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Huang Y, Wang X, Meng N, Li L, Zhang J, Wu Q, Zhang Y. Suboptimal status of tummy time for infants in early childhood education institutions in urban China: A cross-sectional study. J Glob Health 2024; 14:04048. [PMID: 38483439 PMCID: PMC10939112 DOI: 10.7189/jogh.14.04048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Background Although tummy time is recommended as a form of physical activity for non-movable infants worldwide, little is known regarding the current status of tummy time practices among Chinese infants. Early childhood education (ECE) institutions provide children with rich learning experiences; however, tummy time practices among infants in these ECE institutions were unclear. This study aimed to investigate the status of tummy time among infants within the context of ECE institutions. Methods We conducted a cross-sectional survey with primary caregivers of infants aged 0-11 months across 31 provinces of China from 1 March to 30 April 2023. To recruit participants, we collaborated with Gymboree Play & Music, an ECE institution with over 500 centres in nearly 200 cities in urban China. Our survey instrument was developed based on the World Health Organization (WHO) guidelines and literature to collect data on infants' tummy time practices, caregivers' tummy time knowledge and information sources. We used self-administered questionnaires through WeChat, in which participants scanned a quick response (QR) code to complete the questionnaire. Results We included 1040 infants and their primary caregivers, with 504 infants aged 0-5 and 536 infants aged 6-11 months old. Less than half of infants (48.2%) started tummy time in the neonatal period, with 20.5% starting within two weeks after birth. Only 27.2% of infants engaged in at least 30 minutes of tummy time during the last 24 hours, with infants aged 0-5 months significantly lower than those aged 6-11 months (21.6 vs 32.5%, P < 0.0001). No significant difference was found between attending ECE class and non-attending ECE class groups for the proportion of infants with tummy time ≥30 minutes per day (28.9 vs 23.4%, P = 0.0625); however, infants aged 0-5 months in the attending group engaged in longer duration of tummy time than those in the non-attending group (P = 0.0005). The compliance with the tummy time guidelines in infants receiving long-nurturing care was significantly higher than those receiving short-nurturing care (30.4 vs 22.1%, P = 0.0036). Only 42.7% of caregivers knew that at least 30 minutes daily tummy time was necessary for infant, and more primary caregivers in the attending group knew that, compared to the non-attending group (45.3 vs 36.8%, P = 0.0098). Conclusions The current status of infants' tummy time practices and caregivers' knowledge are generally suboptimal within the context of ECE institutions in urban China. Longer nurturing time contributes to higher compliance with tummy time guidelines. Effectively promoting tummy time practices through multiple channels in China is crucial.
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Affiliation(s)
- Yiwen Huang
- Child Healthcare Centre, Children’s Hospital, Capital Institute of Paediatrics, Beijing, China
| | - Xiaotong Wang
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, Beijing, China
| | - Na Meng
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, Beijing, China
| | - Lin Li
- Beijing KidsHome Children Development Centre, Beijing, China
| | - Jian Zhang
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, Beijing, China
| | - Qiong Wu
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, Beijing, China
| | - Yanfeng Zhang
- Department of Integrated Early Childhood Development, Capital Institute of Paediatrics, Beijing, China
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Bruijns BA, Bourke M, Loh A, Tucker P. Movement behaviour education for parents in prenatal, postnatal, and pediatric care in Canada: A needs assessment. BMC Pediatr 2024; 24:164. [PMID: 38459485 PMCID: PMC10921676 DOI: 10.1186/s12887-024-04630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/08/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Parents/guardians can greatly influence their child's movement behaviours (i.e., physical activity, sedentary behaviour, and sleep). Yet, they have reported to lack sufficient background knowledge to foster healthy movement habits, and little is known about specific educational gaps. The aim of this study was to explore the educational background and needs regarding promoting healthy movement behaviours in early childhood among parents/guardians living in Canada. METHODS A cross-sectional study was conducted with parents/guardians living in Canada who had at least one child under the age of 5 years. Participants completed an online survey capturing their demographics, information they received about movement behaviours in early childhood during their prenatal/postnatal care or child's pediatrician appointments, where they sourced information about these topics, content areas they would like more information on, and preferred format for delivery. Descriptive statistics and frequencies were calculated for all outcome variables and logistic regression was used to explore if sociodemographic variables were associated with receiving movement behaviour-related education across care types. RESULTS Among the 576 parents/guardians who completed the survey, many reported no mention of any movement behaviour in their prenatal (49.4%), postnatal (29.6%), and pediatric care (37.2%). Physical activity was the most cited movement behaviour across care types, with 42.4%, 57.9%, and 54.8% of participants indicating this was discussed in their prenatal, postnatal, and pediatric care, respectively. Only 41.7% of parents/guardians reported asking their child's pediatrician about movement behaviours, while most relied on social media (70.9%), internet websites/news articles (68.7%), and family/friends (67.6%). The most sought-after movement behaviour topics included incorporating movement into traditionally sedentary activities (68.8%) and activity ideas to break up sitting time (65.0%), and participants expressed preference to receive more information via social media (63.2%), an online resource package (47.8%), or email (46.6%). CONCLUSIONS Given the noted inconsistencies in education relating to movement behaviours in maternal and pediatric care, this study highlights the opportunity for greater integration of this type of education across care types. Ensuring all parents/guardians receive evidence-based and consistent guidance on their child's movement behaviours will help ensure young children receive the best start to a healthy active life.
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Affiliation(s)
- Brianne A Bruijns
- School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada
| | - Matthew Bourke
- School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada
| | - Aidan Loh
- School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada
| | - Patricia Tucker
- School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada.
- Children's Health Research Institute, London, ON, Canada.
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Quah PL, Loo BKG, Chia MYH, Chua TBK, Tan TSZ, Chan PC, Tan KH. Adherence to 24-hour integrated activity guidelines among infants, toddlers and preschool children in Singapore. PLoS One 2024; 19:e0298968. [PMID: 38408072 PMCID: PMC10896501 DOI: 10.1371/journal.pone.0298968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
This study examined children's adherence to the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood in infants, toddlers and preschoolers aged 0-6 years. A total of 901 caregivers, comprising 219 infants, 379 toddlers, and 303 preschoolers, provided information regarding their children's physical activity (PA), screen viewing time (SVT), and sleep durations on both weekdays and weekends. Meeting the 24-hour integrated activity guidelines was defined as follows: for infants ≥ 30 minutes per day of tummy time or floor-based play; zero SVT; total sleep of 14-17 hours per day for ages 0-3 months, 12-16 hours per day for ages 4-11 months; for toddlers ≥ 180 minutes of total PA per day; zero SVT under 2 years; <1 hour for ages 2 to less than 3 years; and a total sleep of 11-14 hours per day; for preschoolers ≥ 180 minutes of total PA per day; SVT <1 hour per day; total sleep of 10-13 hours per day for those aged 3-5 years, and 10-11 hours per day for 6-year-olds. Chi-squared tests were used to examine the differences in guideline adherence between weekdays and weekends. Compared to weekdays, during weekends there was a higher proportion of toddlers and preschoolers adhering to the PA guidelines (68.9% vs 50.1%; 78.9% vs 55.4%, respectively, p<0.05), and a lower proportion of toddlers adhering to SVT (38.8% vs 21.8%; p = 0.001). There was a declining adherence to all three activity guidelines as age groups progressed from infants (44.7%) to toddlers (15.8%) and then to preschoolers (9.4%). Concurrently, there was a decrease in adherence to SVT recommendations across the age groups, with adherence rates being highest among infants (83.1%), followed by toddlers (15.8%), and preschoolers (9.4%). Decreasing compliance with all three guidelines, coupled with a corresponding decline in adherence to SVT guidelines as children transition from toddlerhood to preschool age, is a cause for concern. This underscores the need for proactive efforts to educate caregivers about reducing or eliminating SVT among infants and young children.
