Physical activity in Filipino youth: the Cebu Longitudinal Health and Nutrition Survey

NHANES-based analysis of the correlation between leisure-time physical activity, serum cotinine levels and periodontitis risk

OBJECTIVE

To investigate the association of leisure-time physical activity and serum cotinine levels with the risk of periodontitis in the general population and to further analyze the interaction between leisure-time physical activity and serum cotinine levels on the risk of periodontitis.

METHODS

This was a cross-sectional study, extracting data from 9605 (56.19%) participants in the National Health and Nutrition Examination Survey (NHANES) database from 2009 to 2014, and analyzing the relationship and interaction effects of serum cotinine level, leisure time physical activity, and risk of periodontitis by weighted univariate logistic modeling; Effect sizes were determined using ratio of ratios (OR), 95% confidence intervals (95% CI).

RESULTS

5,397 (56.19%) of 9,605 participants had periodontitis; an increased risk of periodontitis was found in those in the leisure time physical activity intensity < 750 MET × min/week group (OR = 1.44, 95% CI: 1.17-1.78). Serum cotinine levels ≥ 0.05 ng/ml were associated with an increased risk of periodontitis (OR = 1.99, 95% CI: 1.69-2.33). The group with low leisure physical activity and serum cotinine levels ≥ 0.05 ng/ml had an increased risk of periodontitis compared to the group with high leisure physical activity and serum cotinine levels < 0.05 ng/ml (OR = 2.48, 95% CI: 1.88-3.27). Interaction metrics RERI = 0.90 (95% CI: 0.44-1.36) and API = 0.36 (95% CI: 0.18-0.55); CI for SI = 2.55 (95% CI: 1.03-6.28). for API 0.36.

CONCLUSION

Leisure time physical activity intensity interacted with smoking exposure on periodontitis risk and may provide the general population with the opportunity to Increasing leisure-time physical activity and smoking cessation may provide recommendations for the general population.

Day-to-day regularity and diurnal switching of physical activity reduce depression-related behaviors: a time-series analysis of wearable device data

BACKGROUND

Wearable devices have been widely used in research to understand the relationship between habitual physical activity and mental health in the real world. However, little attention has been paid to the temporal variability in continuous physical activity patterns measured by these devices. Therefore, we analyzed time-series patterns of physical activity intensity measured by a wearable device and investigated the relationship between its model parameters and depression-related behaviors.

METHODS

Sixty-six individuals used the wearable device for one week and then answered a questionnaire on depression-related behaviors. A seasonal autoregressive integral moving average (SARIMA) model was fitted to the individual-level device data and the best individual model parameters were estimated via a grid search.

RESULTS

Out of 64 hyper-parameter combinations, 21 models were selected as optimal, and the models with a larger number of affiliations were found to have no seasonal autoregressive parameter. Conversely, about half of the optimal models indicated that physical activity on any given day fluctuated due to the previous day's activity. In addition, both irregular rhythms in day-to-day activity and low-level of diurnal variability could lead to avoidant behavior patterns.

CONCLUSION

Automatic and objective physical activity data from wearable devices showed that diurnal switching of physical activity, as well as day-to-day regularity rhythms, reduced depression-related behaviors. These time-series parameters may be useful for detecting behavioral issues that lie outside individuals' subjective awareness.

Results from the Philippines' 2022 report card on physical activity for children and adolescents

Background/Objective

The 2022 Philippine Report Card on Physical Activity for Children and Adolescents provides a comprehensive assessment of physical activity and other related behaviors, including the various factors and settings that influence these behaviors. It serves as an advocacy tool to increase awareness of the physical activity situation among children and young people in the country. This article describes the development and results of the first Philippine Report Card on Physical Activity for Children and Adolescents.

Methods

Following a systematic process provided by the Active Healthy Kids Global Alliance, a team consisting of 25 sports and physical activity specialists identified and reviewed the best available nationally representative data related to physical activity indicators. These data were then used to inform the grades of the ten (10) physical activity indicators.

Results

Sufficient data were identified to assign grades to five (5) indicators: Overall Physical Activity (F), Active Transportation (D), Sedentary Behavior (B), School (C-), and Government (B). Insufficient data existed to assign grades to the remaining five (5) indicators: Organized Sport and Physical Activity, Active Play, Physical Fitness, Family and Peers, and Community and Environment.

Conclusion

Despite government policies related to physical activity in the country, the majority of children and adolescents in the Philippines do not meet the recommended amount of physical activity for health. More work is needed to improve the translation of these policies into measurable programs, highlighting the need to create better physical activity opportunities and develop national surveillance mechanisms.

The Association between Physical Activity and Cognitive Function: Data from the China Health and Nutrition Survey

Background

Decreased cognitive function is a common problem in the old adults, which has high risk of progression to Alzheimer's diseases (AD) and other dementias. This study was aimed at finding out the association between physical activity and cognitive function.

Methods

In total, 1514 participants with the age ≥ 55 years old registered in the China Health and Nutrition Survey (CHNS) database were selected in this study. The association between physical activity and cognitive function was analyzed via the generalized additive model. The association between the variables and the cognitive function score was expressed as β coefficient with 95% confidence intervals (CIs).

Results

After adjusting age, ethnicity, stratum, marital status, education, memory status, and memory changes, the cognitive function score was increased by 0.011 points for every 1-point increase in domestic score (β = 0.011, P = 0.043). Subgroup analysis indicated that in the female group, for every 1-point increase in the domestic score, the cognitive function score increased by 0.019 points (β = 0.019, P = 0.017). In people with good memory status, each 1-point increase in domestic score increased the cognitive function score of 0.020 points (β = 0.020, P = 0.017).

Conclusions

The decreased cognitive function was correlated with decreased domestic physical activity. The increased domestic physical activity was associated with an increased cognitive function in females and people with good memory status. The findings might offer a reference for deep understanding of the association between physical activity and cognitive function.

Assessing adolescent diet and physical activity behaviour, knowledge and awareness in low- and middle-income countries: a systematised review of quantitative epidemiological tools

PURPOSE

Quantitative epidemiological tools are routinely used to assess adolescent diet and physical activity (PA) constructs (behaviour, knowledge, and awareness) as risk factors for non-communicable diseases. This study sought to synthesize evidence on the quantitative epidemiological tools that have been used to assess adolescent diet and PA constructs in low to middle-income countries (LMIC).

METHODS

A systematised review was conducted using 3 databases (EbscoHost, Scopus and Web of Science).

RESULTS

We identified 292 LMIC studies assessing adolescent diet and PA. Identified studies predominantly explored behavioural (90%) constructs with a paucity of studies investigating knowledge and awareness. The majority of studies used subjective (94%) and self-administered (78%) tools. Only 39% of LMIC studies used tools validated for their contexts.

CONCLUSIONS

The findings highlight the need for more contextual tools for assessing adolescent diet and PA in LMICs. Diet and PA measurement tools used in future research will need to incorporate measures of knowledge and awareness for a more comprehensive understanding of the epidemiology of diet and PA in adolescents. Furthermore, there is a need for more evidence on the reliability and validity of these tools for use, in both cross sectional and longitudinal studies, in LMIC contexts.

Association of active school commuting with physical activity and sedentary behaviour among adolescents: A global perspective from 80 countries

OBJECTIVES

To examine associations of active school commuting (ASC) with time spent in physical activity (PA) and sedentary behaviour (SB) among adolescents.

