Valid Physical Activity Data Research Articles

Validating device-based physical activity indicators with observation physical activity indicators in Swiss pre-school children

Purpose
 Accelometry is a very important tool to measure physical activity (PA) in preschoolers, as it can measure 24-hour PA and detect activity which cannot be captured by other methods. However, accelerometer validation for preschoolers is lacking (Altenburg et al. 2022). Specifically, for the ActiGraph wGT3X-BT and Move 4 (ActiGraph LLC; Move4 activity sensor, movisens GmbH) only a few, respectively no preschooler validation studies, were found. Thus, the purpose was to validate these two accelerometers in Swiss preschoolers with the System for Observing Children’s Activity and Relationships during Play (SOCARP; Ridgers et al., 2010).
 Methods and Design
 Preschoolers (2-5 years old) from two Swiss Sunday activity programs (MiniMove & Ä Halle wo’s fägt) were randomly selected as part of a larger program evaluation. PA was assessed SOCARP for a duration of 12 minutes per child. During the observation, the children wore both an ActiGraph and a Move4 device taped to their right hip to record steps. Step-counts from the ActiGraph and Move4 were correlated with each other and with moderate-to-vigorous (MV)PA from SOCARP (as SOCARP does not count steps).
 Results
 Valid PA data was available for 45/58 (77.6%) children (49% girls) for SOCARP and for 47/58 (81%) children (51% girls) for accelometry. Step count correlations between the accelerometers (Actigraph and Move4) and %MVPA (SOCARP) was medium and positive (r(43) = .34, p = .03 and r(43) = .37, p = .02; respectively). There was a strong step count correlation between the two devices (r(45) = .90, p < .001), although ActiGraph measured significantly more steps than Move4 (m = 557.74, SD = 255.77 versus m = 397.81, SD = 164.10); t(46)=8.47, p < .001).
 Discussion
 PA measurement in preschool children can be challenging. However, the correlation between step counts and observed %MVPA indicates criterion validity for both devices. The step-counts of Actigraph and Move4 validate each other, but there is a difference in the absolute number of measured steps. Due to different outcome parameters, calculation algorithms, and inaccessibility to raw acceleration the comparison of the two devices on movement intensity was not possible. Although promising preliminary indications of validity of device-based measurement of PA in Swiss preschool children, further investigations into the methodological approaches of comparing measurements of movement intensity are warranted.
 References
 Altenburg, T. M., de Vries, L., op den Buijsch, R., Eyre, E., Dobell, A., Duncan, M., & Chinapaw, M. J. M. (2022). Cross-validation of cut-points in preschool children using different accelerometer placements and data axes. Journal of Sports Sciences, 40(4), 379-385. https://doi.org/10.1080/02640414.2021.1994726
 Ridgers, N. D., Stratton, G., & McKenzie, T. L. (2010). Reliability and validity of the system for observing children’s activity and relationships during play (SOCARP). Journal of Physical Activity and Health, 7(1), 17–25. https://doi.org/10.1123/jpah.7.1.17

INADEQUATE PHYSICAL ACTIVITY ON HEALTHCARE EXPENDITURES AMONG MIDDLE AGE AND OLDER WORKING ADULTS IN THAILAND

Abstract Physical inactivity is a significant risk factor for developing non-communicable diseases. This study estimates the additional health costs due to physical inactivity in Thai middle age and older working adults. We included participants aged 40 years and above from the Physical Activity at Work study, who had valid physical activity data from ActiGraph. Health costs were collected using the Health and Welfare Survey and the Work Productivity and Activity Impairment Questionnaire in Thailand. Direct and indirect costs (absenteeism and presenteeism) of the most recent illness in the previous month were collected. Active participants were defined as having at least 150 minutes of moderate-intensity equivalent activity per week. Two-part models were used to compare health costs between active and non-active participants. Data from 105 participants aged 40 to 63 were included in the analysis, where 42% of participants were active. Inadequate physical activity was significantly associated with increased direct health costs of 160.5THB (95%CI: 31.3 to 289.7THB) (~7.8 times higher in inactive). Further adjustment for sex, age, education, obesity, and cardiovascular condition yielded similar findings. After incorporating these indirect costs, the societal cost of having inadequate physical activity was 791.22THB (95%CI: 115.6 to 1466.8THB) (~1.3 times higher in inactive), even after adjusting for the covariates. Obesity and the female were also associated with higher societal costs (551.9THB and 342.9THB, respectively), although these results were not significant. Increasing physical activity in middle age and older working adults to meet the current guidelines may reduce Thailand’s health costs.

