Active Living Research Research Articles

The virtual special section of active transport papers from the 2017 active living research conference

Since 2004, the Active Living Research (ALR) Conference has focused on advancing knowledge and practice related to the creation of communities that increase opportunities for physical activity. Communities designed for active living are better for health, economic vitality, and environmental sustainability. The Annual ALR Conference serves as a premier venue for cross-disciplinary learning, as over 30 disciplines are represented among participants. This commentary serves as an introduction to a virtual Special Section of Journal of Transport and Health that includes several of the best transport-related studies that were presented at ALR 2017. The theme of the 2017 ALR Conference, Active Living across the Life Span, placed emphasis on the importance of promoting physical activity from childhood through mature adulthood and offered solutions for achieving this goal. The theme challenged attendees to consider the myriad needs across age cohorts and the ways that community design, policies, and programs affect opportunities for active living. The conference highlighted the importance of policy-relevant research and facilitated cross-sector exchange among scientists, practitioners, and policymakers to create and sustain active living environments where residents can grow, live, and thrive at any age. Jana Lyncott from the AARP Public Policy Institute delivered the Keynote Address on creating environments for active and engaged living for all ages. The presentation provided examples from communities across the United States that are promoting livability and fostering healthy, active, and engaged lifestyles. The presentation highlighted AARP's Livability Index, which scores neighborhoods and communities for the services and amenities that have a significant impact on residents. The featured panel included Drs. Adrian Bauman, NiCole Keith, and David Bann and focused on the challenges of integrating equity perspectives in research on active living across the lifespan. Dr. Bauman, from Australia, shared lessons from his research on middle-age-to-older adults and his international collaborations. Dr. Keith, from the United States, described the effort to ensure disadvantaged populations were given high priority in developing the multi-sector strategies of the US National Physical Activity Plan. Dr. Bann, from the UK, presented findings on active living across the lifespan from a large, long-term birth cohort study. The second panel featured Deputy Commissioner Adetokunbo 'Toks' Omishakin, (Tennessee Department of Transportation), Councillor Kristyn Wong-Tam (City of Toronto, Canada), and Otis Johnson (Former Mayor of Savannah, Georgia) and provided local and state examples of active transportation and lessons learned. A clear takeaway from the keynote and panelists was the need to integrate and apply life-course research and practice/policy lessons learned to most effectively create activity-supportive cities. The concept of active living includes physical activity for all purposes, including transport, recreation, occupation, and household. Active transport continues to be a dominant theme at ALR Conferences, and the link between transport and health outcomes is rising on research and policy agendas internationally, as shown by extensive coverage in Journal of Transport and Health and the 2016 Lancet Series on Urban Design, Transport, and Health. In the Lancet Series, Giles-Corti and colleagues (2016) reviewed a wide range of physical, mental, and social health problems linked with motorized transport. Stevenson and colleagues (2016) reported models that revealed a shift of just 10% of motorized trips to active modes could produce important reductions in mortality in cities as diverse as Copenhagen and Delhi. Thus, as co-chairs of the ALR 2017 Conference we want to thank Dr. Jennifer Mindell, Editor-in-Chief of Journal of Transport and Health, for facilitating this virtual special section of papers that will further advance evidence on active transport and health.

