Assessment of physical activity levels, fitness and perceived barriers to physical activity practice in adolescents: cross-sectional study

Effectiveness of a school-based behavioural change intervention in reducing chronic disease risk factors in Chandigarh, India: a cluster-randomised controlled trial

Background

Early behavioural risk factors such as unbalanced diets, physical inactivity and tobacco and alcohol consumption lead to chronic diseases in later life. We conducted a cluster-randomised controlled trial to measure the effect of a school-based health-promotion intervention in reducing the behavioural risk factors of chronic diseases.

Methods

Twelve public schools in the Chandigarh, India were randomised to the intervention and control arm. Adolescents studying in eighth grade (n = 453), their parents (n = 395) and teachers (n = 94) were recruited for the current study. The Precede-Proceed Model was followed for intervention development. Intervention in each cluster comprised of one classroom session, four physical activity (PA) sessions every week for adolescents and four separate sessions for parents and teachers. Primary outcomes were eight binary or continuous measures of behavioural risk factors among adolescents (n = 359). Physical Activity Questionnaire-Adolescents (PAQ-A) scores were used to estimate physical activity. The ANCOVA based on cluster proportions or means was used to estimate the intervention effect accounting for baseline data.

Findings

Among adolescents, the intervention reduced salt intake by 0.5 g/d (95% CI: -0.9, -0.1), proportion of current alcohol users by 5% (95% CI: -9, -0.007), and increased fruit consumption by 18 g/d (95% CI: 5, 30) and PA by 0.2 PAQ-A score (95% CI: 0.07, 0.3). However, the intervention had no effect on the sugar and vegetable intake and on smokers and tobacco chewers. Exploratory analysis revealed that among parents, PA increased by 205 metabolic equivalents task (MET) units (95% CI: 74.5, 336), fruits intake by 20 g/d (95% CI: 6, 34), and vegetable intake by 117 g/d (95% CI: 50.5, 183). Whereas salt consumption decreased by 0.5 g/d (95% CI: 0.15, 0.9) and the proportion of current alcohol users declined by 5% (95% CI: 9, -1) among parents. Vegetable consumption increased by 149 g/d (95% CI: 12, 286) among teachers.

Interpretation

The intervention package implemented among adolescents by involving parents and teachers is an effective model for school-based behaviour-change interventions.

Funding

MK received partial funding from the George Institute for Global Health, Hyderabad, India for the salt-reduction component of the study.

Trends of physical fitness related to weight status: An analysis including over 412,000 Swiss young male conscripts from 2007 to 2022

Objective

The high prevalence of obesity among young adults in the civilian population pose challenges in recruiting physically fit soldiers. We assessed the trend of physical fitness related to weight status among Swiss male conscripts.

Methods

Cross-sectional data of medical examination data during mandatory conscription for the Swiss Armed Forces, 2007-2022 (N = 412,186). The conscription physical test (CPT) assessed five aspects of physical fitness, each aspect scoring 0-25, one component being an endurance test (ET). CPT and ET categories were defined as per military guidelines: "Insufficient", "Sufficient", "Good", "Very Good" and "Excellent". Weight status was based on body mass index (BMI).

Results

Conscripts with obesity (BMI ≥ 30 kg/m2) and overweight (BMI 25-29.99) had significantly (p < 0.001) lower CPT and ET scores compared to normal weight [multivariable-adjusted mean: 54.7 ± 0.1 and 66.5 ± 0.1, vs. 73.6 ± 0.1 for CPT; 8.8 ± 0.1 and 12.5 ± 0.1, vs. 15.3 ± 0.1 for ET] and a higher likelihood to be categorized as "Insufficient" [weighted relative-risk ratio and (95 %CI): 70.4 (63.7-77.7) and 2.35 (2.16-2.55) for CPT; 77.1 (71.0-83.7) and 3.05 (2.91-3.20) for ET] or "Sufficient" [7.67 (7.38-7.97) and 2.02 (1.99-2.06) for CPT; 8.93 (8.37-9.52) and 2.02 (1.98-2.06) for ET]. Compared to normal weight conscripts, the CPT and ET scores decreased over the conscription years for conscripts with obesity (multivariable-adjusted mean yearly change: -0.11 ± 0.02 for CPT; -0.032 ± 0.007 for ET) and overweight (-0.16 ± 0.01 for CPT and -0.044 ± 0.004 for ET).

Conclusion

Male Swiss conscripts with overweight and obesity have lower physical fitness than normal weight conscripts, and this condition tends to worsen over the conscription years.

Facilitators and barriers to physical activity among English adolescents in secondary schools: a mixed method study

Background

It is evident that physical activity (PA) programmes implemented in schools were not effective in improving PA behaviours among adolescents. This study investigated students' perceptions of barriers to PA among inactive English adolescents in secondary schools based on the Capability, Opportunity, Motivation, and Behaviour (COM-B) model, the Behaviour Change Wheel (BCW), and Theoretical Domains Framework (TDF). The study compared barriers faced by inactive and active groups participating in sports and PA in secondary schools to identify sources of behaviour contributing to inactivity.

Methods

A pre-intervention online survey was distributed to affiliated schools by 233 Teaching Schools Alliances (TSAs) as part of the monitoring and evaluation of the Secondary Teacher Training study. Data were cross-tabulated to analyse activity levels and behavioural barriers for active and inactive groups, using the COM-B domains. The research team followed a seven-step process to categorise barriers based on their relevant domain in the TDF mapped to the COM-B.

Results

The findings were derived from one of the most extensive surveys of adolescents ever undertaken involving 200,623 active and 8,231 inactive respondents. The study identified 52 barriers and 68 behaviours that prevent adolescents from participating in PA. Psychological and social barriers were found to affect all activity levels, genders, and ethnic groups, with a lack of confidence and self-consciousness being the most prevalent. Certain demographic groups, such as those from minority ethnic groups and disabled individuals, were found to be overrepresented among inactive populations. The finding of the study indicated that there were common barriers that affected both inactive and active groups, with further similarity when examining barriers between active and inactive girls. The study also found that girls were more likely to experience the main barriers compared to boys, while inactive boys were more likely to encounter these barriers compared to active boys. The findings suggest that common barriers could be addressed across the population, while recognising some differences in demographics, and the need to provide personalised support. Targeted interventions are also suggested for all girls and inactive boys.

Conclusion

This study highlights the range of barriers that impact adolescents and provides insight into potential mechanisms for behaviour change, including intervention functions, policy categories, and evidence-based behaviour change tools. The study highlights the need for further research to address the barriers to PA among adolescents, particularly those who are inactive. Utilising the findings of this study, future research should investigate the effectiveness of novel digital exercise interventions and policies in increasing PA levels among children and adolescents. Complex digital exercise interventions, including conversational AI solutions, could provide personalised tools to identify and revolutionise support around the multitude of barriers that impact adolescents globally."For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission."

Assessment of physical activity among adolescents: a guide to the literature

Purpose

The aim of this article is to systematically review articles and annual reports concerning young peoples' physical activity (PA) and linking this to considerations of the state and national defense.

Method

A systematic search of the literature included an analysis of publications accessible in global databases and other available books, student papers, and projects. The articles and reports were categorized based on year of publication, methods used, age of respondents, sample size, country, and digital object identifier (DOI).

Results

The result of this search is an overview of the extent and manner in which the worldwide scientific community is addressing the current situation and the long-term development of the physical fitness of adolescents. This publication also maps to what extent professional publications and articles are addressing PA from the perspective of the needs of armies and armed forces of various countries around the world.

Conclusions

The article provides a systematic overview of methods used to measure PA, and an overview of articles dealing with assessing PA. The examined articles indicate that from the perspective of not only national defense, but also health and overall quality of life, in particular, we need initiatives to encourage and motivate young people to increase their everyday PA. The research therefore also includes an overview of factors that may considerably influence PA. The results ascertained in this publication will be used, i.a. for investigating a longitudinal defense research project of the Ministry of Defense of the Czech Republic in which the authors are participating.

Mitral valve prolapse and physical performance in Asian military males: The CHIEF Heart study

The impact of mitral valve prolapse (MVP) and mitral regurgitation (MR) on physical performance has not been examined. Of 1,808 physically fit Asian military males, we compared the physical fitness between 62 subjects with MVP (MVP(+)) and 1,311 age- and anthropometrics-matched controls from the 1,746 participants without MVP (MVP(-)). MVP and MR grade were defined based on the American Society of Echocardiography criteria. Aerobic endurance capacity was evaluated by a 3000-m run and muscular endurance capacity was separately evaluated by 2-min sit-ups and 2-min push-ups. Analysis of covariance was used to determine the difference between groups. As compared to the MVP(-), the MVP(+) completed the 3000-m run test faster (839.2 ± 65.3 sec vs. 866.6 ± 86.8 sec, p = 0.019), but did fewer push-ups (41.3 ± 3.92 vs. 48.0 ± 10.1, p = 0.02) and similar sit-ups within 2 min. Of the MVP(+), those with any MR (trivial, mild or moderate) completed the 3000-m run test faster than those without MR (830.6 ± 61.7 sec vs. 877.2 ± 61.7 sec, p = 0.02). Our findings suggest that in physically active Asian military males, the MVP(+) may have greater aerobic endurance capacity but lower muscular endurance capacity than the MVP(-). The presence of MR may play a role for the MVP(+) to have greater aerobic endurance capacity.

