The clustering of physical activity and screen time behaviours in early childhood and impact on future health-related behaviours: a longitudinal analysis of children aged 3 to 8 years.

BACKGROUND: Meeting physical activity and screen time guidelines has been associated with improved health in children. Research has shown that lifestyle behaviours happen in combination and can be tracked into later life. Thus, a complex approach is needed to identify the effects of physical activity and screen time altogether. This study aims to identify clusters of both behaviours in a cohort of Irish 3-year-old children (n = 8833) and determine the association with sociodemographic characteristics and behaviours at age 5 and 7-8. METHODS: Data from the "Growing Up in Ireland" study collected between 2010 and 2016 was used in this study. Two-step cluster analysis was used to understand how physical activity and recreational screen time behaviours group together among 3-year-old children. Binary logistic regressions were conducted to examine if cluster placement at age 3 determined physical activity and recreational screen time behaviours at age 5 and 7-8 years, while controlling for gender of child, gender, age and employment status of the primary caregiver. RESULTS: Six clusters were identified in 9771 (49.3% female) 3-year-old children with the majority falling into a "High Active & Mixed Screen Time" (23.2%). Those in the "High Active & Mixed Screen Time" cluster at age 3 were more likely to engage in all physical activities reported at age 5 (p < 0.01) and age 7-8 (p < 0.01) when compared to a "Low Active & Screen Time Exceed" cluster. Children categorised in a "Moderate Active & Screen Time Below" and "Moderate Active & Screen Time Exceed" were more likely to engage in the same physical activities at age 5 and 7-8 (p < 0.05 - p < 0.01). However, children in the latter cluster were also more likely (p < 0.05) to play on a computer or tablet device. CONCLUSIONS: This paper highlights the importance of establishing positive health-related behaviours during early childhood, as this predicts future engagement in health-promoting activities. Regardless of screen time level, being part of a cluster with moderate or high levels of physical activity positively influences a child's future physical activity at age 5 and again at age 7 -8 years. The multiple layers of influence on a child's development should be leveraged to support the adoption of health-enhancing behaviours.

Interventions outside the workplace for reducing sedentary behaviour in adults under 60 years of age.