Intradialytic hypotension and objectively measured physical activity among patients on hemodialysis

Intradialytic hypotension is related to patient-reported outcomes such as post-dialysis fatigue, but its impact on physical activity has not been fully studied. We aimed to examine the relationship between intradialytic blood pressure (BP) and objectively measured physical activity. In this cross-sectional study, 192 hemodialysis patients underwent 4weeks of physical activity measurement using triaxial accelerometers to measure step counts and moderate-to-vigorous physical activity (MVPA). Intradialytic BP parameters (pre-dialysis BP, post-dialysis BP, nadir BP, and fall in BP) were measured during all dialysis sessions. Mixed-effects linear regression models were used to analyze associations between intradialytic BP parameters and physical activity (1) after dialysis sessions on dialysis days and (2) on the following non-dialysis days. The mean age of the patients was 71years, and 47% had diabetes mellitus. Valid physical activity data were obtained in a total of 1938 dialysis days and 2629 non dialysis days. Lower nadir diastolic BP was significantly associated with lower step counts and shorter moderate-to-vigorous physical activitynot only on dialysis days but also on the following non-dialysis days. Nadir diastolicBP showed a higher discrimination capacity for physical inactivity, defined as a step count < 4000 on non-dialysis days, than the other BP parameters. The optimal cutoff point of nadir diastolicBP for discriminating physical inactivity was 68mmHg; its sensitivity and specificity were 66% and 67%, respectively. Lower nadir diastolicBP was strongly associated with lower physical activity on both dialysis and non-dialysis days. Nadir diastolicBP may be a predictor for physical inactivity.

Move more – be happier? physical activity and health-related quality of life in children with congenital heart disease

This cross-sectional study aimed to determine whether there is an association between objectively assessed physical activity (PA) and health-related quality of life (HRQoL) in children with CHD. From September 2017 to January 2021, 343 children with CHD (12.1 ± 3.3 years, 135 girls) provided valid PA data after a 7-day objective PA assessment. PA was evaluated as average daily steps and moderate-to-vigorous physical activity (MVPA) minutes assessed via wearable bracelet Garmin vivofit Jr. These children also completed the KINDL - a 24 Likert-scaled item questionnaires assessing HRQoL in the six dimensions physical well-being, emotional well-being, self-esteem, family, friends and everyday functioning. Daily Steps (r=0.166, P=.003) and daily MVPA minutes (r=0.134, P=.017,) were both correlated to total KINDL score. Furthermore, both steps and MVPA were associated with the subscales physical well-being (steps: r=0.165 p=.003; MVPA: r=0.129, P=.022), friends (steps: r=0.210, P < .001, MVPA: r=0.179, P=.001), steps, and to everyday functioning (r=0.142, P=.012). Logistic regression showed each MVPA minute increase conferred to a 1% increase in reporting better HRQoL (OR: 1.009 [95% CI: 1.002 - 1.017], P=.019). PA was positively associated with HRQoL in children with CHD. Patients who move more are more likely to report better HRQoL. While the magnitude of this association needs to be further understood, continuous encouragement towards more PA seems to be crucial in a holistic approach to medical aftercare in children with CHD.

Temporal trends in physical activity levels across more than a decade \u2013 a national physical activity surveillance system among Norwegian children and adolescents

BackgroundThere is a scarcity of device measured data on temporal changes in physical activity (PA) in large population-based samples. The purpose of this study is to describe gender and age-group specific temporal trends in device measured PA between 2005, 2011 and 2018 by comparing three nationally representative samples of children and adolescents.MethodsNorwegian children and adolescents (6, 9 and 15-year-olds) were invited to participate in 2005 (only 9- and 15-year-olds), 2011 and 2018 through cluster sampling (schools primary sampling units). A combined sample of 9500 individuals participated. Physical activity was assessed by hip worn accelerometers, with PA indices including overall PA (counts per minute), moderate-to-vigorous intensity PA (MVPA), and PA guideline adherence (achieving on average ≥ 60 min/day of moderate-to-vigorous PA). Random-effects linear regressions and logistic regressions adjusted for school-level clusters were used to analyse temporal trends.FindingsIn total, 8186 of the participating children and adolescents provided valid PA data. Proportions of sufficiently active 6-year-olds were almost identical in 2011 and 2018; boys 95% (95% CI: 92, 97) and 94% (95%CI: 92, 96) and girls 86% (95% CI: 83, 90) and 86% (95% CI: 82, 90). Proportions of sufficiently active 15-year-olds in 2005 and 2018 were 52% (95% CI: 46, 59) and 55% (95% CI: 48, 62) in boys, and 48% (95% CI: 42, 55) and 44% (95% CI: 37, 51) in girls, respectively, resulting from small differences in min/day of MVPA. Among 9-year-old boys and girls, proportions of sufficiently active declined between 2005 and 2018, from 90% (95% CI: 87, 93) to 84% (95% CI: 80, 87)) and 74% (95% CI: 69, 79) to 68% (95% CI: 64, 72), respectively. This resulted from 9.7 min/day less MVPA in boys (95% CI: − 14.8, − 4.7; p < 0.001) and 3.2 min/day less MVPA (95% CI: − 7.0, 0.7; p = 0.106) in girls.ConclusionsPA levels have been fairly stable between 2005, 2011 and 2018 in Norwegian youth. However, the declining PA level among 9-year-old boys and the low proportion of 15-year-olds sufficiently active is concerning. To evaluate the effect of, and plan for new, PA promoting strategies, it is important to ensure more frequent, systematic, device-based monitoring of population-levels of PA.

