interactions for any of the outcomes analyzed. However, university students living in more walkable areas reported two more ACU trips per week compared to those living in less walkable neighborhoods (p < 0.01). University students living in lower-SES neighborhoods reported more ACU trips per week than those living in higher-SES neighborhoods (p < 0.05). Regarding LTPA, there were no significant SES or walkability main effects. Neighborhood SES was negatively related to active commuting in the neighborhood and to time spent in SB (all p < 0.05). Participants living in lower-SES neighborhoods reported more active commuting per week and had the highest average minutes spent in SB. This study highlights the relevance of assessing university's residential environment when active transportation and SB are analyzed.

Precursors of Body Dissatisfaction and its Implication for Psychological Well-Being in Young Adults

The authors examined leisure-time physical activity (LTPA), body mass index (BMI), and perceived physical ability as body dissatisfaction antecedents, and analyzed their relationship to well-being. The sample comprised 501 university students. Data were collected using a self-administered survey. Path analysis revealed that LTPA positively predicted perceived physical ability. BMI and perceived physical ability predicted body dissatisfaction (positively and negatively, respectively). Body dissatisfaction negatively predicted subjective vitality, whereas perceived physical ability positively predicted subjective vitality. These results support the inclusion of LTPA in intervention programs that seek to promote more satisfactory physical perceptions and psychological well-being.

Built Environment, Psychosocial Factors and Active Commuting to School in Adolescents: Clustering a Self-Organizing Map Analysis

Although the built environment and certain psychosocial factors are related to adolescents' active commuting to and from school (ACS), their interrelationships have not been explored in depth. This study describes these interrelationships and behavioral profiles via a self-organizing map (SOM) analysis. The sample comprised 465 adolescents from the IPEN (International Physical Activity and the Environment Network) Adolescent study in Valencia, Spain. ACS, barriers to ACS, physical self-efficacy, social support and sociodemographics were measured by questionnaire. Street-network distance to school, net residential density and street intersection density were calculated from the Geographic Information System. The clustering of the SOM outcomes resulted in eight areas or clusters. The clusters which correspond to the lowest and highest ACS levels were then explored in depth. The lowest ACS levels presented interactions between the less supportive built environments (i.e., low levels of residential density and street connectivity in the neighborhood and greater distances to school) and unfavorable psychosocial variables (i.e., low values of physical self-efficacy and medium social support for ACS) and good access to private motorized transport at home. The adolescents with the lowest ACS values exhibited high ACS environment/safety and planning/psychosocial barrier values. Future interventions should be designed to encourage ACS and change multiple levels of influence, such as individual, psychosocial and environmental factors.

Biking to School: The Role of Bicycle-Sharing Programs in Adolescents

BACKGROUND

The purpose of this study was to: (1) describe modes of transport to school, with a specific focus on the use of public bicycle share programs (PBSP); and (2) assess sociodemographic, psychosocial, and environmental correlates of bike and PBSP use to go to school.

METHODS

A group of 465 adolescents from the International Physical Activity and the Environment Network (IPEN) Adolescent Study (Valencia, Spain) participated in the research. Mixed regression analyses were conducted on the data obtained.

RESULTS

Not having bicycle access, a PBSP card, or a public bike lane close to the school is negatively associated with bicycle use. PBSP is positively associated with physical self-efficacy and bicycle availability and negatively associated with the number of vehicles per drivers at home and not having PBSP stations close to the school.

CONCLUSIONS

The strongest predictive factor, as regards cycling as an active mode of transport to school among adolescents is having a PBSP card. Schools have a crucial role in promoting bicycle use through collaboration when designing public policies that consider access to bike lane networks and PBSP stations and therefore should encourage local government implementation policies and/or increase PBSP stations within 250 m of the school.

Development and reliability of a streetscape observation instrument for international use: MAPS-global

BACKGROUND

Relationships between several built environment factors and physical activity and walking behavior are well established, but internationally-comparable built environment measures are lacking. The Microscale Audit of Pedestrian Streetscapes (MAPS)-Global is an observational measure of detailed streetscape features relevant to physical activity that was developed for international use. This study examined the inter-observer reliability of the instrument in five countries.

METHODS

MAPS-Global was developed by compiling concepts and items from eight environmental measures relevant to walking and bicycling. Inter-rater reliability data were collected in neighborhoods selected to vary on geographic information system (GIS)-derived macro-level walkability in five countries (Australia, Belgium, Brazil, Hong Kong-China, and Spain). MAPS-Global assessments (n = 325) were completed in person along a ≥ 0.25 mile route from a residence toward a non-residential destination, and a commercial block was also rated for each residence (n = 82). Two raters in each country rated each route independently. A tiered scoring system was created that summarized items at multiple levels of aggregation, and positive and negative valence scores were created based on the expected effect on physical activity. The intraclass correlation coefficient (ICC) was computed for scales and selected items using one-way random models.