DESIGN

Cross-sectional study.

METHODS

Global School-based Student Health Survey data from 277,833 adolescents aged 11-17 years (48.9% girls), collected during 2007-2016, were analysed. Adolescents were asked how many days per week they walked or bicycled to and from school, were physically active, and how much time they spent sitting on a typical day. ASC was defined as ≥3 days/week, meeting PA recommendations as ≥60min/day, high SB as leisure-time sitting ≥3h/day. Multilevel logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) of the association estimates.

RESULTS

Adolescents who used ASC≥3 days/week had over double the odds of meeting PA recommendations (OR: 2.06, 95% CI: 2.01-2.12), after adjusting for a set of covariates. Adolescents who reported ASC≥3 days/week had 17% lower odds of reporting high SB (0.83, 0.81-0.85). The estimated OR of ASC and PA was 2.57 (2.31-2.86) in low-income and 1.84 (1.75-1.94) in high-income countries. Adolescents with ASC≥3 days/week had 22% lower odds of reporting high SB in African and Eastern Mediterranean regions (0.78, 0.73-0.84 and 0.75-0.82, respectively). Country-wise estimates of the associations are presented.

CONCLUSIONS

ASC is strongly and positively associated with PA recommendations and moderately with lower SB in adolescents. These estimates vary across WHO regions and by country's income. Promoting ASC has the potential to promote active lifestyle among adolescents around the globe.

Determining the Cut Off Score of the Healthy Lifestyle Screening Tool among High School Students

Background

Several lifestyle factors such as not smoking, drinking alcohol in moderation, eating healthily, regular exercise, and maintaining a normal weight have been known to play an important role in optimal health. A screening tool that has a standardized score that indicates healthy or risky lifestyle behaviors is needed for health promotion. However, such a tool that focuses on lifestyle behaviors have not incorporated scores to summarize the results. The purpose of this study is to develop the cut-off points of the Healthy Lifestyle Screening tool.

Methods

Data collection in this study was done from 198 Filipino high school students utilizing the Healthy Lifestyle Screening Tool.

Results

Receiver Operating Curve (ROC) results indicated cut-off score of 98 to separate into low and high score groups. The mean scores for all subcomponents were significantly different in between two groups. The general population fell in the high score category with a mean total score of 105.61 in which 81.31% were categorized in the high score group and 18.61% in the low score group. Subjects in general obtained low mean scores in specific subscale components such as rest (2.46) water (2.66) and exercise (2.78).

Conclusion

Increasing the total score by working on low scoring components will be beneficial in achieving a healthy lifestyle. This study reinforced the importance of holistic approach regarding health and well-being among high school students.

Measurement of Physical Activity and Sedentary Behavior by Accelerometry Among a Nationwide Sample from the KiGGS and MoMo Study: Study Protocol

BACKGROUND

Currently, no nationwide objective physical activity data exists for children and adolescents living in Germany. The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) and the Motorik-Modul study (MoMo) is a national cohort study that has incorporated accelerometers in its most recent data collection wave (wave 2, since 2014). This wave 2 marks the first nationwide collection of objective data on the physical activity of children and adolescents living in Germany.

OBJECTIVE

The purpose of this protocol is to describe the methods used in the KiGGS and MoMo study to capture the intensity, frequency, and duration of physical activity with accelerometers.

METHODS

Participants (N=11,003, aged 6 to 31 years) were instructed to wear an ActiGraph GT3X+ or wGT3X-BT accelerometer laterally on the right hip. Accelerometers were worn on consecutive days during waking hours, including at least 4 valid weekdays and 1 weekend day (wear time >8 hours) in the evaluation. A nonwear time protocol was also implemented.

RESULTS

Data collection was completed by October 2017. Data harmonization took place in 2018. The first accelerometer results from this wave were published in 2019, and detailed analyses are ready to be submitted in 2020.

CONCLUSIONS

This study protocol provides an overview of technical details and basic choices when using accelerometers in large-scale epidemiological studies. At the same time, the restrictions imposed by the specified filters and the evaluation routines must be taken into account.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/14370.

Changes in blood pressure during the transition of retirement: the role of physical activity in China

As baby boomers begin to retire, China faces an unprecedented transition in its labor market. A healthy transition into retirement, whereby a health status is retained, can curb medical care expenditures. However, little is known about health effects of retirement in China. Thus, this study investigated whether and to what extent retirement affected retirees' blood pressure, and the role that leisure physical activity played in this relationship. We used a nationally representative panel data collected during the 2004, 2006, 2009, and 2011 waves of the Chinese Health Nutrition Survey. Respondents who were older than 35 years and younger than 70 were included; our final sample size was 26,190. A four-step mediation model was constructed to examine the relationships between retirement, leisure physical activity, and blood pressure. Retirement predicted an decrease in systolic (coefficient of length time of retirement: -0.117; standard error:0.041; p < 0.01) and diastolic blood pressure level (coefficient of length time of retirement: -0.204; standard error: 0.062; p < 0.01), and a lower prevalence of hypertension (odd ratio of length time of retirement: 0.979; 95% CI: 0.968-0.990; p < 0.01) without leisure physical activity adjusted. However, these effects were reduced when the effects of physical activity were controlled for. A mediation effect of physical activity on the association between retirement and likelihood of hypertension/blood pressure was observed. These findings have implications for public policy that aims to promote health by taking advantage of postretirement adaptation; specifically, the findings suggest that the promotion of physical activity may facilitate a healthier transition into retirement.

Association between spicy food consumption and lipid profiles in adults: a nationwide population-based study

CVD remains the leading cause of mortality worldwide, with abnormal lipid metabolism as a major risk factor. The aim of this study was to investigate associations between spicy food consumption and serum lipids in Chinese adults. Data were extracted from the 2009 phase of the China Health and Nutrition Survey, consisting of 6774 apparently healthy Chinese adults aged 18-65 years. The frequency of consumption and degree of pungency of spicy food were self-reported, and regular spicy food consumption was assessed using three consecutive 24-h recalls. Total cholesterol, TAG, LDL-cholesterol and HDL-cholesterol in fasting serum were measured. Multilevel mixed-effects models were constructed to estimate associations between spicy food consumption and serum lipid profiles. The results showed that the frequency and the average amount of spicy food intake were both inversely associated with LDL-cholesterol and LDL-cholesterol:HDL-cholesterol ratio (all P for trend<0·05) after adjustment for potential confounders and cluster effects. HDL-cholesterol in participants who usually consumed spicy food (≥5 times/week) and who consumed spicy food perceived as moderate in pungency were significantly higher than those who did not (both P<0·01). The frequency and the average amount of spicy food intake and the degree of pungency in spicy food were positively associated with TAG (all P for trend<0·05). Spicy food consumption was inversely associated with serum cholesterol and positively associated with serum TAG, and additional studies are needed to confirm the findings as well as to elucidate the potential roles of spicy food consumption in lipid metabolism.

Accelerometer-measured physical activity among older adults in urban India: Results of a study on global AGEing and adult health substudy

OBJECTIVES

Accelerometry provides researchers with a powerful tool to measure physical activity in population-based studies, yet this technology has been underutilized in cross-cultural studies of older adults. The present study was conducted among older adults in an urban setting in India with the following three objectives: (1) to compare average activity levels obtained through different durations of monitoring (1, 3, and 7 days); (2) to document differences in physical activity patterns by sex and age; and (3) to evaluate links between measures of physical activity and anthropometrics, as well as between activity parameters and measures of household size, work status, and social cohesion.