Relationships of BMI, muscle-to-fat ratio, and handgrip strength-to-BMI ratio to physical fitness in Spanish children and adolescents

This study aimed to determine the relationship of body mass index (BMI), muscle-to-fat ratio (MFR), and handgrip strength-to-BMI ratio to physical fitness parameters in an active young population according to sex across four different time points. A total of 2256 Spanish children and adolescents (aged 5-18) from rural areas participating in an extracurricular sport in different municipal sports schools participated in this study. Participants were divided into children (5-10 years) and adolescents (11-18 years), boys and girls, and across four different time points (2018, 2019, 2020, 2021). Data on anthropometric measures (BMI, MFR, appendicular skeletal muscle mass) and physical fitness (handgrip strength, cardiorespiratory fitness, and vertical jump) were collected. Boys who were overweight, but especially boys with obesity, had higher absolute handgrip strength in children and adolescents than their normal weight counterparts in 2020 and 2021. Boys and girls with normal weight presented higher cardiorespiratory fitness and vertical jump than their overweight and obese peers over the years. The MFR was directly correlated with the cardiorespiratory fitness and vertical jump variables, but not with handgrip strength, in boys and girls. The handgrip strength-to-BMI ratio in both sexes was positively correlated to the different physical fitness parameters.  Conclusion: BMI, MFR, and handgrip strength-to-BMI can be used as health and physical fitness indicators in this population. What is Known: • BMI is the main indicator commonly used as a proxy for obesity for many years. Nevertheless, it cannot differentiate between fat mass and fat-free mass. • There are other indicators such as MFR and handgrip strength-to-BMI that might be more accurate and can serve to monitor the health and fitness of children and adolescents. What is New: • MFR showed a positive and significant correlation with cardiorespiratory fitness and vertical jump in both sexes. On the other hand, the handgrip strength-to-BMI presented a positive correlation with cardiorespiratory fitness, vertical jump, and handgrip strength. • The use of these indicators obtained through different parameters of body composition and physical fitness can serve as a tool to identify the relationships of the paediatric population with physical fitness.

Sex and educational level differences in physical activity and motivations to exercise among Spanish children and adolescents

Children and adolescents worldwide, especially girls, do not meet moderate to vigorous physical activity (MVPA) guidelines, a situation which is related to obesity and other comorbidities. Sex/gender differences in the practice of MVPA and motivations to engage in physical activity have not been previously examined among Spanish students considering different educational levels. Therefore, the purpose of this study was to explore these differences and analyse if motivations mediate the relationship between educational levels and MVPA in a large sample of students. From different schools in the Madrid region (primary: 11,122; lower secondary: 12,379; upper secondary: 3228) 26,729 students (13,491 boys and 13,238 girls; 9-19 years old) were recruited to participate in this study. The short form of the International Physical Activity Questionnaire and the third version of the Behavioural Regulation in Exercise Questionnaire were used to evaluate, MVPA and motivations to exercise, respectively. Two-way ANCOVA and a mediation analysis were performed. Female students were found to be less active than males (43.4±38.7 and 58.6±45.9 min of MVPA; p < 0.001; η_p² = 0.023) and showed lower intrinsic (η_p² = 0.003), and integrated (η_p² = 0.007) motivations than their male counterparts (p < 0.001). Primary school students were more active than lower and upper secondary students (53.3±44.2, 49.9±42.3 and 48.0±42.8 min of MVPA; p < 0.001; η_p² = 0.002) and also presented higher intrinsic (η_p² = 0.011) and integrated (η_p² = 0.010) motivation than secondary school students (p < 0.001).    Conclusion:   Among Spanish children and adolescents, females showed lower levels of MVPA and intrinsic and integrated motivation across all the educational levels, and among primary school students in comparison to secondary school. This suggests that inner motivation is more determinant of increased engagement in MVPA and thus, there is need to reinforce it before the transition to secondary school and with special focus on females' preferences. What is Known: •Many children and adolescents worldwide, do not meet physical activity (PA) recommendations. • Within the self-determination theory, autonomous motivation seems to be the main responsible of greater PA levels. What is New: •This study shows for the first time sex and educational level differences in PA levels in a representative sample of Spanish students (9-19 yrs). •Autonomous motivation decreased from primary school onwards and was lower in female students than in their male counterparts.

Promoting Physical Activity Habits after Completing Secondary School: Does the Age Matter?

Physical inactivity is one of the most important problems in our society, especially during adolescence. During this stage of schooling, students practice physical activity in physical education classes, but after they finish school, many of them stop practicing it. This research aims to determine which variables predict the intention to practice physical activity after finishing secondary school and to discover the effect that age during adolescence has on these predictive variables. A questionnaire was administered to a sample of secondary school students. The results show that physical exercise identity influences the three antecedents of this theory, while the attitude towards the behaviour (β = 0.13; p < 0.05), perceived behavioural control (β = 0.46; p < 0.05), and physical self-concept (β = 0.41; p < 0.05), have a statistically significant influence on the intention to be physically active. Moreover, when the age is lower, is more important to develop a positive perceived behavioural control and physical exercise identity. Moreover, for younger male adolescents instead of the physical exercise itself, identity seems more important in developing a positive attitude towards behaviour. Likewise, in young female adolescents a low level of support from their close environment (subjective norm) leads to dropping out. The research concludes with the importance of including these variables in physical education classes to promote physical activity practice after completion of secondary school. Some practical implications are presented.

Associations between Motives for Physical Exercise, Body Composition and Cardiorespiratory Fitness: A Cross-Sectional Study

Adolescents' need for some minimum amount of daily physical exercise has been widely studied so as to assist better health outcomes and to reduce future obesity rates. However, the motivations of adolescents to exercise are less well-known. This manuscript aims to analyze the motives that explain the practice of physical exercise in adolescents and the possible associations with elements of body composition and cardiorespiratory fitness. For this purpose, the Self-Report of Motives for the Practice of Physical Exercise questionnaire (AMPEF) was administered to 917 students between 13-16 years of age (50.1% girls, 49.9% boys, M age = 14.82) from Seville, Spain. Subscales Ill-Health Avoidance and Positive Health, Revitalization and Enjoyment, Strength and Endurance, and Challenge represent the participants' main reasons for practicing physical exercise. Associations between BMI and FAT % with the subscales Weight Management and Appearance (direct association) and Revitalization and Enjoyment (inverse association) were found. A direct association between cardiorespiratory fitness and Revitalization and Enjoyment, Competition, Strength, and Endurance and Challenge subscales was found for both genders. Conclusions emphasize the practice of physical exercise in adolescents due to intrinsic motives based on improving their state of health, increasing their levels of strength and endurance (boys), and achieving short-term objectives (girls).

Physical activity habits and their relationship with sociodemographic factors in Chilean adolescents

Physical activity plays an important role in the well-being and development of adolescents. Physical activity habits expressed in terms of frequency and duration are consistently associated with sociodemographic factors such as age, gender, and socioeconomic status. However, there is less evidence of the relationship between the type and context of physical activity in adolescents. The aim of this article is to analyze physical activity habits and their relationship with sociodemographic factors in Chilean adolescents. The cross-sectional study consisted of 7,263 adolescents aged between 10 and 20 years old, students from both public and private schools in all regions of Chile. Physical activity habits were examined by means of a self-report questionnaire. The age groups were classified according to the three stages of adolescence (early: 10 to 13, middle: 14 to 16, and late: 17 to 20 years old). Socioeconomic level was established based on the school vulnerability index (SVI) of the school attended by each adolescent. In the study it was obvious to the level of physical activity for the adolescents was below the international recommendations. A statistically significant association can also be found between the sociodemographic factors studied and the physical activity habits reported by the young people. The multivariate regression analysis established that the risk of not achieving the physical activity recommendations was 2.8 times higher in females than in males, 2.4 times higher in the older age groups (14–16 and 17–20 years old) compared to the 10–13-year age range and 1.1 times in the medium and high vulnerability groups than in the low socioeconomic vulnerability group. These findings highlight the importance of considering all these factors holistically whenever designing programs or public policies that promote the development of healthy physical activity habits in adolescents.

