Quick, Effective Screening Tasks Identify Children With Medical Conditions or Disabilities Needing Physical Literacy Support.

PURPOSE: This study evaluated screening tasks able to identify children with medical conditions or disabilities who may benefit from physical literacy. METHOD: Children completed ≤20 screening tasks during their clinic visit and then the Canadian Assessment of Physical Literacy (2nd edition) at a separate visit. Total Canadian Assessment of Physical Literacy scores <30th percentile were categorized as potentially needing physical literacy support. Receiver operator characteristic curves identified assessment cut points with 80% sensitivity and 40% specificity relative to total physical literacy scores. RESULTS: 223 children (97 girls; 10.1 [2.6] y) participated. Physical activity adequacy, predilection, and physical competence achieved ≥80% sensitivity and ≥40% specificity in both data sets. Adequacy ≤ 6.5 had 86% to 100% sensitivity and 48% to 49% specificity. Daily screen time >4.9 hours combined with Adequacy ≤6.15 had 88% to 10% sensitivity and 53% to 56% specificity. CONCLUSIONS: Activity adequacy, alone or with screen time, most effectively identified children likely to benefit from physical literacy support. Adequacy and screen time questionnaires are suitable for clinical use. Similar results regardless of diagnosis suggest physical competence deficits are not primary determinants of active lifestyles. Research to enhance screening specificity is required.

Poor adherence to sleep and physical activity guidelines among children with epilepsy.

OBJECTIVE: To assess physical activity and sleep rates in a cohort of children with epilepsy (CWE) and determine if there is a relationship between physical activity and sleep time. METHODS: Children aged 8-14 years with a diagnosis of epilepsy and at least one seizure in the past 12 months were monitored via a wrist-worn activity tracker for 16 weeks, to objectively measure daily physical activity, as assessed by step counts, and sleep time. Adherence to physical activity (≥12,000 steps/day) and sleep recommendations (≥9 h for children aged 8-12 years, or ≥8 h for children aged 13-15 years) was determined. To predict daily activity or nightly sleep, a series of multivariable models incorporating age, sex, day-type (all combinations of weekday or weekend and summer holiday or school), participant (as a random effect), daily physical activity (for models predicting sleep), nightly sleep (for models predicting physical activity), and autoregressive terms of previous sleep or physical activity were constructed, and the best-performing models were selected with Akaike information criterion analysis. RESULTS: Twenty-two children with mild to moderate epilepsy were recruited (54.5% female, median (IQR) age 11 (10, 13) years) and monitored for 16 weeks. They met the recommended level of physical activity only in 38.0% (21.7%, 59.4%), and sleep in 49.1% (30.0%, 68.5%) of days. They met both physical activity and sleep guidelines on the same day in only 17.8% (95% CI 7.1%, 38.0%). There was no association between meeting the recommended levels of daily physical activity and sleep time (p = 0.86, ρ = 0.03). In the best-performing model, age, sex, day type, and participant explained 28.9% of the variance in daily physical activity, with no additional insight provided by measures of sleep time. Age, sex, day type, participant, and daily physical activity explained 17.3% of the variance in nightly sleep time, with a statistically discernable but small association between physical activity and sleep time (1.79 ±â€¯0.53, p = 0.001). CONCLUSION: Our cohort of children with mild to moderate epilepsy showed poor adherence to sleep and physical activity guidelines. There was no clinically relevant association between daily physical activity and sleep among these children who were similarly active to healthy peers. Future studies should assess the effect of increased sleep hygiene and physical activity on overall well-being and seizure control in CWE.

Attitudes toward physical activity as a treatment component for adolescents with anorexia nervosa: An exploratory qualitative study of patient perceptions.

OBJECTIVE: Anorexia nervosa (AN) with compulsive exercise is associated with poor treatment outcomes. This study sought to understand the attitudes of adolescents with AN from various stages of treatment, toward physical activity research practices and physical activity as a component of treatment. METHOD: Seventeen adolescents 12-18 years old (15 female) with AN (10 with acknowledged history of compulsive exercise) were recruited from a Canadian Tertiary Care Hospital's Eating Disorder Program. Six inpatients, 5-day program patients, and six outpatients treated by either the inpatient and/or day treatment program in the past 2 years completed individual, semi-structured interviews that were audio-recorded and transcribed. Results were analyzed deductively using qualitative techniques. RESULTS: Participants recognized both benefits (psychological, sociological, and physiological) and risks (trigger negative thoughts, increase competitive behavior) of implementing physical activity into acute AN treatment. Patient characteristics, such as stage of treatment and exercise history, had an impact on participants' perceptions toward physical activity in AN. Participants suggested that the ideal physical activity program would be focused on fun, individualized and progressively integrated, group-based, and directly supported by staff. Although the majority of participants stated that they would wear an activity monitor for research purposes, concerns were voiced regarding compliance and the potential impact on eating disorder symptomatology. DISCUSSION: Participants overwhelmingly supported the careful implementation of structured physical activity and physical activity psychoeducation into the acute treatment of adolescents with AN. This study allows for the inclusion of patient voices in the conversation surrounding the role of physical activity in AN treatment.