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Affiliation(s)
- Phaik Ling Quah
- Division of Obstetrics & Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Benny Kai Guo Loo
- General Paediatric Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Michael Yong Hwa Chia
- Physical Education & Sports Science, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Terence Buan Kiong Chua
- Physical Education & Sports Science, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Teresa Shu Zhen Tan
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Poh Chong Chan
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Kok Hian Tan
- Division of Obstetrics & Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Huang Y, Li L, Zhao C, Zhong P, Wang X, Geng Y, Meng N, Wu Q, Zhang Y. Leveraging nursery and early childhood education institutions for improving feeding and movement behaviours of infants and young children in China. J Glob Health 2024; 14:03011. [PMID: 38330205 PMCID: PMC10852538 DOI: 10.7189/jogh.14.03011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Affiliation(s)
- Yiwen Huang
- Child Healthcare Center, Children’s Hospital, Capital Institute of Paediatrics, Beijing, China
| | - Lin Li
- Beijing KidsHome Children Development Center, Beijing, China
| | - Chen Zhao
- Beijing KidsHome Children Development Center, Beijing, China
| | - Peijing Zhong
- GYMBOREE Educational Information Consultation CO. LTD, Shanghai, China
| | - Xiaotong Wang
- Department of Integrated Early Childhood Development, Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Paediatrics, Beijing, China
| | - Yi Geng
- Beijing KidsHome Children Development Center, Beijing, China
| | - Na Meng
- Department of Integrated Early Childhood Development, Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Paediatrics, Beijing, China
| | - Qiong Wu
- Department of Integrated Early Childhood Development, Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Paediatrics, Beijing, China
| | - Yanfeng Zhang
- Department of Integrated Early Childhood Development, Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Paediatrics, Beijing, China
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Loh GY, Chua TBK, Hian Tan K, Loo BKG, Quah PL, Chia MYH. Adherence to the Singapore Integrated 24-Hour Activity Guidelines by Infants and Toddlers and Its Association With Well-Being. J Phys Act Health 2024; 21:171-180. [PMID: 38061354 DOI: 10.1123/jpah.2023-0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND This study estimated the prevalence of Singapore infants and toddlers who met the new Singapore Integrated 24-Hour Activity Guidelines for Early Childhood and examined its association with well-being. METHODS A total of 267 parents of children aged between 0 and 2 years completed an online questionnaire that consists of the Singaporean Children Lifestyle Questionnaire and either the Pediatric Quality of Life (PedsQL) Inventory Infant Scale or the Strength and Difficulties Questionnaire. Well-being of infants was measured through parent responses to PedsQL and that of toddlers was measured through Strength and Difficulties Questionnaire. Data were benchmarked against age-specific guidelines for physical activity, screen time, and sleep in the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood. RESULTS A higher percentage of infants (37.3%) than toddlers (20.6%) had met 3 guidelines. In contrast, a lower percentage of infants than toddlers met at least one or did not meet any guidelines (3.8% and 0% for infants vs 22.4% and 1.8% for toddlers, respectively). Infants who met more guidelines had significantly higher parent-reported PedsQL total scale score than infants who met fewer guidelines (P < .05). However, the present study found that the number of guidelines met was not associated to infants' PedsQL scale score and toddlers' total difficulty score (P > .05). CONCLUSION Adherence to this set of local guidelines should be widely publicized, so parents will have greater awareness and knowledge on cultivating good physical activity, screen time, and sleep habits for their child from a young age.
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Affiliation(s)
- Guan Yuan Loh
- Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Terence Buan Kiong Chua
- Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Kok Hian Tan
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Benny Kai Guo Loo
- Sport and Exercise Medicine Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Phaik Ling Quah
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Michael Yong Hwa Chia
- Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, Singapore, Singapore
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Francisco ASPG, Graciosa MD, Pacheco SCDS, Sonza A, Sanada LS. Does premature birth affect Brazilian parents' practices related to infant positioning? REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 42:e2022163. [PMID: 37493671 PMCID: PMC10365550 DOI: 10.1590/1984-0462/2024/42/2022163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 04/21/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To verify whether the time spent in prone, supine, or seated positions differed between term and preterm infants; and to determine whether a single verbal guidance session for parents changed the time spent in different positions, and, consequently, the motor development scores, after one month in preterm infants. METHODS Sixty-one infants from a full-term and preterm group from Brazil were included. Motor development was assessed by the Alberta Infant Motor Scale (AIMS) and the parents registered the time spent in each position on a 24-hour schedule. A month after verbal guidance, a second assessment was performed only on the preterm infants. RESULTS The positioning times awake determined for the full-term and preterm parents were similar. Preterm infants spent more time in the prone sleeping position (2.1 vs. 0.8 h; p=0.037) than full-term infants. The AIMS percentile scores did not differ significantly between the groups. For preterm infants, the time spent in all positions did not change during the second assessment (n=18). CONCLUSIONS The fact that some parents position their infants in the prone posture during sleeping periods reinforce the importance of parental education approaches for sudden infant death syndrome (SIDS) prevention during the first months of life. The verbal guidance provided to parents of preterm infants did not influence the AIMS percentile and time spent in various positions but increased preterm parents' confidence in placing their infants in a prone position to play.
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Affiliation(s)
| | | | | | - Anelise Sonza
- Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil
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Downing KL, del Pozo Cruz B, Sanders T, Zheng M, Hnatiuk JA, Salmon J, Hesketh KD. Outdoor time, screen time and sleep reported across early childhood: concurrent trajectories and maternal predictors. Int J Behav Nutr Phys Act 2022; 19:160. [PMID: 36581865 PMCID: PMC9798690 DOI: 10.1186/s12966-022-01386-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/26/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Understanding the developmental trajectories of outdoor time, screen time and sleep is necessary to inform early interventions that promote healthy behaviours. This study aimed to describe concurrent trajectories of outdoor time, screen time and sleep across the early childhood period and their maternal predictors. METHODS Data across five time points at child age 4, 9, 19, 42 and 60 months from the INFANT intervention were analysed. Mothers reported their child's usual outdoor time, screen time and sleep duration, in addition to a range of maternal beliefs, attitudes, expectations and behaviours. Group-based multi-trajectory modelling was used to model concurrent trajectories of children's behaviours. Multinomial logistic regression models determined the associations of maternal predictors with trajectory groups, adjusting for child sex and baseline age, intervention allocation, and clustering by recruitment. RESULTS Of the 542 children recruited, 528 had data for outdoor time, screen time and sleep at one or more time points and were included in trajectory analyses Four trajectories were identified: 'unstable sleep, increasing outdoor time, low screen' (~ 22% of sample), 'high outdoor time, low screen, high sleep' (~ 24%), 'high sleep, increasing outdoor time, low screen' (~ 45%), 'high screen, increasing outdoor time, high sleep' (~ 10%). The 'high sleep, increasing outdoor time, low screen' group, comprising the largest percentage of the sample, demonstrated the healthiest behaviours. Predictors of group membership included: views of physically active children, screen time knowledge, screen time use, self-efficacy, physical activity optimism, future expectations for children's physical activity and screen time, perceptions of floor play safety, and maternal physical activity, screen time, and sleep quality. CONCLUSIONS Four distinct trajectories of outdoor time, screen time and sleep were identified, with the most common (and healthiest) characterized by high levels of sleep. Maternal beliefs, attitudes, expectations and behaviours are important in the development of movement behaviour trajectories across early childhood. Future interventions and public policy may benefit from targeting these factors to support healthy movement behaviours from a young age.
