Children's physical activity in family child care homes: Influence of quality status, environment and policy features, and child characteristics.

BACKGROUND: About half of preschool-age children are not meeting recommendations of 15 min/h of physical activity (PA), and nearly one out of seven children between the ages of 2-5 years are living with obesity. Furthermore, children attending family child care homes (FCCHs), compared with larger child care centers, engage in lower levels of PA and appear to be at a higher risk of obesity. Therefore, examining PA and multi-level factors that influence PA in children who attend FCCHs is essential. METHODS: The Childcare Home Eating and Exercise Study (CHEER) examined PA behaviors of 184 children enrolled in 56 FCCHs and FCCH quality status, environment and policy features, and child characteristics. PA was assessed by accelerometer, and FCCH environment and policy was assessed via structured observation. Multiple linear regression was used to model associations between school day total PA and FCCH quality status, environment and policy features, and child characteristics. RESULTS: Child participants were on average 3.1 years old; participants were non-Hispanic Black (47.3%), Non-Hispanic White (42.9%), other race/ethnicity (7.1%), and Hispanic/Latin (2.7%). Children in FCCH settings participated in 11.2 min/h of total PA, which is below the recommended 15 min per hour. The PA environment and policy observation yielded a score of 11.8 out of a possible 30, which is not supportive of child PA. There were no associations between total child PA and FCCH quality status, environment and policy features, and child characteristics in these FCCH settings. CONCLUSIONS: This study was unique in its examination of PA and a comprehensive set of factors that may influence PA at the individual, organizational, environmental, and policy levels in a diverse sample of children attending FCCHs in South Carolina. Additional research is needed to better understand how to increase children's physical activity while they are in the FCCH setting. This research should use multi-level frameworks and apply longitudinal study designs.

Harnessing technology and gamification to increase adult physical activity: a cluster randomized controlled trial of the Columbia Moves pilot.

BACKGROUND: The use of health technologies and gamification to promote physical activity has increasingly been examined, representing an opportunistic method for harnessing social support inherent within existing social ties. However, these prior studies have yielded mixed findings and lacked long-term follow-up periods. Thus, a pilot cluster randomized controlled trial was conducted to gauge the feasibility and preliminary efficacy of a digital gamification-based physical activity promotion approach among teams of insufficiently active adults with existing social ties. METHODS: Teams (N = 24; 116 total participants) were randomized to either a 12-week intervention (Fitbit, step goals, app, feedback; TECH) or the same program plus gamification (TECH + Gamification). Mixed effects models were used to compare group differences in treatment adherence, and changes in social support, steps, and moderate-to-vigorous physical activity at 12 weeks and 52 weeks from baseline, adjusted for sociodemographic characteristics and team size. RESULTS: TECH had a lower mean number of days of Fitbit self-monitoring versus TECH + Gamification during the intervention (adjusted difference: -.30; 95% CI, -.54 to -.07; P = .01). Post-intervention, TECH had 47% lower odds of self-monitoring 7 days per week versus TECH + Gamification (.53; 95% CI, .31 to .89; P = .02). No differences were observed between TECH + Gamification and TECH in increases in social support (0.04; 95% CI, -.21 to .29; P = .76), ActiGraph-measured daily steps (-425; 95% CI, -1065 to 215; P = .19), or moderate-to-vigorous physical activity minutes (-3.36; 95% CI, -8.62 to 1.91; P = .21) from baseline to 12 weeks or in the regression of these improvements by 1 year (Ps > .05). Although not significant in the adjusted models (Ps > .05), clinically meaningful differences in Fitbit-measured daily steps (TECH, 7041 ± 2520; TECH + Gamification, 7988 ± 2707) and active minutes (TECH, 29.90 ± 29.76; TECH + Gamification, 36.38 ± 29.83) were found during the intervention. CONCLUSIONS: A gamified physical activity intervention targeting teams of adults with existing social ties was feasible and facilitated favorable, clinically meaningful additive physical activity effects while in place but did not drive enhanced, long-term physical activity participation. Future investigations should explore optimal team dynamics and more direct ways of leveraging social support (training teams; gamifying social support). TRIAL REGISTRATION: Clinicaltrials.gov ( NCT03509129 , April 26, 2018).

