Economic burden of low cardiorespiratory fitness in Canada.

The objective of this study was to estimate health care and health-related productivity costs associated with low cardiorespiratory fitness (CRF) in Canadian adults. We also estimated costs that would be avoided by a 10 percentage point prevalence reduction in low CRF. A prevalence-based approach was used to estimate the economic costs associated with low CRF. Three pieces of information were used: (1) the pooled relative risk estimates of adverse health outcomes consistently associated with low CRF obtained from meta-analyses of prospective cohort studies; (2) the prevalence of low CRF in Canadian men and women obtained from a nationally representative sample; and (3) the direct (health care) and indirect (lost productivity due to premature mortality) costs of the adverse health outcomes based on the Economic Burden of Illness in Canada data. We estimated the total annual economic burden of low CRF in Canadian adults at CAD$3.6 billion, representing 2.7% of the overall Canadian burden of illness costs in 2021. The three most expensive chronic diseases attributable to low CRF were type 2 diabetes (CAD$1.3 billion), heart disease (CAD$701 million), and depression/anxiety (CAD$565 million). Prescription drug expenditures and hospital care expenditures were the main contributors to the total economic burden. An absolute 10% reduction in the prevalence of low CRF (from 45.5% to 35.5%) would save an estimated CAD$644 million per year in costs. In conclusion, low CRF is an important contributor to the economic burden of illness in Canada. Evidence-based and cost-effective strategies that aim to increase CRF at the population level may help alleviate health care costs and improve health.

Physical environment features that predict outdoor active play can be measured using Google Street View images.

BACKGROUND: Childrens' outdoor active play is an important part of their development. Play behaviour can be predicted by a variety of physical and social environmental features. Some of these features are difficult to measure with traditional data sources. METHODS: This study investigated the viability of a machine learning method using Google Street View images for measurement of these environmental features. Models to measure natural features, pedestrian traffic, vehicle traffic, bicycle traffic, traffic signals, and sidewalks were developed in one city and tested in another. RESULTS: The models performed well for features that are time invariant, but poorly for features that change over time, especially when tested outside of the context where they were initially trained. CONCLUSION: This method provides a potential automated data source for the development of prediction models for a variety of physical and social environment features using publicly accessible street view images.

The neighborhood physical environment and the 24-hour movement behavior composition among children.

The time spent in sleep, sedentary behavior, and physical activity form a 24-hour movement behavior composition. The objective was to identify neighborhood physical environment features associated with multiple components of the movement behavior composition among 10 to 13-year-olds. Twenty-three neighborhood physical environment features were measured in 1 km buffers from the participants' homes and from these walkability, traffic safety, dedicated play spaces, non-dedicated play spaces, noise, and artificial light indices were created. Moderate-to-vigorous physical activity, light physical activity, sedentary time, and sleep duration were measured. Compositional data analysis was used to establish differences in movement behaviors according to neighborhood physical environment features. One hundred and sixteen associations, reflecting four movement behaviors X 29 environment variables and indices, were examined. Only three of these were statistically significant. Therefore, neighborhood physical environment features were not meaningful correlates of 24-hour movement behaviors.

The impact of donor type on resource utilisation and costs in allogeneic haematopoietic stem cell transplantation in the Netherlands.

BACKGROUND: Allogeneic haematopoietic stem cell transplantation (HSCT) is increasingly used, but this treatment is complex and costly. As clinical outcomes of HSCT with matched unrelated donor (MUD) and haploidentical donors are similar, costs could influence donor choice. METHOD: We retrospectively compared resource utilisation and costs of HSCT using the three different donor types (matched related donor (MRD) (n = 32), haploidentical related (n = 30) and MUD (n = 60)) within the first year after transplantation. Costs were analysed through a bottom-up method. Non-parametric bootstrapping was applied to test for statistical differences in costs. Subgroup analyses were performed to identify predictors for costs. RESULTS: Cost pre-transplant for search and acquisition of the graft were significantly higher in MUD HSCT (€35 222) versus MRD and haploidentical HSCT (€15 356 and €16 097 respectively). The costs of haploidentical HSCT were the highest in the transplant phase. Main cost factors were inpatient days and medication. Overall, the costs for haploidentical and MUD HSCT were similar (€115 724 for MUD, €113 312 for haploidentical). CONCLUSION: Our study suggests no difference in total transplantation costs between allogeneic HSCT using a MUD or a haploidentical donor. Since clinical outcomes seem similar as well, the choice of donor type might be based on availability, speed and logistics.

Longitudinal Associations Between e-Cigarette Use, Cigarette Smoking, Physical Activity, and Recreational Screen Time in Canadian Adolescents.