Developing patient resources to enable the exchange of healthy lifestyle information between clinicians and families of children with complex heart problems.

BACKGROUND: Healthy active lifestyles are critically important for children with complex heart problems (CHP) that affect heart structure, rhythm or function. They are at increased risk for morbidities such as atherosclerosis, obesity, anxiety and depression. Educating children with CHP and their families about the relevance of healthy lifestyles is an important part of clinical care. DESIGN: This study used a collaborative approach among six patients/family members and 22 health professionals to develop a series of knowledge-to-action tools suitable for counselling children with CHP and their families about their healthy lifestyle needs. METHODS: After development of the knowledge-to-action tools had been completed, one cardiologist and one research assistant implemented one or more of these new resources during each clinic visit as appropriate for each patient. Thirty-nine parents and eight children completed post-clinic interviews to explore their perceptions of the new resources. The nine resources developed included brochures and websites addressing physical activity with a heart condition, body contact restrictions, exercise test results, emotional health, finding community resources, encouragement for asking healthy lifestyle questions and a brief, in-clinic healthy lifestyle assessment. RESULTS: Families found the resources useful and helpful for clarifying their specific concerns. They also provided suggestions to improve the content and delivery of the resources so that they would be suitable for a variety of settings-schools, community and sports. CONCLUSION: Future research is required to evaluate the effectiveness of these resources for raising awareness and knowledge about healthy active lifestyles among children with CHP and the impact of these resources for changing healthy lifestyle behaviours.

Physically active children with epilepsy have good objective sleep duration and efficiency despite subjective reports of fatigue and sleep problems.

OBJECTIVE: The aim of this study was to longitudinally characterize in children with epilepsy the objective and subjective sleep quality and the relationship between increased physical activity and sleep as well as measures of psychosocial well-being. METHODS: Baseline physical activity and sleep were established in children with epilepsy over four weeks, prior to a 12-week exercise intervention (weekly meeting with exercise counselor). Participants continuously wore a wrist pedometer (Fitbit Flex®) to capture daily number of steps, sleep efficiency, and total sleep time. The Early Childhood Epilepsy Severity Scale (E-Chess) assessed baseline epilepsy severity. Subjective sleep quality (Children's Sleep Habits Questionnaire, CSHQ), quality of life (KIDSCREEN-27; Pediatric Quality of Life Inventory, PedsQL™, 4.0 Core), fatigue (PedsQL™ Multidimensional Fatigue Scale), depression (Children's Depression Inventory-Short), and anxiety (Multidimensional Anxiety Scale for Children) were assessed pre- and post-interventions. RESULTS: Our cohort of 22 children with epilepsy aged 8-14 years was similarly active to peers (11,271 ±â€¯3189 mean steps per day) and displayed normal sleeping patterns (mean sleep efficiency: 87.4% ±â€¯3.08 and mean total sleep time: 521 ±â€¯30.4). Epilepsy severity assessed by E-Chess was low to moderate (median baseline E-Chess score of 6, interquartile range: 5-7). Study outcomes did not change with the intervention. Older children and those with lower baseline activity were more likely to increase their activity during the intervention. Changes in physical activity were not associated with changes in sleep outcomes when accounting for age, sex, and baseline E-Chess score. Subjective sleep quality marginally improved with the intervention (CSHQ total score: 44.5 ±â€¯5.8 at baseline and 41.6 ±â€¯7.2 at the end of study, p = 0.05). Quality of life, fatigue, depression, and anxiety did not change with the intervention (p = 0.55, 0.60, 0.12, and 0.69, respectively). SIGNIFICANCE: Children with epilepsy who are as active as peers without epilepsy have good objective measures of sleep despite self-reported fatigue and parent-reported sleep problems. The physical activity of initially less active and older children with epilepsy may benefit from an exercise counseling intervention.

Canadian Assessment of Physical Literacy in grades 7-9 (12-16 years): Preliminary validity and descriptive results.

Background: The Canadian Assessment of Physical Literacy (CAPL) accurately and reliably assesses the physical literacy level of young children. However, in preliminary analyses ceiling effects were noted among 183 older children. The purposes of this study were to assess the validity of a modified CAPL designed for older children (CAPL 789) and to offer descriptive results.Methods: CAPL 789 assessed the physical literacy of Canadian children in grades 7-9. Data were collected from schools and recreation facilities in the provinces of Alberta and Ontario (Canada), yielding a new sample of 245 participants (129 girls, 13.7 ± 0.9 years). Descriptive statistics were calculated for all CAPL domains. Age and gender effects were examined to support the validity.Results: Physical competence score (/32) increased with age (F = 4.90, p < 0.05), the means in grades 7-9 being 18.9 ± 3.2, 20.9 ± 4.4 and 21.2 ± 3.4, respectively. Girls scored significantly higher (t = -2.29, p < 0.05) than boys (6.6 ± 1.2 vs 6.3 ± 1.3) in the knowledge assessment (/10).Conclusion: The CAPL 789 was feasible among children from grades 7-9. Additional research is required to establish the psychometric properties in children 12 to 16 years.