Barriers to Physical Activity in Spanish Children and Adolescents: Sex and Educational Stage Differences

According to worrisome childhood obesity and inadequate physical activity (PA) levels worldwide, especially exacerbated in adolescents girls, this work aimed to identify sex and educational stage differences in barriers to meet PA requirements and international guidelines in Spanish children and adolescents considering the entire educational pathway (primary, secondary, and college). The Short Form of the International PA Questionnaire and the Scale of Perceived Barriers were administered to primary, secondary, and college education students (13,491 boys and 13,238 girls, 9–19 yrs). Two-way ANOVA was performed to analyze barriers to PA according to sex and educational stage with physical status as covariate. Higher disliking and time barriers were reported by females (1.5 ± 1.2 and 3.2 ± 1.5 points) in comparison to males (1.2 ± 1.0 and 2.8 ± 1.4), while primary students showed lower disliking and time (1.2 ± 1.0 and 2.8 ± 1.5) and higher safety (3.1 ± 1.8) constraints in comparison to secondary (1.4 ± 1.1, 3.1 ± 1.4, and 2.8 ± 1.7) and college (1.5 ± 1.2, 3.2 ± 1.5, and 2.8 ± 1.6; p < 0.05 for all comparisons). College females showed higher disliking (1.7 ± 1.2) and time (3.5 ± 1.4) barriers than secondary females (1.5 ± 1.2 and 3.3 ± 1.4; p < 0.05). Sex and educational stage were determinant for time and dislike of PA barriers, which were rated higher by female students in comparison to their male counterparts and from primary education onwards. Altogether this, suggests promotion strategies should carefully consider girls and the step into secondary school.

Factors associated with a low level of physical activity in adolescents from La Rioja (Spain)

INTRODUCTION

Compliance with the recommendations regarding physical activity by adolescents is poor despite its proven benefits on their health.

OBJECTIVE

The objective of this study was to analyse the physical activity engagement in an adolescent population, evaluating its relationship with various indicators of physical and psychological health, as well as the influence of different sociodemographic variables as potential predictors.

METHODS

A cross-sectional study was applied to a sample of 761 students (14.51 ± 1.63 years) from 25 schools in La Rioja (Spain). Physical activity engagement, hours of nightly sleep, maximum oxygen uptake, health-related quality of life, self-esteem, body image satisfaction, adherence to the Mediterranean diet, body mass index, academic performance and various sociodemographic factors were analysed for all participants.

RESULTS

Being older, being a girl, having a low/medium socioeconomic level, living in unfavourable environments for practicing physical activity, not doing extracurricular sports activities, and being dissatisfied with body image were all predictors of a low physical activity engagement. Likewise, physical activity engagement reported positive associations with health-related quality of life, self-esteem, hours of nightly sleep, adherence to the Mediterranean diet and maximum oxygen uptake.

CONCLUSIONS

Interventions aimed at promoting physical activity must take into account these predictive factors, trying to favor their performance, especially in the most vulnerable groups.

Barriers to high school and university students' physical activity: A systematic review

Physical inactivity commonly occurs throughout one's life, particularly during adolescence and young adulthood. Multiple factors can negatively influence participation in physical activity, but there has been no review examining the barriers to physical activity among high school and university students. Therefore, the aim of this systematic review was to summarize evidence of barriers to the practice of physical activity among high school and university students. The literature search was conducted without time limits using five databases, including CINAHL, Cochrane Library, Embase, PubMed, and Scopus. In total, 59 studies (37 with high school students [n = 22,908] and 22 with university students [n = 15,411]) were included. The main barriers identified in high school and university students were lack of time, lack of motivation, and lack of accessible places. These findings may be useful in designing and implementing evidence-informed interventions and programs for physical activity promotion in students.

Differences in Physical Fitness and Body Composition Between Active and Sedentary Adolescents: A Systematic Review and Meta-Analysis

Previous research analyzing the differences in physical fitness and body composition between active and sedentary adolescents aged 12-16 has not provided conclusive results. For this reason, a systematic review with meta-analysis was conducted to provide an overview of the results obtained to date. The objectives of this systematic review and meta-analysis were to investigate the differences in the physical fitness and body composition of adolescents who engaged in daily physical activity and those who were inactive. A search in PubMed, EBSCO, and Web of Sciences databases was performed. A total of 13,884 articles were reviewed and 11 were included in the meta-analysis. In the physical fitness performance, significantly higher values in cardiorespiratory fitness, hamstring and lower back flexibility, sit-ups and upper limb resistance were found in active compared to the inactive participants. In body composition, the inactive group showed significantly higher values in variables related to body fat, mainly in body fat percentage, fat mass and fat mass index compared to the active group. The results revealed that maintaining an active lifestyle through physical activity is a determining factor in improving the physical fitness and body composition of adolescents aged 12-16 years. The study design of the systematic review was previously registered in PROSPERO with code CRD42021241975. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=241975 .

[Does nutritional status moderate the association between social support, self-efficacy, and physical activity time of adolescents?]

The scope of this paper is to analyze the association between social support, self-efficacy and practice time of physical activity of different intensity (light, moderate, vigorous) and evaluate if these associations are moderated by the nutritional status of adolescents. It involved a cross-sectional study with 650 adolescents (10-14 years old, 52.9% female) from João Pessoa, State of Paraíba. Social support was measured by a scale with five items for each source of support (father, mother and friends) and self-efficacy, with a scale of four items. The physical activity time was measured by means of an accelerometer and the nutritional status was assessed by body mass index. The results of the multiple linear regression analysis showed that social support of friends was positively and significantly associated with moderate intensity physical activity time (β=2.67; CI95%: 0.28; 5.07). The nutritional status did not moderate the association of social support and self-efficacy with the duration of physical activity (p>0.05). The conclusion drawn is that adolescents who perceived that they are receiving more social support from friends tend to practice more moderate intensity physical activity, irrespective of their nutritional status.

Encouraging physical fitness in Brazilian adolescents with excess weight: can they outperform their eutrophic peers in some activities?

BACKGROUND

There is the need to encourage physical activity (PA) among adolescents with overweight or obesity.

OBJECTIVES

The present study aimed to assess the relationship between health-related physical fitness (PF) and nutritional status, and to identify those activities more suited to adolescents with excess weight.

METHODS

This cross-sectional study included 3,062 in-school adolescents, aged 10-18 years. We collected information on sex, age, weight, height, skinfold thickness, trunk height and leg length, and calculated body mass index (BMI) z-score, fat mass percentage, and peak height velocity (PHV). Participants were tested for PF by the 20-m shuttle run test (cardiorespiratory fitness); medicine ball throw and standing long jump tests (musculoskeletal fitness) and sit and reach test (flexibility). We used generalized linear mixed models (GLMM) to analyze the relationship between nutritional status and performance in the fitness tests, controlled for maturity offset and fat mass percentage.

RESULTS

1,563 (51%) were boys, mean age 12.6 years (±1.8), 22.8% were overweight and 12.5% had obesity. In both sexes, adolescents with obesity did better in the upper body strength test than their eutrophic peers. Boys with obesity had worse cardiorespiratory fitness and lower body muscular strength than eutrophic boys. Girls with obesity had similar cardiorespiratory fitness and better lower body strength than eutrophic girls.

CONCLUSION

In muscular strength fitness tests, adolescents with obesity performed similarly to, or better than, their eutrophic peers. Motivation to maintain regular PA is reinforced by positive experiences. Interventions that emphasize muscular strength PF should be developed for adolescents with obesity.

Using Telerehabilitation to Deliver a Home Exercise Program to Youth With Arthrogryposis: Single Cohort Pilot Study

BACKGROUND

Arthrogryposis multiplex congenita (AMC) is characterized by joint contractures and muscle weakness, which limit daily activities. Youths with AMC require frequent physical therapeutic follow-ups to limit the recurrence of contractures and maintain range of motion (ROM) and muscle strength; however, access to specialized care may be limited because of geographical distance. Telerehabilitation can offer a potential solution for delivering frequent follow-ups for youth with AMC, but research on the use of telerehabilitation in children with musculoskeletal disorders is scarce.

OBJECTIVE

The study aims to evaluate the feasibility of delivering a home exercise program (HEP) by using telerehabilitation for youth with AMC. We also aim to explore the effectiveness of the HEP as a secondary aim.

METHODS

Youths aged between 8 and 21 years with AMC were recruited at the Shriners Hospitals for Children-Canada. The participants completed baseline and post-HEP questionnaires (the Physical Activity Questionnaire for Adolescents, Pediatrics Outcomes Data Collection Instrument, and Adolescent and Pediatric Pain Tool), and clinicians assessed their active ROM using a virtual goniometer. Clinicians used the Goal Attainment Scale with the participants to identify individualized goals to develop a 12-week HEP and assess the achievement of these goals. Follow-ups were conducted every 3 weeks to adjust the HEP. Data on withdrawal rates and compliance to the HEP and follow-ups were collected to assess the feasibility of this approach. The interrater reliability of using a virtual goniometer was assessed using the intraclass correlation coefficient and associated 95% CI. Nonparametric tests were used to evaluate feasibility and explore the effectiveness of the HEP.

