Developmental trends in young children's device-measured physical activity and sedentary behaviour.

BACKGROUND: Knowledge of developmental trends in meeting age-specific 24-hour movement behaviour guidelines is lacking. This study describes developmental trends in device-measured physical activity and sedentary time over a three-year period among Western Australian children aged two to seven years, including differences between boys and girls. The proportion of children meeting age-specific physical activity guidelines before and after they transition to full-time school was also examined. METHODS: Data from waves 1 and 2 of the Play Spaces and Environments for Children's Physical Activity (PLAYCE) cohort study were used (analysis n = 1217). Physical activity and sedentary time were measured by accelerometry at ages two to five (preschool, wave 1) and ages five to seven (commenced full-time school, wave 2). Accelerometer data were processed using a validated machine-learning physical activity classification model. Daily time spent in sedentary behaviour, energetic play (moderate-to-vigorous physical activity (MVPA)), total physical activity, and meeting physical activity guidelines were analysed using linear and generalised linear mixed-effects models with age by sex interaction terms. RESULTS: All movement behaviours changed significantly with increasing age, and trends were similar in boys and girls. Total daily physical activity increased from age two to five then declined to age seven. Mean daily total physical activity exceeded 180 min/day from ages two to five. Daily energetic play increased significantly from age two to seven, however, was below 60 min/day at all ages except for seven-year-old boys. Daily sedentary time decreased to age five then increased to age seven but remained lower than at age two. All two-year-olds met their age-specific physical activity guideline, decreasing to 5% of girls and 6% of boys at age four. At age seven, 46% of boys and 35% of girls met their age-specific physical activity guideline. CONCLUSIONS: Young children's energetic play and total physical activity increased with age, but few children aged three to seven met the energetic play (MVPA) guideline. Interventions should focus on increasing children's energetic play in early childhood. Clearer guidance and strategies are needed to support young children as they change developmentally and as they transition from one age-specific movement guideline to the next.

Comparing Cadence vs. Machine Learning Based Physical Activity Intensity Classifications: Variations in the Associations of Physical Activity With Mortality.

Step cadence-based and machine-learning (ML) methods have been used to classify physical activity (PA) intensity in health-related research. This study examined the association of intensity-specific PA duration with all-cause (ACM) and CVD mortality using the cadence-based and ML methods in 68 561 UK Biobank participants wearing wrist-worn accelerometers. The two-stage-ML method categorized activity type and then intensity. The one-level-cadence-method (1LC) derived intensity-specific duration using all detected steps (including standing utilitarian steps) and cadence thresholds of ≥100 steps/min (moderate intensity) and ≥130 steps/min (vigorous intensity). The two-level-cadence-method (2LC) detected ambulatory steps (i.e., walking and running) and then applied the same cadence thresholds. The 2LC exhibited the most pronounced association at the lower end of duration spectrum. For example, the 2LC showed the smallest minimum moderate-to-vigorous-PA (MVPA) duration (amount associated with 50% of optimal risk reduction) with similar corresponding ACM hazard ratio (HR) to other methods (2LC: 2.8 min/day [95% CI: 2.6, 2.8], HR: 0.83 [95% CI: 0.78, 0.88]; 1LC, 11.1[10.8, 11.4], 0.80 [0.76, 0.85]; ML, 14.9 [14.6, 15.2], 0.82 [0.76, 0.87]). The ML elicited the greatest mortality risk reduction. For example, the medians and corresponding HR in VPA-ACM association: 2LC, 2.0 min/day [95% CI: 2.0, 2.0], HR, 0.69 [95% CI: 0.61, 0.79]; 1LC, 6.9 [6.9, 7.0], 0.68 [0.60, 0.77]; ML, 3.2 [3.2, 3.2], 0.53 [0.44, 0.64]. After standardizing durations, the ML exhibited the most pronounced associations. For example, the standardized minimum durations in MPA-CVD mortality association were: 2LC, -0.77; 1LC, -0.85; ML, -0.94; with corresponding HR of 0.82 [0.72, 0.92], 0.79 [0.69, 0.90], and 0.77 [0.69, 0.85], respectively. The 2LC exhibited the most pronounced association with all-cause and CVD mortality at the lower end of the duration spectrum. The ML method provided the most pronounced association with all-cause and CVD mortality, thus might be appropriate for estimating health benefits of moderate and vigorous intensity PA in observational studies.