METHODS

The present study uses data from a physical activity substudy of the World Health Organization's Study on global AGEing and adult health (SAGE-PA). This study of 200 older adults (49-90 years old; 72 males, 128 females) in urban India combines 7 continuous days of ActiGraph GT3X accelerometry with anthropometric and sociodemographic data.

RESULTS

Results reveal overall low activity levels, with significantly lower activity energy expenditure (AEE) among females (P < 0.05). No significant differences were documented in activity level by monitoring duration. Age was negatively correlated with AEE in men (P < 0.01) and women (P < 0.001). AEE was positively correlated with BMI in men (P < 0.01) and women (P < 0.05). Finally, women who were more socially integrated had greater AEE (P < 0.01).

CONCLUSIONS

This study illustrates the utility of accelerometry for quantifying activity levels in aging populations in non-Western nations. Am. J. Hum. Biol. 28:412-420, 2016. © 2015 Wiley Periodicals, Inc.

Nutrition Transition and the Global Diabetes Epidemic

Low- and middle-income countries (LMICs) face a rapid change in the nutrition transition toward increases in noncommunicable diseases. Underlying this transition are shifts in the agricultural system and the subsequent growth of the modern retail and food service sectors across all regions and countries, a change in technology affecting physical activity and inactivity, mass media access, urbanization, and penetration of modern food systems into all societies. The resulting major shifts in diet are toward increased refined carbohydrates, added sweeteners, edible oils, and animal-source foods and reduced legumes, other vegetables, and fruits. Most countries are seeing increases in body mass index (BMI), overweight, and waist circumference (WC), and an increased WC-BMI ratio appears to be emerging in many regions. The implications of these rapidly changing diets and body compositions include the prevalence and severity of diabetes in LMICs.

Secular trends in habitual physical activities of Mozambican children and adolescents from Maputo City

Social and economic changes occurring in the last two decades in Mozambique may have induced lifestyle changes among youth. This study aimed to document secular changes in habitual physical activities of Mozambican youth between 1992, 1999 and 2012. A total of 3393 youth (eight–15 years), were measured in three different time periods (1992, 1999, 2012). Habitual physical activity (PA) was estimated with a questionnaire, including items related to household chores, sport participation, traditional games and walking activities. Biological maturation was assessed. Analysis of Covariance (ANCOVA) was used to compare mean differences in PA across the years. Significant decreases between 1992–1999 and 1992–2012 were observed for boys in household chores, games and walking, and a significant decline between 1999 and 2012 was found in sport participation.Among girls, a significant and consistent decline (1992 > 1999 > 2012) was observed for household chores, a decline between 1992–1999 and 1992–2012 for games and walking, and a significant increase between 1992 and 1999 in sport participation. In general, a negative secular trend was found in habitual PA among Mozambican youth. Interventions aimed at increasing PA represent important educational and public health opportunities.

A frequency questionnaire to estimate free-living physical activity among Tunisian preadolescent and adolescent children

OBJECTIVE

To develop a child- and adolescent-appropriate physical activity frequency questionnaire (PAFQ) in Tunisia, North Africa.

DESIGN

A PAFQ was developed from a physical activity (PA) inventory that comprised major activity components (at home, preparing meals, school time, transport, non-sport leisure, sports, prayer and sleeping time). Then, type and duration of each activity undertaken during the past week were estimated. Total energy expenditure (TEE) estimated by the PAFQ was compared with data derived from two criterion methods: heart-rate monitoring (HRM) and a 24 h PA recall (24h-R), both collected during a 3 d period including one weekday and two weekend days.

SETTING

Two elementary schools and two high schools of the most developed and urbanized area, Greater Tunis.

SUBJECTS

One hundred and forty-two volunteer children and adolescents aged 10-19 years.

RESULTS

The PAFQ strongly was correlated with both HRM (r = 0·70; 95% CI 0·62, 0·76) and 24h-R (r = 0·81; 95% CI 0·77, 0·84). It featured acceptable agreement with both criterion measures, slightly underestimating TEE compared with 24h-R (-2·8%, mean of individual differences -272·7 kJ/d; 95% CI -490·6, -57·4 kJ/d) and moderately overestimating it compared with HRM (+11·3%, mean of individual differences +1106·2 kJ/d; 95% CI 845·8, 1366·6 kJ/d). Reliability ranged from moderate to good (weighted kappa coefficients from 0·47 to 0·78 and intra-class correlation coefficients between 0·79 and 0·86 for energy expenditure by PA categories), indicating strong agreement between the two assessments.

CONCLUSIONS

This PAFQ could be useful in the description and surveillance of PA patterns or for the evaluation of population-based interventions directed at promoting PA in Tunisian children and adolescents.

Physical activity and movement skills proficiency of young Filipino children

Recent reports indicate an increasing prevalence of overweight among Filipino children. Considering the known association of physical activity (PA) with obesity, this study reports the findings of an objective monitoring of PA in a sample of Filipino children. The study also explores the relationship of PA with fundamental movement skills (FMS) proficiency. Thirty-two children (6.54 ± 2.45 years old) wore an accelerometer for 7 days of PA monitoring and were assessed on five FMS (throw, catch, kick, run, jump). The children met the World Health Organization's recommendation of 60 min of PA per day, with more active time being accrued during weekdays than weekends. Children with greater FMS proficiency were found to spend more time in PA than those who were less skillful during weekends. Further research is recommended to examine PA and FMS proficiency associations, exploring the role of social interactions on weekends and weekdays.

Synthesis and implications: China's nutrition transition in the context of changes across other low- and middle-income countries

The China Health and Nutrition Survey (CHNS) is important for its insights into current and future diet, physical activity, and obesity-related changes in China and for understanding underlying processes common across low- and middle-income countries (LMICs). While China modernized later than Latin American countries, many changes seen in China echo those in Latin America and in other LMICs. In general, changes in physical activity and diet behaviours in China have occurred at a faster pace relative to other LMICs. Modernization of the overall Chinese food system has lagged behind most other LMICs, yet the now-rapid changes in the Chinese food system are similar to what has been seen in other LMICs. Further, there is variation in these changes across social and geographic space. The incidence of obesity and non-communicable diseases has increased as the major health burden has shifted towards the poor. This paper examines changes in China and addresses the literature and issues that link these changes with those in other LMICs. In many ways, the detailed 20-year CHNS, with nine repeated measures, provides a remarkable window through which to understand nutrition-related changes in other LMICs.

An evaluation of questionnaires assessing physical activity levels in youth populations

The aim of this study was to revise and organize according to recall time based criteria, questionnaires created and validated to assess the level of physical activity in children and adolescents, with the intention of enabling their proper understanding and subsequent use by nurses and health care professionals. In order to determine the questionnaires' quality, their degree of reliability and validity was the main feature to be taken into account. Thirty-eight papers were retrieved and analyzed, 31 of which were aimed at designing and validating a questionnaire intended for physical activity (PA) level assessment in youth populations (four to 19 year olds). The most widely used questionnaires were those whose recall time spans from one to seven days. In general, all questionnaires were characterized by the use of pen-and-paper format and scarce utilization of new technologies. Based upon validity and reliability criteria, in order to assess PA level in children and adolescents, nurses should use the "Children's Leisure Activities Study Survey" and the "Flemish Physical Activity Computer Questionnaire", respectively. There is a need for the validation of these tools in other languages and cultures.