Continuous 7-Month Internet of Things-Based Monitoring of Health Parameters of Pregnant and Postpartum Women: Prospective Observational Feasibility Study.

BackgroundMonitoring during pregnancy is vital to ensure the mother’s and infant’s health. Remote continuous monitoring provides health care professionals with significant opportunities to observe health-related parameters in their patients and to detect any pathological signs at an early stage of pregnancy, and may thus partially replace traditional appointments.ObjectiveThis study aimed to evaluate the feasibility of continuously monitoring the health parameters (physical activity, sleep, and heart rate) of nulliparous women throughout pregnancy and until 1 month postpartum, with a smart wristband and an Internet of Things (IoT)–based monitoring system.MethodsThis prospective observational feasibility study used a convenience sample of 20 nulliparous women from the Hospital District of Southwest Finland. Continuous monitoring of physical activity/step counts, sleep, and heart rate was performed with a smart wristband for 24 hours a day, 7 days a week over 7 months (6 months during pregnancy and 1 month postpartum). The smart wristband was connected to a cloud server. The total number of possible monitoring days during pregnancy weeks 13 to 42 was 203 days and 28 days in the postpartum period.ResultsValid physical activity data were available for a median of 144 (range 13-188) days (75% of possible monitoring days), and valid sleep data were available for a median of 137 (range 0-184) days (72% of possible monitoring days) per participant during pregnancy. During the postpartum period, a median of 15 (range 0-25) days (54% of possible monitoring days) of valid physical activity data and 16 (range 0-27) days (57% of possible monitoring days) of valid sleep data were available. Physical activity decreased from the second trimester to the third trimester by a mean of 1793 (95% CI 1039-2548) steps per day (P<.001). The decrease continued by a mean of 1339 (95% CI 474-2205) steps to the postpartum period (P=.004). Sleep during pregnancy also decreased from the second trimester to the third trimester by a mean of 20 minutes (95% CI –0.7 to 42 minutes; P=.06) and sleep time shortened an additional 1 hour (95% CI 39 minutes to 1.5 hours) after delivery (P<.001). The mean resting heart rate increased toward the third trimester and returned to the early pregnancy level during the postpartum period.ConclusionsThe smart wristband with IoT technology was a feasible system for collecting representative data on continuous variables of health parameters during pregnancy. Continuous monitoring provides real-time information between scheduled appointments and thus may help target and tailor pregnancy follow-up.

A Mobile Health Team Challenge to Promote Stepping and Stair Climbing Activities: Exploratory Feasibility Study.

BackgroundMobile health (mHealth) approaches are growing in popularity as a means of addressing low levels of physical activity (PA).ObjectiveThis study aimed to determine the validity of wearables in measuring step count and floor count per day and assess the feasibility and effects of a 6-week team challenge intervention delivered through smartphone apps.MethodsStaff and students from a public university were recruited between 2015 and 2016. In phase 1, everyone wore a Fitbit tracker (Charge or Charge HR) and an ActiGraph for 7 days to compare daily step count estimated by the two devices under free-living conditions. They were also asked to climb 4 bouts of floors in an indoor stairwell to measure floor count which was compared against direct observation. In phase 2, participants were allocated to either a control or intervention group and received a Fitbit tracker synced to the Fitbit app. Furthermore, the intervention group participants were randomized to 4 teams and competed in 6 weekly (Monday to Friday) real-time challenges. A valid day was defined as having 1500 steps or more per day. The outcomes were as follows: (1) adherence to wearing the Fitbit (ie, number of days in which all participants in each group were classified as valid users aggregated across the entire study period), (2) mean proportion of valid participants over the study period, and (3) the effects of the intervention on step count and floor count determined using multiple linear regression models and generalized estimating equations (GEEs) for longitudinal data analysis.ResultsIn phase 1, 32 of 40 eligible participants provided valid step count data, whereas all 40 participants provided valid floor count data. The Fitbit trackers demonstrated high correlations (step count: Spearman ρ=0.89; P<.001; floor count: Spearman ρ=0.98; P<.001). The trackers overestimated step count (median absolute error: 17%) but accurately estimated floor count. In phase 2, 20 participants each were allocated to an intervention or control group. Overall, 24 participants provided complete covariates and valid PA data for analyses. Multiple linear regressions revealed that the average daily steps was 15.9% higher for the intervention group (95% CI −8.9 to 47.6; P=.21) during the final two intervention weeks; the average daily floors climbed was 39.4% higher (95% CI 2.4 to 89.7; P=.04). GEE results indicated no significant interaction effects between groups and the intervention week for weekly step count, whereas a significant effect (P<.001) was observed for weekly floor count.ConclusionsThe consumer wearables used in this study provided acceptable validity in estimating stepping and stair climbing activities, and the mHealth-based team challenge interventions were feasible. Compared with the control group, the participants in the intervention group climbed more stairs, so this can be introduced as an additional PA promotion target in the context of mHealth strategies. Methodologically rigorous studies are warranted to further strengthen this study’s findings.

