Associations of volumes and patterns of physical activity with metabolic health in children: A multivariate pattern analysis approach

Physical activity and content in a variety of physically active learning: an observational case study of real-world practices

Background

Research on physically active learning (PAL) has mainly been investigated experimentally, where interventions have been introduced to study effects on, for example, physical activity (PA) levels. This might undermine real-world contexts and realistic PA levels when teachers have sustained PAL in their regular teaching practice for several years. The purpose of this study was to observe and describe the organization and content of a variety of teaching where PAL was enacted by experienced teachers and to describe the corresponding PA levels and PA intensity in real-world practices.

Methods

Fifty-eight pupils and four teachers from one primary school and one secondary school were enrolled across the first, sixth, and eighth grades. The pupils' physical activity (PA) levels were assessed during 37 enacted physically active learning (PAL) segments within longer teaching lessons using waist-worn triaxial accelerometers. Evenson cut-off points were employed to define PA intensities. All enacted PAL were passively observed by the same observer regarding primary bodily movement, duration, subject, location, collaborative or individual work, and task orientation.

Results

On average, PAL consisted of 57.8% ± 15.7% sedentary time, 22.9% ± 7.5% light intensity PA, and 19.3% ± 10.8% moderate-to-vigorous intensity PA, displaying a large variety in different PAL segments. More intensive and higher volumes of PA were evident when PAL was facilitated outdoors, in gyms, or in large stairways, while lower PA volumes and intensity were assessed when PAL was enacted inside the classroom. The primary movement in PAL was mainly running and/or walking (78.3%), while the PAL activity was mainly organized as group work (83.7%) in non-competitive tasks (97.3%).

Conclusions

This study provides novel insights by being the first to investigate the organization and content of PAL enacted by experienced teachers in their teaching and the corresponding PA levels in their real-world practices. The results displayed a large diversity in PA levels and intensities and may serve as a starting point to further investigate the coherency of PA levels and PAL content in schools with sustained PAL teaching.

Impact of varying accelerometer epoch length on physical activity patterns in adults: Considerations for public health

BACKGROUND

To process wearables sensors data, end-users face a wide variety of choices influencing physical activity (PA) patterns estimation. This study investigated the impact of varying epoch length on PA patterns in adults and World Health Organization (WHO) PA guidelines prevalence, assessed by accelerometer.

METHODS

The study included 181 adults (18-74 years) from the Esteban Study (2014-2016). Participants wore an accelerometer for 7 consecutive days. Data were processed with ActiLife® software using epoch lengths from 1 to 60 seconds to assess PA patterns. Difference of PA patterns between epoch length was assessed using repeated measures ANOVA. Difference in meeting WHO PA guidelines was assesses using Fisher's exact test.

RESULTS

Significant changes were observed in sedentary behaviour and PA intensities with epoch length variation (p<0.001). Longer epochs led to reduced moderate and vigorous PA, increased light PA, and less sedentary time, affecting adherence to WHO PA guidelines.

CONCLUSION

Result underline the importance of careful epoch length selection when processing accelerometer data to accurately assess sedentary behaviour and PA in adults. Shorter epochs seem preferable to capture short and spontaneous PA bouts and preventing underestimation of MVPA along with prolonged PA bouts. Further investigation including a PA reference measure is needed to confirm these findings and their implications for adult health.

Associations between motor competence and physical activity levels of children with intellectual disabilities and/or autism spectrum disorder: Movement matters

Motor competence is important for lifelong physical activity (PA). The current study aimed to examine associations between PA and motor competence. In total, 43 children aged 7-12 years with intellectual disabilities and/or autism spectrum disorder completed anthropometric measures, the Bruininks-Oseretsky Test of Motor Proficiency-2, and wore a wrist accelerometer to capture total PA, moderate-to-vigorous PA (MVPA), average acceleration, and intensity gradient. No significant associations were found between PA outcomes and motor competence. Motor competence performance was commonly 'below average' or 'average'. The weakest subtests were upper limb coordination and strength. The strongest subtest was running speed and agility. Total weekly MVPA was 336.1 ± 150.3 min, higher than UK recommendations of 120-180 per week for disabled children and young people. Larger scale studies are needed to better understand the relationship between PA and motor competence. Future research should also consider the influence of environmental factors on PA in this group.

Validation of two novel human activity recognition models for typically developing children and children with Cerebral Palsy

Human Activity Recognition models have potential to contribute to valuable and detailed knowledge of habitual physical activity for typically developing children and children with Cerebral Palsy. The main objective of the present study was to develop and validate two Human Activity Recognition models. One trained on data from typically developing children (n = 63), the second also including data from children with Cerebral Palsy (n = 16), engaging in standardised activities and free play. Our data was collected using accelerometers and ground truth was established with video annotations. Additionally, we aimed to investigate the influence of window settings on model performance. Utilizing the Extreme gradient boost (XGBoost) classifier, twelve sub-models were created, with 1-,3- and 5-seconds windows, with and without overlap. Both Human Activity Recognition models demonstrated excellent predictive capabilities (>92%) for standardised activities for both typically developing and Cerebral Palsy. From all window sizes, the 1-second window performed best for all test groups. Accuracy was slightly lower (>75%) for the Cerebral Palsy test group performing free play activities. The impact of window size and overlap varied depending on activity. In summary both Human Activity Recognition models effectively predict standardised activities, surpassing prior models for typically developing and children with Cerebral Palsy. Notably, the model trained on combined typically developing children and Cerebral Palsy data performed exemplary across all test groups. Researchers should select window settings aligned with their specific research objectives.

Comparing Cadence vs. Machine Learning Based Physical Activity Intensity Classifications: Variations in the Associations of Physical Activity With Mortality

Step cadence-based and machine-learning (ML) methods have been used to classify physical activity (PA) intensity in health-related research. This study examined the association of intensity-specific PA duration with all-cause (ACM) and CVD mortality using the cadence-based and ML methods in 68 561 UK Biobank participants wearing wrist-worn accelerometers. The two-stage-ML method categorized activity type and then intensity. The one-level-cadence-method (1LC) derived intensity-specific duration using all detected steps (including standing utilitarian steps) and cadence thresholds of ≥100 steps/min (moderate intensity) and ≥130 steps/min (vigorous intensity). The two-level-cadence-method (2LC) detected ambulatory steps (i.e., walking and running) and then applied the same cadence thresholds. The 2LC exhibited the most pronounced association at the lower end of duration spectrum. For example, the 2LC showed the smallest minimum moderate-to-vigorous-PA (MVPA) duration (amount associated with 50% of optimal risk reduction) with similar corresponding ACM hazard ratio (HR) to other methods (2LC: 2.8 min/day [95% CI: 2.6, 2.8], HR: 0.83 [95% CI: 0.78, 0.88]; 1LC, 11.1[10.8, 11.4], 0.80 [0.76, 0.85]; ML, 14.9 [14.6, 15.2], 0.82 [0.76, 0.87]). The ML elicited the greatest mortality risk reduction. For example, the medians and corresponding HR in VPA-ACM association: 2LC, 2.0 min/day [95% CI: 2.0, 2.0], HR, 0.69 [95% CI: 0.61, 0.79]; 1LC, 6.9 [6.9, 7.0], 0.68 [0.60, 0.77]; ML, 3.2 [3.2, 3.2], 0.53 [0.44, 0.64]. After standardizing durations, the ML exhibited the most pronounced associations. For example, the standardized minimum durations in MPA-CVD mortality association were: 2LC, -0.77; 1LC, -0.85; ML, -0.94; with corresponding HR of 0.82 [0.72, 0.92], 0.79 [0.69, 0.90], and 0.77 [0.69, 0.85], respectively. The 2LC exhibited the most pronounced association with all-cause and CVD mortality at the lower end of the duration spectrum. The ML method provided the most pronounced association with all-cause and CVD mortality, thus might be appropriate for estimating health benefits of moderate and vigorous intensity PA in observational studies.

Comparing cadence-based and machine learning based estimates for physical activity intensity classification: The UK Biobank

OBJECTIVES

Cadence thresholds have been widely used to categorize physical activity intensity in health-related research. We examined the convergent validity of two cadence-based intensity classification approaches against a machine-learning-based intensity schema in 84,315 participants (≥40 years) with wrist-worn accelerometers.

DESIGN

Validity study.

METHODS

Both cadence-based methods (one-level cadence, two-level cadence) calculated intensity-specific time based on cadence-thresholds while the two-level cadence identified stepping behaviors first. We used an overlapping plot, mean absolute error, and Spearman's correlation coefficient to examine agreements between the cadence-based and machine-learning methods. We also evaluated agreements between methods based on practically-important-difference (moderate-to-vigorous-physical activity: ±20 min/day, moderate-physical activity: ±15, vigorous-physical activity: ±2.5, light-physical activity: ±30).

