Comparison of four habitual physical activity questionnaires in girls aged 7-15 yr

The impact of the coronavirus disease 2019 pandemic on physical activity in U.S. children

BACKGROUND

Daily moderate-to-vigorous physical activity (MVPA) is vital to the physical, mental, and social well-being of children. Early restrictions during the coronavirus disease 2019 (COVID-19) pandemic included the closure of schools and physical activity (PA) amenities across the US. This study aimed to examine the impact of the pandemic on the PA and play behavior of U.S. children and to provide evidence-based recommendations to improve their PA.

METHODS

A cross-sectional, online, parent-reported survey was conducted of children aged 3-18 years between April and June 2020 to assess light PA and MVPA using a modified Godin Leisure-Time Exercise Questionnaire. Additional items included family/child socioeconomic demographics, child adaptability to the pandemic, and community access. The survey was shared through social media and snowball sampling distribution.

RESULTS

Analysis of 1310 surveys indicated child PA scores declined significantly during the pandemic (from 56.6 to 44.6, max 119, p < 0.001). Specifically, MVPA score decreased (from 46.7 to 34.7, max 98, p < 0.001) while light PA remained the same. Age-based changes were seen in the quantity, variety, and intensity of PA, with the lowest pandemic-related impact seen in preschoolers and the highest in high schoolers (-4.7 vs. -17.2, p < 0.001). Community-based peer PA decreased across all age groups.

CONCLUSION

This study shows decreased PA levels in U.S. children, according to parent reporting, during the COVID-19 pandemic. Recommendations for community leaders, educators, and parents to improve PA in children are provided. With continued spread of COVID-19, these results and recommendations may be imperative to the physical well-being of U.S. children.

Cultivation and Enabling Effects of Social Support and Self-Efficacy in Parent-Child Dyads

Background

There are two alternative mechanisms, elucidating the reciprocal relationship between self-efficacy and social support when explaining health outcomes: self-efficacy beliefs may operate as the establisher of social support (the cultivation model) or social support may enable the formation of self-efficacy beliefs (the enabling model).

Purpose

In line with the cultivation hypothesis, it was tested if self-efficacy (measured in parents and children) would indirectly predict parental and child moderate-to-vigorous physical activity (MVPA), via the mediator, social support (parent-provided, child-received). In line with the enabling hypothesis, it was tested if social support would predict MVPA indirectly, via the mediator, self-efficacy.

Methods

A total of 879 parent–child dyads (1758 individuals; 52.4% girls, aged 5–11 years old, 83.2% mothers) provided self-reports at the baseline (T1) and the 7- to 8-month follow-up (T2). Body weight and height were measured objectively. Manifest path analyses were performed, controlling for the baseline levels of the mediator and dependent variables.

Results

A similar number of significant simple indirect effects was found for the cultivation and the enabling model. Across the models, the indirect effects followed similar patterns: (a) within-individual indirect effects in children; (b) across-individual indirect effects, with the independent variable measured in children and the mediator/dependent variables measured in parents (e.g., child self-efficacy predicted parental support provision and, indirectly, parental MVPA); (c) across-individual indirect effects, accounting for self-efficacy and MVPA measured in children, combined with parental reports of social support.

Conclusions

The findings provide support for both cultivation and enabling models in the context of MVPA among parent–child dyads.

Development of Brief Child Nutrition and Physical Activity Screening Questions for Electronic Health Record Use

Background: To develop and test brief nutrition and physical activity screening questions for children ages 2-11 years that could be used as a pragmatic screening tool to tailor counseling, track behavior change, and improve population health. Methods: A literature review identified existing validated questions for nutrition and physical activity behaviors in children ages 2-11 years. Response variation and concurrent validity was then assessed using a mechanical Turk (MTurk) crowdsourcing survey employed in 2018. Additionally, cognitive interviews were conducted with both providers and parents of 2- to 11-year-old children to assess screening question priorities and perceived added value. Results: The literature review identified 260 questions, and 20 items were selected with expert guidance based on prespecified criteria (simplicity and potential utility for both clinical interactions during a well-child exam and population health). MTurk surveys yielded 1147 records that met eligibility criteria and revealed 6 items that had adequate response variation and were significantly correlated with parent-reported child BMI or BMI percentile, exhibiting concurrent validity. Cognitive interviews with 10 providers and 20 parents uncovered themes regarding suggestions and usability of the questions, eliminating 3 items due to parent and provider concerns. Combining quantitative and qualitative results, 3 nutrition and physical activity screening items remained for inclusion into the electronic health record (EHR). Conclusions: The three-pronged validation methodology produced a brief, 3-item child nutrition and physical activity screener to incorporate in the EHR, where it can inform tailored counseling for well-child care and be used to test associations with population health outcomes.