BACKGROUND: Adults spend a majority of their time outside the workplace being sedentary. Large amounts of sedentary behaviour increase the risk of type 2 diabetes, cardiovascular disease, and both all-cause and cardiovascular disease mortality. OBJECTIVES: Primary • To assess effects on sedentary time of non-occupational interventions for reducing sedentary behaviour in adults under 60 years of age Secondary • To describe other health effects and adverse events or unintended consequences of these interventions • To determine whether specific components of interventions are associated with changes in sedentary behaviour • To identify if there are any differential effects of interventions based on health inequalities (e.g. age, sex, income, employment) SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PsycINFO, SportDiscus, and ClinicalTrials.gov on 14 April 2020. We checked references of included studies, conducted forward citation searching, and contacted authors in the field to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and cluster RCTs of interventions outside the workplace for community-dwelling adults aged 18 to 59 years. We included studies only when the intervention had a specific aim or component to change sedentary behaviour. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles/abstracts and full-text articles for study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted trial authors for additional information or data when required. We examined the following primary outcomes: device-measured sedentary time, self-report sitting time, self-report TV viewing time, and breaks in sedentary time. MAIN RESULTS: We included 13 trials involving 1770 participants, all undertaken in high-income countries. Ten were RCTs and three were cluster RCTs. The mean age of study participants ranged from 20 to 41 years. A majority of participants were female. All interventions were delivered at the individual level. Intervention components included personal monitoring devices, information or education, counselling, and prompts to reduce sedentary behaviour. We judged no study to be at low risk of bias across all domains. Seven studies were at high risk of bias for blinding of outcome assessment due to use of self-report outcomes measures. Primary outcomes Interventions outside the workplace probably show little or no difference in device-measured sedentary time in the short term (mean difference (MD) -8.36 min/d, 95% confidence interval (CI) -27.12 to 10.40; 4 studies; I² = 0%; moderate-certainty evidence). We are uncertain whether interventions reduce device-measured sedentary time in the medium term (MD -51.37 min/d, 95% CI -126.34 to 23.59; 3 studies; I² = 84%; very low-certainty evidence) We are uncertain whether interventions outside the workplace reduce self-report sitting time in the short term (MD -64.12 min/d, 95% CI -260.91 to 132.67; I² = 86%; very low-certainty evidence). Interventions outside the workplace may show little or no difference in self-report TV viewing time in the medium term (MD -12.45 min/d, 95% CI -50.40 to 25.49; 2 studies; I² = 86%; low-certainty evidence) or in the long term (MD 0.30 min/d, 95% CI -0.63 to 1.23; 2 studies; I² = 0%; low-certainty evidence). It was not possible to pool the five studies that reported breaks in sedentary time given the variation in definitions used. Secondary outcomes Interventions outside the workplace probably have little or no difference on body mass index in the medium term (MD -0.25 kg/m², 95% CI -0.48 to -0.01; 3 studies; I² = 0%; moderate-certainty evidence). Interventions may have little or no difference in waist circumference in the medium term (MD -2.04 cm, 95% CI -9.06 to 4.98; 2 studies; I² = 65%; low-certainty evidence). Interventions probably have little or no difference on glucose in the short term (MD -0.18 mmol/L, 95% CI -0.30 to -0.06; 2 studies; I² = 0%; moderate-certainty evidence) and medium term (MD -0.08 mmol/L, 95% CI -0.21 to 0.05; 2 studies, I² = 0%; moderate-certainty evidence) Interventions outside the workplace may have little or no difference in device-measured MVPA in the short term (MD 1.99 min/d, 95% CI -4.27 to 8.25; 4 studies; I² = 23%; low-certainty evidence). We are uncertain whether interventions improve device-measured MVPA in the medium term (MD 6.59 min/d, 95% CI -7.35 to 20.53; 3 studies; I² = 70%; very low-certainty evidence). We are uncertain whether interventions outside the workplace improve self-reported light-intensity PA in the short-term (MD 156.32 min/d, 95% CI 34.34 to 278.31; 2 studies; I² = 79%; very low-certainty evidence). Interventions may have little or no difference on step count in the short-term (MD 226.90 steps/day, 95% CI -519.78 to 973.59; 3 studies; I² = 0%; low-certainty evidence) No data on adverse events or symptoms were reported in the included studies. AUTHORS' CONCLUSIONS: Interventions outside the workplace to reduce sedentary behaviour probably lead to little or no difference in device-measured sedentary time in the short term, and we are uncertain if they reduce device-measured sedentary time in the medium term. We are uncertain whether interventions outside the workplace reduce self-reported sitting time in the short term. Interventions outside the workplace may result in little or no difference in self-report TV viewing time in the medium or long term. The certainty of evidence is moderate to very low, mainly due to concerns about risk of bias, inconsistent findings, and imprecise results. Future studies should be of longer duration; should recruit participants from varying age, socioeconomic, or ethnic groups; and should gather quality of life, cost-effectiveness, and adverse event data. We strongly recommend that standard methods of data preparation and analysis are adopted to allow comparison of the effects of interventions to reduce sedentary behaviour.

Supporting Our Lifelong Engagement: Mothers and Teens Exercising (SOLE MATES); a feasibility trial.