Combinations of Physical Activity, Sedentary Behaviour and Sleep

PURPOSE:To determine how combinations of physical activity (PA), sedentary behaviour (SB) and sleep are associated with important health indicators in children and youth aged 5-17 years. METHODS: MEDLINE, EMBASE, SPORTdiscus, CINAHL and PsycINFO were searched for studies examining the relationship between time spent engaging in different combinations of PA, SB and sleep with adiposity, cardiometabolic biomarkers, and physical fitness. Meta-analyses were planned for all outcomes; however, this was precluded due to the high levels of heterogeneity across studies. Therefore, narrative syntheses were employed for all health indicators. The quality of evidence was assessed using the GRADE framework. RESULTS: 13 cross-sectional studies and 1 longitudinal study reporting data from 36,560 participants met the inclusion criteria. Children and youth with a combination of High PA/High Sleep/Low SB had more desirable measures of adiposity (e.g. a 2.39 kg/m2 lower fat mass index, and an 8-fold reduction in the odds of obesity, p<0.05) and cardiometabolic health (e.g. a 3.31 unit lower metabolic syndrome score, p<0.05), compared to those with a combination of Low PA/Low Sleep/High SB. Health benefits were also observed for those with a combination of High PA/High Sleep (cardiometabolic health and adiposity) or High PA/Low SB (cardiometabolic health, adiposity and fitness), compared to Low PA/Low Sleep or Low PA/High SB. Of the 3 movement behaviours, PA (especially moderate-to-vigorous PA) was most consistently associated with desirable health indicators. Given the lack of randomized trials, the overall quality of the available evidence was low. CONCLUSIONS:School-aged children and youth characterized by High PA/High Sleep/Low SB have more desirable measures of adiposity and cardiometabolic health, compared to those with a combination of Low PA/Low Sleep/High SB. Further, those with High PA/High Sleep, and High PA/Low SB are also likely to experience health benefits, when compared to Low PA/Low Sleep, or Low PA/High SB. FUNDING: This project was made possible through funding from the Canadian Society for Exercise Physiology, Conference Board of Canada, Healthy Active Living and Obesity Research Group at the CHEO Research Institute and the Public Health Agency of Canada.

Relationships between Objectively Measured Physical Activity and Health Indicators in School-Aged Children and Youth

PURPOSE: Moderate-to-vigorous physical activity (MVPA) is an accepted strategy for disease prevention and health promotion. Emerging evidence suggests that other intensities of physical activity (PA), including light-intensity (LPA), may also be important in this regard, but there has been no rigorous evaluation of the evidence. Therefore, the purpose of this review was to examine the relationships between objectively measured PA (total and all intensities) and health indicators in children and youth. METHODS: Online databases were searched for peer-reviewed studies that met the a priori inclusion criteria: population (apparently healthy, aged 5-17 years), intervention/exposure and comparator (volumes, durations, frequencies, and intensities of objectively measured PA), and outcome (adiposity, cardiometabolic biomarkers, fitness, behavioural conduct/pro-social behaviour, cognition/academic achievement, quality of life/well-being, harms, bone health, motor development, psychological distress, self-esteem). Quality of evidence was assessed using the GRADE framework. Heterogeneity precluded meta-analyses; narrative synthesis of included studies was conducted. RESULTS: 162 publications were included (85,532 participants from 31 countries). Overall, there was strong, consistent evidence that total PA (greater durations and intensities) was favourably associated with adiposity, fitness, cognition/academic achievement and bone health; weaker evidence of favourable relationships with cardiometabolic biomarkers and motor development; and little evidence regarding other outcomes. LPA was favourably associated with several cardiometabolic biomarkers; there was a paucity of data in relation to other outcomes. Evidence quality was very low to moderate. CONCLUSION: These findings continue to support the importance of MVPA for health promotion and disease prevention in children and youth, but also highlight the potential benefits of LPA and total PA. All intensities of PA should be considered in future work aimed at better elucidating the health benefits of PA in children and youth. Funded by: Canadian Society for Exercise Physiology, Conference Board of Canada, Healthy Active Living and Obesity Research Group at the CHEO Research Institute, Public Health Agency of Canada.

Advancing Translation and Dissemination Research and Practice Through the Physical Activity Policy Research Network Plus.