Physical Activity Assessment and Counseling in Pediatric Clinical Settings

Physical activity plays an important role in children's cardiovascular health, musculoskeletal health, mental and behavioral health, and physical, social, and cognitive development. Despite the importance in children's lives, pediatricians are unfamiliar with assessment and guidance regarding physical activity in children. With the release of the 2018 Physical Activity Guidelines by the US Department of Health and Human Services, pediatricians play a critical role in encouraging physical activity in children through assessing physical activity and physical literacy; providing guidance toward meeting recommendations by children and their families; advocating for opportunities for physical activity for all children in schools, communities, and hospitals; setting an example and remaining physically active personally; advocating for the use of assessment tools and insurance coverage of physical activity and physical literacy screening; and incorporating physical activity assessment and prescription in medical school curricula.

Parental Depression Predicts Child Body Mass via Parental Support Provision, Child Support Receipt, and Child Physical Activity: Findings From Parent/Caregiver-Child Dyads

Objective

Although there is substantial evidence corroborating the within-individual associations between depression, social support, moderate-to-vigorous physical activity (MVPA), and body mass, much less is known about across-individual associations. This study investigated the indirect associations between parental depression and objectively measured body mass in children. In particular, it was hypothesized that higher levels of parental depression (measured at Time 1, T1) would explain higher levels of child body mass in children (assessed at Time 2, T2), via three mediators, namely parental reports of provision of MVPA support (T1), child reports of receipt of MVPA support (T1), and child MVPA (T2).

Design:

Parent–child dyads provided self-reports twice, at baseline (T1) and 7- to 8-month follow-up (T2). A total of 879 dyads were enrolled (1,758 individuals; 5- to 11-year-old children, 52.4% girls, 83.2% mothers). Body weight and height were measured objectively. Manifest path analyses were performed to test the indirect effects.

Results

Analyses corroborated the assumed indirect effects: high levels of depression in parents (T1) were indirectly associated with high levels of body mass in children (T2), via three mediators: low levels of parental support provision (T1), low levels of child support receipt (T1), and low levels of child MVPA (T2). The alternative models assuming that either parental support provision or child support receipt can be excluded as the mediators yelded a poor model-data fit. The hypothesized mediation effects were corroborated when controlling for the baseline levels of parental and child MVPA and body mass.

Conclusion

The findings confirm complex across-individual effects of parental depression on high levels of body mass in children. Parental mental health may contribute to the childhood obesity epidemic.

Maternal practices and perceptions of child body mass status explain child energy expenditure behaviors and body mass

This study investigated whether maternal perceptions of child body mass status would predict child body mass index (BMI) z-score via two sets of sequential mediators: (1) four maternal practices promoting child energy expenditure and (2) children’s energy expenditure behaviors. The data of N = 729 mother–child dyads were collected at baseline [T1; n = 495 at 7- to 8-month follow-up (T2)]. Mothers reported perceptions of child body mass status and maternal practices (T1); children reported sedentary screen use and physical activity (T1, T2). Child body mass was assessed objectively (T1, T2). Higher stimulation to be active (T1) was related to a lower child BMI z-score (T2) via higher levels of child physical activity (T2). Higher levels of monitoring of screen use (T1) were associated with higher child BMI z-score (T2) via lower levels of child physical activity (T2). Encouraging parents to stimulate their children to be active may be beneficial for children’s weight maintenance.

Effect of late preterm birth on lung clearance index and respiratory physiology in school-age children

BACKGROUND

We hypothesized that former late preterm (LP) children have abnormal pulmonary physiology parameters, including uneven ventilation distribution, due to premature disruption of normal lung development.

METHODS

A cross-sectional study evaluating former LP children at the age of 6 to 12 years as compared to term controls. Demographics and child's and family history of asthma/atopy/smoking were recorded. The outcome parameters were spirometry, multiple breath washout (MBW) measurement by lung clearance index (LCI), 6-minute walk test (6MWT), symptoms related to asthma and allergy, and Godin Leisure-Time Exercise Questionnaire.

RESULTS

Twenty-nine former LP were compared to 30 term-control children (mean age, 8.2 ± 1.7 and 8.8 ± 1.8 years, respectively). LP had reduced forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) compared to term controls (FEV1 1.59 ± 0.48 vs 1.80 ± 0.39 L, P = 0.005 and FVC 1.73 ± 0.45 vs 1.99 ± 0.49 L, P = 0.009). There were no differences between the two groups regarding FEV1/FVC, forced expiratory flow between 25 and 75 (FEF25-75), LCI (7.10 ± 0.79 vs 6.96 ± 0.75, P = 0.50), 6MW distance, and weekly leisure-activity score. Former LP children had more episodes of wheezing and greater use of asthma medication.