RESULTS

The group-level (median) minutes of moderate-to-vigorous- and moderate-physical activity estimated by one-level cadence were within the range of practically-important-difference compared to the machine-learning method (bias of median: moderate-to-vigorous-physical activity, -3.5, interquartile range [-15.8, 12.2]; moderate-physical activity, -6.0 [-17.2, 4.1]). The group-level vigorous- and light-physical activity minutes derived by two-level cadence were within practically-important-difference range (vigorous-physical activity: -0.9 [-3.1, 0.5]; light-physical activity, -1.3 [-28.2, 28.9]). The individual-level differences between the cadence-based and machine learning methods were high across intensities (e.g., moderate-to-vigorous-physical activity: mean absolute error [one-level cadence: 24.2 min/day; two-level cadence: 26.2]), with the proportion of participants within the practically-important-difference ranging from 8.4 % to 61.6 %.

CONCLUSIONS

One-level cadence showed acceptable group-level estimates of moderate-to-vigorous and moderate-physical activity while two-level cadence showed acceptable group-level estimates of vigorous- and light-physical activity. The cadence-based methods might not be appropriate for individual-level intensity-specific time estimation.

Accelerometry-assessed daily physical activity and compliance with recommendations in Spanish children: importance of physical education classes and vigorous intensity

Background

Physical activity (PA) is associated with numerous health benefits. Vigorous PA (VPA) may have a greater impact on public health than lower-intensity PA. The incorporation of a specific recommendation on VPA could complement and improve existing recommendations for average daily moderate-vigorous PA (MVPA). Physical education classes could have a positive impact on children's adherence to average daily physical activity recommendations. The aim was to investigate the association between MVPA and VPA in children, as well as adherence to recommendations, and obesity and the presence of physical education classes.

Methods

A cross-sectional study of physical activity was conducted in a sample of 8 and 9-year-old children in Andalusia (Spain). GENEActiv accelerometers were used, placed on the non-dominant wrist for at least eight consecutive days (24-h protocol). School days with and without physical education class, and weekend days were defined. ROC curves were used to calculate the threshold associated with obesity for average daily MVPA and VPA for recommendations.

Results

A total of 360 schoolchildren were included in the analyses (184 girls). An average of 7.7 (SD 1.4) valid days per participant were evaluated, with 19.9 (SD 10.5) and 11.4 (SD 5.1) minutes of VPA performed by boys and girls respectively. 25.8% of the participants were classified with central obesity. The optimal threshold determined with ROC analysis was 12.5 and 9.5 minutes of average daily VPA for boys and girls, respectively (RecVPA), and 75 minutes of average daily MVPA for both sexes (RecMVPA). The RecVPA showed stronger association with obesity. On school days with physical education class, compared to days without this class, children showed increased VPA and MVPA engagement and better compliance with recommendations, with smaller differences in adherence according to sex or obesity.

Conclusions

On days with physical education class, more physical activity was accumulated at all intensities and greater adherence to the recommendations than on days without this class. VPA had a stronger correlation with the absence of obesity than lower-intensity activity. It was also observed that boys were physically more active and had higher adherence to the recommendations than girls.

Adherence to the WHO recommendation of three weekly days of vigorous intensity activities in children: an accelerometry study of vigorous physical activity bouts

Background

The World Health Organization (WHO) recommends that children and adolescents incorporate vigorous intensity activities (VIAs) at least three days a week. This recommendation has not been sufficiently studied using objective methods, such as accelerometry. Physical education classes and extracurricular sports activities are optimal opportunities for compliance with this recommendation.

Objective

To identify VIAs through bouts of vigorous physical activity (VPA-Bouts) evaluated with accelerometry and, with this, to know the compliance with the recommendation on VIAs.

Methods

A cross-sectional study of the habitual physical activity of 353 children (8-9 years old) was carried out using accelerometry and participation in organized extracurricular sports activities was asked through a questionnaire. School days with and without physical education class, weekends, and the average weekly day were identified, as well as school time and out-of-school time. A VPA-Bout was defined as an interval of at least 60 minutes with a proportion of VPA of at least 16.7% in boys and 12.5% in girls (10.0 and 7.5 minutes/hour of VPA, respectively).

Results

The average daily time in organized extracurricular sports activities declared by questionnaire and the average daily duration of the VPA-Bouts evaluated with accelerometers in the extracurricular period was 21.3 (SD 19.8) and 23.9 (SD 31.2) minutes, respectively, in boys, whereas, in girls it was 20.2 (SD 17.4) and 11.0 (SD 16.9) minutes, respectively. In school time including a physical education class, there was a higher proportion of VPA-Bouts than without these classes (with: 28.6%, without: 2.1%, p < 0.001). Children who reported at least three weekly hours of organized extracurricular sports activities accumulated a higher proportion of school afternoons with VPA-Bouts than those with fewer weekly hours of this type of activities (≥3 hours/week: 27.5%, <3 hours/week: 9.3%, p < 0.001). On the weekend, boys who reported at least three weekly hours of organized extracurricular sports activities performed more VPA-Bouts than those participating in less weekly hours, while in girls no significant differences were observed (weekend; boys, ≥3 hours/week: 26.0%, <3 hours/week: 9.0%, p < 0.001; girls: 8.3%, 8.0%, p = 0.917). Compliance with the recommendation to incorporate VIAs at least three days a week was 23.8%. Children who reported at least three weekly hours of extracurricular sports activities achieved higher compliance than those who reported fewer extracurricular activities (≥3 hours/week: 35.1%, <3 hours/week: 12.7%, p < 0.001). Additionally, boys showed higher compliance rates than girls (boys: 32.9%, girls: 15.3%, p < 0.001).

Conclusion

One in every four children met the WHO recommendation to incorporate VIAs at least three days a week, as evaluated by accelerometry. Physical education classes and extracurricular organized sports activities contributed to compliance with this recommendation.

Defining and reporting activity patterns: a modified Delphi study

BACKGROUND

Despite significant interest in assessing activity patterns in different populations, there has been no consensus concerning the definition and operationalisation of this term. This has limited the comparability, interpretability, and synthesis of study findings to date. The aim of this study was to establish a consensus regarding the way in which activity patterns and activity pattern components are defined and reported.

METHODS

The activity patterns literature was searched to identify experts to be invited to participate and to develop a proposed definition of activity patterns and activity pattern components. A three-round modified Delphi survey was conducted online (November 2021 to May 2022). In Round 1, participants were asked to rate their agreement with a proposed activity patterns definition, which also included six activity pattern components (e.g., activity intensity, activity bout, transitions), six examples of activity patterns (e.g., frequency of postural transitions in discrete time periods) and eight items for reporting activity patterns in future research (n = 21 items). Open-ended questions enabled participants to provide further comments and suggestions for additional items. Consensus was defined a priori as ≥ 80% participants rating their agreement with an item. In Round 2, participants were asked to rate their agreement with 25 items (13 original items, eight amended, and four new). In Round 3, participants rated their agreement with 10 items (five original items, four amended, and one new).

RESULTS

Twenty experts in activity patterns research participated in Round 1, with response rates of 80% and 60% in Rounds 2 and 3, respectively. The proposed activity pattern definition, all activity pattern components definitions, four of the six activity pattern examples, and 10 items in the activity patterns reporting framework achieved consensus. The removal of one activity component item between Rounds 1 and 2 achieved consensus.

CONCLUSION

This modified Delphi study achieved consensus for defining and reporting activity patterns for the first time. This consensus definition enables standardisation of activity patterns terminology, which is important given the significant interest in quantifying how individuals accumulate their physical activity and sedentary behaviour across the lifespan to inform the development of future public health guidelines and interventions efforts.

Association between physical health and physical activity behaviors for children aged 3-6 years in kindergarten: A cross-sectional study from China

PURPOSE

To explore the association between the physical health (PH) and physical activity behavior (PAB) of children aged 3 to 6 years, and to provide a basis for the scientific planning of children's physical activity behavior in kindergarten.

METHODS

A total of 18041 children in China aged 3 to 6 years were selected as the research subject. The PH monitoring indicators were measured according to "The National Physical Fitness Measurement Standards Manual" (Preschool Children Version) (NPFMSM), and PAB was reported by teachers. The chi-square test was used to test for differences in PH and PAB across groups, the percentile method was used to rank PAB, correlation analysis was used to analyze the association between components of PH and PAB, and multiple linear regression was used to determine the independent association between PAB and PH.

