Objectively measured physical activity among treatment seeking children and adolescents with severe obesity and normal weight peers.

Background: Treatment seeking children and adolescents with severe obesity often experience barriers to physical activity. Studies objectively measuring physical activity in this group and investigating explanatory factors for physical activity levels could inform clinical practice. Objectives: This study aimed to compare objectively measured physical activity levels among treatment seeking children and adolescents with severe obesity and normal weight peers, and to investigate explanatory factors for time spent in moderate physical activity and vigorous physical activity among children and adolescents with severe obesity. Methods: Children with severe obesity (n = 85) were matched 1:1 by age, gender, and the season for accelerometer measurements with normal weight peers (n = 85). Children wore accelerometers for seven consecutive days, yielding measures of physical activity, sleep duration and timing. Parents reported on screen time, parental body mass index and participation in organized sports. Results: Children and adolescents with severe obesity spent significantly less time in moderate physical activity (12 min, p < 0.001) and vigorous physical activity (21 min, p < 0.001) per day compared to normal weight peers. No difference for time spent in sedentary activity was found between groups. For participants with severe obesity, age ≤12 years (p = 0.009) and participation in organized sports (p = 0.023) were related to more moderate physical activity, while age ≤12 years (p = 0.038) and early sleep timing (p = 0.019) were related to more vigorous physical activity. Conclusion: Children and adolescents with severe obesity were less physically active than their normal weight peers. Factors related to more moderate and vigorous physical activity in children with severe obesity were lower age, participation in organized sports and earlier sleep timing.

Family-based treatment of children with severe obesity in a public healthcare setting: Results from a randomized controlled trial.

To compare the effectiveness of family-based behavioural social facilitation treatment (FBSFT) versus treatment as usual (TAU) in children with severe obesity. Parallel-design, nonblinded, randomized controlled trial conducted at a Norwegian obesity outpatient clinic. Children aged 6-18 years referred to the clinic between 2014 and 2018 were invited to participate. Participants were randomly allocated using sequentially numbered, opaqued, sealed envelopes. FBSFT (n = 59) entailed 17 sessions of structured cognitive behavioural treatment, TAU (n = 55) entailed standard lifestyle counselling sessions every third month for 1 year. Primary outcomes included changes in body mass index standard deviation score (BMI SDS) and percentage above the International Obesity Task Force cut-off for overweight (%IOTF-25). Secondary outcomes included changes in sleep, physical activity, and eating behaviour. From pre- to posttreatment there was a statistically significant difference in change in both BMI SDS (0.19 units, 95% confidence interval [CI]: 0.10-0.28, p < .001) and %IOTF-25 (5.48%, 95%CI: 2.74-8.22, p < .001) between FBSFT and TAU groups. FBSFT participants achieved significant reductions in mean BMI SDS (0.16 units, (95%CI: -0.22 to -0.10, p < .001) and %IOTF-25 (6.53%, 95% CI: -8.45 to -4.60, p < .001), whereas in TAU nonsignificant changes were observed in BMI SDS (0.03 units, 95% CI: -0.03 to 0.09, p = .30) and %IOTF-25 (-1.04%, 95% CI: -2.99 to -0.90, p = .29). More FBSFT participants (31.5%) had clinically meaningful BMI SDS reductions of ≥0.25 from pre- to posttreatment than in TAU (13.0%, p = .021). Regarding secondary outcomes, only changes in sleep timing differed significantly between groups. FBSFT improved weight-related outcomes compared to TAU.

The SED-GIH: A Single-Item Question for Assessment of Stationary Behavior-A Study of Concurrent and Convergent Validity.

The unfavorable health consequences of prolonged time spent sedentary (stationary) make accurate assessment in the general population important. However, for many existing questionnaires, validity for identifying stationary time has not been shown or has shown low validity. This study aimed to assess the concurrent and convergent validity of the GIH stationary single-item question (SED-GIH). Data were obtained in 2013 and 2014 from two Swedish cohorts. A total of 711 men and women provided valid accelerometer data (Actigraph GT3X+) and were included for concurrent validity analyses. A total of 560 individuals answered three additional commonly used sedentary questions, and were included for convergent validity analysis. The SED-GIH displayed a significant correlation with total stationary time (rs = 0.48) and time in prolonged stationary time (rs = 0.44). The ROC analysis showed an AUC of 0.72 for identifying individuals with stationary time over 600 min/day. The SED-GIH correlated significantly with other previously used questions (r = 0.72-0.89). The SED-GIH single-item question showed a relatively high agreement with device-assessed stationary behavior and was able to identify individuals with high levels of stationary time. Thus, the SED-GIH may be used to assess total and prolonged stationary time. This has important implications, as simple assessment tools of this behavior are needed in public health practice and research.