"I really like playing games together": Understanding what influences children with congenital heart disease to participate in physical activity.

BACKGROUND: Participation in physical activity is essential to the long-term health and development of all children. However, children living with cardiac conditions are typically not active enough to sustain positive health outcomes. Understanding the experiences of children living with congenital heart disease in community-based settings could help inform the physical activity counselling practices of clinicians. The current study explored the perceptions of 7- to 10-year-old children with moderate or complex congenital heart disease as they participated in a 10-week multisport programme. METHODS: Detailed field notes recorded the discussions and behaviours of 11 participants (45% female participants) each week during the programme sessions. Among those, four participants (50% female participants) were purposively selected to participate in preprogramme and postprogramme focus groups to gather more detailed accounts of their experiences. RESULTS: Four main themes surrounding physical activity were identified: (a) motivation, (b) self-efficacy, (c) peer influences, and (d) family influences. Although feelings of excitement and enjoyment towards physical activity were prevalent throughout the data ("I'm really excited … because I really like those sports"), participants also often felt frustrated, nervous, and fatigued ("I'm not very good at the skills"). Social inclusion with peers and family influences were meaningful reasons to engage in physical activity ("I really like playing games together"). Following the completion of the programme, participants emphasized their enjoyment of physical activity as a primary source of motivation, demonstrating an important shift from recognizing positive health outcomes ( "… it's good for you") towards more intrinsic sources of motivation ("… because it's fun"). CONCLUSION: Opportunities for physical activity that enhance positive experiences and build intrinsic motivation should be identified and promoted to children with congenital heart disease. Community-based programmes may also be an appropriate context for children with cardiac conditions to engage and maintain participation in physical activity through adolescence.

Higher screen time, lower muscular endurance, and decreased agility limit the physical literacy of children with epilepsy.

OBJECTIVE: The objective of this study was to determine the physical literacy (the motivation, confidence, physical competence, and knowledge contributing to the capacity for physical activity) of children with epilepsy, as compared with that of their healthy peers. METHODS: Patients age 8-12 years with epilepsy, without any disabilities interfering with their ability to answer questionnaires and perform vigorous physical activity, were recruited from the Neurology Clinic at the time of visits. They completed the Canadian Assessment of Physical Literacy (CAPL), a comprehensive battery of tests reflecting the primary domains of physical literacy (motivation/confidence, physical competence, knowledge/understanding, and daily behavior). Daily behavior was assessed by pedometer step counts, as well as self-reported moderate-to-vigorous physical activity and screen time. Physical competence included agility and movement skill measures as well as physical fitness. Children with epilepsy were matched with healthy peers from a large research database of over 6000 Canadian children. RESULTS: We tested 35 children with epilepsy, divided into those with presumed self-limiting forms of epilepsy (49%) and those with chronic disease (51%). Only a small proportion of participants (23%) were taking more than one antiepileptic medication, and only one patient was taking three anticonvulsants. Children with epilepsy including those with self-limiting forms had significantly lower total physical literacy scores, lower agility and movement skills, and lower muscular endurance, and reported more screen time than their healthy peers. Only 11% of the children with epilepsy achieved the recommended level of physical literacy. However, the children with epilepsy were knowledgeable about and highly motivated to participate in a physically active lifestyle. CONCLUSIONS: Children with epilepsy demonstrate poor physical literacy levels, with potential immediate and long-lasting negative impacts on general health and psychosocial well-being. Programs promoting physical literacy in children with epilepsy should be encouraged, specifically interventions decreasing screen time and enhancing muscular endurance and motor skills, thereby facilitating healthier lifestyles.

Understanding parent perceptions of healthy physical activity for their child with a chronic medical condition: A cross-sectional study.

OBJECTIVE: We sought to determine the prevalence of, and identify factors associated with, parent questions about physical activity for their child with a chronic cardiac, respiratory, or rheumatologic condition. METHODS: This cross-sectional study of 56 children (32 [57%] female), 3 to 18 years of age, with chronic cardiac (n=21), respiratory (n=18), or rheumatologic (n=17) conditions involved a parent questionnaire about their child's physical activity participation and measurement of the child's activity with an omni-directional accelerometer for 1 week. RESULTS: Parents of 20 (36%) children had at least one question about their child's physical activity participation, and the prevalence of questions did not vary by age (Wald chi square = 0.77, P=0.38), gender (Wald chi square = 0.11, P=0.74), or clinic (Wald chi square = 1.77, P=0.41). Parent questions were associated (P = 0.04) with lower levels of activity for boys (95% confidence interval [CI] for estimated marginal means: With questions: 197, 395; Without questions: 346, 500) and higher levels of activity for girls (95% CI for estimated marginal means: With questions: 268, 448; Without questions: 239, 369). A multivariable logistic regression model found that parents with questions had higher odds of having a child who was less well (odds ratio [OR]=19.9 for unwell, OR=5.6 for generally well with some symptoms versus well and asymptomatic) and had a history of cardiac arrhythmia (OR=7.6). CONCLUSIONS: Over one-third of parents reported having questions about physical activity for their child with a chronic medical condition, suggesting substantial uncertainty even among children reported as active. Presence of parent uncertainty is associated with parent reports of the child being unwell or a history of cardiac arrhythmia. By asking parents if they have questions about their child's activity, health care professionals may be better able to identify inactive boys and overprotective attitudes toward active girls.

