Direct and self-reported measures of physical activity and sedentary behaviours by weight status in school-aged children: results from ISCOLE-Kenya

Objectively measured 24-h movement behaviours of child-guardian pairs in low-to-middle income households in Nairobi City County, Kenya

Background

The decreasing prevalence of physical activity (PA) among urban children in Sub-Saharan Africa is a growing public health concern. More emphasis should focus on examining the influence of parental PA behaviour on the children's PA patterns. We explored associations of 24 ​hour (h) accelerometer-measured movement behaviours of guardian-child pairs in Nairobi City County, Kenya.

Methods

This cross-sectional study assessed 80 pairs consisting of children aged 9-14 years and their guardians in one area of low and one area of middle socioeconomic status (SES) (Embakasi Sub-County and Lang'ata Sub-County), in Nairobi City County, Kenya. The study used waist worn Tri-axial Actigraph (GT3X+ and ActiSleep+) accelerometers to quantify PA and sedentary time (SED). Association between guardians' and children's PA was examined using linear regression, adjusting for guardians' educational attainment and household wealth.

Results

Of the children, 42 (52.5%) and 76 (96.2%) of the guardians were women. Children in low SES areas spent more time (p ​< ​0.001) in moderate-to-vigorous physical activity compared to children from middle SES area. The guardians in low SES area were younger and spent more time in light PA (p ​= ​0.036) while their counterparts had higher daily SED (p ​= ​0.049). Guardian's SED associated with higher children's SED (p ​= ​0.033) even after adjusting for guardians' educational attainment (p ​= ​0.032) and wealth (p ​= ​0.05). There was no association between guardians' and children's MVPA.

Conclusion

Considered alongside the extant literature, these results suggest that health promotion strategies should aim to reduce parental SED time while also planning to increase children's PA.

Differences Between Health- and Skill-Related Physical Fitness Profiles of Kenyan Children from Urban and Rural Areas: The Kenya-LINX Project

Physical fitness is a key indicator of children's health, yet amidst rising inactivity and obesity, data on Kenyan children are scarce. This study assessed health- and skill-related fitness differences between rural and urban Kenyan children while examining demographic influences. Cardiorespiratory fitness (CRF), BMI, strength, flexibility, speed, agility, and coordination were assessed in 1131 children aged 11.07 ± 0.9 years (52.7% girls) recruited using stratified cluster random sampling. Significant rural-urban disparities were observed. In urban areas, 16.6% were overweight and 2.8% obese, compared to 4% and 0.6% in rural areas (p < 0.001). Conversely, 44.5% of the rural cohort were underweight versus 13.7% urban cohort (p < 0.001). Multivariable regression revealed that rural children demonstrated superior CRF (β = -4.68 laps, p < 0.001) and lower back flexibility (β = -2.77 cm, p < 0.001), while urban children excelled in speed and coordination (β = 3.68 bounces, p < 0.001) and grip strength (β = 2.16 kg, p < 0.001). Boys outperformed girls in explosive leg power (β = -6.75 cm, p < 0.001) and CRF (β = -6.92 laps, p < 0.001). These findings highlight fitness inequities among Kenyan children, emphasising the need for equitable, targeted, and inclusive physical activity opportunities.

Wealth and obesity in pre-adolescents and their guardians: A first step in explaining non-communicable disease-related behaviour in two areas of Nairobi City County

The prevalence of non-communicable diseases is increasing in lower-middle-income countries as these countries transition to unhealthy lifestyles. The transition is mostly predominant in urban areas. We assessed the association between wealth and obesity in two sub-counties in Nairobi City County, Kenya, in the context of family and poverty. This cross-sectional study was conducted among of 9-14 years old pre-adolescents and their guardians living in low- (Embakasi) and middle-income (Langata) sub-counties. The sociodemographic characteristics were collected using a validated questionnaire. Weight, height, mid-upper arm circumference, and waist circumference were measured using standard approved protocols. Socioeconomic characteristics of the residential sites were accessed using Wealth Index, created by using Principal Component Analysis. Statistical analyses were done by analysis of variance (continuous variables, comparison of areas) and with logistic and linear regression models.A total of 149 households, response rate of 93%, participated, 72 from Embakasi and 77 from Langata. Most of the participants residing in Embakasi belonged to the lower income and education groups whereas participants residing in Langata belonged to the higher income and education groups. About 30% of the pre-adolescent participants in Langata were overweight, compared to 6% in Embakasi (p<0.001). In contrast, the prevalence of adults (mostly mothers) with overweight and obesity was high (65%) in both study areas. Wealth (β = 0.01; SE 0.0; p = 0.003) and income (β = 0.29; SE 0.11; p = 0.009) predicted higher BMI z-score in pre-adolescents. In, pre-adolescent overweight was already highly prevalent in the middle-income area, while the proportion of women with overweight/obesity was high in the low-income area. These results suggest that a lifestyle promoting obesity is high regardless of socioeconomic status and wealth in Kenya. This provides a strong justification for promoting healthy lifestyles across all socio-economic classes.

