Physical activity and sedentary behaviour in children with spina bifida.

Validity of accelerometry for predicting physical activity and sedentary time in ambulatory children and young adults with cerebral palsy

Child care centers are important for children's behaviors. To examine the cross-sectional associations between child care environmental characteristics and physical activity and sedentary time in children. Participants were 124 toddlers and 118 preschoolers from 19 centers in Alberta and Ontario, Canada, in the supporting Healthy physical AcTive CHildcare setting (HATCH) study. In-care physical activity and sedentary time were assessed using Actigraph accelerometers. Child care environments, including structure (e.g., resources) and process (e.g., activities) quality, were measured using three instruments: (1) the Environment and Policy Assessment and Observation and (2) the Children's Physical Environments Rating Scale, and (iii) the Movement Environment Rating Scale. Mixed models were performed to examine the associations between environmental characteristics and children's sedentary time, light physical activity, and moderate-to-vigorous physical activity. A few structure quality characteristics related to child care policy and indoor environment were associated with higher physical activity and lower sedentary time in toddlers. The overall structure quality (B = 0.04; 95% CI [0.003, 0.08]) and process quality (B = 0.08; 95% CI [0.02, 0.15]) of the child care environment were associated with log moderate-to-vigorous physical activity in preschoolers. Specifically, structure quality characteristics of the outdoor environment and physical activity time, and process quality characteristics relevant to curriculum and pedagogy, were associated with higher physical activity and lower sedentary time in preschoolers. The child care structure quality characteristics that are important for children' physical activity and sedentary behavior may vary by age group. Improving the overall process quality, in particular curriculum and pedagogy, of the child care environment, may promote more physical activity in preschoolers.

The objective was to examine changes of children's time spent in sedentary, light physical activity, moderate to vigorous physical activity (MVPA), and estimated energy expenditure (EE) rates during weekdays and weekends across 3 years. An initial sample of 261 children's (mean age = 7.81y) 5-day physical activity and EE were assessed annually via accelerometry across 3 years using repeated-measures multivariate analysis of variance. The outcome variables were time spent in sedentary, light physical activity, MVPA, and kilocalories per day for weekdays and weekends. A significant decrease in MVPA and EE occurred during weekdays across the 3 years (P = .01). Only the second-year data demonstrated an increase (+2.49min) in weekend MVPA (P = .04). Children's sedentary time during weekdays increased significantly in years 1 and 2 (P = .01), yet significantly decreased in the third year (-44.31min). Children's sedentary time during weekends significantly decreased in the first year (-27.31min), but increased in the following 2 years (P = .01). Children's light physical activity demonstrated a statistically significant increase in year 2 (+3.75min) during weekdays (P = .05). Children's MVPA and EE generally declined during weekdays but were maintained during weekends across a 3-year time span. Children may benefit most from weekday intervention strategies.

Aims/hypothesisWe hypothesised that the insulin-sensitising effect of physical activity depends on the timing of the activity. Here, we examined cross-sectional associations of breaks in sedentary time and timing of physical activity with liver fat content and insulin resistance in a Dutch cohort.MethodsIn 775 participants of the Netherlands Epidemiology of Obesity (NEO) study, we assessed sedentary time, breaks in sedentary time and different intensities of physical activity using activity sensors, and liver fat content by magnetic resonance spectroscopy (n=256). Participants were categorised as being most active in the morning (06:00–12:00 hours), afternoon (12:00–18:00 hours) or evening (18:00–00:00 hours) or as engaging in moderate-to-vigorous-physical activity (MVPA) evenly distributed throughout the day. Most active in a certain time block was defined as spending the majority (%) of total daily MVPA in that block. We examined associations between sedentary time, breaks and timing of MVPA with liver fat content and HOMA-IR using linear regression analyses, adjusted for demographic and lifestyle factors including total body fat. Associations of timing of MVPA were additionally adjusted for total MVPA.ResultsThe participants (42% men) had a mean (SD) age of 56 (4) years and a mean (SD) BMI of 26.2 (4.1) kg/m2. Total sedentary time was not associated with liver fat content or insulin resistance, whereas the amount of breaks in sedentary time was associated with higher liver fat content. Total MVPA (−5%/h [95% CI −10%/h, 0%/h]) and timing of MVPA were associated with reduced insulin resistance but not with liver fat content. Compared with participants who had an even distribution of MVPA throughout the day, insulin resistance was similar (−3% [95% CI −25%, 16%]) in those most active in morning, whereas it was reduced in participants who were most active in the afternoon (−18% [95% CI −33%, −2%]) or evening (−25% [95% CI −49%, −4%]).Conclusions/interpretationThe number of daily breaks in sedentary time was not associated with lower liver fat content or reduced insulin resistance. Moderate-to-vigorous activity in the afternoon or evening was associated with a reduction of up to 25% in insulin resistance. Further studies should assess whether timing of physical activity is also important for the occurrence of type 2 diabetes.Graphical abstract

