Assessing children's physical activity in their homes: the observational system for recording physical activity in children-home

Effectiveness of a Preschool Motor Skill Intervention on Body Mass Index and Movement Behavior: 6-, 18-, and 30-Month Findings From a Cluster Randomized Controlled Trial

PURPOSE

To study the effectiveness of a preschool staff-delivered motor skills intervention on body composition and physical activity over a 2.5-year time frame.

METHODS

In this pragmatic parallel cluster randomized controlled trial (16 preschools), outcome data were collected after 6 (body composition only), 18, and 30 months of intervention. The main physical activity outcomes were accelerometer behavior measures summarizing the total percentage of child daily movement (walk, run, cycle, and standing that included minor movements) and preschool movement during preschool attendance. To estimate between-group mean differences in outcomes, mixed-linear regression analyses including baseline value of the selected outcome and a treatment × time interaction term as a fixed effect were applied. In addition, the baseline preschool and child were included as a random effect.

RESULTS

For body mass index, a total of 437 children (90%) had at least one valid baseline and one follow-up assessment. The corresponding numbers for preschool movement and daily movement were 163 (55%) and 146 (49%), respectively. No significant between-group mean difference was identified for body mass index, waist-to-height ratio, or any physical activity outcomes.

CONCLUSION

Overall, this preschool motor skills intervention had no effect on either child anthropometry or physical activity, consistent with previous studies.

Development and validation of the Chinese family environment influencing physical activity habits scale

Introduction

Adolescence represents a pivotal stage in the development of healthy behaviors, where establishing positive physical activity habits can have enduring effects on an individual's overall wellbeing. The ecological model highlights the influence of environmental factors on human behavior, with the family environment playing a significant role in shaping the physical activity habits of adolescents.

Methods

The aim of this scale is to develop a reliable and effective tool, customized for the unique societal context of China, to assess how family factors influence the physical activity habits of Chinese adolescents. Participants were recruited through stratified cluster sampling from 24 secondary schools in six Chinese provinces between October and November 2021, resulting in 1,061 participants. Analysis was conducted on 1,004 valid questionnaires, divided into two samples. Sample 1, consisting of 502 students (248 males and 254 females; Mage = 15.5), underwent item analysis and exploratory factor analysis. Sample 2, comprising 502 students (267 males and 235 females; Mage = 16.5), underwent confirmatory factor analysis and internal consistency reliability analysis.

Results

Through exploratory factor analysis, we extracted three factors comprising 15 items: "Family Environment Construction" (4 items), "Family Action Support" (6 items), and "Family Health Awareness" (5 items). The Cronbach's alpha values for these factors ranged from 0.890 to 0.894. Confirmatory factor analysis confirmed a satisfactory model fit (CMIN/DF = 1.45, SRMR = 0.027, GFI = 0.991, TLI = 0.989, RMSEA = 0.03).

Discussion

The scale demonstrated strong internal consistency and test-retest reliability, confirming its effectiveness in empirical research. This study holds significant implications for enhancing the physical activity levels of adolescents, promoting their physical and mental wellbeing, enriching their developmental experiences, and contributing to their overall sense of happiness.

Comprehensive Physical Activity Assessment During U.S. Army Basic Combat Training

ABSTRACT

Alemany, JA, Pierce, JR, Bornstein, DB, Grier, TL, Jones, BH, and Glover, SH. Comprehensive physical activity assessment during U.S. Army Basic Combat Training. J Strength Cond Res 36(12): 3505-3512, 2022-Physical activity (PA) volume, intensity, and qualitative contextual information regarding activity type and loads carried are limited during U.S. Army Basic Combat Training (BCT). The purpose of this study was to characterize daily (05:00-20:00 hours) PA during BCT using a comprehensive approach. During 2 10-week BCT cycles ( n = 40 trainees per cycle), pedometers, accelerometers, and direct observation were used to estimate daily step count, PA volume, and intensity. Physical activity intensity was categorized by metabolic equivalents (METs) such as "sedentary" (1-2 METs), "light" (2-3 METs), "moderate" (3-6 METs), or "vigorous" (≥6 METs). Daily PA data were analyzed longitudinally using linear mixed models, with significance set at p ≤ 0.05. The mean daily step count was 13,459 ± 4,376 steps, and the mean daily accelerometer-assessed PA volume and intensity were as follows: sedentary: 505 ± 98 minutes, light: 190 ± 78 minutes, moderate: 168 ± 51 minutes, and vigorous: 14 ± 14 minutes, with no differences between cycles for all measures ( p > 0.50). Cumulative time on feet (∼50%) and sitting (20-25%) accounted for most daily activity types during both cycles. Trainees, on average, carried between 3 and 9 kg, and ≥9 kg, for 60% and 10% of the monitored day, respectively. Basic Combat Training's physical demands are high, where trainees achieved 1.7 to 2.7 times greater daily ambulation and 6 times the recommended weekly moderate-to-vigorous PA compared with civilian counterparts and performed weight-bearing load carriage for nearly half of the day. Basic Combat Training-associated PA may increase injury risk among trainees unaccustomed to arduous PA and exercise. Implementing national PA policies to improve physical fitness and facilitate acclimatization to BCT's high physical demands could reduce public health burdens and military nonreadiness.

