A novel approach to characterize physical activity patterns in preschool-aged children

Leveraging agent-based modeling and a randomized intervention to advance childhood physical activity: A study protocol

This study (1R01HD107002-01A1) protocol describes the planned creation and use of an agent-based model (ABM) of early childhood physical activity (PA). Successful early childhood PA interventions can potentially play an important role in both increasing overall population health as well as closing health disparities across subpopulations. At present, effective strategies for doing so are currently unknown. In large part, this is because PA determinants operate across levels dynamically, interact with one another, and can differ substantially across children. A complex systems approach-specifically, ABM-can be used to provide important insights about effect pathways driving child PA. Design of the proposed ABM will be based on high-quality extant research on childhood physical activity while allowing for the testing of hypotheses that extend beyond this body of literature. Its primary source of input data will be participants in GROW (NCT01316653), a completed cohort-based randomized controlled trial (RCT) that includes extensive longitudinal PA data collected from accelerometer observations of children from ages 3-9. We will iteratively test and improve upon an etiologic ABM of childhood PA, ensuring that it can satisfactorily reproduce micro- and macro-level influences and trends comparable to those seen in GROW. The tested ABM will then be used to extrapolate beyond the context of the GROW RCT, experimentally identifying potentially efficacious intervention strategies to improve childhood physical activity through program implementation or changes in policies and practices. We will use expert input to identify promising intervention approaches. We will use the model to systematically experiment with a wide array of different hypothetical combinations of intervention specifications and combinations. At the end of the model experimentation step, we expect to generate insights of broad applicability to the field of PA science regarding what might work, and for whom, in promoting PA and reducing disparities in these behaviors.

Relations Between Distinct Dimensions of Physical Activity and Preschoolers' ADHD Symptoms

OBJECTIVE

This study examined the unique and interactive effects of PA volume and within-person fluctuations in PA volume (i.e., intraindividual variability in PA volume; PA-var) on preschoolers' (N = 141; 47.5% girls) ADHD symptoms.

METHOD

Preschoolers wore accelerometers during the school day over a 2-week period. Teachers reported on children's hyperactive, impulsive, and inattentive symptoms on the ADHD Rating Scale-IV Preschool Version.

RESULTS

In the context of regression models, higher levels of PA-var were linked with lower levels of impulsive symptoms. Higher levels of PA volume were linked with higher levels of hyperactive and inattentive symptoms, but only when PA fluctuation (i.e., PAvar) was relatively low. Post hoc analyses with teacher-reported impairment as the outcome revealed a significant interaction such that the positive association between PA volume and impairment was stronger at lower, as compared to higher, levels of PA-var.

CONCLUSION

Larger fluctuations in preschoolers' PA volume may indicate lower risk for displaying impulsive symptoms. Moreover, preschoolers with high levels of PA that remain relatively consistent throughout the day may be at increased risk for exhibiting hyperactive and inattentive symptoms and related impairment, suggesting they are unable to regulate their activity to meet expectations in the school environment.

Identifying data gaps in early childhood physical activity evidence

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

Physical Activity Management for Youth With Type 1 Diabetes: Supporting Active and Inactive Children

Regular physical activity and exercise are important for youth and essential components of a healthy lifestyle. For youth with type 1 diabetes, regular physical activity can promote cardiovascular fitness, bone health, insulin sensitivity, and glucose management. However, the number of youth with type 1 diabetes who regularly meet minimum physical activity guidelines is low, and many encounter barriers to regular physical activity. Additionally, some health care professionals (HCPs) may be unsure how to approach the topic of exercise with youth and families in a busy clinic setting. This article provides an overview of current physical activity research in youth with type 1 diabetes, a basic description of exercise physiology in type 1 diabetes, and practical strategies for HCPs to conduct effective and individualized exercise consultations for youth with type 1 diabetes.

