Prevalence and socio-demographic correlates of the compliance with the physical activity guidelines in children and adolescents in Germany

Examining associations between physical activity context and children meeting daily physical activity guidelines: the role of outdoor play, sports, and other organized activities

Background

Less than one-quarter of US children meet physical activity (PA) guidelines. Understanding the context in which PA occurs and how these contexts may play a role in meeting PA guidelines is an essential step toward developing effective behavioral interventions. The purpose of this study was to examine associations between PA context (sports participation, participation in other organized physical activities, active travel to school, and outdoor play) and the number of days children met PA guidelines in a representative sample of children living in Texas.

Methods

We analyzed cross-sectional data from a statewide sample of fourth-grade children in Texas who completed the 2019-2020 Texas School Physical Activity and Nutrition (Texas SPAN) survey. The Texas SPAN survey was designed to monitor the statewide prevalence of overweight/obesity among school children and assess habitual self-reported obesity-related behaviors, including diet and PA. Weighted Poisson regression models were employed to examine the associations between PA contexts (sports participation, participation in other organized physical activities, active travel to school, and outdoor play) and the number of days children met PA guidelines, adjusting for sex, race/ethnicity, overweight/obesity, urban-rural status, and economic disadvantage.

Results

A total of 16.7% of fourth-grade children met physical activity guidelines every day during the week (mean age = 9.4 ± 0.6 years; female = 48.7, 51.8% Hispanic, mean days meeting PA guideline = 3.6 ± 2.3 days). One in ten (11.2%) children did not meet daily PA guidelines on any day of the week, and 72.1% met them between 1 and 6 days. Participating in sports (b = 0.22, 95%CI:0.14, 0.30), any other organized physical activities (b=0.13, 95%CI:0.017, 0.19), and playing outdoors 1-3 days (b = 0.25, 95%CI:0.04, 0.46) and 4-7 days in the past week (b = 0.77, 95%CI:0.57, 0.97) was significantly and positively associated with the number of days children met PA guidelines.

Conclusion

Participating in sports, participating in other organized physical activities, and playing outdoors may beneficially influence the number of days children meet PA guidelines. PA programs should consider these contextual factors and investigate how to promote organized activities and outdoor play effectively and appropriately among children.

Association between lifestyle and height growth in high school students

Introduction

An important indicator that plays a pivotal role in examining the health of individuals living in a community is their height. The aim of this study was to examine the relationship between lifestyle and height among female high school students in Dezful, Iran.

Methods

This research was a cross-sectional descriptive-analytical study. Participants included 351 female high school students who were selected from public and private high schools in Dezful using random cluster sampling. Miller-Smith Lifestyle Assessment Inventory was used to collect data about students' lifestyles, and their height was measured based on self-report.

Results

The total lifestyle score of the study participants was 52.23 ± 11.31. Also, 30.2%, 67.2%, and 2.6% of the students had high, moderate, and low lifestyle scores, respectively. A negative and significant relationship was observed between the total score of lifestyle and its components, that is, nutrition, sleep, exercise, and mental stress, and the height growth of female high school students in Dezful (P < 0.05) according to Pearson's correlation. Results of regression analysis showed that the total lifestyle score and its components could significantly predict the height growth of students.

Conclusion

Our results are indicative of the relationship between lifestyle and its components with height growth among female high school students.

Development and reliability testing of an audit toolbox for the assessment of the physical activity friendliness of urban and rural environments in Germany

Background

According to socio-ecological theories, physical activity behaviors are linked to the physical and social neighborhood environment. Reliable and contextually adapted instruments are needed to assess environmental characteristics related to physical activity. This work aims to develop an audit toolbox adapted to the German context, to urban and rural settings, for different population groups, and different types of physical activity; and to evaluate its inter-rater reliability.

Methods

We conducted a systematic literature search to collect existing audit tools and to identify the latest evidence of environmental factors influencing physical activity in general, as well as in German populations. The results guided the construction of a category system for the toolbox. Items were assigned to the categories based on their relevance to physical activity and to the German context as well as their comprehensibility. We piloted the toolbox in different urban and rural areas (100 street segments, 15 parks, and 21 playgrounds) and calculated inter-rater reliability by Cohen's Kappa.

Results

The audit toolbox comprises a basic streetscape audit with seven categories (land use and destinations, traffic safety, pedestrian infrastructure, cycling infrastructure, attractiveness, social environment, and subjective assessment), as well as supplementary tools for children and adolescents, seniors and people with impaired mobility, parks and public open spaces, playgrounds, and rural areas. 76 % of all included items had moderate, substantial, or almost perfect inter-rater reliability (κ > 0.4).

Conclusions

The audit toolbox is an innovative and reliable instrument for the assessment of the physical activity friendliness of urban and rural environments in Germany.

Habitual physical activity in patients born with oesophageal atresia: a multicenter cross-sectional study and comparison to a healthy reference cohort matched for gender and age

Oesophageal atresia (EA) is associated with life-long gastrointestinal and respiratory morbidity and other associated malformations. The aim of this study is to compare physical activity (PA) levels of children and adolescents with and without EA. A validated questionnaire (MoMo-PAQ) was used to evaluate PA in EA patients EA (4-17 years), who were randomly matched for gender and age (1:5) with a representative sample of the Motorik-Modul Longitudinal Study (n = 6233). Sports activity per week (sports index) and minutes of moderate to vigorous physical activity per week (MVPA minutes) were calculated. Correlations between PA and medical factors were analysed. In total, 104 patients and 520 controls were included. Children with EA were significantly less active at higher intensities (mean MPVA minutes 462; 95% confidence interval (CI): 370-554) compared to controls (626; 95% CI: 576-676), although there was no statistically significant difference in the sports index (187; 95% CI: 156-220 versus 220; 95% CI: 203-237). A lower mean weight-for-age and height-for-age, additional urogenital (r =  - 0.20, p = 0.04) or anorectal malformation (r =  - 0.24, p = 0.01) were associated with fewer MVPA minutes. For other medical factors (prematurity, type of repair, congenital heart disease, skeletal malformation or symptom load), no statistically significant association with PA was found.  Conclusion: EA patients participated in PA at a similar level but lower intensities compared to the reference cohort. PA in EA patients was largely independent of medical factors.

TRIAL REGISTRATION

German Clinical Trials Register (ID: DRKS00025276) on September 6, 2021.

WHAT IS KNOWN

• Oesophageal atresia is associated with a low body weight and height, delayed development of motor skills and impaired lung function and exercise capacity.

WHAT IS NEW

• Patients with oesophageal atresia have a similar amount of sports activity per week but engage significantly less in moderate to vigorous physical activities compared to peers. • Physical activity was  associated with weight-for-age and height-for-age, but largely independent of symptom load and other medical factors.

What Influences Children's Physical Activity? Investigating the Effects of Physical Self-Concept, Physical Self-Guides, Self-Efficacy, and Motivation

Physical fitness self-concept (PFSC) is an important predictor of motivation and physical activity in children. Recent studies revealed that not only PFSC but also its interplay with perceptions of one's ideal and ought physical fitness self are related to motivation and physical activity. As the meaning of ideal and ought selves in children is yet unclear, this study aimed to investigate how PFSC, ideal physical fitness self, and ought physical fitness self are related to children's motivation and physical activity. Six hundred forty-five children (Mage = 8.87 years) filled out questionnaires twice with an interval of approximately 8 months. Polynomial regression with response surface analyses and mediation analyses was conducted. Results showed that PFSC, rather than ideal and ought self-perceptions, is associated with autonomous motivation, self-efficacy, and physical activity. The relationship between PFSC and physical activity was mediated by self-efficacy. Findings indicate that physical activity promotion programs should include PFSC and self-efficacy enhancement in childhood.