Feasibility and effectiveness of two built environmental interventions on physical activity among 3-5-year-oldpreschoolers.

The purpose was to examine the feasibility and preliminary effectiveness of two built environmental interventions with Head Start preschool children to increase minutes and intensity and total physical activity (PA). Aprospective, quasi-experimental, repeated measures design was conducted in two Head Start centers. Centers were randomly assigned to one of two intervention arms. Intervention Arm I added portable play equipment to the school environment; Arm II introduced portable play equipment plus PA education for staff and children. PA was measured during school using accelerometers and by observation using SOPLAY. The data were analyzed using repeated measures ANOVA. Ninety-seven children and eight staff were enrolled; valid PA data were available for 56 children (58%). Minutes of PA were highest at baseline in both groups and declined over the intervention. PA in Arm I decreased 22 min from weeks one to three and 12 min (p < .001) from weeks 3 to 6. In Arm II, PA declined 33 min from weeks one to three and 20 min (p < .001) from weeks 3 to 6. Nurses work to maintain and improve health at multiple levels of influence and are in strategic positions to educate and support PA to maintain and improve the health of all ages. School-based PA interventions have been reported with varying success. The feasibility of this study provides insight into the challenges in planning and conducting school-based interventions including enrollment, attrition, and accelerometer wear-time compliance. Despite our interventions, there was no positive response to either intervention, with PA declining at each time period in both groups. However, baseline PA was significantly higher than in previous studies. Schools can provide children with opportunities to accumulate PA.

Association between objectively assessed physical activity measures and longitudinal knee structural damage

Purpose: The relation between physical activity (PA) and the development of knee osteoarthritis (OA) is an important clinical and public health issue. Studies conducted thus far have shown conflicting results. This is most likely due to the small study samples, semi-quantitative assessment of PA and a lack of objective longitudinal data including intensity of PA. The purpose of the study was to describe the predictors and the longitudinal association between PA level and global knee structural progression. Methods: 864 participants [mean age = 65 (48–84), female % = 58] were included in this study who had valid PA data and right knee MRI data from 48 month and 72 month visits of the Osteoarthritis Initiative (OAI) study. Physical activity was monitored using ActiGraph GT1M uniaxial accelerometers (ActiGraph; Pensacola, FL). PA was categorized into time spent doing light, moderate, moderate to vigorous (MVPA) and vigorous activity depending on the activity counts/minute as described on the OAI website. PA intensity was further categorized into bouts of MVPA and vigorous activity as already describe don the OAI website. PA was further categorized to assess whether the participants met the weekly PA level prescribed American College of Sports Medicine (ACSM) and Department of Health and Human Services (DHHS). MRI data was scored using the modified Whole Organ MRI Score (WORMS). All multivariable analyses were adjusted for age, sex, BMI, radiographic OA and history of knee injury/surgery. Results: 1. Change in total modified WORMS – Baseline predictors Higher number of minutes spent doing light activity independently predicted significant worsening of total modified WORMS (β (per activity count) = +0.99 (+0.51, +1.48)). On the other hand higher number of minutes spent doing vigorous activity (β = −0.17 (−0.33, −0.01)) and more intense (β (per activity bout) = −0.14 (−0.26, −0.01)) PA were associated with a decrease in severity of WORMS over two years. – Longitudinal associations Neither changes in minutes spent in any of the four PA categories nor changes in intensity of PA over two years were significantly associated with total modified WORMS. 2. Changes in individual knee structures on MRI (i) Cartilage defects: – Baseline predictors More minutes spent doing light and moderate PA at baseline were independently associated with a significant worsening of cartilage defects over two years. – Longitudinal associations Increase in the number of minutes spent doing light activity over two years was associated with worsening cartilage defects, however increase in the minutes spent doing vigorous PA was associated with improvement in cartilage defects score. (ii) Bone marrow edema (BME): – Baseline predictors None of the baseline PA categories independently predicted change in BME over 2 years – Longitudinal associations Increase in minutes spent doing light activity was independently associated (β = 3.78 (1.42, 6.19)) with worsening BME over two years, however increase in vigorous activity minutes and intensity was associated with significant improvement in BME lesions. (iii) Meniscal pathologies – Baseline predictors More minutes spent doing light activity were associated with worsening meniscal tears over two whereas vigorous activity and higher intensity were associated with improvement in meniscal score. – Longitudinal associations Increase in time spent doing light to moderate activities was associated with improvement in meniscal scores but remained stable with vigorous PA (iv) Effusion – Baseline predictors Light activity at baseline was associated with significant improvement in severity of effusion whereas vigorous and more intense PA independently predicted worsening effusion grade. Longitudinal associations Increasing time spent doing more vigorous PA was associated with progressively worsening knee effusion. A similar trend was observed with increasing intensity of PA. Increase in PA level from baseline to meet ACSM and DHHS guidelines was generally associated with improvement in knee structural pathology grades. Conclusions: Increases in time spent doing vigorous activity and increase in intensity of PA is generally associated with a protective effect on the knee joint except for knee joint effusion that worsened with increasing level of PA.