INTRODUCTION: This study examined longitudinal associations between e-cigarette use, cigarette smoking, physical activity, and recreational screen time (ST) in a cohort of Canadian adolescents (ages 14-17 years; grades 9-12). AIMS AND METHODS: Data from 5951 adolescents who participated in COMPASS Year 4 (2015-2016; baseline) and Year 6 (2017-2018; follow-up) were used. Exposures included e-cigarette use and cigarette smoking. Outcomes included cutpoints for moderate- to vigorous-physical activity (MVPA; ≥60 min/d), muscular strengthening exercises (MSE; ≥3 time/wk), participation in sport (SP; intramural or competitive), and recreational screen time (ST; ≤430 min/day). Generalized linear mixed models were performed. RESULTS: e-Cigarette use (16.6% vs. 39.2%), cigarette smoking (0.9% vs. 4.7%), and dual use (0.8% vs. 4.1%) increased from baseline to follow-up. SP (70.8% vs. 61.3%) and the prevalence of meeting MVPA (49.8% vs. 42.1%) and MSE cutpoints (54.0% vs. 45.3%) decreased from baseline to follow-up. Recreational ST remained similar from baseline to follow-up. New e-cigarette use at follow-up was associated with maintenance of SP and meeting MVPA and MSE cutpoints, but also with increased ST. New cigarette smoking at follow-up was associated with maintaining high ST and low SP. Cigarette smoking at baseline and follow-up was associated with maintaining high ST, low MSE, and low SP. Cigarette smoking cessation at follow-up was associated with increasing MVPA and MSE, decreasing ST, and maintaining low SP. CONCLUSION: Given the clustering and co-occurring unhealthy behavioral patterns, intervention strategies to promote healthy lifestyles should take a holistic approach, by targeting multiple behavioral changes simultaneously. IMPLICATIONS: This investigation highlighted that, unhealthy behaviors, particularly e-cigarette use, cigarette smoking, and excessive use of screens, tend to co-occur among Canadian adolescents. Therefore, intervention strategies to promote healthy lifestyles should take a holistic approach, by targeting multiple behavioral changes simultaneously particularly in school and community settings. As an exception, new and stable e-cigarette use appears to co-occur with achieving sufficient levels of physical activity. Increasing awareness about the risk of e-cigarette use may target population groups that are physically and socially active (eg, athletes, sport teams).

Health associations with meeting the Canadian 24-hour movement guidelines for adults: Results from the Canadian Health Measures Survey.

BACKGROUND: The Canadian 24-Hour Movement Guidelines for Adults (18-64 years and 65 years or older) were launched in October 2020 and provide evidence-based recommendations for physical activity, sedentary behaviour and sleep. The purpose of this study was to examine whether meeting the 24-Hour Movement Guidelines overall, and different combinations of recommendations within the guidelines, was associated with health indicators in a representative sample of Canadian adults. DATA AND METHODS: Participants were 8,297 adults aged 18 to 79 from cycles 1 to 3 of the Canadian Health Measures Survey. They were classified as meeting or not meeting each of the recommendations required for overall guideline adherence: moderate-to-vigorous physical activity (150 minutes or more per week), sedentary behaviour (8 hours or less per day or 9 hours or less per day of sedentary time, including 3 hours or less per day of recreational screen time) and sleep duration (7 to 9 hours per day for adults 18 to 64 years old, 7 to 8 hours per day for adults aged 65 years or older). A combination of self-reported and device-based measures were used. Indicators of adiposity (n=2), aerobic fitness (n=1) and cardiometabolic health (n=7) were measured. RESULTS: A total of 19.1% of the sample met none of the recommendations, 43.9% met one of them, 29.8% met two and 7.1% met all three. Compared with meeting no recommendations, meeting one, two and all three recommendations was associated with better health for one, six and seven health indicators, respectively (p < 0.05). Compared with adults meeting two or fewer recommendations, those who met all three recommendations had more favourable body mass index; waist circumference; aerobic fitness scores; and triglyceride, insulin, C-reactive protein and serum glucose levels (p < 0.05). INTERPRETATION: These findings provide support for the 24-Hour Movement Guidelines and show that less than 1 in 10 Canadian adults are meeting all three of the healthy movement behaviour guidelines.

A compositional analysis of time spent in sleep, sedentary behaviour and physical activity with all-cause mortality risk.

