Health-enhancing physical activity and sedentary behaviour in children and adolescents

We provide a wide-ranging review of health-related physical activity in children and adolescents using a behavioural epidemiology framework. In contrast to many other reviews, we highlight issues associated with true sedentary behaviours alongside physically active behaviours. Specifically, we review the evidence concerning the links between physical activity and cardiovascular disease, overweight and obesity, psychosocial measures, type II diabetes, and skeletal health. Although the evidence is unconvincing at times, several factors lead to the conclusion that promoting physical activity in youth is desirable. A review of the prevalence of physical activity and sedentary behaviours shows that many young people are active, but this declines with age. A substantial number are not adequately active for health benefits and current trends in juvenile obesity are a cause for concern. Prevalence data on sedentary behaviours are less extensive but suggest that total media use by young people has not changed greatly in recent years. Most children and adolescents do not exceed recommended daily hours of TV viewing. Physical activity is unrelated to TV viewing. We also identified the key determinants of physical activity in this age group, highlighting demographic, biological, psychological, behavioural, social and environmental determinants. Interventions were considered for school, family and community environments. Finally, policy recommendations are offered for the education, governmental, sport and recreation, health, and mass media sectors.     

Relationship between school rhythm and physical activity in adolescents: the HELENA study

The aim was to assess the relationship between school rhythm and physical activity (PA) in adolescents. The study included 2024 adolescents (12.5–17.4 years). Participants wore an accelerometer for 7 days. A short school rhythm was defined as a short time at school with short recesses and less time in teaching per day (Group 1). A long school rhythm was defined as a longer time at school with more time in teaching and recess (Group 2). Adolescents in Group 1 performed less moderate to vigorous PA (MVPA) than those in Group 2 per week (P < .0001), especially during school days (recess: 3.9 ± 4.0 vs. 9.8 ± 7.9 min · day^?1; P < .0001; teaching hours: 14.5 ± 9.8 vs. 19.1 ± 12.0 min · day^?1; P < .0001). Adolescents in Group 1 were less likely to meet the PA recommendations than were adolescents in Group 2: 30.7% vs. 34.1% (P < .0001). During school days, the percentage of adolescents who spent more than 2 h · day^?1 in sedentary activities was greater in the Group 1 (P < .001). Our results suggest that leisure-time out-of-school hours is used mainly for sedentary activities, and that school time provides a good opportunity for promoting PA.     

Association between physical activity and digestive-system cancer: An updated systematic review and meta-analysis

BackgroundPhysical activity (PA) may have an impact on digestive-system cancer (DSC) by improving insulin sensitivity and anticancer immune function and by reducing the exposure of the digestive tract to carcinogens by stimulating gastrointestinal motility, thus reducing transit time. The current study aimed to determine the effect of PA on different types of DSC via a systematic review and meta-analysis.MethodsIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched for relevant studies in PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure. Using a random effects model, the relationship between PA and different types of DSC was analyzed.ResultsThe data used for meta-analysis were derived from 161 risk estimates in 47 studies involving 5,797,768 participants and 55,162 cases. We assessed the pooled associations between high vs. low PA levels and the risk of DSC (risk ratio (RR)  = 0.82, 95% confidence interval (95%CI): 0.79–0.85), colon cancer (RR = 0.81, 95%CI: 0.76–0.87), rectal cancer (RR = 0.88, 95%CI: 0.80–0.98), colorectal cancer (RR = 0.77, 95%CI: 0.69–0.85), gallbladder cancer (RR = 0.79, 95%CI: 0.64–0.98), gastric cancer (RR = 0.83, 95%CI: 0.76–0.91), liver cancer (RR = 0.73, 0.60–0.89), oropharyngeal cancer (RR = 0.79, 95%CI: 0.72–0.87), and pancreatic cancer (RR = 0.85, 95%CI: 0.78–0.93). The findings were comparable between case-control studies (RR = 0.73, 95%CI: 0.68–0.78) and prospective cohort studies (RR = 0.88, 95%CI: 0.80–0.91). The meta-analysis of 9 studies reporting low, moderate, and high PA levels, with 17 risk estimates, showed that compared to low PA, moderate PA may also reduce the risk of DSC (RR = 0.89, 95%CI: 0.80–1.00), while compared to moderate PA, high PA seemed to slightly increase the risk of DSC, although the results were not statistically significant (RR = 1.11, 95%CI: 0.94–1.32). In addition, limited evidence from 5 studies suggested that meeting the international PA guidelines might not significantly reduce the risk of DSC (RR = 0.96, 95%CI: 0.91–1.02).ConclusionCompared to previous research, this systematic review has provided more comprehensive information about the inverse relationship between PA and DSC risk. The updated evidence from the current meta-analysis indicates that a moderate-to-high PA level is a common protective factor that can significantly lower the overall risk of DSC. However, the reduction rate for specific cancers may vary. In addition, limited evidence suggests that meeting the international PA guidelines might not significantly reduce the risk of DSC. Thus, future studies must be conducted to determine the optimal dosage, frequency, intensity, and duration of PA required to reduce DSC risk effectively.     