This study aimed to examine the feasibility of the Supporting Our Lifelong Engagement; Mothers and Teens Exercising (SOLE MATES) program. SOLE MATES, a single-arm six-week feasibility trial, comprised six face-to-face sessions. Participants were mothers (n = 27) with daughters (n = 31) aged 12-16 years. Data were collected in Ireland between January 2018 and March 2018. Feasibility benchmarks examined recruitment, data collection, acceptability, resources and participant responses. The primary outcome was daughters' step counts, measured via sealed pedometer for seven consecutive days at baseline and six weeks. Secondary outcomes included mothers' step counts, measures of communication, co-participation in activity, health-related quality of life and parenting practices. Feasibility benchmarks were reached or exceeded, except for retention. Eligibility rates were 93.4%, and baseline activity levels were low. Program content, measures and facilitators were acceptable, demonstrated through a mean score of 4.14 (SD 0.3) on a 5-point Likert Scale. Daily steps increased in mothers (2,875 increase, p = .009) and daughters (1,393 increase, p = .007). Positive feasibility metrics demonstrated the program's appeal. Participant responses for outcome measures also indicated program success. However, the relatively homogenous sample and relatively poor initial participation rate were study limitations. The intervention should be evaluated in a randomized controlled trial.

Effectiveness of mother and daughter interventions targeting physical activity, fitness, nutrition and adiposity: A systematic review.

BACKGROUND: Physical inactivity and poor dietary habits in women pose a clear public health burden. Mothers are generally the main female role model for daughters, therefore, targeting intergenerational females simultaneously may be a novel approach. However, the effectiveness of this approach to improve physical activity, fitness, nutrition and adiposity has not been systematically examined. OBJECTIVES: To assess the effectiveness of physical activity, fitness and nutrition interventions targeting mothers and their daughters. DATA SOURCES: PubMed, Psychinfo, EMBASE, Ovid Medline, SCOPUS, CINAHL, Sportdiscus and Informit were searched for English language studies (1980-2015). STUDY SELECTION: Randomized controlled trials (RCTS), non-randomized experimental trials and pre-post studies of physical activity, fitness, nutrition and adiposity interventions targeting mothers and daughters were eligible if they reported changes in physical activity, fitness, dietary intake or adiposity. DATA EXTRACTION: Data were extracted using a standardized template and checked by a second author. DATA SYNTHESIS: 3577 articles were screened and 14 unique studies (7 RCTs, 1 pseudo-randomized, 1 non-randomized, 5 pre-post) met the inclusion criteria. The majority of studies were conducted in the US (n=11) and most were limited by methodological concerns. Of the RCTs that targeted each outcome exclusively, ≤20%, ≤20% ≤21% and 0% were successful for improving physical activity, fitness, nutrition and adiposity respectively. CONCLUSIONS: Overall, evidence for the effectiveness of mother-daughter interventions to improve physical activity, fitness, nutrition and adiposity is inconclusive. The diversity of study designs, exposures and outcomes used, along with methodological weaknesses means that well-designed and reported RCTs are warranted.

Associations between metabolic syndrome components and markers of inflammation in Welsh school children.

We investigated the multivariate dimensionality and strength of the relationship between metabolic syndrome (MetS) and inflammation in children. Caucasian school children (N = 229; 12-14 years) from Wales were tested on several health indicators including measures of body composition, inflammation, fasting glucose regulation, blood pressure, and lipids. The multivariate association between MetS and inflammation was investigated via canonical correlation analysis. Data were corrected for non-normality by log transformation, and sex-specific z-scores computed for variables where there was a significant sex difference. Structure r's were interpreted to determine the dimensions of MetS and inflammation responsible for significant canonical variates. The overall multivariate association between MetS and inflammation was significant (Wilks' Lambda = 0.54, p < 0.001). The relationship was explained primarily by the waist circumference dimension of MetS (CC = 0.87) and inflammatory markers of fibrinogen (CC = 0.52) and C-reactive protein (CC = 0.50). The pattern of results was similar regardless of whether variables were adjusted for sex differences. CONCLUSION: Central adiposity is the strongest predictor of the inflammatory aspect of cardiovascular disease risk in Caucasian adolescents. Future research into MetS and cardiometabolic risk should consider multivariate statistical approaches, in order to identify the separate contributions of each dimension in interrelationships and to identify which dimensions are influenced by preventive interventions. What is Known: • Metabolic syndrome (MetS) is associated with increased risk of cardiovascular disease (CVD) and type 2 diabetes. Markers of inflammation are also potential predictors of later development of CVD and type 2 diabetes. • The contribution of individual markers in interrelationships between MetS and inflammation is unknown. What is New: • We uniquely demonstrate that within a multivariate model, waist circumference is the primary link between MetS variables and markers of inflammation in children. • Waist circumference may therefore be a useful population-level screening tool to identify future risk of CVD.