Do Fitter Children Better Assess Their Physical Activity with Questionnaire Than Less Fit Children?

Most physical activity (PA) questionnaires assess moderate to vigorous PA (MVPA) describing the physical exertion of individuals that might be influenced by their physical fitness. Therefore, the aim of this study was to determine whether fitter children could better assess their PA with the questionnaire than less fit children. The cross-sectional validation study was conducted with 108 children (60 girls) aged 11 to 14 years, who were divided into three fitness groups based on the results of the 600 m running test. To answer the research question, the agreement between their assessment of PA using the SHAPES questionnaire and the UKK RM42 accelerometer data was analysed. One quarter of the participants achieved at least 60 min of MVPA each day, measured by accelerometer. The average MVPA obtained was 97.8 ± 35.6 min per day, with the high fitness group having a significantly higher value compared with the other groups. Moderate to high validity coefficients were found in the high fitness group (Spearman’s ρ range 0.34–0.70). In contrast, the lower fitness groups had poor to moderate validity for all variables (Spearman’s ρ range 0.03–0.42). These results suggest that the fittest children self-assess their PA with the questionnaire better than less fit children, which may advance new directions for the development and evaluation of PA questionnaires and their usability.

Description and comparison of physical activity from self-reports and accelerometry among primary school children in Kilimanjaro, Tanzania: a pilot study

Background: Self-reports are commonly used to assess physical activity in children. Existing self-reports for physical activity have not been validated for primary school children in Tanzania. To understand if primary school children can accurately report their physical activity, we examined the validity of self-reported physical activity against accelerometer measured physical activity. Methods: A community-based cross-sectional study was conducted from May to July 2018. We conveniently selected four primary schools in Moshi municipal and Moshi rural districts in Kilimanjaro, Tanzania. From these districts, 51 children aged 9 - 11 years were randomly selected. A self-reported questionnaire was used to collect physical activity-related variables. Children wore accelerometers for seven consecutive days to capture physical activity movements. Spearman's rank test and Bland Altman plots were used for assessing validity and agreement between self-reports and accelerometer moderate to vigorous physical activity (MVPA). Results: The study participants' mean age was 10 (SD=0.8) years, and 32 (63%) were girls. A significant positive correlation was found between self-reports and accelerometer MVPA (rho=0.36, p=0.009). The mean total of weekday minutes in MVPA from accelerometers was higher than from self-reports, 408 (SD = 66) versus 261 (SD = 179). Conclusions: This study found a significant positive correlation between self-reports and accelerometers. Self-reports are prone to errors due to recall bias, which interferes with their validity. More research is needed to develop better self-reported measures with specific activities that children can easily remember. Also, researchers should carefully consider the inherent limitations in the validity of self-reports.

Description and comparison of physical activity from self-reports and accelerometry among primary school children in Kilimanjaro, Tanzania: a pilot study