RESULTS

Overall, 86.6% of individual items and single item indicators showed excellent agreement (ICC ≥ 0.75), and 13.4% showed good agreement (ICC = 0.60-0.74). All subscales and overall summary scores showed excellent agreement. Six of 123 items were too rare to compute the ICC. The median ICC for items and scales was 0.92 with a range of 0.50-1.0. Aesthetics and social characteristics showed lower ICCs than other sub-scales, but reliabilities were still in the excellent range (ICC ≥ 0.75).

CONCLUSION

Evaluation of inter-observer reliability of MAPS-Global across five countries indicated all items and scales had "good" or "excellent" reliability. The results demonstrate that trained observers from multiple countries were able to reliably conduct observations of both residential and commercial areas with the new MAPS-Global instrument. Next steps are to evaluate construct validity in relation to physical activity in multiple countries and gain experience with using MAPS-Global for research and practice applications.

Neighborhood built environment and socio-economic status in relation to multiple health outcomes in adolescents

The study aim was to examine associations of neighborhood built environment and neighborhood socio-economic status (SES) with multiple physical activity (PA) behaviors, sedentary time, and obesity indicators among adolescents. Cross-sectional study of 325 adolescents aged 14-18years recruited from schools in Valencia, Spain. Participants' home neighborhoods were classified according to walkability and SES levels. Walkability was defined as an index of three built environment characteristics (i.e., residential density, land use mix, and street connectivity) based on geographic information system data. Moderate-vigorous PA (MVPA) and sedentary time were assessed using accelerometers. Active commuting to school, leisure-time PA, and time in specific sedentary activities were evaluated by questionnaire. Objectively measured weight and height were used to calculate body mass index, and percent body fat was analyzed by bioelectrical impedance. Data were collected in 2013-15. Mixed model regression analyses were performed. Analyses showed an SES-by-walkability interaction for MVPA on weekends. MVPA was highest in high-SES/high-walkable neighborhoods. Another SES-by-walkability interaction was found for sedentary minutes per weekend day. The lowest average sedentary minutes were found in high-SES/high-walkable areas. Neighborhood SES was positively related to participation in sports teams/PA classes and, negatively to time spent in sedentary behaviors. Adolescents living in lower-SES neighborhoods spent more time watching TV and had more obesity and body fat. Present findings strengthen the rationale for targeting neighborhood built and SES environments as health promotion interventions for adolescents.

Intra and intersession repeatability and reliability of the S-Plate® pressure platform

AIM

The aim of this study was to assess the repeatability and reliability of the S-Plate® pressure platform in a group of healthy subjects.

MATERIAL AND METHODS

Forty subjects, free from physical conditions that would affect normal gait, walked along a five-meter corridor while data were recorded from the pressure platform. A total of 10 steps (five each side) were obtained as well as five static trials; the same measurements were repeated one week later. Peak and mean plantar pressures and contact area were recorded for both dynamic and static trials. Additionally, weight supported on each limb was documented during static trials. To assess intrasession and intersession repeatability and reliability, the intraclass correlation coefficients (ICCs) and coefficient of variation (CoV) were calculated.

RESULTS

Taking the ICC values into account, every static and dynamic variable analysed showed moderate to excellent reliability and the CoV values were all below 12%.

CONCLUSION

Measurements of either static or dynamic plantar pressure variables with the S-Plate® pressure platform show good repeatability and reliability, and so it is useful for comparing steps within and between sessions.

[Perceived barriers to active commuting to school: reliability and validity of a scale]

OBJECTIVE

To examine the reliability and validity of a scale to measure perceived barriers to active commuting to school among Spanish young people.

METHOD

The validity of the scale was assessed in a sample of 465 adolescents (14-18 years) using a confirmatory factor analysis and studying its association with self-reported active commuting to school. The reliability of the instrument was evaluated in a sub-sample that completed the scale twice separated by a one-week interval.

RESULTS

The results showed that the barriers scale had satisfactory fit indices, and two factors were determined. The first included environment- and safety-related items (α=0.72), while the other concerned planning and psychosocial items (α=0.64). Active commuting to school showed significant correlations with the total score of the barriers scale (rho=-0.27; p <0.001), with the environmental/safety barriers (rho=-0.22; p <0.001), as well as with the planning/psychosocial barriers (rho=-0.29; p <0.001). Test-retest ICCs for the barriers ranged from 0.68 to 0.77.

CONCLUSION

The developed scale has acceptable validity and good reliability to assess barriers to active commuting to school among Spanish young people.

Are postural responses to backward and forward perturbations processed by different neural circuits?

