An updated systematic review of correlates of children's physical activity and sedentary time in early childhood education services.

BACKGROUND: Early childhood education services (ECE) continue to be a key setting to promote physical activity and limit sedentary behaviour. Thus, the aim of this study was to (1) provide an updated systematic review of correlates of physical activity and sedentary behaviour among children in ECE settings and (2) discuss changes in physical activity and sedentary behaviour correlates among children in ECEC settings over time. METHODS: A systematic search of eight databases identified 40 studies published between 2015 and 2023 that met the inclusion criteria. The variables were categorized into four domains (child, educator, physical environmental and organizational). Fifty-eight variables were identified. RESULTS: For data from 2015 to 2023, strong associations were identified in all domains (child, educator, physical environmental and organizational) for physical activity, yet no strong associations for sedentary behaviour were identified. Aggregated data (i.e., combining data from previous review and this review) showed strong associations with children's physical activity and age, motor coordination and sex (child), educator behaviour and presence (educator), presence and size of outdoor environments (physical environmental) and active opportunities and service quality (organizational). For sedentary behaviour, sex, outdoor environments and active opportunities were strongly associated in the combined data. CONCLUSION: The correlates of physical activity and sedentary behaviour in ECE settings continue to be multi-dimensional and span different domains. Variables such as educator behaviours and intentionality, provision of active opportunities, use of outdoor space and service quality should be the key focus area for improving physical activity and sedentary behaviour levels of young children.

Different tertiary interactions create the same important 3D features in a distinct flavivirus xrRNA.

During infection by a flavivirus (FV), cells accumulate noncoding subgenomic flavivirus RNAs (sfRNAs) that interfere with several antiviral pathways. These sfRNAs are formed by structured RNA elements in the 3' untranslated region (UTR) of the viral genomic RNA, which block the progression of host cell exoribonucleases that have targeted the viral RNA. Previous work on these exoribonuclease-resistant RNAs (xrRNAs) from mosquito-borne FVs revealed a specific three-dimensional fold with a unique topology in which a ring-like structure protectively encircles the 5' end of the xrRNA. Conserved nucleotides make specific tertiary interactions that support this fold. Examination of more divergent FVs reveals differences in their 3' UTR sequences, raising the question of whether they contain xrRNAs and if so, how they fold. To answer this, we demonstrated the presence of an authentic xrRNA in the 3' UTR of the Tamana bat virus (TABV) and solved its structure by X-ray crystallography. The structure reveals conserved features from previously characterized xrRNAs, but in the TABV version these features are created through a novel set of tertiary interactions not previously seen in xrRNAs. This includes two important A-C interactions, four distinct backbone kinks, several ordered Mg2+ ions, and a C+-G-C base triple. The discovery that the same overall architecture can be achieved by very different sequences and interactions in distantly related flaviviruses provides insight into the diversity of this type of RNA and will inform searches for undiscovered xrRNAs in viruses and beyond.

Healthy kids vids: Development and acceptability of narrative healthy lifestyle videos and text messages for parents of young children from socioeconomically disadvantaged populations.

ISSUE ADDRESSED: Dietary intake and physical activity behaviours of many Australian children are not meeting recommendations, particularly for those living in socioeconomically disadvantaged circumstances. This study aimed to design and assess the feasibility and acceptability of a suite of narrative videos and text messages focused on healthy eating and physical activity behaviours appropriate for parents of young children from socioeconomically disadvantaged backgrounds. METHODS: Parents of 1-5-year-old children (n = 6) were recruited to develop a suite of 12 narrative videos on healthy eating and physical activity behaviours, underpinned by theory. Twelve complementary text messages were subsequently developed. A different group of parents (n = 16) recruited from socioeconomically disadvantaged areas reviewed the videos and text messages over 6 weeks and provided feedback via surveys and qualitative interviews (n = 13). RESULTS: There was a high level of engagement with and acceptability of the videos and text message content. Participants found the videos easy to access and they liked the narrative style. Screen time videos and text messages relating to screen time, play and physical activity, role modelling and fussy eating were most useful. CONCLUSIONS: Narrative style healthy eating, physical activity and screen time videos and complementary text messages were highly acceptable to the sample of parents of 1-5-year-old children from socioeconomically disadvantaged areas recruited from the Illawarra Shoalhaven region of NSW, Australia. SO WHAT?: Short narrative style videos and text messages are an easy to process and acceptable method of delivering healthy lifestyle promotion content to parents.