Background: Self-reports are commonly used to assess physical activity in children. Existing self-reports for physical activity have not been validated for primary school children in Tanzania. To understand if primary school children can accurately report their physical activity, we examined the validity of self-reported physical activity against accelerometer measured physical activity. Methods: A community-based cross-sectional study was conducted from May to July 2018. We conveniently selected four primary schools in Moshi municipal and Moshi rural districts in Kilimanjaro, Tanzania. From these districts, 51 children aged 9 - 11 years were randomly selected. A self-reported questionnaire was used to collect physical activity-related variables. Children wore accelerometers for seven consecutive days to capture physical activity movements. Spearman's rank test and Bland Altman plots were used for assessing validity and agreement between self-reports and accelerometer moderate to vigorous physical activity (MVPA). Results: The study participants' mean age was 10 (SD=0.8) years, and 32 (63%) were girls. A significant positive correlation was found between self-reports and accelerometer MVPA (rho=0.36, p=0.009). The mean total of weekday minutes in MVPA from accelerometers was higher than from self-reports, 408 (SD = 66) versus 261 (SD = 179). Conclusions: This study found a significant positive correlation between self-reports and accelerometers. Self-reports are prone to errors due to recall bias, which interferes with their validity. More research is needed to develop better self-reported measures with specific activities that children can easily remember. Also, researchers should carefully consider the inherent limitations in the validity of self-reports.

Systematic review of the correlates of outdoor play and time among children aged 3-12 years

BACKGROUND

Due to the myriad of benefits of children's outdoor play and time, there is increasing concern over its decline. This systematic review synthesized evidence on the correlates of outdoor play and outdoor time among children aged 3-12 years.

METHODS

A total of 12 electronic databases in five different languages (Chinese, English, Korean, Spanish, Portuguese) were searched between October 28, 2019 and July 27, 2020. Covidence software was used for screening and Microsoft Excel with a predesigned coding form was used for data extraction. Evidence was synthesized and correlates were categorized using the socioecological model framework.

RESULTS

Based on 107 studies representing 188,498 participants and 422 childcare centers from 29 countries, 85 studies examined potential correlates of outdoor play while 23 studies examined that of outdoor time (one examined both). The duration of outdoor play and outdoor time ranged between 60 and 165 min/d and 42-240 min/d, respectively. Out of 287 (outdoor play) and 61 (outdoor time) potential correlates examined, 111 correlates for outdoor play and 33 correlates for outdoor time were identified as significant correlates. Thirty-three variables were identified as key/common correlates of outdoor play/time, including eight correlates at the individual level (e.g., sex/gender, race/ethnicity, physical activity), 10 correlates at the parental level (e.g., parental attitude/support/behavior, parenting practice), nine at the microsystem level (e.g., proximal home/social environment such as residence type, peer influence), three at the macrosystem/community level (e.g., availability of space children can play), and three at the physical ecology/pressure for macrosystem change level (e.g., seasonality, rurality). No key correlates were found at the institutional level.

CONCLUSIONS

Individual, parental, and proximal physical (home) and social environments appear to play a role in children's outdoor play and time. Ecological factors (i.e., seasonality, rurality) also appear to be related to outdoor play/time. Evidence was either inconsistent or lacking at institutional and macrosystem/community levels. Standardizing terminology and measures of outdoor play/time is warranted. Future work should investigate the interactions and processes of multiple variables across different levels of socioecological modelling to better understand the mechanisms through which outdoor play/time opportunities can be optimized for children while paying special attention to varying conditions in which children are born, live, and play.

Description and comparison of physical activity from self-reports and accelerometry among primary school children in Kilimanjaro, Tanzania: a pilot study

Background: Self-reports are commonly used to assess physical activity in children. Existing self-reports for physical activity have not been validated for use among primary school children in, Tanzania. In order to understand if primary school children can accurately report their physical activity, we examined the validity of self-reported physical activity against accelerometer measured physical activity. Methods: A community based cross-sectional study was conducted from May to July, 2018. Four primary schools were conveniently selected in Moshi municipal and Moshi rural districts in Kilimanjaro, Tanzania and from these 51 children aged 9 - 11 years were randomly selected. Self-reported questionnaire was used to collect physical activity related variables. In addition, children wore accelerometers for seven consecutive days to capture physical activity movements. Spearman's rank test and Bland Altman plots were used for assessing validity and agreement between self-reports and accelerometer moderate to vigorous physical activity (MVPA). Results: The mean age of the study participants was 10 (SD=0.8) years and 32 (63%) were girls. A positive significant correlation was found between self-reports and accelerometer MVPA (rho=0.36, p=0.009). Accelerometer had higher mean MVPA 408 (SD = 66) compared to self-reports 261 (SD = 179). Children who reported walking to school had higher MVPA for both accelerometer and self- reports compared to children who use other means of transport to school, e.g. school buses (p < 0.001). Conclusions: This study found a positive significant correlation between self-reports and accelerometers. Self-reports are prone to errors due to recall bias, and this interferes their validity. More research is needed to develop better self-reported measures with specific activities which can easily be recalled by children. Also, researchers have to be aware of self-reports validity limitation.