Pooled Analysis of Physical Activity, Sedentary Behavior, and Sleep Among Children From 33 Countries.

Importance: The prevalence estimates of physical activity, sedentary behavior, and sleep (collectively known as movement behaviors) in 3- and 4-year-old children worldwide remains uncertain. Objective: To report the proportion of 3- and 4-year-old children who met the World Health Organization guidelines for physical activity, sedentary behavior, and sleep across 33 countries. Design, Setting, and Participants: Pooled analysis of data from 14 cross-sectional studies (July 2008 to September 2022) identified through systematic reviews and personal networks. Thirty-three countries of varying income levels across 6 geographical regions. Each study site needed to have at least 40 children aged 3.0 to 4.9 years with valid accelerometry and parent-/caregiver-reported screen time and sleep duration data. Data were analyzed from October 2022 to February 2023. Exposures: Time spent in physical activity was assessed by reanalyzing accelerometry data using a harmonized data-processing protocol. Screen time and sleep duration were proxy reported by parents or caregivers. Main Outcomes and Measures: The proportion of children who met the World Health Organization guidelines for physical activity (≥180 min/d of total physical activity and ≥60 min/d of moderate- to vigorous-intensity physical activity), screen time (≤1 h/d), and sleep duration (10-13 h/d) was estimated across countries and by World Bank income group and geographical region using meta-analysis. Results: Of the 7017 children (mean [SD] age, 4.1 [0.5] years; 3585 [51.1%] boys and 3432 [48.9%] girls) in this pooled analysis, 14.3% (95% CI, 9.7-20.7) met the overall guidelines for physical activity, screen time, and sleep duration. There was no clear pattern according to income group: the proportion meeting the guidelines was 16.6% (95% CI, 10.4-25.3) in low- and lower-middle-income countries, 11.9% (95% CI, 5.9-22.5) in upper-middle-income countries, and 14.4% (95% CI, 9.6-21.1) in high-income countries. The region with the highest proportion meeting the guidelines was Africa (23.9%; 95% CI, 11.6-43.0), while the lowest proportion was in North and South America (7.7%; 95% CI, 3.6-15.8). Conclusions and Relevance: Most 3- and 4-year-old children in this pooled analysis did not meet the current World Health Organization guidelines for physical activity, sedentary behavior, and sleep. Priority must be given to understanding factors that influence these behaviors in this age group and to implementing contextually appropriate programs and policies proven to be effective in promoting healthy levels of movement behaviors.

Population-referenced percentiles for total movement and energetic play at early childhood education and care.

OBJECTIVES: Childcare services such as preschools and long day care centres have been identified as a key setting to promote physical activity in early childhood as they provide access to large numbers of children for prolonged periods. Yet, specific standards for the type and amount of physical activity (PA) children accumulate whilst attending childcare are lacking. The purpose of this study was to derive population-referenced percentile values for children's total movement and energetic play whilst attending early childhood education and care services. DESIGN: We analysed accelerometer data collected in four Australian studies involving over 150 long day care services and 3893 accelerometer records from 1945 children to derive population-referenced percentile values for total movement and energetic play whilst attending formal early childhood education and care. METHODS: Accelerometer data were processed into time spent in total movement and energetic play using a random forest physical activity classification model. Total movement and energetic play estimates were transformed to a standard normal distribution and percentiles were calculated for a 4-, 6-, 8-, and 10-hour early childhood education and care day. RESULTS: On an average 8-hour early childhood education and care day (50th percentile), Australian pre-schoolers spend between 269 and 292 min, or 60 % of their day in movement. In contrast, Australian pre-schoolers only accumulate between 15 and 29 min of energetic play. CONCLUSIONS: The percentile reference values can be used to monitor young children's physical activity and energetic play levels whilst attending childcare. Educators can use the percentiles to assign norm-referenced ratings to identify children who could benefit from additional support for physical activity.

Reliability and validity of rapid assessment tools for measuring 24-hour movement behaviours in children aged 0-5 years: the Movement Behaviour Questionnaire Baby (MBQ-B) and child (MBQ-C).