Sports participation,physical activity,and health in the European regions

In a context of stagnation of the level of health-enhancing physical activity in Europe, this study examines the geographical stratification of sports participation and physical activity (PA) at the regional level in 28 European countries. While previous research has focused on the national approach, this study considers the regional level across 208 European regions. Individual survey data from the Eurobarometer 80.2 is combined with a regional-level approach to the 208 regions to quantify sports participation and PA at the regional level. The results show important differences and a geographical stratification of sports participation and PA among the European regions, albeit following different patterns. In particular, a north–south gap is identified in terms of PA rates and an east–west gap is detected in terms of sports participation levels. Applying the cluster technique, a taxonomy of four different European regions is developed considering both types of indicators. Finally, the existence of sports spatial spillovers among regions is verified, obtaining a positive autocorrelation among neighbouring regions for being involved in PA and sporting activities. The results may have significant implications in terms of policy measures to improve health through PA and sports participation at the regional level in Europe.     

Sex-specific associations of moderate and vigorous physical activity with physical fitness in adolescents

The present study examined the sex-specific associations of moderate and vigorous physical activity (VPA) with physical fitness in 300 Japanese adolescents aged 12–14 years. Participants were asked to wear an accelerometer to evaluate physical activity (PA) levels of various intensities (i.e. moderate PA (MPA), 3–5.9 metabolic equivalents (METs); VPA, ≥6 METs; moderate to vigorous PA (MVPA), ≥3 METs). Eight fitness items were assessed (grip strength, bent-leg sit-up, sit-and-reach, side step, 50?m sprint, standing long jump, handball throw, and distance running) as part of the Japanese standardised fitness test. A fitness composite score was calculated using Japanese fitness norms, and participants were categorised according to their score from category A (most fit) to category E (least fit), with participants in categories D and E defined as having low fitness. It was found that for boys, accumulating more than 80.7?min/day of MVPA may reduce the probability of low fitness (odds ratio (ORs) [95% confidence interval (CI)]?=?0.17 [0.06–0.47], p?=?.001). For girls, accumulating only 8.4?min of VPA could reduce the likelihood of exhibiting low fitness (ORs [95% CI]?=?0.23 [0.05–0.89], p?=?.032). These results reveal that there are sex-specific differences in the relationship between PA and physical fitness in adolescents, suggesting that sex-specific PA recommendation may be needed to improve physical fitness in adolescents.     

Association between fundamental motor skills and physical activity in the early years: A systematic review and meta-analysis

BackgroundPhysical activity (PA) in the early years is associated with a range of positive health outcomes. Fundamental motor skill (FMS) competence is associated with PA and is theorized to be driven by PA in the early years and vice versa in mid to late childhood. However, to date, no studies have meta-analyzed the association between PA and FMS in the early years.MethodsSix electronic databases were searched for articles published up to April 2019. Cross-sectional and longitudinal studies were included if they targeted children (ages 3–6 year) as the population of the study and assessed the association between objectively measured PA and FMS. Total FMS, total physical activity (TPA), and moderate-to-vigorous physical activity (MVPA) data were meta-analyzed using a random effects model.ResultsWe identified 24,815 titles and abstracts. In total, 19 studies met the inclusion criteria, including 14 cross-sectional and 4 longitudinal studies, as well as 1 study with cross-sectional and longitudinal analysis. There was a significant but small positive association between FMS and MVPA (r = 0.20, 95% confidence interval (CI): 0.13–0.26) and TPA (r = 0.20, 95%CI: 0.12–0.28). Findings from longitudinal studies revealed that PA drives FMS in early childhood. Mediation was explored in 1 study, which found that perceived motor competence did not mediate the association between FMS and PA.ConclusionUsing a meta-analysis, this study is the first to show a positive association between FMS, MVPA, and TPA in the early years of childhood, suggesting that the association begins at an early age. Limited evidence from longitudinal studies supports the theory that PA drives FMS in the early years of childhood. More evidence is needed from large studies to track PA and FMS until mid to late childhood and to explore the mediators of this association.     

