Modeling the dose-response rate/associations between VO2max and self-reported Physical Activity Questionnaire in children and adolescents

Physical activity, health-related fitness, and physical performance in children with acquired hypothalamic dysfunction

PURPOSE

Survivors of a pediatric suprasellar tumor may suffer from hypothalamic-pituitary dysfunction (HD), which may result in hypothalamic obesity (HO). The first step in HO treatment is lifestyle intervention (e.g. exercise). Our aim was to assess physical activity (PA), health-related fitness (HRF) and physical performance (PP) in a cohort of children with a suprasellar tumor.

METHODS

Retrospective study on a national cohort including all children with a suprasellar tumor who were referred to the physiotherapy department 2018-2022. Data was collected on: PA defined as minutes of Moderate-to-Vigorous Physical Activity (MVPA) and number of steps per day, HRF defined as body composition, VO2peak percentage of predicted, mean power, and muscle strength, and PP based on the 10-m walk and run test, time up and down the stairs, and time to rise from the floor.

RESULTS

Seventy-three children (mean age 11.09, mean body mass index SDS 2.36) were evaluated. In total, 24.1% reached the guideline of ≥ 60 min MVPA per day. The VO2peak percentage of predicted was 71.0% [IQR 57.0 - 82.8] and in 58.3% mean power was ≤ -2 SDS. Muscle strength was not decreased (median of -0.5 SDS). PP was found to be better than the norm. CONCLUSION AND KEY FINDINGS: PA and HRF are decreased in children with HD, however PP was not decreased. This implies that no PP restrictions are present to engage in PA and that a lifestyle coach can be involved to improve PA and HRF in these children.

Relationship Between Physical Literacy and Cardiorespiratory Fitness in Children and Adolescents: A Systematic Review and Meta-analysis

BACKGROUND

Physical literacy (PL) can positively affect the health of children, adolescents, and adults, and is closely related to cardiorespiratory fitness (CRF).

OBJECTIVE

To perform a systematic review and meta-analysis to examine the relationship between overall physical literacy (PL) and CRF in children and adolescents.

METHODS

Cross-sectional, cohort and experimental studies on the relationship between PL and CRF in children and adolescents were collected by searching the Web of Science Core Collection, PubMed, EBSCOhost, ScienceDirect, Cochrane Library and China National Knowledge Infrastructure (CNKI) databases. Based on the characteristics of the included literature, PL was divided into physical competence (PC), daily behavior (DB), knowledge and understanding (K&U), and motivation and confidence (M&C). R 4.3.6 was used to analyze the combined effect size of PL and the relationships of the four dimensions with CRF among children and adolescents.

RESULTS

A total of 21 articles were included, 42.9% of which were published after 2020, involving a total of 43,352 children and adolescents from 23 countries or regions. The characteristics of the included studies showed that, except for the K&U of children and adolescents aged 13-18 years, the K&U of other age groups and the PL, PC, DB, M&C of all age groups were significantly positively correlated with CRF. Furthermore, the results of male and female samples in all included studies were the same. The results of the meta-analysis indicated that PL (COR = 0.64, 95% CI 0.58, 0.70), PC (COR = 0.74, 95% CI 0.69, 0.79), DB (COR = 0.49, 95% CI 0.40, 0.57), K&U (COR = 0.41, 95% CI 0.23, 0.56), and M&C (COR = 0.45, 95% CI 0.41, 0.49) were significantly positively correlated with CRF. Regarding DB, total physical activity (TPA) was positively correlated with CRF (COR = 0.49, 95% CI = 0.40, 0.57). Moderate to vigorous physical activity (MVPA), vigorous physical activity (VPA) and high physical activity (HPA) were positively correlated with CRF (COR = 0.16, 95% CI 0.09, 0.22; COR = 0.33, 95% CI 0.22, 0.43; COR = 0.38, 95% CI 0.13, 0.58), but light physical activity (LPA) was negatively correlated with CRF (COR = - 0.20, 95% CI - 0.32, 0.06).