BACKGROUND: The development of validated "fit-for-purpose" rapid assessment tools to measure 24-hour movement behaviours in children aged 0-5 years is a research priority. This study evaluated the test-retest reliability and concurrent validity of the open-ended and closed-ended versions of the Movement Behaviour Questionnaire for baby (MBQ-B) and child (MBQ-C). METHODS: 300 parent-child dyads completed the 10-day study protocol (MBQ-B: N = 85; MBQ-C: N = 215). To assess validity, children wore an accelerometer on the non-dominant wrist (ActiGraph GT3X+) for 7 days and parents completed 2 × 24-hour time use diaries (TUDs) recording screen time and sleep on two separate days. For babies (i.e., not yet walking), parents completed 2 × 24-hour TUDs recording tummy time, active play, restrained time, screen time, and sleep on days 2 and 5 of the 7-day monitoring period. To assess test-retest reliability, parents were randomised to complete either the open- or closed-ended versions of the MBQ on day 7 and on day 10. Test-retest intraclass correlation coefficients (ICC's) were calculated using generalized linear mixed models and validity was assessed via Spearman correlations. RESULTS: Test-retest reliability for the MBQ-B was good to excellent with ICC's ranging from 0.80 to 0.94 and 0.71-0.93 for the open- and closed-ended versions, respectively. For both versions, significant positive correlations were observed between 24-hour diary and MBQ-B reported tummy time, active play, restrained time, screen time, and sleep (rho = 0.39-0.87). Test-retest reliability for the MBQ-C was moderate to excellent with ICC's ranging from 0.68 to 0.98 and 0.44-0.97 for the open- and closed-ended versions, respectively. For both the open- and closed-ended versions, significant positive correlations were observed between 24-hour diary and MBQ-C reported screen time and sleep (rho = 0.44-0.86); and between MBQ-C reported and device-measured time in total activity and energetic play (rho = 0.27-0.42). CONCLUSIONS: The MBQ-B and MBQ-C are valid and reliable rapid assessment tools for assessing 24-hour movement behaviours in infants, toddlers, and pre-schoolers. Both the open- and closed-ended versions of the MBQ are suitable for research conducted for policy and practice purposes, including the evaluation of scaled-up early obesity prevention programs.

Physical Activity-Related Practices and Psychosocial Factors of Childcare Educators: A Latent Profile Analysis.

Limited research investigates early childhood education and care (ECEC) educators' involvement in promoting physical activity. The aim was to identify distinct profiles based on physical activity-related practices and psychosocial factors in ECEC educators and examine how they relate to the amount of time allocated to children's physical activity. A secondary analysis of educator-reported survey data from the Play Active study was undertaken. Educators (n = 532) reported on four practices and four psychosocial subscales adapted from the Environment and Policy Evaluation and Observation relating to the provision of physical activity in childcare. Latent profile analysis was used to identify distinct groups of educators based on their practices and psychosocial factors. Logistic regression analysed associations between latent profiles and educator-reported time provided for children's physical activity. Five profiles of educators' physical activity-related practices and psychosocial factors were identified. Profiles with higher practice scores also had higher psychosocial scores. Educators in profiles characterised by higher scores had greater odds of meeting the best practice guidelines for daily time allocated to children for total physical activity and energetic play. This study highlights interventions which address multiple educator behaviour change determinants to improve children's physical activity in childcare.

Markerless motion capture provides accurate predictions of ground reaction forces across a range of movement tasks.

Measuring or estimating the forces acting on the human body during movement is critical for determining the biomechanical aspects relating to injury, disease and healthy ageing. In this study we examined whether quantifying whole-body motion (segmental accelerations) using a commercial markerless motion capture system could accurately predict three-dimensional ground reaction force during a diverse range of human movements: walking, running, jumping and cutting. We synchronously recorded 3D ground reaction forces (force instrumented treadmill or in-ground plates) with high-resolution video from eight cameras that were spatially calibrated relative to a common coordinate system. We used a commercially available software to reconstruct whole body motion, along with a geometric skeletal model to calculate the acceleration of each segment and hence the whole-body centre of mass and ground reaction force across each movement task. The average root mean square difference (RMSD) across all three dimensions and all tasks was 0.75 N/kg, with the maximum average RMSD being 1.85 N/kg for running vertical force (7.89 % of maximum). There was very strong agreement between peak forces across tasks, with R2 values indicating that the markerless prediction algorithm was able to predict approximately 95-99 % of the variance in peak force across all axes and movements. The results were comparable to previous reports using whole-body marker-based approaches and hence this provides strong proof-of-principle evidence that markerless motion capture can be used to predict ground reaction forces and therefore potentially assess movement kinetics with limited requirements for participant preparation.

