Developing a comprehensive school-based physical activity program with flexible design - from pilot to national program.

This article focuses on the process of designing the vital, participatory school-based intervention program aiming to increase the physical activity in schools. The program analyzed is Estonian nationwide comprehensive physical activity program Schools in Motion (SiM) that recently received European Commission's #BeActive Education Award. The program has a good performance in terms of willingness of schools to participate in co-creation of program development, the high interest to join the program and zero dropouts, and strong partnership with ministries which enables to actively participate in policy making. Authors analyze the key elements of the planning, piloting, implementation, and scaling phases of the SiM program and share their lessons learnt in co-working with schools. The difficulties faced during the development process, the strengths and challenges associated with an interdisciplinary approach, and involvement of schools as experts have been addressed.

Validating Fitbit Zip for monitoring physical activity of children in school: a cross-sectional study.

BACKGROUND: Modern activity trackers, including the Fitbit Zip, enable the measurement of both the step count as well as physical activity (PA) intensities. However, there is a need for field-based validation studies in a variety of populations before using trackers for research. Therefore, the purpose of the current study was to investigate the validity of Fitbit Zip step count, moderate to vigorous physical activity (MVPA) and sedentary minutes, in different school segments in 3rd grade students. METHODS: Third grade students (N = 147, aged 9-10 years) wore a Fitbit Zip and an ActiGraph GT3x-BT accelerometer simultaneously on a belt for five days during school hours. The number of steps, minutes of MVPA and sedentary time during class time, physical education lessons and recess were extracted from both devices using time filters, based on the information from school time tables obtained from class teachers. The validity of the Fitbit Zip in different school segments was assessed using Bland-Altman analysis and Spearman's correlation. RESULTS: There was a strong correlation in the number of steps in all in-school segments between the two devices (r = 0.85-0.96, P < 0.001). The Fitbit Zip overestimated the number of steps in all segments, with the greatest overestimation being present in physical education lessons (345 steps). As for PA intensities, the agreement between the two devices in physical education and recess was moderate for MVPA minutes (r = 0.56 and r = 0.72, P < 0.001, respectively) and strong for sedentary time (r = 0.85 and r = 0.87, P < 0.001, respectively). During class time, the correlation was weak for MVPA minutes (r = 0.24, P < 0.001) and moderate for sedentary time (r = 0.57, P < 0.001). For total in-school time, the correlation between the two devices was strong for steps (r = 0.98, P < 0.001), MVPA (r = 0.80, P < 0.001) and sedentary time (r = 0.94, P < 0.001). CONCLUSION: In general, the Fitbit Zip can be considered a relatively accurate device for measuring the number of steps, MVPA and sedentary time in students in a school-setting. However, in segments where sedentary time dominates (e.g. academic classes), a research-grade accelerometer should be preferred.

Physical activity, sedentary time and sleep duration: associations with body composition in 10-12-year-old Estonian schoolchildren.

BACKGROUND: Physical activity, sedentary time, and sleep duration have been associated with body composition among children. The purpose of the present study was to assess the associations of objectively determined daily physical activity, sedentary time, sleep duration and body composition indices in 10-12-year-old children. METHODS: Two hundred and eleven schoolchildren (96 boys and 115 girls) aged 10.9 ± 0.7 years participated in this study. Objective physical activity intensity and sedentary levels were measured for seven days by accelerometry. Sleep duration was self-reported. Percentage of body fat, waist-to-height ratio and fat free mass were calculated from measured anthropometric parameters. Multiple linear regression models were used to examine the associations between sleep duration, moderate-to-vigorous physical activity (MVPA), vigorous physical activity (VPA) level and body composition indices. RESULTS: Boys exceeded girls (p < 0.05) in time spent in MVPA and VPA levels. Only 4.3% of the children met the current daily recommendation of at least 60 min MVPA per day. Sleep duration, MVPA and VPA had a negative association with percentage of body fat and waist-to-height ratio. Vigorous physical activity had a positive association with fat-free mass. Sedentary time had a positive association with percentage of body fat and negative association with fat-free mass. CONCLUSIONS: The present study suggests that both sleep duration and MVPA are associated with body composition parameters. Higher levels of MVPA are associated with lower percentage of body fat and waist-to-height ratio regardless of sleep duration. Sedentary time is associated with higher values of percentage of body fat and lower fat-free mass independently of sleep duration.