Physical Activity, Glycemic Variability, and Parental Hypoglycemia Fear in Preschoolers With Type 1 Diabetes

PURPOSE

The authors examined associations between preschoolers' daily glycemic variability, parents' report of hypoglycemia fear, and preschoolers' daily moderate to vigorous physical activity (MVPA) and sedentary behavior (SB) in 25 families of preschoolers with type 1 diabetes.

METHODS

Parents completed a valid measure of hypoglycemia fear, and their child wore an accelerometer for up to 7 days. Parents provided glucose data from their child's devices. The authors used multiple regression and multilevel modeling to analyze their data.

RESULTS

Preschoolers (mean age 4.2 [1.7] y; 50% boys) engaged in a mean of 154.5 (59.6) and 339.2 (85.1) minutes of MVPA and SB per day, respectively, and parents reported relatively low levels of hypoglycemia worry and avoidance behaviors. Preschoolers' SB (r = .19, P = .02) and MVPA (r = -.20, P = .01) levels were significantly correlated with parental hypoglycemia worry scores but not with parents' hypoglycemia behavior scores (P = .15 and P = .92, respectively). While multilevel models did not show an association between MVPA and preschoolers' glycemic variability, preschoolers who engaged in more daily SB experienced higher glycemic variability (P = .04).

CONCLUSIONS

Research exploring MVPA, SB, and parental hypoglycemia fear in preschoolers with type 1 diabetes could have important clinical implications because it may reveal modifiable treatment targets that can impact preschoolers' health and activity patterns.

Physical Activity Opportunities in US Early Child Care Programs

BACKGROUND AND OBJECTIVES

Physical activity provides health and developmental benefits to young children. The Study of Nutrition and Activity in Child Care Settings describes physical activity opportunities and sedentary occasions for children aged 1 to 5 years at programs participating in the US Department of Agriculture Child and Adult Care Food Program.

METHODS

The Study of Nutrition and Activity in Child Care Settings obtained a nationally representative sample of classrooms within Child and Adult Care Food Program-participating Head Start and child care centers via multistage cluster sampling. For 1 observation day, an observer in each classroom tallied designated outdoor and indoor playspaces; minutes children spent in playspaces; barriers and facilitators to physical activity; and classroom time when most children were physically active (eg, walking, dancing), sedentary (seated, lying down), or neither. Weighted descriptive tabulations by program type compared outdoor physical activity opportunity counts and total physical activity opportunity durations to national guidelines. Multivariate regression analysis investigated association of barriers with physical activity opportunity duration.

RESULTS

The sample included 227 classrooms, 96 in child care centers and 131 in Head Start programs. All had sedentary occasions outside meals, snacks, and naps; virtually all offered opportunities for physical activity. Seventy-four percent of programs met national guidance on sufficient number of outdoor opportunities, weather permitting. Just 50% met guidance of ≥60 to 90 minutes of physical activity, whereas only 43% met both sets of guidance. Weather and staff not joining in outdoor play were associated with 74 and 31 fewer minutes devoted to physical activity, respectively.

CONCLUSIONS

Findings suggest ample room for improvement in provision of physical activity opportunities during child care.

A Systematic Review of Children's Physical Activity Patterns: Concept, Operational Definitions, Instruments, Statistical Analyses, and Health Implications

Despite the widespread use of the expression “physical activity pattern” (PAP), there apparently is no general consensus regarding its definition. This systematic review aimed to examine available research focussing on (1) definitions of PAP, (2) instruments/techniques used to describe PAP, (3) statistical approaches used to analyse PAP, and (4) implications of PAP on children’s health. A systematic review of the available literature was done to identify studies published up to October 2019, and 76 studies were eligible. None of the studies presented a formal definition of PAP; a wide range of instruments were used to investigate children’s PAP, and most of the revised studies did not explicitly present a formal statistical model to define PAP. Twenty-four papers purported to examine associations between PAP and health indicators. The review highlights no consensus on a clear PAP definition whatever the instrument used to capture it, and we did not find any agreement regarding how best to analyse PAP. We suggest that PAP should be used when targeting the investigation of similarities/dissimilarities, as well as stabilities and/or changes in children’s PA at an intra-personal level. In sum, PAP should be used to best describe individual streams of behaviours, and not exclusively PA levels/intensities.