美国青少年体质健康服务现状与启示研究

在对西方社会尤其是美国关注青少年体质健康问题进行历史回顾的基础上,着重分析了美国青少年体质健康促进的有关策略,涉及国家、社区、家庭以及学校等几个层面,最后提出了美国青少年体质健康促进方略对我国青少年体质健康服务体系构建的启示,以期使我国有所借鉴。     

Correlates of physical activity in youth: a review of quantitative systematic reviews

To increase young people's physical activity (PA) levels it is important to understand the correlates of PA in children and adolescents. We sought to identify factors associated with children's and adolescents’ PA by reviewing systematic quantitative reviews of non-intervention research. Systematic reviews examining associations between quantitatively measured variables and PA in young people (< 19 years) from 2000–2010 were identified using electronic and manual searches. Nine systematic reviews were identified. Demographic/biological correlates of PA were age and gender. Psychological correlates of PA were positive motivation, positive body image and the existence of barriers to PA. Behavioural correlates of PA were previous PA, sport participation, smoking, and sedentary behaviour. Social/cultural correlates of PA were parental influence and social support, and environmental correlates of PA were access to facilities, distance from home to school, time spent outside, and local crime. The evidence is suggestive of a number of different types of correlates of PA for children and adolescents. Beyond age and gender, though, most are likely to have only small or small-to-moderate effects in isolation and may work best in interaction with other influences. Psychologists must look to social, organisational and community-level correlates in addition to individual correlates.     

Domain-specific physical activity and health-related quality of life in university students

Abstract

Information on the relationship between domain-specific physical activity (PA) and health-related quality of life (HRQoL) in the general population and specific groups is still scarce. The aim of this study was to determine the relationship between PA in work, transport, domestic and leisure-time domains and HRQoL among university students. PA and HRQoL were assessed in a random stratified sample of 1750 university students using the International Physical Activity Questionnaire – long form and 12-item Short Form Health Survey, respectively. The Spearman's rank correlations, adjusted for age, community size, personal monthly budget, body mass index, smoking habits and alcohol intake ranged from ?0.11 to 0.18 in female students and ?0.29 to 0.19 in male students. Leisure-time, domestic, transport-related PA and total PA were positively related to HRQoL. Inverse correlations with HRQoL were only found for work-related PA in male students. Multiple linear regression analysis showed that only leisure-time PA was related to the Physical Summary Component score (β = 0.08 for females and β = 0.10 for males, P < 0.05). Domain-specific PA levels were not significantly related to the Mental Component Summary score. To get a more comprehensive insight in the relationship between PA and HRQoL, future studies should not only analyse total PA levels but also domain-specific PA levels. The evidence on the positive relationship of leisure-time, transport and domestic PA with HRQoL can potentially be used to support evidence-based promotion of PA in a university setting, and as a hypothesis for future longitudinal studies on such potential causal relationships.     

Monitoring health,activity and fitness in physical education: its current and future state of health

Various government policies, strategies and responses in England over the years have highlighted schools and physical education to be instrumental in addressing health and the focus on health has been strengthened within subsequent revisions of the National Curriculum. Whilst this might seem encouraging, concerns have been expressed that such policies and governmental regulation increasingly bear features of a ‘performative culture’ and that these have led to increasingly widespread health surveillance in schools. Linked to this are long-standing concerns over the way in which health is addressed in schools and physical education, as well as over some of the monitoring measures and practices employed within the curriculum. Despite this, little is known about monitoring practices in physical education. This article, therefore, presents findings of a study which aimed to (1) determine the nature, prevalence and purpose of monitoring health, physical activity and physical fitness within the physical education curriculum and (2) establish physical education teachers' views of and approaches to monitoring. The study comprised two phases. The first phase involved a survey completed by Heads of Physical Education in 110 secondary schools from across England, and the second semi-structured interviews with 18 of those from the original sample. The findings revealed monitoring, and in particular fitness monitoring, to be a common feature within the physical education curriculum in many schools. However, a number of issues and limitations associated with monitoring and some of the schools' monitoring practices were identified, and the individualistic nature and performative culture reflected in and reinforced through monitoring were acknowledged as potentially problematic. It was thus suggested that if the findings are typical, then monitoring practice is currently not in a good state of health. The article concludes proposing a way forward for monitoring within physical education in the form of some recommendations for practice.     

A longitudinal assessment of the links between physical activity and physical self-worth in adolescent females

Abstract

A longitudinal framework was used to examine the hypotheses of (1) whether physical activity predicts changes in physical self-worth or (2) whether physical self-worth predicts changes in physical activity in adolescent girls. Participants (n=272) completed measures of physical self-worth and participation in physical activities at three different points spanning a two-year interval. A cross-lagged panel model using structural equation modelling analyses indicated that physical self-worth predicted subsequent physical activity and physical activity in turn predicted subsequent physical self-worth across time. Findings demonstrated a reciprocal relationship between physical self-worth and physical activity during early adolescence. This study supports the use of the reciprocal effects model (REM) in gaining an understanding of the cross-lagged relationships between physical self-worth and participation in physical activities amongst adolescent girls.     