Exploring the intersectionality of family SES and gender with psychosocial, behavioural and environmental correlates of physical activity in Dutch adolescents: a cross-sectional study

BACKGROUND

Examining the correlates of adolescent's physical activity (PA) and how they may differ according to the intersection of gender and family socioeconomic status (SES) can support the development of tailored interventions to more effectively promote adolescents' PA. This study explored how the associations between psychosocial, behavioural and environmental factors and adolescent's PA differed according to gender and family SES.

METHODS

This study used data from the Dutch Youth Health Survey 2015. Adolescents (n = 9068) aged 12-19 were included in the study. The associations between psychosocial, behavioural, and environmental factors and PA (days per week engaging in at least one hour of PA) were examined with multilevel linear regression analysis. Potential interactions between these correlates, gender and family SES were explored.

RESULTS

On average, adolescents engaged in at least one hour of PA for 4,2 days per week. Poor self-perceived health, low peer social support, and a weak connection with the environment were all associated with lower PA in adolescents. Daily smoking, cannabis use, risk of problematic gaming and social media use, as well as lack of daily consumption of fruit, vegetables, water and breakfast were associated with lower PA, whereas binge drinking was not. Interactions revealed that poor self-perceived health was associated with lower PA in adolescents from moderate- and high-SES families, but not in low-SES adolescents, whereas cannabis use was only associated with lower PA amongst low-SES adolescents. Low peer social support was associated with lower PA across all groups, but it was most strongly associated with lower PA amongst male adolescents from low-SES families than in other subgroups. Amongst low-SES males, low peer social support was associated with a 1.47 reduction in days engaging in sufficient PA, compared with a 0.69 reduction for high-SES males.

CONCLUSIONS

This study identified several psychosocial, behavioural and environmental factors that can be targeted to potentially increase adolescent's PA. We also found that correlates of PA differed according to the intersection of gender and family SES. Our findings suggest that PA interventions should be tailored according to gender and SES to address the specific needs, barriers and facilitators of different subgroups.

Changes of Self-Rated Health Status, Overweight and Physical Activity During Childhood and Adolescence-The Ratchet Effect of High Parental Socioeconomic Status

Childhood and adolescence are important life periods for the development of health status and physical activity (PA) behaviours. This study analyses the stability and potential changes of self-rated health status, overweight and PA behaviour over time, specifically focusing on the age and the socioeconomic status of children and adolescents. We employ representative longitudinal data for German children and adolescents from the Motorik-Modul Study and the German Health Interview and Examination Survey. Using four different dichotomous health status and PA indicators (self-rated health status [SRHS]; overweight; moderate-to-vigorous PA; and leisure sports engagement), we report within-person transition rates across the panel waves when the survey was taken (2003-2006, 2009-2012, and 2014-2017). Additionally, we report results of logistic regressions estimating the impact of children's age, gender, migration background, and their parents' socioeconomic status on these transition rates. The transition rates show mixed results. While children and adolescents from highly problematic states reporting bad SRHS and no leisure sports engagement at an early stage tend to improve later on, overweight children mostly stay overweight. Age and social inequality indicators correlate with some of the chances of improving or worsening the health and PA states. Most clearly, high parental status prevents the health status and PA from worsening over all transitions, particularly becoming overweight, representing a ratchet effect. The results of the present study underline that health policy needs to target specific groups to reduce social inequality in the health status and PA of children and adolescents.

Effect of physical activity and BMI SDS on bone metabolism in children and adolescents

OBJECTIVE

Children with obesity are known to have reduced bone density and are at a higher risk for fractures. This may be caused by decreased physical activity or a metabolic phenomenon. In this study, we evaluated associations of physical activity with bone metabolism in children and adolescents with and without obesity.

METHODS

Results from 574 visits of 397 subjects, 191 girls and 206 boys aged five to 18 years (mean: 11.7 ± 2.8) representing 180 children with (mean BMI SDS 2.5 ± 0.4) and 217 without obesity (mean BMI SDS 0.2 ± 1.0) from the LIFE Child study, a population-based cohort of children/adolescents with normal weight and with obesity were analyzed for the impact of their daily physical activity (MET/day, SenseWear Accelerometer) on serum SDS levels for bone formation (alkaline phosphatase, osteocalcin, procollagen type I N propeptide [P1NP]), bone resorption (beta-crosslaps), and calcium homeostasis (parathormone, OH-25-vitamin D) by a linear regression model adjusted for gender- and age-based differences.

RESULTS

For male subjects, BMI SDS significantly influenced the association of physical activity to PTH, vitamin D, and beta-crosslaps SDS levels. A higher physical activity was accompanied by increased PTH but decreased vitamin D SDS levels in children with normal weight. In males with obesity, all levels remained unaltered. In females, BMI SDS significantly impacted the association of physical activity to PTH, vitamin D, P1NP, beta-crosslaps, and osteocalcin SDS levels. In females with obesity, higher physical activity was related to higher SDS levels of vitamin D, P1NP, and beta-crosslaps. In contrast, in normal weight females, only PTH SDS was higher.

CONCLUSIONS

The effect of daily physical activity on bone metabolic markers and calciotropic hormones depends significantly on gender and BMI SDS. However, higher levels of physical activity were associated with increased bone turnover for female subjects with obesity only. Thus, motivating especially girls with obesity to be physically active may help improve their bone health.

Trends in active commuting to school from 2003 to 2017 among children and adolescents from Germany: the MoMo Study

BACKGROUND

Inactivity in children and adolescents is a global issue requiring interventions that target different domains of physical activity, such as active transport. The aim of this study was to assess the prevalence, historical trends and socio-demographic correlates of active commuting to school (ACS) in a nationwide sample of girls and boys from Germany.

METHODS

Data of commuting behaviour and socio-demographic factors were collected, covering three measurement points from 2003 to 2017. The MoMo Study derived its data from a representative sample of children and adolescents aged 4-17 years who answered a questionnaire (N = 11 387). Statistically significant differences between Baseline, Wave 1 and Wave 2 were determined via 95% confidence intervals (CIs) for complex samples.

RESULTS

Overall, ACS decreased from 84.4% at the first measurement point to 78.3% in the third measurement point. The proportion of cases in which children opted for passive modes of commuting increased predominantly in those aged 4-5 years, in children with a low-to-medium socio-economic status, and in children residing in small- or medium-sized towns. No gender differences were found in active commuting. The results of multinomial logistic regression identified age, migration background and residential area as correlates of walking for boys. For girls, the likelihood of walking, cycling and taking public transport instead of opting for motorized transport increased with age.

CONCLUSIONS

Intervention programmes to increase active transport in children and adolescents should target different age groups and also consider parental influence in determining the child's choice of transport mode.

Are young children with asthma more likely to be less physically active?

BACKGROUND

Previous research suggests that children who experience asthma may be less physically active; however, results have been inconclusive. This study aimed to investigate whether the presence of asthma or wheeze is associated with lower physical activity levels in children, and whether sex, body mass index or earlier asthma or wheeze status modifies the association.

METHODS

This study was conducted in 391 HealthNuts participants in Melbourne, Australia. Asthma and wheeze data were collected via questionnaire at age 4 and 6, and physical activity was measured through accelerometry. Using adjusted linear regression models, the cross-sectional and longitudinal associations were investigated.