Correlates of physical activity in adolescence: a study from a developing country

BACKGROUND

Physical activity is important for adolescent health. The current study aimed to explore factors that predict physical activity among adolescents.

METHODS

This was a cross-sectional study of physical activity among a sample of adolescents in Tabriz, Iran. Information on physical activity was collected using a modified version of the Adolescent Physical Activity and Recall Questionnaire (APARQ). In addition, a self-administrated questionnaire was used to collect data on demographic characteristics, perceived family support, and self-efficacy. Both univariate and multivariate logistic regression analyses were performed to examine the association between physical activity and independent variables including gender and psychosocial predictors.

RESULTS

In all, 402 students were studied. The mean age of adolescents was 12.93 (SD=0.49) years; 51.5% were female. The mean time of moderate and vigorous physical activity for all adolescents was 44.64 (SD=23.24) Metabolic Equivalent (MET) min per day. This figure for female adolescents was 38.77 (SD=19.94) MET min per day and for males it was 50.87 (SD=24.88) (P<0.001). The results obtained from multiple logistic regression analysis indicated that female gender (OR=2.59, 95% CI=1.46-4.57, P=0.001) and poor family support (OR=1.10, 95% CI=1.03-1.20, P=0.038) were the most significant contributing factors to low level physical activity in adolescents. Other variables studied did not show any significant results.

CONCLUSION

The findings from the current study indicated that female adolescents were at risk of lower level of physical activity. In addition, it was found that the lack of family support represented an increased risk for low-level physical activity. It seems that family support should be an integrated part of any health education/promotion programs for improving physical activity among young adolescents in general and for female adolescents in particular.

Review of Physical Activity Prevalence of Asian School-Age Children and Adolescents

Overweight and obese populations in Asia are high and increasing rapidly. Physical activity prevalence studies have found low physical activity rates among Asian school-age children and adolescents. The purpose of this review is to establish a baseline for physical activity rates in Asian school-age children and adolescents and serve as a platform for additional research. Thirty articles published between 2000 and 2011 on physical activity prevalence of school-age children and adolescents were included in the review. Fourteen studies were conducted in East Asia, 10 in Southeast Asia, 2 in South Asia, and 2 in West Asia. Studies used subjective methods (questionnaires or diaries) and objective methods (accelerometers or heart rate monitors). Although nearly all studies found low physical activity levels, it was not possible to provide an accurate picture due to an absence of standardized, reliable, and economically viable measurement tools.

Cluster Analysis Methods Help to Clarify the Activity-BMI Relationship of Chinese Youth

OBJECTIVE

To use cluster analysis to create patterns of overall activity and inactivity in a diverse sample of Chinese youth and to evaluate their use in predicting overweight status.

RESEARCH METHODS AND PROCEDURES

The study populations were drawn from the 1997 and 2000 years of the longitudinal China Health and Nutrition Survey, comprised of 2702 and 2641 schoolchildren in the 1997 and 2000 cross-sectional samples, respectively, and 1175 children in the longitudinal cohort. Cluster analysis was used to group children into nonoverlapping activity/inactivity "clusters" that were subsequently used in models of prevalent and incident overweight. Results were compared with traditional models, with activity and inactivity coded separately, to assess whether further insight was gained with the cluster analysis methodology.

RESULTS

Moderately and highly active youth were shown to have significantly decreased odds of overweight in both cross-sectional and longitudinal analyses using cluster analysis. In incident longitudinal models, youth in the high activity/high inactivity cluster had the lowest odds of overweight [odds ratio=0.12 (0.03, 0.44)]; in contrast, results from traditional models failed to show any significant relationship between overweight and activity or inactivity.

DISCUSSION

Cluster analysis methods allow researchers to simultaneously capture activity and inactivity in new ways. In this comparative study, only with the clustering methodology did we find a significant effect of activity on incident overweight, furthering our ability to examine this complex relationship. Interestingly, no effect of increasing levels of inactivity was observed using either method, indicating that activity seems to be the more important determinant of overweight in this population.

The importance of Active Transportation to and from school for daily physical activity among children

OBJECTIVE

To investigate if students who use of Active Transportation (AT) to and from school among urban and rural Canadian children are more likely to meet physical activity recommendations.

METHODS

The Raising healthy Eating and Active Living in Alberta (REAL Kids Alberta) study is a population-based health survey among Grade 5 students. In 2009, physical activity levels were measured using time-stamped pedometers (number of steps/hour) among 688 children. Parents reported mode of transportation to and from school (AT/non-AT). Multilevel multiple linear regression analyses with corresponding β coefficients were conducted to quantify the relationship between mode of transportation to and from school with (1) overall step count, and (2) the likelihood of achieving at least 13,500 steps per day recommended for optimal growth and development.

RESULTS

Among urban children, those who used AT to and from school accumulated more steps [β=1124(95% CI=170,2077)] and although not significant, were more likely to achieve the recommended 13,500 steps/day compared to those not using AT to and from school [OR=1.61(95% CI=0.93,2.81)].

CONCLUSION

Using AT to and from school appears to be beneficial to children by supplementing their physical activity, particularly those living in urban regions. Strategies to promote physical activity are needed, particular for children residing in rural regions and smaller towns.

Interaction between physical activity and sleep duration in relation to insulin resistance among non-diabetic Chinese adults

BACKGROUND

It is of a public health interest to explore the relationship between different types of physical activity, sleep duration and diabetes/insulin resistance. However, little is known about such relationship. This study examines the single and joint associations of different types of physical activity, and sleep duration on insulin resistance among non-diabetic Chinese adults.

METHODS

Data was collected from 1124 non-diabetic adults in Jiangsu Province from the China Health and Nutrition Survey (CHNS). Domestic, occupational, transportation and leisure physical activity were assessed in terms of metabolic equivalent (MET)-hours-per-week to account for both intensity and time spent. Sleep duration was categorized into three groups: ≤ 7 hours, 7-9 hours, and ≥ 9 hours. Insulin resistance was evaluated by the homeostasis model of assessment (HOMA) and defined as the highest quartile of HOMA.

RESULTS

Total physical activity was mainly composed of occupational activity (75.1%), followed orderly by domestic, transportation and leisure time activity in both men and women. Total physical activity level was strongly negatively associated with fasting insulin and HOMA (p < 0.001). Among four types of physical activity, occupational activity was significantly negatively associated with HOMA after full adjustment (p < 0.05). Transportation activity was also negatively associated with HOMA when adjusted for age and gender (p = 0.028). Moreover, the combination of low physical activity and short sleep duration was associated with the highest odds of insulin resistance (adjusted OR = 3.26, 95% CI: 1.57-6.78), compared to those with high physical activity and adequate sleep duration.

CONCLUSIONS

Physical activity, mainly occupational physical activity, was negatively associated with insulin resistance in non-diabetic Chinese population, independently of potential confounders. There was a synergic effect of low physical activity and short sleep duration on insulin resistance.