A collaborative approach to adopting/adapting guidelines. The Australian 24-hour movement guidelines for children (5-12 years) and young people (13-17 years): An integration of physical activity, sedentary behaviour, and sleep.

BACKGROUND: In 2018, the Australian Government updated the Australian Physical Activity and Sedentary Behaviour Guidelines for Children and Young People. A requirement of this update was the incorporation of a 24-hour approach to movement, recognising the importance of adequate sleep. The purpose of this paper was to describe how the updated Australian 24-Hour Movement Guidelines for Children and Young People (5 to 17 years): an integration of physical activity, sedentary behaviour and sleep were developed and the outcomes from this process. METHODS: The GRADE-ADOLOPMENT approach was used to develop the guidelines. A Leadership Group was formed, who identified existing credible guidelines. The Canadian 24-Hour Movement Guidelines for Children and Youth best met the criteria established by the Leadership Group. These guidelines were evaluated based on the evidence in the GRADE tables, summaries of findings tables and recommendations from the Canadian Guidelines. We conducted updates to each of the Canadian systematic reviews. A Guideline Development Group reviewed, separately and in combination, the evidence for each behaviour. A choice was then made to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. We then conducted an online survey (n=237) along with three focus groups (n=11 in total) and 13 key informant interviews. Stakeholders used these to provide feedback on the draft guidelines. RESULTS: Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Guideline Development Group agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, maintain the wording of the guidelines, preamble, and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-hours), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for children (5-12 years) and young people (13-17 years). CONCLUSIONS: To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used to develop movement behaviour guidelines. The judgments of the Australian Guideline Development Group did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian Guidelines were adopted with only very minor alterations. This allowed the Australian Guidelines to be developed in a shorter time frame and at a lower cost. We recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines that was developed using the GRADE approach is available with all supporting materials. Other countries may consider this approach when developing and/or revising national movement guidelines.

Telephone and Web-Based Delivery of Healthy Eating and Active Living Interventions for Parents of Children Aged 2 to 6 Years: Mixed Methods Process Evaluation of the Time for Healthy Habits Translation Trial.

BACKGROUND: Few translational trials have provided detailed reports of process evaluation results. OBJECTIVE: This study reported on findings from a mixed methods process evaluation of a large translational trial comparing 2 remotely delivered healthy eating and active living interventions with an active control, targeting parents of young children. METHODS: Mixed methods process evaluation data were collected as part of a 3-arm, partially randomized preference trial targeting parents of children aged 2 to 6 years from New South Wales, Australia. Recruitment strategies were assessed through the participant baseline questionnaire and a questionnaire completed by the health promotion staff involved in recruitment. Data on participants' intervention preferences were collected at baseline and after the intervention. Intervention acceptability and demographic data were collected via a postintervention questionnaire (approximately 3 months after baseline), which was supplemented by qualitative participant interviews. Implementation data on intervention fidelity and withdrawal were also recorded. Differences in intervention acceptability, fidelity, and withdrawal rates between telephone and web-based interventions and between randomized and nonrandomized participants were analyzed. The significance level was set at P<.05 for all tests. The interview content was analyzed, key themes were drawn from participant responses, and findings were described narratively. RESULTS: Data were collected from 458 participants in the baseline survey and 144 (31.4%) participants in the 3-month postintervention survey. A total of 30 participants completed the qualitative interviews. A total of 6 health promotion staff members participated in the survey on recruitment strategies. Most participants were recruited from Early Childhood Education and Care services. There was a broad reach of the study; however, better take-up rates were observed in regional and rural areas compared with metropolitan areas. Parents with a university education were overrepresented. Most participants preferred the web-based medium of delivery at baseline. There was high acceptability of the web-based and telephone interventions. Participants found the healthy eating content to be the most useful component of the modules (web-based) and calls (telephone). They regarded text (web-based) or verbal (telephone) information as the most useful component. A high proportion of participants completed the telephone intervention compared with the web-based intervention; however, more participants actively withdrew from the telephone intervention. CONCLUSIONS: This is one of the first studies to comprehensively report on process evaluation data from a translation trial, which demonstrated high acceptability of all interventions but a strong participant preference for the web-based intervention. This detailed process evaluation is critical to inform further implementation and be considered alongside the effectiveness outcomes.