Physical Literacy Knowledge Questionnaire: feasibility, validity, and reliability for Canadian children aged 8 to 12 years.

BACKGROUND: Physical literacy is defined as the motivation, confidence, physical competence, and knowledge and understanding to engage in physical activity for life. Physical literacy knowledge and understanding encompasses movement (how to move), performance (evaluation of movement), and health and fitness (value of exercise, need for relaxation and sleep, etc.). This paper describes the development and evaluation of a standardized assessment of physical literacy knowledge and understanding for Canadian children in grades 4, 5, and 6. METHODS: Proposed Physical Literacy Knowledge Questionnaire (PLKQ) content was identified through expert consultation and a review of provincial/territorial physical education curricula for grades 4 to 6. Open-ended questions verified language and generated response options. Feasibility was assessed via completion time and error frequency. Item validity assessed scores by age, gender, and teacher ratings of student knowledge. Test-retest reliability was assessed over short (2-day) and long (7-day) intervals. RESULTS: Subsets of 678 children (54% girls, 10.1 ± 1.0 years of age) completed the feasibility and validity assessments. Response errors (missing or duplicate responses, etc.) were minimal (2% or less) except for one question (7% error) about the use of safety gear during physical activity. A Delphi process among experts in children's physical activity and fitness achieved consensus on the core content and supported an item analysis to finalize item selection. As expected, knowledge scores increased with age (partial eta2 = 0.07) but were not related to gender (p = 0.63). Teacher ratings of children's knowledge of physical activity behaviour (r = 0.13, p = 0.01) and fitness (r = 0.12, p = 0.03), but not movement skill (r = 0.07, p = 0.19) were associated with PLKQ scores. Test-retest reliability for PLKQ score and individual questions was substantial to excellent for 71% of comparisons over a 2-day interval, but lower over a 7-day interval (53% substantial or excellent). Items with low reliability had high or low proportions of correct responses. CONCLUSIONS: This study provides feasibility and validity evidence for the Physical Literacy Knowledge Questionnaire as an assessment of physical literacy knowledge for Canadian children in grades 4, 5, and 6. Completion rates were high and knowledge scores increased with age. Streamlining of the content in accordance with Delphi panel recommendations would further enhance feasibility, but would also focus the content on items with limited reliability. Future studies of alternative item wording and responses are recommended to enhance test-retest reliability.

Refining the Canadian Assessment of Physical Literacy based on theory and factor analyses.

BACKGROUND: The Canadian Assessment of Physical Literacy (CAPL) is a 25-indicator assessment tool comprising four domains of physical literacy: (1) Physical Competence, (2) Daily Behaviour, (3) Motivation and Confidence, and (4) Knowledge and Understanding. The purpose of this study was to re-examine the factor structure of CAPL scores and the relative weight of each domain for an overall physical literacy factor. Our goal was to maximize content representation, and reduce construct irrelevant variance and participant burden, to inform the development of CAPL-2 (a revised, shorter, and theoretically stronger version of CAPL). METHODS: Canadian children (n = 10,034; Mage = 10.6, SD = 1.2; 50.1% girls) completed CAPL testing at one time point. Confirmatory factor analysis was used. RESULTS: Based on weak factor loadings (λs < 0.32) and conceptual alignment, we removed body mass index, waist circumference, sit-and-reach flexibility, and grip strength as indicators of Physical Competence. Based on the factor loading (λ < 0.35) and conceptual alignment, we removed screen time as an indicator of Daily Behaviour. To reduce redundancy, we removed children's activity compared to other children as an indicator of Motivation and Confidence. Based on low factor loadings (λs < 0.35) and conceptual alignment, we removed knowledge of screen time guidelines, what it means to be healthy, how to improve fitness, activity preferences, and physical activity safety gear indicators from the Knowledge and Understanding domain. The final refined CAPL model was comprised of 14 indicators, and the four-factor correlated model fit the data well (r ranged from 0.08 to 0.76), albeit with an unexpected cross-loading from Daily Behaviour to knowledge of physical activity guidelines (mean- and variance-adjusted weighted least square [WLSMV] χ2(70) = 1221.29, p < 0.001, Comparative Fit Index [CFI] = 0.947, root mean square error of approximation [RMSEA] = 0.041[0.039, 0.043]). Finally, our higher-order model with Physical Literacy as a factor with indicators of Physical Competence (λ = 0.68), Daily Behaviour (λ = 0.91), Motivation and Confidence (λ = 0.80), and Knowledge and Understanding (λ = 0.21) fit the data well. CONCLUSIONS: The scores from the revised and much shorter 14-indicator model of CAPL can be used to assess the four correlated domains of physical literacy and/or a higher-order aggregate physical literacy factor. The results of this investigation will inform the development of CAPL-2.