RESULTS

There was no evidence of a difference in time spent in moderate-to-vigorous physical activity (MVPA) at age 6 years between children with and without asthma at age 4; children with asthma spent 8.3 minutes more time physically active per day (95% CI: -5.6, 22.1, P = .24) than children without asthma. Similar results were seen for children with current wheeze (5.8 minutes per day more, 95% CI: -5.9, 17.5, P = .33) or ever wheeze or asthma (7.7 minutes per day more, 95% CI: -4.8, 20.2, P = .23) at age 4 years. Comparable null results were observed in the cross-sectional analyses. Interaction with BMI could not be assessed; however, previous asthma or wheeze status and sex were not found to modify these associations.

CONCLUSION

This analysis found no evidence of asthma hindering physical activity in these young children. These results are encouraging, as they indicate that the Australian asthma and physical activity public health campaigns are being effectively communicated and adopted by the public.

Can School-Based Physical Activity Projects Such as Skipping Hearts Have a Long-Term Impact on Health and Health Behavior?

Low physical activity, limited motor skills, and an increased number of overweight or obese children are major public health problems. Numerous school-based programs try to improve physical activity and health behavior in children but investigations on sustainable effects of these programs are rare. Therefore, we examined the long-term effects of the Skipping Hearts health promotion project. 486 children (57.7% female, 9.0 ± 0.6 years at baseline) participated in this non-randomized controlled longitudinal trial within a follow-up period of 3.5 years. Of these, 286 subjects received a one-time 90-min workshop in rope skipping (Basic-Workshop) and 140 additionally received 10 lessons in rope skipping (Champion-Program), 78 students served as controls. Anthropometrics, blood pressure, motor skills, screen-based media use, self-assessment of physical fitness, and physical activity were collected at both measurement points; endurance capacity and health-related quality of life only at follow-up. Standard deviation scores of body-mass-index (η² = 0.005) and systolic blood pressure (η² = 0.006) decreased, while diastolic blood pressure (η² = 0.004), motor performance (η² < 0.001), physical fitness, subjective physical activity (η² = 0.008), and screen-based media use (η² = 0.001) increased without significant difference in development between groups (all p > 0.05). At follow-up, groups did not differ in endurance capacity (η² = 0.010) and health-related quality of life (η² < 0.001). Skipping Hearts does not affect the long-term improvement of health status, motor performance, or health behavior. To improve the effects, the project should be implemented as a daily routine in schools to force the transfer of health behavior-related knowledge. Nevertheless, the project offers a physical activity that can be performed in children's everyday life without high costs.

Physical Activity Among Immigrant Children: A Systematic Review

BACKGROUND

The health benefits of physical activity (PA) for children are well documented. However, little is known about PA patterns among immigrant children.

METHODS

The authors reviewed research on PA patterns of immigrant children. The inclusion criteria included peer-reviewed articles published from January 2010 to May 2018 in English, French, or Spanish that included primary-school-aged (6-12 y) children, and data on immigration status.

RESULTS

A total of 11 articles were included in the analyses. These studies revealed a deficit of PA among immigrant children. Immigration status (immigrant or nonimmigrant) and generation of immigration (first, second, and third), ethnic origin, and gender were associated with PA patterns. In general, PA levels were lower among first-generation immigrant children, children of Hispanic and East Asian origin, and girls. The results suggest that questionnaire measures might be biased or inaccurate among immigrant children, highlighting the need for the integration of mixed methods (objective and subjective measures).

CONCLUSIONS

A large proportion of children do not meet PA guidelines, and this might be more problematic for immigrant children. Future studies incorporating time since immigration, comparative analyses on gender, sociocultural and socioeconomic characteristics, and mixed methodology could provide a more complete portrait of PA patterns and opportunities for immigrant children.

Testing the Weiss-Harter-Model: Physical Activity, Self-Esteem, Enjoyment, and Social Support in Children and Adolescents

BACKGROUND

Several theories have been established to explain physical activity (PA) participation. However, many of these theories might not be applicable to adolescent PA behavior as they require a high level of cognitive reflection. Weiss suggests a model for youth which is based on the theoretical concept of Harter, focusing on self-esteem within social, emotional, and developmental aspects to explain behavior. The aim of this study was to test the original and a social support focused alternative version of the Weiss-Harter-model, and to cross-validate the findings in two separate studies.

METHODS

Data from two cross-sectional studies was retrieved and the models tested using structural equation modeling. Participants aged 11-17 years were recruited from a school (Study 1: N = 182) and from the German MoMo study (Study 2: N = 2,274). They filled in questionnaires about perceived competence, social support, self-esteem, PA enjoyment, and minutes of moderate-vigorous PA (MVPA).

RESULTS

None of the studies showed a good model fit for the original model [Study 1: CFI = 0.870, RMSEA 0.118 (90% CI 0.081-0.158), χ 2 = 38.7, p < 0.01; Study 2: CFI = 0.871, RMSEA 0.148 (90% CI 0.140-0.155), χ 2 = 1112.6, p < 0.01], explaining only 12% and 17% of MVPA variance, respectively. The alternative model which added the direct paths of social support to MVPA and PA enjoyment had a very good model fit for both Study 1 [CFI = 1.000, RMSEA 0.000 (90% CI 0.000-0.031), χ 2 = 4.8, p > 0.05] and Study 2 [CFI = 0.990, RMSEA 0.043 (90% CI 0.035-0.051), χ 2 = 103.7, p < 0.01]. The addition of these paths led to changes in effect size and directions of other path coefficients, with self-esteem having a small to meaningless impact on MVPA. The revised models accounted for 38% and 42% explained variance in MVPA, respectively.

DISCUSSION

The prominent role of self-esteem in the original model could not be confirmed. Instead, the results emphasize the role of social support for PA and PA enjoyment, which is in line with current research. Interventions to increase adolescent PA levels should thus focus more on components of social support instead of self-esteem. Future studies are needed to examine the interplay between social support, PA enjoyment and perceived competence as PA determinants.

Parental and peer support and modelling in relation to domain-specific physical activity participation in boys and girls from Germany

Background

Physical activity (PA) as a precondition of child development is related with social environmental correlates. However, domain-specific PA and gender issues have been neglected in studies on social support and modelling and PA in school-aged children. The aim of this study was to assess the relationships of parental and peer modelling and social support with domain-specific PA participation in a large sample of school-aged children, taking gender into account.

Methods

3,505 school children aged 6 to 17 years old participated in the German nationwide ‘MoMo’ cohort-study. By using the MoMo-PAQ the participants and their parents provided self-report data on perceived social support and social modelling and domain-specific PA participation. Relationships of social environmental variables and the physical outcomes were analysed by logistic regression analyses.

Results

At secondary school level, girls were less likely than boys to participate in physical activity in and outside of sports clubs, extra-curricular physical activity and in outdoor play (p < 0.05), but at primary school level this pattern only applied to club sport (p < 0.01). Girls also received less social support than boys (p < 0.01). Physical activity participation in all domains was associated with any of the social support and modelling variables and differences between physical activity domains and between boys and girls occurred. Most consistently physical activity in sports clubs was related with the social environmental correlates in boys (primary school: R² = 0.60; secondary school: R² = 0.45) and girls (primary school: R² = 0.53; secondary school: R² = 0.47).

Conclusions

In future, reciprocal relationships of social environmental variables and PA should be considered in longitudinal studies to obtain insights into the direction of the associations. Furthermore, interventions encompassing the social environment and focussed particularly on the promotion of domain-specific PA in girls in secondary school-age are warranted.