A Summary of One Research Team's Contributions to Understanding Physical Activity Behavior in Children and Youth

Schools are well-positioned to provide physical activity opportunities to help youth achieve the recommended 60 or more daily minutes of moderate-to-vigorous physical activity. The Children's Physical Activity Research Group (CPARG) at the University of South Carolina has focused on understanding physical activity in school-aged youth for 30+ years. The purpose of this article was to critically review (CPARG) contributions to the field in school settings and school-age youth. We reviewed 127 published CPARG articles from six research projects conducted between 1993-2019. The review was guided by questions in five categories: measurement of physical activity and its determinants, characteristics of physical activity behavior, correlates/determinants of physical activity, physical activity interventions, and race/ethnicity and physical activity. Results were summarized by question and synthesized across categories. CPARG contributions included assessing physical activity levels, patterns, forms, and contexts; identifying and measuring physical activity correlates/determinants; and conducting school-based physical activity interventions. Identifying multiple domains of physical activity determinants enables researchers and practitioners to select/design age-appropriate, valid, and reliable instruments to assess determinants. Focusing on determinants enables them to create effective physical activity interventions, environments, programs, and policies in schools. These efforts must address race/ethnicity differences, ensuring that measurement instruments and intervention strategies are culturally appropriate.

Validity and reliability of knowledge, attitude, and practice regarding exercise and exergames experiences questionnaire among high school students

An instrument to measure the Knowledge, Attitude, and Practice (KAP) related to exercise and exergames experiences among high school students is important to identify the KAP gap that may facilitate the health intervention to boost the immunity of the young population. Thus, our study aims to develop and validate a questionnaire assessing KAP regarding exercise and exergames experiences among high school students. A cross-sectional study was conducted among 188 high school students in Malaysia. This research questionnaire was adapted from a previous study and modified with an additional section to assess high school students’ exergames experiences. Content validity, construct validity, and reliability was verified using different tests. Only one item (slimming tea and other drugs could be used in place of exercise to achieve the same effects) did not reach the required level of content validity index in terms of their relevance, clarity, simplicity, and ambiguity. Therefore, this item was removed from the instrument. For factor analysis, three questions were removed from the instrument due to those questions having a factor loading lower than 0.4. The Intraclass Correlation Coefficient values for the test–retest reliability after an interval of two weeks for all questions were > 0.7. Kappa coefficient ranges between 0.67-0.96. The SME value ranged from 0.34 to 1.47. Repeated measured ANOVA did not reveal any significant differences between the test and re-test. This questionnaire has strong validity and reliability that can be used to measure high school student’s knowledge, attitude, and practice about exercise and their exergames experiences. 

Longitudinal changes in objectively-measured physical activity and sedentary time among school-age children in Central Texas, US during the COVID-19 pandemic

BACKGROUND

Most available evidence on the effects of the COVID-19 pandemic on child movement behaviors is from cross-sectional studies using self-report measures. This study aimed to identify change trajectories and their associated factors for objectively-assessed physical activity and sedentary time among an ethnically and socioeconomically diverse sample of school-age children from Central Texas, U.S.A., during COVID-19.