RESULTS

Participants in this study exhibited poor PH status, and the detection rates of failure were 16.4% for boys and 16.8% for girls, and showed a decreasing trend with increasing age. The grade difference and sex difference in PH components were statistically significant (P<0.01). PAB changes to static activities with increasing age, mainly to static indoor physical activities (SIPAs). The regression effects of the total duration of physical activity (TDPA) and dynamic physical activity (DPA) on PH score and physical fitness (PF) score were significant (P < 0.01) but not statistically significant with static physical activity (SPA) (P>0.05). Dynamic outdoor physical activity (DOPA) is the core factor affecting children's PH, and is significantly positively correlated with the components of PH.

CONCLUSION

PAB in kindergarten can improve children's PH, and reasonable planning of PAB in kindergarten has a targeted effect on PH promotion.

Sedentary patterns and cardiometabolic risk factors in Mexican children and adolescents: analysis of longitudinal data

BACKGROUND

Sedentary behavior is a modifiable risk factor for cardiometabolic health; however, the assessment of total sedentary time may not capture youth's highly active and interrupted activity patterns. This study examined the associations between sedentary activity patterns and cardiometabolic risk factors among Mexican youth, who have a disproportionate burden of metabolic diseases, using a repeated measure design out of a longitudinal data.

METHODS

570 subjects in the Early Life Exposure in Mexico to ENvironmental Toxicants (ELEMENT) birth cohort, who were followed up to three-time points during adolescence, were included. Bout duration, and frequency and percentages of waking time spent in specific intensities of activity, were quantified using ActiGraph wGT3X-BT wrist accelerometers. Self-reported questionnaires were used to query the usual duration of different sedentary behaviors. Outcomes were fasting lipid profile, markers for glucose homeostasis, anthropometry, and blood pressure. Associations were modeled using linear mixed-effects models, and isotemporal substitution approach was additionally used to assess the effect of replacing objectively assessed sedentary activity with other activity intensities, adjusting for potential confounders.

RESULTS

Each hour of self-reported screen-based time was positively associated with diastolic blood pressure (mm Hg) [β = 0.30, 95% confidence interval (95% CI) = 0.10, 0.51], and an hour of other sedentary time was associated with log serum glucose (mg/dL) [β = 0.01, 95% CI = 0.004, 0.017]. Substitution models showed that replacing 5% of sedentary time with moderate to vigorous physical activity (MVPA) was associated with lower waist circumference (cm) [β = - 1.35, 95% CI = - 1.91, - 0.79] and log serum triglycerides (mg/dL) [β = - 0.11, 95% CI = - 0.18, - 0.03]. Substituting one uninterrupted sedentary bout with light activity was associated with lower insulin (μIU/mL) [β = - 0.06, 95% CI = - 0.10, - 0.02].

CONCLUSIONS

Sedentary time was associated with cardiometabolic risk factors in Mexican youth in a context-specific manner. Replacing sedentary time with higher intensities was associated with improvements in some cardiometabolic markers.

Comparison of free-living physical activity measurements between ActiGraph GT3X-BT and Fitbit Charge 3 in young people with haemophilia

INTRODUCTION

Measurement of physical activity (PA) using commercial activity trackers such as Fitbit devices has become increasingly popular, also for people with haemophilia (PWH). The accuracy of the Fitbit model Charge 3 has not yet been examined.

AIMS

To compare the Fitbit Charge 3 against the research-grade accelerometer ActiGraph GT3X-BT in measuring average daily steps and minutes spent in different PA intensities.

METHODS

Twenty-four young PWH wore a wrist-worn Fitbit Charge 3 and hip-worn ActiGraph GT3X-BT simultaneously for seven consecutive days in free-living conditions. Correlation of and differences between the devices for daily averages of PA parameters were assessed using Pearson's correlation coefficient and paired t-test, respectively. Agreement between devices was assessed using Bland-Altman plots.

RESULTS

Twenty participants (mean age 21.8) were included in the analyses. We found moderate to high correlations between Fitbit and ActiGraph measured daily averages for all PA variables, but statistically significant differences between devices for all variables except daily minutes of moderate PA. Fitbit overestimated average daily steps, minutes of light, vigorous and moderate-to-vigorous PA. Bland-Altman plots showed a measurement bias between devices for all parameters with increasing overestimation by the Fitbit for higher volumes of PA.

CONCLUSION

The Fitbit Charge 3 overestimated steps and minutes of light, moderate and moderate-to-vigorous PA as compared to the ActiGraph GT3X-BT, and this bias increased with PA volume. The Fitbit should therefore be used with caution in research, and we advise users of the device to be cognizant of this overestimation.

The Physical Behaviour Intensity Spectrum and Body Mass Index in School-Aged Youth: A Compositional Analysis of Pooled Individual Participant Data

We examined the compositional associations between the intensity spectrum derived from incremental acceleration intensity bands and the body mass index (BMI) z-score in youth, and investigated the estimated differences in BMI z-score following time reallocations between intensity bands. School-aged youth from 63 schools wore wrist accelerometers, and data of 1453 participants (57.5% girls) were analysed. Nine acceleration intensity bands (range: 0−50 mg to ≥700 mg) were used to generate time-use compositions. Multivariate regression assessed the associations between intensity band compositions and BMI z-scores. Compositional isotemporal substitution estimated the differences in BMI z-score following time reallocations between intensity bands. The ≥700 mg intensity bandwas strongly and inversely associated with BMI z-score (p < 0.001). The estimated differences in BMI z-score when 5 min were reallocated to and from the ≥700 mg band and reallocated equally among the remaining bands were −0.28 and 0.44, respectively (boys), and −0.39 and 1.06, respectively (girls). The time in the ≥700 mg intensity band was significantly associated with BMI z-score, irrespective of sex. When even modest durations of time in this band were reallocated, the asymmetrical estimated differences in BMI z-score were clinically meaningful. The findings highlight the utility of the full physical activity intensity spectrum over a priori-determined absolute intensity cut-point approaches.

Accelerometer epoch length influence associations for physical activity intensities with body mass index and locomotor skills in young children

The epoch length is decisive for the capture of physical activity intensities from accelerometry and possibly for associations between physical activity intensities and outcomes in children. The aim of the present study was to determine the multivariate physical activity intensity signatures related to body mass index and locomotor skills in preschool children using different epoch lengths. A sample of 1054 Norwegian children (mean age 4.8 years, 52% boys) from the Sogn og Fjordane Preschool Physical Activity Study provided data on physical activity (ActiGraph GT3X+), body mass index and locomotor skills in 2015-2016. Multivariate pattern analysis was used to determine associations between the physical activity intensity spectrum (0-99 to ≥15000 counts per minute) and the outcomes using files aggregated using 8 different epoch lengths from 1 to 60 seconds. We observed that associations across the intensity spectrum, from sedentary time to vigorous intensities, differed for data derived using different epoch lengths. For both outcomes, associations for moderate intensities became stronger and vigorous intensities became weaker for longer as compared to shorter epoch lengths. Aggregation of accelerometer data using different epoch lengths influences the capture of physical activity intensities and associations between physical activity intensities and related outcomes.

Trajectories of physical activity and sedentary time in Norwegian children aged 3-9 years: a 5-year longitudinal study

BACKGROUND

Limited evidence exists regarding the longitudinal development of physical activity during early to mid childhood. The aim of this study was to determine physical activity and sedentary time trajectories in children aged 3‒9 years from Western Norway.

METHODS

A sample of 294 children (51% boys; aged 3‒5 years at baseline) from the Sogn og Fjordane Preschool Physical Activity Study was followed annually over 5 years (2015‒2019). Physical activity was measured every autumn during this period using hip-based accelerometry (ActiGraph GT3X+). Data was processed as counts. We used linear mixed models to analyse the data. Primary analyses included trajectories for total and intensity-specific physical activity (light, moderate, vigorous, and moderate to vigorous intensity) and sedentary time for boys and girls using 1-s epoch. Secondary analyses included trajectories for weekdays versus weekend days, preschool/school hours versus after school hours, and 1- versus 60-s epoch lengths.

RESULTS

Over the total day, significant associations with age were found for boys and girls for all physical activity intensities and sedentary time (p < .001). Total physical activity peaked at age 5, whereas intensity-specific physical activity levels peaked at age 3 to 8 years (light intensity: 3-4 years; moderate intensity: 4-7 years; vigorous intensity: 7-8 years; moderate to vigorous intensity: 5-8 years). Boys had higher physical activity levels and more favourable trajectories than girls. Sedentary time increased from ages 3 to 9. Changes over time were larger for weekdays than for weekend days and larger for preschool/school hours than for after school hours. The use of a 60-s epoch resulted in larger changes over time than a 1-s epoch.

CONCLUSIONS

Our findings suggest physical activity levels peaked between the ages of 3 and 8 years. Finding ways to prevent decline in physical activity during the transition from preschool to primary school is important, especially for girls. Standardising epoch length will help when comparing physical activity and sedentary behaviour across studies.