Social Support and Modelling in Relation to Physical Activity Participation and Outdoor Play in Preschool Children

Physical activity during early childhood is a prerequisite for healthy development in many cases. The aim of this study was to assess the relationships of social modelling and support from parents, peers, and siblings and domain-specific physical activity participation in a nationwide sample of preschool boys and girls from Germany. 519 preschool children aged 4-6 and one of their parents participated in the 'MoMo' Wave 1 Study between 2009 and 2012. Participants and their parents provided self-reported data on social support modelling, and domain-specific physical activity participation (physical activity in sports clubs, physical activity outside of sports clubs, and outdoor play). Parental, peer, and sibling support and modelling were related to domain-specific physical activity: Parental support was particularly relevant for physical activity in sports clubs, and peer support for outdoor play. Parental modelling was only related to physical activity outside of sports clubs: Maternal modelling was a positive correlate in girls and paternal modelling in boys, respectively. Sibling and peer modelling were especially relevant for physical activity in sports clubs. The results were heterogeneous regarding types and providers of support and modelling. Thus, different providers and types of support should be targeted in physical activity promotion programs for preschool children.

Leisure Activities of Healthy Children and Adolescents

The objective of the present study was to give a detailed overview on the leisure behavior of adolescents (frequency, differences between gender, age groups and social class, time trends, and inter-relations). In total, 1449 10- to 18-year-old German adolescents were included in the study. Participants answered questionnaires about their media use, physical activity, outdoor time, engagement in choir/orchestra and theater/dancing, social life and socio-economic status (SES). The results revealed that girls, children with lower SES as well as older children reported to use screen-based media more often and that girls, older children and children with lower SES were less physically active. In addition, boys and children with lower SES engaged less frequently in choir/orchestra and theater/dancing, while children with higher SES met their friends more often. The time trend analysis showed that mobile phone use increased drastically from 2011 to 2017, while engagement in choir/orchestra and theater/dancing decreased. Regarding the inter-relation between leisure activities, high screen times were significantly associated with less physical activity and less outdoor time. Physical activity, in contrast, was significantly related to better social life and more outdoor time. These findings highlight the growing importance of electronic media in adolescents’ lives and their tendency to displace other leisure activities.

Interventions on children's and adolescents' physical activity and sedentary behaviour: protocol for a systematic review from a sex/gender perspective

BACKGROUND

Low levels of physical activity (PA) and high levels of sedentary behaviour (SB) have been observed in young people. Both behaviours are detrimental for health with patterns tending to continue into adulthood. There is sustained value in establishing health habits in early years. Even though levels of SB and participation in PA differ among boys and girls, and the effectiveness of interventions to promote PA and/or prevent sedentary behaviours varies by sex/gender to date, sex/gender in systematic reviews is not yet widely considered. Additionally, while tools have been proposed, there is no consensus on the criteria to assess sex/gender in systematic reviews in the context of health promotion. The main objectives of this systematic review are to evaluate the effects of interventions on girls' and boys' PA and SB and to appraise the extent to which the studies have taken sex/gender into account.

METHODS

Eleven electronic databases will be searched to identify all relevant (randomized) controlled trials. Two independent reviewers will screen studies, extract data and appraise the quality of studies. The main outcome of the studies will be a quantified measure of PA and/or SB. Risk of bias of individual studies will be assessed using the Cochrane Risk of Bias Tool for RCTs. Meta-analyses will be conducted when possible among studies with sufficient homogeneity. To evaluate sex/gender considerations in primary studies, we will use a sex/gender checklist that builds on existing tools and was developed during a 2-day, iterative process among a multidisciplinary panel of 16 experts. The GRADE framework will be used to evaluate evidence across studies for each main efficacy outcome.

DISCUSSION

To our knowledge, our systematic review will be the first to analyse how sex/gender is considered in interventions promoting PA and/or reducing SB in children and adolescents in detail. The review will provide information on how sex/gender aspects have been considered in recent research and the extent to which sex/gender might impact study outcomes. Our findings will be of interest to stakeholders, health promoters, researchers and policy makers who wish to support more equal outcomes from interventions promoting PA and/or reducing SB.

TRIAL REGISTRATION

PROSPERO CRD42018109528 .

Exploratory Determined Correlates of Physical Activity in Children and Adolescents: The MoMo Study

Background: Physical activity is an important contributor to reducing the risk for a variety of diseases. Understanding why people are physically active contributes to evidence-based planning of public health interventions because successful actions will target factors known to be related to physical activity (PA). Therefore the aim of this study is to identify the most meaningful correlates of PA in children and adolescents using a large, representative data set. Methods: Among n = 3539 (1801 boys) 6 to 17-year-old participants of the German representative Motorik-Modul baseline study (2003⁻2006) a total of 1154 different demographic, psychological, behavioral, biological, social and environmental factors were ranked according to their power of predicting PA using least absolute shrinkage and selection operator (LASSO) regressions. Results: A total of 18 (in girls) and 19 (in boys) important PA predictors from different, personal, social and environmental factors have been identified and ranked by LASSO. Peer modeling and physical self-concept were identified as the strongest correlates of PA in both boys and girls. Conclusions: The results confirm that PA interventions must target changes in different categories of PA correlates, but we suggest to focus particularly on the social environment and physical self-concept for interventions targeting children and adolescents in Germany nowadays. We also strongly recommend to repeatedly track correlates of PA, at least every 10 years, from representative samples in order to tailor contemporary PA interventions.

Physical Activity and Outdoor Play of Children in Public Playgrounds-Do Gender and Social Environment Matter?

Background: Few studies have delved into the relationship of the social environment with children’s physical activity and outdoor play in public playgrounds by considering gender differences. The aim of the present study was to examine gender differences and the relationship of the social environment with children’s physical activity and outdoor play in public playgrounds. Methods: A quantitative, observational study was conducted at ten playgrounds in one district of a middle-sized town in Germany. The social environment, physical activity levels, and outdoor play were measured using a modified version of the System for Observing Play and Leisure Activity in Youth. Results: In total, 266 observations of children (117 girls/149 boys) between four and 12 years old were used in this analysis. Significant gender differences were found in relation to activity types, but not in moderate-to-vigorous physical activity (MVPA). The presence of active children was the main explanatory variable for MVPA. In the models stratified by gender, the presence of opposite-sex children was a significant negative predictor of MVPA in girls but not in boys. Conclusions: The presence of active children contributes to children’s physical activity levels in public playgrounds. Girls’ physical activity seems to be suppressed in the presence of boys.

Effects of a Sports-Oriented Primary School on Students' Physical Literacy and Cognitive Performance

As only a small group of children fulfil the guidelines for physical activity, interventions are necessary to promote active lifestyles. We examined the effects of a sports-oriented primary school (N = 79) in comparison to a regular primary school (N = 90) on students' physical literacy and cognitive performance. To evaluate the implementation of the sports-oriented school curriculum a process evaluation was conducted, in which the school curriculum was analysed and guideline-based interviews were carried out with the schoolteachers and the school director. To measure students' physical literacy and cognitive performance several tests were used. Small positive effects of the sports-oriented primary school on students' physical literacy were shown in standing long jump and attitudes towards physical activity. There were no differences between the groups regarding cognitive performance. This study provides the first insights on how a sports-oriented school can promote students' physical literacy in the future. The results are in line with previous research that shows that when children spend more time in physical education and overall physical activities at school, no negative consequences result for their cognitive performance. In future, long-term evaluations of the effects of sports-oriented schools are required to receive valid results on the effects on students.

Prevalence and correlates of insufficient physical activity in school adolescents in Peru

OBJECTIVE

To assess the prevalence and correlates of insufficient physical activity in adolescents in Peru.

METHODS

We used a self-administered questionnaire developed from Global school-based Student Health Survey to collect information from secondary school students in North Lima and Callao in 2015. We carried out Poisson regression with robust variance using generalized linear models to estimate the crude and adjusted prevalence ratios (APR) with 95% confidence intervals (95%CI) of insufficient physical activity for its correlates.