Accelerometry: A feasible method to monitor physical activity during sub-acute rehabilitation of persons with stroke.

To investigate the feasibility of using accelerometers to monitor physical activity in persons with stroke admitted to inpatient rehabilitation. Longitudinal observational study. Persons with stroke admitted to a specialized rehabilitation centre for sub-acute rehabilitation were recruited between August and December 2016. Volume and intensity of physical activity were assessed with accelerometers throughout the rehabilitation period. Indicators of feasibility included processes (recruitment, protocol adherence and participants' experiences) and scientific feasibility, which assessed the accelerometers' ability to detect change in physical activity among stroke survivors who ambulate independently and those who are dependent on a mobility device. Twenty-seven out of 31 eligible individuals took part in this study, with 23 (85%) completing it. In total, 432 days of rehabilitation were monitored and valid physical activity data were obtained for 408 days (94%). There were no indications that the measurement interfered with participants' ability to participate in rehabilitation. Despite the subjects' ambulation status, the number of steps and time spent in moderate-to-vigorous physical activity increased significantly across the first 18 days of rehabilitation, whereas sedentary time was unchanged. This study supports the feasibility of using accelerometers to capture physical activity behaviour in survivors of stroke during inpatient rehabilitation.

A physiotherapist-led exercise and education program for preventing recurrence of low back pain: a randomised controlled pilot trial

BackgroundBefore beginning a large and complex trial it is considered good practice to run a pilot study to assess the feasibility and acceptability so that quality is maintained and resources are not wasted. ObjectiveTo assesses the feasibility and acceptability of procedures for TOPS: Trial Of Prevention Strategies for low back pain. DesignRandomised controlled pilot trial. MethodsThis is a trial of an 8 week, physiotherapist-led group exercise and education program for preventing recurrence of low back pain (LBP) in those recently recovered from LBP. We assessed the feasibility of recruitment and data-collection procedures, acceptability of the trial interventions and loss-to-follow up. ResultsThe feasibility of recruitment, acceptability of the intervention and feasibility of physical activity data-collection procedures were all below anticipated levels. We enrolled 12 participants over 44 weeks, the adherence rate for the intervention group was 63% and valid physical activity data were obtained for 67% of the measurements. Follow-up methods for collection of LBP recurrence were successful with this information able to be collected for 100% of participants. ConclusionIn response to the pilot, modifications were made to the main trial protocol. We will increase recruitment by relaxing inclusion criteria and expanding recruitment sites to include workplaces, community centres and via social media. We will facilitate compliance by expanding treatment sites to provide more options for participants to access the program and we will limit missing data by checking the validity of baseline physical activity measures prior to enrolment.Trial registration: The study was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ref: ACTRN12614000706673).

Correlates of preschool children\u2019s objectively measured physical activity and sedentary behavior: a cross-sectional analysis of the SPLASHY study

BackgroundIdentifying ways to promote physical activity and decrease sedentary time during childhood is a key public health issue. Research on the putative influences on preschool children’s physical activity (PA) and sedentary behavior (SB) is limited and has yielded inconsistent results. Our aim was to identify correlates of PA and SB in preschool children.MethodsCross-sectional data were drawn from the Swiss Preschoolers’ Health Study (SPLASHY), a Swiss population-based cohort study. Of 476 two to six year old children, 394 (54% boys) had valid PA data assessed by accelerometry. Information on exposure data was directly measured or extracted from parental questionnaires. Multilevel linear regression modeling was used to separately assess associations between 35 potential correlates and total PA (TPA), moderate-to-vigorous PA (MVPA) and SB.ResultsIn total, 12 correlates from different domains were identified. TPA and MVPA were greater in boys than girls, increased with age and were positively associated with gross motor skills. Children from single parent families had a higher level of TPA and spent less time sedentary than those living with two parents. Time spent outdoors was positively associated with TPA and negatively with SB. The child’s activity temperament was related all three outcomes, whereas parental sports club membership, living area per person and neighborhood safety were associated with SB only. Fixed and random factors in the final models accounted for 28%, 32% and 22% of the total variance in TPA, MVPA and SB, respectively. Variance decomposition revealed that age, sex and activity temperament were the most influential correlates of both, TPA and MVPA, whereas the child’s activity temperament, time outdoors and neighborhood safety were identified as the most important correlates of SB.ConclusionsA multidimensional set of correlates of young children’s activity behavior has been identified. Personal factors had the greatest influence on PA, whereas environmental-level factors had the greatest influence on SB. Moreover, we identified a number of previously unreported, potentially modifiable correlates of young children’s PA and SB. These factors could serve to define target groups or become valuable targets for change in future interventions.Trial registrationCurrent Controlled Trials ISRCTN41045021 (date of registration: 21.03.14).