RESULTS

Of the 11 youths who were recruited, 7 (median age: 16.9 years) completed the HEP. Of the 47 appointments scheduled, 5 had to be rescheduled in ≤24 hours. The participants performed their HEP 2.04 times per week (95% CI 1.25-4.08) and reported good satisfaction with the approach. A general intraclass correlation coefficient of 0.985 (95% CI 0.980-0.989) was found for the web-based ROM measurement. Individualized goals were related to pain management; endurance in writing, standing, or walking; sports; and daily activities. In total, 12 of the 15 goals set with the participants were achieved. Statistically significant improvements were observed in the pain and comfort domain of the Pediatrics Outcomes Data Collection Instrument (preintervention: median 71; 95% CI 34-100; postintervention: median 85; 95% CI 49-100; P=.08) and Physical Activity Questionnaire for Adolescents (preintervention: median 1.62; 95% CI 1.00-2.82; postintervention: median 2.32; 95% CI 1.00-3.45; P=.046).

CONCLUSIONS

The remote delivery of an HEP for youth with AMC is feasible. Promising results were found for the effectiveness of the HEP in helping youths with AMC to achieve their goals. The next step will be to assess the effectiveness of this exercise intervention in a randomized controlled trial.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/18688.

Factors associated with grip strength among adolescents: An observational study

STUDY DESIGN

Cross-sectional.

INTRODUCTION

The muscle strength has been studied in different populations in relation with individual and other factors.

PURPOSE OF THE STUDY

The purpose of this study was to determine values of grip strength in adolescents and to examine its association with sex, age, weight, height, nutritional status, handedness, and academic performance.

METHODS

A total of 452 adolescents (246 men and 206 women) aged 12 to 17 years were included in the study. Grip strength was measured using a Takei dynamometer.

RESULTS

Boys were significantly stronger than girls with both the dominant hand (33.1 kgf vs 25.0 kgf; mean difference = 8.1 kgf; P < .001) and the nondominant hand (30.9 kgf vs 23.1 kgf; mean difference = 7.8 kgf; P < .001), and there was a significant increase in strength values as the age rises in both sexes (P < .001). The dominant hand was stronger than the nondominant one (29.4 kgf vs 27.3 kgf; mean difference = 2.1 kgf; P < .001), except for left-handed subjects who were significantly stronger than right-handed ones in their nondominant hand. Furthermore, strength was positively associated with nutritional status and negatively associated with academic performance in men.

CONCLUSIONS

Sex, age, handedness, nutritional status, and academic performance have a significant influence on the grip strength values. There seems to be a sexual dimorphism in the relationship between strength and both nutritional status and academic performance.

Association of Psychological Stress with Physical Fitness in a Military Cohort: The CHIEF Study

INTRODUCTION

Psychological stress is associated with sedentary behavior, which may impair exercise performance. The aim of our study was to examine the association between psychological stress and physical fitness in military personnel.

METHOD

A military cohort of 4080 subjects in Taiwan was used for the analysis. The Brief Symptoms Rating Scale (BSRS-5) includes items of anxiety, depression, hostility, interpersonal sensitivity, and insomnia measured by a five-point Likert-type scale of 0-4. Psychological stress was defined as normal (n = 3657), slight (n = 314), and great (n = 109) by BSRS-5 score ≤5, 6-9, and ≥10, respectively. Aerobic fitness and anaerobic fitness were evaluated by the time of 3000-meter running and the numbers of 2-min sit-ups and 2-min push-ups, respectively. Multiple linear and logistic regression analyses were used to determine the relationship.

RESULTS

As compared with normal stress, slight and great stress were positive dose-dependently correlated with 3000-meter running time (β = 9.09 and 14.44; P = 0.0032 and 0.048, respectively) after adjusting for age, sex, service specialty, body mass index, systolic blood pressure, cigarette smoking, alcohol intake, hemoglobin levels, and exercise frequency. Similarly, those with slight stress were more likely to be the worst 10% performers in the 3000-meter run test relative to the normal individuals (odds ratio and 95% confidence intervals: 1.50, 1.00-2.24). By contrast, there was no relationship of psychological stress with the numbers of 2-min sit-ups and 2-min push-ups.

CONCLUSIONS

Our findings suggest that the presence of higher psychological stress on military personnel may reduce their cardiorespiratory fitness but not affect the anaerobic fitness.

[Factors associated with a low level of physical activity in adolescents from La Rioja (Spain)]

INTRODUCTION

Compliance with the recommendations regarding physical activity by adolescents is poor despite its proven benefits on their health.

OBJECTIVE

The objective of this study was to analyse the physical activity engagement in an adolescent population, evaluating its relationship with various indicators of physical and psychological health, as well as the influence of different sociodemographic variables as potential predictors.

METHODS

A cross-sectional study was applied to a sample of 761 students (14.51 ± 1.63 years) from 25 schools in La Rioja (Spain). Physical activity engagement, hours of nightly sleep, maximum oxygen uptake, health-related quality of life, self-esteem, body image satisfaction, adherence to the Mediterranean diet, body mass index, academic performance and various sociodemographic factors were analysed for all participants.

RESULTS

Being older, being a girl, having a low/medium socioeconomic level, living in unfavourable environments for practicing physical activity, not doing extracurricular sports activities, and being dissatisfied with body image were all predictors of a low physical activity engagement. Likewise, physical activity engagement reported positive associations with health-related quality of life, self-esteem, hours of nightly sleep, adherence to the Mediterranean diet and maximum oxygen uptake.

CONCLUSIONS

Interventions aimed at promoting physical activity must take into account these predictive factors, trying to favor their performance, especially in the most vulnerable groups.

"More than just another physical activity program": exploring the GUM program for at-risk adolescent girls

Physical activity (PA) levels among adolescent girls continue to steadily decline, especially for those classified as 'at-risk'. To mitigate these trends, Girls United and on the Move (GUM) was created as a dual-component PA and psychosocial program. The primary purpose of this study was to explore participant experiences within GUM, with a secondary purpose of qualitatively informing future PA programs for 'at-risk' adolescent girls. Semi-structured interviews (N = 30) were conducted with a purposeful sample of girls from the GUM program. An inductive thematic analysis was utilized to analyze verbatim transcripts. Two themes were generated from the data: 1) Girls uplifting girls, outlining the importance of a girls-only environment and introducing opportunities for alternative PAs, and 2) finding balance between the physical and psychological, detailing the importance of the dual-component program. These findings provide support for the acceptability of an integrated psychosocial and PA program for at-risk adolescent girls.

Tobacco Smoking and Association between Betel Nut Chewing and Metabolic Abnormalities Among Military Males: The CHIEF Study

AIM

To investigate the effect of smoking and alcohol intake on the association between betel nut chewing and each metabolic abnormality.

BACKGROUND

Betel nut chewing has been associated with metabolic syndrome.

OBJECTIVE

Whether the association is affected by tobacco or alcohol use is not clarified so far.

METHODS

The authors conducted a cross-sectional study using 6,657 military males, aged 18-50 years in eastern Taiwan in 2013-2014. Metabolic syndrome was defined according to the International Diabetes Federation's ethnic criteria for Asians. The population was classified as non-betel nut chewers (N =5,749), current chewers with both tobacco and alcohol use (N =615), and current chewers without tobacco and/or alcohol use (N =293). Multiple logistic regression analyses were stepwise adjusted for the confounders including alcohol and tobacco use to determine the association of betel chewing with the metabolic abnormalities.

RESULTS

As compared to the non-current chewers, the current chewers with both tobacco/alcohol use and those without had a higher risk of metabolic syndrome (odds ratios (OR) and 95% confidence intervals: 2.46 (2.00-3.02), and 2.04 (1.53-2.73), respectively) after controlling for age, service specialty, total cholesterol levels ≥200 mg/dL and exercise frequency (model 1). The association did not change much in the two chewing groups after additionally adjusting for alcohol consumption (model 2) (OR: 2.49 (1.99-3.12), and 2.04 (1.52-2.73), respectively), whereas the relationship reduced significantly in the chewers with both tobacco/alcohol use rather than those without after further adjusting for smoking (model 3) (OR: 2.18 (1.71-2.78) and 2.02 (1.51-2.71), respectively). This was in parallel with the pattern for the association of betel nut chewing with serum triglycerides >150 mg/dL in the chewers with both tobacco/alcohol use and those without in model 1 (OR: 2.90 (2.40-3.51) and 1.90 (1.45-2.49), respectively, p =0.011), in model 2 (OR: 2.82 (2.30-3.46) and 1.89 (1.44-2.49), respectively, p =0.040), and in model 3 (2.26 (1.81-2.81) and 1.87 (1.42-2.45), respectively, p =0.76).

CONCLUSION

Our findings suggest that tobacco smoking but not alcohol intake could increase the relationship of betel nut chewing with metabolic syndrome, which is likely mediated by a synergic effect on increasing serum triglycerides levels.