CONCLUSIONS

This pilot study suggests that LP have lower pulmonary function tests (PFTs) but not ventilation inhomogeneity measured by LCI or functional disturbance. It is unclear if the differences in PFTs are due to late prematurity by itself or are the consequence of maternal and neonatal factors associated with LP. Further larger studies are required to assess the long-term respiratory consequences of LP birth.

Perceptions of Physical Activity Promotion, Transportation Support, Physical Activity, and Body Mass: an Insight into Parent-Child Dyadic Processes

Background

Socio-ecological models indicate that family, school, and community environment explains children’s physical activity and body weight. This study investigated whether parental perceptions of school/community-based physical activity (PA) promotion programs as well as parental and child perceptions of parental instrumental support for child PA (transportation provision) would predict child body weight. Child moderate-to-vigorous physical activity (MVPA) was hypothesized to mediate these associations.

Method

Data of 879 parent-child dyads were collected at two measurement points: the baseline (T1) and the 7–8-month follow-up (T2). Parents were 23–68 years old (83.3% women), while children were 5–11 years old (52.4% girls). Parents and children reported their perceptions of environment, support (T1), and MVPA (T1, T2). Parental and child body weight and height were measured objectively (T1, T2).

Results

Path analyses indicated indirect effects of parental perceptions of school/community-based PA policies (T1) and parental perceptions of transportation provision (T1) on child body weight (T2), with child MVPA (T2) operating as the mediator. There were no direct or indirect effects of child perceptions of parental transportation provision (T1) on child MVPA or body weight (T2). Similar patterns of associations were found for the total sample and the subsample of children with overweight/obesity.

Conclusion

Parental perceptions of school/community-based PA policies and transportation provision may explain changes in child MVPA and body weight. Interventions aimed at prevention of child overweight/obesity may benefit from a focus on parental transportation provision to PA facilities and parental awareness of PA promotion at local environment.

Electronic supplementary material

The online version of this article (10.1007/s12529-019-09780-9) contains supplementary material, which is available to authorized users.

The Influence of a Prefabricated Foot Orthosis on Lower Extremity Mechanics During Running in Individuals With Varying Dynamic Foot Motion

Study Design Controlled laboratory study, cross-sectional. Background Orthotic prescription is often based on the premise that the mechanical effects will be more prominent in individuals with greater calcaneal eversion. Objective To compare the effects of a prefabricated foot orthosis on lower extremity kinematics and kinetics between recreational athletes with high and low calcaneal eversion during running. Methods Thirty-one recreational athletes were included in this study. Three-dimensional kinematic and kinetic data were collected while running with and without a foot orthosis. Participants were grouped based on the degree of calcaneal eversion during the running trials relative to a standing trial (dynamic foot motion). The effects of the orthosis on the frontal and transverse plane angles and moments of the hip and knee were compared between the 10 participants with the greatest and least amount of dynamic foot motion. Results There were no significant interactions (group by orthotic condition) for any of the kinematic or kinetic variables of interest. Conclusion The effects of an orthosis on the mechanics of the hip and knee do not appear to be dependent on an individual's dynamic foot motion. J Orthop Sports Phys Ther 2016;46(9):749-755. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6253.

Physical activity in pediatric onset multiple sclerosis: Validating a questionnaire for clinical practice and research

BACKGROUND

Knowledge regarding physical activity (PA) and its benefits in pediatric onset multiple sclerosis (POMS) is growing and suggests high levels of inactivity. The utility of a validated screening tool for clinical settings is unknown. This study evaluated the Godin Leisure-Time Exercise Questionnaire (GLTEQ) as a measure of PA in POMS.

METHODS

POMS patients (n=27) and healthy controls (n=45) wore an accelerometer over a 7-day period and then completed the GLTEQ.

RESULTS

The GLTEQ captured expected group differences in PA for vigorous, moderate, and moderate-to-vigorous physical activity (MVPA), confirmed by accelerometry. There was a large, positive correlation between GLTEQ and accelerometry scores for vigorous PA in POMS (r=0.736, p=0.001), and a nearly significant and moderate, positive correlation between MVPA scores (r=0.319, p=.053).

CONCLUSION

We provide evidence that supports the validity of GLTEQ scores as measures of vigorous and MVPA in POMS. Researchers and clinicians might adopt this scale for measuring PA.

Multilevel analyses of school and children's characteristics associated with physical activity

BACKGROUND

Children spend most of their awake time at school, and it is important to identify individual and school-level correlates of their physical activity (PA) levels. This study aimed to identify the between-school variability in Portuguese children PA and to investigate student and school PA correlates using multilevel modeling.