Sleep and BMI in South African urban and rural, high and low-income preschool children.

BACKGROUND: The extent to which income setting or rural and urban environments modify the association between sleep and obesity in young children is unclear. The aims of this cross-sectional observational study were to (i) describe and compare sleep in South African preschool children from rural low-income (RL), urban low-income (UL) and urban high-income (UH) settings; and (ii) test for associations between sleep parameters and body mass index (BMI). METHODS: Participants were preschoolers (5.2 ± 0.7y, 49.5% boys) from RL (n = 111), UL (n = 65) and UH (n = 22) settings. Height and weight were measured. Sleep, sedentary behaviour and physical activity were assessed using accelerometery. RESULTS: UL children had higher BMI z-scores (median: 0.39; interquartile range: - 0.27, 0.99) than the UH (- 0.38; - 0.88, 0.11) and RL (- 0.08; - 0.83, 0.53) children (p = 0.001). The UL children had later bedtimes (p < 0.001) and wake-up times (p < 0.001) and shorter 24 h (p < 0.001) and nocturnal (p < 0.001) sleep durations than the RL and UH children. After adjusting for age, sex, setting, SB and PA, for every hour less sleep obtained (24 h and nocturnal), children were 2.28 (95% CI: 1.28-4.35) and 2.22 (95% CI: 1.27-3.85) more likely, respectively, to belong to a higher BMI z-score quartile. CONCLUSIONS: Shorter sleep is associated with a higher BMI z-score in South African preschoolers, despite high levels of PA, with UL children appearing to be particularly vulnerable.

Relationships Between the Home Learning Environment, Weight Status, and Dietary Intake: Results From a Cross-Sectional Study of Preschool-Aged Children in New South Wales, Australia.

The home learning environment is a potential correlate of childhood obesity and obesity-related factors. We examined relationships between the home learning environment and weight status and the home learning environment and dietary intake, in a sample of 303 preschool-aged children from Australia. We measured their height and weight, and their parents completed a questionnaire that included questions related to demographics, dietary intake, and the home learning environment. Parents reported their children's usual consumption of foods from each food group, the frequency of their discretionary food intake, and the frequency of home activities that might support cognitive stimulation. We analysed relationships using regression, adjusting for parents' education level, and household income. We found no significant associations between the home learning environment and BMI or weight category. We found a significant inverse relationship between the overall home learning environment and discretionary food intake scores, but when stratified by income, this result was significant for children from lower-income families only. Regarding specific elements of the home learning environment, we found significant inverse relationships between discretionary food intake and both reading to children, and teaching them the alphabet. While reading was significant across all income levels, teaching the alphabet was only significant in children from higher-income families. We also found significant inverse relationships between discretionary food intake and: visiting a library, teaching numbers or counting, and teaching songs, poems and nursery rhymes in lower-income families only. There was no association between the home learning environment and meeting individual dietary guidelines. This area requires further research to explore broader home environment factors that may influence these relationships. We also suggest that interventions explore the use of strategies to improve the home learning environment to determine its efficacy in improving healthy eating behaviors.

'Jump start' childcare-based intervention to promote physical activity in pre-schoolers: six-month findings from a cluster randomised trial.

BACKGROUND: Participation in adequate levels of physical activity during the early years is important for health and development. We report the 6-month effects of an 18-month multicomponent intervention on physical activity in early childhood education and care (ECEC) settings in low-income communities. METHODS: A cluster randomised controlled trial was conducted in 43 ECEC settings in disadvantaged areas of New South Wales, Australia. Three-year-old children were recruited and assessed in the first half of 2015 with follow-up 6 months later. The intervention was guided by Social Cognitive Theory and included five components. The primary outcome was minutes per hour in total physical activity during ECEC hours measured using Actigraph accelerometers. Intention-to-treat analysis of the primary outcome was conducted using a generalized linear mixed model. RESULTS: A total of 658 children were assessed at baseline. Of these, 558 (85%) had valid accelerometer data (mean age 3.38y, 52% boys) and 508 (77%) had valid accelerometry data at 6-month follow-up. Implementation of the intervention components ranged from 38 to 72%. There were no significant intervention effects on mins/hr. spent in physical activity (adjusted difference = - 0.17 mins/hr., 95% CI (- 1.30 to 0.97), p = 0.78). A priori sub-group analyses showed a greater effect among overweight/obese children in the control group compared with the intervention group for mins/hr. of physical activity (2.35mins/hr., [0.28 to 4.43], p = 0.036). CONCLUSIONS: After six-months the Jump Start intervention had no effect on physical activity levels during ECEC. This was largely due to low levels of implementation. Increasing fidelity may result in higher levels of physical activity when outcomes are assessed at 18-months. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12614000597695.