Correlates of sedentary time in young children: A systematic review

Background: Young children appear to spend large portions of their waking time being sedentary. Understanding the correlates of sedentary time would assist in developing effective interventions among young children. The purpose of this systematic review was to summarize the current literature on the correlates of objectively measured sedentary time in young children aged 1-5.99y. Methods: This review was registered with PROSPERO (registration no. CRD42017081374) and aligned with the PRISMA Statement for systematic reviews. Five electronic databases (MEDline, CINAHL Complete, PsycINFO, SportDiscus, Scopus) were searched up to October 26, 2017 for studies investigating correlates of sedentary time measured using objective devices. A semiquantitative approach was used to synthesize data. Results: Forty-five studies were retrieved comprising 13,430 participants, and 84 correlates of sedentary time in young children were evaluated. The associations between sex, sleep habits, daily patterns (childcare vs. non-childcare hours), childcare type and sedentary time were indeterminate. Thirty-nine correlates were consistently unrelated. Forty-one potential correlates were examined in too few studies (<4) to make confident conclusions. Parental sedentary behaviour was reported 3 times and maternal sedentary behaviour was reported once. Out of these four studies, three were positively associated with child sedentary time. Conclusions: Despite reviewing 45 studies that evaluated associations for 84 correlates, this review was unable to identify any consistent correlates of sedentary time in young children. Additional research is needed in this area to provide robust evidence of the correlates of sedentary time in young children, particularly for those examined in only a small number of studies.

Physical Activity and Social Behaviors of Urban Children in Green Playgrounds

INTRODUCTION

Nature exposure is associated with many wellbeing benefits. However, the influence of green space on the physical activity and social behaviors of children is not completely understood. The purpose of the study was to complete a stepwise impact evaluation of a large-scale playground greening project at a Title 1 elementary school in Los Angeles, California.

METHODS

Physical activity and social interaction data were collected with direct observation and accelerometers pre-, immediately post-, and 4 months post-greening at control (students enrolled=393) and experimental (students enrolled=538) locations from 2016 to 2017. Effects of relevant variables on recess behavior were analyzed with linear mixed models in 2018.

RESULTS

Zone popularity and recess behaviors did not change for control students during the study (p>0.05). Areas replaced by green space became the most popular for experimental students who transitioned from traditional playground games/sports to tag/chasing, gymnastics, climbing/jumping, and creative play. The percentage of students observed as sedentary decreased by 10.0% (95% CI=4.9%, 15.0%) at 4 months, p=0.003. Vigorous activity participation increased pre to post at the individual (48.5%, 95% CI=29.1%, 67.9%, p<0.001) and population level (41.2%, 95% CI=27.3%, 55.1%, p=0.003) and remained higher than pre-greening at 4 months (p<0.05) for girls in the experimental group only. The moderate to vigorous physical activity differential between green space and hardscape was greater for fifth graders than all other grades, p=0.002. Student physical and verbal conflict rates decreased below pre-greening rates after 4 months for the experimental group, p<0.001.

CONCLUSIONS

Results suggest that adding green space to asphalt-covered schoolyards helps expose children to nature, increases daily activity levels, and promotes social wellbeing in sex- and age-dependent ways.

Prevalence of objectively measured sedentary behavior in early years: Systematic review and meta-analysis

BACKGROUND

The early years have been identified as a critical period during which sedentary habits may be established, as this behavior appears to track throughout life.

OBJECTIVE

The purpose of this systematic review and meta-analysis is to summarize the current literature on the prevalence of sedentary behavior in children aged 1-5.99 years, reporting differences between boys and girls, weekdays and weekend days, childcare hours and nonchildcare hours, and between time spent indoors and outdoors while children attended childcare.

METHODS

Five databases were searched until 26.10.2017 and meta-analyses were conducted to estimate prevalence and calculate mean differences in prevalence between groups.