PURPOSE: This study aimed to validate five published ActiGraph (AG) cut-off points for the measurements of physical activity (PA) and sedentary time (ST) in ambulatory children and young adults with cerebral palsy (CP). Additionally, four energy expenditure (EE) prediction equations based on AG counts and activPAL (AP) steps were examined in this population, using oxygen uptake (VO2) as the criterion. METHODS: Four male and six female participants with CP (GMFCS levels I-III, ages 9-21 years) completed seven activities while simultaneously wearing an AG, AP monitor and indirect calorimetry unit. VO2 was measured on a breath-by-breath basis using the indirect calorimetry and was converted into EE using metabolic equivalents. AG counts were classified as sedentary, light PA (LPA) or moderate-to-vigorous PA (MVPA) using five cut-off points: Puyau, Evenson, Romanzini, Clanchy and Baque. The predicted EE was computed using three AG-based equations (Freedson, Trost and Treuth) and an AP step-based equation. The classification accuracies of the five AG cut-off points were assessed using Spearman correlation (r) and kappa (κ) coefficients. Agreements between measured and predicted EE values were assessed using paired-t tests, mean differences (95% confidence interval) and Bland-Altman plots. RESULTS: Of the five AG cut-off points, Baque (r = 0.896, κ = 0.773) and Clanchy (r = 0.935, κ = 0.721) classified PA and ST most accurately. All the equations overestimated EE during sitting activities and underestimated EE during rapid walking. Across all activities, the mean bias and 95% limits of agreement for the Freedson, Trost, Treuth and AP prediction equations were -0.05 METs (-2.15, 2.05), -0.28 kcal·min-1 (-2.18, 2.74), -0.54 METs (-2.37, 1.29) and 0.04 METs (-2.60, 2.68), respectively. The Freedson, Treuth and AP equations exhibited systematic bias during rapid walking, as their differences from the criterion measure increased progressively with increasing activity intensity. CONCLUSION: The AG accurately classified PA and ST when the Baque and Clanchy cut-off points were used. However, none of the available AG or AP equations accurately predicted the EE during PA and ST in children and young adults with CP. Further development is needed to ensure that both devices can estimate EE accurately in this population.

BackgroundStudies on parent-child correlations of physical activity have been mixed. Few studies have examined concurrent temporal patterns of physical activity and sedentary behaviors in parents and children using direct measures. The purpose of this study was to examine parent-child activity correlations by gender, day of week, and time of day, using accelerometers - a method for direct assessment of physical activity.MethodsAccelerometers were used to assess physical activity and sedentary time in 45 fathers, 45 mothers and their children (23 boys, 22 girls, mean age 9.9 years) over the course of 4 days (Thursday - Sunday). Participants were instructed to wear accelerometers for 24 hours per day. Data from accelerometers were aggregated into waking hours on weekdays and weekends (6:00 am to midnight) and weekday after-school hours (3:00 - 7:00 pm).ResultsAcross the 4 days, the mean minutes per day of moderate-to-vigorous physical activity (MVPA) for fathers was 30.0 (s.d. = 17.3), for mothers was 30.1 (s.d. = 20.1) and for children was 145.47 (s.d. = 51.64). Mothers' and fathers' minutes of MVPA and minutes of sedentary time were positively correlated with child physical activity and sedentary time (all ps < .05, with the exception of mothers' and children's sedentary time on weekdays from 6 am to 12 am). Multivariate linear regression analyses resulted in significant effects between parents and children for MVPA across all time segments. For sedentary activity, significant associations were observed only between father and child on the weekend. Sedentary activity of parents and children were not related for other time segments. Models examining the associations of one or two parents with high levels of MVPA or sedentary time indicated a dose response increase in child activity relative to parent.ConclusionsGreater parental MVPA was associated with increased child MVPA. In addition, having two parents with higher levels of MVPA was associated with greater levels of activity in children. Sedentary time in children was not as strongly correlated with that of their parents. Findings lend support to the notion that to increase childhood activity levels it may be fruitful to improve physical activity among parents.