RESULTS

We have found that 78% of the adolescents did not meet the global recommendation of the World Health Organization on physical activity in the last week before the survey. Female respondents (APR = 1.13, 95%CI 1.04–1.21), respondents who perceived themselves as overweight (APR = 1.10, 95%CI 1.03–1.18), and respondents who consumed insufficient vegetables and fruits [no vegetables (APR = 1.30, 95%CI 1.06–1.59), no fruits (APR = 1.15, 95%CI 1.00–1.31) as compared to those who consumed ≥ 2 servings every day in the last seven days] were more likely to report insufficient physical activity. Adolescents who worked after school (APR = 0.92, 95%CI 0.84–0.99), had physical education classes five times per week (APR = 0.94, 95%CI 0.88–0.99), and had parental supervision (APR = 0.92, 95%CI 0.87–0.98) were less likely to report insufficient physical activity.

CONCLUSIONS

Sex, work after school, perceived body weight, physical education class, parental support, and healthy dietary behaviors were associated with insufficient physical activity. Attempts to improve physical activity should look for ways to enhance leisure-time physical activity, parental support, physical education classes, healthy dietary behaviors, and normal body weight maintenance in adolescents with integrated efforts from the family and school.

Physical Activity Intensity Among Adolescents and Association With Parent-Adolescent Relationship and Well-Being

Participation in physical activity (PA) provides young people significant health benefits, including improved well-being. However, large percentages of children and adolescents do not meet the recommendations for PA. Given that PA patterns are established during childhood and adolescence, and evolve within the context of the family, the current study explores the relationship between perceived parent–adolescent relationships and adolescents’ PA levels, body mass index (BMI), and subjective well-being. The study was conducted in Israel, and the sample included 233 participants (126 girls, 107 boys) aged 13 to 18 years.

Participants self-reported the following measures: demographic information, BMI, the Godin-Shephard Leisure-Time Physical Activity Questionnaire, the Personal Well-Being Index, and parent–adolescent relationship. The data were analyzed using Pearson analyses, t tests, and regressions. A clear difference emerged in strenuous PA activity by sex [t(₂₂₃) = 2.1, p < .01]; the average strenuous PA was greater for boys (M = 3.9, SD = 2.4) than for girls (M = 1.8, SD = .2.4). Furthermore, different predictors of strenuous PA by sex were found: for boys, parent–adolescent relationship was a significant predictor; for girls, subjective well-being was a predictor. The findings can shed light on the need for different intervention programs for adolescent boys and girls to increase their involvement in PA.

Cross-sectional and longitudinal associations of screen time and physical activity with school performance at different types of secondary school

Background

Previous studies have already reported associations of media consumption and/or physical activity with school achievement. However, longitudinal studies investigating independent effects of physical activity and media consumption on school performance are sparse. The present study fills this research gap and, furthermore, assesses relationships of the type of secondary school with media consumption and physical activity.

Methods

The consumption of screen-based media (TV/video, game console, PC/internet, and mobile phone) and leisure physical activity (organized and non-organized) of 10 – to 17-year old adolescents participating in the LIFE Child study in Germany were related to their school grades in two major school subjects (Mathematics and German) and in Physical Education. In addition to a cross-sectional analysis at baseline (N = 850), a longitudinal analysis (N = 512) investigated the independent effects of these activities on the school grades achieved 12 months later. All associations were adjusted for age, gender, socio-economic status, year of data assessment, body-mass-index, and school grades at baseline. A further analysis investigated differences in the consumption of screen-based media and physical activity as a function of the type of secondary school (highest vs. lower secondary school).

Results

Adolescents of lower secondary schools reported a significantly higher consumption of TV/video and game consoles than adolescents attending the highest secondary school. Independently of the type of school, a better school performance in Mathematics was predicted by a lower consumption of computers/internet, and a better performance in Physical Education was predicted by a lower consumption of TV/video and a higher frequency of non-organized physical activity. However, the association between non-organized physical activity and subsequent grades in Physical Education was significant in girls only.

Conclusion

The present results suggest that media consumption has a negative effect on school achievement, whereas physical activity has a positive effect, which, however, is restricted to the subject Physical Education. Future studies might explore the relationship between media consumption and school career, for example, the choice or change of the secondary school type, in more detail.

Trial registration

LIFE Child study: ClinicalTrials.gov, clinical trial number NCT02550236

Playground usage and physical activity levels of children based on playground spatial features

Aim

Being outdoors is one of the strongest correlates of physical activity in children. Playgrounds are spaces especially designed to enable and foster physical activity in children. This study aimed to analyze the relationship between the spatial features of public playgrounds and the usage and physical activity levels of children playing in them.

Subjects and methods

A quantitative, observational study was conducted of ten playgrounds in one district of a middle-sized town in Germany. Playground spatial features were captured using an audit instrument and the playground manual of the town. Playground usage and physical activity levels of children were assessed using a modified version of the System for Observing Play and Leisure Activity in Youth. Negative binomial models were used to analyze the count data.

Results

The number of children using the playgrounds and the number of children actively playing in them were higher in those with more varied facilities and without naturalness. Girls played more actively in playgrounds without multi-purpose areas. Cleanliness, esthetics, play facility quality, division of functional areas and playground size were not related to any outcome variable.

Conclusion

Playground spatial features are related to playground usage and activity levels of the children in the playgrounds. Playgrounds should offer a wide variety of play facilities and provide spaces for diverse play activities to respond to the needs of large numbers of different children and to provide activity-friendly areas enabling their healthy development.

"Are Thai children and youth sufficiently active? prevalence and correlates of physical activity from a nationally representative cross-sectional study"

Background

Children and youth gain multiple health benefits from regular participation in physical activity (PA). However, in Thailand there is limited national data on children and youth’s PA behaviors and recent reports suggest that Thai children and youth have low levels of PA. Furthermore, there is almost no data on the factors associated with inactivity to support the development of a Thai National PA Plan. The purpose of this paper is to investigate Thai children and youth’s participation in PA and its correlates across sociodemographic characteristics and different PA domains.

Methods

This study applied a cross-sectional study design with a multi-stage stratified cluster sampling. A national representative sample of 13,255 children and youth aged 6-17 years were used for data analysis. A previously validated questionnaire was used to assess PA prevalence. Logistic regression was conducted to examine the relationships of socio-demographic factors, and participation in different PA domains with overall PA.

Results

Only 23.4% of Thai children and youth met recommended levels of PA and there were large gender and regional differences. PA levels generally declined with age, although the level observed in the 10-13 year group was slightly higher than other year groups. A majority of children and youth engaged in a large number of different activities across PA domains. Sex, age, BMI, geographical regions, organized sports, participation in sport and recreational activities were significant predictors of meeting the global PA guidelines, whereas participation in physical education, active transport, and the number of screen time activities had no association. Girls were less likely to achieve sufficient PA levels (OR = 0.49, 95%CI; 0.45-0.54, p < 0.001), as were obese children (OR = 0.78, 95%CI; 0.64-0.94, p = 0.01), children living in the West (OR = 0.47, 95%CI; 0.38-0.59, p < 0.001), and those who did no participation in organized sports and sport/exercise activities, or minimal participation (1-2 activities) in recreational activities (OR = 0.79, 95%CI; 0.68-0.90, p < 0.001).

Conclusions

The prevalence estimate of meeting the recommended guideline of sufficient PA in Thai children and youth is low, despite the high levels of engagement in a large number of PA. The results indicate that policy and interventions aimed at increasing PA are needed with special attention required to address specific groups less likely to meet the PA guideline. Strategies to promote a large volume of participation in all possible types of PA as part of Thai children and youth’s daily life should be considered.