Using compositional data analysis to explore accumulation of sedentary behavior, physical activity and youth health

PURPOSE

The study aimed to describe youth time-use compositions, focusing on time spent in shorter and longer bouts of sedentary behavior and physical activity (PA), and to examine associations of these time-use compositions with cardiometabolic biomarkers.

METHODS

Accelerometer and cardiometabolic biomarker data from 2 Australian studies involving youths 7-13 years old were pooled (complete cases with accelerometry and adiposity marker data, n = 782). A 9-component time-use composition was formed using compositional data analysis: time in shorter and longer bouts of sedentary behavior; time in shorter and longer bouts of light-, moderate-, or vigorous-intensity PA; and "other time" (i.e., non-wear/sleep). Shorter and longer bouts of sedentary time were defined as <5 min and ≥5 min, respectively. Shorter bouts of light-, moderate-, and vigorous-intensity PA were defined as <1 min; longer bouts were defined as ≥1 min. Regression models examined associations between overall time-use composition and cardiometabolic biomarkers. Then, associations were derived between ratios of longer activity patterns relative to shorter activity patterns, and of each intensity level relative to the other intensity levels and "other time", and cardiometabolic biomarkers.

RESULTS

Confounder-adjusted models showed that the overall time-use composition was associated with adiposity, blood pressure, lipids, and the summary score. Specifically, more time in longer bouts of light-intensity PA relative to shorter bouts of light-intensity PA was significantly associated with greater body mass index z-score (zBMI) (β = 1.79; SE = 0.68) and waist circumference (β = 18.35, SE = 4.78). When each activity intensity was considered relative to all higher intensities and "other time", more time in light- and vigorous-intensity PA, and less time in sedentary behavior and moderate-intensity PA, were associated with lower waist circumference.

CONCLUSION

Accumulating PA, particularly light-intensity PA, in frequent short bursts may be more beneficial for limiting adiposity compared to accumulating the same amount of PA at these intensities in longer bouts.

Physical activity intensity profiles associated with cardiometabolic risk in middle-aged to older men and women

Accelerometers provide detailed data about physical activity (PA) across the full intensity spectrum. However, when examining associations with health, results are often aggregated to only a few summary measures [e.g. time spent "sedentary" or "moderate-to-vigorous" intensity PA]. Using multivariate pattern analysis, which can handle collinear exposure variables, we examined associations between the full PA intensity spectrum and cardiometabolic risk (CMR) in a population-based sample of middle-aged to older adults. Participants (n = 3660; mean ± SD age = 69 ± 8y and BMI = 26.7 ± 4.2 kg/m²; 55% female) from the EPIC-Norfolk study (UK) with valid accelerometry (ActiGraph-GT1M) data were included. We used multivariate pattern analysis with partial least squares regression to examine cross-sectional multivariate associations (r) across the full PA intensity spectrum [minutes/day at 0-5000 counts-per-minute (cpm); 5 s epoch] with a continuous CMR score (reflecting waist, blood pressure, lipid, and glucose metabolism). Models were sex-stratified and adjusted for potential confounders. There was a positive (detrimental) association between PA and CMR at 0-12 cpm (maximally-adjusted r = 0.08 (95%CI 0.06-0.10). PA was negatively (favourably) associated with CMR at all intensities above 13 cpm ranging between r = -0.09 (0.07-0.12) at 800-999 cpm and r = -0.14 (0.11-0.16) at 75-99 and 4000-4999 cpm. The strongest favourable associations were from 50 to 800 cpm (r = 0.10-0.12) in men, but from ≥2500 cpm (r = 0.18-0.20) in women; with higher proportions of model explained variance for women (R² = 7.4% vs. 2.3%). Most of the PA intensity spectrum was beneficially associated with CMR in middle-aged to older adults, even at intensities lower than what has traditionally been considered "sedentary" or "light-intensity" activity. This supports encouragement of PA at almost any intensity in this age-group.

Influence of Epoch Length and Recording Site on the Relationship Between Tri-Axial Accelerometry-Derived Physical Activity Levels and Structural, Functional, and Hemodynamic Properties of Central and Peripheral Arteries

Background

It remains to be established to what extent physical activity (PA) levels among individuals are independently associated with deviations from the “optimal” state of the arterial system. Accelerometers have been proposed as means to obtain reliable, objective, and more comprehensive data of PA. Decisions at the time of data collection/processing could influence the association between accelerometry-derived indices and arterial properties.

Objectives

(i) To identify to what extent the strength of association between arterial properties and accelerometer-derived indices depend on the recording site and/or the epoch length; (ii) to determine whether some arterial characteristics (hemodynamic vs. structural vs. functional) or regions (elastic vs. transitional vs. muscular arteries; central vs. peripheral) have higher levels of association with accelerometry-derived indices.

Methods

Physical activity (PA), cardiovascular risk factors (CRFs), and cardiovascular properties were evaluated in 60 volunteers (general population; age: 23–62 years; women: 43%). PA was measured daily for 7 days (free-living situation; triaxial-accelerometers ActiGraph-GT3X+; hip and wrist; “Worn-to-wrist” option) and raw data was converted at epoch lengths of 1, 5, 10, 30, and 60-s. PA-related energy expenditure, daily time in moderate-to-vigorous PA, steps/minute, and counts-per-minute for vector magnitude were calculated. The cardiovascular evaluation included hemodynamic (central and peripheral pressure), structural (diameters and intima-media thickness), and functional (local and regional stiffness) parameters of carotids, femoral, and brachial arteries, and carotid-femoral and carotid-radial pathways. Arterial z-scores were obtained using age-related equations derived from healthy participants not exposed to CRFs (n = 1,688; age: 2–84 years; female: 51.2%) to evaluate at which degree each parameter deviates from the “optimal” value.

Methods

In general, hip recordings outperformed those obtained on the wrist regarding the strength of association with arterial parameters. Accelerometer-derived indices and their association with arterial properties vary depending on the recording site and epoch length. PA indices are stronger associated with functional (local) than structural variables and with central than peripheral arteries.

Conclusions

Regardless of the PA index, there were independent associations with central artery characteristics, which reinforces that these territories would be the most related to PA levels. Differences in data acquisition and processing could lead to differences in conclusions when addressing the association between accelerometer-derived indices and the cardiovascular system.

The consequences of using different epoch lengths on the classification of accelerometer based sedentary behaviour and physical activity

We examined the influence of using different epoch lengths on the classification accuracy of laboratory-controlled sedentary behaviour (SB), and free-living total time and time spent in bouts of SB and moderate-to-vigorous physical activity (MVPA), in children and adolescents. We used two studies including accelerometer-derived data of: 1) controlled activities, i.e. seven sedentary, one standing and one dancing (n = 90); 2) free-living activities (n = 902). For the controlled-activity data, we calculated percentages of time classified as SB and MVPA. For the free-living data, we calculated medians (25th-75th percentiles) of total time and time spent in bouts of SB and MVPA. Applying 8counts/5seconds, 25counts/15seconds and 100counts/60seconds for SB on controlled-activity data revealed respectively (1) 92-96%, 89-99% and 98-100% of sedentary time accurately classified as SB (activity- and age-dependent); (2) 91-98%, 88-99% and 97-100% of standing time classified as SB (age-dependent); (3) 25-37%, 20-25% and 25-38% of dancing time classified as SB (age-dependent). Using longer epochs, children's total time in SB and MVPA decreased while time accumulated in bouts of SB and MVPA accumulated in bouts increased. We conclude that a 60-second epoch seems preferable when the aim is to classify sedentary behaviour, while a shorter epoch length is needed to capture children's short bursts of MPVA. Furthermore, we should be aware that a longer epoch results in averaging of intensities to the middle category.

High-intensity activity is more strongly associated with metabolic health in children compared to sedentary time: a cross-sectional study of the I.Family cohort

Background

Physical activity (PA) during childhood is important for preventing future metabolic syndrome (MetS). To examine the relationship between PA and MetS in more detail, accurate measures of PA are needed. Previous studies have only utilized a small part of the information available from accelerometer measured PA. This study investigated the association between measured PA and MetS in children with a new method for data processing and analyses that enable more detailed interpretation of PA intensity level.

Methods

The association between PA pattern and risk factors related to MetS was investigated in a cross- sectional sample of children (n = 2592, mean age 10.9 years, 49.4% male) participating in the European multicenter I. Family study. The risk factors examined include body mass index, blood pressure, high-density lipoprotein cholesterol, insulin resistance and a combined risk factor score (MetS score). PA was measured by triaxial accelerometers and raw data was processed using the 10 Hz frequency extended method (FEM). The PA output was divided into an intensity spectrum and the association with MetS risk factors was analyzed by partial least squares regression.