The impact of physical activity and fitness on academic achievement and cognitive performance in children

The potential for physical activity and fitness to improve cognitive function, learning and academic achievement in children has received attention by researchers and policy makers. This paper reports a systematic approach to identification, analysis and review of published studies up to early 2009. A three-step search method was adopted to identify studies that used measures of physical activity or fitness to assess either degree of association with or effect on a) academic achievement and b) cognitive performance. A total of 18 studies including one randomised control trial, six quasi-experimental and 11 correlational studies were included for data extraction. No studies meeting criteria that examined the links between physical activity and cognitive function were found. Weak positive associations were found between both physical activity and fitness and academic achievement and fitness and elements of cognitive function, but this was not supported by intervention studies. There is insufficient evidence to conclude that additional physical education time increases academic achievement; however there is no evidence that it is detrimental. The quality and depth of the evidence base is limited. Further research with rigour beyond correlational studies is essential.     

The mirror’s curse: Weight perceptions mediate the link between physical activity and life satisfaction among 727,865 teens in 44 countries

Purpose:The present study aimed to examine the link between physical activity(PA)and life satisfaction in a large international study of adolescents.We also aimed to test whether overweight and underweight perceptions act as mediators and whether age and sex acted as moderators.Methods:For this purpose,we analyzed data from the Health Behavior in School-aged Children study,which comprises 727,865 observations from 44 nations at 4 measurement occasions.Results:Multilevel analyses revealed a positive link between PA and life satisfaction.In addition,underweight and overweight perceptions mediated the effect of PA on life satisfaction.We further found that age and sex acted as moderators.In older adolescents,stronger effects were found in the links between PA and life satisfaction,PA and overweight perception,and both weight perceptions and life satisfaction.In addition,in female adolescents,the link between overweight perception and life satisfaction was stronger.Conversely,the links between PA and both weight perceptions were stronger for boys.Conclusion:The results suggest that weight perception explains part of the relationship between PA and life satisfaction in adolescents and that these effects vary as a function of age and sex.     

The transtheoretical model in the context of physical activity in a school-based sample of German adolescents

Abstract

Physical activity in adolescents is an important public health issue. Regular participation in physical activity is associated with various health benefits. However, problems with motivational adherence to physical activity have been documented. The transtheoretical model is a model of behaviour change. This model, which consists of stages of change, self-efficacy, decisional balance, and processes of change, has not been extensively investigated in youth. In addition, the health-enhancing physical activity concept has rarely been applied in this context.

A cross-sectional design was used. A random sample of seven junior high schools from Bremen (Germany) resulted in a sample of 588 adolescents (50.5% males, mean age=15.0 years, s=0.67). Respondents completed a self-administered questionnaire assessing stages of change, self-efficacy, decisional balance, and processes of change. Univariate analyses of variance were used to identify which constructs differed significantly across the stages of change. Discriminant analysis was used to determine which variables best discriminate the stages.

Distribution of the sample across the stages was: precontemplation, n=175 (29.8%); contemplation, n=135 (22.0%); preparation, n=63 (10.7%); action, n=20 (3.4%); and maintenance, n=195 (33.2%). Significant effects of stages of change were found for self-efficacy, pros, and seven of the ten processes of change. In general, scores of these constructs increased across the stages. Cons did not differ significantly across the stages.

The results provide support for some of the assumptions of the transtheoretical model in a German sample of adolescents. Some of our findings raise questions about the usefulness of five discrete stages. From a public health viewpoint, tailored interventions based on motivational readiness to change would be fruitful, but further research is warranted.     

In-school and out-of-school physical activity in primary and secondary school children