BACKGROUND: Daily time spent in sleep, sedentary behaviour (SED), light intensity physical activity (LIPA), and moderate-to-vigorous intensity physical activity (MVPA) are compositional, co-dependent variables. The objectives of this study were to use compositional data analysis to: (1) examine the relationship between the movement behaviour composition (daily time spent in sleep, SED, LIPA and MVPA) and all-cause mortality risk, and (2) estimate the extent to which changing time spent in any given movement behaviour (sleep, SED, LIPA, or MVPA) within the movement behaviour composition was associated with changes in risk of all-cause mortality. METHODS: 2838 adult participants from the 2005-2006 cycle of the U.S. National Health and Nutrition Examination Survey were studied using a prospective cohort design. Daily time spent in SED, LIPA and MVPA were determined by accelerometer. Nightly time spent sleeping was self-reported. Survey data were linked with mortality data through to the end of December 2015. Compositional data analysis was used to investigate relationships between the movement behaviour composition and mortality. RESULTS: The movement behaviour composition was significantly associated with mortality risk. Time spent in MVPA relative to other movement behaviours was negatively associated with mortality risk (HR = .74; 95% CI [.67, .83]) while relative time spent in SED was positively associated with mortality risk (HR = 1.75; 95% CI [1.10, 2.79]). Time displacement estimates revealed that the greatest estimated changes in mortality risk occurred when time spent in MVPA was decreased and replaced with sleep, SED, LIPA or a combination of these behaviours (HRs of 1.76 to 1.80 for 15 min/day displacements). CONCLUSIONS: The daily movement behaviour composition was related to mortality. Replacing time in MVPA or SED with equivalent time from any other movement behaviour was associated with an increase and decrease in mortality risk, respectively.

Systematic review of the correlates of outdoor play and time among children aged 3-12 years.

BACKGROUND: Due to the myriad of benefits of children's outdoor play and time, there is increasing concern over its decline. This systematic review synthesized evidence on the correlates of outdoor play and outdoor time among children aged 3-12 years. METHODS: A total of 12 electronic databases in five different languages (Chinese, English, Korean, Spanish, Portuguese) were searched between October 28, 2019 and July 27, 2020. Covidence software was used for screening and Microsoft Excel with a predesigned coding form was used for data extraction. Evidence was synthesized and correlates were categorized using the socioecological model framework. RESULTS: Based on 107 studies representing 188,498 participants and 422 childcare centers from 29 countries, 85 studies examined potential correlates of outdoor play while 23 studies examined that of outdoor time (one examined both). The duration of outdoor play and outdoor time ranged between 60 and 165 min/d and 42-240 min/d, respectively. Out of 287 (outdoor play) and 61 (outdoor time) potential correlates examined, 111 correlates for outdoor play and 33 correlates for outdoor time were identified as significant correlates. Thirty-three variables were identified as key/common correlates of outdoor play/time, including eight correlates at the individual level (e.g., sex/gender, race/ethnicity, physical activity), 10 correlates at the parental level (e.g., parental attitude/support/behavior, parenting practice), nine at the microsystem level (e.g., proximal home/social environment such as residence type, peer influence), three at the macrosystem/community level (e.g., availability of space children can play), and three at the physical ecology/pressure for macrosystem change level (e.g., seasonality, rurality). No key correlates were found at the institutional level. CONCLUSIONS: Individual, parental, and proximal physical (home) and social environments appear to play a role in children's outdoor play and time. Ecological factors (i.e., seasonality, rurality) also appear to be related to outdoor play/time. Evidence was either inconsistent or lacking at institutional and macrosystem/community levels. Standardizing terminology and measures of outdoor play/time is warranted. Future work should investigate the interactions and processes of multiple variables across different levels of socioecological modelling to better understand the mechanisms through which outdoor play/time opportunities can be optimized for children while paying special attention to varying conditions in which children are born, live, and play.

Global prevalence of physical activity for children and adolescents; inconsistencies, research gaps, and recommendations: a narrative review.

BACKGROUND: One of the strategic actions identified in the Global Action Plan on Physical Activity (PA) 2018-2030 is the enhancement of data systems and capabilities at national levels to support regular population surveillance of PA. Although national and international standardized surveillance of PA among children and adolescents has increased in recent years, challenges for the global surveillance of PA persist. The aims of this paper were to: (i) review, compare, and discuss the methodological inconsistencies in children and adolescents' physical activity prevalence estimates from intercontinental physical activity surveillance initiatives; (ii) identify methodological limitations, surveillance and research gaps. METHODS: Intercontinental physical activity surveillance initiatives for children and adolescents were identified by experts and through non-systematic literature searches. Prevalence of meeting PA guidelines by country, gender, and age were extracted when available. A tool was created to assess the quality of the included initiatives. Methods and PA prevalence were compared across data/studies and against the methodological/validity/translation differences. RESULTS: Eight intercontinental initiatives were identified as meeting the selection criteria. Methods and PA definition inconsistencies across and within included initiatives were observed, resulting in different estimated national prevalence of PA, and initiatives contradicting each other's cross-country comparisons. Three findings were consistent across all eight initiatives: insufficient level of PA of children and adolescents across the world; lower levels of PA among girls; and attenuation of PA levels with age. Resource-limited countries, younger children, children and adolescents not attending school, with disability or chronic conditions, and from rural areas were generally under/not represented. CONCLUSIONS: There are substantial inconsistencies across/within included initiatives, resulting in varying estimates of the PA situation of children and adolescents at the global, regional and national levels. The development of a new PA measurement instrument that would be globally accepted and harmonized is a global health priority to help improve the accuracy and reliability of global surveillance.