A great way to bring up health behaviour topics at playgroup: a qualitative evaluation of the Healthy Conversations @ Playgroup program.

BACKGROUND: The early years is a critical stage to establish optimal nutrition and movement behaviours. Community playgroups are a relaxed environment for parents with a focus on social connection and supporting parents in their role as 'First Teachers'. Playgroups are therefore an opportunistic setting to promote health behaviours in the early years. To support parents with young children around healthy lifestyle behaviours, the Healthy Conversations @ Playgroup program was delivered in urban and regional areas, across three Australian jurisdictions between 2021-2023. OBJECTIVE: This qualitative evaluation aimed to understand how the Healthy Conversations @ Playgroup program was experienced by parents, playgroup coordinators and peer facilitators. DESIGN: Semi-structured virtual interviews and focus groups were conducted with parents, playgroup coordinators (i.e., person responsible for coordinating the playgroup) and peer facilitators (i.e., trained facilitator for the program) that participated in the Healthy Conversations @ Playgroup study. Transcripts were analysed following a thematic analysis approach. RESULTS: Twenty-eight playgroup parents, coordinators or peer facilitators participated in one of 8 focus groups or 5 interviews. Four themes were developed: Program strengths and challenges; Setting strengths and challenges; Factors that impact program delivery; Participant's suggestions for future program delivery. CONCLUSIONS: The Healthy Conversations @ Playgroup program was valued by parents, providing validation and normalisation of parenting practices, and fostering a shared experience of parenting. Playgroups are a convenient setting for families to attend. The dynamic and distracting nature of the playgroup setting were carefully considered when designing the program. Strategies to further enhance program engagement could include use of coordinator or parent champions, tailored delivery, and extending the reach to other family members. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12621000055808, registered 22 January 2021, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380890.

Maternal physical activity and sitting time and its association with placental morphology and blood flow during gestation: Findings from the Queensland Family Cohort study.

OBJECTIVES: Antenatal exercise is associated with placental morphological alterations, however research in this area is limited. Given the emphasis on the beneficial effects of antenatal exercise, it is important to understand its effect on placental function and the relationship to foetal development. The aim of this study was to investigate the association between physical activity, sitting time, and placental outcomes measured during gestation. DESIGN: Prospective cohort study. METHODS: Pregnant women in the Queensland Family Cohort study self-reported physical activity at 24 and 36 weeks of gestation (n = 203) and were categorised into physical activity volume groups of nil-low (0-<500 metabolic equivalent of task·minutes/week), moderate (500-<1000 metabolic equivalent of task·minutes/week), or high-volume activity (≥1000 metabolic equivalent of task·minutes/week). Participants reported average daily sitting time, whereby excessive sitting time was considered as ≥8h/day. Placental stiffness, thickness, and uteroplacental blood flow resistance were measured by ultrasound imaging at each timepoint. RESULTS: Physical activity volume was not associated with changes to placental morphometrics or uteroplacental blood flow resistance at 24 or 36 weeks of gestation. Excessive sitting time at 36 weeks was associated with greater placental stiffness (p = 0.046), and a lower umbilical artery pulsatility index (p = 0.001). CONCLUSIONS: Placental tissue stiffness and umbilical artery resistance were altered in late gestation with higher maternal sitting time but not with physical activity volume. Overall, excessive sitting time may be a risk for suboptimal placental function and could be an important focus for antenatal care.

Longitudinal effects of dog ownership, dog acquisition, and dog loss on children's movement behaviours: findings from the PLAYCE cohort study.