Translation of two healthy eating and active living support programs for parents of 2-6 year old children: a parallel partially randomised preference trial protocol (the 'time for healthy habits' trial).

BACKGROUND: Parents are key decision makers and role models in establishing and maintaining healthy behaviours in their children. Interventions involving parents have been shown to be more effective than those that do not, but there are barriers to participation. Efficacy trials have previously been conducted on two such parent-focussed healthy eating and active living interventions with the potential to overcome these barriers - Healthy Habits (telephone-based) and Time2bHealthy (online) with promising results. Further research is now required to determine the effectiveness of these interventions in a real-world context. The Time for Healthy Habits study is a 3-arm partially randomised preference trial which aims to evaluate the effectiveness and cost-effectiveness of two theory-based programs to promote healthy eating and appropriate levels of movement behaviours (physical activity, sedentary behaviour and sleep) for parents of 2- to 6-year-old children (Healthy Habits Plus telephone-based program and Time2bHealthy online program), when compared to a comparison group receiving written materials. METHODS: Participants will be recruited across five Local Health Districts in New South Wales, Australia. The partially randomised preference design initially allows for participants to decide if they wish to be randomised or opt to select their preferred intervention and has been recommended for use to test effectiveness in a real-world setting. Both interventions incorporate multiple behaviour change techniques and support parents to improve their children's healthy eating, and movement behaviours (physical activity, sedentary behaviour and sleep) and run for 12 weeks, followed by a 3-month and 9-month post-baseline follow-up. Participants will also be asked to complete a process evaluation questionnaire at the completion of the intervention (3-months post-baseline). Outcomes include fruit and vegetable intake (primary outcome), non-core food intake, weight status, physical activity, sedentary behaviour, and sleep habits. DISCUSSION: To our knowledge, this is the first translational research trial evaluating the effectiveness and cost-effectiveness of a healthy eating and active living intervention in the 2- to 6-years age group. The results will build the evidence base in regard to translation of effective childhood obesity prevention interventions and inform the implementation and delivery of community based childhood obesity prevention programs. TRIAL REGISTRATION: UTN: U1111-1228-9748, ACTRN: 12619000396123p.

Prevalence and risk factors of gross motor delay in pre-schoolers.

AIM: Gross motor skills are important for children's health and development. Delays in these skills are a concern for healthy developmental trajectories and therefore early identification of delay is important. This study screened for gross motor delay in children from low-income communities and investigated potential risk factors associated with gross motor delay. METHODS: This cross-sectional study involved 701 pre-schoolers (Mage = 54.1 ± 8.6 months, 52.8% boys) from childcare services in low-income and remote communities in Australia. Gross motor delay was assessed using the Ages and Stages Questionnaire - third edition. Potential risk factors included: sex, age, birthweight, prematurity status, weight status, childcare service, postcode, parent's education, parent's marital status, parent's employment and family income. RESULTS: Results showed 4.4% of the children were delayed in gross motor skills and 8.8% were at risk of delay. Logistic regression showed being a boy (odds ratio (OR) 1.78, 95% confidence interval (CI) 1.12-2.84), underweight (OR 2.72, 95% CI 1.18-6.30) or overweight (OR 1.83, 95% CI 1.00-3.33), and parental unemployment (OR 1.79, 95% CI 1.01-3.16) were factors associated with a higher odds of children being delayed or at risk of gross motor delay. A higher family income (OR 0.35, 95% CI 0.13-0.93) was associated with lower odds of delay. CONCLUSION: This unique study demonstrated children in low-income communities, especially boys, underweight and overweight children, have higher odds of being at risk of gross motor delay. Therefore, early screening is vital in this population in order to identify delays and potentially intervene with appropriate motor skill interventions.

Can Parental Engagement in Social Media Enhance Outcomes of an Online Healthy Lifestyle Program for Preschool-Aged Children?