The Canadian 24-Hour Movement Guidelines and Psychological Distress among Adolescents: Les Directives canadiennes en matière de mouvement sur 24 heures et la détresse psychologique chez les adolescents.

OBJECTIVE: The Canadian 24-Hour Movement Guidelines for Children and Youth recommend at least 60 minutes of physical activity per day, 2 hours or less of recreational screen time per day, and 9 to 11 hours of sleep per night for 5 to 13 years old and 8 to 10 hours per night for 14 to 17 years old. This study examined the association between meeting these guidelines and psychological distress among adolescents. METHODS: The present cross-sectional sample included 6,364 students aged 11 to 20 years from the 2017 Ontario Student Drug Use and Health Survey. This provincially representative school-based survey is based on a 2-stage cluster design. A confirmatory factor analysis (CFA) was first conducted to confirm the factor structure of the K6, and structural equation modeling adjusted for age, sex, ethnoracial background, subjective socioeconomic status, and body mass index z-score was used to investigate the association between meeting the 24-Hour Movement Guidelines and K6 factors among adolescents. RESULTS: The CFA demonstrated that a 2-factor model (representing anxiety and depressive symptoms) of the K6 fit the data well. The anxiety and depression items demonstrated a composite reliability (Cronbach's α) of 0.86 and 0.83, respectively, indicating a high level of internal consistency. Compared to meeting none of the recommendations, meeting all 3 movement behavior recommendations was associated with lower anxiety (ß = -0.076; P = 0.028) and depressive symptoms (ß = -0.067; P = 0.028). Meeting the screen time + sleep duration recommendations had the strongest association with anxiety (ß = -0.157; P < 0.001) and depressive symptoms (ß = -0.139; P < 0.001), followed by meeting the sleep duration recommendation only for both anxiety (ß = -0.135; P < 0.001) and depressive symptoms (ß = -0.106; P < 0.001). CONCLUSIONS: Meeting the 24-Hour Movement Guidelines was associated with lower anxiety and depressive symptoms among adolescents, and these associations appear mainly driven by meeting the sleep duration recommendation.

Do adolescent sedentary behavior levels predict type 2 diabetes risk in adulthood?

BACKGROUND: The objective was to determine whether time spent in different types of sedentary behavior during adolescence are associated with the risk of developing type 2 diabetes in adulthood. METHODS: Participants were 3942 adolescents aged 16 years who were part of the 1970 British Cohort Study. Sedentary behavior was assessed using a questionnaire that asked participants to indicate how much time they spent watching TV and videos, using the computer, reading, and doing homework. Incident cases of type 2 diabetes were determined quadrennially until 46 years of age. The association between adolescent sedentary behaviors and type 2 diabetes was determined using Cox proportional hazards regression that controlled for sex, body mass index, sugary beverage consumption, smoking status, physical activity at baseline, and physical activity in adulthood . RESULTS: There were 91 incident cases of type 2 diabetes with an incidence rate of 9 cases/10,000 person-years. By comparison to those who watched TV and videos for 2 or less hours/day, type 2 diabetes risk was not different in those who watched for 2.1-4.0 h/day (HR = 0.89, 95% CI = 0.54, 1.47) but was increased by 2.06-fold (95% CI = 1.24, 3.43) in those who watched for more than 4 h/day. Time spent using a computer, reading, and doing homework were not significantly associated with type 2 diabetes. CONCLUSION: Spending more than 4 h/day watching television and videos at age 16 was associated with an increased risk of type 2 diabetes. Conversely, using a computer and non-screen based sedentary behaviors were not associated with type 2 diabetes risk.

Do fit kids have fit parents?

BACKGROUND: Physical fitness is an important indicator of current and future health status. This analysis examines the relationships among child-parent dyads in physical fitness measures. DATA AND METHODS: The analysis is based on biological child-parent dyads from three cycles of the Canadian Health Measures Survey (Cycle 1: 2007 to 2009, Cycle 2: 2009 to 2011, and Cycle 5: 2016 to 2017). Physical fitness components-cardiorespiratory (CRF) (n = 615), muscular strength (n = 1,319) and flexibility (n = 1,295)-were measured at mobile examination centres using standardized fitness tests. Descriptive, correlation and regression analyses were used to examine relationships among child-parent dyads. RESULTS: CRF (R = 0.12), muscular strength (R = 0.23) and flexibility (R = 0.22) measures were weakly correlated among child-parent dyads. Modest increases in the physical fitness levels of children were observed with increases in the fitness rating scores of their parents. According to unadjusted and adjusted regression models, CRF (p< 0.05), muscular strength (p< 0.001) and flexibility (p< 0.001) were positively associated among child-parent dyads. When examined by sex of parent and child, CRF was significantly associated in mother-son dyads only, grip strength was associated in all dyad types except father-son pairings, and flexibility was associated in mother-son and father-son pairings only. DISCUSSION: A significant and positive association was evident in measured physical fitness among parents and children. Some variation in the presence and strength of associations existed according to child and parent sex.