Self-rated walking pace and all-cause, cardiovascular disease and cancer mortality: individual participant pooled analysis of 50 225 walkers from 11 population British cohorts.

BACKGROUND/OBJECTIVES: Walking pace is associated with risk of premature mortality. However, whether this relationship is independent of total volume of physical activity and highest physical activity intensity remains unclear. We examined the associations between walking pace and cause-specific mortality, investigating the potential modifying effect of factors such as total physical activity volume, highest physical activity intensity, age, sex and body mass index (BMI). METHODS: Prospective pooled analysis of 11 population-based baseline surveys in England and Scotland between 1994 and2008 that were linked with mortality records. Multivariate-adjusted Cox proportional hazards models examined associations between walking pace (slow, average, brisk/fast) and all-cause, cancer and cardiovascular disease (CVD) mortality. RESULTS: 50 225 walkers were entered in the core analyses. Among participants who did not experience an event in the first 2 years of follow-up (n=49 731), walking at an average or brisk/fast pace was associated with a reduced risk of all-cause (20% (95% CI 12% to 28%) and 24% (95% CI 13% to 33%), respectively) and CVD mortality (24% (95% CI 9% to 36%) and 21% (95% CI 1% to 38%), respectively), compared with reporting walking at a slow pace. In stratified analyses, such associations were evident among those over 50 years, those not meeting the physical activity recommendations and those who did not undertake vigorous-intensity activity. There were no interactions by sex or BMI. No associations were seen between pace and cancer mortality. CONCLUSION: Walking benefits health. Assuming causality, these analyses suggest that increasing walking pace could reduce risk for all-cause and CVD mortality. Walking pace could be emphasised in public health messages, especially in situations when increase in walking volume or frequency is less feasible.

Effects of frequency, intensity, duration and volume of walking interventions on CVD risk factors: a systematic review and meta-regression analysis of randomised controlled trials among inactive healthy adults.

OBJECTIVE: Walking interventions in healthy populations show clinically relevant improvements for many cardiovascular disease (CVD) risk factors. We aimed to assess the changes in CVD risk factors and the dose-response relationship between frequency, intensity, duration and volume of walking and cardiovascular risk factors based on randomised controlled trials (RCTs). DESIGN: A systematic review with meta-analysis and meta-regression. DATA SOURCES: Four electronic databases searched from January 1971 to April 2017. ELIGIBILITY CRITERIA: Walking RCTs reporting one or more CVD risk factor outcomes; trials including at least one group with walking intervention and a no-walking control group; duration ≥8 weeks; participants ≥18 years old, inactive but healthy; risk factors assessed preintervention and postintervention; English-language articles in peer-reviewed journals. RESULTS: Thirty-seven RCTs, involving 2001 participants (81% women) and assessing 13 CVD risk factors, were identified. Pooled meta-analysis showed favourable effects (P≤0.05) of walking intervention for seven CVD risk factors (body mass, body mass index, body fat, systolic and diastolic blood pressure, fasting glucose and VO2max). There were no significant effects (P>0.05) for waist circumference, waist-to-hip ratio and four blood lipid variables.Despite testing 91 possible dose-response relationships, linear meta-regression analysis adjusted for age indicated just 7 (or 7.7%) statistically significant findings. SUMMARY/CONCLUSION: Walking interventions benefit a number of CVD risk factors. Despite multiple studies and tested metrics, only a few dose-response relationships were identified and the possibility of chance findings cannot be ruled out. There is insufficient evidence to quantify the frequency, length, bout duration, intensity and volume of the walking required to improve CVD risk factors. PROSPERO REGISTRATION NUMBER: CRD42016039409.