METHODS

The sample included 1075 Portuguese children of both sexes, aged 6-10 years, from 24 schools. Height and weight were measured and body mass index (BMI) was estimated. Physical activity was estimated using the Godin and Shephard questionnaire (total PA score was used); cardiorespiratory fitness was estimated with the 1-mile run/walk test. A structured inventory was used to access information about the school environment. A multilevel analysis (level-1: student-level; level-2: school-level) was used.

RESULTS

Student-level variables (age, sex, 1-mile run/walk test) explained 7% of the 64% variance fraction of the individual-level PA; however, school context explained approximately 36% of the total PA variance. Variables included in the model (school size, school setting, playground area, frequency and duration of physical education class, and qualification of physical education teacher) are responsible for 80% of the context variance.

CONCLUSIONS

School environment is an important correlate of PA among children, enhancing children's opportunities for being active and healthy.

Pressure pain sensitivity changes after use of shock-absorbing insoles among young soccer players training on artificial turf: a randomized controlled trial

STUDY DESIGN

Prospective, randomized, controlled single-blind intervention trial.

OBJECTIVES

Shock-absorbing insoles (SAIs), compared with usual insoles, were hypothesized to result in larger increases in pressure pain threshold (PPT) after 3 weeks of use.

BACKGROUND

Shock-absorbing insoles can decrease self-reported pain among young soccer players training on artificial turf. However, nothing is known about the underlying changes in pain sensitivity assessed by PPT. Methods Seventy-five players were included from the youth teams of under 15, under 17, and under 19 years of age, playing for the Aalborg Boldspilklub (AaB) professional sports club. After a randomization stratified by team and age, players were divided into 2 groups, one that received SAIs and a control group that used their usual insoles. Assessments were made in both groups after 3 weeks of training on artificial turf (baseline) and 3 weeks later (follow-up). The primary outcome was change in PPTs from baseline to follow-up, with PPTs measured over 13 locations on the plantar surface of the foot, leg, and low back of the nonpreferred kicking leg.

RESULTS

A significantly larger increase was found in PPTs from baseline to follow-up for the SAI group compared with the control group (mean difference, 62 kPa; 95% confidence interval [CI]: 40, 85 kPa). The PPTs increased significantly more among the SAI group compared with the control group (P<.05) for the abductor digiti minimi (mean difference, 82 kPa; 95% CI: 6, 157 kPa), tibialis anterior (mean difference, 125 kPa; 95% CI: 20, 230 kPa), medial gastrocnemius (mean difference, 83 kPa; 95% CI: -6, 171 kPa), and erector spinae (mean difference, 86 kPa; 95% CI: -17, 188 kPa).

CONCLUSION

The use of SAIs resulted in increased PPTs after 3 weeks of training on artificial turf compared with controls, suggesting a protective role of SAIs in pressure sensitivity and pain perception.

Practical physical activity measurement in youth: a review of contemporary approaches

BACKGROUND

The accurate evaluation of physical activity levels amongst youth is critical for quantifying physical activity behaviors and evaluating the effect of physical activity interventions. The purpose of this review is to evaluate contemporary approaches to physical activity evaluation amongst youth.

DATA SOURCES

The literature from a range of sources was reviewed and synthesized to provide an overview of contemporary approaches for measuring youth physical activity.

RESULTS

Five broad categories are described: self-report, instrumental movement detection, biological approaches, direct observation, and combined methods. Emerging technologies and priorities for future research are also identified.

CONCLUSIONS

There will always be a trade-off between accuracy and available resources when choosing the best approach for measuring physical activity amongst youth. Unfortunately, cost and logistical challenges may prohibit the use of "gold standard" physical activity measurement approaches such as doubly labelled water. Other objective methods such as heart rate monitoring, accelerometry, pedometry, indirect calorimetry, or a combination of measures have the potential to better capture the duration and intensity of physical activity, while self-reported measures are useful for capturing the type and context of activity.

Patellofemoral pain: proximal, distal, and local factors, 2nd International Research Retreat

Patellofemoral pain (PFP) is one of the most common lower extremity conditions seen in orthopaedic practice. The mission of the second International Patellofemoral Pain Research Retreat was to bring together scientists and clinicians from around the world who are conducting research aimed at understanding the factors that contribute to the development and, consequently, the treatment of PFP. The format of the 2.5-day retreat included 2 keynote presentations, interspersed with 6 podium and 4 poster sessions. An important element of the retreat was the development of consensus statements that summarized the state of the research in each of the 4 presentation categories. In this supplement, you will find the consensus documents from the meeting, as well as the keynote addresses, schedule, and platform and poster presentation abstracts.