BackgroundPhysical activity has emerged as an important lifestyle factor for primary prevention of numerous diseases, including postmenopausal breast cancer. No study to date has assessed the acute and long-term effects of year-long aerobic exercise programs differing in prescribed exercise volume on physical activity and sedentary time in postmenopausal women. Therefore, we aimed to examine the effects of two moderate-vigorous intensity exercise doses on total, light and moderate-vigorous intensity physical activity times, and sedentary time in postmenopausal women during the year-long intervention and one year later.MethodsThe Breast Cancer and Exercise Trial in Alberta (BETA) was a two-center, two-arm, 12-month randomized controlled trial that included 400 previously inactive postmenopausal women randomized to either 150 (MODERATE) or 300 (HIGH) minutes/week of aerobic exercise. Physical activity and sedentary time were assessed at baseline, 6- (intervention mid-point), 12- (prior to end of intervention) and 24-months (follow-up) with waist-mounted accelerometers (Actigraph GTX3®). Self-reported activity and sedentary time at baseline, 12- and 24-months was also assessed (Past Year Total Physical Activity Questionnaire and SIT-Q). Intention-to-treat analyses were conducted using linear mixed models and adjusted for baseline variables.ResultsBoth physical activity interventions led to increases in objective and subjective measures of total and moderate-vigorous intensity/recreational physical activity time, coupled with decreases in sedentary time, at 6- and 12-months compared to baseline. Additionally, greater increases in accelerometry-derived total physical activity time at 6- and 12-months, and self-reported recreational activity time at 12-months, compared to baseline were noted in the HIGH versus MODERATE groups. Decreases in total, light and moderate-vigorous intensity physical activity time, and an increase in sedentary time, in both groups were noted at 24-months compared to 12-months. A decrease in light intensity physical activity time in both groups at 24-months compared to baseline was also noted.ConclusionThese findings have important health implications, suggesting that total physical activity time can be increased with greater volumes of prescribed exercise, but that additional support and resources could be used to promote the maintenance of these high levels of aerobic exercise participation following study completion.Trial registrationclinicaltrials.gov identifier: NCT01435005 (BETA Trial). Registred September 15th 2011 (retrospectively registered).

BackgroundLow levels of physical activity (PA) and high sedentary time (ST) are common in older adults and lack of PA is a risk factor for cardiovascular disease (CVD). Knowledge about associations with accelerometer-measured PA, ST and CVD risk in older adults is insufficient. This study examines the associations of accelerometer-measured PA and ST with cardiovascular risk measured using the Framingham risk score (FRS) and all-cause mortality in older adults.MethodsA population-based sample of 660 (277 men, 383 women) older people (mean age 68.9) participated in the Oulu45 cohort study from 2013‒2015. PA and ST were measured with wrist-worn accelerometers at baseline for two weeks. Ten-year CVD risk (%) was estimated with FRS. The data for all-cause mortality were identified from the Digital and Population Data Services Agency, Finland after an average of 6.2 years follow-up. The associations between moderate to vigorous physical activity (MVPA), light physical activity (LPA), ST and FRS were analyzed using the multivariable linear regression analysis. Associations between LPA, ST and mortality were analyzed using the Cox proportional-hazard regression models.ResultsEach 10 min increase in MVPA (β = -0.779, 95% CI -1.186 to -0.371, p < 0.001) and LPA (β = -0.293, 95% CI -0.448 to -0.138, p < 0.001) was negatively associated with FRS while a 10 min increase in ST (β = 0.290, 95% CI 0.158 to 0.421, p < 0.001) was positively associated with FRS. After adjustment for waist circumference, only ST was significantly associated with FRS. Each 10 min increase in LPA was associated with 6.5% lower all-cause mortality risk (HR = 0.935, 95% CI 0.884 to 0.990, p = 0.020) and each 10 min increase in ST with 5.6% increased mortality risk (HR = 1.056, 95% CI 1.007 to 1.108, p = 0.025).ConclusionA higher amount of daily physical activity, at any intensity level, and avoidance of sedentary time are associated with reduced cardiovascular disease risk in older people. Higher time spent in light physical activity and lower sedentary time are associated with lower all-cause mortality.