Influence of the relative age effect on children's scores obtained from the Canadian assessment of physical literacy.

BACKGROUND: Age grouping by the imposition of a cut-off date, common in sports and education, promotes a relative age difference that is associated with developmental advantages for children who are born on the "early side" of the cut-off date and disadvantages to those born later in the same year, which is known as the relative age effect (RAE) bias. Acquiring an adequate level of physical literacy is important for children to remain active for life. The Canadian Assessment of Physical Literacy (CAPL) is an assessment protocol that encompasses measures in the domains of children's Daily Behaviours, Physical Competence, Motivation and Confidence, and Knowledge and Understanding. The purpose of this study was to ascertain whether the CAPL scores were susceptible to the RAE, which could affect our interpretation of the CAPL findings. METHODS: This cross-sectional study examined if scores obtained in the CAPL (i.e., the four domains individually and the total CAPL score) were susceptible to the RAE in children aged 8 to 12 years and, if so, which physical competence assessments (movement skills, cardiorespiratory, strength, muscular endurance, flexibility, and body composition measurements) were more susceptible. Participants (n = 8233, 49.8% boys) from the Royal Bank of Canada-CAPL Learn to Play project from 11 sites in seven Canadian provinces were tested using the CAPL protocol. RESULTS: Among boys and girls, the RAE was significantly associated with two and three of the four domain scores, respectively, after controlling for covariates. However, effect sizes were negligible for the comparisons between quarters of the year and physical literacy domains and overall scores. For the main effect of the relative age, boys and girls born in the first three months of the year were taller (F(3, 4074) = 57.0, p < 0.001, ƒ2 = 0.04 and F(3, 4107) = 58.4, p < 0.001, ƒ2 = 0.04, respectively) and demonstrated greater muscular strength (F(3, 4037) = 29.2, p < 0.001, ƒ2 = 0.02 and F(3, 4077) = 25.1, p < 0.001, ƒ2 = 0.02, respectively) compared with those born later in the same year. CONCLUSIONS: Collectively, our results suggest that the RAE bias is mainly negligible with regard to the domain scores and overall CAPL scores in this large sample of children.

Revising the motivation and confidence domain of the Canadian assessment of physical literacy.

BACKGROUND: The Motivation and Confidence domain questionnaire in the Canadian Assessment of Physical Literacy (CAPL) was lengthy (36 single items that aggregate to five subscales), and thus burdensome to both participants and practitioners. The purpose of this study was to use factor analysis to refine the Motivation and Confidence domain to be used in the CAPL-Second Edition (CAPL-2). METHODS: Children, primarily recruited through free-of-charge summer day camps (n = 205, Mage = 9.50 years, SD = 1.14, 50.7% girls), completed the CAPL-2 protocol, and two survey versions of the Motivation and Confidence questionnaire. Survey 1 contained the Motivation and Confidence questionnaire items from the original CAPL, whereas Survey 2 contained a battery of items informed by self-determination theory to assess motivation and confidence. First, factor analyses were performed on individual questionnaires to examine validity evidence (i.e., internal structure) and score reliability (i.e., coefficient H and omega total). Second, factor analyses were performed on different combinations of questionnaires to establish the least burdensome yet well-fitted and theoretically aligned model. RESULTS: The assessment of adequacy and predilection, based on 16 single items as originally conceptualized within the CAPL, was not a good fit to the data. Therefore, a revised and shorter version of these scales was proposed, based on exploratory factor analysis. The self-determination theory items provided a good fit to the data; however, identified, introjected, and external regulation had low score reliability. Overall, a model comprising three single items for each of the following subscales was proposed for use within the CAPL-2: adequacy, predilection, intrinsic motivation, and perceived competence satisfaction. This revised domain fit well within the overall CAPL-2 model specifying a higher-order physical literacy factor (MLRχ2(63) = 81.45, p = 0.06, CFI = 0.908, RMSEA = 0.038, 90% CI (0.00, 0.060)). CONCLUSIONS: The revised and much shorter questionnaire of 12 items that aggregate to four subscales within the domain of Motivation and Confidence is recommended for use in the CAPL-2. The revised domain is aligned with the definition of motivation and confidence within physical literacy and has clearer instructions for completion.

Canadian Assessment of Physical Literacy Second Edition: a streamlined assessment of the capacity for physical activity among children 8 to 12 years of age.