[Validity and reliability of self-report instruments for measuring physical activity in adolescents: a systematic review]

This was a systematic review of studies on the reliability and validity of self-report instruments for measuring physical activity, or subjective measurements, in adolescents (10-18 years). Searches were conducted in databases (MEDLINE, PsycInfo, SportsDiscus, Scopus, Web of Science, SciELO, Lilacs) and in the references of the retrieved articles. Sixty-six studies met the inclusion criteria. The majority were from North America, with only 5 from Brazil. Fifty-two different instruments were identified: 42 questionnaires, 6 diaries or logs, and 4 interviews. "Test-retest" reliability varied from 0.20 to 0.98; the majority (28/50) of the coefficients showed values < 0.70. Validity coefficients showed wide variation (-0.13 to 0.88), with the majority (64/84) < or = 0.50. Only 3 instruments displayed correlations > or = 0.70. Various instruments were tested in adolescents, especially questionnaires. These instruments generally showed better "test-retest" reliability than validity.

Trajectories of pain in adolescents: a prospective cohort study

Identification of different patterns of change in pain over time - trajectories - has the potential to provide new information on the course of pain. Describing trajectories among adolescents would improve understanding of how pain conditions can develop. This prospective cohort study identified distinct trajectories of pain among adolescents (11-14 years) in the general population (n=1336). Latent class growth analysis was carried out on the self-reported frequency of back pain, headache, stomach pain and facial pain, which was collected every 3 months for 3 years. Forty four percent of adolescents had a 'painful' trajectory for at least one pain site, and 12% reported persistent pain at one or more pain site. Headache was the most common; 25% of subjects were in a 'painful' trajectory and 5% reported persistent pain. Back pain and stomach pain were also common, with 22% and 21% of subjects in painful trajectories, respectively. Facial pain was the least common, with only 10% in a painful trajectory, and 1% reporting persistent pain. Trajectory characteristics were similar at baseline across pain sites, with the more painful trajectories having significantly higher levels of depression and somatization, lower life satisfaction and more females. Trajectories did not differ significantly at baseline in physical activity levels or BMI. Agreement of trajectory membership among pain sites was moderate. In summary, reporting a painful trajectory was common among adolescents, but persistent pain was reported by a small minority, and was usually experienced at a single pain site.

Arterial distensibility is reduced in overweight pre- and early pubescent children

The objective of this study was to examine the differences in arterial distensibility between overweight/obese and normal weight pre- and early pubescent boys and girls. Arterial distensibility was measured in 65 children (43 normal weight and 22 overweight/obese) between the ages of 9 and 12 years. Weight classification was based on age and sex-specific body mass index (BMI) cut-offs and pubertal maturation by Tanner staging. Distensibility was determined using B-Mode echo-Doppler ultrasound to measure changes in the right common carotid artery (CCA) diameter, while carotid pulse pressure was measured at the left CCA by applanation tonometry. Accounting for age and sex (ANCOVA), CCA distensibility showed a significant difference (P < 0.05) between normal weight (0.79 +/- 0.21) and overweight children (0.61 +/- 0.21 mmHg(-1) x 10(-2)). Univariate analysis revealed that CCA distensibility was related to BMI, systolic blood pressure, brachial pulse pressure, and relative oxygen uptake (VO(2peak), milliliter per kilogram per minute). Multivariate analysis revealed that, when adjusting for brachial pulse pressure and relative VO(2peak), differences in CCA distensibility by BMI were no longer significant. This study demonstrates that attenuated arterial distensibility exists in overweight pre- and early pubescent children. As well, this study highlights the influential role of blood pressure and aerobic fitness on arterial distensibility.

Depressive symptoms in adolescence: the association with multiple health risk behaviors

OBJECTIVE

Although multiple studies of adolescents have examined the association of depression with individual health risk behaviors such as obesity or smoking, this is one of the few studies that examined the association between depression and multiple risk behaviors.

METHODS

A brief mail questionnaire, which screened for age, gender, weight, height, sedentary behaviors, physical activity, perception of general health, functional impairment and depressive symptoms, was completed by a sample of 2291 youth (60.7% response rate) aged 13-17 enrolled in a health care plan. A subset of youth who screened positive on the two-item depression screen and a random sample of those screening negative were approached to participate in a telephone interview with more in-depth information obtained on smoking and at-risk behaviors associated with drug and alcohol use.