Regional sociocultural differences as important correlate of physical activity and sedentary behaviour in Swiss preschool children.

Regional differences in physical activity in school-aged children and adults even within one country with the same political and health care system have been observed and could not be explained by sociodemographic or individual variables. We analysed whether such differences were already present in preschool children. Swiss children from 84 childcare centres in five cantons (Aargau, Bern, Fribourg, Vaud, Zurich) comprising about 50% of the population of the country participated. Physical activity was quantified with accelerometers (ActiGraph, wGT3X-BT) and potential correlates were assessed with measurements at the childcare centre or questionnaires. Mixed regression models were used to test associations between potential correlates of total physical activity (TPA), moderate-to-vigorous physical activity (MVPA), light physical activity (LPA) or sedentary behaviour with a special focus on regional differences. 394 of 476 children (83%) provided valid physical activity data (at least 2 weekdays and 1 weekend day with 10 h recording; mean age 3.9 ± 0.7 years, 54% boys) with 26% and 74% living in the French- and German-speaking parts of Switzerland, respectively. Days consisted of (mean ± standard deviation) 1.5 ± 0.5 h MVPA, 5.0 ± 0.6 h LPA, and 6.3 ± 0.8 h sedentary behaviour with an average of 624 ± 150 counts/min TPA. TPA and MVPA (but not sedentary behaviour or LPA) increased with age, were higher in boys and children with better motor skills. Despite controlling for individual characteristics, familial factors and childcare exposure, children from the French-speaking part of Switzerland showed 13% less TPA, 14% less MVPA, 6% less LPA and 8% more sedentary behaviour than German-speaking children. Beside motor skills and non-modifiable individual factors, the regional sociocultural difference was the most important correlate of phyical activity and sedentary behaviour. Therefore, regionally adapted public health strategies may be needed.

Correlates of Objectively Measured Physical Activity in Swiss Preschool Children

Globally, many children engage in insufficient physical activity (PA) to maintain good health. In order to promote PA among children it is essential to understand the factors associated with children’s PA behavior. However, research on the putative influences on young children’s PA is relatively new and has yielded inconsistent results. PURPOSE: To identify correlates of young children’s PA by simultaneously examining an extended set of potential correlates of objectively measured Total and Moderate-to-Vigorous PA (TPA and MVPA, respectively) from multiple domains (demographic and biological, cognitive/emotional, behavioral, social/cultural and physical environment). METHODS: Cross-sectional data were used from the Swiss Preschooler’s Health Study (SPLASHY), a Swiss population-based cohort study. 397 (52% boys) 2- to 6-year old children attending 84 randomly selected childcare centers had valid PA data assessed with accelerometry (ActiGraph) and exposure data collected either by direct measurement or parental questionnaires. After checking for multicollinearity, 35 potential correlates of PA were examined using multilevel linear models. All explanatory variables moderately associated (p<0.1) with TPA and/or MVPA were included in the final model. Variables that remained significant (p<0.05) were considered correlates of TPA and MVPA, respectively. RESULTS: MVPA minutes were greater in boys and increased with age, better gross motor skills and higher activity sub-score of the Emotionality Activity and Sociability temperament survey (EAS-activity). In summer (June-August), children were less active than during the spring and fall months. Similarly, TPA counts were positively associated with age and EAS-activity score, and greater in boys. Children living in a single-parent household as well as those who spent more time outdoors and had a higher number of fixed toys at home were more physically active. CONCLUSIONS: Six correlates of TPA and MVPA, respectively, have been identified in Swiss preschool children, which illustrates that only a few modifiable factors can be tackled in interventions to increase PA in preschoolers.

Differences in energy balance-related behaviours in European preschool children: the ToyBox-study.