BACKGROUND: The Canadian Assessment of Physical Literacy (CAPL) assesses the capacity of children to lead a physically active lifestyle. It is comprised of a battery of standardized assessment protocols that reflect the Canadian consensus definition of physical literacy. The Royal Bank of Canada Learn to Play - Canadian Assessment of Physical Literacy study implemented the CAPL with 10,034 Canadian children (50.1% female), 8 to 12 years of age. Feedback during data collection, necessary changes identified by the coordinating centre, and recent data analyses suggested that a streamlined, second edition of the CAPL was required. The purpose of this paper is to describe the methods used to develop the CAPL second edition (CAPL-2). METHODS: The larger dataset created through the RBC-Learn to Play CAPL study enabled the re-examination of the CAPL model through factor analyses specific to Canadian children 8 to 12 years of age from across Canada. This comprehensive database was also used to examine the CAPL protocols for redundancy or variables that did not contribute significantly to the overall assessment. Removing redundancy had been identified as a priority in order to reduce the high examiner and participant burden. The "lessons learned" from such a large national surveillance project were reviewed for additional information regarding the changes that would be required to optimize the assessment of children's physical literacy. In addition, administrative changes, improvements, and corrections were identified as necessary to improve the quality and accuracy of the CAPL manual and training materials. RESULTS: For each domain of the CAPL, recommended changes based on the factor analyses, qualitative feedback and theoretical considerations significantly reduced the number of protocols. Specific protocol combinations were then evaluated for model fit within the overarching concept of physical literacy. The CAPL-2 continues to reflect the four components of the Canadian consensus definition of physical literacy: Motivation and Confidence, Physical Competence, Knowledge and Understanding, and engagement in Physical Activity Behaviour. The CAPL-2 is comprised of three Physical Competence protocols (plank, Progressive Aerobic Cardiovascular Endurance Run [PACER], Canadian Agility and Movement Skill Assessment [CAMSA]), two Daily Behaviour protocol (pedometer steps, self-reported physical activity), and a 22-item questionnaire assessing the physical literacy domains of Motivation and Confidence, and Knowledge and Understanding. Detailed information about the CAPL-2 is available online ( www.capl-eclp.ca ). CONCLUSIONS: The CAPL-2 dramatically reduces examiner and participant burden (three Physical Competence protocols, two Daily Behaviour protocols, and a 22-response questionnaire; versus eight Physical Competence protocols, three Daily Behaviour protocols and a 72-response questionnaire for the original CAPL), while continuing to be a comprehensive assessment of all aspects of children's physical literacy using the Canadian consensus definition of this term. Like the original, the CAPL-2 continues to offer maximum flexibility to practitioners, who can choose to complete the entire CAPL-2 assessment, only one or more domains, or select individual protocols. Regardless of the assessment selected, scores are available to interpret the performance of each child relative to Canadian children of the same age and sex. All of the protocols included in the CAPL-2 have published reports of validity and reliability for this age group (8 to 12 years). The detailed manual for CAPL-2 administration, along with training materials and other resources, are available free of charge on the CAPL-2 website ( www.capl-eclp.ca ). All CAPL-2 materials and resources, including the website, are available in both English and French.

Associations between domains of physical literacy by weight status in 8- to 12-year-old Canadian children.

BACKGROUND: The Canadian Assessment of Physical Literacy (CAPL) is divided into four domains (Physical Competence, Daily Behaviour, Motivation and Confidence, and Knowledge and Understanding) and provides a robust and comprehensive assessment of physical literacy. As weight status is known to influence health-related behaviours such as physical fitness and activity, it is important to investigate whether the associations between the domains of physical literacy vary among children of different weight status. The aim of this study was to determine the associations among the four domains of physical literacy stratified by weight status. METHODS: Canadian children aged 8 to 12 years (n = 8343, 63.6% healthy-weight) completed the CAPL. Differences in domain scores and overall physical literacy score by weight status (children of healthy weight versus children with overweight/obese) were assessed using MANOVA (multivariate analysis of variance). Partial correlations between the four domains were calculated, adjusting for gender and age, and correlation coefficients of both weight status groups were compared using the Steiger test. RESULTS: For all four domains as well as overall physical literacy, healthy-weight children had higher scores than their overweight/obese peers (Cohen's d ranged from 0.05 to 0.44). Weak to moderate correlations were found between all of the domains for both groups. Correlation coefficients for Physical Competence and Daily Behaviour as well as for Physical Competence and Knowledge and Understanding were generally stronger in the healthy-weight children (r = 0.29 and 0.22, respectively) compared with the overweight/obese children (r = 0.23 and 0.17, respectively). CONCLUSIONS: All of the domains of the CAPL correlate positively with each other regardless of weight status, with a trend for these correlation coefficients to be slightly stronger in the healthy-weight children. The overall weak to moderate correlations between the domains in both groups suggest that the CAPL domains are not measuring the same constructs, thus providing support for CAPL's psychometric architecture in both healthy-weight and overweight/obese children.

A cross-sectional study exploring the relationship between age, gender, and physical measures with adequacy in and predilection for physical activity.