RESULTS

Youth screening positive for high levels of depressive symptoms compared to those with few or no depressive symptoms were significantly more likely to meet criteria for obesity, had a poorer perception of health, spent more time on the computer, got along less well with parents and friends, had more problems completing school work and were more likely to have experimented with smoking and a wide array of behaviors associated with drug and alcohol use.

CONCLUSIONS

Because many adverse health behaviors that develop in adolescence continue into adulthood, the association of depressive symptoms with multiple risk behaviors and poor functioning suggest that early interventions are needed at an individual, school, community and primary care level.

Differences in left ventricular mass between overweight and normal-weight preadolescent children

This study examined cardiac and arterial differences between overweight and normal-weight preadolescent children. Twenty children (10.2 +/- 0.4 years of age) classified as overweight, on the basis of age-appropriate body mass index (BMI) cutoffs, were compared with 43 normal-weight controls. Height, mass, and body surface area were measured. Relative body fat and lean body mass were estimated from skinfold thickness. Each child's weekly physical activity metabolic equivalent (PAME) was calculated using a standardized questionnaire, and his or her sexual maturation was self-assessed using the Tanner scale. Peak aerobic power was assessed using a cycle ergometer and normalized to lean body mass. Mean arterial pressure was calculated from systolic and diastolic blood pressure (DBP) measurements taken with a Finapres. Cardiac dimensions were measured, using Mu-mode 2-dimensional echocardiography, and normalized to body surface area and height2.7. Left carotid artery pulse pressure (CaPP) was assessed with applanation tomometry. Overweight boys and girls had a higher left ventricular mass (LVM) and LVMHT2.7 than normal-weight boys and girls. CaPP was signficantly lower in the overweight than in the normal-weight groups, whereas PAME and relative peak aerobic power were significantly higher in the boys than the girls. Although overweight children had significantly higher stroke volumes and cardiac outputs than normal-weight children, ejection fraction was similar in the weight groups. Adjusted LVMHT2.7 was associated with cardiac volume measurements, BMI, and DBP in normal-weight children, whereas in the overweight children LVMHT2.7 did not significantly correlate with any variable. In conclusion, we found that cardiovascular adaptations can be seen in prepubescent overweight children as young as 10 years of age.

Predictors of onset of facial pain and temporomandibular disorders in early adolescence

There are few prospective studies assessing risk factors for onset of temporomandibular (TMD) pain disorders in any age group. The aim of this prospective cohort study was to identify risk factors for onset of clinically significant TMD pain (i.e., pain meeting research diagnostic criteria for myofascial pain and/or arthralgia) during early adolescence. Subjects were 1,996 boys and girls, initially 11 years old, randomly selected from a large nonprofit health care system. Subjects completed a baseline telephone interview and were followed up with mailed questionnaires every 3 months for 3 years. At baseline and all follow ups, subjects were asked to report the presence of facial pain in the past 3 months. Subjects reporting a first onset of facial pain received a standardized clinical examination. In multivariate analyses, baseline predictors of clinically significant pain included female gender [Odds Ratio (OR)=2.0, 95% Confidence Interval (CI)=1.2-3.3] and negative somatic and psychological symptoms including somatization (OR=1.8, CI=1.1-2.8), number of other pain complaints (OR=3.2, CI=1.7-6.1) and life dissatisfaction (OR=4.1, CI=1.9-9.0). Many of the risk factors for onset of clinically significant TMD pain in adolescents are similar to risk factors for onset of TMD and other pain problems in adults, as well as risk factors for onset of other pain conditions in adolescents. These findings suggest that the development of TMD pain in adolescence may reflect an underlying vulnerability to musculoskeletal pain that is not unique to the orofacial region.

Wise Mind project: a school-based environmental approach for preventing weight gain in children

OBJECTIVE

The Wise Mind pilot study compared the efficacy of an environmental approach for prevention of inappropriate weight gain in children with an active control condition that used an environmental approach for modifying expectancies related to the use of alcohol, tobacco, and drugs.

RESEARCH METHODS AND PROCEDURES

A total of 670 second to sixth grade students from four schools were enrolled in the study. The study spanned 2 academic years, and 586 students were available for evaluation at the end of the study. Two schools were randomly assigned to each treatment arm. The environmental approach for weight gain prevention focused on modification of eating habits and physical activity, and the active control group focused on modification of expectancies related to substance use.

RESULTS

Using an intention to treat design, the study found no differences in weight gain prevention between the two interventions. The weight gain prevention program was associated with reduction of total caloric intake, reduction of dietary fat intake, reduction of protein intake, and increased physical activity in comparison with the active control group and relative to baseline. These changes in food intake were attributed to changes in food selections that resulted from modification of school cafeteria menus and food preparation.