INTRODUCTION: Regular physical activity is important for children's physical and mental health, yet many children do not achieve recommended amounts of physical activity. Dog ownership has been associated with increased physical activity in children, however, there have been no longitudinal studies examining this relationship. This study used data from the Play Spaces and Environments for Children's Physical Activity (PLAYCE) cohort study to examine the longitudinal effects of dog ownership status on children's movement behaviours. METHODS: Change in dog ownership from preschool (wave 1, age 2-5) to fulltime school (wave 2, age 5-7) was used as a natural experiment with four distinct dog ownership groups: continuing non-dog owners (n = 307), continuing dog owners (n = 204), dog acquired (n = 58), and dog loss (n = 31; total n = 600). Daily movement behaviours, including physical activity, sedentary time, sleep, and screen time, were measured using accelerometry and parent-report surveys. Differences between groups over time and by sex were tested using linear mixed effects regression models. RESULTS: Girls who acquired a dog increased their light intensity activities and games by 52.0 min/day (95%CI 7.9, 96.0) and girls who lost a dog decreased their light intensity activities and games by 62.1 min/day (95%CI -119.3, -4.9) compared to no change among non-dog owners. Girls and boys who acquired a dog increased their unstructured physical activity by 6.8 (95%CI 3.2, 10.3) and 7.1 (95%CI 3.9, 10.3) occasions/week, compared to no changes among non-dog owners. Girls and boys who lost a dog reduced their unstructured physical activity by 10.2 (95%CI -15.0, -5.3) and 7.7 (95%CI -12.0, -3.5) occasions/week. Girls who lost a dog decreased their total physical activity by 46.3 min/day (95%CI -107.5, 14.8) compared to no change among non-dog owners. Continuing dog ownership was typically not associated with movement behaviours. Dog ownership group was not associated with changes in sleep and had mixed associations with screen time. CONCLUSION: The positive influence of dog ownership on children's physical activity begins in early childhood and differs by child sex. Further research should examine the specific contributions dog-facilitated physical activity makes to children's overall physical activity, including the intensity and duration of dog walking and play.

Goal-directed therapeutic exercise for paediatric posterior fossa brain tumour survivors: a qualitative analysis of experiences.

PURPOSE: To explore child and parent experiences of a 12-week goal-directed therapeutic exercise intervention in paediatric posterior fossa brain tumours survivors and to identify features of the program that influenced program adherence and acceptability. METHODS: Eleven interviews were conducted; five parent-child dyads (mothers = 83%) and one parent only (mean child age = 10.6 ± 3.0 years; 83% male). Posterior fossa brain tumour survivors, who participated in a weekly goal-directed exercise program for 12 weeks, completed semi-structured interviews to discuss their experience of the program. An inductive content analysis was undertaken. Interviews were transcribed, imported into NVivo and independently coded by two reviewers. Code and content categories were iteratively discussed and refined. RESULTS: Five content categories were generated: (1) perceived improvements, (2) program logistics, (3) activity selection, (4) connection with the therapist and (5) options for technology. All participants valued the tailored exercise program and described improvements in movement competence. Children and their parents discussed preferring home- and community-based locations and favoured face-to-face delivery. Occasionally, parents reported difficulty completing the home program due to low child motivation or family time restrictions. Multiple families suggested an interactive digital application would be an effective delivery channel for the supplemental home-based program. CONCLUSION: A goal-directed exercise program delivered at home and in community-based locations was considered valuable and helpful for improving movement competence in paediatric survivors of posterior fossa brain tumour. TRIAL REGISTRATION: ACTRN12619000841178 June 12, 2019.

Construct Validity of the Both Hands Assessment Using Wrist-Worn Accelerometers.

AIM: The aim of this study was to evaluate the construct validity of the Both Hands Assessment (BoHA) using activity of the upper limbs as detected by accelerometry in children with bilateral cerebral palsy (CP). METHODS: Observational study of children with CP (n = 44, n = 27 boys, aged 9.1 ± 1.6 years; Manual Ability Classification Scale I: n = 15, II: n = 22, III: n = 7) completing a BoHA assessment while wearing a triaxial accelerometer on each wrist. BoHA Each-Hand sub-scores, BoHA percentage difference between hands, BoHA Units, mean activity for each hand, mean activity asymmetry index and total mean activity were calculated. Linear regressions were used to analyze associations between measures. RESULTS: There were significant, positive associations between BoHA Units and total mean activity (B = 0.86, 95%CI: 0.32, 1.40), BoHA Percentage difference between hands and mean activity asymmetry index (B = 0.95, 95%CI: 0.75,1.15), and BoHA Each-Hand sub-score and mean activity for the non-dominant hand (B = 1.71, 95%CI: 1.16, 2.28), but not the dominant hand (B = 0.50, 95%CI: -0.45, 1.45). CONCLUSIONS: This study provides further evidence for the construct validity of the BoHA as a measure of upper limb performance. Wearable wrist sensors such as accelerometers capture and quantify gross upper limb movement in children with CP but cannot measure fine finger movements captured by the BoHA. CLINICAL TRIALS REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12616001488493 and ACTRN12618000164291).