METHODS

Pre- (Sept. 2019 - Feb. 2020) and during- (Oct. 2020 - March 2021) COVID-19 physical activity and sedentary behavior data were collected for school-age children (8-11 years) enrolled in the Safe Travel Environment Evaluation in Texas Schools (STREETS) cohort study. Daily time spent in moderate- to vigorous-intensity physical activity (MVPA) and sedentary time were assessed using GT3X-wBT Actigraph accelerometers. Parent surveys were used to assess socio-ecological factors. Latent class linear mixed models were used to identify change trajectories of MVPA and sedentary time. Logistic regression models were used to assess the association between socio-ecological characteristics with physical activity and sedentary time change trajectory groups.

RESULTS

There was a significant decrease in mean daily MVPA (- 9.4 mins, SD = 18.54) and an increase in sedentary behavior (0.83 hrs, SD = 1.18). Two trajectory groups were identified for MVPA ('decrease MPVA' and 'maintain high MVPA'), with the majority (82.1%) being in the 'decrease MVPA' group. Three trajectory groups were identified for sedentary behavior ('moderate increase sedentary, 'steep increase sedentary,' and 'decrease sedentary'), with most children (78.5%) being in the 'moderate increase' group. Girls had significantly lower odds of being in the 'maintain high MVPA' group than boys (OR = 0.27, 95% CI = 0.11, 0.61). Children living in neighborhoods with higher perceived social cohesion had significantly higher odds of being in the 'maintain high MVPA' group (OR = 1.22, 95% CI = 1.06, 1.41), while those in neighborhoods with higher social cohesion had lower odds of being in the 'decrease sedentary' group (OR = 0.86, 95% CI = 0.74, 0.99).

CONCLUSIONS

Declines in physical activity and increases in sedentary time among most school-age children during COVID-19 in a socioeconomically and ethnically diverse U.S. sample, were observed in our study, especially among girls. These findings highlight the need to counteract the short-term negative changes in movement behaviors in response to COVID-19 among children.

Individual heart rate assessment and bout analysis of vigorous physical activity in children

Children should engage in 1 hr/day of moderate‐to‐vigorous physical activity (MVPA) that results in increased heart rates (HRs) (CDC, 2022). However, precise individualized HR criteria for MVPA are not provided, and it is unclear whether observed behaviors classified as MVPA are associated with elevated HRs indicative of MVPA. The current study replicated an individualized heart rate assessment (IHRA) for identifying MVPA HR zones in children (Van Camp et al., 2021). We then evaluated whether engaging in vigorous PA (VPA) for half of the session resulted in HRs indicative of VPA for at least half of the session when children engaged in running for 30, 60, 90, and 120 s bouts. Individual differences were observed during the IHRA. During the bout analysis, HRs were not within VPA zones for 50% of the session. However, HRs were within moderate PA (MPA) zones, with 30 s bouts producing the highest percentages of MPA.

Longitudinal Associations Among Diet Quality, Physical Activity and Sleep Onset Consistency With Body Mass Index z-Score Among Toddlers in Low-income Families

BACKGROUND

Habits surrounding health behaviors (i.e., sleep, physical activity, diet) are developed in toddlerhood. Lack of consistent health habits may increase obesity risk among toddlers in low-income families.

PURPOSE

To compare the role of sleep onset consistency, physical activity and diet quality as mediators between household poverty and toddler weight.

METHODS

Two hundred and seven toddlers (mean age = 20.2 months, 46% female, 68.1% Black) participating in an obesity prevention trial were assessed at three time points over 12 months. Using Actical accelerometers, we assessed sleep and physical activity at each time point for up to 1 week. We defined sleep onset consistency as the standard deviation of sleep onset across all days. We calculated the Healthy Eating Index-2015 from a 24-hr dietary recall. We used WHO standards to calculate BMI-for-age z-scores from toddlers' weight/length, and calculated poverty ratio from parent-reported income and family size. Multilevel mediation models tested toddler sleep onset consistency, physical activity, and diet quality as mediators between household poverty and toddler BMI z-score.

RESULTS

Toddlers from households with higher poverty ratios had more inconsistent sleep onset times. Toddlers with more inconsistent sleep onset times had higher BMI z-scores across all timepoints, even when accounting for physical activity and diet quality. Sleep onset consistency indirectly explained the association between household poverty and BMI z-score.

CONCLUSIONS

Inconsistent sleep schedules could help explain the association between poverty and BMI. Future research should examine strategies to support low-income families to develop and maintain routines as a mechanism to prevent obesity and reduce disparities.