Validation of self-reported physical activity by accelerometry among primary school children in Kilimanjaro, Tanzania: a pilot study

Background: Self-reports are commonly used to assess physical activity in children.  Existing self-reports for physical activity have not been validated for use among primary school children in Kilimanjaro, Tanzania. In order to understand if primary school children can accurately report their physical activity, we examined the validity of self-reported physical activity against accelerometer measured physical activity. Methods: A community based cross-sectional study was conducted from May to July, 2018 among four primary schools in Moshi municipal and Moshi rural districts, Kilimanjaro, Tanzania.  A total of 51 primary school children aged 9-11 years were enrolled using a simple random sampling technique. A self-reported questionnaire was used to collect physical activity related variables. In addition, children wore accelerometers for seven consecutive days to capture physical activity movements. Spearman's rank test and Bland Altman plots were used for assessing validity and agreement between self-reports and accelerometer moderate to vigorous physical activity (MVPA). Results: The mean age of the study participants was 10 (SD=0.8) years. Majority of the study participants were female 32 (63%). A moderate, positive correlation was found between self-reports and accelerometer MVPA (rho=0.36, p=0.009). Accelerometer had higher MVPA compared to self-reports. Children who reported walking to school had higher MVPA for both accelerometer and self- reports compared to children who use other means of transport to school, e.g. school buses (p < 0.001). Conclusions: This study found the moderate positive correlation between self-reports and accelerometers. Self-reports are prone to errors due to recall bias, and this interferes their validity.  More research is needed to develop better self-reported measures with specific activities which can easily be recalled by children. Also, researchers have to be aware of self-reports validity limitation.

Obesity and Body Composition in Preschool Children with Different Levels of Actigraphy-Derived Physical Activity-A Cross-Sectional Study

Detailed associations between physical activity (PA) and body composition in preschoolers remain unclear. The aim of this study was to assess body composition among preschool children differentiated according to their levels of PA and to assess whether meeting the current PA recommendations is associated with a lower risk of obesity, determined by body mass index (BMI) and body fat percentage (BFP). Free-living PA was measured using accelerometers for 7 days in children aged 5 to 6 years. Bioelectrical impedance analysis was used to estimate body composition. Significant differences in content of BFP, fat-free mass (FFM), and total body water (TBW) were found between boys meeting and not meeting moderate-to-vigorous PA (MVPA) recommendations. Meeting the MVPA recommendation was associated with a twofold lower risk of obesity determined by BFP in boys but not in girls. In contrast, the total number of recommended steps per day was not related to adiposity in boys or girls. No statistically significant differences were observed in body composition indices and quintiles of MVPA. Boys in the 3rd–5th quintiles of steps per day presented significantly lower BFP and higher muscle mass and TBW than their peers in quintile 1. However, different associations were observed between body composition indices and quintiles of PA.

The Importance of Self-Monitoring for Behavior Change in Youth: Findings from the SWITCH® School Wellness Feasibility Study

School Wellness Integration Targeting Child Health (SWITCH^®) is a school wellness implementation initiative focused on building capacity for schools to plan and coordinate wellness programming. Grounded in Social Cognitive Theory (SCT), the purpose of this study was to evaluate the utility of the web-based, self-regulation system on physical activity (PA) behavior outcomes. At pre-test and post-test, students in SWITCH^® schools (n = 8) completed the online Youth Activity Profile (YAP) to assess PA and sedentary behavior (SB). Students (n = 513) were categorized into high or low self-monitoring groups (using a median split) based on their use of the web-based self-regulation platform. Linear mixed models were used to assess differences in moderate-to-vigorous PA (MVPA) and sedentary behavior, with school, classroom, student, time-by-school, and time-by-classroom random effects and main and interaction fixed effects for student self-monitoring, gender, and time. Significant self-monitoring-by-time interactions were observed for estimates of PA F(1, 477) = 5.55, p = 0.02 and SB F(1, 477) = 4.90, p = 0.03. Students in the high self-monitoring group had larger gains in PA per day and larger declines in hours per day of sedentary screen time behavior compared to students in the low self-monitoring group. These findings support the utility of web-based self-regulation for facilitating PA change in youth.