BACKGROUND: Physical literacy is a complex construct influenced by a range of physical, behavioural, affective, and cognitive factors. Researchers are interested in relationships among these constituent factors. The purpose of this study was to investigate how age, gender, and physical competence components of physical literacy relate to a child's adequacy in and predilection for physical activity. METHODS: A sample of 8530 Canadian youth (50% girl) aged 8.0 to 12.9 years participated in the study. Participants completed the Canadian Assessment of Physical Literacy (CAPL) protocol, which assesses physical literacy in four domains: Physical Competence, Daily Behaviour, Motivation and Confidence, and Knowledge and Understanding. Stepwise multiple regression analyses were conducted to investigate the relationship between physical competence components of physical literacy (Progressive Aerobic Cardiovascular Endurance Run [PACER], Canadian Agility and Movement Skill Assessment [CAMSA], sit and reach, handgrip, plank, and body mass index) and children's perceived adequacy and predilection toward physical activity as measured by subscales from the Children's Self-Perceptions of Adequacy in and Predilection for Physical Activity scale (CSAPPA). RESULTS: The variable most strongly associated with adequacy and predilection was the PACER shuttle run score. The PACER accounted for 10.9% of the variance in adequacy and 9.9% of the variance in predilection. Participants' age was inversely related to adequacy (ß = - 0.374) and predilection (ß = - 0.621). The combination of other variables related to adequacy brought the total variance explained to 14.7%, while the model for predilection explained a total of 13.7%. CONCLUSIONS: Results indicate an association between cardiorespiratory fitness and measures of physical activity adequacy and predilection. These findings suggest that practitioners should consider the physiological and psychological makeup of the child, and ways to enhance adequacy and predilection among children with limited cardiorespiratory fitness, in order to create the best possible environment for all children to participate in physical activity.

Associations between teacher training and measures of physical literacy among Canadian 8- to 12-year-old students.

BACKGROUND: Quality physical education (PE) contributes to the development of physical literacy among children, yet little is known about how teacher training relates to this development. We assessed the association between teacher training, and the likelihood that children met recommended achievement levels for components of physical literacy as defined by the Canadian Assessment of Physical Literacy (CAPL). METHODS: Canadian children (n = 4189; M = 10.72 years, SD = 1.19) from six provinces completed the CAPL. Logistic regression was used to examine the relationship between teacher training (generalist/PE specialist), adjusting for children's age and gender, and physical competence protocols (sit and reach, handgrip, plank, Progressive Aerobic Cardiovascular Endurance Run [PACER], body mass index [BMI], waist circumference, Canadian Agility and Movement Skill Assessment [CAMSA]), the four CAPL domain scores, and the total CAPL score. RESULTS: Teacher training, in addition to children's age and gender, explained only a very small proportion of variance in each model (all R2 < 0.03). Children taught by a generalist were less likely to reach recommended levels of motivation and confidence (OR = 0.83, 95% CI, 0.72-0.95) or CAMSA scores (OR = 0.77, 95% CI, 0.67-0.90), even when accounting for a significant increase in CAMSA score with age (OR = 1.18, 95% CI, 1.12-1.26). All other associations between measures of components of physical literacy and teacher training were not significant. CONCLUSIONS: While teacher training is hypothesized to contribute to the development of physical literacy among elementary school students, the observed effects in this study were either small or null. Children taught by PE specialists were more likely than those taught by generalists to demonstrate recommended levels of motivation and confidence, and to have better movement skills, which are hypothesized to be critical prerequisites for the development of a healthy lifestyle. Further research with more robust designs is merited to understand the impact of teachers' training on the various components of physical literacy development.

The relationship between sedentary behaviour and physical literacy in Canadian children: a cross-sectional analysis from the RBC-CAPL Learn to Play study.

BACKGROUND: Physical literacy is the foundation of a physically active lifestyle. Sedentary behaviour displays deleterious associations with important health indicators in children. However, the association between sedentary behaviour and physical literacy is unknown. The purpose of this study was to identify the aspects of physical literacy that are associated with key modes of sedentary behaviour among Canadian children participating in the RBC-CAPL Learn to Play study. METHODS: A total of 8,307 children aged 8.0-12.9 years were included in the present analysis. Physical literacy was assessed using the Canadian Assessment of Physical Literacy, which measures four domains (Physical Competence, Daily Behaviour, Motivation and Confidence, Knowledge and Understanding). Screen-based sedentary behaviours (TV viewing, computer and video game use), non-screen sedentary behaviours (reading, doing homework, sitting and talking to friends, drawing, etc.) and total sedentary behaviour were assessed via self-report questionnaire. Linear regression models were used to determine significant (p<0.05) correlates of each mode of sedentary behaviour. RESULTS: In comparison to girls, boys reported more screen time (2.7±2.0 vs 2.2±1.8 hours/day, Cohen's d=0.29), and total sedentary behaviour (4.3±2.6 vs 3.9±2.4 hours/day, Cohen's d=0.19), but lower non-screen-based sedentary behaviour (1.6±1.3 vs 1.7±1.3 hours/day, Cohen's d=0.08) (all p< 0.05). Physical Competence (standardized ß's: -0.100 to -0.036, all p<0.05) and Motivation and Confidence (standardized ß's: -0.274 to -0.083, all p<0.05) were negatively associated with all modes of sedentary behaviour in fully adjusted models. Knowledge and Understanding was negatively associated with screen-based modes of sedentary behaviour (standardized ß's: -0.039 to -0.032, all p<0.05), and positively associated with non-screen sedentary behaviour (standardized ß: 0.098, p<0.05). Progressive Aerobic Cardiovascular Endurance Run score and log-transformed plank score were negatively associated with all screen-based modes of sedentary behaviour, while the Canadian Agility and Movement Skill Assessment score was negatively associated with all modes of sedentary behaviour other than TV viewing (all p<0.05). CONCLUSIONS: These results highlight differences in the ways that screen and non-screen sedentary behaviours relate to physical literacy. Public health interventions should continue to target screen-based sedentary behaviours, given their potentially harmful associations with important aspects of physical literacy.