Perspectives of children and adolescents on the perceived determinants of physical activity during recess.

Promotion of healthy lifestyles in youth focuses on school-based interventions with the aim to increase physical activity (PA) during school days. Drawing on seventeen focus group discussions from three purposively selected Estonian schools, we explored factors that perceivably affect students' recess physical activity (RPA). Both inductive and deductive principles of data analysis were used to extract major and subthemes related to factors that inhibit or enhance RPA. Participants identified barriers and facilitators to recess PA as originating mainly from physical and organizational school environment. Also, unsuitable weather was described as a barrier to being active. Additionally, feelings, behavioral and normative beliefs were described as constraining or facilitating RPA. Results highlighted two culture-specific unique perceived determinants of RPA that need to be addressed during the development of school-based interventions to increase PA.

Objectively measured sedentary behaviour and moderate and vigorous physical activity in different school subjects: a cross-sectional study.

BACKGROUND: Evidence shows the positive influence of moderate and vigorous physical activity (MVPA) and negative influence of sedentary time on health and academic achievement. Although schools can significantly contribute to overall physical activity, little is known about MVPA and sedentary behaviour in different school subjects in different grades. METHODS: Physical activity of 646 students from 18 schools (94 classes) and from three school stages (grades 1-9, aged 7-16) was measured with accelerometry for 5 school days. Time and proportion of MVPA and sedentary time, also average sedentary bout length was calculated for native language (Estonian), mathematics, science, foreign language, music and crafts lessons. RESULTS: A total of 6363 lessons were measured, with lesson duration of 45 min. The average lesson time MVPA remained below 2.2 min in all school stages and in all subjects. Students in grades 4-6 had greatest decline in the proportion of lesson time MVPA in science (ß = -1.9, 95%CI -3.1- -0.6) and music (-1.2, -2.1- -0.4) and in grades 7-9 in music (-1.7, -3.1- -0.3) lessons compared to grades 1-3. In grades 1-3 students spent on average 76% of lesson time (34.0 ± 7.0 min) as sedentary, whereas in grades 7-9 the average proportion of sedentary time was 87% (38.9 ± 5.7 min). An average sedentary bout length increased from 13 min in grades 1-3 to 20 min in grades 7-9. An increase in sedentary bout length from grades 1-3 compared to grades 7-9 was present in most subjects, except crafts, with smallest increase in foreign language (6 min, 3.5-8.9) and greatest in music lessons (16.6 min, 11.9-21.3). Lessons with prolonged sedentary bouts formed a maximum 36% of all lessons in grades 1-3 and 73% in grades 7-9. CONCLUSION: The long sedentary time, bout length and low MVPA in most subjects were unfavourable in respect of both health and academic achievement. Significantly increasing sedentary time and sedentary bout length in older school stages highlights the need for interventions in all subjects and especially in older grades in order to combat the inactivity of children.

Objectively measured physical activity levels and sedentary time in 7-9-year-old Estonian schoolchildren: independent associations with body composition parameters.

BACKGROUND: Sufficient daily physical activity (PA) is necessary for physical, social and mental health benefits during growth. Most of the available data on children is based on subjective reports, while only limited data on objective PA and sedentary levels is available for primary school children. Increased PA is also an important health indicator of body composition parameters, especially body adiposity indices. The aim of the present study was to determine objectively the amount of daily PA levels at different intensities and sedentary time in normal-weight (NW) and overweight (OW) 7-9-year-old boys and girls, and to find associations between objectively measured PA levels and sedentary time with different body composition values. METHODS: Two hundred and seventy eight (142 boys and 136 girls) primary school children aged 7.9 ± 0.7 years participated in this study. Objective PA intensity and sedentary levels were measured over 7 days by accelerometry. Indices of total fat mass (body fat %, sum of skinfolds), fat distribution (waist-to-height ratio) and muscular component (fat free mass [FFM]) were calculated from measured anthropometric parameters. RESULTS: There were no differences (p > 0.05) in PA intensity levels and sedentary time between boys and girls as well as between NW and OW children. About 11 % of children met the current guidelines of at least 60 min per day of moderate-to-vigorous PA (MVPA). Sedentary time was positively and negatively associated (p < 0.05) with all body fat and FFM values, respectively. Moderate and vigorous PA along with MVPA were negatively and positively associated (p < 0.05) with all body fat and FFM indices, respectively. CONCLUSIONS: The results of present study showed that about 11 % of primary school children were engaged in PA of at least 60 min of MVPA daily. While MVPA is negatively associated with fat mass indices and positively associated with FFM regardless of different confounders, sedentary time is negatively related to FFM and positively with fat mass values after adjusting for several confounders. These results suggest that higher MVPA level and lower sedentary time level are important in maintaining and developing healthy body composition in primary school children during growth.