An Updated Systematic Review of Childhood Physical Activity Questionnaires

Background and Objective

This review is an update of a previous review published in 2010, and aims to summarize the available studies on the measurement properties of physical activity questionnaires for young people under the age of 18 years.

Methods

Systematic literature searches were carried out using the online PubMed, EMBASE, and SPORTDiscus databases up to 2018. Articles had to evaluate at least one of the measurement properties of a questionnaire measuring at least the duration or frequency of children’s physical activity, and be published in the English language. The standardized COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used for the quality assessment of the studies.

Results

This review yielded 87 articles on 89 different questionnaires. Within the 87 articles, 162 studies were conducted: 103 studies assessed construct validity, 50 assessed test–retest reliability, and nine assessed measurement error. Of these studies, 38% were of poor methodological quality and 49% of fair methodological quality. A questionnaire with acceptable validity was found only for adolescents, i.e., the Greek version of the 3-Day Physical Activity Record. Questionnaires with acceptable test–retest reliability were found in all age categories, i.e., preschoolers, children, and adolescents.

Conclusion

Unfortunately, no questionnaires were identified with conclusive evidence for both acceptable validity and reliability, partly due to the low methodological quality of the studies. This evidence is urgently needed, as current research and practice are using physical activity questionnaires of unknown validity and reliability. Therefore, recommendations for high-quality studies on measurement properties of physical activity questionnaires were formulated in the discussion.

PROSPERO Registration Number

CRD42016038695.

Electronic supplementary material

The online version of this article (10.1007/s40279-018-0987-0) contains supplementary material, which is available to authorized users.

What's Physical Activity Got to Do With It? Social Trends in Less Active Students at Recess

BACKGROUND

Public health concerns regarding childhood obesity and sedentary behavior make investigations of children's physical activity (PA) promotion crucial. School recess, a highly discretional time, plays a central role in shaping children's activity preferences.

METHODS

Participants included 40 children (30 girls, 10 boys) from fourth and fifth grades, categorized as low active during recess (<26% moderate-to-vigorous PA [MVPA]). PA was measured via accelerometer (Actigraph wGT3X+) and activity choice gauged through a self-report measure over a 3-day period. To assess attitudes and perceptions of recess, individual interviews were conducted. Accelerometer data were analyzed into minutes and percentage of MVPA; interviews were transcribed verbatim and analyzed utilizing open and axial coding.

RESULTS

Participants were active for 18% of recess, choosing activities that were primarily individual-based. Interview data showed low active children attribute recess enjoyment to social interaction and time away from schoolwork as well as an intention to avoid other children who were unkind and/or caused social conflict.

CONCLUSIONS

This study supports the importance of gaining a child's perspective of their own behavior, particularly those children classified as less active. Findings add a unique contribution to school health research through an innovative, child-centered approach to explore perceptions of PA.

Understanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis

BACKGROUND

Although the scientific community has acknowledged modest improvements can be made to weight status and obesogenic behaviors (i.e., physical activity, sedentary/screen time, diet, and sleep) during the school year, studies suggests improvements are erased as elementary-age children are released to summer vacation. Emerging evidence shows children return to school after summer vacation displaying accelerated weight gain compared to the weight gained occurring during the school year. Understanding how summer days differ from when children are in school is, therefore, essential.

DISCUSSION

There is limited evidence on the etiology of accelerated weight gain during summer, with few studies comparing obesogenic behaviors on the same children during school and summer. For many children, summer days may be analogous to weekend days throughout the school year. Weekend days are often limited in consistent and formal structure, and thus differ from school days where segmented, pre-planned, restrictive, and compulsory components exist that shape obesogenic behaviors. The authors hypothesize that obesogenic behaviors are beneficially regulated when children are exposed to a structured day (i.e., school weekday) compared to what commonly occurs during summer. This is referred to as the 'Structured Days Hypothesis' (SDH). To illustrate how the SDH operates, this study examines empirical data that compares weekend day (less-structured) versus weekday (structured) obesogenic behaviors in U.S. elementary school-aged children. From 190 studies, 155 (~80%) demonstrate elementary-aged children's obesogenic behaviors are more unfavorable during weekend days compared to weekdays.