Cadence (steps/min) and relative intensity in 61 to 85-year-olds: the CADENCE-Adults study.

BACKGROUND: We previously demonstrated that a heuristic (i.e., evidence-based, rounded yet practical) cadence threshold of ≥ 100 steps/min was associated with absolutely-defined moderate intensity physical activity (i.e., ≥ 3 metabolic equivalents [METs]) in older adults 61-85 years of age. Although it was difficult to ascertain achievement of absolutely-defined vigorous (6 METs) intensity, ≥ 130 steps/min was identified as a defensible threshold for this population. However, little evidence exists regarding cadence thresholds and relatively-defined moderate intensity indicators, including ≥ 64% heart rate [HR] maximum [HRmax = 220-age], ≥ 40% HR reserve [HRR = HRmax-HRresting], and ≥ 12 Borg Scale Rating of Perceived Exertion [RPE]; or vigorous intensity indicators including ≥ 77%HRmax, ≥ 60%HRR, and ≥ 14 RPE. PURPOSE: To analyze the relationship between cadence and relatively-defined physical activity intensity and identify relatively-defined moderate and vigorous heuristic cadence thresholds for older adults 61-85 years of age. METHODS: Ninety-seven ostensibly healthy adults (72.7 ± 6.9 years; 49.5% women) completed up to nine 5-min treadmill walking bouts beginning at 0.5 mph (0.8 km/h) and progressing by 0.5 mph speed increments (with 2-min rest between bouts). Directly-observed (and video-recorded) steps were hand-counted, HR was measured using a chest-strapped monitor, and in the final minute of each bout, participants self-reported RPE. Segmented mixed model regression and Receiver Operating Characteristic (ROC) curve analyses identified optimal cadence thresholds associated with relatively-defined moderate (≥ 64%HRmax, ≥ 40%HRR, and ≥ 12 RPE) and vigorous (≥ 77%HRmax, ≥ 60%HRR, and ≥ 14 RPE) intensities. A compromise between the two analytical methods, including Youden's Index (a sum of sensitivity and specificity), positive and negative predictive values, and overall accuracy, yielded final heuristic cadences. RESULTS: Across all relatively-defined moderate intensity indicators, segmented regression models and ROC curve analyses identified optimal cadence thresholds ranging from 105.9 to 112.8 steps/min and 102.0-104.3 steps/min, respectively. Comparable values for vigorous intensity indicators ranged between126.1-132.1 steps/min and 106.7-116.0 steps/min, respectively. Regardless of the relatively-defined intensity indicator, the overall best heuristic cadence threshold aligned with moderate intensity was ≥ 105 steps/min. Vigorous intensity varied between ≥ 115 (greater sensitivity) or ≥ 120 (greater specificity) steps/min. CONCLUSIONS: Heuristic cadence thresholds align with relatively-defined intensity indicators and can be useful for studying and prescribing older adults' physiological response to, and/or perceived experience of, ambulatory physical activity. TRIAL REGISTRATION: Clinicaltrials.gov NCT02650258. Registered 24 December 2015.

Longitudinal association of biological maturation with physical activity behaviors in girls transitioning from 5th to 7th grade.