What works to promote walking at the population level? A systematic review.

OBJECTIVE: Interventions to promote walking have focused on individual or group-based approaches, often via the randomised controlled trial design. Walking can also be promoted using population health approaches. We systematically reviewed the effectiveness of population approaches to promote walking among individuals and populations. DESIGN: A systematic review. DATA SOURCES: 10 electronic databases searched from January 1990 to March 2017. ELIGIBILITY CRITERIA: Eligibility criteria include pre-experimental and postexperimental studies of the effects of population interventions to change walking, and the effects must have been compared with a 'no intervention', or comparison group/area/population, or variation in exposure; duration of ≥12 months of follow up; participants in free-living populations; and English-language articles. RESULTS: 12 studies were identified from mostly urban high-income countries (one focusing on using tax, incentivising the loss of parking spaces; and one using policy only, permitting off-leash dogs in city parks). Five studies used mass media with either environment (n=2) or community (n=3) approaches. Four studies used environmental changes that were combined with policies. One study had scaled up school-based approaches to promote safe routes to schools. We found mass media, community initiatives and environmental change approaches increased walking (range from 9 to 75 min/week).

The effect of a classroom activity break on physical activity levels and adiposity in primary school children.

AIM: Despite recognition that regular physical activity is essential for good health, many children do not accumulate sufficient daily physical activity. The aim of this study was to examine the effect of a classroom-based activity break on accelerometer-determined moderate-to-vigorous intensity physical activity (MVPA) and adiposity in primary school children. METHODS: One hundred twenty children from seven primary schools in Northern Ireland participated in the study. In each school, one class of children was randomly assigned to an intervention group and another class to a control group. Teachers of the intervention classes led a 5-min activity break three times per day for 12 weeks. Accelerometer-determined MVPA, height, weight and four skinfolds were measured at baseline and post-intervention. RESULTS: Compared with the control group, the intervention group significantly increased weekday MVPA (+9.5 min) from baseline to post-intervention. There were no significant changes in BMI; however, an increase in sum-of-skinfolds of the intervention group was observed. CONCLUSIONS: Classroom-based activity breaks led by the teacher are successful in increasing children's physical activity levels. The programme shows a positive step in improving overall physical activity levels and contributing to the goal of 60 min daily MVPA.

The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials.

OBJECTIVE: To conduct a systematic review and meta-analysis of randomised control trials that examined the effect of walking on risk factors for cardiovascular disease. METHODS: Four electronic databases and reference lists were searched (Jan 1971-June 2012). Two authors identified randomised control trials of interventions ≥ 4 weeks in duration that included at least one group with walking as the only treatment and a no-exercise comparator group. Participants were inactive at baseline. Pooled results were reported as weighted mean treatment effects and 95% confidence intervals using a random effects model. RESULTS: 32 articles reported the effects of walking interventions on cardiovascular disease risk factors. Walking increased aerobic capacity (3.04 mL/kg/min, 95% CI 2.48 to 3.60) and reduced systolic (-3.58 mm Hg, 95% CI -5.19 to -1.97) and diastolic (-1.54 mm Hg, 95% CI -2.83 to -0.26) blood pressure, waist circumference (-1.51 cm, 95% CI -2.34 to -0.68), weight (-1.37 kg, 95% CI -1.75 to -1.00), percentage body fat (-1.22%, 95% CI -1.70 to -0.73) and body mass index (-0.53 kg/m(2), 95% CI -0.72 to -0.35) but failed to alter blood lipids. CONCLUSIONS: Walking interventions improve many risk factors for cardiovascular disease. This underscores the central role of walking in physical activity for health promotion.

Active travel to school and physical activity levels of Irish primary schoolchildren.