CONCLUSION

PL and CRF are positively correlated among children and adolescents, suggesting that the development of physical literacy has a wide range of effects on children and adolescents' cardiopulmonary health and that these effects are not limited by PL and its various dimensions or sex. In addition, to exert the positive effect of daily activities on cardiopulmonary health, the intensity of physical activity should reach a moderate level or above.

The Most Active Child Is Not Always the Fittest: Physical Activity and Fitness Are Weakly Correlated

The present cross-sectional study aimed to evaluate the impact of physical activity level (PA) on physical fitness by controlling for individual characteristics in Italian children. A total of 329 children (girls n = 155, 42.6%; from five primary schools, 17 classes) aged 8-10 filled out the Physical Activity Questionnaire for Older Children (PAQ-C) to assess their PA level and performed anthropometric measurements (body mass, height, and BMI) and physical tests for measuring sprint (20 m sprint), cardiorespiratory fitness (shuttle-run test), balance (single-leg stance), handgrip strength (handgrip), lower-limb power (standing long-jump), peak force (countermovement jump), and low-back flexibility (sit-and-reach) skills. Linear mixed-effects models were applied to determine the relationship between physical fitness and PAQ-C score controlling for individual characteristics (i.e., gender, age, BMI). Results reported significant relationships between PAQ-C scores and sit-and-reach, shuttle-run, long-jump, and sprint tests. All considered physical tests were correlated with gender, age, and BMI, except for sit-and-reach from BMI. The variance in age, gender, BMI, and PAQ-C score accounted altogether for 30.0% of the variance in handgrip, 23.0% in single-leg stance, 26% in sit-and-reach, 36% in shuttle-run, 31% in long-jump, 34% in sprint, and 31% in countermovement jump. Therefore, the relationship between PA and fitness is not absolute and depends on the test and children's characteristics.

Predicting VO2max in Children and Adolescents Aged between 6 and 17 Using Physiological Characteristics and Participation in Sport Activities: A Cross-Sectional Study Comparing Different Regression Models Stratified by Gender

Background: The aim of this study is to use different regression models to capture the association between cardiorespiratory fitness VO2max (measured in mL/kg/min) and somatometric characteristics and sports activities and making better predictions. Methods: multiple linear regression (MLR), quantile regression (QR), ridge regression (RR), support vector regression (SVR) with three different kernels, artificial neural networks (ANNs), and boosted regression trees (RTs) were compared to explain and predict VO2max and to choose the best performance model. The sample consisted of 4908 children (2314 males and 2594 females) aged between 6 and 17. Cardiorespiratory fitness was assessed by the 20 m maximal multistage shuttle run test and maximal oxygen uptake (VO2max) was calculated. Welch t-tests, Mann−Whitney-U tests, X2 tests, and ANOVA tests were performed. The performance measures were root mean square error (RMSE), mean absolute error (MAE), and coefficient of determination (R2). All analyses were stratified by gender. Results: A comparison of the statistical indices for both the predicted and actual data indicated that in boys, the MLR model outperformed all other models in all indices, followed by the linear SVR model. In girls, the MLR model performed better than the other models in R2 but was outperformed by SVR-RBF in terms of RMSE and MAE. The overweight and obesity categories in both sexes (p < 0.001) and maternal prepregnancy obesity in girls had a significant negative effect on VO2max. Age, weekly football training, track and field, basketball, and swimming had different positive effects based on gender. Conclusion: The MLR model showed remarkable performance against all other models and was competitive with the SVR models. In addition, this study’s data showed that changes in cardiorespiratory fitness were dependent, to a different extent based on gender, on BMI category, weight, height, age, and participation in some organized sports activities. Predictors that are not considered modifiable, such as gender, can be used to guide targeted interventions and policies.

The effects of forest therapy on public mental health and circular economy: A policy support model in Japan

Background

Forest therapy has gained popularity in Japan and even other nations/regions due to its health benefits. In addition, forest therapy has contributed to the development of circular economy and industrial upgrading. Japanese successful practice can serve as a model for other countries in the Asia-Pacific region. To this end, the aim of this study was to determine whether forest therapy can improve the whole well-being of the participants and has a positive effect on the development of circular economy in the region.