This study explored parental engagement, child BMI and secondary outcomes from the social media component of an online healthy lifestyle program for parents of preschool-aged children. Intervention group participants received access to an online program and Facebook group. Data were collected at baseline and 3- and 6-months follow-up. Facebook usage data on comments and posts were used to determine total active engagement. There was a high level of Facebook group membership and most parents actively engaged at least once. Although there were varying levels of engagement between modules and cohorts, it was modest overall. User acceptability of the Facebook group was lower than expected. Children of parents in the intervention who engaged more in the Facebook group (by posting and commenting) demonstrated greater sleep duration over time (estimate 1.79, 95% CI 0.42 to 3.17, p = .01) Children of parents who engaged more in the Facebook group also participated in less moderate- to vigorous-intensity physical activity (estimate -0.14, 95% CI -0.26 to -0.01, p = .03). This study is one of the first parent-focussed healthy lifestyle interventions to include a social media component. Further research is recommended with larger sample sizes and longer duration to further explore the potential of social media in childhood obesity interventions.

Objectively Measured Physical Activity in South African Children Attending Preschool and Grade R: Volume, Patterns, and Meeting Guidelines.

PURPOSE: To assess physical activity (PA) and determine the proportion of preschoolers meeting PA recommendations in different income settings in South Africa. METHODS: Preschoolers from urban high-income (UH), urban low-income (UL), and rural low-income (RL) settings wore an ActiGraph GT3X+ accelerometer for 7 days. PA variables of interest included volume moderate- to vigorous-intensity PA (MVPA) and total PA (light- to vigorous-intensity PA), hourly PA patterns, and percentage of children meeting guidelines (180 min/d of total PA, inclusive of 60 min/d of MVPA). Between-sex differences were assessed using t tests and Mann-Whitney U tests; between-setting differences assessed using 1-way analyses of variance and Kruskal-Wallis tests. RESULTS: For all children (n = 229, aged 5.17 [0.69] y), average MVPA was 124.4 (37.5) minutes per day and total PA was 457.0 (61.1) minutes per day; 96.9% of children met guidelines. Boys did significantly more MVPA than girls (136.7 [39.37] vs 111.5 [30.70] min/d, P < .001), and UH preschoolers were significantly less active than UL and RL preschoolers (UH 409.1 [48.4] vs UL 471.1 [55.6] and RL 461.6 [61.4], P < .001). CONCLUSION: In both practice and research, it is necessary to explore ways to ensure that South African preschoolers from all income settings continue to engage in and benefit from healthy volumes of PA. This is especially important as preschoolers transition to a formal school environment.

Cross-sectional associations of physical activity and gross motor proficiency with adiposity in South African children of pre-school age.

OBJECTIVE: The study aimed to investigate the relationship between physical activity, gross motor skills and adiposity in South African children of pre-school age. DESIGN: Cross-sectional study. SETTING: High-income urban, and low-income urban and rural settings in South Africa. PARTICIPANTS: Children (3-6 years old, n 268) were recruited from urban high-income (n 46), urban low-income (n 91) and rural low-income (n 122) settings. Height and weight were measured to calculate the main outcome variables: BMI and BMI-for-age Z-score (BAZ). Height-for-age and weight-for-age Z-scores were also calculated. Actigraph GT3X+ accelerometers were used to objectively measure physical activity; the Test of Gross Motor Development (Version 2) was used to assess gross motor skills. RESULTS: More children were overweight/obese and had a higher BAZ from urban low-income settings compared with urban high-income settings and rural low-income settings. Being less physically active was associated with thinness, but not overweight/obesity. Time spent in physical activity at moderate and vigorous intensities was positively associated with BMI and BAZ. Gross motor proficiency was not associated with adiposity in this sample. CONCLUSIONS: The findings of this research highlight the need for obesity prevention particularly in urban low-income settings, as well as the need to take into consideration the complexity of the relationship between adiposity, physical activity and gross motor skills in South African pre-school children.

Structural characterization of acyl-CoA oxidases reveals a direct link between pheromone biosynthesis and metabolic state in Caenorhabditis elegans.