In the United States (U.S.), physical inactivity is the fourth leading cause of death, with an estimated 200,000 deaths annually (Danaei et al., 2009). The lack of activity across the life span is important because it is a well-documented risk factor for leading non-communicable diseases including cardiovascular disease, cancers, obesity, and type 2 diabetes, as well as impaired quality of life (U.S. Burden of Disease Collaborators, 2013; U.S. Department of Health and Human Services, 2008). The need for policies and environments that promote population-wide increases in physical activity is important, given that only half of U.S. adults meet the recommended 150 minutes of moderate intensity physical activity weekly, 75 minutes of vigorous intensity activity, or an equivalent combination (U.S. Department of Health and Human Services, 2010). In addition, approximately 25% of adults report no leisure time physical activity (U.S. Department of Health and Human Services, 2010). Despite the availability of evidence-based interventions targeting the various factors that influence participation in, and opportunities for, physical activity, there is little indication that many of these interventions are being widely disseminated or implemented in the U.S. (King & Sallis, 2009; Owen, Glanz, Sallis, & Kelder, 2006). Eyler, Brownson, and Schmid (2013) recently noted slow progress in the evolution of physical activity interventions that targeted individual behavior change to ones that focus on multilevel policy and environmental changes. Moreover, the authors noted the persistence of health disparities in physical activity and a need for more work on translation, dissemination, and implementation (TDI) research, specifically to reduce physical activity disparities (Eyler et al., 2013). The U.S. Centers for Disease Control and Prevention (CDC) created the Physical Activity Policy Research Network (PAPRN) in October 2004 to study the effectiveness of policies related to increasing physical activity in communities and build the research base on physical activity policy. This national thematic network was led by investigators at St. Louis University and consisted of university researchers, physical activity practitioners, and local partners. Between 2004 and 2014, PAPRN grew from the five original sites to include 18 additional non-funded sites, including 13 Prevention Research Centers (PRCs). To organize and rationalize a research agenda, PAPRN established a policy framework along three axes, including the sector (e.g., health, transportation, parks, worksite, school), scale (e.g., local, regional, state, national, international), and policy status (e.g., policies, determinants, outcomes; Schmid, Pratt, & Witmer, 2006). Recognizing the importance of practitioner participation, a concept mapping process was used to establish a research agenda; 238 practitioners and researchers identified and prioritized policy research. To ensure a wide range of policy research, PAPRN then mapped its ongoing and future research projects across sectors and stage of policy development (Brownson et al., 2008). An evaluation concluded that PAPRN did increase the quality and quantity of physical activity policy research over the last decade. Consensus of those interviewed was that PAPRN had increased the quality and quantity of physical activity policy research and personal connections and networking were one of the greatest benefits of PAPRN (Eyler, Manteiga, Valko, Brownson, & Schmid, in review). Beginning in October 2014, the Network became known as PAPRN Plus (PAPRN+) to illustrate an increased emphasis on translation and dissemination (i.e., “plus”). The 5-year Network format for PAPRN+ is the same as for PAPRN—one Coordinating Center, several funded Collaborating Centers, and numerous unfunded sites (often at PRCs). The Coordinating Center for PAPRN+ is located at the Johns Hopkins Bloomberg School of Public Health (JHSPH) and is jointly led with a team from Active Living Research (ALR) at the University of California, San Diego. To bridge the gap between research and practice, PAPRN+ also includes several partners from the practice community representing health departments, non-profits from various sectors including parks and recreation and transportation, as well as government agencies. Currently, there are five funded Collaborating Centers, and at the 2016 ALR Conference, each Center will describe how they are advancing the physical activity policy research as part of a special session highlighting PAPRN+. The mission, vision, and functions of PAPRN+ are described in the following sections.

Physical activity report cards: Active Healthy Kids Global Alliance and The Lancet Physical Activity Observatory.

Tremblay (mtremblay@cheo.on.ca) is with the Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada. Gonzalez is with the Dept of Public Health, School of Medicine, Universidad de los Andes, Bogota, Colombia. Katzmarzyk is with the Pennington Biomedical Research Center, Baton Rouge, LA. Onywera is with the Dept of Recreation Management and Exercise Science, Kenyatta University, Nairobi, Kenya. Reilly is with the Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland. Tomkinson is with the Alliance for Research in Exercise, Nutrition, and Activity, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia. Physical Activity Report Cards: Active Healthy Kids Global Alliance and the Lancet Physical Activity Observatory

Obesity prevention lessons from Latin America

This is an invited commentary for the Active Living Research (ALR) special issue. The commentary focuses on the lessons that can be learned from Latin America regarding obesity prevention. Examples from Brazil, Mexico, and Colombia that may inform US policy are described.