TRIAL REGISTRATION NUMBER

NCT02615158.

The effect of photographic activity schedules on moderate-to-vigorous physical activity in children with autism spectrum disorder

Regular moderate-to-vigorous physical activity (MVPA) has been linked to improved bone health, muscular fitness, cognitive function, sleep, and a reduced risk of depression and obesity. Many children are not engaging in the recommended amount of physical activity. Furthermore, children with autism spectrum disorder (ASD) were found to engage in less physical activity than their peers of typical development. We extended previous research by conducting a physical activity context assessment, which included a comparison of indoor to outdoor activities to evaluate which environment produced the lowest percent of MVPA as recorded by the Observational System for Recording Physical Activity in Children. Given the utility of activity schedules to increase self-management and independent engagement during unstructured and low-preferred tasks, we then taught 3 preschool children diagnosed with ASD to use photographic activity schedules to increase the number of different activities that met the definition of MVPA in the 2 lowest-responding conditions of the physical activity context assessment. MVPA remained low during baseline sessions for all participants and immediately increased with the introduction of activity schedule teaching. All participants quickly met activity schedule teaching mastery criterion and demonstrated high levels of MVPA in generalization and maintenance probes without additional teaching.

Context influences preference for and level of physical activity of adolescents with intellectual and developmental disabilities

The purpose of the current study was to replicate and extend Hustyi, Normand, Larson, and Morley (2012) by determining the effects of different contexts on physical activity displayed by adolescents with intellectual and developmental disabilities, and determining preference for various activities. Results indicated that an exergaming condition produced the highest levels of activity. Results of a preference assessment indicated that 2 out of 3 participants preferred the physical activity context to the sedentary. For the third participant, an intervention was included to increase activity. Although the intervention was successful, participant preference for the sedentary activity context remained unchanged.

Using heart rate as a physical activity metric

Physical activity (PA) is critical for a healthy lifestyle. The current study assessed heart rate (HR) as a primary measure of moderate and vigorous PA with four typically developing children. First, individualized HR assessments were conducted to determine moderate and vigorous HR zones. Next, participants engaged in various exercises at a local YMCA facility (i.e., biking, elliptical, basketball, and exergame boxing) to determine how HR during these activities aligned with their individualized HR zones. During exercise bouts, HR was typically above moderate, but below vigorous HR zones for all participants. Additionally, exercises that restricted range of motion (i.e., biking and elliptical) engendered generally lower HR than exercises with greater range of motion. Vocal instructions to exercise at vigorous levels were effective at increasing HR to vigorous levels for one participant. The advantages of using HR as a metric of PA during assessment and intervention are discussed.

The Effects of Peer Presence on Variables Maintaining Moderate-to-Vigorous Physical Activity in Children

An increasing number of children fail to meet the recommended levels of physical activity. The purpose of this study was to examine the effects of peer presence on variables that have been shown to evoke moderate-to-vigorous physical activity (MVPA) in children. We recorded the levels of MVPA in three preschool children across no adult, attention, and interactive play conditions, with a peer present and absent. All conditions were compared with a naturalistic baseline and presented in a multielement design with a brief reversal to baseline and reintroduction of the most effective condition. All three participants displayed most MVPA during the interactive play condition with a peer present. This study furthers research on the identification of variables that evoke MVPA in young children and emphasizes the interaction of peer presence and contingent social positive reinforcement as relevant variables.

Screen Media and Autism Spectrum Disorder: A Systematic Literature Review

OBJECTIVE

Previous studies suggest that psychiatric disorders are associated with problematic use of screen media. This article systematically reviews the literature on the associations between screen media and autism spectrum disorder (ASD). The review uses the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHOD

Electronic databases were searched from inception to April 2018, using the term "ASD/autism" along with one of the following terms: "screen time"/"media"/"computer"/"phone"/"television"/"video game."

RESULTS

A total of 16 studies met the inclusion criteria. The studies support the view that children and adolescents with ASD are exposed to more screen time than their typically developing peers or other clinical groups and that the exposure starts at a younger age. The content and context of screen use (e.g., with parents vs alone) may affect the behaviors associated with media exposure. Correlates and long-term consequences of early screen exposure (before the age of 3 years) remain largely unexamined.