Trends in physical fitness among Canadian adults, 2007 to 2017.

BACKGROUND: The fitness levels of Canadian adults declined substantially between 1981 and the years 2007 to 2009, suggesting a reduction in population health. This paper updates the fitness trends of Canadians aged 20 to 69 years by extending the time period to 2017. DATA AND METHODS: The Canadian Health Measures Survey is a repeated cross-sectional survey that is conducted to produce nationally representative health estimates. Descriptive statistics are presented for fitness measures in 2016 and 2017 by age and sex, and trends in fitness were calculated spanning a period of 10 years (2007 to 2017). The associations between fitness measures and meeting the 2020 Canadian physical activity recommendations were also assessed. RESULTS: From 2007 to 2017, there were few statistically significant changes in the fitness levels of Canadian adults. When all ages were combined, there were declining trends in predicted cardiorespiratory fitness, from 39.5 to 36.7 mL•kg⁻¹â€¢min⁻¹ among men and 34.0 to 32.2 mL•kg⁻¹â€¢min⁻¹ among women. Trends indicated declining flexibility among men. In general, meeting the current Canadian moderate-to-vigorous physical activity recommendation was associated with better fitness, particularly in the categories of predicted cardiorespiratory fitness and body composition. INTERPRETATION: The periodic assessment of fitness in Canadians provides valuable insight into population health. The present update provides evidence that fitness levels among adults have generally stabilized over the past 10 years. Taken with the reported declines in fitness that occurred from 1981 to the 2007-to-2009 period, this study shows that the fitness of Canadian adults remained low between 2007 to 2009 and 2016 to 2017. It is necessary to explore new ways to help improve the fitness levels of the Canadian population.

Cardiovascular and diabetes burden attributable to physical inactivity in Mexico.

BACKGROUND: Physical inactivity (PI) is associated with the development of non-communicable chronic diseases. The purposes of this study were to estimate the extent to which the 31% relative increase in PI among 35-64 years old Mexicans between 2006 and 2012 influenced diabetes (T2D) and cardiovascular disease (CVD) incidence and mortality, and to estimate the impact of the World Health Organization recommended 10% and 15% relative decrease in PI on CVD and T2D incidence and mortality by 2025 and 2030, respectively. METHODS: Estimates were derived using the Cardiovascular Disease Policy Model-Mexico, a computer simulation, Markov model. Model inputs included cross-national data on PI levels from 2006 and 2012 measured using the International Physical Activity Questionnaire and the published literature review on the independent relationship between PI and cardiometabolic risk. RESULTS: The models estimated that the 31% increase in PI resulted in an increase in the number of cases of T2D (27,100), coronary heart disease (10,300), stroke (2200), myocardial infarction (1500), stroke deaths (400) and coronary heart disease deaths (350). A hypothetical 10% lowering of PI by 2025 compared to status quo is projected to prevent 8400 cases of T2D, 4200 cases of CHD, 1000 cases of stroke, 700 cases of MI, and 200 deaths of CHD and stroke, respectively. A 15% reduction resulted in larger decreases. CONCLUSIONS: While the burden of T2D and CVD raised from 2006 to 2012 in association with increased PI, achieving the WHO targets by 2030 could help reverse these trends.

Combinations of physical activity, sedentary time, and sleep duration and their associations with depressive symptoms and other mental health problems in children and adolescents: a systematic review.