Effects of a Randomised Controlled School-Based Health Promotion Intervention on Obesity Related Behavioural Outcomes of Children with Migration Background

Children with migration background (MB) appear to be at higher risk of developing obesity, therefore, prevention is necessary to avoid possible health inequalities. This study investigated a 1-year intervention with focus on increasing physical activity (PA) and fruit and vegetable intake (FVI), decreasing screen media use (SMU) and soft drink consumption (SDC) in children with MB. 525 children (7.1 ± 0.7 years) with MB who participated in the cluster-randomised study were assessed at baseline and after 1 year. Daily SMU, PA behaviours, SDC and FVI were assessed using a parental questionnaire. After one year, significant effects were found in the intervention group for FVI (p ≤ 0.035). Partially strong tendencies but no significant differences were found for PA and SDC. Although the effects are small, the intervention seems to reach children with MB. An intervention lasting longer than one year might result in more changes.

Does Physical Self-Concept Mediate the Relationship between Motor Abilities and Physical Activity in Adolescents and Young Adults?

The purpose of this study is to examine the reciprocal relationship between motor abilities and physical activity and the mediation effects of physical self-concept in this relationship using longitudinal data. We expect that the effects of motor abilities on physical activity are rather indirect via physical self-concept and that the effects of physical activity on motor abilities are rather direct without involvement of the motor ability self-concept. Data was obtained from the Motorik-Modul (MoMo) Longitudinal Study in which 335 boys and 363 girls aged 11–17 years old at Baseline were examined twice in a period of six years. Physical activity was assessed by the MoMo Physical Activity Questionnaire for adolescents, physical self-concept by Physical Self-Description Questionnaire and motor abilities by MoMo Motor Test which comprised of the dimensions strength, endurance, coordination and flexibility. Multiple regression analyses were used to analyse the direct and indirect effects. The results of the multiple regression analyses show that the effects of motor abilities on physical activity were only indirect for the dimensions strength, coordination, and flexibility. For the dimension endurance, neither direct nor indirect effects were significant. In the opposite direction, the effects of physical activity on motor abilities were partially mediated by the self-concept of strength. For the dimensions endurance, coordination and flexibility, only indirect were significant. The results of this study support the assumption that the relationship between motor abilities and physical activity is mediated by physical self-concept in both directions. Physical self-concept seems to be an important determinant of adolescents´ physical activity.

Elaboration of the Environmental Stress Hypothesis-Results from a Population-Based 6-Year Follow-Up

The aim of this paper was to contribute to the elaboration of the Environmental Stress Hypothesis framework by testing eight hypotheses addressing the direct impact of gross motor coordination problems in elementary-school on selected physical, behavioral and psychosocial outcomes in adolescence. Results are based on a longitudinal sample of 940 participants who were (i) recruited as part of a population-based representative survey on health, physical fitness and physical activity in childhood and adolescence, (ii) assessed twice within 6 years, between the ages of 6 and 10 years old as well as between the ages of 12 and 16 years old (Response Rate: 55.9%) and (iii) classified as having gross motor coordination problems (N = 115) or having no gross motor coordination problems (N = 825) at baseline. Motor tests from the Körperkoordinationstest, measures of weight and height, a validated physical activity questionnaire as well as the Strength and Difficulties Questionnaire were conducted. Data were analyzed by use of binary logistic regressions. Results indicated that elementary-school children with gross motor coordination problems show a higher risk of persistent gross motor coordination problems (OR = 7.99, p < 0.001), avoiding organized physical activities (OR = 1.53, p < 0.05), an elevated body mass (OR = 1.78, p < 0.05), bonding with sedentary peers (OR = 1.84, p < 0.01) as well as emotional (OR = 1.73, p < 0.05) and conduct (OR = 1.79, p < 0.05) problems in adolescence in comparison to elementary-school children without gross motor coordination problems. However, elementary-school children with gross motor coordination problems did not show a significantly higher risk of peer problems (OR = 1.35, p = 0.164) or diminished prosocial behavior (OR = 1.90, p = 0.168) in adolescence, respectively in comparison to elementary-school children without gross motor coordination problems. This study is the first to provide population-based longitudinal data ranging from childhood to adolescence in the context of the Environmental Stress Hypothesis which can be considered a substantial methodological progress. In summary, gross motor coordination problems represent a serious issue for a healthy transition from childhood to adolescence which substantiates respective early movement interventions.

Exercise, bodyweight perception and related weight loss behavior among adolescents in Trinidad and Tobago

AIM

This study attempted to evaluate the real and perceived body weight, exercise habits and weight-altering dietary supplement use by adolescents attending schools in Trinidad and Tobago.

METHODS

A de novo questionnaire was administered prospectively to 15-19-year-old to determine their exercise habits, their perceived body weights, and their use of any weight gain or weight loss supplements. A subset of students had their actual height and weights recorded and BMI calculated.

RESULTS

Five hundred and eighty-three students did the questionnaire (88% response rate), and 363 students had BMI calculated. Some 14.9% (54/363) of the students were overweight, and 15.4% (56/363) were obese, and more than 75% of the obese students had attempted weight loss in the past. These measures included exercise in the majority of the students and use of dietary supplements in the minority. Only 6% of the obese students exercised five or more times per week. About 28% of the students misclassified their body weights, and perception of body weight influenced weight loss behaviors more than actual body weights.

CONCLUSION

Almost one third of the students were overweight or obese. Overweight students were motivated to lose weight, and these students need to have some structured health promotion program, which educates them on correct exercise habits, safe measures to lose weight, and which informs them of their actual body weight.

Does socioeconomic status impact physical activity and sleep among children with cancer?

BACKGROUND

Compared with healthy children, pediatric oncology patients have impaired sleep and engage in less physical activity (PA). Socioeconomic status (SES) may be one determinant of PA and sleep among pediatric oncology patients.

PROCEDURE

Between November 12, 2009 and March 27, 2013, 50 pediatric oncology patients between the ages of 8 and 18 years were recruited from an urban children's hospital. PA and sleep were assessed by actigraphy and diaries over 7 days. Fatigue was assessed using the Fatigue Scale. SES was defined by primary payer status of insurance (state or private) and by Median Household Income (MHI) obtained from 2010 U.S. Census block data for residences. MHI was compared to Connecticut state median income ($67,000). Multivariate regression models examined the relationship between SES and PA, sleep and fatigue.

RESULTS

PA and sleep efficiency were strongly correlated (r = 0.31, P = 0.03). Children with state insurance had higher average PA (P = 0.004) than children on private insurance. There were no significant differences in PA or sleep efficiency by block MHI. The 7-day fatigue score was lower among the participants aged 8-12 years in the group with MHI less than $67,000 (P = 0.03), although there was no significant difference among participants aged 13-18 years in the group. There was no difference in mean fatigue scores by insurance status.

CONCLUSIONS

Participants on state insurance had higher PA than those with private insurance. Although block MHI did not influence PA or sleep efficiency among children with cancer, participants aged 8-12 years in a lower MHI block had less fatigue. Future research is needed to further understand how SES influences PA.