School Children's Physical Activity and Preferred Activities during Outdoor Recess in Estonia: Using Accelerometers, Recess Observation, and Schoolyard Mapping.

Studies about recess have found that children have higher physical activity (PA) during outdoor recess compared to indoor recess, and well-constructed schoolyards play an important role in stimulating PA in children. This study aimed at investigating the affordances of schoolyards and outdoor recess PA in two urban and two rural primary schools in Estonia. Schoolyards were described with the geographical mapping method, children's activities during outdoor recess were registered by using observations, and PA levels were measured with accelerometers. Students from grades two to six (8-13-year-olds) were included in the study. All observed schoolyards had different spaces including various ball game areas, climbing facilities, and slacklines. The natural environment dominated in the rural schools, and artificial surfaces dominated in the urban schools. Boys in the study tended to enjoy more sport-related activities, whereas girls preferred more social and less active activities. Students participating in outdoor recess spent about twice as much time (20.4%) on moderate-to-vigorous PA (MVPA) compared to indoor recess (9.5%), although boys were more active than girls (22.9% vs. 17.3%). All schoolyards afforded more MVPA during outdoor recess compared to indoor recess, whereas schoolyards with more space per child and natural environment elements generated more varied PA and higher MVPA. These findings confirm the importance of schoolyard design and quality for the variety and intensity of students' PA during outdoor recess.

Results from Estonia's 2022 Report Card on Physical Activity for Children and Youth: Research Gaps and Five Key Messages and Actions to Follow.

The aim of this article is to summarize the results of the 2022 Estonian Physical Activity Report Card across 10 indicators based on available scientific data and national databases, and, additionally, to compare the current results with previous Report Card results. A national expert panel, consisting of research and policy experts, identified the available sources and synthesized as well as graded relevant data related to the physical activity (PA) of Estonian children and youth. Grade B was assigned to Organized Sports and Physical Activity (B-), Community and Environment (B+), and Government (B). Grade C was assigned to Overall Physical Activity (C+), Physical Fitness (C+), Family and Peers (C-), and School (C+). The lowest grade, D, was assigned to Active Play (D), Active Transportation (D+), and Sedentary Behaviors (D-). In Estonia, the participation rate in organized sport is relatively high, and government in addition to community support seem to be at a relatively good level. However, a relatively high number of children and youth did not meet the current PA guidelines, and the levels of sedentary behavior and screen time were very high. The PA of children and youth should be a cross-disciplinary priority, and focus should be put on developing schoolyards and outdoor breaks, varied and easily accessible organized sport, the use of active transportation, and the implementation of physical education that supports leisure time activities.

Relationship between low depressiveness and domain specific physical activity in women.

In this study we investigated how different domains of physical activity are associated with depressiveness among women, and how individual variables moderate this relationship. Participants were 956 women, and the data were collected by mail-out survey using the Global Physical Activity Questionnaire, Beck Depression Inventory, and International Personality Item Pool. Lower depressiveness was related to higher leisure time physical activity and to lower occupational physical activity. Income, health problems, level of neuroticism, and extraversion had strong effects on depressiveness, and mediated the link between the leisure and occupational activities and depression.

Relationship between various physical activity domains and self-perceived health and obesity in women.

The purpose of this study was to determine the relationship between self-perceived health and obesity and recreational, occupational, commuting, and total physical activity in women. The sample included 956 Estonian women aged 18-50. Cross-sectional data were collected in the Estonian Women Physical Activity Study via a mail-out survey in 2008 using the Global Physical Activity Questionnaire and self-reported measures of health indicators. The associations between physical activity and health indicators were examined using multiple logistic regression and were adjusted for potential confounding factors (age, education, and income). The women in the highest occupational physical activity group were significantly less likely to have good health (OR 0.51; CI 0.33-0.77) compared to women with no occupational physical activity. A significant association was observed, however, between being in the highest recreational physical activity group and having better self-perceived health (OR = 2.09, 95% CI 1.36-3.21) and not being obese (BMI ≥ 30) (OR = 0.42, 95% CI 0.21-0.86). A higher total amount of physical activity was not related to better health status or obesity. These findings suggest that the specific domains of physical activity may be more important for self-perceived health and obesity among women than the total amount of physical activity.