Gender differences in barriers to participation in after-school physical activities and related factors in Australian schoolchildren: A cross-sectional study

INTRODUCTION

This study investigated the gender differences in reported barriers to participation in after-school physical activity (PA) and related health and socio-behavioural factors in Australian schoolchildren.

METHODS

5001 students aged 10 to 16 years completed the health and well-being survey in 2014 indicating that they would like to participate in after-school PA. Negative binomial regression models, stratified by gender, tested the relationship of age, reported health, junk food, participation in leisure PA, TV watching, weight status and socio-economic index for area score (related factors) with the total number of barriers.

RESULTS

Girls were more likely to report a greater number of barriers to participation in after-school PA than boys (P < .05). Older age was associated with a higher number of barriers in girls (B(95% CI) = 1.061 (1.032, 1.090)) but not in boys. In both boys and girls, being overweight (boys: very overweight (1.367 (1.081, 1.730)); girls: slightly overweight (1.186 (1.100, 1.278)) or very overweight (1.414 (1.197, 1.667))), compared to students who reported "being about the right weight," was associated with a greater number of barriers. Schoolchildren who reported less than excellent health status perceived a greater number of barriers to after-school PA (girls: good (1.141 (1.060, 1.228)), fair (1.189 (1.070, 1.321)) and poor health (1.329 (1.093, 1.614)); boys: good health (1.166 (1.0728, 1.267))).

CONCLUSIONS

There are gender differences in barriers to participation in after-school PA; these should be taken into account when developing programs to increase schoolchildren's after-school PA.

SO WHAT

The prevalence of physical inactivity in Australian adolescents is staggering. We observed that girls reported a greater number of barriers to participation in after-school PA than boys; and being overweight and reporting poorer overall health were associated with a greater number of barriers. Affordable, gender- and age-specific after-school PA programs suitable for schoolchildren of all body shapes and sizes and all abilities are needed.

Beyond TTM and ABC: A Practice Perspective on Physical Activity Promotion for Adolescent Females from Disadvantaged Backgrounds

This paper builds on a growing body of literature on the promise of practice theory in understanding and promoting behavior change in society and develops upon Blue (2017) and Spotswood et al.’s (2019) rationale for evolving theories of practice into the domain of contemporary physical activity research. We begin by considering the intersectional nature of the problem. Statistics reveal that physical activity gradients exist based on gender, as well as socio-economic position. Women, girls, and disadvantaged populations report lower levels of activity than more affluent males and females. More problematic still is what StreetGames (2017) call the “double jeopardy”, where these characteristics intersect, intensifying the negative gradient. Our argument then comprises three parts. First, we provide a critical discussion of intervention studies seeking to transform exercise behavior amongst these populations. The issue we identify is that studies typically rely on behavior change models, such as the Transtheoretical Model (TTM) and the ABC framework. However, these models tend to take insufficient account of the practical and social aspects of behavior change in physical activity, and thus their subjects often succumb to value-action gaps (Shove, 2010). Second, in contrast, we propose that practice theory provides a promising alternative theoretical lens for promoting behavior change in disadvantaged and often resistant populations. Third, the paper highlights a range of conceptual considerations for exploring the relationship between young, disadvantaged women and physical activity, as well as the development of tangible solutions to improve participation.

Quantitative Physical Fitness Measures Inversely Associated With Myopia Severity in Military Males: The CHIEF Study

Myopia has been linked to body weight and sedentary status, but the association with quantitatively measured physical fitness in adults has not been examined. Cross-sectional analyses were performed to investigate the association between physical fitness and myopia in 3,669 military men (aged 29.4 years) in Taiwan. The severity of myopia obtained from the left eye was classified as mild (−0.5 to −3.0 diopters; n = 544), moderate −3.1 to −6.0 diopters; n = 563), and high (<−6.0 diopters; n =150); others were defined as nonmyopia (n = 2,412). Aerobic fitness was evaluated by time for a 3000-meter run test, and muscular endurance was evaluated by numbers of 2-min sit-ups and 2-min push-ups. A value of p < .0125 was considered significant. A multiple linear regression analysis was used to determine the relationship. Individuals who were less physically fit had higher risk of myopia. The associations were dose-dependently significant with mild, moderate, and high myopia for 3000-meter running time (β = 9.64; 95% confidence intervals [3.22, 16.05], β = 12.41; 95% CI [6.05, 18.76], and β = 20.87; 95% CI [9.22, 32.51], respectively) after controlling for the potential covariates. There tended to be an inverse association with moderate and high myopia for numbers of 2-min push-ups (β = −1.38; 95% CI [−2.43, −0.34] and β = −2.10; 95% CI [− 3.97, −0.22], respectively) and 2-min sit-ups (β = −0.83; 95% CI [−1.54, −0.12] and β = −1.29; 95% CI [−2.56, −0.02], respectively), respectively. This study suggested that physical fitness, particularly aerobic fitness of the military males who received regular training, is inversely associated with myopia severity, independent of service specialty, body mass index, and educational level.

Evolution of the Habits of Physical Activity and Television Viewing in Spanish Children and Pre-Adolescents between 1997 and 2017

Background: Promoting healthy lifestyles in children, has become a priority for public health institutions. However, electronic devices with screens encourage sedentary behaviors. The aim of this study was to analyze the evolution of the habits of physical activity practice and television watching in a cohort of 20 years of research in Spanish children. Methods: A cross-sectional, observational study was based on data from the Spain National Health Surveys between 1997 and 2017 (N = 11,444). The dependent variables considered were the frequency with which the minor practiced physical activity (PA) in his/her spare time, the daily TV viewing habit, and the daily hours of TV viewing. Results: The children who practiced physical activity daily has decreased 7.3% throughout the study period. The proportion of children who watched the television daily for more hours increased significantly (6.3%). Such increase was constant throughout the years, and the analysis by sex showed that the proportion of boys who watched television for more than three hours per day increased three percent, and that of girls increased fourfold. Conclusions: The habits of physical activity practice and television viewing have changed towards sedentary lifestyle. Particularly, the girls and the children between 12 and 14 years showed the most sedentary behavior. Public health policies must consider the differences between sexes in order for such interventions to be effective in the population of pre-adolescents, in general, and girls, in particular.

The Relationship of Vitamin D Status, Adherence to the Mediterranean Diet, and Physical Activity in Obese Children and Adolescents

Vitamin D deficiency is associated with a range of chronic diseases, including childhood obesity. Prevalence of vitamin D deficiency in obese children and adolescents ranges from 6.5% to 57%. This cross-sectional study included 92 obese patients with body mass index z-score >2 and 39 subjects in the control group. Anthropometric and laboratory patient assessment were performed, including the fasting 25-hydroxyvitamin D (25(OH)D). Adherence to the Mediterranean diet was assessed by Mediterranean Diet Quality Index for children and adolescents (KIDMED index), while physical activity was evaluated by Physical Activity Questionnaire (PAQ). Serum levels of 25(OH)D were significantly lower in obese subjects compared to the control group (52.0 ± 17.93 vs. 64.09 ± 25.82 nmol/L, P = .003). The subgroup of obese patients with metabolic syndrome (MS) had significantly lower levels of serum vitamin D when compared to the subgroup of obese patients without MS and the control group (46.99 ± 17.11 vs. 54.58 ± 17.93 vs. 64.09 ± 25.82 nmol/L, P = .003). Obese patients with MS had lower PAQ score when compared to obese without MS and the control group (2.32 ± 0.55 vs. 2.49 ± 0.67 vs. 2.85 ± 0.63 nmol/L, P = .002), while no significant differences were observed in the KIDMED index (4.23 ± 1.81 vs. 4.21 ± 2.13 vs. 4.87 ± 2.29, P = .251), respectively. PAQ score was in positive correlation with serum levels of 25(OH)D (r = 0.305, P < .001). This study demonstrated that obese children and adolescents have significantly lower values of serum 25(OH)D. The positive correlation between vitamin D and PAQ score points to the importance of physical activity in the prevention of further cardiovascular complications and MS.

Network Effects on Adolescents' Perceived Barriers to Physical Activity

BACKGROUND

Adolescent physical activity (PA) is widely linked to positive health outcomes. Unfortunately, 80% of adolescents do not meet recommendations, which may be due to perceived barriers to PA. Peer interactions significantly affect adolescent PA behaviors. This study aims to analyze distribution of PA barriers throughout adolescent friendship networks and barriers' associations with PA.

METHODS

Adolescents (N = 383, mean = 10.77 y, SD = 1.30 y, 51.4% male) reported frequency of experiencing PA barriers (body related, social, fitness, convenience, and resource) and names of their friends. Average steps and minutes of moderate- to vigorous-intensity PA per day were measured using accelerometers. Linear network autocorrelation models determined if friends perceived barriers similarly when compared with nonfriends and analyzed relationships between barriers and objective PA measures while controlling for network effects.