Evaluation of Active Living Research

The Robert Wood Johnson Foundation Active Living Research (ALR) program commissioned an evaluation of its initiative to assess 10 years (2001-2011) of progress in establishing a new interdisciplinary field to develop and translate research focused on policy and environmental factors affecting physical activity in children and families. The second-phase evaluation (ALR-2) was conducted from March to July 2011 to measure progression from evidence- and field-building (Goals 1 and 2) to policy and practice contributions (Goal 3) to inform childhood obesity strategies, and to develop recommendations for a third phase (ALR-3). The evaluation was a retrospective, in-depth descriptive study utilizing qualitative and quantitative methods. Key informant interviews (N=100) across seven stakeholder groups were conducted and analyzed in 2011. Data from web-based surveys of grantee investigators conducted from 2007 to 2011 and analyzed in 2011 served as the primary quantitative source. Key indicators of ALR's overall progress confirmed ALR's success across its three goals: (1) establishing a strong research base: 309 publications filling major knowledge gaps; (2) building an interdisciplinary and diverse field: grantees represented 31 disciplines, with more than one quarter (28%) of investigators having ≤5 years of experience, of which 39% were people of color; and (3) using research to inform policy and practice: 62 examples, of which slightly more than one half (n=32) resulted in actual policy or practice change. Overall, ALR met its three goals during ALR-2 and was well positioned to implement a third phase of the program to further accelerate the translation of its research into policy and practice.

Revolution/Evolution of Active Living Research: Perspectives from Interdisciplinary Grantees

The path that the Active Living Research (ALR) program of the Robert Wood Johnson Foundation has taken over the past 10 years shows how a new transdisciplinary field has become established through evidence building, research translation, and community engagement. ALR’s multifaceted approach toward promoting environmental and policy approaches to increase physical activities among children and families 1 brought together researchers, policy makers, advocates, and practitioners from multiple fields that have traditionally worked separately. ALR’s main goal is to improve the health of the population by touching upon the daily lives of children and families through active living, but the ALR grants program has made many positive impacts on those involved in creating the research. This commentary shares three stories of ALR grantees whose careers developed closely with the evolution of ALR. The authors offer their personal reflections and insights for the future of ALR.

The Active Living Research 2013 Conference: Achieving Change across Sectors: Integrating Research, Policy, and Practice

Achieving Change Across Sectors: Integrating Research, Policy, and Practice (C. D. Economos) The 2013 Active Living Research (ALR) Annual Conference brought together a network of individuals from research, policy, and practice to exchange data, experiences, and aspirations toward building a more active-friendly national landscape. There were evidence generators, evidence users, and those who do a bit of both. Primarily a generator, I also find myself at the intersection when called upon to inform policy or to implement evidence-based practice. My own approach to research has become more interdisciplinary and participatory to generate evidence that is inclusive and relevant to policy debates, so the conference theme created a comfortable atmosphere for me. The rich dialogue among attendees exemplified the commitment of many to uphold our individual roles, varied at times throughout our careers, in designing and implementing evidence-based public health strategies and policies to promote effective and sustained action. What becomes exceedingly clear when sectors are brought together is that the system is interdependent—evidence informs policy development and practice, and evaluating policy implementation and practice-based interventions generates new evidence. The cycle is continuous. Public health has several health priorities that require thoughtful and careful collaborations between researchers, practitioners, and policymakers across many sectors. Perhaps most pressing is the fact that we have an obesity epidemic caused by environments and policies that encourage overconsuming and underexpending energy. The urgency of addressing the epidemic compels a variety of policy-related actions that reach far and deep within the population. To maximize impact, these actions must be feasible, synergistic, cost-effective, free of unintended adverse consequences, and based on the best available evidence. From the perspective of an evidence generator, the following questions are contemplated on a regular basis: What is the status of the evidence? How do we go forward in the absence of complete evidence? What types of studies are required to fill the gaps and expand the evidence base? What are the disciplines that would enrich a research study? Who should participate in the research process? How do we communicate useful results to people who can use them? From the perspective of a policymaker or practitioner (or evidence user), the questions begin once a body of evidence exists: How can the data be combined and compiled to inform decision makers and stakeholders about the value and importance of evidence and how it could inform a particular policy decision? What type of methods should be used to evaluate the impact of new policy implementation? To address these questions and others, the Institute of Medicine’s Bridging the Evidence Gap report explains how various forms of evidence are used in evidence-based public health decision making. A closer look at the types of evidence and how it’s used in policymaking illustrates the range of information often taken into account by policymakers and suggests an expanded role for evidence generators. For example, when conducting a controlled trial in a community with multilevel outcomes, it is important to pay attention to the knowledge, ideas and interests, and opinions and views of the community as well as costs and resources used. A variety of distinct pieces of evidence (quantitative and qualitative) and sources of knowledge have meaning and can ultimately inform policy. This generally makes the results more meaningful for the community and their representatives. Different types of evidence can be merged with specific capacities, such as an individual’s skills, experience, and participation in networks, to influence the adoption and adaptation of evidence in practice. At the organizational levels, capacity is often visible leadership, Christina D. Economos, PhD, is at Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts. James F. Sallis, PhD, is with Active Living Research, University of California, San Diego, San Diego, California. NiCole R. Keith, PhD, is at the Department of Kinesiology, Indiana UniversityPurdue University, Indianapolis, Indiana. Jimmy Newkirk, BS, is with the National Physical Activity Society, Coats, North Carolina.