INTRODUCTION: This longitudinal study determined if social cognitive variables influence physical activity in girls stratified on the basis of maturity status. METHODS: Participants attended South Carolina public schools (Mage in 5th grade = 11.1 years) and included a cohort of 529 girls who provided physical activity data in the 5th grade and in 6th and/or 7th grade. The measure of maturity status was age at peak height velocity (APHV) estimated from maturity offset when the children were in the 5th grade. The Earlier Maturity (EM) group included girls whose APHV was one standard deviation or more below the mean APHV for the full sample. All other girls were placed in the Later Maturity (LM) group. Physical activity was assessed at each time point via accelerometry. Social-cognitive variables were assessed at each time point by a questionnaire measuring self-efficacy, enjoyment, competence, appearance, fitness, and social motives for physical activity. Growth curves for the total, Earlier Maturing, and Later Maturing groups assessed relationships between physical activity over time and time-varying social cognitive variables. RESULTS: Physical activity was lower in the Earlier Maturing group and was positively associated with self-efficacy and enjoyment motivation in the total group. These relationships were observed in the 5th grade and maintained through 7th grade. In the Later Maturing group, we observed positive relationships between physical activity and self-efficacy, enjoyment and competence motivation. CONCLUSIONS: Strategies to increase confidence, skills, and enjoyment of physical activity may only be effective for promoting activity among later maturing girls.

Linking Activity, Nutrition, and Child Health (LAUNCH): protocol for a longitudinal cohort study of children as they develop from infancy to preschool age.

BACKGROUND: Physical activity is known to provide important health benefits in children ages 3 years and above, but little is known about the effects of physical activity on health in very young children under age 3. LAUNCH (Linking Activity, Nutrition, and Child Health) is a study designed to expand the body of knowledge on development of physical activity behavior and associations between physical activity and other health characteristics as children transition from infancy to preschool age. METHODS: Physical activity and sedentary behavior will be measured objectively in young children over a period of 30 months. Each child will complete a measurement protocol at 6, 12, 18, 24, 30 and 36 months of age. The following factors will be measured at each time point: physical activity, sedentary behavior, anthropometric characteristics, and motor developmental status. Objectively-measured sleep behavior will be included as an optional component of the protocol. Parents will provide information on demographic factors, parenting behaviors, home and childcare characteristics, and the child's dietary and sleep behaviors. DISCUSSION: LAUNCH will employ a longitudinal study design and objective measures of physical activity, sedentary behavior and sleep in examining developmental trends for those characteristics in children between the ages of 6 and 36 months. Associations among physical activity, sedentary behavior, sleep, and weight status will be examined. Findings will inform public health guidance and intervention strategies for very young children.

Policies, Practices, and Environmental Characteristics Among Family Child Care Homes in South Carolina.

Background: Child care program requirements have adopted nutrition and physical activity standards to address childhood obesity, but few studies have examined the effects of these standards in family child care homes (FCCHs). Methods: In a cross-sectional study (2017-2019), the Childcare Home Eating and Exercise study examined self-reported provider characteristics and observed policies and practices related to physical activity and nutrition in FCCHs in South Carolina. Two-sample t-tests were used to compare observed nutrition and physical activity policy, practice, and environment scores in child care homes that participated in versus did not participate in the state's ABC Quality program, which is designed to improve child care and includes policies and practices intended to increase physical activity levels and improve diet quality. Results: Environment and Policy Assessment and Observation results for nutrition and physical activity were 7.5 out of 21 and 11.8 out of 30, respectively, indicating much room for improvement in nutrition and physical activity policies, practices, and environment in South Carolina FCCHs. The study found one difference between FCCHs that did and did not participate in the ABC Quality program; non-ABC homes provided more time for physical activity. Conclusions: Future research should develop ways to strengthen the guidelines and improve the implementation of obesity prevention standards in FCCHs.

Determinants of Change in Physical Activity in Children during the Transition from Elementary to High School.

INTRODUCTION: Effective public health interventions targeting factors that influence physical activity are urgently needed to reduce the age-related decline in physical activity in youth. The purpose of this study was to identify associations between physical activity and a set of potential influences on physical activity in children as they transition from elementary to high school. METHODS: Participants were 951 children from South Carolina school districts who completed outcome and independent variable measures on at least two time points from the 5th to 11th grades in 2010-2017. The primary outcome variable was physical activity, measured by accelerometry. Independent variables included a comprehensive set of variables in the child, parent/home, school, and community domains. Children, parents and school administrators, and staff completed questionnaires to assess psychosocial and home, school, and neighborhood environmental influences. Growth curve analyses identified independent variables associated with physical activity over time, either as a main effect or as an interaction with age. RESULTS: As main effects, self-efficacy, self-schema, sport participation, weekday outdoor hours, importance of child participating in sports and physical activity, safe to play outside, and Physical Activity Resource Assessment weighted score were positively associated with physical activity. The associations between physical activity and enjoyment motivation, appearance motivation, weekend outdoor time, and home equipment exhibited significant interactions with age. Enjoyment motivation influenced physical activity during the earlier years, whereas the remaining three variables influenced physical activity in the later years. CONCLUSIONS: Interventions should target multiple domains of influences that may vary by age.