Startle pathways may contribute to rapid accomplishment of postural stability. Here we investigate the possible influence of a startling auditory stimulus (SAS) on postural responses. We formulated four specific questions: (1) can a concurrent SAS shorten the onset of automatic postural responses?; and if so (2) is this effect different for forward versus backward perturbations?; (3) does this effect depend on prior knowledge of the perturbation direction?; and (4) is this effect different for low- and high-magnitude perturbations? Balance was perturbed in 11 healthy participants by a movable platform that suddenly translated forward or backward. Each participant received 160 perturbations, 25% of which were combined with a SAS. We varied the direction and magnitude of the perturbations, as well as the prior knowledge of perturbation direction. Perturbation trials were interspersed with SAS-only trials. The SAS accelerated and strengthened postural responses with clear functional benefits (better balance control), but this was only true for responses that protected against falling backwards (i.e. in tibialis anterior and rectus femoris). These muscles also demonstrated the most common SAS-triggered responses without perturbation. Increasing the perturbation magnitude accelerated postural responses, but again with a larger acceleration for backward perturbations. We conclude that postural responses to backward and forward perturbations may be processed by different neural circuits, with influence of startle pathways on postural responses to backward perturbations. These findings give directions for future studies investigating whether deficits in startle pathways may explain the prominent backward instability seen in patients with Parkinson's disease and progressive supranuclear palsy.

Preparedness for landing after a self-initiated fall

A startling auditory stimulus (SAS) causes a faster execution of voluntary actions when applied together with the imperative signal in reaction time tasks (the StartReact effect). However, speeding up reaction time may not be the best strategy in all tasks. After a self-initiated fall, the program for landing has to be time-locked to foot contact to avoid damage, and therefore advanced execution of the program would not be convenient. We examined the effects of SAS on the landing motor program in 8 healthy subjects that were requested to let themselves fall from platforms either 50 or 80 cm high at the perception of a visual imperative signal and land on specific targets. In trials at random, SAS was applied either together with the imperative signal (SAS(IS)) or at an appropriate prelanding time (SAS(PL)). As expected, the latency of takeoff was significantly shortened in SAS(IS) trials. On the contrary, the timing of foot contact was not significantly different for SAS(PL) compared with control trials. No changes were observed in the size of the electromyograph bursts in the two experimental conditions with respect to the control condition. Our results indicate that the landing program after a self-initiated fall may in part be organized at the time of takeoff and involve precise information on timing of muscle activation. Once launched, the program is protected against interferences by external inputs.

Leisure-Time Physical Activity and Psychological Well-Being in University Students

An analysis of psychological well-being (self-esteem and subjective vitality) of 639 Spanish university students was performed, while accounting for the amount of leisure-time physical activity. The Spanish versions of the Rosenberg Self-Esteem Scale and Subjective Vitality Scale were employed. Participants were divided into four groups (Low, Moderate, High, and Very high) depending on estimation of energy expenditure in leisure-time physical activity. Men and women having higher physical activity rated higher mean subjective vitality; however, differences in self-esteem were observed only in men, specifically between Very high and the other physical activity groups.

Speeding up gait initiation and gait-pattern with a startling stimulus

Human gait involves a repetitive leg motor pattern that emerges after gait initiation. While the automatic maintenance of the gait-pattern may be under the control of subcortical motor centres, gait initiation requires the voluntary launching of a different motor program. In this study, we sought to examine how the two motor programmes respond to an experimental manipulation of the timing of gait initiation. Subjects were instructed to start walking as soon as possible at the perception of an imperative signal (IS) that, in some interspersed trials was accompanied by a startling auditory stimulus (SAS). This method is known to shorten the latency for execution of the motor task under preparation. We reasoned that, if the two motor programmes were launched together, the gait-pattern sequence would respond to SAS in the same way as gait initiation. We recorded the gait phases and the electromyographic (EMG) activity of four muscles from the leg that initiates gait. In trials with SAS, latency of all gait initiation-related events showed a significant shortening and the bursts of EMG activity had higher amplitude and shorter duration than in trials without SAS. The events related to gait-pattern were also advanced but otherwise unchanged. The fact that all the effects of SAS were limited to gait initiation suggests that startle selectively can affect the neural structures involved in gait initiation. Additionally, the proportional advancement of the gait-pattern sequence to the end of gait initiation supports the view that gait initiation may actually trigger the inputs necessary for generating the gait-pattern sequence.

Relation of Body Mass Index and Body Fat Mass for Spanish University Students, Taking into Account Leisure-Time Physical Activity

The objective of this cross-sectional study was to analyze the relation of Body Mass Index with body fat mass while taking into account the amount of leisure-time physical activity for 299 male university students. Body fat mass was measured by bioelectrical impedance analysis. An estimation of energy expenditure in leisure-time physical activity in metabolic equivalents (METs) was obtained so participants were divided into six activity groups by percentile: no physical activity by the first group and participants physically active were divided into five groups by percentiles: <25%, 26–50%, 51–75%, 76–90%, and 91–100%. Correlations of Body Mass Index with body fat mass were strong in different groups—values ranged from .76 to .85, except for the >90% group.