Food insecurity in early life and BMI z‐score change among children from 2 to 15 years

Food insecurity disproportionately affects children and families at highest risk for obesity. Initially perceived as separate health problems, there is growing concern that food insecurity and obesity are related. Longitudinal studies that examine the relationship food insecurity and weight status in children have found contradicting and inconclusive results. We hypothesized that the timing and transitions in food insecurity have different consequences for risk of developing obesity. Longitudinal data from a rural New York State birth cohort (n=517) were used to determine whether the rate of change in BMI z‐score in childhood, 2 to 15 years, differ by exposure food insecurity at birth and 2 years of age. Linear mixed models were used to estimate the rate of change in BMI z‐score during childhood. We found that food‐insecure children compared to food‐secure children, were smaller in early childhood. Due to a greater rate of change in BMI, by the time food‐insecure children reach 15 years of age they had higher BMI z‐scores. We provide evidence that children who experience food insecurity early in life have higher rates of change in BMI compared to food‐secure children, putting them at greater risk for overweight and obesity in adolescence. Our findings provide new insight into why longitudinal studies in early childhood have been inconclusive.Grant Funding Source: Support for this project was provided by a Dissertation Award from the Robert Wood Johnson Foundation through its national program Active Living Research (ALR). Support for this student is provided in part by USDA National Needs Graduate Fellowship Competitive Grant No. 2008–38420‐04825 from the National Institute of Food and Agriculture. The data on biological and early life risk come from a NIH‐funded study No. HD 29549, “Biosocial Influences on Postpartum Weight Retention.”

Social inequalities in physical activity: do environmental and policy interventions help to reduce the gap? A pilot systematic review

BackgroundPhysical inactivity is a mounting public health concern in many countries. A substantial proportion of the UK adult population do not achieve recommended levels of physical activity. Furthermore, growing evidence suggests that opportunities to achieve adequate levels of physical activity might be restricted in some disadvantaged social groups. Several systematic reviews have examined the effectiveness of interventions to promote physical activity, but little is known about the social distribution of intervention effects. Without greater emphasis on the distributional effect of broad environmental or policy interventions, some efforts to improve health might contribute to increasing inequalities. We report the findings of a pilot study that examines how distributional effects have been reported in systematic reviews and primary studies, what methods are available to synthesise distributional effects, and what conclusions can be drawn from these data. MethodsWe used the Active Living Research (ALR) reference lists (2002–10) to search for relevant studies. These lists are generated through systematic searches of PubMed, ISI Web of Science, and various journals. We obtained 2586 abstracts that were scanned for potentially relevant systematic reviews and primary studies; conference abstracts and unpublished studies were not included. Studies were coded by one reviewer using several published instruments that identify information about distributional effects, assess the suitability of study design, and assess the methodological execution of studies. With the PROGRESS-Plus instrument (Campbell Cochrane Equity Methods Group), relevant studies were assessed for intent to present social distributional effects in terms of baseline participant characteristics, intervention effects, adjusted associations, or interaction effects. We then synthesised relevant information from primary studies with a harvest plot to summarise evidence for the presence and direction of any social gradient in intervention effectiveness. FindingsWe identified 19 systematic reviews of environmental and policy interventions. Few (n=5, 26%) were prospectively designed to synthesise distributional effects. However, several studies presented post-hoc descriptive analyses of intervention effects by age and sex. Ten (52%) reviews presented baseline sociodemographic data, and ten reported adjusted associations. We identified no examples of reviews that reported distributional interaction effects. To further investigate the availability of information we analysed the availability of data in primary studies. Relevant information was reported more frequently in primary studies than in reviews: 37 (42%) of studies reported subgroup intervention effects; 16 (18%) reported sociodemographic interaction effects; 26 (30%) reported associations adjusted for sociodemographic characteristics; and, most notably, 80 (90%) reported baseline sociodemographic characteristics of their study samples. In synthesis of this information we noted that primary studies had most frequently examined differential effectiveness by comparing effectiveness by sex, age, ethnic origin, and socioeconomic status. For sex, effects seemed to be evenly distributed overall, although heterogeneity in gradients between studies suggested that some interventions might affect men and women differently. InterpretationPractitioners and policy makers need to understand how initiatives to improve health could affect inequalities. Findings from this pilot study suggest that existing systematic reviews may have insufficient information about the distributional effectiveness of physical activity interventions. However, information is available within existing primary studies of physical activity interventions that might support the investigation and synthesis of distributional effects. Therefore, generation of improved evidence about how public health interventions could affect health inequalities might be both necessary and feasible, with use of innovative methods of research synthesis. FundingThis work was undertaken by the Centre for Diet and Activity Research, a UKCRC Public Health Research Centre of Excellence, with funding from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, NIHR, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration.