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Affiliation(s)
- Katherine L. Downing
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Borja del Pozo Cruz
- grid.10825.3e0000 0001 0728 0170Center for Active and Healthy Ageing, Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Taren Sanders
- grid.411958.00000 0001 2194 1270Institute for Positive Psychology and Education, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Miaobing Zheng
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jill A. Hnatiuk
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jo Salmon
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Kylie D. Hesketh
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Carson V, Zhang Z, Predy M, Pritchard L, Hesketh KD. Adherence to Canadian 24-Hour Movement Guidelines among infants and associations with development: a longitudinal study. Int J Behav Nutr Phys Act 2022; 19:154. [PMID: 36522740 PMCID: PMC9753321 DOI: 10.1186/s12966-022-01397-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To examine: 1) longitudinal adherence to the Canadian 24-Hour Movement Guidelines in a sample of infants and 2) associations between adherence to the guidelines over time and development. METHODS Participants were 250 parent-infant dyads from the Early Movers project in Edmonton, Alberta. At 2, 4, and 6 months of age, physical activity, sedentary behaviour, sleep, and development were measured with a parental questionnaire that included items from the Ages & Stages Questionnaire (ASQ-3). Parents also reported the dates six major gross motor milestones were acquired during the first 18 months of life according to World Health Organization criteria. In a sub-sample (n = 93), movement behaviours were also measured with a time-use diary at 2, 4, and 6 months and gross motor development was measured by a physiotherapist using the Alberta Infant Motor Scale (AIMS) at 6 months. Guideline adherence was defined as: 1) ≥ 30 min/day of tummy time, 2) no screen time, some reading time, no restrained bouts > 1 h (time-use diary only), and 3) 14-17 h (2 months) or 12-16 h (4 and 6 months) of sleep per 24-h period. Generalized estimating equations were conducted as well as linear mixed models and linear regression models that adjusted for demographic characteristics. RESULTS Few infants met the guidelines at all time-points (questionnaire: 2%; time-use diary: 0%). Infants that met a recommendation at 2 months, compared to those that did not, were 1.8-8.2 times more likely to meet that recommendation at subsequent time-points. Meeting more recommendations across time-points, according to both measures, was associated with a higher mean ASQ-3 gross motor score. Each additional time-point of tummy time recommendation adherence (questionnaire-measured) was associated with a 5-11-day earlier acquisition of independent sitting, crawling, and independent standing milestones. In the sub-sample, each additional time-point of guideline adherence was associated with a 16% higher AIMS score at 6 months. CONCLUSIONS Guideline adherence was low across the first 6 months of infancy. Overall, meeting more recommendations over this period appeared important for gross motor development. Parents and caregivers should be targeted as early as possible with guideline dissemination and activation strategies to promote healthy infant development.
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Affiliation(s)
- Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada.
| | - Zhiguang Zhang
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Madison Predy
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Lesley Pritchard
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Vic, Australia
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Hewitt L, Frohmuller C, Wall J, Okely AD. Clinician and early childhood educator knowledge and advice given to parents regarding physical activity, screen time and sleep. An observational study. J Pediatr Nurs 2022; 66:143-150. [PMID: 35759995 DOI: 10.1016/j.pedn.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/19/2022] [Accepted: 06/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Global guidelines regarding infant physical activity, screen time and sleep were released by the World Health Organisation in 2019. Clinician and Early Childhood Educator's knowledge and advice given to parents regarding this content is unknown. The aims of this study were to determine the advice given to parents regarding infant care. This will enable a baseline from which future interventions and multidisciplinary professional development can be compared and reviewed. METHODS 80 Clinicians (Medical, Nursing, Allied Health) and Early Childhood Educators from a local health district in NSW Australia completed an online survey. Medical records (N = 272) were also reviewed to determine if the documentation included advice in accordance with guidelines. FINDINGS Staff were aware that infant guidelines contributes to positive health outcomes (all >85%). Nursing entered the most information into the medical record with >80% of files containing general advice about infant physical activity and sleep. Only 30% of entries contained evidence of guideline specific information. Minimal entries from all clinicians contained information about screen time (2%). DISCUSSION The majority of clinicians and Early Childhood Educators were aware of the content of the guidelines and the advice they report to provide is consistent. Medical record documentation regarding the specificity of advice provided is lacking. APPLICATION TO PRACTICE This study provides a baseline from which professional development interventions aimed at increasing compliance to infant guidelines can be compared.
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Affiliation(s)
- Lyndel Hewitt
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, 2500, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, 2522, Australia; Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, 2522, Australia.
| | - Carolyn Frohmuller
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, 2500, Australia.
| | - Jacinta Wall
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, 2500, Australia.
| | - Anthony D Okely
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, 2522, Australia; Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, 2522, Australia.
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Hesketh KR, Janssen X. Movement behaviours and adherence to guidelines: perceptions of a sample of UK parents with children 0-18 months. Int J Behav Nutr Phys Act 2022; 19:58. [PMID: 35598015 PMCID: PMC9124375 DOI: 10.1186/s12966-022-01300-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Movement behaviours are important for infant (0-12 mo) and toddler (1-2 yrs) health and development, yet very little is known about adherence to the 24-hour movement behaviour guidelines and parents perception of these behaviours in these age groups. This study aimed to examine parental perceptions of movement behaviours and adherence to guidelines in a sample of UK parents with children 0-18 months. METHODS Participants were 216 parent-child dyads from the cross-sectional Movement Behaviour Assessment in Infants and Toddlers (M-BAIT) study. Tummy time, screen time, restraint time and sleep were measured using a parental questionnaire. A sub-sample of parents were asked about their priority areas for their child's health and development. Frequencies were used to describe the proportion of children meeting movement behaviour guidelines, the number of guidelines met and priority areas for parents. Mann-Whitney U-tests (continuous variables) and chi-square tests (categorical variables) were used to assess the differences between boys and girls. RESULTS For those under 12 months of age, just over 30% of children met tummy time recommendations, 41.3% met the screen time guidelines, 57.8% met restraint guidelines and 76.2% met sleep guidelines. For those 12 months and over, 24.1% met the screen time guidelines, 56.9% met restraint guidelines and 82.8% met sleep guidelines. Parents identified sleep and physical activity as top priorities for their child. Limiting screen time was deemed least important. CONCLUSION In this sample of UK infants and toddlers (0-18 months), few adhered to the sedentary behaviour and tummy time guidelines, whereas the majority meet sleep guidelines. This mirrors parental priorities; limiting screen time was seen as less important, with sleep and physical activity deemed most important. These findings suggest greater efforts are needed to raise awareness about screen and tummy time, supporting parents and care-providers to promote positive movement behaviours.
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Affiliation(s)
- Kathryn R Hesketh
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Xanne Janssen
- Physical Activity for Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, G1 1QN, UK.
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Hewitt L, Frohmuller C, Wen LM, Okely AD. Effect of a multicomponent intervention in postnatal mothers' groups on meeting the Australian Physical Activity Guidelines for infants: protocol for a randomised controlled trial. BMJ Open 2022; 12:e054183. [PMID: 35440448 PMCID: PMC9020305 DOI: 10.1136/bmjopen-2021-054183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Given the importance of tummy time and the low levels of tummy time reported globally, there is a need for high-quality intervention strategies to promote tummy time. This study describes the protocol of a randomised controlled trial that aims to determine the effectiveness of a multicomponent intervention delivered in postnatal mothers' groups in increasing infant tummy time. METHODS AND ANALYSIS A randomised controlled trial will be conducted. Eligible participants will be mothers and their infants attending postnatal mothers' groups (New South Wales, Australia). Participants will be randomised to participate in either (1) infant tummy time intervention group (practice, education, WhatsApp) plus usual care; or (2) usual care group. Randomisation process and outcome assessors will be blinded. The intervention will comprise an online education and practice session (60 min) and 4 weeks of WhatsApp messaging (standardised, three times per week). Usual care will be attendance at a mothers group once per week for 3 weeks for information and support for ad hoc mother craft activities (standard practice provided by early childhood nurses for this local health district). The primary outcome will be the amount of infant tummy time using the GENEActiv accelerometer and a questionnaire (post intervention). The accelerometer will be worn on the right hip secured by an elastic belt around the waist. Wear and non-wear time will be classified using temperature and z-axis cut points as per previous research. This protocol paper presents the scientific background and proposed methods of the randomised controlled trial. Findings will inform the design of practically based strategies to inform clinicians, educators and parents about infant physical activity. ETHICS AND DISSEMINATION The University of Wollongong and Illawarra Shoalhaven Local Health District Health and Medical Human Research Ethics Committee approved the study (2020/ETH02970). Dissemination plan is publication, staff training and conference presentations. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry ACTRN12621000575831; Pre-results.