RESULTS

Moderate- to vigorous-intensity PA, steps per day, body-related barriers, and social barriers displayed significant network effects, suggesting significant association with the scores of their friends. Average steps per day were significantly associated with age, sex, and social barriers, while inversely associated with fitness barriers.

CONCLUSIONS

This research suggests adolescents' perceived PA barriers are significantly associated with those of their friends. Researchers and practitioners aiming to reduce barriers to PA among adolescents may wish to assess peer reinforcing effects.

Association of Single Measurement of dipstick proteinuria with physical performance of military males: the CHIEF study

BACKGROUND

Proteinuria, a marker of kidney injury, may be related to skeletal muscle loss. Whether the severity of proteinuria is associated with physical performance is unclear.

METHODS

We examined the association of proteinuria severity with physical performance cross-sectionally in 3357 military young males, free of chronic kidney disease, from the cardiorespiratory fitness and hospitalization events in armed Forces (CHIEF) study in Taiwan. The grades of proteinuria were classified according to one dipstick urinalysis which were collected at morning after an 8-h fast as unremarkable (0, +/-, and 1+), moderate (2+) and severe (3+ and 4+). Aerobic physical performance was evaluated by time for a 3000-m run and anaerobic physical performance was evaluated by numbers of 2-min sit-ups and 2-min push-ups, separately. Multiple linear regressions were used to determine the relationship.

RESULTS

As compared with unremarkable proteinuria, moderate and severe proteinuria were dose-dependently correlated with 3000-m running time (β: 4.74 (95% confidence intervals (CI): - 0.55, 10.02) and 7.63 (95% CI: 3.21, 12.05), respectively), and inversely with numbers of 2-min push-ups (β = - 1.13 (- 1.97, - 0.29), and - 1.00 (- 1.71, - 0.28), respectively) with adjustments for age, service specialty, body mass index, blood pressure, alcohol intake, smoking, fasting plasma glucose, blood urea nitrogen, serum creatinine and physical activity. However, there was no association between proteinuria severity and 2-min sit-ups.

CONCLUSIONS

Our findings show a relationship of dipstick proteinuria with aerobic physical performance and parts of anaerobic physical performance in military healthy males. This mechanism is not fully understood and requires further investigations.

CORRELATES OF PHYSICAL ACTIVITY IN ADOLESCENTS OF PUBLIC SCHOOLS IN CURITIBA, PARANÁ, BRAZIL

Objective:

To verify the association of nutritional status, biological maturation, social support and self-efficacy with the physical activity level of 2,347 students of both sexes, aged between 11 and 15 years old, enrolled in state schools in the city of Curitiba, Paraná, Brazil.

Methods:

Anthropometric measurements of body mass, height and sitting height were collected. The assessment of biological maturation was based on the analysis of the age at peak height and sexual maturity. The physical activity level, social support from parents and friends and self-efficacy were evaluated by self-reported questionnaires. Sex/age-specific body mass index (BMI) cutoff points identified the nutritional status. Gross and adjusted binary logistic regression were used to obtain odds (OR) ratios with 95% confidence intervals (95%CI), adopting p≤0.05 as significant.

Results:

More than half (52.3%; n=1,227) of students were active, with boys in a higher proportion (64.1%; p≤0.01). The correlates of physical activity were: nutritional status (OR 1.25; 95%CI 1.01-1.56), early somatic maturation (OR 0.71; 95%CI 0.54-0.93), moderate (OR 1.85; 95%CI 1.50-2.30) and high social support from parents (OR 2.70; 95%CI 2.11-3.42) and high social support from friends (OR 1.78; 95%CI 1.42-2.24).

Conclusions:

Nutritional status, early somatic maturation, social support of parents and friends were correlates of physical activity. Overweight girls with moderate and high parental support and boys with greater social support from parents and friends were more active. Girls with early somatic maturation were less active.

Weight Status, Adherence to the Mediterranean Diet, and Physical Fitness in Spanish Children and Adolescents: The Active Health Study

The aim of this study was to analyze the differences in body composition and physical fitness according to the weight status (normoweight, overweight and obese) and the level of adherence to the Mediterranean diet (MD; low, medium or high), in physically active children and adolescents. Furthermore, this study also analyzed the relationship between body composition and physical fitness with Body Mass Index (BMI), fat mass and the level of adherence to the MD. In total, 1676 participants aged 6–17 from different municipal sports schools participated in this cross-sectional study. Data on adherence to the MD (a KIDMED questionnaire), anthropometric measurements, body composition and physical fitness parameters (the 20-m shuttle run test and muscular strength) were collected. A total of 43.5% of the sample were presented as overweight and obese, and only 35.7% had high or optimal adherence to the MD. The results revealed that a normoweight status was associated with greater cardiorespiratory fitness (p < 0.05; ES: 0.50 to 0.67) and lower-body muscular strength (p < 0.05; ES: 0.58 to 1.10). The overweight group showed more significant results than the other groups in handgrip strength (p < 0.01). Greater adherence to the MD in this population indicated better physical fitness, but only in boys. It is concluded that normoweight status and optimal adherence to the MD in children and adolescents are associated with health benefits, which are significant in the body composition and the effect on physical fitness.

Association between Leukocyte Counts and Physical Fitness in Male Military Members: The CHIEF Study

Low-grade inflammation, which is related to obesity and toxic substance use in young adults, may be associated with poor physical fitness. We investigated the association between total leukocyte count and physical fitness in a military cohort of 3,453 healthy young Taiwanese males aged 20-50 years in a cross-sectional study in 2014. Low-grade inflammation was defined according to equally sized quartiles of total leukocyte counts within the suggested normal limits (4.00-9.99 × 10³/mm³). Aerobic fitness was assessed by the time for a 3-kilometer run test, and anaerobic fitness was evaluated by the numbers of sit-ups and push-ups performed in 2 minutes. Automatic monitoring systems were used to verify the scores for all procedures. Multiple linear regression was utilized to identify the associations among variables. When compared with the lowest counts (4.00-5.49 × 10³/mm³), the second highest (6.50-7.49 × 10³/mm³) and highest normal leukocyte counts (7.50-9.99 × 10³/mm³) were correlated with longer times for a 3-kilometer run (β and 95% confidence intervals =4.93 (1.61, 8.25) and 4.65 (2.20, 7.10), respectively) and fewer numbers of push-ups performed in 2 minutes (β = -0.59 (-1.15, -0.03) and -0.56 (-0.96, -0.17), respectively), after adjustments for age, service specialty, waist circumference, body mass index, alcohol consumption, tobacco smoking, and physical activity. However, the association with 2-minute sit-ups was null. Our study suggested an inverse association between total leukocyte count and not only aerobic fitness but also parts of anaerobic fitness in young males. The temporal association needs confirmation in longitudinal studies.

Well-Being, Obesity and Motricity Observatory in Childhood and Youth (WOMO): A Study Protocol

Background: Childhood obesity is one of the greatest public health problems facing advanced societies, and Spain is one of the countries with the highest incidence. There are many studies that monitor at the national level, but given the lack of specificity, lack of updating and scarcity of epidemiological data on overweight, obesity, physical condition and well-being of children and adolescents in Extremadura, it seems necessary to create a Well-being, Obesity and Motricity Observatory in Childhood and Youth (WOMO) in Extremadura in order to follow up on the evolution of this problem and to propose strategies to combat it. Therefore, this project aims (1) to obtain information on the physical condition, body composition and well-being of children and youth in Extremadura every year and (2) to evaluate the relationship between obesity, overweight, physical condition, well-being, self-perceived physical fitness, physical activity adherence, physical literacy, health-related quality of life (HRQoL), happiness and satisfaction with life, connection with nature, barriers to sports practice, self-concept and bullying in children and youth. Methods: An annual monitoring cross-sectional and follow-up study will be performed. Primary outcome measures will be (1) personal data and anthropometric measurements, (2) family and school information, (3) physical condition, (4) obesity and overweight level, and (5) well-being. Secondary outcome measures will be (1) self-perceived physical fitness, (2) physical activity adherence, (3) physical literacy, (4) HRQoL, (5) happiness and satisfaction with life, (6) connection with nature, (7) barriers to sports practice, (8) self-concept and (9) bullying. Discussion: This project will provide valuable information to adopt appropriate strategies to reduce the level of overweight and obesity in children and youth. Furthermore, orientations will be given to transfer the results obtained to the business sector or to the public sector to evaluate or change the policies adopted.

Anthropometry, dietary intake, physical activity and sitting time patterns in adolescents aged 15-17 years: an international comparison in eight Latin American countries

BACKGROUND

Although there is high prevalence of obesity and other cardiovascular risk factors among Latin American adolescents, there is limited evidence on dietary intake and physical activity (PA) patterns in this population. Therefore, we characterized anthropometry, dietary intake, PA and sitting time (ST) in adolescents aged 15-17 years from eight Latin American countries.