BACKGROUND: For optimal health benefits, the Canadian 24-Hour Movement Guidelines for Children and Youth (aged 5-17 years) recommend an achievement of high levels of physical activity (≥60 min of moderate-to-vigorous physical activity), low levels of sedentary behaviour (≤2 h of recreational screen time), and sufficient sleep (9-11 h for children or 8-10 h for adolescents) each day. The objective of this systematic review was to examine how combinations of physical activity, sedentary time, and sleep duration relate to depressive symptoms and other mental health indicators among children and adolescents. METHODS: Literature was obtained through searching Medline, EMBASE, PsycINFO, and SportDiscus up to September 30, 2019. Peer-reviewed studies published in English or French were included if they met the following criteria: population (apparently healthy children and adolescents with a mean age of 5-17 years), intervention/exposure (combinations of physical activity, sedentary time, and sleep duration), and outcomes (depressive symptoms and other mental health indicators). A risk of bias assessment was completed for all included studies using the methods described in the Cochrane Handbook. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the quality of evidence for each health indicator. Narrative syntheses were employed to describe the results due to high levels of heterogeneity across studies. RESULTS: A total of 13 cross-sectional studies comprised in 10 papers met inclusion criteria. Data across studies involved 115,540 children and adolescents from 12 countries. Overall, the findings indicated favourable associations between meeting all 3 recommendations and better mental health indicators among children and adolescents when compared with meeting none of the recommendations. There was evidence of a dose-response gradient between an increasing number of recommendations met and better mental health indicators. Meeting the screen time and sleep duration recommendations appeared to be associated with more mental health benefits than meeting the physical activity recommendation. The quality of evidence reviewed was "very low" according to GRADE. CONCLUSIONS: The findings indicate favourable associations between meeting all 3 movement behaviour recommendations in the 24-h guidelines and better mental health indicators among children and adolescents. There is a clear need for high-quality studies that use robust measures of all movement behaviours and validated measures of mental health to increase our understanding in this topic area.

Development of a consensus statement on the role of the family in the physical activity, sedentary, and sleep behaviours of children and youth.

BACKGROUND: Children and youth who meet the physical activity, sedentary, and sleep behaviour recommendations in the Canadian 24-Hour Movement Guidelines are more likely to have desirable physical and psychosocial health outcomes. Yet, few children and youth actually meet the recommendations. The family is a key source of influence that can affect lifestyle behaviours. The purpose of this paper is to describe the process used to develop the Consensus Statement on the Role of the Family in the Physical Activity, Sedentary, and Sleep Behaviours of Children and Youth (0-17 years) and present, explain, substantiate, and discuss the final Consensus Statement. METHODS: The development of the Consensus Statement included the establishment of a multidisciplinary Expert Panel, completion of six reviews (three literature, two scoping, one systematic review of reviews), custom data analyses of Statistics Canada's Canadian Health Measures Survey, integration of related research identified by Expert Panel members, a stakeholder consultation, establishment of consensus, and the development of a media, public relations, communications and launch plan. RESULTS: Evidence from the literature reviews provided substantial support for the importance of family on children's movement behaviours and highlighted the importance of inclusion of the entire family system as a source of influence and promotion of healthy child and youth movement behaviours. The Expert Panel incorporated the collective evidence from all reviews, the custom analyses, other related research identified, and stakeholder survey feedback, to develop a conceptual model and arrive at the Consensus Statement: Families can support children and youth in achieving healthy physical activity, sedentary and sleep behaviours by encouraging, facilitating, modelling, setting expectations and engaging in healthy movement behaviours with them. Other sources of influence are important (e.g., child care, school, health care, community, governments) and can support families in this pursuit. CONCLUSION: Family is important for the support and promotion of healthy movement behaviours of children and youth. This Consensus Statement serves as a comprehensive, credible, and current synopsis of related evidence, recommendations, and resources for multiple stakeholders.

Patterns of daily activity among young people with epilepsy.

AIM: To: (1) explore how young people with epilepsy spend time on physical activity, screen-time, and sleep in a 24-hour period; (2) compare these findings to young people without epilepsy; and (3) evaluate the findings relative to the Canadian 24-hour movement guidelines for children and youth. METHOD: The study is based on Canadian data from the 2013 to 2014 'Health Behaviour in School-aged Children study' (HBSC), a cross-sectional sample of young people aged 10 to 17 years. Three groups participated: 163 young people with epilepsy, 3613 young people with non-neurological conditions, and 18 339 population norms. Self-reported activity data were compared across groups. RESULTS: Demographics were similar across groups. Young people with epilepsy spent 5.8 hours per week on moderate-to-vigorous physical activity versus 5.6 hours per week in population norms; 32% met the recommended 1 hour or more per day. Screen-time was 8.7 hours per day versus 7.4 hours per day in population norms; only 5.4% met the 2 hours or less per day recommendation. Sleep duration was 10.2 hours per day versus 9.8 hours per day in population norms, and 50.7% met the recommendation. Overall, 25.7% of young people with epilepsy did not meet any of the guidelines, 60.5% met one, 13.5% met two, and 0.3% met all three recommendations; whereas 2.8% of population norms and 2% of young people with non-neurological conditions met all three recommendations. INTERPRETATION: These data could inform future interventions and alert policy-makers, health care professionals, parents, educators, and advocacy-groups to the low adherence of young people with epilepsy with Canadian guidelines and their risk for poor health. WHAT THIS PAPER ADDS: Young people with epilepsy adhere poorly to Canadian guidelines for daily sleep duration, physical activity, and sedentary screen time. Young people with epilepsy accumulate more screen-time than those with non-neurological conditions or population norms.