Rural libraries implementing walking groups or walking groups plus civic engagement for walkability in rural communities: a comparative effectiveness trial study protocol.

BACKGROUND: Rural residents generally lack adequate physical activity to benefit health and reduce disparities in chronic diseases, such as cardiovascular disease and certain cancers. The Socioecological Model describes physical activity as involving a dynamic and reciprocal interaction between individual, social, and community factors. Community group-based walking programs and civic engagement interventions aimed at enhancing physical activity have been successful in rural communities but have not targeted all three socioecological levels. Public libraries can act as innovative public health partners in rural communities. However, challenges remain because rural libraries often lack the capacity to implement evidence-based health promotion programming. The goals of this study are (1) build the capacity for rural libraries to implement evidence-based health promotion programs, (2) compare changes in physical activity between a group-based walking program and a combined group-based walking and civic engagement program with rural residents, and (3) conduct an implementation evaluation. METHODS: We will conduct a comparative effectiveness study of a group-based walking (standard approach) versus a group-based walking plus civic engagement program (combined approach) aimed at enhancing walkability to increase physical activity among rural adults. Key mediators between the program effects and change in outcomes will also be identified. Finally, we will evaluate program implementation, conduct a cost effectiveness evaluation, and use a positive deviance analysis to understand experiences of high and low changers on key outcomes. Twenty towns will be matched and randomized to one of the two conditions and our aim is to enroll a total of 350-400 rural residents (15-20 per town). Study outcomes will be assessed at baseline, and 6, 12, and 24 months. DISCUSSION: This study will build the capacity of rural libraries to implement evidence-based walking programs as well as other health promotion programs in their communities. The study results will answer questions regarding the relative effectiveness and cost effectiveness of two multilevel physical activity interventions targeting rural communities. We will learn what works and how these multilevel interventions can be implemented in rural populations. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05677906.

Cognitive Testing of Items Measuring Movement Behaviours in Young Children Aged Zero to Five Years: Development of the Movement Behaviour Questionnaires for -Baby (MBQ-B) and -Child (MBQ-C).

This paper describes the cognitive interview phase of the development of two brief surveys, the Movement Behaviour Questionnaire-Baby (MBQ-B) and Movement Behaviour Questionnaire-Child (MBQ-C), which measure the duration of physical activity, screen time, and sleep of children aged 0-5 years. The aims were (1) review the format, content, and clarity of questionnaire items and response options, (2) understand how parents retrieve, encode, and formulate responses when asked about their child's movement behaviours, and (3) identify potential sources of response error and make appropriate modifications. Interviews with parents of children aged 0-5 years were conducted using concurrent think-aloud techniques and probing questions. Parents reviewed the MBQ-B and/or MBQ-C depending on the developmental stage of their child(ren). Twenty-nine interviews were conducted with 20 parents, over four iterative rounds. Participants recalled usual family routines and rules when estimating the duration/frequency of behaviours. To estimate active play, parents referred to the child's daily routine considering wake and bedtimes, naps, and mealtimes. Participants were influenced by the examples provided, being unable to interpret these as exemplars only. Decomposing general items into specific questions with examples was well received. Use of numeracy skills when estimating duration was evident. Interviews informed revisions to item wording, examples, and recall prompts, which will be taken forward into the MBQ-B and MBQ-C validation studies. Utilising cognitive interviewing can enhance confidence that questionnaire items are correctly interpreted and understood by participants.

Healthy weight and overweight adolescents with type 1 diabetes mellitus do not meet recommendations for daily physical activity and sleep.

AIMS: Physical activity (PA) plays an important role in the prevention of cardiovascular disease (CVD), particularly in individuals with type 1 diabetes mellitus (T1DM) who are at increased risk. Our aim was to determine levels of moderate-to-vigorous physical activity (MVPA), sedentary behaviour and sleep in adolescents with T1DM, and identify barriers to PA. METHODS: Participants aged 12-18 with T1DM wore an accelerometer and continuous glucose monitor for 24 h over 7-days. Data was processed into PA metrics and sleep. Pearson correlations were used to test associations between MVPA and metabolic measures. Barriers to PA were measured using a questionnaire. RESULTS: Thirty-seven adolescents provided valid accelerometer data. Mean daily MVPA was 44.0 min [SD 17.6] with 16.2% achieving the guideline of ≥ 60 min/day. Participants had 11 h [SD 1.2] of sedentary behaviour and 7.6 h [SD 1.5] of sleep/day. There was no difference in MVPA in overweight or obese (53.8%) vs. healthy weight (44.2%) adolescents (45.0 min [SD 16.6] vs. 43.1 min [SD 18.8]). Only 39.6% reported one or more diabetes specific barrier to PA. CONCLUSION: Adolescents with T1DM engage in insufficient MVPA and sleep, irrespective of body weight status, suggesting the need for targeted interventions.