METHODS

Six hundred seventy-one adolescents (41.4% girls) from the Latin American Study of Nutrition and Health (ELANS) were included. Nutritional status was classified by four BMI (kg/m²) categories. Waist circumference (WC) was categorized as above or below thresholds. Dietary intake was assessed through two non-consecutive 24-h dietary recalls. PA and ST were measured using the International Physical Activity Questionnaire (IPAQ). We calculated overall and country-specific estimates by sex and tested for differences between boys and girls.

RESULTS

Differences in the prevalence of overweightness (15.1 and 21.6%) and obesity (8.5 and 6.5%) between boys and girls, respectively, were statistically insignificant (p = 0.059). Average energy intake was 2289.7 kcal/day (95% CI: 2231-2350) for boys and 1904.2 kcal/day (95% CI: 1840-1963) for girls (p < 0.001). In relation to macronutrient intake for boys and girls, respectively, the average intake (expressed as percentage of total energy) was 15.0 and 14.9% for protein; 55.4 and 54.9% for carbohydrates; 14.1 and 14.5% for added sugar; 29.5 and 30.1% for total fat; and 9.6 and 9.9% for saturated fat (p > 0.05 for all outcomes). There was no statistically significant difference in the prevalence of total energy (TE) saturated fat and added sugar (>10% of TE) between girls and boys (49.6% versus 44.8 and 81.7% versus 76.1%, respectively). Prevalence of physical inactivity was 19% in boys and 43.7% in girls (p < 0.001). Median levels of vigorous-intensity PA and total PA were significantly higher for boys than for girls (p < 0.05 for both outcomes); whereas levels of ST were similar (273.7 versus 220.0 min/day for boys and girls, respectively; p > 0.05).

CONCLUSIONS

These findings highlight the high prevalence of poor dietary intake and physical inactivity in adolescents from Latin American countries. Therefore, effective and sustainable strategies and programmes are needed that promote healthier diets, regular PA and reduce ST among Latin American adolescents.

TRIAL REGISTRATION

Clinical Trials NCT02226627. Retrospectively registered on August 27, 2014.

Association between Adherence to the Mediterranean Diet and Physical Fitness with Body Composition Parameters in 1717 European Adolescents: The AdolesHealth Study

Obesity, low levels of physical fitness, and unhealthy eating patterns are responsible for part of the health problems of adolescents today. The current study aimed at examining the association between the adherence to the Mediterranean diet (MD), through each answer to the items of the Adherence to the MD Questionnaire (KIDMED), and physical fitness with body composition parameters (body mass index (BMI), percentage of body fat, and waist circumference) in 1717 European adolescents (N = 900 boys, N = 817 girls). Data of body composition, physical fitness results, and the answers to KIDMED were analyzed by the Student’s t-test. Additionally, the effect size (ES) was calculated and a Chi-square test analyzed the proportion of participants with and without over waist circumference, overfat, and overweight in each KIDMED question. The relative risk of suffering over waist circumference, overfat and overweight in relation to the responses was calculated by Odd-Ratio. Adherence to the MD did not influence the condition of over waist circumference, overfat and overweight, although certain dietary habits were identified as risk factors for their development. Over waist circumference, overfat, and overweight boys and girls presented higher levels of body mass, waist circumference, body fat percentage, and BMI (p < 0.001; ES = 1.73–3.38), as well as lower levels of all the parameters of the physical fitness analyzed (p < 0.001; ES = 0.45–1.08), except the handgrip test. A direct relationship between fitness and over waist circumference, overfat, and overweight was found.

Psychosocial Variables Related to Weight-Related Self-Stigma in Physical Activity among Young Adults across Weight Status

A healthy lifestyle with sufficient physical activity (PA) can contribute to weight management. Yet, many people do not maintain a healthy lifestyle. To explain PA, we propose a model that incorporates the Theory of Planned Behavior (TPB) with weight-related self-stigma. We recruited 325 young adults to complete questionnaires regarding their physical activities, weight-related self-stigma, and TPB factors. We used structural equation modeling to examine the model fit and the path invariance across weight groups. The model showed excellent model fit, but path invariance was not supported. Weight-related self-stigma significantly explained the perceived behavioral control, behavioral intention, and engagement of PA. People without overweight and people with overweight have different considerations for PA. Weight-related self-stigma is important for PA as well. To promote a healthy lifestyle, healthcare providers should provide different suggestions or interventions that suit their patients' weight-related concerns.

Evaluation of Physical Fitness, Body Composition, and Adherence to Mediterranean Diet in Adolescents from Estonia: The AdolesHealth Study

Unhealthy lifestyles, low levels of physical fitness, and adherence to the Mediterranean diet (MD) are associated with bad quality of life and the development of a wide range of non-communicable diseases (NCDs). The current study aimed to evaluate the level of adherence to the MD in physical fitness performance and body composition parameters in children and adolescents of Estonia. Therefore, 413 adolescents (56% boys) from the city of Tartu completed the Mediterranean Diet Questionnaire (KIDMED) for analyzing the adherence to MD and performed the Alpha Fitness Test for measuring physical fitness and body composition. A 41.67% of low, 44.05% of average, and 14.28% of high adherence to MD was detected, without difference between genders (p = 0.747). In the Alpha Fitness battery, a higher performance was observed in all tests for boys vs. girls (p < 0.05). In relation to body composition, higher height, weight, and waist values were observed in boys (p < 0.05) and a lower body fat percentage (p < 0.01) without differences in body mass index (BMI; p = 0.906). The adherence to the MD is classified as average/low. Gender significantly influences all variables of the Alpha Fitness battery and anthropometrics measures excepting BMI. According the levels of adherence to the MD, no statistically different prevalence was observed for Non-Overweight (N-O_weight), Non-Overfat (N-O_fat), or Non-Overwaist (N-O_waist). Still, a risk factor for Overweight (O_weight) in boys with low adherence was observed in comparison to those with a mid-level of adherence to the MD.

Mediterranean Diet, Physical Fitness and Body Composition in Sevillian Adolescents: A Healthy Lifestyle

Childhood and adolescent obesity has become one of the most vital challenges to overcome in the present age. Physical fitness, physical activity and the Mediterranean diet (MD) are valuable tools for its prevention and treatment. The main objective of this study is to analyze the associations between health-related physical fitness components, body composition and adherence to the MD in 917 adolescents aged from 13- to 16-years-old. The ALPHA-Fitness Test was used to measure physical fitness and body composition, and the Adherence to the Mediterranean Diet (KIDMED) questionnaire was employed to assess the adherence to the MD. The associations between variables were tested according to gender and age a generalized linear model (GLM) univariate analysis (two factors) and one-way analysis of variance (ANOVA, with Bonferroni posthoc). As to the body composition and physical fitness variables, significant differences were obtained in both genders but not in relation to the adherence to the MD. The boys performed better in the physical fitness tests. Age was a determinant factor in adherence to the MD in the total sample, lowering as the age of the sample increases. Both the boys and girls who had a significantly higher performance in the endurance test were those who showed high/medium adherence to the MD. It is concluded that higher levels of cardiovascular endurance in boys and girls are associated with a medium and high adherence to the MD.

Association of electrocardiographic left and right ventricular hypertrophy with physical fitness of military males: The CHIEF study

AIM

To investigate the association of electrocardiographic (ECG) left and/or right ventricular hypertrophy (LVH and RVH) with physical fitness of military males.

METHODS

We used a military cohort of 2587 males, who were on average 29.1 years of age, from the cardiorespiratory fitness and hospitalization events in armed forces (CHIEF) study in Taiwan for the analysis. Isolated ECG-LVH (n = 779) was diagnosed by either the Sokolow-Lyon or Cornell voltage criteria. Isolated ECG-RVH (n = 234) was defined by either the Sokolow-Lyon or Myers et al. voltage criteria. Combined ECG-LVH/RVH (n = 140) was defined as those who met the voltage criteria for both LVH and RVH. The other ECGs were defined as unaffected (n = 1434). Physical fitness was evaluated by the upper and lower 16% exercise performance (beyond 1-standard deviation) in 3000-meter run, 2-minute sit-ups, and 2-minute push-ups. All procedures were standardized and monitored by unified computerized scoring systems. A multiple logistic regression was used to determine the relationship.

RESULTS

Compared with unaffected participants, those with an isolated ECG-LVH were tended to have a better 3000-meter run performance (odds ratio (OR) and 95% confidence intervals: 1.22 [0.99-1.50], p-value = 0.064) after adjusting for age, service specialty, body mass index, mean blood pressure, smoking status, alcohol intake, hemoglobin level, and exercise frequency. By contrast, those with an isolated ECG-RVH were tended to have a worse 2-minute sit-up performance (OR: 1.46 [0.99-2.16], p-value = 0.054).

CONCLUSION

Military males with ECG-LVH and/or ECG-RVH compared to unaffected participants may have diverse exercise performances. However, these observations narrowly failed to reach statistical significance.