PATRONES DE ACTIVIDAD DIARIA ENTRE JÓVENES CON EPILEPSIA: OBJETIVO: 1) Explorar como los jóvenes con epilepsia invierten su tiempo en actividad física, tiempo de pantalla, y sueño, en un período de 24 horas. 2) Comparar estos hallazgos con jóvenes sin epilepsia. 3) Evaluar estos hallazgos en relación con las guías canadienses de movimiento en 24 horas para niños y jóvenes. METODO: El estudio se basa en datos canadienses de 2013 a 2014. Estudio del comportamiento saludable en niños de edad escolar. Es un estudio transversal con jóvenes de 10 a 17 años. Tres grupos participaron: 163 jóvenes con epilepsia, 3.613 jóvenes con condiciones no neurológicas y 18.339 jóvenes con desarrollo típico. Los auto reportes fueron comparados entre los grupos. RESULTADOS: Los datos demográficos fueron similares entre los grupos. Los jóvenes con epilepsia pasan 5,8 horas por semana con actividad física moderada a vigorosa, versus 5,6 horas por semana en la población normal. En total, 32% cumplía la recomendación de actividad física de 1 hora o más al día. El tiempo de pantalla fue de 8,7 horas al día versus 7,4 horas al día en población típica, solo 5,4% cumple las 2 horas o menos al día recomendadas. La duración del sueño fue de 10,2 horas al día versus 9,8 horas al día en población típica y 50,7% cumple la recomendación. En general 25,7% de los jóvenes con epilepsia no cumple ninguna de las recomendaciones, 60,5% cumple una recomendación, 13,5% cumple 2 y el 0,3% cumple las 3 recomendaciones; mientras que 2,8% de la población sana y 2% de la población con condiciones no neurológicas cumple las 3 recomendaciones. INTERPRETACIÓN: Estos datos pueden ayudar a planear intervenciones futuras y alertar a responsables de crear políticas públicas, profesionales de la salud, padres, educadores y grupos de derechos, sobre la baja adherencia de jóvenes con epilepsia a las guías canadienses y su riesgo para la salud.

PADRÕES DE ATIVIDADE DIÁRIA EM JOVENS COM EPILEPSIA: OBJETIVO: (1) Explorar como jovens com epilepsia passam o tempo com relação a atividade física, tempo de tela e sono em um período de 24 horas; (2) comparar esses achados com jovens sem epilepsia e (3) avaliar os achados relativos as Diretrizes Canadenses de movimentação 24 horas para crianças e jovens. MÉTODOS: O estudo foi baseado nos dados Canadenses de 2013 a 2014 'Estudo do comportamento em saúde em crianças em idade escolar' (ECSCE), uma amostra transversal de jovens de 10 a 17 anos. Participaram três grupos: 163 jovens com epilepsia, 3.613 jovens com condições não neurológicas e 18.339 jovens da população típica. Os dados de atividades autorreferidos foram comparados entre os grupos. RESULTADOS: Os dados demográficos foram semelhantes entre os grupos. Jovens com epilepsia gastaram 5,8 horas por semana realizando atividade física moderada a vigorosa versus 5,6 horas por semana na população típica; 32% cumpriram a recomendação de 1 hora ou mais por dia. O tempo de tela foi de 8,7 horas por dia versus 7,4 horas por dia na população típica; apenas 5,4% cumpriram a recomendação de 2 horas ou menos por dia. A duração do sono foi de 10,2 horas por dia versus 9,8 horas por dia na população típica e 50,7% cumpriram a recomendação. No geral, 25,7% dos jovens com epilepsia não cumpriram nenhuma das orientações, 60,5% cumpriram uma, 13,5% cumpriram duas e 0,3 por cento cumpriram as três recomendações; encontrou-se que 2,8% da população típica e 2% dos jovens com condições não neurológicas cumpriram as três recomendações. INTERPRETAÇÃO: Esses dados podem orientar futuras intervenções e alertar formuladores de políticas, profissionais de saúde, pais, educadores e grupos de defesa da baixa aderência dos jovens com epilepsia segundo às diretrizes Canadenses e seu risco de problemas de saúde.

Accelerometer-measured moderate-to-vigorous physical activity of Canadian adults, 2007 to 2017.