A Qualitative Analysis of Emotional Facilitators in Exercise

Although previous research has shown that emotions are consistently associated with sport and exercise behavior, the working mechanisms are not understood to the extent of creating an intervention. The aim of this study is to identify situations and aspects of recreational sport and exercise, which lead to positive emotional reactions in people taking part in regular and long-term exercise. In this study, 24 adults (12 female, 12 male) distributed over three age groups (young, middle, and late adulthood), took part in recreational sports (individual or team sport) for at least 5 years. Semi-structured in depth interviews with questions about sport and exercise habits, long term participation and emotional response in a sporting environment were conducted in order to ascertain those situations and aspects of the exercise program triggering positive emotions. Interviews were transcribed verbatim and followed Grounded Theory principles. Emerging concepts were grouped and merged into different categories representing the key aspects of sport and exercise. Four factors were identified which are associated with the emergence of positive emotions in recreational sport and exercise. Firstly, perceived competence is one of the major factors influencing emotions during exercise and can represent individual and collective success and progress, competition and challenge. Secondly, perceived social interaction is another factor comprising of all sorts of peer-related aspects such as communication with others, being part of a group and creating close relationships or friendships. Thirdly, novelty experience in contrast to other none-sporting activities such as work, family or other leisure activities was another factor. The last factor found was the perceived physical exertion comprising of the degree of exhaustion, a possibly delayed turnaround in the emotional response and the aspect of sport being a physical compensation for everyday sedentary life. The results of this study provide the starting point for the development of interventions to enhance positive emotions in sports in order to increase maintenance and adherence to recreational sport and exercise.

Interdisciplinary, child-centred collaboration could increase the success of potentially successful Internet-based physical activity interventions

Physical activity promotes health in children and adolescents, but activity levels are low. The Internet offers opportunities for physical activity interventions because children and adolescents are widely exposed to the web and enjoy being online. This review investigated the success of Internet-based interventions designed to increase physical activity in children and adolescents. Of the 13 studies we included, five reported that Internet-based interventions had significant effects on most physical activities.

CONCLUSION

Internet-based physical activity interventions in children and adolescents are potentially successful, but interdisciplinary, child-centred collaboration is needed to design interventions that align with their Internet experiences and preferences.

Height and skeletal morphology in relation to modern life style

Height and skeletal morphology strongly relate to life style. Parallel to the decrease in physical activity and locomotion, modern people are slimmer in skeletal proportions. In German children and adolescents, elbow breadth and particularly relative pelvic breadth (50th centile of bicristal distance divided by body height) have significantly decreased in recent years. Even more evident than the changes in pelvic morphology are the rapid changes in body height in most modern countries since the end-19th and particularly since the mid-20th century. Modern Japanese mature earlier; the age at take-off (ATO, the age at which the adolescent growth spurt starts) decreases, and they are taller at all ages. Preece-Baines modelling of six national samples of Japanese children and adolescents, surveyed between 1955 and 2000, shows that this gain in height is largely an adolescent trend, whereas height at take-off (HTO) increased by less than 3 cm since 1955; adolescent growth (height gain between ATO and adult age) increased by 6 cm. The effect of globalization on the modern post-war Japanese society (“community effect in height”) on adolescent growth is discussed.

Health Promotion in a Low-income Primary School: Children with and Without DCD Benefit, but Differently

Poor motor performance and reduced physical fitness are characteristic of children with Developmental Coordination Disorder (DCD). These features have also been identified more frequently among children living in low socio-economic circumstances.

AIMS

To evaluate the outcomes of a nine-week health promotion program (HPP) on the motor performance and fitness levels of children (6-10 years) with and without DCD attending a low-income primary school.

METHODS

The HPP was designed and implemented by undergraduate physiotherapy students using guidelines from the World Health Organization School Health Initiative and their physiotherapy curriculum. Children with DCD (n = 22) and a control group without DCD (n = 19) participated in the evaluation. Motor skill, functional strength, aerobic capacity, and anaerobic power were measured at baseline and after nine weeks.

RESULTS

Both groups of children improved on all measures at the conclusion of the HPP. Children with DCD showed greater improvement than the control group in motor performance and the control group showed greater improvement on one of the anaerobic fitness outcomes.

CONCLUSIONS

A school-based HPP that focuses on increasing opportunities for physical activity may be effective in improving motor performance in children with DCD and can increase fitness levels in general.

Individual and school level correlates of moderate to vigorous physical activity among school-children in Germany--a multi-level analysis

Background

Young people spend half of their days in school, but evidence concerning the influence of school environment on the physical activity (PA) of pupils is still inconsistent. A better understanding of potential correlates of PA on the school-level and their possible interaction with individual aspects is needed to improve the development of more effective interventions.

Methods

We used data from the 2009/10 German Health Behaviour in School-aged Children study (HBSC)-sample (n=5,005 students aged 11–15 years) including self-reported moderate to vigorous intensity PA as well as a variety of biological, demographic and behavioral correlates and matched them with school-level data from the national school principals’ HBSC questionnaire. We analyzed the associations of individual- and school-level correlates with MVPA by gender-specific multi-level regression.

Results

Only a small share of the overall variation in student’s PA was attributable to the school-level. Consequently, the associations of individual-level correlates with PA were stronger than those of the school-level. Our analysis revealed significant associations of individual-level (i.e. age, consumption of softdrinks, overweight) as well as school-level correlates (i.e. the availability of a football ground and a swimming pool) with MVPA. We also observed some gender-specific findings especially for the school level correlates. Cross-level interactions between individual- and school-level were not apparent.

Conclusions

Our findings indicate the usefulness of applying an ecological framework to understand and explain complex health behaviors like PA. As we found gender-specific association it might be important to acknowledge that boys and girls have specific needs to be more physically active. Further research should also take other features/elements of the school environment and neighborhood as well as socio-cognitive correlates into account to advance the field.

Tracking physical activity in different settings from late childhood to early adulthood in Germany: the MoMo longitudinal study

BACKGROUND

Regular physical activity is important for remaining healthy. Most studies on the association between active child- and adulthood were based on small non-representative populations. The purpose of the study was to quantify tracking of leisure-time PA (in and outside sports clubs) for 6 years from adolescence into young adulthood in a representative sample in Germany.

METHODS

This study was a subsample of the "Motorik-Modul (MoMo) Longitudinal Study" (baseline: 2003-2006, wave 1: 2009-2012). Representative longitudinal physical activity data of N = 947 adolescents were included and collected using the MoMo-physical activity questionnaire (MoMo-PAQ). Stability of different physical activity indices was measured using Spearman's rank-order correlations and ANOVA with repeated measurement with age, sex and socio-economic status (SES) as determinants.

RESULTS

While mean leisure-time physical activity outside sports clubs (LTPA) (F(1,397) = 7.9, df = 1; p < .01), sports club physical activity (SCPA) (F(387) = 4.8, df = 1; p < .05) and overall physical activity (OPA) (F(1,441) = 7.7, df = 1; p < .01) changed significantly over time, no changes in overall sports index (OS index) (F(371) = 3.2, df = 1; p > .05) were observed. Low tracking correlations were found for different physical activity indices (LTPA: r = .094, p < .05; SCPA: r = .248 p = <.05; OPA: r = .211 p < .05; OS index: r = .266 p < .05). Results by sex, age and SES were inconsistent. Analyses of agreement showed different results for determinants and settings.

CONCLUSION

The results of this representative study were comparable to previous studies and showed significant but low stability. Possible reasons for low stability coefficients are a relatively long timespan between both measurement points and potential effects of the reliability of subjective assessment methods. The results confirm that physical activity is a fluctuating variable. Future studies should examine the determinants of tracking and change in physical activity.