RESULTS

Fifty studies representing 14 598 children (2-5.99 years) were included. Children spent 51.4% of their waking time in sedentary behaviors. Boys spent less time being sedentary than girls (estimate difference = -1.4%; 95%CI = -2.0: -0.7; P < .001). No significant differences were found between weekdays/weekend days (estimate difference = -0.4; 95%CI = -2.0: 1.2; P = .61) nor between childcare hours/nonchildcare hours (estimate difference = %; 95%CI = -0.9: 6.6; P = .136). While attending childcare centers, children were more sedentary indoors than outdoors (estimate difference = 14.4%; 95%CI = 11.8: 16.9; P < .001).

CONCLUSIONS

Our results suggest that young children spend a significant portion of their waking hours in sedentary behaviors. While at childcare, young children accumulated more sedentary behavior indoors than outdoors. Girls were more likely to be more sedentary than boys. No significant differences were found between weekdays and weekends, or between childcare and nonchildcare hours. There is a need for higher-quality studies with strong designs, using age and device appropriate cut-off points, to improve evidence-base and to better establish prevalence of sedentary behavior in young children.

Acceptability and Feasibility of Examining Physical Activity in Young Children with Type 1 Diabetes

Physical activity is important but may be difficult to evaluate in young children (YC) with Type 1 diabetes (T1D) because of parents' fears of hypoglycemia, difficulties engaging YC in physical activity, and use of assessment devices. This study aimed to explore the acceptability and feasibility of an in-lab exercise session for YC with T1D. Ten YC ages 3 through7 years with T1D participated in a 20-minute exercise session while wearing blinded continuous glucose monitors and accelerometers. High acceptability was found for participation in the exercise session; high feasibility and acceptability were reported for the assessments. Although most children completed the session, it did not produce moderate to vigorous physical activity. YC were found to spend most of their day sedentary, and they had frequent blood glucose excursions. Findings support the feasibility of conducting a more extensive examination of the relationship among blood glucose levels and physical activity in YC with T1D.

Novel patterns of physical activity in a large sample of preschool-aged children

Background

Moderate-to-vigorous physical activity (MVPA), shown to be associated with health benefits, is not well-characterized in preschool-aged children. MVPA is commonly described as a threshold amount to achieve. We examined a novel way to characterize MVPA patterns in preschool-aged children by gender and age.

Methods

Preschool-aged children from Nashville, TN and Minneapolis, MN wore triaxial accelerometers. Four distinct MVPA patterns were identified: isolated spurt (IS), isolated sustained activity (ISA), clustered spurt (CS), and clustered sustained activity (CSA). Multivariable linear regression models were used to test associations of gender and age with each pattern.

Results

One thousand one hundred thirty-one children (3.9 years old, 51% girls, 30% overweight, 11% obese, and 76% Hispanic) wore accelerometers for 12.9 (SD = 1.4) hours/day for 6.7 (SD = 0.7) days. Children spent 53% of wear time in sedentary behavior and 13% in MVPA. On average, boys and girls achieved > 90 min/day of MVPA (98.2 min, SD = 32.3). Most MVPA (80%) was obtained in spurt-like (IS and CS) MVPA; however, girls spent a higher proportion of MVPA in IS and CS, and lower proportion of time in CSA (all p < 0.001). Controlling for gender, an increase of 1-year in age corresponded to a 1.5% increase in CSA (p < 0.05).

Conclusions

How MVPA was obtained varied depending on the gender and age of the child. On average, boys spent more time in sustained MVPA than girls and MVPA was more sustained in older children. Utilizing these patterns could inform PA practice and policy guidelines.

Trial registration

NCT01316653, date of registration: March 3, 2011; NCT01606891, date of registration: May 23, 2012.

Parent's Physical Activity Associated With Preschooler Activity in Underserved Populations

INTRODUCTION

In the U.S., children from low-income families are more likely to be obese. The impact of parent modeling of physical activity (PA) and sedentary behaviors in low-income American ethnic minorities is unclear, and studies examining objective measures of preschooler and parent PA are sparse.