Secular trends: a ten-year comparison of the amount and type of physical activity and inactivity of random samples of adolescents in the Czech Republic

BACKGROUND

An optimal level of physical activity (PA) in adolescence influences the level of PA in adulthood. Although PA declines with age have been demonstrated repeatedly, few studies have been carried out on secular trends. The present study assessed levels, types and secular trends of PA and sedentary behaviour of a sample of adolescents in the Czech Republic.

METHODS

The study comprised two cross-sectional cohorts of adolescents ten years apart. The analysis compared data collected through a week-long monitoring of adolescents' PA in 1998-2000 and 2008-2010. Adolescents wore either Yamax SW-701 or Omron HJ-105 pedometer continuously for 7 days (at least 10 hours per day) excluding sleeping, hygiene and bathing. They also recorded their number of steps per day, the type and duration of PA and sedentary behaviour (in minutes) on record sheets. In total, 902 adolescents (410 boys; 492 girls) aged 14-18 were eligible for analysis.

RESULTS

Overweight and obesity in Czech adolescents participating in this study increased from 5.5% (older cohort, 1998-2000) to 10.4% (younger cohort, 2008-2010). There were no inter-cohort significant changes in the total amount of sedentary behaviour in boys. However in girls, on weekdays, there was a significant increase in the total duration of sedentary behaviour of the younger cohort (2008-2010) compared with the older one (1998-2000). Studying and screen time (television and computer) were among the main sedentary behaviours in Czech adolescents. The types of sedentary behaviour also changed: watching TV (1998-2000) was replaced by time spent on computers (2008-2010).The Czech health-related criterion (achieving 11,000 steps per day) decreased only in boys from 68% (1998-2000) to 55% (2008-2010). Across both genders, 55%-75% of Czech adolescents met the health-related criterion of recommended steps per day, however less participants in the younger cohort (2008-2010) met this criterion than in the older cohort (1998-2000) ten years ago. Adolescents' PA levels for the monitored periods of 1998-2000 and 2008-2010 suggest a secular decrease in the weekly number of steps achieved by adolescent boys and girls.

CONCLUSION

In the younger cohort (2008-2010), every tenth adolescent was either overweight or obese; roughly twice the rate when compared to the older cohort (1998-2000). Sedentary behaviour seems relatively stable across the two cohorts as the increased time that the younger cohort (2008-2010) spent on computers is compensated with an equally decreased time spent watching TV or studying. Across both cohorts about half to three quarters of the adolescents met the health-related criterion for achieved number of steps. The findings show a secular decrease in PA amongst adolescents. The significant interaction effects (cohort × age; and cohort × gender) that this study found suggested that secular trends in PA differ by age and gender.

Factors associated with physical inactivity in adolescents in Ho Chi Minh City, Vietnam

PURPOSES

To identify factors associated with physical inactivity among adolescents in Ho Chi Minh City (HCMC).

METHODS

A cross-sectional survey was conducted in 2004 among 2684 junior high school students using multistage cluster sampling. Time spent for physical and sedentary activities was collected with a validated questionnaire. Anthropometry, parental/family characteristics, neighborhood, and school environments were also measured. Level of activity was classified as physically active or inactive using standard criteria. Potential risk factors for physical inactivity were identified with hierarchical multivariate logistic regression, stratified by gender.

RESULTS

Physical inactivity was positively associated with child's overweight status (odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.9, 3.2), passive transportation (OR = 4.2, 95% CI = 3.3-5.2), not having recess exercises (OR = 1.3, 95% CI = 1.1-5.6), availability of a nearby game shop (OR = 1.8, 95% CI = 1.5-2.2), more time spent playing video games, watching television, and studying after class (OR = 2.3, 95% CI = 1.7-3.1; OR = 1.5, 95% CI = 1.2-1.9; and OR = 1.8, 95% CI = 1.3-2.4, respectively). The following factors decreased the odds of inactivity: schools having one to two sport meetings per year (OR = 0.7, 95% CI = 0.5-1.0), availability of a play yard (OR = 0.7, 95% CI = 0.6-0.9), older age group (OR = 0.2, 95% CI = 0.1-0.2), and male gender (OR = 0.6, 95% CI = 0.5-0.7). In boys, transportation, school sport meeting, availability of game shop near by, family's economic status, parental body mass index status, and time spent watching television were strongly associated with physical inactivity. In girls, time spent for study after class was one of the most important factors related to students' physical inactivity.

CONCLUSIONS

Physical activity among adolescents in HCMC is related to household, school, and community factors. These factors and gender differences should be taken into account when promoting physical activity in adolescents.

Cumulative incidence trends of selected cancer sites in a Philippine population from 1983 to 2002: a joinpoint analysis

BACKGROUND

Few studies have investigated incidence trends in the Philippines.

METHODS

From the databases of the Manila Cancer Registry, cumulative cancer incidence rates were determined for the five most common cancers for both sexes combined. Using joinpoint analysis, incidence trends for 1983-2002 were estimated.

RESULTS

Among females, increasing trends were found for breast, 5% annual change, lung (0.5%) and colorectal (1.5%) cancers. Decreasing trends were found for cancers of the liver (-1.2%) and cervix (-1.9%). Among males, increasing trends were found for lung cancer (0.5%), whereas liver cancer rates have been decreasing (-1.0%). Colorectal cancer rates fluctuated.

CONCLUSION

Certain sites showed declining incidence trends, but incidence trends for lifestyle-related cancers continue to rise. The prevention of infection-related cancers should also receive priority, particularly by vaccination programmes.

Sustained active transportation is associated with a favorable body mass index trajectory across the early school years: findings from the Quebec Longitudinal Study of Child Development birth cohort

OBJECTIVE

To determine the extent to which active transportation (AT) to and from school is associated with changes in body mass index (BMI) from kindergarten (6-year-olds) through grade 2 (8-year-olds).

METHODS

The sample included 1170 children (50.4% of baseline participants) who were part of the Quebec Longitudinal Study of Child Development (QLSCD), a birth cohort established in 1998 in Quebec, Canada. Data were collected by trained interviewers using structured interviews and measuring height and weight in the home with the person most knowledgeable about the child's health. Relative weight was operationalized as age- and sex-adjusted BMI Z-scores.

RESULTS

Growth curve analyses showed that using AT to and from school both when in kindergarten and in grade 1 was predictive of a lower BMI Z-score (coeff=-0.18, SE=0.09, p=0.05) in grade 1. Using AT to and from school in kindergarten, grade 1, and grade 2 was predictive of a lower BMI Z-score (coeff=-0.30, SE=0.098, p=0.003) in grade 2. No other covariates were predictive of relative weight across time, although having an overweight or obese mother was associated with a BMI Z-score of 0.39 (SE=0.07, p<0.001) across all time points.

CONCLUSION

Sustained AT is associated with more healthful trajectories of BMI across the early school years.

Physical activity pattern of prepubescent Filipino school children during school days

BACKGROUND

Little is known about pre-pubescent Filipino children's involvement in moderate-to-vigorous physical activity (MVPA). There are international guidelines regarding required levels of MVPA for healthy children.

METHODS

This study describes participation of 11- to 12-year-olds in randomly selected public and private schools in San Juan, Metromanila, in MVPA and sports during a school day. The Filipino-modified Physical Activity Questionnaire for Older Children (F_PAQ_C) was administered in English and Filipino. Additional data was collected on sex, age, type of school, and amount of time spent using television and computers. Children's self-assessment of physical activities (1 question in the F_PAQ_C) was correlated with their cumulative F_PAQ_C score.