Telephone-based adiposity prevention for families with overweight children (T.A.F.F.-Study): one year outcome of a randomized, controlled trial

The one-year outcome of the randomized controlled T.A.F.F. (Telephone based Adiposity prevention For Families) study is presented. Screening of overweight (BMI-SDS > 90th centile) children 3.5–17.4 years was performed via the German CrescNet database, and candidates were randomized to an intervention group (IG) and control group (CG). The intervention consisted of computer-aided telephone counselling for one year, supported by mailed newsletters. The primary endpoint was change in BMI-SDS; secondary endpoints were eating behavior, physical activity, media consumption, quality of life. Data from 289 families (145 IG (51% females); 144 CG (50% females)) were analyzed (Full Analysis Set: FAS; Per Protocol Set: PPS). Successful intervention was defined as decrease in BMI-SDS ≥ 0.2. In the FAS, 21% of the IG was successful as compared to 16% from the CG (95% CI for this difference: (−4, 14), p = 0.3, mean change in BMI-SDS: −0.02 for IG vs. 0.02 for CG; p = 0.4). According to the PPS, however, the success rate was 35% in the IG compared to 19% in the CG (mean change in BMI-SDS: −0.09 for IG vs. 0.02 for CG; p = 0.03). Scores for eating patterns (p = 0.01), media consumption (p = 0.007), physical activity (p = 9 × 10⁻⁹), quality of life (p = 5 × 10⁻⁸) decreased with age, independent of group or change in BMI-SDS. We conclude that a telephone-based obesity prevention program suffers from well-known high attrition rates so that its effectiveness could only be shown in those who adhered to completion. The connection between lifestyle and weight status is not simple and requires further research to better understand.

Relationship of parental health-related behaviours and physical fitness in girls and boys

Aim

Physical activity (PA) and physical fitness (PF) are known to be closely connected. Various environmental and biological constraints have been shown to influence children’s PA with parents being among strong determinants of their children’s PA behaviour. However, little is known about parental influence on PF in children. Therefore, the purpose of this study was to identify the influence of parental health-related behaviours and attitudes on PF in boys and girls.

Subjects and methods

Baseline data of 1,875 primary school children (7.1 ± 0.6 years; 50 % male) were included in the analyses. Lateral jumping performance was used as a proxy for whole-body coordination and the 6-min run for cardiovascular fitness. Parental health-related behaviours, attitudes and sociodemographic variables were assessed via questionnaire. Regression analyses, adjusting for age and BMI, were performed separately for boys and girls.

Results

The final models of the regression analyses showed that children’s age and BMI are significantly related to PF. Mothers’ self-efficacy to encourage their children to be active is significantly associated with boys’ coordination and cardiovascular fitness and girls’ coordination. Mothers’ PA affects PF in boys, not in girls. Maternal smoking has a significantly negative effect on both boys’ and girls’ cardiovascular fitness.

Conclusion

This study shows that parental health-related behaviours and self-efficacy to encourage their children to be active affect children’s PF. Influencing factors, however, differ in girls and boys, and mothers seem especially influential.

Is there an influence of modern life style on skeletal build?

OBJECTIVES

Modern human life style has led to significant decrease in everyday physical activity and bipedal locomotion. It has previously been shown that skeletal robustness (relative elbow breadth) is associated with daily step counts. The aim of the study was to investigate whether also other skeletal measures, particularly pelvic breadth may have changed in recent decades.

METHODS

We re-analyzed elbow breadth, pelvic breadth (bicristal), and thoracic depth and breadth, of up to 28,975 healthy females and 28,288 healthy males aged 3-18 years from cross-sectional anthropological surveys performed between 1980 and 2012 by the Universities of Potsdam and Berlin, Germany.

RESULTS

Relative elbow breadth (Frame index) significantly decreased in both sexes since 1980 (<0.001). The trend toward slighter built was even more pronounced in absolute and relative pelvic breadth. In contrast, equivalent changes of parts of the skeletal system that are not involved in bipedal locomotion such as thoracic breadth, thoracic depth, and the thoracic index were absent.

CONCLUSIONS

The present investigation confirms the decline in relative elbow breadth in recent decades. Analogue, but even more pronounced changes were detected in pelvic breadth that coincides with the modern decline in upright locomotion. The findings underscore the phenotypic plasticity of humans while adapting to new environmental conditions.

Metformin, oral contraceptives or both to manage oligo-amenorrhea in adolescents with polycystic ovary syndrome? A clinical review

The management of oligo-amenorrhea in adolescent patients with polycystic ovary syndrome (PCOS) represents an important and difficult challenge. Metformin and/or oral contraceptives (OCs) are different strategies widely proposed in these patients. The objective of the current review was to provide an overview on the use of metformin and/or OCs for the management of oligo-amenorrhea in adolescents with PCOS underlining their potential risks and benefits in order to help the clinician to choose the best patients' tailored treatment.

Trends in television time, non-gaming PC use and moderate-to-vigorous physical activity among German adolescents 2002-2010

Background

Studies in youth highlight that moderate-to-vigorous physical activity (MVPA) and screen-time behaviours such as television viewing and PC use are associated with a range of health outcomes. However, little is known about recent trends in these behaviours in adolescents. This paper presents time trends in German adolescents’ television time, non-gaming PC use as well as MVPA from 2002 to 2010.

Methods

Data were derived from the cross-sectional German Health Behaviour in School-aged Children (HBSC) study in 2002, 2006 and 2010. Analyses were based on 16,918 11-to 15-year olds boys (49.1%) and girls. Outcome variables were time spent in TV viewing and using a PC (weekday and weekend day) as well as the number of days achieving 60 minutes of MVPA. Changes in both screen-time behaviours and MVPA over time were analysed using sex-specific linear regression, controlling for age and family affluence.

Results

TV viewing on weekdays, but not at weekends, declined steadily over time with a difference between 2002 and 2010 of 12.4 min/day in girls and 18.3 min/day in boys (p for trend < .01). We found a strong increase in PC use for non-gaming purposes over time for girls only, with a difference between 2002 and 2010 of 54.1 min/weekday and 68.8 min/weekend day (p < .001). For MVPA we found a slight statistically significant increase in terms of meeting PA guidelines as well as days/week in MVPA for boys and girls (p < .001). In 2010 14.0% of girls and 19.9% of boys met PA guideline.

Conclusion

Although MVPA increased from 2002 to 2010 in German adolescents, the time spent in MVPA was still low. Despite the observed decrease in TV viewing, there was no overall decline in the observed screen-based behaviours, especially for girls. This is mainly due to a marked increase in use of a PC for chatting on-line, internet, emailing, homework etc. among girls during the last ten years which outweighs the corresponding decrease in TV viewing. The findings highlight a need for strategies and interventions aimed at reducing screen-time behaviours and promoting MVPA.

Proximity to sports facilities and sports participation for adolescents in Germany

OBJECTIVES

To assess the relationship between proximity to specific sports facilities and participation in the corresponding sports activities for adolescents in Germany.

METHODS

A sample of 1,768 adolescents aged 11-17 years old and living in 161 German communities was examined. Distances to the nearest sports facilities were calculated as an indicator of proximity to sports facilities using Geographic Information Systems (GIS). Participation in specific leisure-time sports activities in sports clubs was assessed using a self-report questionnaire and individual-level socio-demographic variables were derived from a parent questionnaire. Community-level socio-demographics as covariates were selected from the INKAR database, in particular from indicators and maps on land development. Logistic regression analyses were conducted to examine associations between proximity to the nearest sports facilities and participation in the corresponding sports activities.

RESULTS

The logistic regression analyses showed that girls residing longer distances from the nearest gym were less likely to engage in indoor sports activities; a significant interaction between distances to gyms and level of urbanization was identified. Decomposition of the interaction term showed that for adolescent girls living in rural areas participation in indoor sports activities was positively associated with gym proximity. Proximity to tennis courts and indoor pools was not associated with participation in tennis or water sports, respectively.

CONCLUSIONS

Improved proximity to gyms is likely to be more important for female adolescents living in rural areas.