The purpose of this study was to (1) determine the physical activity levels of 9-11 year old children, and (2) compare the activity levels of children who commute to school by active and passive modes. 140 children aged 9-11 years (85 boys) were recruited from four urban Irish schools. Mode of commuting was assessed by questionnaire. Step counts were measured for 4 consecutive days. Mean daily step counts for the sample were 14386 ± 5634. Boys were significantly more active than girls (15857 ± 5482 vs. 12113 ± 5127 steps). Eighty-seven children (62.1%) traveled by car, 51 children (36.4%) walked to school, one child traveled by bus and one child cycled. Children who walked or cycled to school had higher daily step counts than those who traveled by passive modes (16118 ± 5757 vs. 13363 ± 5332 steps). Active commuting to school may therefore represent a worthwhile strategy for improving children's physical activity levels.

Estimates of the number of people in England who attain or exceed vigorous intensity exercise by walking at 3 mph.

Walking is a safe, accessible and low cost activity, amenable to change and known to have great potential to increase physical activity levels in sedentary individuals. The objective of this study is to estimate the proportion of the 2009 adult population of England who would attain or exceed vigorous intensity activity (>70% maximum heart rate [HR(max)]) by walking at 3 mph. We conducted predictive impact modelling using participants' (n = 1741, aged 25-64 years) cardiovascular fitness data from treadmill walking tests. We combined this data with English population estimates adjusted for age and sex to estimate the numbers of individuals that would exceed 70% HR(max) (an intensity considered sufficient for fitness gains) when walking at 3 mph (4.8 km · h(-1)). We estimate 1.5 million men (95% confidence interval [CI] 0.9-2.2 million) (from 13.4 million corresponding to 11.6% (95% CI 7.0-16.2%)) and 3.9 million women (95% CI 3.0-4.8 million) (from 13.6 million corresponding to 28.6% (95% CI 22.0-35.1%)) in England aged 25-64 years would benefit from regularly walking at 3 mph. In total, a projected 5.4 million individuals (95% CI 3.9-6.9 million) aged 25-64 (from 26.97 million corresponding to 20.1% (95% CI 14.6-25.7%)) could benefit from walking at 3 mph. Our estimates suggest a considerable number of individuals in the English population could receive fitness and health benefits by walking regularly at 3 mph. Physical activity messages that promote walking at this speed may therefore have the potential to significantly impact national fitness levels and health in England.

Outdoor Walking Speeds of Apparently Healthy Adults: A Systematic Review and Meta-analysis.

BACKGROUND: Walking outdoors can be used by many individuals to meet public health guidelines for moderate-to-vigorous-intensity physical activity. The speed at which adults walk may be a proxy for intensity. Traditional estimates of indoor walking speed are unlikely to reflect self-selected usual or other instructed paces of outdoor walking speed. OBJECTIVE: To inform estimates of pace-based walking speed of apparently healthy adults in outdoor settings. METHODS: We searched four electronic databases for articles published in English between January 1970 and March 2019. Studies that reported walking speed (m/s), cadence (steps/min), or intensity (mL/kg/min) of ambulatory, apparently healthy, and community-dwelling adults (> 18 years) were included. Walking speed categories were defined according to the description provided in each study. Meta-analysis was used to synthesise speed, cadence, and intensity data by slow, usual, medium, fast, and maximal pace (where reported). RESULTS: Thirty-five studies, representing 14,015 participants (6808 women, 5135 men, and 2072 sex not specified), were identified. The mean (95% CI) walking speed for slow, usual, medium, fast, and maximal pace was 0.82 (0.77-0.86), 1.31 (1.27-1.35), 1.47 (1.44-1.49), 1.72 (1.64-1.81), and 1.62 (1.45-1.79) m/s, respectively. Mean cadence (95% CI) for usual and fast paces were 116.65 (114.95-118.35) and 126.75 (121.87-131.63) steps/min, respectively. The mean oxygen consumption (95% CI) for the usual and medium paces was 11.97 (11.69-12.25) and 13.34 (12.94-13.73) mL/kg/min, respectively. CONCLUSION: These findings provide greater clarity with regard to how various indicators of enacted walking pace, speed, and intensity overlap and how each can be best communicated in the real-world setting to optimise health-related outcomes. Pace-based instructions can be used to support walking in outdoor settings within public health guidelines.