CONCLUSION

The current review provides important information about how ASD is associated with screen use and exposure. Future longitudinal research should examine the impact of early screen exposure on child development while accounting for potential moderating environmental factors (e.g., socioeconomic status, parent-child relationship). This will help determine whether-and if so, how much-exposure is detrimental and allow appropriate recommendations and interventions related to screen time among children with ASD.

Identifying and Quantifying the Unintended Variability in Common Systematic Observation Instruments to Measure Youth Physical Activity

BACKGROUND

Direct observation protocols may introduce variability in physical activity estimates.

METHODS

Thirty-five physical education lessons were video recorded and coded using the System for Observing Fitness Instruction Time (SOFIT). A multistep process examined variability in moderate to vigorous physical activity (MVPA%; walking + vigorous/total scans). Initially, per-SOFIT protocol MVPA% (MVPA%SOFIT) estimates were produced for each lesson. Second, true MVPA% (mean MVPA% of all students using all observations, MVPA%true) estimates were calculated. Third, MVPA% (MVPA%perm) was calculated based on all permutations of students and observation order. Fourth, physical education lessons were divided into 2 groups with 5 lessons from each group randomly selected 10,000 times. Group MVPA%perm differences between the 10 selected lessons were compared with the MVPA%true difference between group 1 and group 2.

RESULTS

Across all lessons, 10,212,600 permutations were possible (average 291,789 combinations per lesson; range = 73,440-570,024). Across lessons, the average absolute difference between MVPA%true and MVPA%SOFIT estimates was ±4.8% (range = 0.1%-17.5%). Permutations, based on students selected and observation order, indicated that the mean range of MVPA%perm estimates was 41.6% within a lesson (range = 29.8%-55.9%). Differences in MVPA% estimates between the randomly selected groups of lessons varied by 32.0%.

CONCLUSION

MVPA% estimates from focal child observation should be interpreted with caution.

Data presentation options to manage variability in physical activity research

This paper presents seven tactics for managing the variability evident in some physical activity data. High levels of variability in daily step-count data from pedometers or accelerometers can make typical visual inspection difficult. Therefore, the purpose of the current paper is to discuss several strategies that might facilitate the visual interpretation of highly variable data. The seven strategies discussed in this paper are phase mean and median lines, daily average per week, weekly cumulative, proportion of baseline, 7-day moving average, change point detection, and confidence intervals. We apply each strategy to a data set and discuss the advantages and disadvantages.

Development and Testing of the Observational System for Recording Physical Activity in Children: Elementary School

PURPOSE

This study describes the development and pilot testing of the Observational System for Recording Physical Activity-Elementary School (OSRAC-E) Version.

METHOD

This system was developed to observe and document the levels and types of physical activity and physical and social contexts of physical activity in elementary school students during the school day. Interobserver agreement scores and summary data were calculated.

RESULTS

All categories had Kappa statistics greater than .80, with the exception of the activity initiator category. Interobserver agreement scores were 96% or greater. The OSRAC-E was shown to be a reliable observation system that allows researchers to assess physical activity behaviors, the contexts of those behaviors, and the effectiveness of physical activity interventions in the school environment.

CONCLUSION

The OSRAC-E can yield data with high interobserver reliability and provide relatively extensive contextual information about the physical activity of students in elementary schools.

Active Living: development and quasi-experimental evaluation of a school-centered physical activity intervention for primary school children

Background

The worldwide increase in the rates of childhood overweight and physical inactivity requires successful prevention and intervention programs for children. The aim of the Active Living project is to increase physical activity and decrease sedentary behavior of Dutch primary school children by developing and implementing tailored, multicomponent interventions at and around schools.

Methods/design

In this project, school-centered interventions have been developed at 10 schools in the south of the Netherlands, using a combined top-down and bottom-up approach in which a research unit and a practice unit continuously interact. The interventions consist of a combination of physical and social interventions tailored to local needs of intervention schools. The process and short- and long-term effectiveness of the interventions will be evaluated using a quasi-experimental study design in which 10 intervention schools are matched with 10 control schools. Baseline and follow-up measurements (after 12 and 24 months) have been conducted in grades 6 and 7 and included accelerometry, GPS, and questionnaires. Primary outcome of the Active Living study is the change in physical activity levels, i.e. sedentary behavior (SB), light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), and counts-per-minute (CPM). Multilevel regression analyses will be used to assess the effectiveness of isolated and combined physical and social interventions on children’s PA levels.