CONCLUSION

In light of the SDH, consistent evidence demonstrates the structured environment of weekdays may help to protect children by regulating obesogenic behaviors, most likely through compulsory physical activity opportunities, restricting caloric intake, reducing screen time occasions, and regulating sleep schedules. Summer is emerging as the critical period where childhood obesity prevention efforts need to be focused. The SDH can help researchers understand the drivers of obesogenic behaviors during summer and lead to innovative intervention development.

Physical Activity, Sleep, and BMI Percentile in Rural and Urban Ugandan Youth

BACKGROUND

Uganda is experiencing a dual burden of over- and undernutrition, with overweight prevalence increasing while underweight remains common. Potential weight-related factors, particularly physical activity, sleep, and rural/urban status, are not currently well understood or commonly assessed in Ugandan youth.

OBJECTIVE

The purpose of this study was to pilot test a survey measuring weight-related factors in rural and urban Ugandan schoolchildren.

METHODS

A cross-sectional survey measured sociodemographics, physical activity, sleep patterns, and dietary factors in 148 rural and urban schoolchildren aged 11-16 in central Uganda. Height and weight were objectively measured. Rural and urban youth were compared on these factors using χ² and t tests. Regression was used to identify correlates of higher body mass index (BMI) percentile in the full sample and nonstunted youth.

FINDINGS

Youth were on average 12.1 ± 1.1 years old; underweight (10%) was more common than overweight (1.4%). Self-reported sleep duration and subjective sleep quality did not differ by rural/urban residence. Rural children overall had higher BMI percentile and marginally higher stunting prevalence. In adjusted analyses in both the full and nonstunted samples, higher BMI percentile was related to living in a rural area, higher frequency of physical activity, and higher subjective sleep quality; it was negatively related to being active on weekends. In the full sample, higher BMI percentile was also related to female gender, whereas in nonstunted youth, higher BMI was related to age. BMI percentile was unrelated to sedentary time, performance of active chores and sports, and dietary factors.

CONCLUSIONS

This study is one of the first to pilot test a survey assessing weight-related factors, particularly physical activity and sleep, in Ugandan schoolchildren. BMI percentile was related to several sociodemographic, sleep, and physical activity factors among primarily normal-weight school children in Uganda, providing a basis for understanding weight status in the context of the nutrition transition.

Physical Activity Level and Sedentary Behaviors among Public School Children in Dakar (Senegal) Measured by PAQ-C and Accelerometer: Preliminary Results

Background: Physical inactivity and sedentary lifestyles are major risk factors of childhood obesity. This study aimed to measure physical activity (PA) levels by accelerometer and Physical Activity Questionnaire for Older Children (PAQ-C) among Senegalese school children and the relation with Body Mass Index (BMI) and body composition. Methodology: 156 pupils 8-11 years old were randomly selected in four elementary public schools of Dakar. BMI z-score was used to categorize children according to their weight status. PA was measured by PAQ-C in the 156 pupils and by accelerometer (Actigraph GT3X+, Pensacola, FL, USA) in a subsample of 42 children. Body composition was determined by deuterium dilution method. Results: PAQ-C results were comparable in the 156 and 42 pupils. The 42 pupils presented a light activity measured by accelerometer, while PAQ-C classified the majority of them (57%; n = 24) in the moderate PA level. Children spent most of their time (min/day) in sedentary activities and light activities than in moderate and intense activity levels. Accumulation of 60 min/day Moderate-to-Vigorous Physical Activity (MVPA) was achieved by 54.8% (n = 23) of the pupils. MVPA decreased in girls in relation to their body fatness. There was a significant difference in MVPA between boys and girls. Similarly, overweight/obese (45 ± 16 min/day) children had lower MVPA than their normal and underweight peers (88 ± 34 and 74 ± 36 min/day, respectively; p = 0.004). Conclusions: The two methods are inconsistent for measuring light and moderate PA levels. Although PAQ-C is an uncomplicated routine method, various activities were not adapted for genuine activities in Senegalese children and therefore needs to be validated in African children.