The participation in organised sport doubles the odds of meeting physical activity recommendations in 7-12-year-old children.

The purpose of this study was to determine the contributing role of organised sport participation to daily physical activity (PA) and to describe the PA during training. Children aged 7-12 wore the accelerometer for 1 week. Children with activity data for a minimum of 5 days were included in the analysis (n = 492). Evenson cut-points were used to extract PA data for whole day and training sessions. Compliance with PA recommendations was assessed with two methods - weekly average and daily data. More than half (52.5%) of the children participated in an organised sport at least once a week. Participation in organised sport three or more times a week increased the odds of meeting PA recommendations (average method: OR = 4.02, 95% CI: 1.98-8.19, p < 0.001, days method: OR = 2.82, 95% CI: 1.35-5.88, p = 0.006). On average, children acquired 23.3 ± 15.3 min of moderate to vigorous PA (MVPA) during trainings, while boys accrued more MVPA minutes compared to girls (ß = 5.2, 95% CI: 2.4-8.0) and the training time MVPA decreased with age (ß = -1.0, 95% CI: -1.9 to -0.1), respectively. Each additional MVPA minute during training increased daily MVPA by 1.3 min (95% CI: 1.1-1.5). On days with training children accumulated 24.9 (95% CI: 21.8-28.0) more MVPA minutes compared to days without training. In conclusion, these findings highlight the importance of organised sport in supporting the PA levels of children. However, participation in the organised sport only is not sufficient to meet PA recommendations, and therefore, PA should be supported throughout the day.

Longitudinal stability of sedentary behaviors and physical activity during early adolescence.

The purpose of this study was to examine the stability of sedentary behaviors and physical activity in Estonian school children aged 11-12 year at the beginning of the study. In addition, the consequence of changes in sedentary behaviors on a change in physical activity was investigated. Adolescents (N = 345) completed the 3-Day Physical Activity Recall on four occasions over a 22-month period. Results indicated the curvilinear changes in sedentary behaviors and physical activity across time. There was a significant decrease in physical activity and an increase in sedentary behaviors across three years. Stability coefficients indicated a moderate differential stability of the sedentary behaviors (ranged from 0.31 to 0.64) and physical activity (ranged from 0.36 to 0.59) during early adolescence. Latent growth modeling indicated that increase in sedentary behaviors across a 22-month period was inversely associated with a change in physical activity. Interventions targeted at "high-risk" groups to reduce sedentary behaviors during early adolescence are encouraged.

Physical Education Increases Daily Moderate to Vigorous Physical Activity and Reduces Sedentary Time.

BACKGROUND: Physical activity (PA) is important to mental and physical health. Physical education (PE) lessons have the potential to increase daily moderate to vigorous PA (MVPA) and reduce sedentary time (SED). We measured MVPA and SED in primary school PE, determined the contribution of PE to daily MVPA and SED, and compared PA on days with and without PE. METHODS: PA was measured in 504 first (ages 7-9) and second (ages 10-12) school level children for 1 school week, with inclusion criteria of at least 10 hours of valid data. Linear mixed methods were used for data analysis. RESULTS: In PE, students spent 28.6 ± 16.5% in MVPA and 29.3 ± 19.8% in SED. Each additional MVPA minute in PE was associated with 1.4 more daily MVPA minutes. On days with PE, students had 12.8 (95% CI 10.5; 15.0) minutes more MVPA and 9.7 (95% CI 16.3; 3.1) minutes less SED compared with days without PE. CONCLUSIONS: Although MVPA in PE was relatively low and SED high, PE significantly increased daily MVPA and reduced SED, confirming the important role of PE in supporting the healthy development of children.

Results From Estonia's 2016 Report Card on Physical Activity for Children and Youth.