Caenorhabditis elegans secretes ascarosides as pheromones to communicate with other worms and to coordinate the development and behavior of the population. Peroxisomal ß-oxidation cycles shorten the side chains of ascaroside precursors to produce the short-chain ascaroside pheromones. Acyl-CoA oxidases, which catalyze the first step in these ß-oxidation cycles, have different side chain-length specificities and enable C. elegans to regulate the production of specific ascaroside pheromones. Here, we determine the crystal structure of the acyl-CoA oxidase 1 (ACOX-1) homodimer and the ACOX-2 homodimer bound to its substrate. Our results provide a molecular basis for the substrate specificities of the acyl-CoA oxidases and reveal why some of these enzymes have a very broad substrate range, whereas others are quite specific. Our results also enable predictions to be made for the roles of uncharacterized acyl-CoA oxidases in C. elegans and in other nematode species. Remarkably, we show that most of the C. elegans acyl-CoA oxidases that participate in ascaroside biosynthesis contain a conserved ATP-binding pocket that lies at the dimer interface, and we identify key residues in this binding pocket. ATP binding induces a structural change that is associated with tighter binding of the FAD cofactor. Mutations that disrupt ATP binding reduce FAD binding and reduce enzyme activity. Thus, ATP may serve as a regulator of acyl-CoA oxidase activity, thereby directly linking ascaroside biosynthesis to ATP concentration and metabolic state.

An Internet-Based Childhood Obesity Prevention Program (Time2bHealthy) for Parents of Preschool-Aged Children: Randomized Controlled Trial.

BACKGROUND: Electronic health (eHealth) obesity programs offer benefits to traditionally delivered programs and have shown promise in improving obesity-related behaviors in children. OBJECTIVE: This study aimed to assess the efficacy of a parent-focused, internet-based healthy lifestyle program for preschool-aged children, who are overweight or at or above the fiftieth percentile for body mass index (BMI) for their age and sex, on child BMI, obesity-related behaviors, parent modeling, and parent self-efficacy. METHODS: The Time2bHealthy randomized controlled trial was conducted in Australia, during 2016 to 2017. Participants were recruited both online and through more traditional means within the community. Parent or carer, and child (aged 2-5 years) dyads were randomized into an intervention or comparison group. Intervention participants received an 11-week internet-based healthy lifestyle program, underpinned by social cognitive theory, followed by fortnightly emails for 3 months thereafter. Intervention participants set goals and received individual feedback from a dietitian. They were also encouraged to access and contribute to a closed Facebook group to communicate with other participants and the dietitian. Comparison participants received email communication only. Objectively measured child BMI was the primary outcome. Secondary outcomes included objectively measured physical activity, parent-measured and objectively measured sleep habits, and parent-reported dietary intake, screen time, child feeding, parent modeling, and parent self-efficacy. All data were collected at face-to-face appointments at baseline, 3 months, and 6 months by blinded data collectors. Randomization was conducted using a computerized random number generator post baseline data collection. RESULTS: A total of 86 dyads were recruited, with 42 randomized to the intervention group and 44 to the comparison group. Moreover, 78 dyads attended the 3- and 6-month follow-ups, with 7 lost to follow-up and 1 withdrawing. Mean child age was 3.46 years and 91% (78/86) were in the healthy weight range. Overall, 69% (29/42) of participants completed at least 5 of the 6 modules. Intention-to-treat analyses found no significant outcomes for change in BMI between groups. Compared with children in the comparison group, those in the intervention group showed a reduced frequency of discretionary food intake (estimate -1.36, 95% CI -2.27 to -0.45; P=.004), and parents showed improvement in child feeding pressure to eat practices (-0.30, 95% CI 0.06 to -0.00; P=.048) and nutrition self-efficacy (0.43, 95% CI 0.10 to 0.76; P=.01). No significant time by group interaction was found for other outcomes. CONCLUSIONS: The trial demonstrated that a parent-focused eHealth childhood obesity prevention program can provide support to improve dietary-related practices and self-efficacy but was not successful in reducing BMI. The target sample size was not achieved, which would have affected statistical power. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ANZCTR12616000119493; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370030 (Archived by WebCite at http://www.webcitation.org/74Se4S7ZZ).

Physical activity in early childhood education and care settings in a low-income, rural South African community: an observational study.