DISCUSSION

The Wise Mind school-based weight gain prevention program induced behavioral changes in healthy eating and physical activity but did not induce significant changes in body weight in comparison with the control arm. Recommendations for future research are provided.

Parents' perceptions of neighborhood safety and children's physical activity

OBJECTIVE

The obesity epidemic disproportionately affects minority and poor children. Negative perceptions of neighborhood safety in poor communities may affect overweight by inhibiting children's physical activity. This study investigates the degree to which parents in a poor inner city vs. a middle-class suburban community limit their children's outdoor activity because of neighborhood safety concerns.

METHOD

Parents of children aged 5-10 years from an inner city family practice in a poor community and from a suburban pediatric practice in a middle-class community completed a 20-item questionnaire. Parents estimated the amount of their child's activity in various situations and indicated their level of anxiety concerning gangs, child aggression, crime, traffic, and personal safety in their neighborhood.

RESULTS

Inner city children (n = 204) engaged in less physical activity than suburban children (N = 103) (P < 0.001). Inner city parents expressed much greater anxiety about neighborhood safety than suburban parents (P < 0.0001). In the inner city population, children's physical activity levels were negatively correlated with parental anxiety about neighborhood safety (r = -0.18, P < 0.05).

CONCLUSIONS

Inner city parents have high levels of anxiety about neighborhood safety. While these concerns may not entirely explain the discrepancy in activity levels between inner city and suburban children, a safe environment is crucial to increasing opportunities for physical activity.

Feasibility of using accelerometers to measure physical activity in young adolescents

PURPOSE

Accelerometers may provide valid measures of physical activity, but the feasibility of using accelerometers with large groups of children is unknown. We assessed feasibility in the Eating and Activity Survey Trial (Project EAST), a study designed to develop valid tools to assess eating and physical activity patterns among middle school children.

METHODS

Two hundred eighty-two Project EAST participants in grades 6-8 wore an accelerometer (Manufacturing Technologies, Inc., Fort Walton Beach, FL) for seven consecutive days. Multiple strategies were employed to encourage compliance and return of the accelerometer: 1) staff demonstrated how to wear the device properly; 2) students were given written and verbal instructions; 3) staff visited the students twice during 7 d to remind them to wear the devices and return them on time; and 4) movie tickets were given to students who returned the accelerometers on time.

RESULTS

Data from 27 accelerometers were lost as a result of mechanical and nontechnical problems, resulting in unusable data for 8.5% of students. Days of data for the remaining 255 students were considered incomplete if the accelerometer registered less than three consecutive waking hours of zero counts. The percentage of students with complete accelerometer data for 3-7 d of data were > or = 3 d, 92%; > or = 4 d, 86%; > or = 5 d, 75%; > or = 6 d, 67%; and 7 d, 50%. Twenty-eight students (10%) returned their accelerometers late. Overweight children were significantly more likely to have 7 d of complete data than nonoverweight children.

CONCLUSION

Our findings suggest that accelerometers are acceptable to most students. However, researchers working with middle school students should carefully monitor compliance to ensure that devices are worn properly and regularly.

Comparison of two approaches to structured physical activity surveys for adolescents

PURPOSE

To compare the test-retest reliability, convergent validity, and overall feasibility/ usability of activity-based (AB) and time-based (TB) approaches for obtaining self-reported moderate-to-vigorous physical activity (MVPA) from adolescents.

METHODS

Adolescents (206 females and 114 males) completed two 3-d physical activity recalls using the AB and TB surveys, which contained identical lists of physical activities. The participants wore an MTI Actigraph accelerometer for the same period.

RESULTS

The TB instrument took about 3 min longer to complete (P = 0.022). Overall 2-d test-retest correlations for MVPA were similar for the two surveys (r = 0.676 and 0.667), but the girls had higher reliability on the AB survey than the boys (girls: r = 0.713; boys: r = 0.568). The overall 3-d correlations for MVPA surveys and Actigraph counts varied by gender (girls: AB = 0.265 vs TB = 0.314; boys: AB = 0.340 vs TB = 0.277). Correlations for vigorous physical activity and Actigraph counts were higher for the AB than for the TB (r = 0.281 vs 0.162). As the interval between completing the surveys and the days being recalled increased, reliability and validity were lower, especially for the AB survey.

CONCLUSION

For both genders, either approach is acceptable for obtaining MVPA information on a single day, but the TB approach appears to be slightly favored over the AB approach for obtaining multiple days of MVPA. A 3-d recall period appears to be too long for accurate recall of MVPA information from either instrument. For both genders, the surveys overestimated activity levels; thus, self-reports should be supplemented with objective data.

Bilateral rearfoot asymmetry and anterior knee pain syndrome

STUDY DESIGN

Single-session observational study.