Results

PA patterns differed between the European countries investigated, with Swedish children being most active and Italian children least active. Moderate intensity physical activity was associated with lower insulin resistance (R² = 2.8%), while vigorous intensity physical activity was associated with lower body mass index (R² = 3.6%), MetS score (R² = 3.1%) and higher high-density lipoprotein cholesterol (R² = 2.3%). PA of all intensities was associated with lower systolic- and diastolic blood pressure, although the associations were weaker than for the other risk factors (R² = 1.5% and R² = 1.4%). However, the multivariate analysis implies that the entire PA pattern must be considered. The main difference in PA was observed between normal weight and overweight children.

Conclusions

The present study suggests a greater importance of more PA corresponding to an intensity of at least brisk walking with inclusion of high-intense exercise, rather than a limited time spent sedentary, in the association to metabolic health in children. The methods of data processing and statistical analysis enabled accurate analysis and interpretation of the health benefits of high intensity PA that have not been shown previously.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01156-1.

Relationship of Physical Activity and Sedentary Time with Metabolic Health in Children and Adolescents Measured by Accelerometer: A Narrative Review

The purpose of this study was to summarize the associations of physical activity (PA) and sedentary time (SED) with metabolic health and examine the effects of time reallocation on metabolic health in adolescents using accelerometer data. A literature search was conducted using PubMed, ScienceDirect, Web of Science, Cochran Library, and Google Scholar, and 27 articles were reviewed. Recent research generally confirms the associations of PA and SED with metabolic health. High PA levels and low SED levels had a positive relationship with metabolic health. Moreover, reallocating 10 min of daily SED to PA was associated with better metabolic health indicators. These results were stronger for moderate-to-vigorous physical activity than for light intensity PA. Thus, efforts to convert SED into PA of at least moderate intensity appear to be an effective strategy to prevent metabolic disease development in children and adolescents. However, some of the associations between PA and metabolic health indicators were inconsistent, depending on age, obesity degree, and PA intensity. Additionally, various accelerometer data collection and processing criteria impact the interpretation of the results. Therefore, consistent accelerometer data collection and analysis methods are needed in future studies. Further, intervention studies are required to verify the causality and effectiveness of the isotemporal substitution model.

Physical activity accumulation along the intensity spectrum differs between children and adults

PURPOSE

Detailed exploration of physical activity accumulation with fine grading along the intensity spectrum has indicated the potential pragmatic utility of such an approach. However, it is currently unclear what sorts of accumulation patterns along particular intensity bands are found in the children and adult populations. Therefore, we conducted a comparison of activity accumulation in specific intensity bands between four distinct populations: children, adults with sedentary lifestyles, habitual joggers, habitual marathon runners.

METHODS

Free-living waist-worn accelerometry records from 28 children aged 7 to 11, and 61 adults aged 25 to 35 were analysed. Activity intensity was evaluated in 5 s non-overlapping epochs as mean amplitude deviation (MAD) and normalised to acceleration intensities corresponding to walking at 3 metabolic equivalents of a task (METs). Adult data were normalised to 0.091 g MAD based on literature, and data from children to 0.170 g MAD based on laboratory experimentation. The normalised epoch values were divided into 100 intensity gradations.

RESULTS

Children accumulated more activity in 0.74 to 1.58 normalised acceleration intensities (all p < 0.005) compared to adults. Adult joggers/runners accumulated more activity in normalised acceleration intensities from 7.1 to 11.1 compared to the other groups (p < 0.008).

CONCLUSION

The primary bulk of children's free-living activities are of relatively low intensity not likely to provoke cardiometabolic improvement. These sorts of explorations could be used in informing intervention development aiming at optimising healthy development. Evidence is mounting to justify randomised controlled trials based on intervention targets identified based on exploring the intensity spectrum.

Children and Adolescents Treated for Valvular Aortic Stenosis Have Different Physical Activity Patterns Compared to Healthy Controls: A Methodological Study in a National Cohort

Previous research in children and adolescents with congenital heart defects presents contradictory findings concerning their physical activity (PA) level, due to methodological limitations in the PA assessment. The aim of the present cross-sectional study was to compare PA in children and adolescents treated for valvular aortic stenosis with healthy controls using an improved accelerometer method. Seven-day accelerometer data were collected from the hip in a national Swedish sample of 46 patients 6-18 years old treated for valvular aortic stenosis and 44 healthy controls matched for age, gender, geography, and measurement period. Sports participation was self-reported. Accelerometer data were processed with the new improved Frequency Extended Method and with the traditional ActiGraph method for comparison. A high-resolution PA intensity spectrum was investigated as well as traditional crude PA intensity categories. Children treated for aortic stenosis had a pattern of less PA in the highest intensity spectra and had more sedentary time, while the adolescent patients tended to be less physically active in higher intensities overall and with less sedentary time, compared to the controls. These patterns were evident using the Frequency Extended Method with the detailed PA intensity spectrum, but not to the same degree using the ActiGraph method and traditional crude PA intensity categories. Patients reported less sports participation than their controls in both age-groups. Specific differences in PA patterns were revealed using the Frequency Extended Method with the high-resolution PA intensity spectrum in Swedish children and adolescents treated for valvular aortic stenosis.

Physical activity in children and adolescents with CHD: review from a measurement methodological perspective

AIM

To compile a literature overview of physical activity in children with CHD and to critically evaluate the methodology used for physical activity assessment.

METHODS

A review of the literature was performed using PubMed to identify studies examining accelerometer and subjectively assessed physical activity in children and adolescents with CHD.

RESULT

A total of 15 studies were included (6 studies using subjective measures and 9 articles using accelerometers for the assessment of physical activity). The patients generally failed to meet the recommendations of physical activity. When compared to healthy controls, the results were widely divergent in the subjectively assessed measures and the accelerometer-based studies showed a tendency of no difference in physical activity. Neither subjective methods nor accelerometer-based studies reported any difference in physical activity in general, in relation to the severity of the heart disease.

CONCLUSION

Methodological variation and limitations in the assessment of physical activity largely explain the divergent results and the inability to establish differences in physical activity between children with CHD of different severity and compared to healthy controls. Methodological knowledge and guidelines are provided for improved assessment of physical activity using accelerometers in clinical research.

The multivariate physical activity signature associated with body mass index in young children

The evidence regarding associations between intensity-specific physical activity and adiposity in young children is conflicting. Moreover, the evidence is limited by analytical approaches that cannot handle the multicollinearity among multiple variables across the entire intensity spectrum. We aimed to determine the multivariate physical activity intensity signature associated with body mass index in a large sample of preschool children aged 3-6 years. 1182 Norwegian preschool children (mean age 4.7 years, 51% boys) provided data on physical activity (ActiGraph GT3X+) and body mass index during 2015-2016. Multivariate pattern analysis was used to determine associations between the entire triaxial intensity spectra (time spent in intensities from 0-99 to ≥ 15000 counts per minute) and body mass index in the total sample and in subgroups split by sex and age (median split). The association patterns were comparable across the three axes. For the vertical axis, associations were negative for time spent sedentary (0-99 counts per minute), positive for time spent in lower intensities (100-2999 counts per minute), and negative for time spent in vigorous intensities (4000-12,999 counts per minute). Associations were stronger in older than in younger children and no associations were observed for vigorous intensities among younger children. Association patterns were comparable for boys and girls. In conclusion, we found clear associations with body mass index across the physical activity intensity spectrum in preschool children. However, the age-specific association patterns suggest negative (unfavorable) associations with vigorous physical activity intensities develop around 5-6 years of age.

Volume and accumulation patterns of physical activity and sedentary time: longitudinal changes and tracking from early to late childhood

BACKGROUND

Physical activity (PA) decreases and sedentary time (SED) increases across childhood, with both behaviours tracking. However, no studies have examined how accumulation patterns of PA and SED (i.e., prolonged bouts, frequency of breaks in sedentary time) change and track over time. The aim of this study was to investigate longitudinal changes in and tracking of total volume and accumulation patterns of SED, light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA) among boys and girls.

METHODS

In 2008/09 (T1), children in HAPPY (3-5y; n = 758) in Melbourne, Australia wore ActiGraph GT1M accelerometers to objectively assess SED, LPA, MPA and VPA. This was repeated at age 6-8y (T2; n = 473) and 9-11y (T3; n = 478). Ten pattern variables were computed: bouts of ≥ 5-, ≥ 10-, ≥ 15- and ≥ 20-min for SED, ≥ 1- and ≥ 5-min for LPA, ≥ 1-min for MPA, ≥ 1- and ≥ 5-min for VPA, and breaks in SED (interruptions of > 25 counts 15 s^- 1). Longitudinal mixed models examined changes from T1-3, controlling for T1 age. Generalized estimating equations assessed tracking over the three time points, controlling for T1 age and time between measurements. Analyses were stratified by sex.