RESULTS

Three hundred eighty subjects (167 boys, 213 girls) participated. Participation in MVPA varied between sex and age groups, from 56.1% to 65.0%. Fewer than 10% of participants were very active. The children were more active during physical education classes than at recess or lunch, after class, or in the evening. Walking for exercise, jumping, jogging and running, free play, and dance were most common. Boys, younger children, and private school students most commonly engaged in MVPA. Self-assessed physical activity had modest correlation (r(2)= 0.21) with cumulative F_PAQ_C score, after adjusting for sex, age, and school type.

CONCLUSION

Most children were not physically active during the school day, except in physical education classes. To reduce the gap between recommended and current activity levels, more opportunities should be provided for preteen Filipino children to engage in MVPA during and after school.

Historical cohort studies and the early origins of disease hypothesis: making sense of the evidence

The hypothesis that early-life growth patterns contribute to non-communicable diseases initially emerged from historical cohort studies, consistently associating low birth weight and infant weight gain with later disease risk. Cohort studies offer crucial life-course data on disease aetiology, but also suffer from important limitations, including the difficulty of adjusting for confounding factors and the challenge of interpreting data on early growth. Prospective randomised trials of infant diet appear to provide evidence in direct contradiction to cohort studies, associating faster early growth with disease risk. The present article attempts to resolve this contradiction on two grounds. First, insufficient attention has been directed to inconsistency of outcomes between cohort studies and prospective trials. Cohort studies can assess actual mortality, whereas prospective trials investigate proxies for disease risk. These proxies are often aspects of phenotype that reflect the ‘normalisation’ of metabolism in response to growth, and not all those displaying normalisation in adolescence and early adulthood may go on to develop disease. Second, a distinction is made between ‘metabolic capacity’, defined as organ development that occurs in early life, and ‘metabolic load’, which is imposed by subsequent growth. Disease risk is predicted to be greatest when there is extreme disparity between metabolic capacity and metabolic load. Whereas cohort studies link disease risk with poor metabolic capacity, prospective trials link it with increased metabolic load. Infancy is a developmental period in which nutrition can affect both metabolic capacity and metabolic load; this factor accounts for reported associations of both slow and fast infant growth with greater disease risk.

Walking and Bicycling to School: A Review

Walking and bicycling (active commuting) to school has been proposed as a strategy for increasing youth physical activity and decreasing the prevalence of overweight. Citations for this review were retrieved through PubMed, Transport, ERIC, and ISI database searches using relevant keywords (1975 to March 2007), government and organization Web sites, and bibliographic citations. This review presents (1) prevalence estimates for active commuting to school; (2) the correlates of active commuting to school, presented using a new conceptual framework; (3) the associations between active commuting to school and health (ie, physical activity, weight status, environmental); and (4) a summary of the findings and recommendations for further research. Considerable heterogeneity exists among the reviewed studies for sample size and demographics, the methods used to measure active commuting, and the definition used to identify a positive case (active commuter). In general, active commuting to school is much less prevalent in the United States compared with European countries. A wide range of correlates of active commuting to school have been studied (individual to policy level). Active commuters tend to be more active than nonactive commuters, although no difference in weight status was observed in most studies. More research is needed to corroborate these findings and build on the knowledge base so that effective walk-to-school interventions can be implemented independently or as part of other health promotion efforts, including physician counseling for physical activity.

Patterns of physical activity and overweight among 7-13-year-old Russian children: a 7-year nationally representative monitoring study

This is a repeated cross-sectional study of overweight and physical activity (PA) and inactivity patterns of successive samples of 7-13-year-old Russian children who were surveyed six times between 1995 and 2002 as part of the Russian Longitudinal Monitoring Survey. This analysis focused on moderate/vigorous (MOD/VIG) PA (e.g., active commuting to school, during school MOD/VIG PA as part of physical education classes, and/or before/after school MOD/VIG PA) and inactivity patterns (e.g, television viewing habits) obtained through parent proxy-reports of 3,507 boys (M age = 10.1 years, SD = 2.0; body mass index = 17.5 kg/m2, SD = 3.0) and 3,273 girls (M age = 10.1 years, SD = 2.0; body mass index = 17.2 kg/m2, SD = 3.0). Time spent in MOD/VIG PA appears to be on the rise, while the proportion of those actively commuting to school is decreasing, especially among girls.

Validity and reliability of a school travel survey

BACKGROUND

Despite the growing interest in active (ie, nonmotorized) travel to and from school, few studies have explored the measurement properties to assess active travel. We evaluated the criterion validity and test-retest reliability of a questionnaire with a sample of young schoolchildren to assess travel to and from school, including mode, travel companion, and destination after school.

METHODS

To assess test-retest reliability, 54 children age 8 to 11 years completed a travel survey on 2 consecutive school days. To assess criterion validity, 28 children age 8 to 10 years and their parents completed a travel survey on 5 consecutive weekdays.

RESULTS

Test-retest reliability of all questions indicated substantial agreement. The questions on mode of transport, where you will go after school, and how you will get there also displayed substantial agreement between parental and child reports.

CONCLUSIONS

For this population, a questionnaire completed by school-age children to assess travel to and from school, including mode, travel companion, and destination after school, was reliably collected and indicated validity for most items when compared with parental reports.

Measurement of television viewing in children and adolescents: a systematic review

The relationship between television (TV) viewing and overweight in children is likely to be influenced by the quality of measures used. We systematically reviewed studies related to overweight in children that had included a measure of TV exposure. Literature searches were conducted in MedLINE, PsychInfo, SportDiscus and ISIWeb of Science. Methods of assessing TV viewing were evaluated, including the type of measure, the administration procedure and reported psychometric properties. The majority of studies assessed TV viewing using self-report surveys and very few studies used direct observation. The validity or reliability of measures was often not examined. The majority of tools that were evaluated were compared with another self-report measure or an objective measure of physical activity. TV viewing measures should be selected that are specific to the research question, the study design, as well as methodological feasibility. However, it is recommended that measures of TV viewing be used only if they have psychometric data to support their validity and reliability. Selecting measures that are valid and reliable enables us to examine with greater accuracy the influence of TV viewing on childhood overweight, as well as the efficacy of interventions designed to reduce TV viewing in children.

Cross-sectional comparison of physical activity and inactivity patterns in Chinese and Filipino youth

BACKGROUND

To compare and contrast youth physical activity (PA) and inactivity patterns in two developing Asian countries: the Philippines and China.

METHODS

Comparative analysis of 1997-1999 Cebu Longitudinal Health and Nutrition Survey and the 1997 China Health and Nutrition Survey, large-scale surveys that included questions on type, frequency and duration of: commuting mode to school, sports/exercise in and outside of school, select sedentary activities and chores.

RESULTS

Filipino data included 760 males and 872 females aged 14-16 years. The comparable Chinese sample consisted of 202 males and 197 females. Active commuting is proportionately high in both countries (70-71% in the Philippines vs. 77-90% in China), although commuting by bicycling is rare in the Philippines (<1%) vs. China ( approximately 35%). Patterns of school sport/exercise participation differ between countries by gender; more Filipino males report school sport/exercise than females (63 vs. 49%) vs. China, where more females participate than males (75 vs. 69%). Sport/exercise outside of school is proportionately low (6-12%) for youth from both countries with a single exception: 74% of Filipino males participate in extra-curricular sport/exercise. Although a higher percentage of Filipino youth report watching television >4 h/day (<10%) vs. Chinese youth (<1%), both are lower than comparable US reports.