Discussion

The current intervention study is unique in its combined approach of physical and social environmental PA interventions both at school(yard)s as well as in the local neighborhood around the schools. The strength of the study lies in the quasi-experimental design including objective measurement techniques, i.e. accelerometry and GPS, combined with more subjective techniques, i.e. questionnaires, implementation logbooks, and neighborhood observations.

Trial registration

Current Controlled Trials ISRCTN25497687 (registration date 21/10/2015), METC 12-4-077, Project number 200130003

Top 10 research questions related to assessing physical activity and its contexts using systematic observation

Numerous methods are available to assess physical activity (PA) but systematic observation (SO) excels in being able to provide contextually rich data on the setting in which the activity occurs. As SO is particularly useful for determining how activity is influenced by the immediate physical and social environments, its use is becoming more popular. Observation tools have the advantages of flexibility, high internal validity, low inference, and low participant burden, while their disadvantages include the need for careful observer training and recalibration, inaccessibility to certain environments, and potential participant reactivity. There is a need for both scientists and practitioners to have additional information on observation techniques and systems relative to making environmental and policy decisions about PA, and in this article, we describe concepts and identify questions related to using SO in researching PA behavior. We present 10 general questions in 3 sections, including those related to: (a) ensuring data accuracy through the selection of the most appropriate methodological protocols; (b) investigating PA in school settings, including physical education, recess, and other programs; and (c) investigating PA in community settings (e.g., parks, recreation centers, youth and adult sport programs) and homes.

The Role of the Physical Environment in Promoting Physical Activity in Children Across Different Group Compositions

Physical activity is an important health-related behavior, but the environmental variables that promote or abate it are not well understood. The purpose of this study was to conduct a functional analysis evaluating the effect of the physical environment on moderate-to-vigorous physical activity (MVPA) in preschool children, and to evaluate the utility of the methodology across different group compositions. The Observational System for Recording Physical Activity in Children was used to define the test conditions and the measures of physical activity for eight preschool children. The functional analysis was implemented according to a multi-element experimental design. The highest levels of MVPA were observed when fixed playground equipment was available and at least one peer was present. Moreover, differential responding was observed across group compositions. The implications of this methodology and these findings on the development of interventions to increase MVPA are discussed.

Screen time use in children under 3 years old: a systematic review of correlates

Background

A large percentage (68%) of children under age 3 use screen media, such as television, DVDs and video games, on a daily basis. Research suggests that increased screen time in young children is linked to negative health outcomes, including increased BMI, decreased cognitive and language development and reduced academic success. Reviews on correlates of screen time for young children have included preschool age children and children up to age 7; however, none have focused specifically on correlates among infants and toddlers. As research suggests that screen media use increases with age, examining correlates of early media exposure is essential to reducing exposure later in life. Thus, this paper systemically reviews literature published between January 1999 and January 2013 on correlates of screen time among children between 0 and 36 months of age.

Methods

Two methods were used to conduct this review: (1) Computerized searches of databases (PubMed, PsycINFO, ERIC, Medline); and (2) Reference sections of existing reviews and primary studies. Inclusion criteria were: (1) The article included separate data for children 36 months and younger, (2) English language, (3) peer reviewed article, (4) analysis reported for screen viewing as a dependent variable, (5) original research article and, (6) examined correlates or associations between screen time and other demographic, contextual or behavioral variables. Articles were compiled between 2011 and 2013 and evaluation occurred in 2012 and 2013.

Results

The literature search identified 29 studies that met inclusion criteria. These studies investigated a total of 33 potential correlates, which were examined in this review. Findings suggest demographic variables most commonly correlated with high screen time among infants and toddlers are child’s age (older) and race/ethnicity (minority). Child BMI, maternal distress/depression, television viewing time of the mother and cognitive stimulation in the home environment were also associated with screen media use. Studies reported that child sex, first born status, paternal education, non-English speaking family, two-parent household, number of children in the home and non-parental childcare were not associated with screen time among children aged 0–36 months. Associations were unclear (fewer than 60% of studies report an association) for maternal age, maternal education and household income. The remaining correlates were investigated in fewer than three studies and thus not coded for an association.

Conclusions

The correlates identified in this study point to avenues for intervention to reduce screen time use in young children. However, further research is necessary to explore a number of environmental, socio-cultural and behavioral correlates that are under-examined in this population and may further inform prevention and intervention strategies.