BACKGROUND: Surveillance of physical activity among Canadian adults has typically relied on questionnaire-based data, which have many limitations. The Canadian Health Measures Survey (CHMS) has been collecting objective, accelerometer-based physical activity data on a nationally representative sample of Canadian adults since 2007. DATA AND METHODS: Data are from Cycle 1 (2007 to 2009), Cycle 2 (2009 to 2011), Cycle 3 (2012 to 2013), Cycle 4 (2014 to 2015) and Cycle 5 (2016 to 2017) of the CHMS. The study sample included adults aged 18 to 79 years (Cycle 1: n = 2,952; Cycle 2: n = 2,959; Cycle 3: n = 2,517; Cycle 4: n = 2,390; Cycle 5: n = 2,355). Average daily minutes of moderate physical activity (MPA), vigorous physical activity (VPA) and moderate-to-vigorous physical activity (MVPAALL) were derived from minute-by-minute accelerometer data captured over seven consecutive days. MVPA accumulated in bouts of at least 10 minutes (MVPABOUTS) were also calculated, and adherence to the Canadian Physical Activity Guidelines was assessed. RESULTS: No significant linear trend was observed in accelerometer-measured MVPA from 2007 to 2017. According to the most recent cycle of CHMS data (2016 and 2017), Canadian adults accumulated an average of 26 minutes of MVPAALL per day, less than half of which (12 minutes per day, on average) was accumulated in bouts of at least 10 minutes. Average daily VPA was less than five minutes. About 3% of Canadian adults accumulated no MVPA at all, while approximately 36% did not accumulate any MVPA in bouts of at least 10 minutes; 16% of Canadian adults met the current physical activity guidelines of 150 minutes of MVPA per week in bouts of at least 10 minutes. DISCUSSION: These results may be important to governments and other organizations for initiatives geared toward increasing physical activity levels in Canadian adults.

Trends in physical fitness among Canadian children and youth.

BACKGROUND: Physical fitness during childhood is an important indicator of current and future health. This paper provides an overview of the fitness of Canadian children and youth aged 6 to 19 years. DATA AND METHODS: Data are from three cycles of the Canadian Health Measures Survey (CHMS) spanning a 10-year period: 2007 to 2009 (n = 2,081), 2009 to 2011 (n = 2,133) and 2016 to 2017 (n = 2,070). The CHMS is a comprehensive direct health measures survey conducted on a nationally representative sample of Canadians. Descriptive statistics for measures of cardiorespiratory fitness, muscular strength and power, flexibility, and body composition are provided by age group and sex. Physical fitness measures are presented for participants who met and did not meet the physical activity and screen time recommendations. RESULTS: Few changes in the fitness measures occurred over the past decade. Cardiorespiratory fitness decreased between 2007-2009 and 2016-2017 in 8 to 10 (52.1 to. 51.0 mL•kg-1•min-1) and 11 to 14 (50.8 to 49.8 mL•kg-1•min-1) year old boys. Girls generally had lower levels of fitness compared to boys, except for flexibility which was higher in girls. Cardiorespiratory fitness was higher in children and youth who met the current Canadian recommendations for physical activity and screen time. Grip strength was higher in boys who met the current Canadian screen time recommendation. DISCUSSION: Ongoing and periodic surveillance of fitness through the CHMS is important to monitor trends, assess future interventions designed to improve fitness levels at the population level and to increase our understanding of the relationships between fitness and health.

Compositional associations of time spent in sleep, sedentary behavior and physical activity with obesity measures in children.

BACKGROUND/OBJECTIVES: The 24 h day is made up of four movement behaviors: sleep, sedentary behavior (SB), light intensity physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA). Previous studies examining associations between movement behaviors and obesity have used flawed statistical methods that did not account for the co-dependent and compositional nature of movement behaviors. Our objective was to use compositional data analysis methods to investigate the relationships between movement behaviors and obesity measures among children. SUBJECTS/METHODS: Participants were 434 children aged 10-13 years. They wore an accelerometer for 7 days to determine time spent in SB, LIPA, and MVPA. Sleep duration was determined from the accelerometer and a log. The obesity measures were the body mass index, waist circumference, and fat mass index. Compositional data analysis was used to estimate whether the composition of movement behaviors was associated with obesity measures, and the extent to which changing time in movement behaviors within the movement behavior composition was associated with changes in obesity measures. RESULTS: The composition of movement behaviors across the 24 h day was associated with all three obesity measures (p < 0.001). Relative to other movement behaviors, time spent in MVPA was negatively associated with obesity measures (p < 0.01), time spent in LIPA was positively associated with obesity measures (p < 0.05), while time spent in SB and sleep were not associated with obesity measures. The estimates suggested that an 18 min/day increase in MVPA, 21 min/day decrease in LIPA, 87 min/day decrease in SB, or 67 min/day increase in sleep relative to the remaining behaviors would be associated with a 0.1 unit decrease in BMI z-score. CONCLUSIONS: The composition of movement behaviors across the day is associated with obesity measures. The findings suggest that changing the movement behavior composition by increasing MVPA and decreasing LIPA would be the most effective approach for improving obesity measures.