OBJECTIVES

To examine the magnitude and extent of asymmetry between right and left rearfoot angles in individuals who are asymptomatic versus symptomatic for anterior knee pain.

BACKGROUND

Asymmetry in lower limb measures has been linked to the occurrence of knee pathologies, yet the practice of deriving unilateral rather than bilateral data and thereafter averaging the findings may play a role in obscuring the true nature of the rearfoot angle-knee pain relationship.

METHODS AND MEASURES

A convenience sample of participants was recruited from the local university and business communities and a university-affiliated physiotherapy clinic. Eighty-on young adult males and females volunteered to participate in this study. Following an extensive screening process, including mandatory exclusion for a previous history of lower limb dysfunction or injury, data were collected from 75 individuals classified as asymptomatic (n = 50), unilaterally symptomatic (n = 11), or bilaterally symptomatic (n = 14) for anterior knee pain. Right and left rearfoot angles were goniometrically measured under static, weight-bearing conditions.

RESULTS

No significant differences in mean right and left rearfoot angles by group or limb were observed. However, these mean values did not always reflect the true variation of data within the sample. Fifty-six percent of the individuals studied demonstrated a minimum of 4 degrees bilateral rearfoot angle difference, while for 20% of the sample this difference exceeded 7 degrees. Only a we yet statistically significant correlation existed between right and left rearfoot angles (r = 0.31, P < 0.01).

CONCLUSIONS

Rearfoot angles in weight bearing are not bilaterally symmetric, and the magnitude and direction of the observed asymmetry does not appear to be indicative of whether an individual is asymptomatic or symptomatic for anterior knee pain.

Validation of the Godin-Shephard questionnaire in prepubertal girls

PURPOSE

This study was designed to provide validation of the Godin-Shephard questionnaire for the assessment of habitual activity in prepubertal children.

METHODS

Twenty-nine female competitive gymnasts and 32 recreational and nongymnasts, aged 7-11 yr, underwent multiple measures of physical activity over a 15 month period. The Godin-Shephard questionnaire (G-S) was completed once, in the middle of the study period. The Physical Activity Checklist Inventory (PACI) was completed 6 times, at intervals throughout the study, for 2 weekend days and 4 weekdays. Caltrac activity monitors (Hemokinetics, Madison, WI) were worn by each subject in two waves consisting of 2 weekdays and 1 weekend day each. Self-reported activity (h/wk) was recorded by the gymnasts in daily logs and for the nongymnasts through quarterly queries regarding participation in organized activities. A rank order was assigned to each subject for each tool. Spearman rank order correlations assessed the relationship between the G-S versus each measure and combination of measures. Subjects were also divided into gymnast and recreational/nongymnast groups, and alternately into 7-9 yr old and >or= 10 yr old groups, re-ranked and re-analyzed.

RESULTS

The average rank of combined PACI, Caltrac and h/wk scores showed only moderate correlation with ranked G-S scores for the overall group and for the 7-9 yr old subset, rho = 0.380 (P = 0.003) and rho = 0.422 (P = 0.043), respectively. The average rank of combined PACI and Caltrac scores also showed only moderate correlation with the ranked G-S scores for the gymnast subset, rho = 0.423 (P = 0.025). No measure or combination of measures correlated significantly with the ranked G-S scores for the >or= 10 yr old subset or the nongymnast subset.

CONCLUSION

Based upon comparison with multiple single day measures of activity, the G-S did not provide a good estimate of habitual activity in preadolescent females.

A cohort study of dietary fibre intake and menarche

OBJECTIVE

To evaluate the influence of dietary fibre on menarche in a cohort of pre-menarcheal girls.

DESIGN

Prospective cohort study.

SETTING

Ontario, Canada.

SUBJECTS

Free-living pre-menarcheal girls (n = 637), 6 to 14 years of age.

METHODOLOGY

Information on dietary intake, physical activity and date of menarche was collected at baseline and was updated annually by self-administered questionnaires for three years. Cox proportional hazards models were used to evaluate the association between dietary fibre and menarche, adjusting for age at entry to the study and potential confounders.

RESULTS

A higher intake of energy-adjusted dietary fibre was associated with a lower risk of (i.e. a later age at) menarche (relative hazard 0.54, 95% confidence interval (CI) 0.31-0.94 for highest vs. lowest quartile, P for trend = 0.027). At the fibre component level, a higher intake of energy-adjusted cellulose was associated with a lower risk of menarche (relative hazard 0.45, 95% CI 0.26-0.76, P for trend = 0.009).

CONCLUSIONS

The findings are consistent with the hypothesis that pre-menarcheal dietary intake can influence menarche.