RESULTS

Total volume and bouts of SED and SED breaks increased, while total volume and bouts of LPA decreased for both sexes. There was a small decrease in total volume of MPA for girls, but time spent in ≥ 1-min bouts increased for both sexes. Total volume of VPA increased for both sexes, with time spent in ≥ 1-min bouts increasing for boys only. All volume and pattern variables tracked moderately for boys, except for all SED bouts ≥ 15-min, LPA bouts ≥ 5-min and MPA bouts ≥ 1-min (which tracked weakly). For girls, total SED and SED bouts ≥ 1-min tracked strongly, total volume of LPA, MPA and VPA, ≥ 5- and ≥ 10-min SED bouts, and ≥ 1-min LPA and MPA bouts tracked moderately, and SED breaks, all SED bouts ≥ 15 min, LPA bouts ≥ 5 min and all VPA bouts tracked weakly.

CONCLUSIONS

Patterns of SED and PA change from early to late childhood; with the exception of SED breaks and VPA, changes were detrimental. Total volumes and short bouts tended to track more strongly than longer bouts. Interventions to prevent declines in PA and increases in SED are important from early in life.

The multivariate physical activity signature associated with metabolic health in children and youth: An International Children's Accelerometry Database (ICAD) analysis

There is solid evidence for an association between physical activity and metabolic health outcomes in children and youth, but for methodological reasons most studies describe the intensity spectrum using only a few summary measures. We aimed to determine the multivariate physical activity intensity signature associated with metabolic health in a large and diverse sample of children and youth, by investigating the association pattern for the entire physical intensity spectrum. We used pooled data from 11 studies and 11,853 participants aged 5.8-18.4 years included in the International Children's Accelerometry Database. We derived 14 accelerometry-derived (ActiGraph) physical activity variables covering the intensity spectrum (from 0-99 to ≥8000 counts per minute). To handle the multicollinearity among these variables, we used multivariate pattern analysis to establish the associations with indices of metabolic health (abdominal fatness, insulin sensitivity, lipid metabolism, blood pressure). A composite metabolic health score was used as the main outcome variable. Associations with the composite metabolic health score were weak for sedentary time and light physical activity, but gradually strengthened with increasing time spent in moderate and vigorous intensities (up to 4000-5000 counts per minute). Association patterns were fairly consistent across sex and age groups, but varied across different metabolic health outcomes. This novel analytic approach suggests that vigorous intensity, rather than less intense activities or sedentary behavior, are related to metabolic health in children and youth.

Changes in Physical Activity and Sedentary Patterns on Cardiometabolic Outcomes in the Transition to Adolescence: International Children's Accelerometry Database 2.0

OBJECTIVE

To examine the associations of changes in physical activity and sedentary patterns with changes in cardiometabolic outcomes from childhood to adolescence.

STUDY DESIGN

Youth from the International Children's Accelerometry Database (n = 1088; 55% girls), aged 8-13 years and followed for ∼4 years, were used in this analysis. Hip-mounted accelerometers were used and all physical activity intensities were expressed as the % of total wear-time. Sedentary time was separated into time spent in bouts <10 minutes and ≥10 minutes. A composite z score for cardiometabolic risk (CMR score) was computed by summing the standardized values for systolic and diastolic blood pressure, triglycerides (TG), low-density lipoprotein cholesterol (LDL-c), and the inverse high-density lipoprotein cholesterol. Multivariate analyses were performed using adjusted linear regression models.

RESULTS

Increase in sedentary time was unfavorably associated with changes in CMR score (β = 0.021; CI 0.004-0.037), TG (β = 0.003; CI 0.001-0.005), and diastolic blood pressure (β = 0.068; CI 0.009-0.128). Decrease in moderate-to-vigorous physical activity was unfavorably associated with changes in LDL-c (β = -0.009; CI -0.017 to -0.001) and TG (β = -0.007; CI -0.013 to -0.001). Increase in ≥10 minutes sedentary time was unfavorably associated with changes in CMR score (β = 0.017; CI 0.004-0.030), LDL-c (β = 0.003; CI 0.000-0.005), and TG (β = 0.003; CI 0.000-0.004). Decrease in light-intensity physical activity was unfavorably associated with changes in CMR score (β = -0.020; CI = -0.040 to 0.000).

CONCLUSIONS

More physical activity and less prolonged sedentary time are beneficial for cardiometabolic health in youth transitioning to adolescence.

Reallocating sedentary time with total physical activity and physical activity bouts in children: Associations with cardiometabolic biomarkers

This cross-sectional study examined theoretical effects of reallocating sedentary time (SED) with total physical activity, and physical activity bouts of varying intensities, on children's cardiometabolic biomarkers. Baseline data from the Transform-Us! trial (Melbourne, Australia) was used. Participant data were included if accelerometer and blood biomarker data were complete (n = 169; 8.7 [0.4] years; 56% girls). Isotemporal substitution models assessed the impact of replacing 10 minutes of SED with 10 minutes of total physical activity or physical activity in bouts of varying intensities on cardiometabolic biomarkers. In adjusted models, replacing 10 minutes of SED with vigorous-intensity physical activity (VPA) was associated with lower triglycerides in the whole sample. Replacing SED with VPA was associated with better high-density lipoprotein cholesterol (HDL-C) and triglycerides in children with healthy weight. Replacing SED with MPA was associated with better homoeostatic model assessment of insulin resistance (HOMA-IR) and HDL-C, in children with healthy weight and overweight, respectively. Substituting SED with VPA specifically accumulated in ≥1-min bouts was detrimentally associated with HOMA-IR in children with healthy weight but beneficially with the cardiometabolic summary score in the overweight sample. This suggests that replacing SED with MPA or VPA may have some benefits on cardiometabolic health.

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

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

Active Learning Norwegian Preschool(er)s (ACTNOW) - Design of a Cluster Randomized Controlled Trial of Staff Professional Development to Promote Physical Activity, Motor Skills, and Cognition in Preschoolers

INTRODUCTION

There is a dearth of high-quality evidence on effective, sustainable, and scalable interventions to increase physical activity (PA) and concomitant outcomes in preschoolers. Specifically, there is a need to better understand how the preschool context can be used to increase various types of physically active play to promote holistic child development. The implementation of such interventions requires highly competent preschool staffs, however, the competence in promoting PA is often low. The main aim of the ACTNOW study is therefore to investigate the effects of professional development for preschool staffs on child PA and developmental outcomes.

METHODS

The study will be conducted in Norway 2019-2022 and is designed as a two-arm (intervention, control) cluster randomized controlled trial (RCT) with 7- and 18-months follow-ups. We aim to recruit 60 preschools and 1,200 3- to 5-years-old children to provide sufficient power to detect effect sizes (ESs) between 0.20 and 0.30. The intervention is nested within two levels: the preschool and the child. Central to the ACTNOW intervention are opportunities for children to engage in a variety of "enriched," meaningful, and enjoyable physically active play that supports the development of the whole child. To this end, the main intervention is a 7-month professional development/education module for preschool staff, aimed to provide them with the necessary capacity to deliver four core PA components to the children (moderate-to-vigorous PA, motor-challenging PA, cognitively engaging play, and physically active learning). We will include a range of child-level outcomes, including PA, physical fitness, adiposity, motor skills, socioemotional health, self-regulation, executive function, and learning. At the preschool level, we will describe implementation and adaptation processes using quantitative and qualitative data.

DISCUSSION

Professional development of staff and a whole-child approach that integrates PA with cognitively engaging play and learning activities in the preschool setting may provide a feasible vehicle to enhance both physical and cognitive development in young children. ACTNOW is designed to test this hypothesis to provide a sustainable way to build human capital and provide an early solution to lifelong public health and developmental challenges.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov identifier NCT04048967.

Cross-Sectional Associations of Total Daily Volume and Activity Patterns across the Activity Spectrum with Cardiometabolic Risk Factors in Children and Adolescents

Sedentary and physical activity patterns (bouts/breaks) may be important for cardiometabolic health in early life. This study aimed to examine cross-sectional associations of total daily volume and patterns across the activity spectrum with cardiometabolic risk factors in youth aged 7-13 years. Objectively measured accelerometer and cardiometabolic risk factor data were pooled from two studies (n = 1219; 69% valid accelerometry). Total daily volume of sedentary time and light-, moderate-, and vigorous-intensity physical activity was determined. Time in sustained bouts and median bout lengths of all intensities and breaks in sedentary time were also calculated. Outcomes included body mass index, waist circumference, blood pressure, blood lipids, and a cardiometabolic summary score. Regression models revealed beneficial associations between total daily volumes of moderate- and vigorous-intensity physical activity and cardiometabolic risk. Time spent in ≥1 min vigorous-intensity physical activity bouts was beneficially associated with cardiometabolic risk, yet this disappeared after adjusting for total vigorous-intensity physical activity and confounders. Time accumulated in light- (≥1 min; ≥5 min) and moderate-intensity (≥1 min) physical activity bouts was detrimentally associated with cardiometabolic risk. Total daily volume and activity patterns may have implications for cardiometabolic risk early in life. Sporadic physical activity may be more beneficial for health than sustained physical activity.