BackgroundLimited physical activity (PA) and a high level of sedentary time (ST) are associated with childhood obesity and are a target for intervention. This study aimed to assess objectively measured PA and ST in Dutch children across weight categories, age groups and sex.Methods202 children with overweight, obesity and morbid obesity (55% girls, 12 ± 3y of age, BMI z-score + 3.15 ± 0.73), referred to the Centre for Overweight Adolescents and Children’s Healthcare (COACH, Maastricht UMC+) were included. PA (total PA, light PA and moderate to vigorous PA (MVPA)) and ST were measured with the GT3X Actigraph accelerometer. Wear time validation was set to include at least four days, 480 min/day, including one weekend day.ResultsPA levels in children with morbid obesity were higher compared to children with obesity, also after correction for age and sex (corrected difference (B) 118 counts per minute (cpm), p = .006). ST was lower in children with morbid obesity compared to children with obesity (B − 51 min/day, p = .018). Girls performed significantly less MVPA than boys (B − 11 min/day, p < .001) and for each year increase of age, children performed less PA (B − 46 cpm, p < .001) and ST increased (B 18 min/day, p < .001).ConclusionPA and ST is different in subgroups of children with overweight, obesity and morbid obesity, depending on sex, age and overweight severity. In particular, children with obesity perform less PA and more ST compared to children with morbid obesity. Future research could explore the preferences and needs for PA and ST in children in the different weight categories.Trial registrationThe trial is registered with Clinicaltrials.govNCT02091544 at March 19, 2014.

To develop healthy ageing interventions, longitudinal associations between objectively assessed physical behaviours and physical function need to be better understood. We assessed associations between accelerometer-assessed total physical activity (PA), moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary time and prolonged sedentary bout time, and clinically assessed physical function (grip strength, usual walking speed (UWS), chair stand speed) at two time-points in 3188 participants (≥ 60 years) of the EPIC-Norfolk study. Bidirectional associations were assessed using multivariable linear regression. Over an average of 6.1 years, baseline physical behaviours (greater total PA, MVPA and LPA, and less sedentary time) were associated with better subsequent walking and chair stand speed. Better baseline physical function was associated with better follow-up physical behaviours. There were no bidirectional associations between changes in physical behaviours and grip strength. Improvements in UWS were associated with improvements in all physical behaviours. Improvements in chair stand speed were associated with improvements in total PA, MVPA, and sedentary bout time. Improvements in physical behaviours were associated with improvements in UWS (3.1 cm/s/yr per 100 cpm/yr total PA, 3.6 cm/s/yr per hr/day/yr MVPA, 2.5 cm/s/yr per hr/day/yr LPA, − 2.9 cm/s/yr per hour/day/yr sedentary time, and − 1.6 cm/s/yr per hr/day/yr prolonged sedentary bout time). Only improvements in total PA, MVPA and sedentary bout time were associated with improvements in chair stand speed. In conclusion, we found bidirectional associations between changes in some physical behaviours and physical function and between baseline physical behaviours and subsequent physical function, highlighting the importance of considering the full range of physical behaviours to promote healthy ageing.

THE USE OF INDIVIDUALIZED EXERCISE PRESCRIPTION AND ACTIVITY TRACKERS TO PROMOTE PHYSICAL ACTIVITY IN CHILDREN WITH CONGENITAL HEART DISEASE

Purpose: To determine how physical activity-related self-efficacy is associated with physical activity and sedentary behaviour time among ambulatory children with cerebral palsy (CP). Method: Children with CP, Gross Motor Function Classification System (GMFCS) Levels I-III (N=26; aged 9-18 y), completed the task self-efficacy component of a self-efficacy scale and wore Actigraph GT3X+ accelerometers for 5 days. Correlations (Pearson and Spearman's rank-order; α=0.050) were conducted to evaluate the relationships among age, GMFCS level, self-efficacy, and both daily moderate-to-vigorous physical activity (MVPA) and sedentary time. Linear regression models were used to determine the relationships among the independent variables and MVPA and sedentary time. Results: Self-efficacy was positively associated with MVPA time (r=0.428, p=0.015) and negatively correlated with sedentary time (r=-0.332, p=0.049). In our linear regression models, gross motor function (β=-0.462, p=0.006), age (β=-0.344, p=0.033), and self-efficacy (β=0.281, p=0.080) were associated with MVPA time (R2=0.508), while GMFCS level (β=0.439, p=0.003) and age (β=0.605, p < 0.001) were associated with sedentary time (R2=0.584). Conclusions: This research suggests that self-efficacy, age, and gross motor function are associated with MVPA in children with CP. Additional research is needed to confirm these findings and further explore the influence of self-efficacy on sedentary behaviour.