Healthy Lifestyle: Relationship between Mediterranean Diet, Body Composition and Physical Fitness in 13 to 16-Years Old Icelandic Students

Childhood and adolescent obesity are currently among the greatest challenges for public health. Physical activity, physical fitness, and adherence to the Mediterranean diet (MD), representing powerful indicators of healthy lifestyles, are shown as determinant factors in the prevention and treatment of obesity. The aim of the present study has been to analyse the relationship between health-related physical fitness components, body composition, and adherence to MD in 387 Icelandic adolescents of 13⁻16-years old (54% boys). The ALPHA Fitness Test was used to measure physical fitness and body composition. The KIDMED questionnaire was used to assess the adherence to MD among participants. Associations between variables were tested according to gender and age using linear regression models and analysis of variance. Participants with high/medium adherence to MD showed significantly higher endurance scores in both the boys and the girls. Gender differences were found. The boys in high/medium MD categories had significantly lower fat percentages and ran a 4 × 10 m sprint faster than the girls. The girls scored higher than the boys in endurance and speed-agility tests. It can be concluded that a high and medium adherence to MD is associated with high and very high endurance in both the girls and the boys.

Fitness and academic performance in adolescents. The mediating role of leptin: DADOS study

We tested the mediating effect of leptin on the association between physical fitness (PF) components and academic performance indicators in healthy adolescents. A total of 263 adolescents (13.9 ± 0.3 years, 47.5% girls, 12.5% overweight) from the DADOS (Deporte, ADOlescencia y Salud) Study were included in the analysis. PF components were assessed by the handgrip test for upper-limb muscular strength, standing long jump test for lower-limb muscular strength, 4 × 10-m shuttle run test for speed-agility, and 20-m shuttle run test for cardiorespiratory fitness. Plasma leptin concentration was assessed from antecubital vein blood after an overnight fast using a sensitive ELISA kit. Academic performance indicators were assessed through final school grades and through the Spanish version of the SRA Test of Educational Ability. Body composition was assessed by body mass index and skinfold thicknesses. Boot-strapped mediation procedures were performed and indirect effects with confidence intervals not including zero were interpreted as statistically significant. Our findings suggest that the positive associations observed between cardiorespiratory fitness and lower-limb muscular strength with academic performance indicators were mediated by leptin concentration after adjusting for sex, pubertal stage, socioeconomic status, and adiposity (percentage of mediation ranging from 54.61 to 82.02%).

CONCLUSIONS

Improvements on PF components, particularly in cardiorespiratory fitness and lower-limb muscular strength, might reduce leptin concentration with potential benefits on academic performance in adolescents, independently of adiposity. What is Known: • Academic performance is associated with physical fitness and leptin concentration in children and adolescents. • Fitness modulates leptin concentration levels, regardless of physical activity and adiposity. What is New: • Leptin concentration mediates the association of cardiorespiratory fitness and muscular strength with academic performance in adolescents. • Improvements in cardiorespiratory fitness and muscular strength might reduce leptin concentration levels enhancing academic performance.

Association of betel nut chewing with exercise performance in a military male cohort: the CHIEF study

INTRODUCTION

Betel nut chewing may cause obesity, neurohormonal activation and inflammation, possibly impairing exercise performances.

METHODS

We examined the cross-sectional association in 4388 military male adults aged 18-50 years from the cardiorespiratory fitness in armed forces study in Taiwan between 2013 and 2014. The status of betel nut chewing was classified as current and former/never based on each participant's response to a questionnaire. Physical fitness was evaluated by three basic exercise tests including 3000 m running, 2 min sit-ups and 2 min push-ups. Multiple logistic regression for the best 10% and the worst 10% performers in each exercise, and linear regression were used to determine the relationship.

RESULTS

There were 564 current chewers and 3824 non-current chewers for the analysis. The linear regression shows that current betel nut chewing was positively correlated with 3000 m running duration (r=0.37, p=0.042) after adjusting for age, service specialty, body mass index, exercise frequency and alcohol intake. In addition, the logistic regression shows that as compared with non-current chewers, current chewers had lower odds of being the top 10% performers in 2 min push-ups and higher odds of being the bottom 10% performers in 2 min sit-ups (ORs and 95% CIs: 0.71 (0.50 to 0.99) and 1.32 (1.00 to 1.75), respectively). However, the associations between betel nut chewing and physical fitness were all insignificant after further adjusting for current smoking.

CONCLUSIONS

Our findings suggest that the impairment of physical fitness associated with betel nut chewing of military young men might be mainly mediated or moderated by the coexisted cigarette smoking.

Changes in muscular fitness and its association with blood pressure in adolescents

The aims of this study were to examine the longitudinal association between muscular fitness (MF) and blood pressure (BP) 2 years later, and to determine whether changes in MF over a 2-year period were associated with BP at follow-up, in adolescents. The sample comprised 734 youths (349 girls) aged from 12 to 18 years. MF was assessed with the standing long jump and handgrip tests. Socioeconomic status, pubertal stage, waist circumference, resting BP, and cardiorespiratory fitness were measured according to standard procedures. Regression analyses showed a significant inverse association between MF at baseline and systolic BP (β = - 0.072; p = 0.032) and rate pressure product (β = - 0.124; p < 0.001) at follow-up, after adjustments for age, sex, height, pubertal stage, and socioeconomic status. However, when analyses were further adjusted for waist circumference and cardiorespiratory fitness, these associations did not remain significant. Adolescents with persistently high and increasing MF exhibited the lowest levels of diastolic BP (F_{(3, 721)} = 3.814, p = 0.018) and systolic BP (F_{(3, 721)} = 3.908, p = 0.014) when compared to those with persistent low MF after adjustment for age, sex, height, socioeconomic status, cardiorespiratory fitness, and waist circumference.Conclusion: This study suggests that persistent greater and increasing MF in youth are associated with lower levels of BP across the adolescence. What is Known: • Currently, there is a growing interest on the health benefits of muscular fitness. • Cross-sectional studies have identified an association between muscular fitness and blood pressure in adolescents. What is New: • Changes in muscular fitness during adolescence were associated with systolic and diastolic BP over a 2-year period. • Adolescents with persistently low muscular fitness exhibited the highest levels of diastolic and systolic BP.

Chronic hepatitis B, nonalcoholic steatohepatitis and physical fitness of military males: CHIEF study

AIM

To investigate the association of chronic hepatitis B and nonalcoholic steatohepatitis with physical fitness in a Taiwanese military male cohort.

METHODS

We made a cross-sectional examination of this association using 3669 young adult military males according to cardiorespiratory fitness and hospitalization events recorded in the Taiwan Armed Forces study. Cases of chronic hepatitis B (n = 121) were defined by personal history and positive detection of hepatitis B surface antigen. Cases of nonalcoholic steatohepatitis (n = 129) were defined by alanine transaminase level > 60 U/L, liver ultrasound finding of steatosis, and absence of viral hepatitis A, B or C infection. All other study participants were defined as unaffected (n = 3419). Physical fitness was evaluated by performance in 3000-m run, 2-min sit-ups, and 2-min push-ups exercises, with all the procedures standardized by a computerized scoring system. Multiple linear regression analysis was used to determine the relationship.

RESULTS

Chronic hepatitis B negatively correlated with 2-min push-up numbers (β = -2.49, P = 0.019) after adjusting for age, service specialty, body mass index, systolic and diastolic blood pressures, current cigarette smoking, alcohol intake status, serum hemoglobin, and average weekly exercise times. Nonalcoholic steatohepatitis was borderline positively correlated with 3000-m running time (β = 11.96, P = 0.084) and negatively correlated with 2-min sit-up numbers (β = -1.47, P = 0.040).

CONCLUSION

Chronic hepatitis B viral infection and nonalcoholic steatohepatitis affects different physical performances in young adult military males, and future study should determine the underlying mechanism.

Physical Activity Perceptions in Adolescents: A Qualitative Study Involving Photo Elicitation and Discussion Groups

Adolescence is a key period in life when most of the healthy habits that will affect health during adulthood are established. Numerous interventions based on the acquisition of regular physical activity (PA) in the adolescent population have so far yielded no success, mainly in the long term. Qualitative phenomenological research was used to identify adolescents’ perceived barriers and motivations to regular PA practice, and how they form the concept of PA through thought and action. This study constitutes an explicative design using photo elicitation (PE) and discussion group (DG) techniques to explore different aspects and meanings associated with PA, as well as their perceptions toward PA practice. The study was conducted on adolescents from a randomly selected district in Barcelona (Catalonia), Spain. Through the use of PE, a total of 67 photographs were analyzed. A DG was conducted with a group of 10 teenagers. Input from the DG was examined using interpretative phenomenological analysis. The findings show that social, familial, and environmental factors become motivational elements for the regular practice of PA. The findings observed relevant aspects linked to general barriers and to particular ones associated with young women. This study also considered implications for future interventions.