Sedentary Behavior and Public Health: Integrating the Evidence and Identifying Potential Solutions

In developed and developing countries, social, economic, and environmental transitions have led to physical inactivity and large amounts of time spent sitting. Research is now unraveling the adverse public health consequences of too much sitting. We describe improvements in device-based measurement that are providing new insights into sedentary behavior and health. We consider the implications of research linking evidence from epidemiology and behavioral science with mechanistic insights into the underlying biology of sitting time. Such evidence has led to new sedentary behavior guidelines and initiatives. We highlight ways that this emerging knowledge base can inform public health strategy: First, we consider epidemiologic and experimental evidence on the health consequences of sedentary behavior; second, we describe solutions-focused research from initiatives in workplaces and schools. To inform a broad public health strategy, researchers need to pursue evidence-informed collaborations with occupational health, education, and other sectors.

Bi-directional prospective associations between objectively measured physical activity and fundamental motor skills in children: a two-year follow-up

Background

The direction of the longitudinal relationship between physical activity (PA) and fundamental motor skills (FMS) remains unclear. We evaluated the bi-directional, prospective relationships between intensity-specific physical activity (PA) and domain-specific fundamental motor skills (FMS) over 2 years in children attending preschool at baseline.

Methods

A sample of 230 children (mean age at baseline 4.7 yr, 52% boys) from the 'Sogn og Fjordane Preschool Physical Activity Study' was measured 2 years apart. PA was assessed using ActiGraph accelerometers (GT3X+). FMS were evaluated by a test battery guided by the 'Test of Gross Motor Development 3' and the 'Preschooler Gross Motor Quality Scale'. PA outcomes were total PA (TPA [counts per minute]) and intensity specific PA and sedentary behaviour (SED) (min/day). FMS outcomes were locomotor, object control, and balance skills. Linear mixed model adjusting for potential co-variates was used to evaluate the bi-directional prospective associations between these variables, including the moderating effect of sex and age.

Results

Baseline total PA, moderate-to-vigorous PA (MVPA), and vigorous PA predicted higher locomotor, object control, and balance skills at follow-up (standardized regression coefficient (β): 0.17 to 0.26, p = 0.002–0.017). Baseline SED predicted lower locomotor skills at follow-up (β: − 0.27, p = 0.012). Baseline light PA did not predict FMS at follow-up. Baseline FMS were not associated with PA or SED at follow-up.

Conclusions

MVPA was positively associated with development of FMS in young children. In contrast, FMS were not related to future PA levels. Our results suggest promotion of MVPA is important for FMS development in young children.

Changes in Physical Activity Behaviour and Psychosocial Correlates Unique to the Transition from Primary to Secondary Schooling in Adolescent Females: A Longitudinal Cohort Study

Few studies have investigated physical activity changes over the transition from primary to secondary school. This study assessed change in physical activity and the psychosocial correlates across 12 months in two cohorts of adolescent girls, who were either in primary school in year 1, moving to secondary school in year 2 (Transition cohort) or an older cohort (Secondary cohort) who remained in early secondary school. Female adolescents (n = 191; 38% response rate) in South Australia self-reported physical activity and psychosocial correlates of physical activity. Changes between baseline and 12-month follow-up were assessed using paired t-tests. Multiple regression modelling identified psychosocial predictors of physical activity change. Physical activity declined in the transition but not the secondary cohort. The decline was most pronounced during school break times. Independent predictors of physical activity change were: change in enjoyment in the transition cohort; and changes in enjoyment, perceived outcomes, and friend encouragement in the secondary cohort. Transitioning from primary to secondary school is a critical period during which physical activity typically declines, particularly among females. Effective physical activity promotion in this vulnerable group will depend on a deeper understanding of the sociocultural, curricular and environmental influences on physical activity that are unique to each school context.

Accelerometer epoch setting is decisive for associations between physical activity and metabolic health in children

When analysing physical activity (PA) levels using accelerometry, the epoch setting is critical to capture intensity-specific PA correctly. The aim of the present study was to investigate the PA intensity signatures related to metabolic health in children using different epoch settings. A sample of 841 Norwegian children (age 10.2 ± 0.3 years; BMI 18.0 ± 3.0; 50% boys) provided data on accelerometry (ActiGraph GT3X+) and several indices of metabolic health (aerobic fitness, abdominal fatness, insulin sensitivity, lipid metabolism, blood pressure) that were used to create a composite metabolic health score. We created intensity spectra from 0-99 to ≥ 10000 counts per minute (cpm) for files aggregated using 1, 10, and 60-second epoch periods and used multivariate pattern analysis to analyse the data. The association patterns with metabolic health differed substantially between epoch settings. The intensity intervals most strongly associated with metabolic health were 7000-8000 cpm for data analysed using 1-second epoch, 5500-6500 cpm for data analysed using 10-second epoch, and 4000-5000 cpm analysed using 60-second epoch. Aggregation of data over different epoch periods has a clear impact on how PA intensities in the moderate and vigorous range are associated with childhood metabolic health.

Multicollinear physical activity accelerometry data and associations to cardiometabolic health: challenges, pitfalls, and potential solutions

Background

The analysis of associations between accelerometer-derived physical activity (PA) intensities and cardiometabolic health is a major challenge due to multicollinearity between the explanatory variables. This challenge has facilitated the application of different analytic approaches within the field. The aim of the present study was to compare association patterns of PA intensities with cardiometabolic health in children obtained from multiple linear regression, compositional data analysis, and multivariate pattern analysis.

Methods

A sample of 841 children (age 10.2 ± 0.3 years; BMI 18.0 ± 3.0; 50% boys) provided valid accelerometry and cardiometabolic health data. Accelerometry (ActiGraph GT3X+) data were characterized into traditional (four PA intensity variables) and more detailed categories (23 PA intensity variables covering the intensity spectrum; 0–99 to ≥10,000 counts per minute). Several indices of cardiometabolic health were used to create a composite cardiometabolic health score. Multiple linear regression and multivariate pattern analyses were used to analyze both raw and compositional data.

Results

Besides a consistent negative (favorable) association between vigorous PA and the cardiometabolic health measure using the traditional description of PA data, associations between PA intensities and cardiometabolic health differed substantially depending on the analytic approaches used. Multiple linear regression lead to instable and spurious associations, while compositional data analysis showed distorted association patterns. Multivariate pattern analysis appeared to handle the raw PA data correctly, leading to more plausible interpretations of the associations between PA intensities and cardiometabolic health.

Conclusions

Future studies should consider multivariate pattern analysis without any transformation of PA data when examining relationships between PA intensity patterns and health outcomes.

Trial registration

The study was registered in Clinicaltrials.gov 7th of April 2014 with identification number NCT02132494.

Electronic supplementary material

The online version of this article (10.1186/s12966-019-0836-z) contains supplementary material, which is available to authorized users.

Measurement of physical activity in clinical practice using accelerometers

Accelerometers are commonly used in clinical and epidemiological research for more detailed measures of physical activity and to target the limitations of self-report methods. Sensors are attached at the hip, wrist and thigh, and the acceleration data are processed and calibrated in different ways to determine activity intensity, body position and/or activity type. Simple linear modelling can be used to assess activity intensity from hip and thigh data, whilst more advanced machine-learning modelling is to prefer for the wrist. The thigh position is most optimal to assess body position and activity type using machine-learning modelling. Frequency filtering and measurement resolution needs to be considered for correct assessment of activity intensity. Simple physical activity measures and statistical methods are mostly used to investigate relationship with health, but do not take advantage of all information provided by accelerometers and do not consider all components of the physical activity behaviour and their interrelationships. More advanced statistical methods are suggested that analyse patterns of multiple measures of physical activity to demonstrate stronger and more specific relationships with health. However, evaluations of accelerometer methods show considerable measurement errors, especially at individual level, which interferes with their use in clinical research and practice. Therefore, better objective methods are needed with improved data processing and calibration techniques, exploring both simple linear and machine-learning alternatives. Development and implementation of accelerometer methods into clinical research and practice requires interdisciplinary collaboration to cover all aspects contributing to useful and accurate measures of physical activity behaviours related to health.