Adaptations to scale-up an early childhood education and care physical activity intervention for real-world availability - Play Active.

BACKGROUND: Adaptations for scale-up are ubiquitous but are rarely described in detail. Adaptations may be a key reason for the "scale-up penalty" which is when there is a reduction in intervention effect size following scale-up. The Play Active intervention consists of a physical activity policy for early childhood education and care (ECEC) services, with accompanying implementation support strategies. It was first implemented with 81 ECEC services in Perth, Western Australia, in 2021 - with significant positive changes in physical activity practice uptake. The aim of this paper is to describe the extent, type, fidelity consistency, goals, size, scope, and proposed impact of proposed adaptations to the implementation support strategies for scaling-up Play Active. METHODS: Proposed adaptations were defined as planned changes, made prior to making the intervention available. The authors created a list of adaptations from a comparison of the Play Active implementation support strategies, before and after adaptation for proposed statewide availability across Western Australia, Queensland and South Australia, Australia. We used the Framework for Reporting Adaptations and Modifications-Enhanced Implementation Strategies (FRAME-IS) to code adaptations to implementation support strategies. Three authors coded each adaptation and rated their size, scope and proposed impact. RESULTS: Fifty-three adaptations to Play Active were identified. Most (68%) were proposed for the 'content' of implementation strategies, including aspects of their delivery. In practice, this involved changing the delivery mode of implementation support strategies from phone call and email support, to website-based delivery. More than half (56%) of adaptations involved 'adding elements' for scale-up. Most adaptations were 'fidelity consistent' (95%). The main goals for adaptations were related to 'increasing the acceptability, appropriateness, or feasibility' (45%), 'decreasing the costs' (19%) and 'increasing adoption of the evidence-based practice' (19%). Adaptations were small to medium in size, with most proposed to have a positive (87%) or neutral (8%) effect on the effectiveness of the intervention, rather than negative (4%). CONCLUSIONS: A large number of small, fidelity-consistent, adaptations were proposed for Play Active scale-up. Overall, the process of reporting adaptations was found to be feasible. To understand the impact of these adaptations, it will be important to re-evaluate implementation, effectiveness and process outcomes, at-scale.

The moderating role of parent perceptions in relationships between objectively measured neighbourhood environment attributes and pre-schooler's physical activity: Findings from the PLAYCE study.

We examined the moderating effects of parent perceptions of the neighbourhood environment on associations between objectively measured neighbourhood environment attributes and physical activity among pre-schoolers. The number of neighbourhood parks was positively associated with pre-schooler energetic play when parents had above average perceptions of access to services. Objectively measured street connectivity was associated with fewer minutes of energetic play when pedestrian and traffic safety was perceived to be below average by parents. Greater understanding of the role played by parents in pre-schooler's exposure to physically active supportive environments is needed to inform environmental interventions for specific age groups.

Play Active physical activity policy intervention and implementation support in early childhood education and care: results from a pragmatic cluster randomised trial.