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Affiliation(s)
- Lyndel Hewitt
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Carolyn Frohmuller
- Kids and Families, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Preventive Research Collaboration, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Health Promotion, Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Anthony D Okely
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
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12
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McArthur BA, Volkova V, Tomopoulos S, Madigan S. Global Prevalence of Meeting Screen Time Guidelines Among Children 5 Years and Younger: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:373-383. [PMID: 35157028 PMCID: PMC8845032 DOI: 10.1001/jamapediatrics.2021.6386] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Pediatric guidelines suggest that infants younger than 2 years avoid screen time altogether, while children aged 2 to 5 years receive no more than 1 hour per day. Although these guidelines have been adopted around the world, substantial variability exists in adherence to the guidelines, and precise estimates are needed to inform public health and policy initiatives. OBJECTIVE To derive the pooled prevalence via meta-analytic methods of children younger than 2 years and children aged 2 to 5 years who are meeting guidelines about screen time. DATA SOURCES Searches were conducted in MEDLINE, PsycINFO, and Embase up to March 2020. STUDY SELECTION Studies were included if participants were 5 years and younger and the prevalence of meeting (or exceeding) screen time guidelines was reported. DATA EXTRACTION AND SYNTHESIS Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two independent reviewers extracted all relevant data. Random-effects meta-analyses were used to derive the mean prevalence rates. MAIN OUTCOMES AND MEASURES Prevalence of meeting screen time guidelines. RESULTS From 63 studies, 95 nonoverlapping samples with a total of 89 163 participants were included. For children younger than 2 years, the pooled prevalence of meeting the screen time guideline (0 h/d) was 24.7% (95% CI, 19.0%-31.5%). Moderator analyses revealed that prevalence of meeting screen time guidelines varied as a function of year of data collection (increased over time), measurement method (higher when questionnaires compared with interview), and type of device use (higher when a combination of screen use activities compared with television/movies only). For children aged 2 to 5 years, the mean prevalence of meeting the screen time guideline (1 h/d) was 35.6% (95% CI, 30.6%-40.9%). Moderator analyses revealed that the prevalence of meeting screen time guidelines varied as a function of type of device use (higher when screen time was television/movies only compared with a combination of screen use activities). CONCLUSIONS AND RELEVANCE The findings of this meta-analysis indicate that only a minority of children 5 years and younger are meeting screen time guidelines. This highlights the need to provide support and resources to families to best fit evidence-based recommendations into their lives.
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Affiliation(s)
- Brae Anne McArthur
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Valeriya Volkova
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine–Bellevue Hospital Center, New York
| | - Sheri Madigan
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
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13
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Prioreschi A, Norris SA. Describing correlates of early childhood screen time and outdoor time in Soweto, South Africa. INFANT AND CHILD DEVELOPMENT 2022. [DOI: 10.1002/icd.2313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Shane A. Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
- Global Health Research Institute, School of Human Development and Health, and NIHR Southampton Biomedical Research Centre University of Southampton Southampton UK
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14
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Demographic Correlates of Movement Behaviors in Infants: A Longitudinal Study. J Phys Act Health 2022; 19:177-185. [PMID: 35135898 DOI: 10.1123/jpah.2021-0570] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Demographic correlates of movement behaviors in infants are unclear. This study examined the longitudinal associations between demographic correlates and movement behaviors in infants. METHODS Participants were 411 parents of infants from the Early Movers project in Edmonton, Canada. Movement behaviors, infant and parental age, and nonparental care time were assessed using a parental questionnaire at 2, 4, and 6 months of age. Other infant and parental demographic variables were assessed at 2 months of age. Linear and generalized linear mixed models were conducted. RESULTS Infant age was associated with all movement behaviors except for restrained time. White infants and those with older parents had less tummy time but increased odds of having reading time. Infants of the most educated parents also had lower tummy time. Higher parental education and more siblings were associated with no screen time and longer infant sleep time. Infants with immigrant parent(s) were less likely to have reading time. No associations were found for infant sex, time spent in nonparental care, and parental marital status. CONCLUSION Since no single demographic group demonstrated healthy patterns for all movement behaviors, promotion of a healthy balance of movement behaviors may be needed universally for all infants.
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15
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Snyder K, Chaudhary P, Pereira A, Masuda K, Niski J, Dinkel D. Early impact of the COVID-19 pandemic on promotion of infant activity, strength and communication: A qualitative exploration. Acta Psychol (Amst) 2022; 222:103480. [PMID: 34971950 PMCID: PMC8719057 DOI: 10.1016/j.actpsy.2021.103480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Fostering physical activity, muscle strengthening and communication skills in diverse environments are vital to ensuring healthy infant development; however, promotion of these skills may be impacted by the COVID-19 pandemic. Therefore, the purpose of this study was to explore healthcare workers, parents and childcare providers' perceptions of the pandemic's influence on how they engage with infants to promote physical activity, muscle strength and communication. METHODS 37 subjects (12 = parents; 12 = childcare providers, 13 = healthcare workers) participated in a semi-structured interview. Data were analyzed via an inductive content analysis. RESULTS The majority of caregivers identified concerns related to: limitations in social interactions (especially masks impacting communication), lack of access to peer modeling, fewer opportunities for physical exploration, and a need for creative activities in diverse environments (e.g., home/childcare) for infant development during and after the pandemic. CONCLUSIONS Caregivers are concerned about the role COVID-19 is having on infant development. Additional resources on how to promote infant physical activity, muscle strength and communication despite challenges associated with the COVID-19 pandemic are needed.
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Affiliation(s)
- Kailey Snyder
- Creighton University, Omaha, NE 68130, United States of America.
| | - Priyanka Chaudhary
- University of Nebraska at Omaha, Omaha, NE 68124, United States of America.
| | - Angela Pereira
- Creighton University, Omaha, NE 68130, United States of America.
| | - Kimberly Masuda
- Creighton University, Omaha, NE 68130, United States of America.
| | - Jessica Niski
- Creighton University, Omaha, NE 68130, United States of America.
| | - Danae Dinkel
- University of Nebraska at Omaha, Omaha, NE 68124, United States of America.
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16
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A Longitudinal Analysis Examining the Associations of Tummy Time With Active Playtime, Screen Time, and Sleep Time. J Phys Act Health 2021; 18:1215-1222. [PMID: 34380110 DOI: 10.1123/jpah.2021-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/23/2021] [Accepted: 05/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Evidence links tummy time (ie, the time spent in awake prone positioning that is encouraged and supervised by an adult) to infants' health outcomes such as gross motor and total development. However, the associations between tummy time and other movement and sleep behaviors as the child develops remain unknown. The aim of this study was to examine whether early introduction and practice of tummy time within the first 6 months of age were associated with active and outdoor playtime, screen time, and nocturnal sleep time of children when they were 12 and 24 months old. METHODS A longitudinal analysis was conducted using data extracted from an Australian trial. Using telephone surveys with mothers, demographic data were collected from third trimester of pregnancy and tummy time data were collected at 6 months of age. Data on playtime, screen time, and nocturnal sleep duration as dependent variables were collected at 12 and 24 months of age. Multiple logistic regression models were built to investigate the associations. RESULTS Children who started tummy time within 4 weeks of age were more likely to have >10 hours sleep at night at 12 months (adjusted odds ratio 1.54, 95% confidence interval, 1.08-2.19). They were more likely to have >3 hours per day of outdoor play and have <1 hour per day of screen time at 24 months. Children who practiced tummy time every day were more likely to have >2 hours per day of active play at 12 months and have <1 hour per day of screen time at 24 months. CONCLUSIONS Starting tummy time earlier and frequently was associated with more favorable movement and sleep of young children at 12 and 24 months of age.
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17
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Byrne R, Terranova CO, Trost SG. Measurement of screen time among young children aged 0-6 years: A systematic review. Obes Rev 2021; 22:e13260. [PMID: 33960616 PMCID: PMC8365769 DOI: 10.1111/obr.13260] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/16/2022]
Abstract
The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.