CONCLUSION

In the Philippines, continued modernization augurs a decrease in local primary PA sources (chores and active commuting). In China, where youth already are not expected to perform chores, shifts to more passive commuting modes (i.e. increased motorized transportation) are anticipated.

Obesity Increases Metabolic Syndrome Risk Factors in School-Aged Children from an Urban School in Mexico City

OBJECTIVE

To characterize the nutritional status of school-aged children from an urban public school in Mexico City, Mexico, and to assess the influence of obesity on health status in a subgroup of these children.

DESIGN

Cross-sectional descriptive study. A nutrition screening was done for all children, including anthropometric (ie, weight, height, and waist circumference) and blood pressure assessment. In the subgroup of children, complementary dietary and biochemical assessment (ie, glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, insulin, albumin, hemoglobin, and hematocrit levels) was done.

SUBJECTS

Children from an urban school in Mexico City (N=561) aged 6 to 13 years. The representative subgroup (n=88) was selected based on age (9 to 12 years) and weight status (ie, normal, overweight, or obese).

STATISTICAL ANALYSIS

Descriptive statistics, correlations, mean differences tests (analysis of variance, Kruskal-Wallis and Mann-Whitney U), and chi(2) tests (categorical variables) were done with SPSS version 13 (2005, SPSS Inc, Chicago, IL).

RESULTS

In the whole school, overweight and obesity prevalence were 27.1% and 21.4%, respectively. High systolic blood pressure was seen in 8.4% of children and 6.2% of children had prehypertension. Higher hypertension risk was seen in children with body mass index > or =95th percentile and waist circumference > or =90th percentile (88 cm). Significantly higher waist circumference, systolic blood pressure, insulin resistance indexes, and triglyceride levels were found among the obese when compared with normal-weight children.

CONCLUSIONS

Childhood obesity prevalence is high in Mexico and it is having an influence on children's health. It is urgent to design, implement, and evaluate specific childhood obesity prevention programs.

Physical activity and associated socio-demographic factors among school adolescents in Jiangsu Province, China

BACKGROUND

Obesity prevalence is increasing among adolescents in China, especially in urban areas and among higher socio-economic strata. Physical inactivity may be one of the causes. We examined socio-demographic differences in physical activity among school adolescents in Jiangsu Province.

METHODS

In 2002, 824 adolescents (12-14 years) in 8 schools filled in a self administered questionnaire on physical activity, sedentary behaviors and socio-demographic characteristics. RESULTS.: In girls, low SES elicited the highest physical activity score, mainly derived from housework. More boys (49.1%) than girls (41%) had vigorous physical activity (VPA) >or=3 times/week. Associations between VPA and residence, age, SES were not significant. 88% of the adolescents were actively commuting to schools. Boys with high SES or high education fathers had the lowest percentage walking to school. The students spent daily on average 10.8 h on studying, however, little time was spent on watching TV or playing PC games.

CONCLUSIONS

Active commuting to school was common among the adolescents. However, the sedentary activity level is high. Physical activity was negatively associated with SES.

Barriers to and Facilitators of Walking and Bicycling to School: Formative Results From the Non-Motorized Travel Study

Barriers to and facilitators of walking and bicycling to school were explored through 12 focus groups made up of fourth- and fifth-grade students and their parents who lived near their respective schools. The barriers and facilitators reported by parents and children generally fell into one of three categories: intrapersonal and interpersonal characteristics of parents and children, environmental characteristics of the neighborhood, and environmental and policy characteristics of the school. Findings indicate that a supportive environment is a necessary but insufficient condition to increase walking and biking to school. Initiatives to increase active school travel may need to include multiple levels of intervention to be effective.

Validating MOSPA questionnaire for measuring physical activity in Pakistani women

BACKGROUND

Precise measurements of activity at a population level are important for monitoring trends and evaluating health promotion strategies. Few studies have assessed the measurement of physical activity in developing countries. The aim of this study was to validate the MOSPA (Monica Optional Study of Physical Activity) questionnaire which was developed for the WHO-Monitoring trends and determinants of cardiovasculr disease (MONICA) study sites.

METHODS

The MOSPA questionnaire assesses energy expendtiture (EE) related to physical activity (employment, household work, transportation, and leisure time) over a one year period. This questionnaire has been described in the manuscript as the long term (LT) questionnaire. An adapted short term (ST) 5 day questionnaire was developed to assess convergent validity. Questionnaire data were compared with physical activity EE estimates from a Caltrac accelerometer and with body composition measures (height, weight and bioelectrical impedance) in 50 women from the Aga Khan University (AKU) hospital antenatal clinics, Pakistan. Other forms of EE i.e. resting EE and thermic effect of food were not assessd in this study.

RESULTS

Subjects were aged 26 +/- 3.8 years and were 16.1 +/- 6.7 weeks pregnant. Their average weight was 58.8 +/- 10.7 Kg. The average EE/day assessed by the Caltrac accelerometer, was 224 kcal and by MOSPA LT questionnaire it was 404 kcal. The questionnaires and Caltrac data were reasonably well correlated: r = 0.51 and r = 0.60 (P < 0.01) for LT and ST questionnaires respectively. Energy expenditure from questionnaire data was not correlated with body composition measures.

CONCLUSION

The MOSPA questionnaire is useful in assessing physical activity levels in a sedentary population over a one year period.

Accelerometer data reduction: a comparison of four reduction algorithms on select outcome variables

PURPOSE

Accelerometers are recognized as a valid and objective tool to assess free-living physical activity. Despite the widespread use of accelerometers, there is no standardized way to process and summarize data from them, which limits our ability to compare results across studies. This paper a) reviews decision rules researchers have used in the past, b) compares the impact of using different decision rules on a common data set, and c) identifies issues to consider for accelerometer data reduction.

METHODS

The methods sections of studies published in 2003 and 2004 were reviewed to determine what decision rules previous researchers have used to identify wearing period, minimal wear requirement for a valid day, spurious data, number of days used to calculate the outcome variables, and extract bouts of moderate to vigorous physical activity (MVPA). For this study, four data reduction algorithms that employ different decision rules were used to analyze the same data set.

RESULTS

The review showed that among studies that reported their decision rules, much variability was observed. Overall, the analyses suggested that using different algorithms impacted several important outcome variables. The most stringent algorithm yielded significantly lower wearing time, the lowest activity counts per minute and counts per day, and fewer minutes of MVPA per day. An exploratory sensitivity analysis revealed that the most stringent inclusion criterion had an impact on sample size and wearing time, which in turn affected many outcome variables.

CONCLUSIONS

These findings suggest that the decision rules employed to process accelerometer data have a significant impact on important outcome variables. Until guidelines are developed, it will remain difficult to compare findings across studies.

Health and road transport in Pakistan

OBJECTIVE

The 1998 Global Burden of Disease Study estimated that road traffic injuries (RTIs) will become the third leading cause of lost disability-adjusted life years, with two-thirds of the deaths occurring in the least developed nations. Moreover, automobile-based transport systems are associated with air pollution (lead toxicity, asthma and greenhouse gas accumulation), noise disturbances, physical inactivity and obesity.