BACKGROUND: Policy interventions to increase physical activity in early childhood education and care (ECEC) services are effective in increasing physical activity among young children. However, a large proportion of ECEC services do not have nor implement a physical activity policy. Play Active is an evidence-informed physical activity policy intervention with implementation support strategies to enable ECEC services to successfully implement their policy. This study examined the effectiveness, implementation, and process outcomes of Play Active. METHODS: A pragmatic cluster randomised trial in 81 ECEC services in Perth, Western Australia was conducted in 2021. Services implemented their physical activity policy over a minimum of three months. The effectiveness outcomes were changes in educator practices related to daily time provided for total physical activity and energetic play. Implementation outcomes included changes in director- and educator-reported uptake of policy practices and director-reported uptake of high impact and low effort policy practices. Process evaluation outcomes included awareness, fidelity, reach, and acceptability of the intervention and implementation strategies. Analysis involved descriptive statistics and generalised linear mixed effects models. RESULTS: There was a significant increase in the uptake of director-reported policy practices (p = 0.034), but no change in the uptake of the subset of high impact and low effort policy practices. Intervention group educators reported high awareness of the Play Active policy recommendations (90%). Play Active acceptability was high among educators (83%) and directors (78%). Fidelity and reach were high for most implementation support strategies (> 75%). There were no significant changes in the amount of physical activity or energetic play educators provided to children or in the proportion of educators providing the policy recommended ≥ 180 min of physical activity/day or ≥ 30 min of energetic play/day for intervention compared to wait-listed comparison services. CONCLUSIONS: Play Active resulted in significantly higher uptake of physical activity practices. However, there was no change in the amount of physical activity provided to children, which may be explained by the relatively short policy implementation period. Importantly, Play Active had high awareness, fidelity, reach, and acceptability. Future research should investigate the effectiveness of Play Active over longer implementation periods and its scalability potential. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (reference number 12620001206910, registered 13/11/2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378304&isReview=true ).

Parental Influences on Physical Activity and Screen Time among Preschool Children from Low-Income Families in Brazil.

Background: Children from low-middle income countries (LMIC) are disproportionately affected by obesity, and low physical activity (PA) and high screen time (ST) are major contributors. Parents are key influencers on children's PA and ST, yet, no study has investigated relationships between parenting practices and children's PA and ST in LMIC families. This study examined parental influences on PA and ST among preschool-aged children from low-income families in Brazil. Methods: Parents completed a validated, culturally adapted interviewer-administered survey assessing child ST and parenting practices. Child sedentary time, total movement, and energetic play were measured by accelerometery. Results: Data were available on 77 parent-child dyads [mean age 4.6 years (standard deviation = 0.8), 53% male, and 41% mixed-race]. Parenting practices associated with greater PA were use of PA to reward/control behavior (rho = 0.34-0.49), limiting or monitoring ST (rho = 0.30), explicit modeling/enjoyment of PA (rho = 0.24), verbal encouragement for PA (rho = 0.30), and importance and value of PA (rho = 0.24-0.38; p < 0.05). Parenting practices associated with higher ST were rules around active play indoor (rho = 0.23), use of ST to reward/control behavior (rho = 0.30), exposure to screens (rho = 0.40), and explicit modeling/enjoyment of ST (rho = 0.50; p < 0.05). Conclusion: Recognized parenting practices such as explicit modeling of PA and ST, monitoring and limiting ST, and rules and restrictions about PA and ST are associated with young children's PA and ST in low-income Brazilian families. The findings identify potential targets for family-based interventions to promote healthy lifestyle behaviors and prevent childhood obesity.

Barriers and facilitators of physical activity in children with bronchiectasis: Perspectives from children and parents.

Background: Current bronchiectasis management guidelines recommend regular physical activity but a large proportion of children with bronchiectasis do not meet public health recommendations which call for 60 min or more of moderate-to-vigorous intensity physical activity daily. Knowing the factors that influence physical activity in children with bronchiectasis is necessary for the development of effective interventions to increase physical activity in this patient group. The objective of this study was to identify facilitators and barriers to physical activity in children with bronchiectasis unrelated to cystic fibrosis (CF) from the perspectives of children and their parents. Materials and methods: This was a qualitative study informed by the theoretical domains framework (TDF). Children aged 7-15 years (8.8 years, 8.4-11.0) (median, interquartile range) and parents (45.8 years, 39.7-48.3) completed separate, semi-structured interviews (n = 21). Recordings were transcribed verbatim, and barriers and facilitators related to each TDF domain deductively coded. Emergent themes were inductively derived via consensus moderation. Results: From the perspectives of children, fun with friends, organized sport and activities, and family co-participation in physical activity emerged as facilitators. Inability to keep up with their peers and time on technology emerged as barriers. From the perspectives of parents, instrumental and logistic support for physical activity and supportive social and physical activity environments emerged as facilitators, while management of symptoms associated with bronchiectasis emerged as a barrier. Conclusion: Programs to increase physical activity in children with bronchiectasis should be fun, accessible, provide opportunities for social interaction and address barriers related to exercise tolerance, perceived competence, and presence of respiratory symptoms.