INTRODUCTION: Research has not been conducted on physical activity in early child education and care (ECEC) settings in low-income, rural communities in South Africa. This study aimed to describe the physical activity environment of these settings and identify child and contextual factors associated with physical activity in these settings. By understanding physical activity in this environment, it will be possible to identify context-specific opportunities, including with teachers, to overcome potential challenges and maximise physical activity in a low- and middle-income country setting. METHODS: The study was conducted in rural Bushbuckridge, Mpumalanga in 2014. Preschool-aged children (n=55) were recruited from five ECEC settings, including three preschools and two primary schools, where preschool-aged children are in their reception year, grade R. Preschool environment characteristics were assessed using an observational tool adapted from existing tools. Children's physical activity was assessed using the Observational System for Recording Physical Activity in Children - Preschool Version. Differences between preschool and grade R settings were assessed using χ2 analyses, and multinomial logistic regression analysis was used to determine factors associated with physical activity in the ECEC settings. RESULTS: The physical activity environment differed between preschool and grade R ECEC settings in terms of space (preschoolpgrade R, p<0.001). On average, children spent 28.7% of their day in the ECEC settings engaged in physical activity, of which 22.3% was moderate- to vigorous-intensity physical activity (MVPA). Children spent the greatest proportion of the day in sedentary activities (69.9%) and this differed significantly between preschool (63.2%) and grade R children (81.3%, p<0.001). Preschool children were significantly more active than grade R children, and spent greater proportions of time in light-intensity physical activity (8.6% v 2.7%, p<0.001) and MVPA (25.4% v 15.3%, p<0.001). Irrespective of ECEC setting, children were significantly more likely to participate in MVPA if they were outdoors (p=0.001), and significantly less likely to do MVPA if they were overweight/obese (p=0.006). CONCLUSION: These findings provide insight into child-level and contextual factors associated with preschool-aged children's physical activity within ECEC settings in a low-income, rural community in South Africa. Particularly, the physical and social features of ECEC settings are important in the promotion of physical activity. Findings from this study suggest that it is necessary to upskill and encourage teachers in ECEC settings to maximise opportunities for physical activity in rural low-income communities in South Africa.

Goal setting for weight-related behavior change in children: An exploratory study.

BACKGROUND: There is an absence of studies exploring different goal-setting appraches and none which have examined the use of proxy goal-setting by parents for their children. AIM: To explore how proficient parents are in setting health behaviour goals for their children according to SMART (specific, measurable, achievable, realistic and time-framed) goal principles. A secondary aim was to examine associations between goal setting and change in health behaviors. METHODS: Participants were parents and children taking part in one of two trials incorporating goal setting. Study 1 ( Time2bHealthy) was an online program for parents of preschoolers ( n = 36) and Study 2 ( HIKCUPS) was a three-arm face-to-face trial examining a parent-centered dietary intervention, (Study2Diet); a child-centered physical activity intervention, (Study2PA); or combination of both (Study2Combo) ( n = 83). Goals were coded on five 'SMART' principles. Goals were scored 1 or 0 for each principle (1 indicated the principle was met and 0, not met). The total maximum score for each goal was 5. Mean total goal-score and means for each SMART principle were calculated. RESULTS: Mean (and standard deviation) goal setting scores for Study 1 were 3.84 (0.61), Study2Diet 2.17 (1.33), Study2PA 3.18 (1.45) and Study2Combo 2.24 (1.30). Goal-scores were significantly higher for Study 1 than Study 2 ( p < 0.001). In Study2Diet, goal setting was significantly associated with greater reduction in energy intake ( p = 0.019). CONCLUSIONS: Goal-scores were highest in Study 1, which used a supported online format for setting goals. Parents were better at setting physical activity goals, but these goals did not translate into improvements in physical activity behavior. Goals set by parents may be useful in energy intake reduction, however further research is required to determine benefits for weight status or physical activity.

A collaborative approach to adopting/adapting guidelines - The Australian 24-Hour Movement Guidelines for the early years (Birth to 5 years): an integration of physical activity, sedentary behavior, and sleep.