The effects of an auditory startle on obstacle avoidance during walking

Movement execution is speeded up when a startle auditory stimulus is applied with an imperative signal in a simple reaction time task experiment, a phenomenon described as StartReact. The effect has been recently observed in a step adjustment task requiring fast selection of specific movements in a choice reaction time task. Therefore, we hypothesized that inducing a StartReact effect may be beneficial in obstacle avoidance under time pressure, when subjects have to perform fast gait adjustments. Twelve healthy young adults walked on a treadmill and obstacles were released in specific moments of the step cycle. On average the EMG onset latency in the biceps femoris shortened by 20% while amplitude increased by 50%, in trials in which an auditory startle accompanied obstacle avoidance. The presentation of a startle increased the probability of using a long step strategy, enlarged stride length modifications and resulted in higher success rates, to avoid the obstacle. We also examined the effects of the startle in a condition in which the obstacle was not present in comparison to a condition in which the obstacle was visibly present but it did not fall. In the latter condition, the obstacle avoidance reaction occurred with a similar latency but smaller amplitude as in trials in which the obstacle was actually released. Our results suggest that the motor programmes used for obstacle avoidance are probably stored at subcortical structures. The release of these motor programmes by a startling auditory stimulus may combine intersensory facilitation and the StartReact effect.

A startle speeds up the execution of externally guided saccades

The control of eye movements depends in part on subcortical motor centres. Gaze is often directed towards salient visual stimuli of our environment with no conscious voluntary commands. To further understand to what extent preprogrammed eye movements can be triggered subcortically, we carried out a study in normal volunteers to examine the effects of a startling auditory stimulus (SAS) on externally guided saccades. A peripheral visual cue was presented in the horizontal plane at a site distant 15 degrees from the fixation point, and subjects were instructed to make a saccade to it. SAS was presented together with the peripheral visual cue in 20% of trials. To force rapid visual fixation at the end of the saccade, targets were loaded with a second cue, a small arrow pointing towards the right or the left (or a neutral sign), not distinguishable with peripheral vision. Subjects were requested to perform a flexion/extension wrist movement, according to the direction of the arrow (or not to move if the second cue was the neutral sign). SAS presented together with the visual target caused a significant shortening of the latency of saccadic movements. The wrist movements performed as a response to the second cue had similar reaction times regardless of whether the trial contained a SAS or not. Our results show that voluntary saccades to peripheral targets are speeded up by activation of the startle circuit, and that this effect does not cause a significant disturbance in the execution of simple in-target cues. These results suggest that subcortical structures play a main role in preparation of externally guided saccades.

[Visual evoked potentials and electroretinogram in pediatrics. Concept methodology and clinical applications]

INTRODUCTION

Since the first visual evoked potentials were obtained in the early 1940s, many important technical advances have been developed helping to produce more correct responses. One of the most important has been the incorporation of computers in the 1960s. This allowed the improvement in the relation signal/noise and consequently the responses are much more reliables technically. Also the improvement in the stimulators and electrodes necessaries for this test. However, all this advances introduced the use of the physical and technical concepts and magnitudes that sometimes fall outside the strict field of the medicine.

MATERIAL AND METHODS

Therefore we have divided this work into three very different parts. The first part is dedicated to remembering and defining a series of physical concepts and their usefulness in the obtention of VEPs and ERGs specially in the physical process witch the proper use are basic to attain correct responses. In the second part we will discuss VEPs and ERGs in pediatric patients under the age of two years., concentrating basically on the every day specific problems witch appear on treating young patients. Finally we will review briefly their most frequent clinical applications.

[Parasomnias in infants below one-year old of age]

INTRODUCTION

Certain sleep disorders which occur in children and adults show the same phenomena, although presentation, significance, cause and treatment are all different. However, there are some disorders which are only found in infancy, as in the four conditions which we review below. In spite of great variation between individuals, the general way in which the wakefulness-sleep states mature during the first months of life is well known. In general the physiological patterns of REM and NREM are in general the same in children as in adults. However, the pathological patterns are similar, but there are major differences between them. These differences are mainly physiological, behavioural, parent-child relationship and specific disorders. We shall see that the central alveolar hypoventilation syndrome of infants is not the same as that of adults. The sleep apnea syndrome of the newborn is different to the apneas seen in older children. Benign neonatal myoclonia of sleep are not present in adults, and finally the sudden death of an infant is not like the unexplained nocturnal sudden death or sinus arrest linked to paradoxical sleep in adults.