Assessing and increasing physical activity

Increasing physical activity is a crucial component of any comprehensive approach to combat the growing obesity epidemic. This review summarizes recent behavioral research on the measurement of physical activity and interventions aimed at increasing physical activity and provides directions for future research.

Physical activity behaviours of highly active preschoolers

BACKGROUND

Understanding the physical activity behaviour of young children who are highly active may provide important guidance for promoting physical activity in preschools.

OBJECTIVES

The objective of this study was to describe the movement characteristics of high-active (HA) children during attendance at preschools.

METHODS

Children in 20 preschools (n = 231) wore accelerometers and were classified into tertiles of moderate-to-vigorous physical activity. Children's movement characteristics were observed using the Observational System for Recording Physical Activity in Children-Preschool Version. Mixed-model analyses compared movement types between HA children and lower-active (LA) children during the total school day.

RESULTS

HA (n = 77) children were observed to be more active than LA children (n = 154) indoors (P < 0.001), but no differences were observed outdoors. HA children were more frequently observed running, crawling, climbing, jumping, skipping, swinging and throwing across the total school day than LA children. Outdoors, HA children participated in more swinging and throwing and less jumping or skipping than LA children. Indoors, HA children spent more time pulling, pushing and running, and less time walking than LA children.

CONCLUSIONS

HA children have unique activity patterns. Further interventions to increase physical activity of all preschoolers should increase the time spent outside and include varied activity types throughout the entire school day.

A functional analysis of moderate-to-vigorous physical activity in young children

Inadequate physical activity increases the risks related to a number of health problems in children, most notably obesity and the corresponding range of associated health problems. The purpose of the current study was to conduct a functional analysis to investigate the effects of several consequent variables on moderate-to-vigorous physical activity (MVPA). We observed the level of MVPA exhibited by 2 preschool children in 4 conditions: alone, attention contingent on MVPA, adult interaction contingent on MVPA, and escape from task demands contingent on MVPA. These four conditions were compared to a naturalistic baseline and to a control condition. Overall, results indicated that the children were most active when attention and interactive play were contingent on MVPA. Social environments that encourage MVPA could be arranged based on this information, with these arrangements tailored to the individual child.

The effect of outdoor activity context on physical activity in preschool children

The purpose of the current study was to develop and test a method for assessing the effect of outdoor activity context on level of physical activity in preschool children. The observational system for recording physical activity in children was used to define the test conditions and various levels of physical activity within a multielement design. In general, all participants were fairly sedentary during the analysis. The fixed playground equipment condition produced the most moderate-to-vigorous physical activity, a finding that does not correspond to the descriptive assessment literature on childhood physical activity.

Prevalence and correlates of exergaming in youth

OBJECTIVES

Less than 15% of children and adolescents participate regularly in physical activity (PA) and, with ever-increasing obesity, strategies to improve PA levels in youth are urgently needed. Exergaming offers a PA alternative that may be especially attractive in our increasingly technophilic society. However, there are no observational studies of exergaming in population-based samples of adolescents. The purpose of this study was to investigate potential sociodemographic, lifestyle, psychosocial, weight-related, and mental health correlates of exergaming as well as describe the type, timing, and intensity of exergaming in a population-based sample of adolescents.

METHODS

Data on exergame use and potential sociodemographic, lifestyle, psychosocial, weight-related, and mental health correlates of exergaming were collected in mailed self-report questionnaires completed by 1241 grade 10 and 11 students from the Montreal area with a mean age of 16.8 years (SD = 0.05 years; 43% male) participating in the AdoQuest study. The independent correlates of exergaming were identified in multivariable logistic regression models.

RESULTS

Nearly one-quarter (24%) of participants reported exergaming. Exergamers played 2 days per week on average, for ∼50 minutes each bout; 73% of exergamers played at a moderate or vigorous intensity. Exergamers were more likely than nonexergamers to be girls, to play nonactive video games, to watch ≥2 hours of television per day, to be stressed about weight, and to be nonsmokers.

CONCLUSIONS

Many adolescents exergame at intensity levels that could help them achieve current moderate-to-vigorous PA recommendations. Interventions that encourage exergaming may increase PA and decrease sedentary behavior in select youth subgroups, notably in girls.