METHODS

This cross-sectional study examined 1,003 parent-child pairs who were of low income, largely Latino and African American, and living in one of two geographically disparate metropolitan areas in the U.S. Parents and children wore GT3X/GT3X+ accelerometers for an average of >12 hours/day (7:00am-9:00pm) for 1 week (September 2012 to May 2014). Analysis occurred in 2015-2016.

RESULTS

About 75% of children were Latino and >10% were African American. Mean child age was 3.9 years. The majority of children (60%) were normal weight (BMI ≥50th and <85th percentiles), and more than a third were overweight/obese. Children's total PA was 6.03 hours/day, with 1.5 hours spent in moderate to vigorous PA (MVPA). Covariate-adjusted models showed a monotonic, positive association between parent and child minutes of sedentary behavior (β=0.10, 95% CI=0.06, 0.15) and light PA (β=0.06; 95% CI=0.03, 0.09). Child and parent MVPA were positively associated up to 40 minutes/day of parent MVPA, but an inverse association was observed when parental MVPA was beyond 40 minutes/day (p=0.002).

CONCLUSIONS

Increasing parental PA and reducing sedentary behavior correlate with increased PA-related behaviors in children. However, more work is needed to understand the impact of high levels of parental MVPA on the MVPA levels of their children.

Objective reports versus subjective perceptions of crime and their relationships to accelerometer-measured physical activity in Hispanic caretaker-child dyads

Crime and safety are commonly cited barriers to physical activity (PA). We had three objectives, 1) describe the association between objective crime measures and perceptions of crime, 2) analyze the relationships between each type of crime and accelerometer-measured physical activity in caretakers and young children (ages 3-5years), and 3) explore for early gender differences in the relationship between crime and physical activity in young children. Data are from the cross-sectional baseline data of an ongoing randomized controlled trial in Nashville, Tennessee spanning September 2012 through May 2014. Data was analyzed from 480 Hispanic dyads (adult caretaker and 3-5year old child). Objective crime rate was assessed in ArcGIS and perception of crime was measured by caretaker agreement with the statement "The crime rate in my neighborhood makes it unsafe to go on walks." The primary outcome was accelerometer-measured physical activity over seven consecutive days. Objective and perceived crime were significantly positively correlated. Caretaker vigorous PA was significantly related to perceptions of crime; however, its relationship to objective crime was not significant. Child PA was not significantly related to caretaker perceptions of crime. However, interactions suggested that the relationship between crime rate and PA was significantly more negative for girls than for boys. Objective and subjective measures of crime rate are expected to be important correlates of PA, but they appear to have complex relationships that are different for adults than they are for young children, as well as for young girls compared to boys, and research has produced conflicting findings.

Physical Activity in Youth With Type 1 Diabetes: a Review

Youth with type 1 diabetes are at risk for developing cardiovascular disease, and regular physical activity is strongly recommended as one strategy for prevention, as well as for good glycemic control. Despite recommendations, families in this pediatric population face unique barriers to physical activity, including fear of hypoglycemia. Moreover, families are not routinely counseled in the specific health and psychosocial benefits of following physical activity recommendations for youth with type 1 diabetes. To bridge this gap, the recent literature regarding physical activity in children with type 1 diabetes is reviewed with particular focus on young children. A discussion of the limitations of the current body of research, and recommendations for objectively measured physical activity are provided. Specific recommendations for clinical practice are given, including provider endorsements for regular physical activity for longer than 60 minutes, at least three times a week.

Treating Obesity in Preschoolers: A Review and Recommendations for Addressing Critical Gaps

Developing interventions targeting obesity reduction in preschoolers is an emergent area. Although intensive, multicomponent interventions seem a promising approach to preschool obesity reduction, this review identifies and discusses approaches to 3 critical gaps (poor reach to families from low-income and minority backgrounds, lack of sufficient evidence to determine the most effective and efficient treatment components and approaches to treating obesity in early childhood, and lack of consensus on how best to discern intervention effectiveness) that need to be addressed to advance the preschool obesity literature.