BACKGROUND: In 2017, the Australian Government funded the update of the National Physical Activity Recommendations for Children 0-5 years, with the intention that they be an integration of movement behaviours across the 24-h period. The benefit for Australia was that it could leverage research in Canada in the development of their 24-h guidelines for the early years. Concurrently, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group published a model to produce guidelines based on adoption, adaption and/or de novo development using the GRADE evidence-to-decision framework. Referred to as the GRADE-ADOLOPMENT approach, it allows guideline developers to follow a structured and transparent process in a more efficient manner, potentially avoiding the need to unnecessarily repeat costly tasks such as conducting systematic reviews. The purpose of this paper is to outline the process and outcomes for adapting the Canadian 24-Hour Movement Guidelines for the Early Years to develop the Australian 24-Hour Movement Guidelines for the Early Years guided by the GRADE-ADOLOPMENT framework. METHODS: The development process was guided by the GRADE-ADOLOPMENT approach. A Leadership Group and Consensus Panel were formed and existing credible guidelines identified. The draft Canadian 24-h integrated movement guidelines for the early years best met the criteria established by the Panel. These were evaluated based on the evidence in the GRADE tables, summaries of findings tables and draft recommendations from the Canadian Draft Guidelines. Updates to each of the Canadian systematic reviews were conducted and the Consensus Panel reviewed the evidence for each behaviour separately and made a decision to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. An online survey was then conducted (n = 302) along with five focus groups (n = 30) and five key informant interviews (n = 5) to obtain feedback from stakeholders on the draft guidelines. RESULTS: Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Consensus Panel agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, keep the wording of the guidelines, preamble and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-h), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for infants (<1 year), toddlers (1-2 years) and preschoolers (3-5 years). CONCLUSIONS: To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used. Following this approach, the judgments of the Australian Consensus Panel did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian recommendations were adopted with very minor alterations. This allowed the Guidelines to be developed much faster and at lower cost. As such, we would recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines, with all supporting materials and developed using a transparent process, is available. Other countries may consider using this approach when developing and/or revising national movement guidelines.

Correlates of children's objectively measured physical activity and sedentary behavior in early childhood education and care services: A systematic review.

OBJECTIVE: To systematically review the correlates of physical activity and sedentary behavior among children in Early Childhood Education and Care (ECEC) services. Appropriate levels of physical activity and sedentary behavior are important to promote in ECEC services. METHODS: A systematic search of 8 databases identified 27 studies published between 1992 and 2015 that met the inclusion criteria. The data were collected and analyzed in 2014 and 2015, and variables were categorized using a Social Ecological Framework. RESULTS: Sixty-six variables were identified. The domains of child characteristics (18 studies) and physical environmental factors (17 studies) were most consistently studied, and, for physical activity had the most positive associations. The strongest associations of physical activity were: child's sex and age, children's gross motor coordination, provision of active opportunities for physical activity, and features of outdoor environments (size, use of and presence). The only strong association for sedentary behavior was the presence of outdoor environments. CONCLUSION: The correlates of physical activity and sedentary behavior in ECEC services vary. It appears that the most significant influence from within these settings is the physical environments for both physical activity and sedentary behavior. There was an absence of consistent evidence at the educator and organizational levels. Further research in this area should focus on effective use of space, intentional teaching opportunities and well as professional development for educators with an emphasis on their role as a facilitator of quality experiences. This review has been registered with Prospero, #CRD42014013660.

"Just because you're pregnant, doesn't mean you're sick!" A qualitative study of beliefs regarding physical activity in black South African women.

BACKGROUND: Despite the benefits of physical activity during pregnancy, the physiological and psychological changes that occur during this unique period may put women at greater risk of being sedentary. Lifestyle and environmental transitions have left black South African women at increased risk of physical inactivity and associated health risks. Therefore, the aim of this qualitative study was to describe the beliefs regarding physical activity during pregnancy in an urban African population. METHODS: Semi-structured interviews (n = 13) were conducted with pregnant black African women during their third trimester. Deductive thematic analysis was completed based on the Theory of Planned Behaviour. Coding and analysis was completed with the assistance of ATLAS.ti software. RESULTS: Participants had a mean age of 28 (19-41) years, and a mean BMI of 30 (19.6-39.0) kg/m(2). Although the majority of women believed that physical activity was beneficial, this did not appear to translate into behaviour. Reported reasons for this included barriers such as pregnancy-related discomforts, lack of time, money and physical activity related education, all of which can contribute to a reduced perceived control to become active. Opportunities to participate in group exercise classes was a commonly reported facilitator for becoming active. In addition, influential role players, such as family, friends and healthcare providers, as well as cultural beliefs, reportedly provided the women with vague, conflicting and often discouraging advice about physical activity during pregnancy. CONCLUSIONS: This study provides new theoretical insight on the beliefs of urban South African pregnant women regarding physical activity. Findings from this study suggest a holistic approach to improve physical activity compliance during pregnancy, inclusive of physical activity education and exercise opportunities within a community setting. This study presents critical formative work upon which contextually and culturally sensitive interventions can be developed.