Walking: the first steps in cardiovascular disease prevention.

PURPOSE OF REVIEW: Health professionals are presented with the challenge of prescribing physical activity that is likely to be sustained by the sedentary majority. Walking is eminently suited to physical activity prescription for inactive individuals as it is accessible to men and women of all ages and social groups and poses little risk of injury. This paper reviews recent evidence of the health benefits of walking and promotion of walking behavior. RECENT FINDINGS: Large observational studies consistently show associations between walking and cardiovascular disease endpoints over long periods of follow-up. Intervention studies further support the health benefits of walking, showing improvements in clinical biomarkers and measures after shorter periods of follow-up. Walking appears to have cardiovascular disease-related health benefits in younger, middle-aged, and older men and women, in both healthy and patient populations. Pedometer-based, mobile phone-based, and computer-based programs are effective in increasing walking levels. Neighborhood and workplace amenities and programs may be important supports for walking behaviors. SUMMARY: Walking has the potential to play a key role in the primary and secondary prevention of cardiovascular disease. Clinicians can prescribe walking to assist patients meet physical activity recommendations and help identify supports available to the patient.

Accumulated versus continuous exercise for health benefit: a review of empirical studies.

Current physical activity guidelines endorse the notion that the recommended amount of daily physical activity can be accumulated in short bouts performed over the course of a day. Although intuitively appealing, the evidence for the efficacy of accumulated exercise is not plentiful. The purpose of this review was to compare the effects of similar amounts of exercise performed in either one continuous or two or more accumulated bouts on a range of health outcomes. Sixteen studies met the selection criteria for inclusion in the review, in which at least one outcome known to affect health was measured before and after continuous and accumulated exercise training interventions. Where improvements in cardiovascular fitness were noted, most studies reported no difference in the alterations between accumulated and continuous patterns of exercise. In the few studies where a normalization of blood pressure was observed from baseline to post-intervention, there appear to be no differences between accumulated and continuous exercise in the magnitude of this effect. For other health outcomes such as adiposity, blood lipids and psychological well-being, there is insufficient evidence to determine whether accumulated exercise is as effective as the more traditional continuous approach. Seven short-term studies in which at least one health-related outcome was measured during the 0- to 48-hour period after a single continuous bout of exercise and a number of short bouts of equivalent total duration were included in the review. Many of the studies of such short-term effects considered the plasma triglyceride response to a meal following either accumulated short or continuous bouts of exercise. Collectively, these studies suggest that accumulated exercise may be as effective at reducing postprandial lipaemia. Further research is required to determine if even shorter bouts of accumulated exercise (<10 minutes) confer a health benefit and whether an accumulated approach to physical activity increases adherence among the sedentary population at whom this pattern of exercise is targeted.

Adolescent Girls' Perceptions of Physical Activity: A Systematic Review of Qualitative Studies.