STUDY DESIGN

This study (1) reviewed road transport literature in Pakistan and the impacts on health outcomes; (2) examined health policies to assess their focus on transport-related health problems; and (3) identified policy gaps for future research.

METHODS

A methodological review of the literature on direct and indirect effects of road transportation in Pakistan. This review includes government documents, memos, statements and draft policies as well as relevant articles indexed in MEDLINE.

RESULTS

A systematic review revealed no approved transport policy in Pakistan, despite three national health policy documents. The Health Chapter of the 9th Five Year Plan appreciates the grave threat of unchecked RTI, but fails to offer specific policy interventions. Despite ambitious plans by the Pakistan Environmental Protection Agency, actual projects and their implementation remain scarce, resulting in ever-increasing air pollution. The health impact of lead toxicity, noise pollution and RTIs remain high, while obesity is on the rise.

CONCLUSION

The increasing health impact of road transport on 140 million people calls for immediate policy action. Government agencies must intervene effectively to establish monitoring and decentralised enforcement nationwide, while simultaneously supporting alternative modes of transportation.

Active commuting to school among NSW primary school children: implications for public health

Regular active commuting by walking/cycling can help maintain an active lifestyle. The frequency, duration and correlates of school active commuting were examined for primary school children in NSW, Australia. Walking/cycling-only and in combination with bus/car were of short duration (median 7 or 4 min, respectively) and their frequency dropped within a short distance (>0.75 km) from school. Apart from distance, child's age, school affiliation and perceived safety, regular walking/cycling (10 trips, 22%) was associated with parents' travel mode to work and with father taking the child to school. Frequent walking/cycling (5 trips, 37%) was associated with child's level of independence and the perceived benefits of active commuting. Behaviour change in this setting requires multi-level strategies.

Patterns of walking for transport and exercise: a novel application of time use data

Background

Walking for exercise is a purposeful or structured activity that can be captured relatively easily in surveys focused on leisure time activity. In contrast, walking for transport is an incidental activity that is likely to be missed using these same assessment approaches. Therefore, the purpose of this analysis was to utilize 1997 Australian Bureau of Statistics (ABS) Time Use Survey diary data to describe nationally representative patterns of walking for transport and for exercise.

Methods

Household members ≥ 15 years of age were recruited from over 4,550 randomly selected private dwellings in Australia. Time use diaries were collected for two designated days during all four seasons over the calendar year. 3,471 males and 3,776 females (94% household response rate and 84% person response rate) provided 14,315 diary days of data. The raw diary data were coded and summarized into bouts and minutes that included walking for transport and for exercise.

Results

Walking for transport was indicated on a higher proportion of days compared to walking for exercise (20 vs. 9%). Based on participant sub-samples ('doers'; those actually performing the activity) walking for transport was performed over 2.3 ± 1.4 bouts/day (12.5 minutes/bout) for a total of ≈28 mins/day and walking for exercise over 1.2 ± 0.5 bouts/day (47 minutes/bout) for a total of ≈56 mins/day.

Conclusion

Although walking for transport is typically undertaken in multiple brief bouts, accumulated durations approximate public health guidelines for those who report any walking for transport.

The nutrition transition: worldwide obesity dynamics and their determinants

OBJECTIVE

This paper explores the major changes in diet and physical activity patterns around the world and focuses on shifts in obesity.

DESIGN

Review of results focusing on large-scale surveys and nationally representative studies of diet, activity, and obesity among adults and children.

SUBJECTS

Youth and adults from a range of countries around the world.

MEASUREMENTS

The International Obesity Task Force guidelines for defining overweight and obesity are used for youth and the body mass index > or =25 kg/m(2) and 30 cutoffs are used, respectively, for adults.

RESULTS

The nutrition transition patterns are examined from the time period termed the receding famine pattern to one dominated by nutrition-related noncommunicable diseases (NR-NCDs). The speed of dietary and activity pattern shifts is great, particularly in the developing world, resulting in major shifts in obesity on a worldwide basis. Data limitations force us to examine data on obesity trends in adults to provide a broader sense of changes in obesity over time, and then to examine the relatively fewer studies on youth. Specifically, this work provides a sense of change both in the United States, Europe, and the lower- and middle-income countries of Asia, Africa, the Middle East, and Latin America.

CONCLUSION

The paper shows that changes are occurring at great speed and at earlier stages of the economic and social development of each country. The burden of obesity is shifting towards the poor.

Physical activity and levels of inactivity in adolescent females ages 11-16 years in the United Arab Emirates

The purpose of this study was to investigate patterns of physical activity and levels of inactivity in adolescent females in the United Arab Emirates (UAE). A total of 58 adolescent females, age 11-16 years, were recruited from two female-only governmental schools in Abu-Dhabi. Subjects were divided into two groups: 11-13 years (n = 22) and 14-16 years (n = 36). Physical activity patterns were determined from a 3-day activity diary. Total energy expenditure (TEE) was estimated using a factorial approach. The amount of physical activity was expressed as the physical activity level (PAL) and the activity-related energy expenditure (AEE). The number of hours spent watching television was estimated from the activity diaries. There were no significant differences in the energy expenditure parameters between age groups or between schooldays and weekends. PAL was low in both age groups. Television was the predominant leisure time pursuit. The number of hours per day spent watching television (median and interquartile range) was 2.5 (2.3-3.1) in 11-13 years and 2.5 (2.3-2.8) in 14-16 years. Television-watching was significantly higher during the weekend than schooldays: 11-13 years (P = 0.006) and 14-16 years (P < 0.001). In conclusion, the amount of physical activity undertaken by adolescent females in the UAE was very low. Cultural and weather restrictions and social change of the community in the UAE are not conducive to physical activity and play a major role in levels of physical inactivity. This may explain, in part, the rise in the incidence of obesity in this population.

Physical activity and inactivity in Chinese school-aged youth: the China Health and Nutrition Survey

OBJECTIVE

To describe physical activity (PA) and inactivity levels and patterns in Chinese school children (aged 6-18 y).

DESIGN

PA and inactivity were assessed in a youth cohort enrolled in the China Health and Nutrition Survey (CHNS) in 1997.

SUBJECTS

A total of 1423 males (11.5+/-3.2 y) and 1252 females (11.5+/-3.3 y).

MEASUREMENTS

PA and inactivity were assessed by self-reported usual activity (questionnaire). Children under 10 y were assisted by parents.

RESULTS

Approximately 84% of Chinese youth actively commute to school for a median of 100-150 min/week. A total of 72% engage in in-school moderate/vigorous (MOD/VIG) PA for a median of 90-110 min/week. Relatively few children ( approximately 8%) participate in any MOD/VIG PA outside of school. A total of 72% engage in study-related activities outside of school for a median of 420 min/week. Only 8% of Chinese school children, regardless of gender, watch television > or =2 h/day; less than 1% watch > or =4 h/day. Chores related to housework are not a part of life for Chinese school children; fewer than 20% performed these tasks.

CONCLUSION

Chinese youth are unique compared to those in other developing countries because they do not perform household chores. Instead, they are under pressure to achieve scholastically. Participation in MOD/VIG PA outside of school is almost nonexistent. Current television watching habits are relatively low compared to developed countries and walking/biking is a common form of commuting. The descriptive analysis herein represents the foundation upon which future longitudinal studies of PA in this population will be based.