BACKGROUND: The 2016 Report Card on Physical Activity for Children and Youth, the first of its kind, aims to set baseline physical activity (PA) indicators using the Active Healthy Kids Global Alliance grading system. METHODS: A research work group analyzed and selected data for the grade assignment meeting (GAM). During the GAM, 17 leading researchers and policy experts from Estonia assessed the data and assigned grades for each of the 9 PA indicators. In addition, recommendations were provided for further actions to improve the grades. RESULTS: Grades from A (highest) to F (lowest) were assigned as follows: 1) Overall PA (F); 2) Organized Sport (C); 3) Active Play [incomplete data (INC)]; 4) Active Transportation (INC); 5) Sedentary Behaviors (F); 6) Family and Peers (C); 7) School (C); 8) Community and the Built Environment (B); and 9) Government (C). An indicator was marked as incomplete (INC) when there was a lack of representative quality data. CONCLUSIONS: Evidence suggests that PA levels of Estonian children remain very low, despite moderately supportive social, environmental, and regulatory factors. There are many challenges to overcome in supporting and promoting PA of children and youth (eg, cross-sectional cooperation, implementing interventions, changing social norms, empowerment of parents and educational institutions).

Different Methods Yielded Two-Fold Difference in Compliance with Physical Activity Guidelines on School Days.

INTRODUCTION: The aim was to compare the average and the days method in exploring the compliance of children with physical activity guidelines and describe their physical activity patterns in different school day segments. METHODS: Physical activity was objectively measured in 472 children aged 6-13 for one school week. Children were compliant when fulfilling PA recommendations 1) on average over all measured days (average method) or 2) on at least four measured days (days method). To explore the difference in moderate to vigorous physical activity (MVPA) minutes between compliant and non-complaint children (using both the average and days method) in various day segments, linear mixed models was used. RESULTS: Compliance with physical activity guidelines was significantly higher with the average compared to the days method (51.7% and 23.7%, respectively). In segmented-day analysis, compliant children accrued more MVPA minutes in all day segments, especially during after-school. Gender differences appeared only during the in-school segments, where girls spent less time in MVPA (average method: -4.39 min, 95% CI = -5.36,-3.42, days method: -4.45 min, 95%CI = -5.46,-3.44). Older children accrued more MVPA minutes during physical education classes, but less during breaks, compared to younger children. CONCLUSIONS: The used methods yielded remarkably different prevalence estimates for compliance to physical activity recommendations. To ensure comparability between studies, interventions and reports, there is a need for internationally agreed operationalization and assessment methods of physical activity guidelines. As non-compliant children had lower MVPA during all day segments, greater efforts should be made to provide physical activity opportunities both during and after school.

A longitudinal assessment of the links between physical activity and physical self-worth in adolescent females.

A longitudinal framework was used to examine the hypotheses of (1) whether physical activity predicts changes in physical self-worth or (2) whether physical self-worth predicts changes in physical activity in adolescent girls. Participants (n=272) completed measures of physical self-worth and participation in physical activities at three different points spanning a two-year interval. A cross-lagged panel model using structural equation modelling analyses indicated that physical self-worth predicted subsequent physical activity and physical activity in turn predicted subsequent physical self-worth across time. Findings demonstrated a reciprocal relationship between physical self-worth and physical activity during early adolescence. This study supports the use of the reciprocal effects model (REM) in gaining an understanding of the cross-lagged relationships between physical self-worth and participation in physical activities amongst adolescent girls.

Health inequality among Estonian women.

In Eastern Europe, in post-Communist countries, transformations during the past 10 years have considerably affected the life of women. Our aims were to (a) examine health status and socioeconomic inequalities among Estonian women, and (b) study the relationships between women's social roles and health. A group of 659 women, aged 18-45, completed the Health Questionnaire for Adults (HQA) and the General Health Questionnaire (GHQ). Income had the largest effect on self-related health and psychoemotional health ratings. The second important indicator was education. Women's additional social roles (marital status, parental role) were not detrimental to their health in our study.

The relationships between physical activity, health status and psychological well-being of fertility-aged women.

The purpose of this investigation was to measure the association between leisure time physical activity and health status, mental health and depression. The participants were women aged 18-45. The data were collected using questionnaires that were mailed to 1200 women. The response rate was 55%. The questionnaire contained three instruments: the General Health Questionnaire (GHQ), the Health Questionnaire for Adults, and the Beck Depression Inventory (BDI). The results showed that 52.8% of the sample were physically inactive. Physically active women experienced better mental health (P < 0.05), less depression (P < 0.05) and they had better general health status (P < 0.005). Differences in the emotional state (GHQ score) and depression (BDI score) between active (participating in exercise 3 or 1-2 times a week) and inactive women were significant (P < 0.05). Even a low level of physical activity (1-2 times per week) was positively related to women's mental health (P < 0.05).