Longitudinal associations between sleep and weight status in infants and toddlers.

BACKGROUND: The limited research assessing relationships between sleep duration and weight status in infants and toddlers relies primarily on parent-reported sleep and cross-sectional studies. OBJECTIVES: Examine whether average sleep duration and changes in sleep duration among 6-24-month-old children were associated with weight-for-length z-scores, and whether these associations varied by race/ethnicity, socioeconomic status and sex. METHODS: Data were collected when children were approximately 6, 12, 18 and 24 months old (N = 116). Sleep duration was measured using actigraphy. Weight-for-length z-scores were calculated using children's height and weight. Physical activity was assessed using accelerometry. Diet was assessed using a feeding frequency questionnaire. Demographic characteristics included sex, race/ethnicity and socioeconomic status. Separate associations of between- and within-person changes in sleep duration were estimated with weight-for-length z-score treated as the outcome variable in linear mixed model analyses. Additional models were assessed that included interactions between sleep and demographic characteristics. RESULTS: At time points where children slept longer at night compared to their own average, their weight-for-length z-score was lower. This relationship was attenuated by physical activity levels. CONCLUSIONS: Increasing sleep duration can improve weight status outcomes in very young children who have low physical activity levels.

Walkability indices and children's walking behavior in rural vs. urban areas.

PURPOSE: This study described associations between selected walk indices (WI) and walking and physical activity behaviors in rural and urban children. FINDINGS: WI were higher in urban environments, yet children from rural areas walked for transportation more than children from urban areas. There was a negative correlation between National WI scores and walking for transportation in urban areas, and between the Frank WI scores and walking for exercise in rural areas. CONCLUSIONS: Indices of walkability are not associated with objectively measured physical activity or self-reported walking behavior in children living in rural and urban settings.

Nighttime sleep and physical activity in 6-7 month-old infants.

This study examined associations between objectively-measured nighttime sleep duration and physical activity in a sample of 6-7 month-old infants (N=93). The study also investigated relationships between infant sleep and demographic and environmental characteristics. Cross-sectional relationships were assessed using linear regression analyses. Nighttime sleep duration was positively associated with physical activity levels. Nighttime sleep duration was greater when infants had a consistent bedtime, slept in a separate room, were male, and had mothers who reported having a college education or greater. These findings can inform the development of interventions that aim to improve infant sleep.

Operationalizing and Testing the Concept of a Physical Activity Desert.

BACKGROUND: The prevalence of childhood obesity is higher in economically and socially deprived areas. Higher levels of physical activity reduce the risk of excessive weight gain in youth, and research has focused on environmental factors associated with children's physical activity, though the term "physical activity desert" has not come into wide use. METHODS: This exploratory study operationalized the term "physical activity desert" and tested the hypothesis that children living in physical activity deserts would be less physically active than children who do not. A cross-sectional study design was applied with 992 fifth-grade students who had provided objectively measured physical activity data. Five of 12 possible elements of the built environment were selected as descriptors of physical activity deserts, including no commercial facilities, no parks, low play spaces, no cohesion, and the presence of incivilities. RESULTS: Univariate and multivariate analyses showed that only the absence of parks was associated with less physical activity in children. CONCLUSION: Children living in a "no park" zone were less active than their counterparts who lived near a park. This study contributes preliminary conceptual and operational definitions of "physical activity desert." Future studies of physical activity deserts should be undertaken in larger and more diverse samples.