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Affiliation(s)
- Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Caroline O. Terranova
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Stewart G. Trost
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
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18
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Health Promotion through Movement Behaviors and Its Relationship with Quality of Life in Spanish High School Adolescents: A Predictive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147550. [PMID: 34299997 PMCID: PMC8303880 DOI: 10.3390/ijerph18147550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/04/2021] [Accepted: 07/13/2021] [Indexed: 12/12/2022]
Abstract
A growing number of studies have highlighted the health benefits of high physical activity, low screen time, and optimal sleep duration among school-age children and adolescents. Objective: The present study proposes to examine the individual and combined association between movement behaviors (physical activity, screen time, and sleep time) and quality of life in boys and girls. Method: A total of 319 Spanish primary and secondary school students participated in the study. Physical activity, screen time, sleep duration, and quality of life were evaluated. Results: Descriptive, correlation, and regression analyses were carried out in order to improve knowledge about health-related behaviors for all participants. The results found significant positive associations between physical activities and sleep time with quality of life. Finally, the regression models showed that physical activity scores predict quality of life, especially in children. It is concluded that movement behaviors are important in association with quality of life. Likewise, the impact of physical activity on the quality of life is highlighted as the main behavior in the prediction of the quality of life for a population of school adolescents.
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19
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Feng J, Zheng C, Sit CHP, Reilly JJ, Huang WY. Associations between meeting 24-hour movement guidelines and health in the early years: A systematic review and meta-analysis. J Sports Sci 2021; 39:2545-2557. [PMID: 34176439 DOI: 10.1080/02640414.2021.1945183] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This systematic review examined the compliance with the 24-h movement guidelines, and investigated its associations with health indicators for healthy children under 5 years of age. MEDLINE, PsycINFO, EMBASE, PubMed, Web of Science and SPORTDiscus were searched for peer-reviewed studies and the last search was conducted on 27 October 2020. The Newcastle-Ottawa Scales were used to assess the quality of included studies. Eighteen articles including 8,943 participants from 11 countries were included. On average around 13% of the children met all three guidelines. Meta-analyses of the associations between meeting all three guidelines and adiposity yielded no significant results (r = - 0.03; 95% CI = - 0.12, 0.06; I2 = 51%; P = 0.48). Meeting more guidelines was associated with better psychosocial health (3/4 studies). Associations between meeting individual or combined guidelines and motor development yielded mixed results (2/2 studies), while no associations between meeting guidelines and cognitive development were observed (1 study). Compliance with all three guidelines was low. Further evidence is required to understand the associations between meeting the 24-h movement guidelines and health outcomes. Nevertheless, there was evidence of a dose-response relationship between meeting the guidelines and better psychosocial health in the early years.
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Affiliation(s)
- Jie Feng
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, China
| | - Chen Zheng
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, China
| | - Cindy Hui-Ping Sit
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, China
| | - John J Reilly
- Physical Activity and Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland
| | - Wendy Yajun Huang
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, China
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20
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Zhang Z, Sousa-Sá E, Pereira JR, Okely AD, Feng X, Santos R. Correlates of Sleep Duration in Early Childhood: A Systematic Review. Behav Sleep Med 2021; 19:407-425. [PMID: 32496141 DOI: 10.1080/15402002.2020.1772264] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This systematic review aimed to summarize correlates of sleep duration in children under 5 years of age. METHODS Six electronic databases (PubMed, PsycINFO, MEDLINE, CINAHL, SPORTDiscus, and Scopus) were searched from inception to May 2019. Observational studies and intervention studies reporting cross-sectional results from baseline data were considered. Data were extracted using a predesigned form and potential correlates were categorized following a sociological framework. RESULTS One-hundred and sixteen studies, representing 329,166 children, met the inclusion criteria, with a high risk of bias in 62 included studies. A total of 83 correlates of sleep duration were identified. Among the associations studied four or more times, correlates of nap duration were child's age and nighttime sleep onset/bedtime; correlates of nighttime sleep duration were household income, parent marital status, parental adiposity level, nighttime sleep duration at younger age, nighttime sleep onset/bedtime, nighttime sleep wakeup time, and frequency of current bedtime routine; correlate of total sleep duration was screen time. CONCLUSIONS Young children from low-income households, single families, or having overweight parents may be at risk for short sleep duration. Promoting healthy sleep duration from an early age appears essential. Effective practices may include encouraging an earlier bedtime, limiting screen time, and establishing a regular bedtime routine. The absence of consistent evidence in the psychological, cognitive, and emotional domain as well as the physical environmental domain warrants further research.
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Affiliation(s)
- Zhiguang Zhang
- Early Start, Faculty of Social Sciences, University of Wollongong, Australia
| | - Eduarda Sousa-Sá
- Early Start, Faculty of Social Sciences, University of Wollongong, Australia.,Illawarra Health and Medical Research Institute, Australia
| | - João R Pereira
- Early Start, Faculty of Social Sciences, University of Wollongong, Australia.,CIDAF (Uid/dtp/04213/2016), University of Coimbra, Coimbra, Portugal
| | - Anthony D Okely
- Early Start, Faculty of Social Sciences, University of Wollongong, Australia.,Illawarra Health and Medical Research Institute, Australia
| | - Xiaoqi Feng
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Australia.,Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
| | - Rute Santos
- Early Start, Faculty of Social Sciences, University of Wollongong, Australia.,Research Centre in Physical Activity, Health and Leisure, University of Porto, Porto, Portugal.,Universidade Lusófona de Humanidades e Tecnologia, Lisboa, Portugal
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21
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Khan A, Lee EY, Tremblay MS. Meeting 24-h movement guidelines and associations with health related quality of life of Australian adolescents. J Sci Med Sport 2021; 24:468-473. [DOI: 10.1016/j.jsams.2020.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/08/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
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22
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Validity of GENEActiv Accelerometer Wear and Nonwear Time for Use in Infants. J Phys Act Health 2021; 18:488-494. [PMID: 33837166 DOI: 10.1123/jpah.2019-0486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/10/2020] [Accepted: 02/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Tummy time is recommended by the World Health Organization as part of its global movement guidelines for infant physical activity. To enable objective measurement of tummy time, accelerometer wear and nonwear time requires validation. The purpose of this study was to validate GENEActiv wear and nonwear time for use in infants. METHODS The analysis was conducted on accelerometer data from 32 healthy infants (4-25 wk) wearing a GENEActiv (right hip) while completing a positioning protocol (3 min each position). Direct observation (video) was compared with the accelerometer data. The accelerometer data were analyzed by receiver operating characteristic curves to identify optimal cut points for second-by-second wear and nonwear time. Cut points (accelerometer data) were tested against direct observation to determine performance. Statistical analysis was conducted using leave-one-out validation and Bland-Altman plots. RESULTS Mean temperature (0.941) and z-axis (0.889) had the greatest area under the receiver operating characteristic curve. Cut points were 25.6°C (temperature) and -0.812g (z-axis) and had high sensitivity (0.84, 95% confidence interval, 0.838-0.842) and specificity (0.948, 95% confidence interval, 0.944-0.948). CONCLUSIONS Analyzing GENEActiv data using temperature (>25.6°C) and z-axis (greater than -0.812g) cut points can be used to determine wear time among infants for the purpose of measuring tummy time.