Methods

Both empirical and inductive research methods were used; empirical approach was conducted to perform comparative analysis of regional data that was retrieved from the research project of Japanese Forestry Agency in 2015. Specifically, the efficacy of forest therapy on physical (blood glucose, blood pressure, body weight) and mental (sleep quality e.g.,) health outcomes among 815 participants was investigated. Regional data are from the statistics of Iiyama City from 1990 to 2005. After the concept of forest therapy became popular in the late 1990s, this element had a great positive impact on the economic benefits of Ishiyama City and other major forest scenic areas. We summarize and analyze a series of policies made by relevant departments of the Japanese government in the years from 2019 to 2021 to promote forest therapy and related circular industry development.

Results

Significant (pre-to-post participation) changes in physical measure was observed. Firstly, mean weight of those overweight participants decreased across three different time points (pre-test/enrollment = 79.7 kg, 3-month participation = 77.2, and 6-month participation = 76.8 kg), while overall mean weight of the participants decreased to 61, 60.5, and 60.4 kg, respectively. Secondly, Participant with normal weight showed a decrease on mean HbA1C (from 6.09 to 6.06) at Week 24, while overweight participants demonstrated a slight change 6.03-6.01 after 6 months the average HOMA-IR for overweight participants decreased from 3.5 to 2.5 at Week 24, while participants with normal weight demonstrated a decrease from 2.2 to 1.7 at Week 24. Forest Therapy has emerged in Japan since Mid-1990s and has attracted a large number of tourists all over the world due to its unique health benefits.

Conclusion

Forest therapy in Japan has positive effects on whole well-being of Japanese residents and it has helped public mental health promotion and economic growth. Under the guidance and support of government policies, it can promote the development of circular economy and industrial transformation and set a model of Japanese forest therapy development for other countries in the Asia-Pacific region.

Associations of physical condition with lung function and asthma in adolescents from the general population

BACKGROUND

The relation of physical condition with respiratory outcomes in adolescents is unclear. We examined the hypothesis that adolescents with a lower physical condition represented by a lower cardiorespiratory fitness and physical activity, and a higher screen time have a lower lung function and higher risk of asthma.

METHODS

In a population-based prospective cohort study on 4854 children aged 13 years, we assessed cardiorespiratory fitness by using the peak work rate measured by the steep ramp test. Information on physical activity and screen time was obtained by self-reported questionnaires. Lung function was measured by spirometry and current asthma was assessed by a parental-reported questionnaire.

RESULTS

Taking sociodemographic, lifestyle, and growth-related confounders and multiple hypothesis testing into account, a 1 SD lower cardiorespiratory fitness was associated with a lower FEV₁ , FVC, and FEF₇₅ (Z-score difference (95% CI): -0.31 (-0.35, -0.28), -0.30 (-0.33, -0.26), -0.13 (-0.17, -0.10), respectively), and a higher risk of asthma (Odds Ratio (95% CI) 1.25 (1.06, 1.46)). A 1 SD higher screen time was associated with a lower FVC (Z-score difference (95% CI): -0.06 (-0.10, -0.03)). Physical activity and screen time were not related to asthma. Results did not materially change after additional adjustment for respiratory outcomes at an earlier age.

CONCLUSION

Adolescents with a lower cardiorespiratory fitness had a lower lung function and a higher risk of asthma. Those with a higher screen time had a lower FVC. Further studies are needed to explore the effect of improvements in physical condition on long-term respiratory outcomes.

School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18

BACKGROUND

Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school.

OBJECTIVES

The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information.

SELECTION CRITERIA

Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update.  DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type.

MAIN RESULTS

Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias.  Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events.

AUTHORS' CONCLUSIONS

Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.

Assessing the Physical Activity Questionnaire for Adolescents (PAQ-A): Specific and General Insights from an Ethiopian Context

The Physical Activity Questionnaire for Adolescents (PAQ-A) has been used in a variety of forms and in a range of countries. This study involves a detailed examination of the PAQ-A to determine its applicability and effectiveness in an Ethiopian setting. We administered the scale to 110 Ethiopian adolescents on two occasions, 5 weeks apart. Data were inspected for features typical of the participants and analyzed to identify interitem correlations, the scale's factor structure, and a range of descriptive statistics concerning composite scores. Most of the scale's items were satisfactorily interrelated according to lenient criteria, and most items loaded on a single factor in exploratory factor analyses. However, a number of the scale's properties were deficient according to stringent or conventionally accepted psychometric criteria. Close inspection of participants' responses highlighted problems in the way the scale is worded, interpreted by participants, and scored. Although the scale does not capture PA as an homogeneous construct, we argue that this is not a problem and neither is its poor test-retest reliability. We make recommendations concerning presentation and scoring of the PAQ-A that are likely to enhance its validity beyond Ethiopia, and we provide a modified version of the scale.