Reexamination of Accelerometer Calibration with Energy Expenditure as Criterion: VO2net Instead of MET for Age-Equivalent Physical Activity Intensity

Accelerometer calibration for physical activity (PA) intensity is commonly performed using Metabolic Equivalent of Task (MET) as criterion. However, MET is not an age-equivalent measure of PA intensity, which limits the use of MET-calibrated accelerometers for age-related PA investigations. We investigated calibration using VO_2net (VO_2gross - VO_2stand; mL⋅min^-1⋅kg^-1) as criterion compared to MET (VO_2gross/VO_2rest) and the effect on assessment of free-living PA in children, adolescents and adults. Oxygen consumption and hip/thigh accelerometer data were collected during rest, stand and treadmill walk and run. Equivalent speed (Speed_eq) was used as indicator of the absolute speed (Speed_abs) performed with the same effort in individuals of different body size/age. The results showed that VO_2net was higher in younger age-groups for Speed_abs, but was similar in the three age-groups for Speed_eq. MET was lower in younger age-groups for both Speed_abs and Speed_eq. The same VO_2net-values respective MET-values were applied to all age-groups to develop accelerometer PA intensity cut-points. Free-living moderate-and-vigorous PA was 216, 115, 74 and 71 min/d in children, adolescents, younger and older adults with VO_2net-calibration, but 140, 83, 74 and 41 min/d with MET-calibration, respectively. In conclusion, VO_2net calibration of accelerometers may provide age-equivalent measures of PA intensity/effort for more accurate age-related investigations of PA in epidemiological research.

Interpretation of Multivariate Association Patterns between Multicollinear Physical Activity Accelerometry Data and Cardiometabolic Health in Children-A Tutorial

Associations between multicollinear accelerometry-derived physical activity (PA) data and cardiometabolic health in children needs to be analyzed using an approach that can handle collinearity among the explanatory variables. The aim of this paper is to provide readers a tutorial overview of interpretation of multivariate pattern analysis models using PA accelerometry data that reveals the associations to cardiometabolic health. A total of 841 children (age 10.2 ± 0.3 years) provided valid data on accelerometry (ActiGraph GT3X+) and six indices of cardiometabolic health that were used to create a composite score. We used a high-resolution PA description including 23 intensity variables covering the intensity spectrum (from 0-99 to ≥10000 counts per minute), and multivariate pattern analysis to analyze data. We report different statistical measures of the multivariate associations between PA and cardiometabolic health and use decentile groups of PA as a basis for discussing the meaning and impact of multicollinearity. We show that for high-resolution accelerometry data; considering all explanatory variables is crucial to obtain a correct interpretation of associations to cardiometabolic health; which is otherwise strongly confounded by multicollinearity in the dataset. Thus; multivariate pattern analysis challenges the traditional interpretation of findings from linear regression models assuming independent explanatory variables.

Acute Cardiometabolic Responses to Multi-Modal Integrative Neuromuscular Training in Children

Integrative neuromuscular training (INT) has emerged as an effective strategy for improving health- and skill-related components of physical fitness, yet few studies have explored the cardiometabolic demands of this type of training in children. The aim of this study was to examine the acute cardiometabolic responses to a multi-modal INT protocol and to compare these responses to a bout of moderate-intensity treadmill (TM) walking in children. Participants (n = 14, age 10.7 ± 1.1 years) were tested for peak oxygen uptake (VO₂) and peak heart rate (HR) on a maximal TM test and subsequently participated in two experimental conditions on nonconsecutive days: a 12-min INT protocol of six different exercises performed twice for 30 s with a 30 s rest interval between sets and exercises and a 12-min TM protocol of walking at 50% VO₂peak. Throughout the INT protocol mean VO₂ and HR increased significantly from 14.9 ± 3.6 mL∙kg^-1∙min^-1 (28.2% VO₂ peak) to 34.0 ± 6.4 mL∙kg^-1∙min^-1 (64.3% VO₂ peak) and from 121.1 ± 9.0 bpm (61.0% HR peak) to 183.5 ± 7.9 bpm (92.4% HR peak), respectively. While mean VO₂ for the entire protocol did not differ between INT and TM, mean VO₂ and HR during selected INT exercises and mean HR for the entire INT protocol were significantly higher than TM (all Ps ≤ 0.05). These findings suggest that INT can pose a moderate to vigorous cardiometabolic stimulus in children and selected INT exercises can be equal to or more metabolically challenging than TM walking.

Examining accelerometer validity for estimating physical activity in pre-schoolers during free-living activity

The present study examined the efficacy of accelerometers for the assessment of free play physical activity (PA) in pre-school-aged children with consideration of epoch length and wear location. Following ethics approval, parental informed consent, and child assent, 66 pre-schoolers aged 3-4 years (30 females and 36 males) wore an accelerometer (ActiGraph GT3X; sampling at 100 Hz) on their non-dominant wrist and their right hip during 1 hour of free play. Concurrently, direct observation, using the OSRAC-P, was used to determine sedentary behavior (SB), light (LPA), or moderate-to-vigorous (MVPA) intensity PA. For the ActiGraph, vertical axis counts and summed vector magnitude (VM) for hip, and VM for wrist, were downloaded using 5-, 10-, 15-, and 30-second epoch lengths. Accelerometer counts were averaged over each 30 seconds to match the observation periods. Receiver operating curve analysis was used to evaluate the ability of the ActiGraph to predict SB, LPA, and MVPA. SB and MVPA obtained from wrist- and hip-worn accelerometers demonstrated fair agreement with direct observation (AUC => 0.7). LPA determined by accelerometer had poor agreement with observed LPA, for both the hip and wrist placement (AUC = 0.53-0.56), with weak levels of specificity (0.34-0.43), although sensitivity was fair (0.74-0.84). This study is the first to examine accelerometer validity, considering wear location and epoch in pre-schoolers during free play, and suggests that the ActiGraph is a fair measure for SB and MVPA in pre-school children. Neither placement performed predominantly better irrespective of epochs or used count data (vertical axis, VM).

Changes in volume and bouts of physical activity and sedentary time across early childhood: a longitudinal study

BACKGROUND

Understanding changes in physical activity and sedentary time (SED) during early childhood may provide insights into how to effectively promote a healthy start to life. This study examined changes in total volume and bouts of SED, light- (LPA), and moderate- to vigorous-intensity physical activity (MVPA) across early childhood, and explored differences in change between boys and girls.

METHODS

Data were drawn from 330 children participating in the Melbourne InFANT Program, collected between 2008 and 2013 and analysed in 2017. Children's physical activity and SED were assessed for at least 7 days at each timepoint using ActiGraph GT1M accelerometers at 19 months, 3.5 and 5 years of age. Total volume of SED (≤100 counts per minute [CPM]), LPA (101-1680 CPM) and MVPA (≥1681 CPM) were expressed as a percentage of wear time, and the frequency (number of bouts/day) and duration (mins/bout) of SED, LPA and MVPA bouts ≥1 min were calculated at each time point. Multilevel models with random intercepts and slopes were used to examine changes in total volume and bouts of SED, LPA and MVPA for boys and girls.

RESULTS

Compared to aged 19 months, children's total volume of SED and LPA decreased at 3.5 and 5 years old, while MVPA increased. The frequency of SED bouts at 3.5 and 5 years was greater than at 19 months, but the duration was shorter. Additionally, the frequency and duration of LPA bouts was lower and MVPA bout frequency and duration was greater at 3.5 and 5 years. In general, there was no evidence of sex differences in trajectories of children's physical activity and SED. However, variations in trajectory were observed at the individual child level.

CONCLUSIONS

Children's total volume and bouts of SED, LPA and MVPA change across early childhood, mostly in a favourable direction. Trajectories appear to be similar for boys and girls. Investigation of individual variation in trajectories is likely to provide greater insight into associations between physical activity and future health and behavioural outcomes.

Effects of Frequency Filtering on Intensity and Noise in Accelerometer-Based Physical Activity Measurements

In objective physical activity (PA) measurements, applying wider frequency filters than the most commonly used ActiGraph (AG) filter may be beneficial when processing accelerometry data. However, the vulnerability of wider filters to noise has not been investigated previously. This study explored the effect of wider frequency filters on measurements of PA, sedentary behavior (SED), and capturing of noise. Apart from the standard AG band-pass filter (0.29-1.63 Hz), modified filters with low-pass component cutoffs at 4 Hz, 10 Hz, or removed were analyzed. Calibrations against energy expenditure were performed with lab data from children and adults to generate filter-specific intensity cut-points. Free-living accelerometer data from children and adults were processed using the different filters and intensity cut-points. There was a contribution of acceleration related to PA at frequencies up to 10 Hz. The contribution was more pronounced at moderate and vigorous PA levels, although additional acceleration also occurred at SED. The classification discrepancy between AG and the wider filters was small at SED (1-2%) but very large at the highest intensities (>90%). The present study suggests an optimal low-pass frequency filter with a cutoff at 10 Hz to include all acceleration relevant to PA with minimal effect of noise.