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Rollo S, Antsygina O, Tremblay MS. The whole day matters: Understanding 24-hour movement guideline adherence and relationships with health indicators across the lifespan. JOURNAL OF SPORT AND HEALTH SCIENCE 2020; 9:493-510. [PMID: 32711156 PMCID: PMC7749249 DOI: 10.1016/j.jshs.2020.07.004] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/21/2020] [Accepted: 06/22/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND New research suggests that the composition (mix) of movement behaviors within a 24-h period may have important implications for health across the lifespan. Consistent with this integrated movement behavior paradigm, a number of countries across the world have developed and released 24-h movement guidelines for specific age groups. The purpose of this systematic review was to examine the associations between the 24-h time-use composition of movement behaviors, or adherence to 24-h movement guidelines, and multiple health indicators across the lifespan. METHODS Five online databases (PsycINFO, PubMed, SPORTDiscus, Web of Science, and Ovid MEDLINE) were searched for relevant peer-reviewed studies published between January 2015 and January 2020 that met the a priori inclusion criteria, with no study design limits. The methodological quality of research evidence for each individual study and for each health indicator was assessed by using a modified version of the Downs and Black checklist. RESULTS A total of 51 studies from 20 different countries met the inclusion criteria. A total of 31 studies examined adherence (meeting vs. not meeting) to 24-h movement guidelines, and 20 studies used compositional analyses to explore the 24-h time-use composition of movement behaviors. Findings indicated that meeting the 24-h movement guidelines were (1) not associated with adiposity among toddlers, (2) favorably associated with health-related quality of life, social-cognitive development, and behavioral and emotional problems among preschoolers, (3) favorably associated with global cognition, health-related quality of life, and healthy dietary patterns in children, and (4) favorably associated with adiposity, fitness, and cardiometabolic, mental, social, and emotional health among children and youth. Significant associations were also found between the composition of 24-h movement behaviors and indicators of (1) adiposity and bone and skeletal health among preschoolers, (2) health-related quality of life among children, (3) adiposity, fitness, and cardiometabolic, social, and emotional health among children and youth, (4) cardiometabolic health in adults, (5) adiposity and fitness among adults and older adults, and (6) mental health and risk of mortality among older adults. The quality of the available evidence ranged from poor to good. CONCLUSION The current evidence indicates that the composition of movement behaviors within a 24-h period may have important implications for health at all ages and that meeting the current 24-h movement guidelines is associated with a number of desirable health indicators in children and youth. Future studies should employ longitudinal and experimental designs, include valid and reliable measures of 24-h movement behaviors, and examine a wide array of health indicators across all age groups. Such studies would confirm the results from the primarily cross-sectional evidence drawn from studies included in our review and further advance our understanding of the relationships between 24-h movement behaviors and health.
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Affiliation(s)
- Scott Rollo
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada.
| | - Olga Antsygina
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada; Department of Health Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, K1H 8M5, Canada; Department of Health Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada
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Hewitt L, Stephens S, Spencer A, Stanley RM, Okely AD. Weekly group tummy time classes are feasible and acceptable to mothers with infants: a pilot cluster randomized controlled trial. Pilot Feasibility Stud 2020; 6:155. [PMID: 33072396 PMCID: PMC7556919 DOI: 10.1186/s40814-020-00695-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 09/28/2020] [Indexed: 01/10/2023] Open
Abstract
Background The World Health Organization recommends 30 min of tummy time daily for improved motor development and reduced likelihood of plagiocephaly. As only 30% of infants meet this recommendation, parents require strategies and support to increase this proportion. Methods The aim of this study was to determine the feasibility, acceptability, and potential efficacy of a group intervention to promote tummy time. The design is a cluster randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Five groups of healthy infants (N = 35, baseline mean (SD) age 5.9 (2.8) weeks) and their mothers attending local mother’s groups (Australia) were randomly allocated to the intervention or control group. The intervention group received group tummy time classes in addition to usual care. The control group received usual care with their child and family health nurse. Primary outcomes were intervention feasibility and acceptability. Secondary outcomes were tummy time duration (accelerometry), adherence to physical activity guidelines, head shape, and motor development. Measures were taken at baseline, post-intervention, and when infants were 6 months of age. Analyses were by linear mixed models and Cohen’s d statistic. Results Recruitment, retention, and collection of objective data met feasibility targets. Acceptability was also met with intervention mothers reporting the information, goal planning, and handouts significantly more useful and relevant than control group mothers (p < 0.01). Moderate effect sizes were also found at post-intervention for tummy time duration, adherence to physical activity guidelines and infant ability in prone and supine favoring the intervention group (intervention infants had a mean of 30 min and 30% adherence to guidelines (95% CI 0 to 60.6 min) compared to the control infants who had a mean of 16.6 min and 13% adherence to the guidelines (95% CI 0 to 42.1 min, Cohen’s d = 0.5). Limitations were the small sample size, 4-week intervention, limited accelerometer use, and a homogenous sample of participants. Conclusion Group tummy time classes delivered in a mother’s group setting were shown to be feasible and acceptable. A larger randomized controlled trial is warranted. Trial registration ANZCTR, ACTRN12617001298303p. Registered 11 September 2017
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Affiliation(s)
- Lyndel Hewitt
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales 2522 Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales 2500 Australia.,Illawarra Shoalhaven Local Health District, Illawarra and Shoalhaven Regions, New South Wales Australia
| | - Samantha Stephens
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales 2522 Australia.,Illawarra Shoalhaven Local Health District, Illawarra and Shoalhaven Regions, New South Wales Australia
| | - Abbe Spencer
- Illawarra Shoalhaven Local Health District, Illawarra and Shoalhaven Regions, New South Wales Australia
| | - Rebecca M Stanley
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales 2522 Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales 2500 Australia
| | - Anthony D Okely
- Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales 2522 Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales 2500 Australia
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Hewitt L, Kerr E, Stanley RM, Okely AD. Tummy Time and Infant Health Outcomes: A Systematic Review. Pediatrics 2020; 145:peds.2019-2168. [PMID: 32371428 DOI: 10.1542/peds.2019-2168] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The World Health Organization recommends tummy time for infants because of the benefits of improved motor development and reduced likelihood of plagiocephaly. Because of poor uptake of these recommendations, the association of tummy time with other health outcomes requires further investigation. OBJECTIVE To review existing evidence regarding the association of tummy time with a broad and specific range of infant health outcomes. DATA SOURCES Electronic databases were searched between June 2018 and April 2019. STUDY SELECTION Peer-reviewed English-language articles were included if they investigated a population of healthy infants (0 to 12 months), using an observational or experimental study design containing an objective or subjective measure of tummy time which examined the association with a health outcome (adiposity, motor development, psychosocial health, cognitive development, fitness, cardiometabolic health, or risks/harms). DATA EXTRACTION Two reviewers independently extracted data and assessed their quality. RESULTS Sixteen articles representing 4237 participants from 8 countries were included. Tummy time was positively associated with gross motor and total development, a reduction in the BMI-z score, prevention of brachycephaly, and the ability to move while prone, supine, crawling, and rolling. An indeterminate association was found for social and cognitive domains, plagiocephaly, walking, standing, and sitting. No association was found for fine motor development and communication. LIMITATIONS Most studies were observational in design and lacked the robustness of a randomized controlled trial. High selection and performance bias were also present. CONCLUSIONS These findings guide the prioritization of interventions aimed at assisting parents meet the global and national physical activity guidelines.
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Affiliation(s)
- Lyndel Hewitt
- Early Start, Faculty of Social Sciences, University of Wollongong and Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Erin Kerr
- Early Start, Faculty of Social Sciences, University of Wollongong and Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Rebecca M Stanley
- Early Start, Faculty of Social Sciences, University of Wollongong and Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Anthony D Okely
- Early Start, Faculty of Social Sciences, University of Wollongong and Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
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Moderators of Parents' Perceptions of the Neighborhood Environment and Children's Physical Activity, Time Outside, and Screen Time. J Phys Act Health 2020; 17:557-565. [PMID: 32294621 DOI: 10.1123/jpah.2019-0433] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/10/2020] [Accepted: 03/01/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Increased physical inactivity and sedentary behavior among children are a global health concern. PURPOSE Examine associations between parents' perceived neighborhood environment and children's physical activity, outside time, and screen time, and whether these associations were moderated by age and socioeconomic position (SEP). METHODS Parents (N = 1212) completed a survey during the Recording and EValuating Activity in a Modified Park study. The neighborhood perceptions (social and physical environment), children's age, physical activity, outside time, and screen time were parent-reported. The SEP was derived from the Index of Relative Socio-economic Advantage and Disadvantage. Multiple linear and logistic regressions were performed with age and SEP interactions. RESULTS Favorable perceptions of opportunities to be active and exercise were associated with a higher likelihood of meeting physical activity guidelines. Favorable perceptions of neighborhood ease for walking and a larger social network were also associated with more outdoor time. Moderation analyses revealed that favorable perceptions of several physical and social neighborhood environment features were associated with a higher likelihood of meeting physical activity guidelines in the high-SEP group and were negatively associated with preschoolers' weekday screen time. CONCLUSION Future neighborhood environment initiatives and interventions aiming to promote active living communities should consider differences in age and SEP.