Abstract

The aim of this study was to compare in-school and out-of-school physical activity within a representative sample. Socio-demographic, physical activity, and anthropometric data were collected from a random sample of children (250 boys, 253 girls) aged 3–16 years attending nine primary and two secondary schools. Actigraph GT1M accelerometers, worn for seven days, were used to estimate physical activity levels for in-school (typically 09.00–15.00 h), out-of-school (weekday), and weekend periods. Physical activity as accelerometer counts per minute were lower in school versus out of school overall (in school: 437.2 ± 172.9; out of school: 575.5 ± 202.8; P < 0.001), especially in secondary school pupils (secondary: 321.6 ± 127.5; primary: 579.2 ± 216.3; P < 0.001). Minutes of moderate-to-vigorous physical activity accumulated in school accounted for 29.4 ± 9.8% of total weekly moderate-to-vigorous physical activity overall but varied by sector (preschool: 37.4 ± 6.2%; primary: 33.6 ± 8.1%; secondary: 23.0 ± 9.3%; F = 114.3, P < 0.001). Approximately half of the children with the lowest in-school activity compensated out of school during the week (47.4%) and about one-third at the weekend (30.0%). Overall, physical activity during the school day appears to be lower than that out of school, especially in secondary school children, who accumulate a lower proportion of their total weekly moderate-to-vigorous physical activity at school than younger children. As low in-school activity was compensated for beyond the school setting by less than half of children, promoting physical activity within the school day is important, especially in secondary schools.     

Get moving! A comparison of ideas about body,health and physical activity in materials produced for health education in the Danish Primary School

In the debate over health, one political message has become more and more dominant in western societies over the past decade: Get moving! The logic seems to be that physical activity per se equals better health and that the more physical activity, the better one's health. This logic has, among other things, induced an increased political focus on educational settings and physical education (PE) as a central place for promoting health by increasing physical activity. Today PE is often explicitly identified with health in contemporary school curricula, and this means that PE teachers unavoidably encounter contemporary perceptions of health and physical activity in their professional practice. Taking as its starting point four different teaching resources produced for health education in the Danish Primary School, this article presents four different health cultures and their recommendations for physical activity as a health-promoting practice. The aim is to challenge current perceptions of health and the related recommendations for physical activity in providing a springboard for health communicators and PE teachers to reflect on the health cultures they encounter and maybe to consider how these aligns their own preferred health culture.     

Self-reported physical activity within and outside the neighborhood: Criterion-related validity of the Neighborhood Physical Activity Questionnaire in German older adults

The Neighborhood Physical Activity Questionnaire allows to assess physical activity within and outside the neighborhood. Study objectives were to examine the criterion-related validity and health/functioning associations of Neighborhood Physical Activity Questionnaire-derived physical activity in German older adults. A total of 107 adults aged ≥60 years completed the Neighborhood Physical Activity Questionnaire and Short Form 12 Health Survey. A subsample of 58 participants wore piezoelectric pedometers for 7 consecutive days. Rank correlation coefficients (ρ) along with 95% confidence intervals (CIs) were computed for the criterion-related validity and health/functioning associations of single Neighborhood Physical Activity Questionnaire modules and total physical activity. Criterion-related validity was moderate (ρ ≤ .60) for total physical activity, total walking, and neighborhood walking, but low (ρ ≤ .40) for walking outside the neighborhood. Health/functioning associations were moderate for recreation walking and low for total physical activity, total walking, and walking within as well as outside the neighborhood. The study provides low-to-moderate validity evidence of Neighborhood Physical Activity Questionnaire-derived physical activity in older adults.     

Activity-related typologies and longitudinal change in physical activity and sedentary time in children and adolescents: The UP&DOWN Study

BackgroundChildren and adolescents can be distinguished by different typologies (clusters) of physical activity and sedentary behavior. How physical activity and sedentary behaviors change over time within different typologies is not known. This study examined longitudinal changes in physical activity and sedentary time among children and adolescents with different baseline typologies of activity-related behavior.MethodsIn this longitudinal study (3 annual time points) of children (n = 600, age = 9.2 ± 0.4 years (mean ± SD), 50.3% girls) and adolescents (n = 1037, age = 13.6 ± 1.7 years, 48.4% girls), participants were recruited in Spain in 2011–2012. Latent class analyses identified typologies based on self-reported screen, educational, social and relaxing sedentary behaviors, active travel, muscle strengthening activity, and sport at baseline. Within each typology, linear mixed growth models explored longitudinal changes in accelerometer-derived moderate-to-vigorous physical activity and sedentary time, as well as time by class interactions.ResultsThree typologies were identified among children (“social screenies”, 12.8%; “exercisers”, 61.5%; and “non-sporty active commuters”, 25.7%) and among adolescents (“active screenies”, 43.5%; “active academics”, 35.0%; and “non-sporty active commuters”, 21.5%) at baseline. Sedentary time increased within each typology among children and adolescents, with no significant differences between typologies. No changes in physical activity were found in any typology among children. In adolescents, physical activity declined within all typologies, with “non-sporty active commuters” declining significantly more than “active screenies” over 3 years.ConclusionThese results support the need for intervention to promote physical activity and prevent increases in sedentary time during childhood and adolescence. Adolescents characterized as “non-sporty active commuters” may require specific interventions to maintain their physical activity over time.