Categorical answer modes provide superior validity to open answers when asking for level of physical activity: A cross-sectional study.

AIMS: Physical activity (PA) used as prevention and treatment of disease has created a need for effective tools for measuring patients' PA level. Our aim was therefore to assess the validity of two PA questions and their three associated answer modes. METHODS: Data on PA according to the PA questions and Actigraph GT3X+ accelerometers, aerobic fitness (VO(2)max), cardiovascular biomarkers, and self-rated general health were collected in 365 Swedish adults (21-66 years). The PA questions ask about weekly PA via categories (Categorical), an open-ended answer (Open), or specified day by day (Table). RESULTS: The Categorical mode, compared with the Open mode, correlated (Spearman's rho) significantly more strongly (p<0.05) with accelerometer PA (0.31 vs. 0.18) and VO(2)max (0.27 vs. 0.06), and the level of BMI (-0.20 vs. -0.02), waist circumference (-0.22 vs. -0.03), diastolic blood pressure (-0.16 vs. 0.08), glucose (-0.18 vs. 0.04), triglycerides (-0.31 vs. -0.07), and general health (0.35 vs. 0.19). The validity of the Categorical and Table modes were similar regarding VO(2)max and accelerometry, but the Categorical mode exhibited more significant and stronger correlations with cardiovascular biomarkers. The capacity of the PA questions to identify insufficiently physically active individuals ranged from 0.57 to 0.76 for sensitivity and from 0.47 to 0.79 for specificity. CONCLUSIONS: The Categorical mode exhibits the strongest validity and Open mode the weakest. The PA questions may be used on a population level, or as a tool for determining patents' appropriateness for treatment.

Effects of the Swedish physical activity on prescription model on health-related quality of life in overweight older adults: a randomised controlled trial.

BACKGROUND: The effects of physical activity on prescription (PAP) on health-related quality of life (HRQoL) in overweight adults are unclear. We therefore aimed to explore the effects of the Swedish PAP model on HRQoL in overweight older adults. METHODS: Participants were recruited from a cohort of men and women born between 1937 and 1938, and living in Stockholm County. Inclusion criteria were; insufficiently physically active, i.e. <30 min of at least moderate intensity physical activity (PA) per day; body mass index >25 kg/m(2); and waist circumference ≥102 cm (men) or ≥88 cm (women). Altogether, 101 individuals, aged 67 years, were randomly assigned to two parallel groups: intervention group (n = 47) receiving individualised PAP or control group (n = 54). The 36-item Short Form Health Survey (SF-36) was administered before and after the six months intervention. Main outcomes were the SF-36 physical component summary (PCS) and mental component summary (MCS) scores. Intention to treat analysis was utilised. Regression analysis was performed to assess whether changes in PA and body weight affected changes in HRQoL. RESULTS: At the six months follow-up, regarding the MCS score, the intervention group had improved significantly more (median: 4.4 [interquartile range (IQR): -2.4 to 23.3]) vs (median: 0.0 [IQR: -4.0 to 4.9]); p < 0.05) and a higher proportion of participants had attained relevant improvements (OR 2.43 (95% CI 1.00-5.88) p < 0.05) compared to the controls. A within group improvement in the PCS score (median: 3.8 [IQR: -1.9 to 19.5] p < 0.05) was found in the intervention group. Changes in PA and body weight had a small, but significant, mediating effect on the changes in HRQoL. CONCLUSIONS: PAP had a positive effect on HRQoL, measured by the SF-36 MCS, but no significant between group effect was seen on the PCS in overweight older adults. These effects were, to some extent, mediated by changes in PA and body weight. Our findings support clinical use of the Swedish PAP model. TRIAL REGISTRATION: ClinicalTrials.gov NCT02320760.