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Sivanesan H, Vanderloo LM, Keown-Stoneman CDG, Parkin PC, Maguire JL, Birken CS. The association between screen time and cardiometabolic risk in young children. Int J Behav Nutr Phys Act 2020; 17:41. [PMID: 32345327 PMCID: PMC7189472 DOI: 10.1186/s12966-020-00943-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 02/28/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES While studies exist on the association between screen time and cardiometabolic risk among adolescents, research examining the effect of screen time on cardiometabolic risk in young children is lacking. The primary objective of this study was to examine the association between daily screen time and cardiometabolic risk (CMR) [sum of age- and sex-standardized z-scores of systolic blood pressure (SBP), glucose, log-triglycerides, waist circumference (WC), and negative high-density lipoprotein (HDL) cholesterol divided by the square root of five] in young children. Secondary objectives included examining individual CMR risk factors, including waist-to-height ratio and non high-density lipoprotein (non-HDL) cholesterol, as well as the individual cut-offs of these risk factors. Additional analyses include examining the association between screen time and CMR by handheld/non-handheld devices. METHODS A study was conducted among young children 3 to 6 years from the TARGet Kids! practice-based research network in Toronto and Montreal, Canada. Children with one or more measures of screen time and CMR were included in this study. Generalized estimating equation (GEE) multivariable linear regressions and multivariable logistic regressions, using published cut-offs, were conducted to evaluate these associations. RESULTS Data from 1317 children [mean age 52 months (SD = 13.36), 44.34% female] were included for analyses. There was no evidence of associations between screen time and total CMR score or individual risk factors (p > 0.05) after adjusting for confounders. A statistically significant, but small association between daily screen time and non-HDL cholesterol was found (B = 0.046; CI = [0.017 to 0.075]; p = 0.002. CONCLUSIONS Though no relationship was reported between daily screen time and the majority of CMR factors in early childhood, there was an association between daily screen time and non-HDL cholesterol. As the relationship between daily screen time and CMR factors may not be apparent in early childhood, studies to evaluate longer-term cardiometabolic effects of screen time are needed. Although there is an evidence-based rationale to reduce screen time in early childhood, prevention of cardiometabolic risk may not be the primary driver.
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Affiliation(s)
- Harunya Sivanesan
- Master of Public Health, Epidemiology, University of Toronto, Toronto, Canada.,The Hospital for Sick Children Research Institute, Child Health and Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - Leigh M Vanderloo
- The Hospital for Sick Children Research Institute, Child Health and Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
| | - Charles D G Keown-Stoneman
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health and Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada.,The Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.,Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Catherine S Birken
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health and Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
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Benjamin-Neelon SE, Bai J, Østbye T, Neelon B, Pate RR, Crainiceanu C. Physical Activity and Adiposity in a Racially Diverse Cohort of US Infants. Obesity (Silver Spring) 2020; 28:631-637. [PMID: 31944621 PMCID: PMC7042075 DOI: 10.1002/oby.22738] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/10/2019] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Early life physical activity may help prevent obesity, but objective quantification in infants is challenging. METHODS A total of 506 infants were examined from 2013 to 2016. Infants wore accelerometers for 4 days at ages 3, 6, 9, and 12 months. Daily log-transformed physical activity counts were computed, averaged, and standardized across assessments. A linear mixed model was used to examine trends in standardized physical activity counts as well as associations between physical activity and BMI z score, sum of subscapular and triceps skinfold thickness for overall adiposity (SS+TR), and their ratio for central adiposity (SS:TR). RESULTS Among infants, 66% were black and 50% were female. For each additional visit, standardized physical activity counts increased by 0.23 (CI: 0.18 to 0.27; P < 0.0001). This translates to 126.3 unadjusted physical activity counts or a 4% increase for each visit beyond 3 months. In addition, a 1-SD increase in standardized physical activity counts (550 unadjusted physical activity counts) was associated with a 0.01-mm lower SS:TR (95% CI: -0.02 to -0.001; P = 0.03). However, standardized physical activity counts were not associated with BMI z score or SS+TR. CONCLUSIONS Physical activity increased over infancy and was associated with central adiposity. Despite limitations, researchers should consider objective measurement in infants.
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Affiliation(s)
- Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jiawei Bai
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Brian Neelon
- Division of Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Russell R Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Ciprian Crainiceanu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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GRADE-ADOLOPMENT Process to Develop 24-Hour Movement Behavior Recommendations and Physical Activity Guidelines for the Under 5s in the United Kingdom, 2019. J Phys Act Health 2020; 17:101-108. [DOI: 10.1123/jpah.2019-0139] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/05/2019] [Accepted: 07/22/2019] [Indexed: 11/18/2022]
Abstract
Background: This article summarizes the approach taken to develop UK Chief Medical Officers’ physical activity guidelines for the Under 5s, 2019. Methods: The Grading of Recommendations Assessment, Development and Evaluation (GRADE)-Adaptation, Adoption, De Novo Development (ADOLOPMENT) approach was used, based on the guidelines from Canada and Australia, with evidence updated to February 2018. Recommendations were based on the associations between (1) time spent in sleep, sedentary time, physical activity, and 10 health outcomes and (2) time spent in physical activity and sedentary behavior on sleep outcomes (duration and latency). Results: For many outcomes, more time spent in physical activity and sleep (up to a point) was beneficial, as was less time spent in sedentary behavior. The authors present, for the first time, evidence in GRADE format on behavior type–outcome associations for infants, toddlers, and preschoolers. Stakeholders supported all recommendations, but recommendations on sleep and screen time were not accepted by the Chief Medical Officers; UK guidelines will refer only to physical activity. Conclusions: This is the first European use of GRADE-ADOLOPMENT to develop physical activity guidelines. The process is robust, rapid, and inexpensive, but the UK experience illustrates a number of challenges that should help development of physical activity guidelines in future.
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Compliance With Physical Activity and Sedentary Behavior Guidelines and Associations With Abdominal Adiposity in a Sample of Infants and Toddlers From Soweto, South Africa. J Phys Act Health 2019; 16:872-879. [DOI: 10.1123/jpah.2018-0182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 03/07/2019] [Accepted: 04/04/2019] [Indexed: 11/18/2022]
Abstract
Background: This study reported compliance with 24-hour physical activity and sedentary behavior guidelines, and associations with adiposity in the first 2 years of life. Methods: Participants (N = 119) were recruited from Soweto, South Africa. Visceral and subcutaneous abdominal adipose tissue was measured by ultrasound. Participation in 2 movement behaviors (physical activity and sedentary time) was reported by mothers. Differences in adiposity between those meeting each individual guideline, as well as the combination of both movement guidelines, compared with those not meeting the guidelines were assessed. Results: Only 5% of infants met the sedentary guidelines; however, 58% met the physical activity guidelines. Subcutaneous adipose tissue was significantly higher in those meeting the physical activity guideline (0.50 [0.01] vs 0.47 [0.01] cm, P = .03) compared with those not meeting the guideline. Meeting the screen time component of the sedentary guideline was associated with higher visceral adipose tissue (β = 0.96, P < .01), while meeting one guideline compared with meeting none was associated with higher subcutaneous adipose tissue (β = 0.05, P = .01). Conclusions: Most infants and toddlers from this low- to middle-income setting were not meeting sedentary behavior guidelines. Both behaviors were associated with abdominal adiposity, but not with body mass index z score; implying these movement behaviors may impact abdominal fat deposition rather than body size.