BackgroundThe aim of the current study was to compare levels of energy balance-related behaviours (physical activity, sedentary behaviour, and dietary behaviours (more specifically water consumption, sugar-sweetened beverage consumption and unhealthy snacking)) in four- to six-year-old preschoolers from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, and Spain) within the ToyBox cross-sectional study.MethodsA sample of 4,045 preschoolers (4.77 ± 0.43 years; 52.2% boys) had valid physical activity data (steps per day), parents of 8,117 preschoolers (4.78 ± 0.46 years; 53.0% boys) completed a parental questionnaire with questions on sedentary behaviours (television viewing, computer use, and quiet play), and parents of 7,244 preschoolers (4.77 ± 0.44 years; 52.0% boys) completed a food frequency questionnaire with questions on water consumption, sugar-sweetened beverage consumption and unhealthy snacking.ResultsThe highest levels of physical activity were found in Spain (12,669 steps/day on weekdays), while the lowest levels were found in Bulgaria and Greece (9,777 and 9,656 steps/day on weekdays, respectively). German preschoolers spent the least amount of time in television viewing (43.3 min/day on weekdays), while Greek preschoolers spent the most time in television viewing (88.5 min/day on weekdays). A considerable amount of time was spent in quiet play in all countries, with the highest levels in Poland (104.9 min/day on weekdays), and the lowest levels in Spain (60.4 min/day on weekdays). Belgian, German, and Polish preschoolers had the lowest intakes of water and the highest intakes of sugar-sweetened beverages. The intake of snacks was the highest in Belgian preschoolers (73.1 g/day) and the lowest in Greek preschoolers (53.3 g/day).ConclusionsAcross six European countries, differences in preschoolers’ energy balance-related behaviours were found. Future interventions should target European preschoolers’ energy balance-related behaviours simultaneously, but should apply country-specific adaptations.

Change in level of physical activity during pregnancy in obese women: findings from the UPBEAT pilot trial.

BackgroundMaternal obesity is associated with an increased risk of pregnancy complications, including gestational diabetes. Physical activity (PA) might improve glucose metabolism and reduce the incidence of gestational diabetes. The purpose of this study was to explore patterns of PA and factors associated with change in PA in obese pregnant women.MethodsPA was assessed objectively by accelerometer at 16 – 18 weeks’ (T0), 27 – 28 weeks’ (T1) and 35 – 36 weeks’ gestation (T2) in 183 obese pregnant women recruited to a pilot randomised trial of a combined diet and PA intervention (the UPBEAT study).ResultsValid PA data were available for 140 (77%), 76 (42%) and 54 (30%) women at T0, T1 and T2 respectively. Moderate and vigorous physical activity as a proportion of accelerometer wear time declined with gestation from a median of 4.8% at T0 to 3% at T2 (p < 0.05). Total activity as a proportion of accelerometer wear time did not change. Being more active in early pregnancy was associated with a higher level of PA later in pregnancy. The intervention had no effect on PA.ConclusionsPA in early pregnancy was the factor most strongly associated with PA at later gestations. Women should be encouraged to participate in PA before becoming pregnant and to maintain their activity levels during pregnancy. There is a need for effective interventions, tailored to the needs of individuals and delivered early in pregnancy to support obese women to be sufficiently active during pregnancy.Trial registrationCurrent Controlled Trials ISRCTN89971375 (Registered 28/11/2008).

Physical Activity in School-Age Children Born Preterm

To compare objectively measured physical activity in 11- and 15-year-old children who were born preterm with term-born controls and related physical activity measures to lung function measures. We used data from the Avon Longitudinal Study of Parents and Children. We compared total physical activity, moderate-to-vigorous physical activity, and sedentary behavior between children born at 25-32, 33-34, 35-36, and 37-43 weeks' gestation at ages 11 and 15 years. At age 11 years, physical activity measures were correlated with lung spirometry recorded at age 7-9 years. Valid physical activity data at age 11 years were available for 5025, 197, 57, and 48 children born at 37-43, 35-36, 33-34, and 25-32 weeks' gestation, respectively. At age 15 years, valid physical activity data were available for 1829, 62, 32, and 24 children born at 37-43, 35-36, 33-34, and 25-32 weeks' gestation. Boys were more physically active than girls at both ages. There were no differences in total physical activity, moderate-to-vigorous physical activity, or sedentary behavior in children between the different gestation groups. Physical activity at age 11 years did not correlate with spirometry measures at age 7-9 years. Physical activity was similar for the different gestational groups and did not correlate with lung spirometry. Physical activity does not appear to be limited in preterm-born children despite lung function deficits noted in childhood.