The HALO submaximal treadmill protocol to measure cardiorespiratory fitness in obese children and youth: a proof of principle study

Many limitations exist with completing cardiorespiratory fitness testing in obese children. The aim of this study was to determine if the new Healthy Active Living and Obesity Research Group's (HALO's) submaximal cardiorespiratory fitness testing protocol for obese children and youth provides a comparable estimate of peak oxygen uptake to that measured using validated maximal and submaximal, equation-based protocols in the obese pediatric population. A group of obese children (n = 21; all ≥95th body mass index percentile; aged 10-17 years) completed 3 exercise testing protocols. Testing was completed as part of an ongoing cohort study and 2 submaximal cardiorespiratory fitness tests were completed, in randomized order, during a second visit. Significant correlations were found between observed peak oxygen uptake (mL·min(-1)) and predicted peak oxygen uptake for both the HALO (r = 0.75, p = 0.001) and Nemeth (r = 0.66, p = 0.001) submaximal protocols. A similar correlation was found, after accounting for body mass, between measured and predicted HALO peak oxygen uptake (mL·kg(-1)·min(-1)) values (r = 0.54, p = 0.01). HALO predicted peak oxygen uptake values showed a significant correlation when plotted against the measured values (r = 0.99). A Bland-Altman analysis found agreement between the maximal and HALO submaximal protocols (mean bias = -201.75 mL·min(-1)). The significant relationships found between estimates of peak oxygen uptake from the HALO submaximal protocol and measures of peak oxygen uptake during maximal cardiorespiratory testing support the use of the HALO submaximal protocol as a valid measure to estimate maximal cardiorespiratory fitness within the obese pediatric population. Given the proof of principle goal of this study, future research in the obese, pediatric population is encouraged to confirm the generalizability of the protocol.

Corrigendum: The HALO submaximal treadmill protocol to measure cardiorespiratory fitness in obese children and youth: a proof of principle study.

Many limitations exist with completing cardiorespiratory fitness testing in obese children. The aim of this study was to determine if the new Healthy Active Living and Obesity Research Group's (HALO's) submaximal cardiorespiratory fitness testing protocol for obese children and youth provides a comparable estimate of peak oxygen uptake to that measured using validated maximal and submaximal, equation-based protocols in the obese pediatric population. A group of obese chil- dren (n = 21; all ≥95th body mass index percentile; aged 10-17 years) completed 3 exercise testing protocols. Testing was completed as part of an ongoing cohort study and 2 submaximal cardiorespiratory fitness tests were completed, in random- ized order, during a second visit. Significant correlations were found between observed peak oxygen uptake (mL·min -1 ) and predicted peak oxygen uptake for both the HALO (r = 0.75, p = 0.001) and Nemeth (r = 0.66, p = 0.001) submaximal pro- tocols. A similar correlation was found, after accounting for body mass, between measured and predicted HALO peak oxy- gen uptake (mL·kg -1 ·min -1 ) values (r = 0.54, p = 0.01). HALO predicted peak oxygen uptake values showed a significant correlation when plotted against the measured values (r = 0.99). A Bland-Altman analysis found agreement between the maximal and HALO submaximal protocols (mean bias = -201.75 mL·min -1 ). The significant relationships found between estimates of peak oxygen uptake from the HALO submaximal protocol and measures of peak oxygen uptake during maxi- mal cardiorespiratory testing support the use of the HALO submaximal protocol as a valid measure to estimate maximal car- diorespiratory fitness within the obese pediatric population. Given the proof of principle goal of this study, future research in the obese, pediatric population is encouraged to confirm the generalizability of the protocol.