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Benjamin-Neelon SE, Neelon B, Pearce J, Grossman ER, Gonzalez-Nahm S, Slining M, Duffey K, Frost N. State Regulations Promoting Infant Physical Activity in Early Care and Education. Child Obes 2019; 14:368-374. [PMID: 30199297 DOI: 10.1089/chi.2018.0087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND State policies have the potential to improve early care and education (ECE) settings, but little is known about the extent to which states are updating their licensing and administrative regulations, especially in response to national calls to action. In 2013, we assessed state regulations promoting infant physical activity in ECE and compared them with national recommendations. To assess change over time, we conducted this review again in 2018. METHODS We reviewed regulations for all US states for child care centers (centers) and family child care homes (homes) and compared them with three national recommendations: (1) provide daily tummy time; (2) use cribs, car seats, and high chairs for their primary purpose; and (3) limit the use of restrictive equipment (e.g., strollers). We performed exact McNemar's tests to compare the number of states meeting recommendations from 2013 to 2018 to evaluate whether states had made changes over this period. RESULTS From 2013 to 2018, we observed significant improvement in one recommendation for homes-to use cribs, car seats, and high chairs for their primary purpose (odds ratio 11.0; 95% CI 1.6-47.3; p = 0.006). We did not observe any other significant difference between 2013 and 2018 regulations. CONCLUSIONS Despite increased awareness of the importance of early-life physical activity, we observed only modest improvement in the number of states meeting infant physical activity recommendations over the past 5 years. In practice, ECE programs may be promoting infant physical activity, but may not be required to do so through state regulations.
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Affiliation(s)
- Sara E Benjamin-Neelon
- 1 Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD
| | - Brian Neelon
- 2 Department of Public Health Sciences, Medical University of South Carolina , Charleston, SC
| | - John Pearce
- 2 Department of Public Health Sciences, Medical University of South Carolina , Charleston, SC
| | - Elyse R Grossman
- 1 Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD
| | - Sarah Gonzalez-Nahm
- 1 Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD
| | - Meghan Slining
- 3 Department of Health Sciences, Furman University , Greenville, SC
| | - Kiyah Duffey
- 4 Kiyah Duffey Consulting, Inc. , Blacksburg, VA
| | - Natasha Frost
- 5 Public Health Law Center , Mitchell Hamline School of Law, St Paul, MN
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Associations between meeting the Canadian 24-Hour Movement Guidelines for the Early Years and behavioral and emotional problems among 3-year-olds. J Sci Med Sport 2019; 22:797-802. [DOI: 10.1016/j.jsams.2019.01.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/20/2018] [Accepted: 01/06/2019] [Indexed: 11/23/2022]
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Hewitt L, Stanley RM, Cliff D, Okely AD. Objective measurement of tummy time in infants (0-6 months): A validation study. PLoS One 2019; 14:e0210977. [PMID: 30811395 PMCID: PMC6392225 DOI: 10.1371/journal.pone.0210977] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/04/2019] [Indexed: 01/01/2023] Open
Abstract
The 2017 Australian and Canadian 24-hour movement guidelines recommend infants receive 30 minutes of tummy time daily. Currently, there are no validated objective measurement tools or devices to assess tummy time. The purpose of this study was to: 1) test the practicality of using devices on infants as an objective measure of tummy time, and 2) test the accuracy of developed algorithms and cut-points for predicting prone posture. Thirty-two healthy infants aged 4 to 25 weeks completed a protocol of 12 positions. Infants were placed in each position for 3 minutes while wearing a MonBaby (chest), GENEActiv (right hip) and two ActiGraphs (right hip and ankle). Direct observation was the criterion measure. The accuracy of the algorithms or cut-points to predict prone on floor, non-prone and prone supported positions were analyzed. Parents also completed a practicality questionnaire. Algorithms and cut-points to classify posture using devices from MonBaby, GENEActiv and ActiGraph (hip and ankle) were 79%, 95%, 90% and 88% accurate at defining tummy time and 100%, 98%, 100% and 96% accurate at defining non-prone positions, respectively. GENEActiv had the smallest mean difference and limits of agreement (-8.4s, limits of agreement [LoA]: -78.2 to 61.3s) for the prone on floor positions and ActiGraph Hip had the smallest mean difference and LoA for the non-prone positions (-0.2s, LoA: -1.2 to 0.9s). The majority of parents agreed all devices were practical and feasible to use with MonBaby being the preferred device. The evaluated algorithms and cut-points for GENEActiv and ActiGraph (hip) are of acceptable accuracy to objectively measure tummy time (time spent prone on floor). Accurate measurement of infant positioning practices will be important in the observation of 24-hour movement guidelines in the early years.
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Affiliation(s)
- Lyndel Hewitt
- Early Start, Faculty of Social Sciences and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, Australia
- * E-mail:
| | - Rebecca M. Stanley
- Early Start, Faculty of Social Sciences and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, Australia
| | - Dylan Cliff
- Early Start, Faculty of Social Sciences and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, Australia
| | - Anthony D. Okely
- Early Start, Faculty of Social Sciences and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, Australia
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Taylor RW, Haszard JJ, Meredith-Jones KA, Galland BC, Heath ALM, Lawrence J, Gray AR, Sayers R, Hanna M, Taylor BJ. 24-h movement behaviors from infancy to preschool: cross-sectional and longitudinal relationships with body composition and bone health. Int J Behav Nutr Phys Act 2018; 15:118. [PMID: 30477518 PMCID: PMC6260686 DOI: 10.1186/s12966-018-0753-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/14/2018] [Indexed: 12/02/2022] Open
Abstract
Background New physical activity guidelines for children address all movement behaviors across the 24-h day (physical activity, sedentary behavior, sleep), but how each component relates to body composition when adjusted for the compositional nature of 24-h data is uncertain. Aims To i) describe 24-h movement behaviors from 1 to 5 years of age, ii) determine cross-sectional relationships with body mass index (BMI) z-score, iii) determine whether movement behaviors from 1 to 5 years of age predict body composition and bone health at 5 years. Methods 24-h accelerometry data were collected in 380 children over 5–7 days at 1, 2, 3.5 and 5 years of age to determine the proportion of the day spent: sedentary (including wake after sleep onset), in light (LPA) and moderate-to-vigorous physical activity (MVPA), and asleep (including naps). BMI was determined at each age and a dual-energy x-ray absorptiometry (DXA) scan measured fat mass, bone mineral content (BMC) and bone mineral density (BMD) at 5 years of age. 24-h movement data were transformed into isometric log-ratio co-ordinates for multivariable regression analysis and effect sizes back-transformed. Results At age 1, children spent 49.6% of the 24-h day asleep, 38.2% sedentary, 12.1% in LPA, and 0.1% in MVPA, with corresponding figures of 44.4, 33.8, 19.8 and 1.9% at 5 years of age. Compositional time use was only related significantly to BMI z-score at 3.5 years in cross-sectional analyses. A 10% increase in mean sleep time (65 min) was associated with a lower BMI z-score (estimated difference, − 0.25; 95% CI, − 0.42 to − 0.08), whereas greater time spent sedentary (10%, 47 min) or in LPA (10%, 29 min) were associated with higher BMI z-scores (0.12 and 0.08 respectively, both p < 0.05). Compositional time use from 1 to 3.5 years was not related to future BMI z-score or percent fat. Although MVPA at 2 and 3.5 years was consistently associated with higher BMD and BMC at 5 years, actual differences were small. Conclusions Considerable changes in compositional time use occur from 1 to 5 years of age, but there is little association with adiposity. Although early MVPA predicted better bone health, the differences observed had little clinical relevance. Trial registration ClinicalTrials.gov number NCT00892983. Electronic supplementary material The online version of this article (10.1186/s12966-018-0753-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachael W Taylor
- Departments of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand.
| | - Jillian J Haszard
- Departments of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Kim A Meredith-Jones
- Departments of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Barbara C Galland
- Departments of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Anne-Louise M Heath
- Departments of Human Nutrition, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Julie Lawrence
- Departments of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew R Gray
- Departments of Biostatistics Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rachel Sayers
- Departments of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Maha Hanna
- Departments of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Barry J Taylor
- Departments of Office of the Dean, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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