The relationship between physical literacy scores and adherence to Canadian physical activity and sedentary behaviour guidelines.

BACKGROUND: Physical literacy is an emerging construct in children's health promotion, and may impact their lifelong physical activity habits. However, recent data reveal that only a small portion of Canadian children are regularly physically active and/or meet sedentary behaviour guidelines. To our knowledge, no study has investigated the association between physical literacy and movement behaviour guidelines. Therefore, the purpose of this study was to examine the relationship between physical literacy scores in Canadian children who meet or do not meet physical activity and sedentary behaviour guidelines. METHODS: Children (n = 2956; 56.6% girls) aged 8-12 years from 10 Canadian cities had their physical literacy levels measured using the Canadian Assessment of Physical Literacy, which consists of four domains (Physical Competence; Daily Behaviour; Knowledge and Understanding; and Motivation and Confidence) that are aggregated to provide a composite physical literacy score. Physical activity levels were measured by pedometers, and sedentary behaviour was assessed through self-report questionnaire. Analyses were conducted separately for each guideline, comparing participants meeting versus those not meeting the guidelines. Comparisons were performed using MANOVA and logistic regression to control for age, gender, and seasonality. RESULTS: Participants meeting physical activity guidelines or sedentary behaviour guidelines had higher physical literacy domain scores for Physical Competence and for Motivation and Confidence compared to those not meeting either guideline (both p < 0.0001). Participants had increased odds of meeting physical activity guidelines and sedentary behaviour guidelines if they met the minimum recommended level of the Physical Competence and Motivation and Confidence domains. Significant age (OR 0.9; 95% CI: 0.8, 0.9), gender (OR 0.4; 95% CI: 0.3, 0.5) and seasonality effects (OR 1.6; 95% CI: 1.2, 2.2 spring and OR 1.7; 95% CI: 1.2, 2.5 summer, reference winter) were seen for physical activity guidelines, and age (OR 0.8; 95% CI: 0.7, 0.8) and gender effects (OR 1.7; 95% CI: 1.4, 2.0) for sedentary behaviour guidelines. Knowledge and Understanding of physical activity principles was not related to guideline adherence in either model. CONCLUSIONS: These cross-sectional findings demonstrate important associations between physical literacy and guideline adherence for physical activity and sedentary behaviour. Future research should explore the causality of these associations.

Cardiorespiratory fitness is associated with physical literacy in a large sample of Canadian children aged 8 to 12 years.

BACKGROUND: The associations between cardiorespiratory fitness (CRF) and physical literacy in children are largely unknown. The aim of this study was to assess the relationships between CRF, measured using the 20-m shuttle run test (20mSRT), and components of physical literacy among Canadian children aged 8-12 years. METHODS: A total of 9393 (49.9% girls) children, with a mean (SD) age of 10.1 (±1.2) years, from a cross-sectional surveillance study were included for this analysis. The SRT was evaluated using a standardized 15 m or 20 m protocol. All 15 m SRTs were converted to 20mSRT values using a standardized formula. The four domains of physical literacy (Physical Competence, Daily Behaviour, Motivation and Confidence, and Knowledge and Understanding) were measured using the Canadian Assessment of Physical Literacy. Tertiles were identified for 20mSRT laps, representing low, medium, and high CRF for each age and gender group. Cohen's d was used to calculate the effect size between the low and high CRF groups. RESULTS: CRF was strongly and favourably associated with all components of physical literacy among school-aged Canadian children. The effect size between low and high CRF tertile groups was large for the Physical Competence domain (Cohen's d range: 1.11-1.94) across age and gender groups, followed by moderate to large effect sizes for Motivation and Confidence (Cohen's d range: 0.54-1.18), small to moderate effect sizes for Daily Behaviour (Cohen's d range: 0.25-0.81), and marginal to moderate effect sizes for Knowledge and Understanding (Cohen's d range: 0.08-0.70). CONCLUSIONS: This study identified strong favourable associations between CRF and physical literacy and its constituent components in children aged 8-12 years. Future research should investigate the sensitivity and specificity of the 20mSRT in screening those with low physical literacy levels.