Neighborhood Environment and Physical Activity Among Youth: A Review

Research examining the association between environmental attributes and physical activity among youth is growing. An updated review of literature is needed to summarize the current evidence base, and to inform policies and environmental interventions to promote active lifestyles among young people. A literature search was conducted using the Active Living Research (ALR) literature database, an online database that codes study characteristics and results of published papers on built/social environment and physical activity/obesity/sedentary behavior. Papers in the ALR database were identified through PubMed, Web of Science, and SPORTDiscus using systematically developed and expert-validated search protocols. For the current review, additional inclusion criteria were used to select observational, quantitative studies among youth aged 3-18 years. Papers were categorized by design features, sample characteristics, and measurement mode. Relevant results were summarized, stratified by age (children or adolescents) and mode of measurement (objective or perceived) for environmental attributes and physical activity. Percentage of significant results was calculated. Mode of measurement greatly influenced the consistency of associations between environmental attributes and youth physical activity. For both children and adolescents, the most consistent associations involved objectively measured environmental attributes and reported physical activity. The most supported correlates for children were walkability, traffic speed/volume, access/proximity to recreation facilities, land-use mix, and residential density. The most supported correlates for adolescents were land-use mix and residential density. These findings support several recommendations for policy and environmental change from such groups as the IOM and National Physical Activity Plan.

Short sleep duration as a cause of obesity: myth or reality?

Short sleep duration as a <i>cause</i> of obesity: myth or reality?

Canadian Sedentary Behaviour Guidelines for Children and Youth

The Canadian Society for Exercise Physiology (CSEP), in partnership with the Healthy Active Living and Obesity Research Group (HALO) at the Children's Hospital of Eastern Ontario Research Institute, and in collaboration with ParticipACTION, and others, has developed the Canadian Sedentary Behaviour Guidelines for Children (aged 5-11years) and Youth (aged 12-17years). The guidelines include a preamble to provide context, followed by the specific recommendations for sedentary behaviour. The entire development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guidelines have gone through a rigorous and transparent developmental process and the recommendations are based on evidence from a systematic review and interpretation of the research evidence. The final guidelines benefitted from an extensive online consultation process with 230 domestic and international stakeholders and key informants. The final guideline recommendations state that for health benefits, children (aged 5-11years) and youth (aged 12-17years) should minimize the time that they spend being sedentary each day. This may be achieved by (i) limiting recreational screen time to no more than 2h per day- lower levels are associated with additional health benefits; and (ii) limiting sedentary (motorized) transport, extended sitting time, and time spent indoors throughout the day. These are the first evidence-based Canadian Sedentary Behaviour Guidelines for Children and Youth and provide important and timely recommendations for the advancement of public health based on a systematic synthesis, interpretation, and application of the current scientific evidence.

Associations between obesity and morbidity: effects of measurement methods

Obesity ReviewsVolume 9, Issue 5 p. 501-502 Associations between obesity and morbidity: effects of measurement methods M. Shields, M. Shields Statistics Canada, Health Information and Research Division, OttawaSearch for more papers by this authorS. Connor Gorber, S. Connor Gorber Statistics Canada, Health Information and Research Division, OttawaSearch for more papers by this authorM. S. Tremblay, M. S. Tremblay Statistics Canada, Physical Health Measures Division, Ottawa, and Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, CanadaE-mail: Margot.Shields@statcan.caSearch for more papers by this author M. Shields, M. Shields Statistics Canada, Health Information and Research Division, OttawaSearch for more papers by this authorS. Connor Gorber, S. Connor Gorber Statistics Canada, Health Information and Research Division, OttawaSearch for more papers by this authorM. S. Tremblay, M. S. Tremblay Statistics Canada, Physical Health Measures Division, Ottawa, and Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, CanadaE-mail: Margot.Shields@statcan.caSearch for more papers by this author First published: 11 August 2008 https://doi.org/10.1111/j.1467-789X.2008.00496.xCitations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume9, Issue5September 2008Pages 501-502 RelatedInformation