BackgroundExisting research has documented inconsistent findings for the associations among breakfast frequency, physical activity (PA), and sedentary time in children. The primary aim of this study was to examine the associations among breakfast frequency and objectively-measured PA and sedentary time in a sample of children from 12 countries representing a wide range of human development, economic development and inequality. The secondary aim was to examine interactions of these associations between study sites.MethodsThis multinational, cross-sectional study included 6228 children aged 9–11 years from the 12 International Study of Childhood Obesity, Lifestyle and the Environment sites. Multilevel statistical models were used to examine associations between self-reported habitual breakfast frequency defined using three categories (breakfast consumed 0 to 2 days/week [rare], 3 to 5 days/week [occasional] or 6 to 7 days/week [frequent]) or two categories (breakfast consumed less than daily or daily) and accelerometry-derived PA and sedentary time during the morning (wake time to 1200 h) and afternoon (1200 h to bed time) with study site included as an interaction term. Model covariates included age, sex, highest parental education, body mass index z-score, and accelerometer waking wear time.ResultsParticipants averaged 60 (s.d. 25) min/day in moderate-to-vigorous PA (MVPA), 315 (s.d. 53) min/day in light PA and 513 (s.d. 69) min/day sedentary. Controlling for covariates, breakfast frequency was not significantly associated with total daily or afternoon PA and sedentary time. For the morning, frequent breakfast consumption was associated with a higher proportion of time in MVPA (0.3%), higher proportion of time in light PA (1.0%) and lower min/day and proportion of time sedentary (3.4 min/day and 1.3%) than rare breakfast consumption (all p ≤ 0.05). No significant associations were found when comparing occasional with rare or frequent breakfast consumption, or daily with less than daily breakfast consumption. Very few significant interactions with study site were found.ConclusionsIn this multinational sample of children, frequent breakfast consumption was associated with higher MVPA and light PA time and lower sedentary time in the morning when compared with rare breakfast consumption, although the small magnitude of the associations may lack clinical relevance.Trial registrationThe International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at (Identifier NCT01722500).

BackgroundParents could be important influences on child physical activity and parents are often encouraged to be more active with their child. This paper examined the association between parent and child physical activity and sedentary time in a UK cohort of children assessed when the children were in Year 1 (5–6 years old) and in Year 4 (8–9 years old).MethodsOne thousand two hundred twenty three children and parents provided data in Year 4 and of these 685 participated in Year 1. Children and parents wore an accelerometer for five days including a weekend. Mean minutes of sedentary time and moderate-to-vigorous intensity physical activity (MVPA) were derived. Multiple imputation was used to impute all missing data and create complete datasets. Linear regression models examined whether parent MVPA and sedentary time at Year 4 and at Year 1 predicted child MVPA and sedentary time at Year 4. Change in parent MVPA and sedentary time was used to predict change in child MVPA and sedentary time between Year 1 and Year 4.ResultsImputed data showed that at Year 4, female parent sedentary time was associated with child sedentary time (0.13, 95% CI = 0.00 to 0.27 mins/day), with a similar association for male parents (0.15, 95% CI = −0.02 to 0.32 mins/day). Female parent and child MVPA at Year 4 were associated (0.16, 95% CI = 0.08 to 0.23 mins/day) with a smaller association for male parents (0.08, 95% CI = −0.01 to 0.17 mins/day). There was little evidence that either male or female parent MVPA at Year 1 predicted child MVPA at Year 4 with similar associations for sedentary time. There was little evidence that change in parent MVPA or sedentary time predicted change in child MVPA or sedentary time respectively.ConclusionsParents who were more physically active when their child was 8–9 years old had a child who was more active, but the magnitude of association was generally small. There was little evidence that parental activity from three years earlier predicted child activity at age 8–9, or that change in parent activity predicted change in child activity.

Physical activity (PA) data were downloaded from 113 participants who owned a Garmin or Fitbit activity tracker in 2019 and 2020. Upon participant authorization, data were automatically downloaded from the Garmin and Fitbit cloud storages. The mSpider tool, a solution for automatic and continuous data extraction from activity tracker providers, were used to download participant data. Available data are daily averages by year, as well as monthly averages between 2019 and 2020, for steps, activity energy expenditure (AEE), total energy expenditure (TEE), moderate-to-vigorous physical activity (MVPA), light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and sedentary time. In addition, March 2020 was divided in two, giving the daily average before and after the Norwegian COVID-19 lockdown date. Raw daily values for these variables are also included in a separate file. In addition, daily values for non-wear time are also include as raw data.In a previous study, differences between months, i.e., comparing 2019 with 2020 for months between March to December, were analysed for steps, MVPA, and AEE [1]. Further insights may be achieved by exploring other variables. This includes: (1) monthly averages for TEE, LPA, MPA, VPA, and sedentary time, (2) yearly averages (2019 and 2020) for steps, MVPA, TEE, AEE, LPA, MPA, VPA, and sedentary time (3) monthly average for steps, MVPA, TEE, AEE, LPA, MPA, VPA, and sedentary time for January, February, and March 2019, as well as March 2020. Additional analysis can also be conducted on the raw data.