Balancing time use for children's fitness and adiposity: Evidence to inform 24-hour guidelines for sleep, sedentary time and physical activity

PURPOSE

Daily time spent on one activity cannot change without compensatory changes in others, which themselves may impact on health outcomes. Optimal daily activity combinations may differ across outcomes. We estimated optimal daily activity durations for the highest fitness and lowest adiposity.

METHODS

Cross-sectional Child Health CheckPoint data (1182 11-12-year-olds; 51% boys) from the population-based Longitudinal Study of Australian Children were used. Daily activity composition (sleep, sedentary time, light physical activity [LPA], moderate-to-vigorous physical activity [MVPA]) was from 8-day, 24-hour accelerometry. We created composite outcomes for fitness (VO2max; standing long jump) and adiposity (waist-to-height ratio; body mass index; fat-to-fat-free log-ratio). Adjusted compositional models regressed activity log-ratios against each outcome. Best activity compositions (optimal time-use zones) were plotted in quaternary tetrahedrons; the overall optimal time-use composition was the center of the overlapping area.

RESULTS

Time-use composition was associated with fitness and adiposity (all measures p<0.001). Optimal time use differed for fitness and adiposity. While both maximized MVPA and minimized sedentary time, optimal fitness days had higher LPA (3.4 h) and shorter sleep (8.25 h), but optimal adiposity days had lower LPA (1.0 h) and longer sleep (10.9 h). Balancing both outcomes, the overall optimal time-use composition was (mean [range]): 10.2 [9.5; 10.5] h sleep, 9.9 [8.8; 11.2] h sedentary time, 2.4 [1.8; 3.2] h LPA and 1.5 [1.5; 1.5] h MVPA.

CONCLUSION

Optimal time use for children's fitness and adiposity involves trade-offs. To best balance both outcomes, estimated activity durations for sleep and LPA align with, but for MVPA exceed, 24-h guidelines.

Cardiorespiratory fitness in adolescents before and after the COVID-19 confinement: a prospective cohort study

Long periods of free-movement restrictions may negatively affect cardiorespiratory fitness and health. The present study investigated changes after the COVID-19 confinement in maximal oxygen intake (VO₂ max) levels in a sample of 89 Spanish school children aged 12 and 14 years at baseline (49.8% girls). The 20-m shuttle run test served to estimate VO₂ max before and after the COVID-19 confinement. Paired t-tests estimated an overall difference of - 0.5 ml.kg^-1.min^-1 (SD 0.3) (p = 0.12), whereas the highest significant reductions were observed for girls aged 14 years (- 1.5 ml.kg^-1.min^-1 (SD 0.6) (p < 0.05)). Boys aged 14 years showed a slight increase (0.4 ml.kg^-1.min^-1 (SD 0.5) (p = 0.44)), whereas boys aged 12 years presented an important decrease (- 1.2 ml.kg^-1.min^-1 (SD 0.7) (p = 0.14)). Healthy Fitness Zone (HFZ) levels also experienced a decrease of - 3.4% as regards baseline levels over the examined period. All the examined subgroups showed lower levels in relation to a normal VO₂ max rate development, although girls aged 14 and boys aged 12 years accounted for the highest part.Conclusion: The results indicate that COVID-19 confinement might delay the normal development of VO₂ max in adolescents. Strategies to tackle this concerning decline are warranted. What is Known: • First study analyzing cardiorespiratory fitness levels in teenagers after COVID-19 confinement. What is New: • Important delay in maximal oxygen intake identified in a sample of Spanish teenagers. • These results should be considered to develop strategies of a more active lifestyle in teenagers during and after confinements.