Diet and physical activity in pre-school children: a pilot project for surveillance in three regions of Italy

Objective

To test a surveillance system on diet and physical activity based on data gathered at well-child visits.

Design

Cross-sectional data collection on growth, diet, physical activity and sociodemographic variables.

Setting

Offices of 179 paediatricians in three Italian regions.

Subjects

26 898 children for a total of 32 915 well-child visits at 1, 3, 5–6, 8–9, 12, 18, 24, 36 and 60–72 months of age.

Results

The BMI Z-score was lower than the WHO standard at 1 and 3 months but higher from 8–9 months onwards. The rates of breast-feeding at 1, 3, 5–6, 8–9 and 12 months were 88 %, 75 %, 64 %, 52 % and 32 %, respectively, with 5 % and 3 % continuing up to 24 and 36 months. Exclusive breast-feeding was 64 %, 54 % and 20 % at 1, 3 and 5–6 months, respectively; 57 % at 5 months and 85 % at 6 months were given complementary foods. Only 8 % and 10 % of children were taking five portions of fruit and vegetables daily, while 47 % and 51 % were consuming sugar-sweetened beverages at 36 and 60–72 months, respectively. At 60–72 months, less than 10 % reported at least 1 h of moderate-to-vigorous physical activity on 5–7 d/week, and 32 % watched television or played videogames for more than 2 h/d, every day. The majority of paediatricians rated the surveillance system as reliable and feasible.

Conclusions

Surveillance for diet and physical activity in pre-school children, with data gathered during well-child visits, is feasible and potentially useful to plan and evaluate activities for the prevention of obesity.

Behavioral assessment of physical activity in obese preschool children

We measured changes in physical activity in 2 obese preschool children when a package intervention was evaluated in a reversal design. Physical activity was measured via direct observation and pedometers. Although the intervention produced only modest increases in activity, the results provide preliminary concurrent validation for the dependent measures used, in that the two measures covaried and a similar degree of change was observed with each across baseline and intervention phases.

Obesity in preschoolers: behavioral correlates and directions for treatment

Nearly 14% of American preschoolers (ages 2-5) are obese (BMI ≥ 95th percentile for age and gender), yet this group has received little attention in the obesity intervention literature. This review examines what is known about behavioral correlates of obesity in preschoolers and the developmental context for lifestyle modification in this age group. Information was used to critically evaluate existing weight management prevention and intervention programs for preschoolers and formulate suggestions for future intervention research development. A systematic search of the medical and psychological/behavioral literatures was conducted with no date restrictions, using PubMed, PsycInfo, and MEDLINE electronic databases and bibliographies of relevant manuscripts. Evidence suggests several modifiable behaviors, such as sugar sweetened beverage intake, television use, and inadequate sleep, may differentiate obese and healthy weight preschoolers. Developmental barriers, such as food neophobia, food preferences, and tantrums challenge caregiver efforts to modify preschoolers' diet and activity and parental feeding approaches, and family routines appear related to the negative eating and activity patterns observed in obese preschoolers. Prevention programs yield modest success in slowing weight gain, but their effect on already obese preschoolers is unclear. Multi-component, family-based, behavioral interventions show initial promise in positive weight management for already obese preschoolers. Given that obesity intervention research for preschoolers is in its infancy, and the multitude of modifiable behavioral correlates for obesity in this age group, we discuss the use of an innovative and efficient research paradigm (Multiphase Optimization Strategy; MOST) to develop an optimized intervention that includes only treatment components that are found to empirically reduce obesity in preschoolers.

The effects of exergaming on physical activity among inactive children in a physical education classroom

Childhood obesity, which is due in part to lack of physical activity, is a serious concern that requires the attention of the behavioral community. Although excessive video game play has been noted in the literature as a contributor to childhood obesity, newer video gaming technology, called exergaming, has been designed to capitalize on the reinforcing effects of video games to increase physical activity in children. This study evaluated the effects of exergaming on physical activity among 4 inactive children in a physical education (PE) classroom. Results showed that exergaming produced substantially more minutes of physical activity and more minutes of opportunity to engage in physical activity than did the standard PE program. In addition, exergaming was socially acceptable to both the students and the PE teacher. Exergaming appears to hold promise as a method for increasing physical activity among inactive children and might be a possible intervention for childhood obesity.