OBJECTIVE: To synthesize evidence from qualitative studies relating to adolescent girls' perceptions of physical activity participation. The protocol for this review is registered with PROSPERO (ID no. CRD42017054944). DATA SOURCE: PubMed, Sports Discus, Academic Search Complete, and Education Resources Information Centre. INCLUSION AND EXCLUSION CRITERIA: Studies reporting qualitative data that explored the views/opinions/perceptions of adolescent girls (>12 and <18 years old) published between 2001 and 2016 were included. Studies not in English, those focusing on school physical education or specific sports, and those including special populations were excluded. EXTRACTION: Study characteristics and results were extracted to a form developed by the authors and managed using NVivo 10 (QSR International's NVivo 10 software). Data were extracted by 1 reviewer, and a sample (25%) was checked by a second reviewer. SYNTHESIS: Data were synthesized using a thematic network and managed using NVivo 10. The validity of the included studies was assessed using the "Critical Appraisal Skills Programme (2018)" checklist. The ENTREQ and PRISMA statement was followed when reporting this qualitative synthesis. RESULTS: Of the 1818 studies identified in the search strategy, 24 met the inclusion criteria and were included in the analysis. Global themes were identified using a thematic network. These themes were "Gender Bias in Sport," "Motivation and Perceived Competence," "Competing Priorities during Adolescence," and "Meeting Societal Expectations." CONCLUSIONS: The results of this review provide insights into adolescent girls' views on physical activity. Future research is needed to investigate the potential impact of alternative activity programs on adolescent girls with appropriate follow-up. Researchers and individuals working with young girls must consider the role of perceived motor competence in participation and how this can impact their perceptions.

Effect of Active Lessons on Physical Activity, Academic, and Health Outcomes: A Systematic Review.

PURPOSE: The purpose of this study was to conduct a systematic review of classroom-based physical activity interventions that integrate academic content and assess the effectiveness of the interventions on physical activity, learning, facilitators of learning, and health outcomes. METHOD: Six electronic databases (ERIC, PubMed, Google Scholar, Science Direct, Cochrane Library, and EMBASE) and reference lists were searched for English-language articles, published January 1990 through March 2015, reporting classroom-based interventions that deliberately taught academic content using physically active teaching methods for at least 1 week duration, with physical activity, health, learning, or facilitators-of-learning outcomes. Two authors reviewed full-text articles. Data were extracted onto an Excel spreadsheet, and authors were contacted to confirm accuracy of the information presented. RESULTS: Fifteen studies met the inclusion criteria. Six studies reporting on physical activity levels were found to have medium-to-large effect sizes. All 4 studies reporting learning outcomes showed positive effects of intervention lessons. Teachers and students were pleased with the programs, and enhanced on-task behavior was identified (n = 3). Positive effects were also reported on students' body mass index levels (n = 3). CONCLUSIONS: Physically active academic lessons increase physical activity levels and may benefit learning and health outcomes. Both students and teachers positively received and enjoyed these teaching methods. These findings emphasize the need for such interventions to contribute toward public health policy.

Involvement of Fathers in Pediatric Obesity Treatment and Prevention Trials: A Systematic Review.

CONTEXT: Despite their important influence on child health, it is assumed that fathers are less likely than mothers to participate in pediatric obesity treatment and prevention research. OBJECTIVE: This review investigated the involvement of fathers in obesity treatment and prevention programs targeting children and adolescents (0-18 years). DATA SOURCES: A systematic review of English, peer-reviewed articles across 7 databases. Retrieved records included at least 1 search term from 2 groups: "participants" (eg, child*, parent*) and "outcomes": (eg, obes*, diet*). STUDY SELECTION: Randomized controlled trials (RCTs) assessing behavioral interventions to prevent or treat obesity in pediatric samples were eligible. Parents must have "actively participated" in the study. DATA EXTRACTION: Two authors independently extracted data using a predefined template. RESULTS: The search retrieved 213 eligible RCTs. Of the RCTs that limited participation to 1 parent only (n = 80), fathers represented only 6% of parents. In RCTs in which participation was open to both parents (n = 133), 92% did not report objective data on father involvement. No study characteristics moderated the level of father involvement, with fathers underrepresented across all study types. Only 4 studies (2%) suggested that a lack of fathers was a possible limitation. Two studies (1%) reported explicit attempts to increase father involvement. LIMITATIONS: The review was limited to RCTs published in English peer-reviewed journals over a 10-year period. CONCLUSIONS: Existing pediatric obesity treatment or prevention programs with parent involvement have not engaged fathers. Innovative strategies are needed to make participation more accessible and engaging for fathers.