Differences in energy balance-related behaviours in European preschool children: The ToyBox-study

Introduction Weight gain is determined by the cumulative effect of low levels of physical activity, high levels of sedentary behaviour, and unhealthy dietary behaviours, also referred to as energy balance-related behaviours. The aim of the current study was to compare levels of energy balance-related behaviours in 3.5–5.5 year-old children from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, and Spain) within the ToyBox-study ( http://www.toybox-study.eu ) [1] , [2] . Methods A sample of 4045 preschoolers (4.77 ± 0.43 years; 52.2% boys) had valid physical activity data (steps per day), parents/caregivers of 8117 preschoolers (4.78 ± 0.46 years; 53.0% boys) completed a parental questionnaire with questions on sedentary behaviours (TV/DVD viewing, PC/video games, and quiet play), and parents of 7244 preschoolers (4.77 ± 0.44 years; 52.0% boys) completed a food frequency questionnaire with questions on water consumption, sugar-sweetened beverage consumption and unhealthy snacking. Results Across six European countries, significant differences in preschoolers’ energy balance-related behaviours were found. The highest levels of physical activity were found in Spain (12,669 steps/day on weekdays), while the lowest levels were found in Bulgaria and Greece (9777 and 9656 steps/day on weekdays, respectively). German preschoolers spent the least amount of time in television viewing (43.3 min/day on weekdays), while Greek preschoolers spent the most time in television viewing (88.5 min/day on weekdays). A considerable amount of time was spent in quiet play in all countries, with the highest levels in Poland (104.9 min/day on weekdays), and the lowest levels in Spain (60.4 min/day on weekdays). Belgian, German, and Polish preschoolers had the lowest intakes of water and the highest intakes of sugar-sweetened beverages. The intake of unhealthy snacks was the highest in Belgian preschoolers (73.1 g/day) and the lowest in Greek preschoolers (53.3 g/day). Conclusions Future interventions should target European preschoolers’ energy balance-related behaviours simultaneously, but should apply country-specific adaptations.

Do Activity Levels Increase After Total Hip and Knee Arthroplasty?

People with osteoarthritis (OA) often are physically inactive. Surgical treatment including total hip arthroplasty or total knee arthroplasty can substantially improve pain, physical function, and quality of life. However, their impact on physical activity levels is less clear. We used accelerometers to measure levels of physical activity pre- and (6 months) postarthroplasty and to examine the proportion of people meeting the American Physical Activity Guidelines. Sixty-three people with hip or knee OA awaiting arthroplasty were recruited from a major metropolitan hospital. Physical activity was measured using accelerometry before, and 6 months after, surgery. The ActiGraph GT1M (ActiGraph LLC, Fort Walton Beach, FL, USA) was used in this study and is a uniaxial accelerometer contained within a small activity monitor designed to measure human movement through changes in acceleration, which can then be used to estimate physical activity over time. Questionnaires were used to assess patient-reported changes in pain, function, quality of life, and physical activity. Complete data sets (including valid physical activity data) for both time points were obtained for 44 participants (70%). At baseline before arthroplasty, the activity level of patients was, on average, sedentary for 82% of the time over a 24-hour period (based on accelerometry) and self-rated as "sometimes participates in mild activities such as walking, limited shopping, and housework" according to the UCLA activity scale. There was no change in objectively measured physical activity after arthroplasty. The majority of participants were sedentary, both before and after arthroplasty, and did not meet the American Physical Activity Guidelines recommended to promote health. This was despite significant improvements in self-reported measures of pain, function, quality of life, and physical activity after arthroplasty. Despite patient-reported improvements in pain, function, and physical activity after arthroplasty, objectively measured improvements in physical activity may not occur. Clinicians should incorporate strategies for improving physical activity into their management of patients after hip and knee arthroplasty to maximize health status. Future research is needed to explore the factors that impact physical activity levels in people after arthroplasty. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Correlates of Light and Moderate-to-Vigorous Objectively Measured Physical Activity in Four-Year-Old Children

BackgroundCorrelates of physical activity (PA) are hypothesized to be context and behaviour specific, but there is limited evidence of this in young children. The aim of the current study is to investigate associations between personal, social and environmental factors and objectively measured light and moderate-to-vigorous PA (LPA and MVPA, respectively) in four-year-old children.MethodsCross-sectional data were used from the Southampton Women’s Survey, a UK population-based longitudinal study. Four-year old children (n = 487, 47.0% male) had valid PA data assessed using accelerometry (Actiheart) and exposure data collected with a validated maternal questionnaire (including data on child personality, family demographics, maternal behaviour, rules and restrictions, and perceived local environment). Linear regression modelling was used to analyse associations with LPA and MVPA separately, interactions with sex were explored.ResultsLPA minutes were greater in children whose mothers reported more PA (vs. inactive: regression coefficient±standard error: 6.70±2.94 minutes), and without other children in the neighbourhood to play with (−6.33±2.44). MVPA minutes were greater in children with older siblings (vs. none: 5.81±2.80) and those whose mothers used active transport for short trips (vs. inactive: 6.24±2.95). Children accumulated more MVPA in spring (vs. winter: 9.50±4.03) and, in boys only, less MVPA with availability of other children in the neighbourhood (−3.98±1.70).DiscussionYoung children’s LPA and MVPA have differing associations with a number of social and environmental variables. Interventions targeting PA promotion in young children outside of formal care settings should consider including intensity specific factors.