Mothers' perceptions of the UK physical activity and sedentary behaviour guidelines for the early years (Start Active, Stay Active): a qualitative study

OBJECTIVES

Higher levels of physical activity (PA) during early childhood have been associated with improved health outcomes, whereas sedentary behaviour (SB) has been associated with poorer health outcomes in children. In 2011, the UK produced guidelines for PA and SB in children under 5 years. Mothers have been identified as key influences in young children's PA and SB. The aim of this study was to use in-depth interviews with mothers of preschool children to examine attitudes to the guidance.

DESIGN

Qualitative study using one-to-one, semistructured interviews; Data were analysed thematically using a framework approach.

SETTING

Mothers were recruited from preschools, nurseries, and mother and toddler groups located in four areas of varying socioeconomic status within Bristol, UK.

PARTICIPANTS

24 mothers who were considered the main or joint carer for a preschool child who was at least 2 years of age but had not yet started formal schooling.

RESULTS

Mothers are not aware of the UK PA and SB guidelines for the early years. They believe that their child achieves the guideline targets for PA and SB and therefore, they do not believe these quidelines are relevant to them. Mothers feel that an increase in PA and reduction in SB (especially screen-viewing) would cause stress for mothers. Mothers found defining and quantifying PA and SB in their preschool child problematic.

CONCLUSIONS

As mothers do not identify with the need to increase PA or reduce SB in their child, awareness of the guidelines alone is unlikely to initiate behaviour change. Information on how mothers can make a more accurate assessment of their preschool child's PA and SB levels, and information about the benefits of increased PA and reduced SB should be provided alongside the guideline targets. Clear messages need to be developed that reframe the guidelines into pragmatic and usable targets.

Environmental factors associated with physical activity in childcare centers

BACKGROUND

Child care centers influence physical activity levels among children, yet little is known about the specific aspects of the environment that support generous amounts of activity. The purpose of this study was to examine the practices, and environmental aspects of the child care center that are associated with children's moderate and vigorous physical activity.

METHODS

Thirty-five child care centers serving 389 3 to 5 year old children were assessed for: 1) environmental characteristics of the center; and 2) staff practices related to child physical activity. Children's physical activity was measured using accelerometers over a single day in child care.

RESULTS

Fourteen percent (an average of 9 minutes per waking hour) were spent in moderate to vigorous physical activity (MVPA). The strongest environmental predictors of MVPA were: time spent in outdoor play, suitability of indoor play space, and teacher encouragement of (but not participation in) indoor play.

CONCLUSIONS

In order to reach the U.S. recommended 120 minutes of physical activity per day, significant changes will need to occur in the child care setting, including increased time outdoors and more opportunities for indoor physical activity.

Activity Patterns of Preschool-Aged Children at Risk for Obesity

BACKGROUND

Although the prevalence of obesity in young children highlights the importance of early interventions to promote physical activity (PA), there are limited data on activity patterns in this age group. The purpose of this study was to describe activity patterns in preschool-aged children and explore differences by weight status.

METHODS

Analyses use baseline data from Healthy Homes/Healthy Kids-Preschool, a pilot obesity prevention trial of preschool-aged children who are overweight or at risk for being overweight. A modified parent-reported version of the previous-day PA recall was used to summarize types of activity. Accelerometry was used to summarize daily and hourly activity patterns.

RESULTS

"Playing with toys" accounted for the largest proportion of a child's previous day, followed by "meals and snacks" and "chores." Accelerometry-measured daily time spent in sedentary behavior, light PA, and moderate-to-vigorous PA (MVPA) was 412, 247, and 69 minutes, respectively. Percentage of hourly time spent in MVPA ranged from 3% to 13%, peaking in the late morning and evening hours. There were no statistically significant MVPA differences by weight status.

CONCLUSIONS

This study extends our understanding of activity types, amounts, and patterns in preschool-aged children and warrants further exploration of differences in PA patterns by weight status.