Top 10 International Priorities for Physical Fitness Research and Surveillance Among Children and Adolescents: A Twin-Panel Delphi Study.

BACKGROUND: The measurement of physical fitness has a history that dates back nearly 200 years. Recently, there has been an increase in international research and surveillance on physical fitness creating a need for setting international priorities that could help guide future efforts. OBJECTIVE: This study aimed to produce a list of the top 10 international priorities for research and surveillance on physical fitness among children and adolescents. METHODS: Using a twin-panel Delphi method, two independent panels consisting of 46 international experts were identified (panel 1 = 28, panel 2 = 18). The panel participants were asked to list up to five priorities for research or surveillance (round 1), and then rated the items from their own panel on a 5-point Likert scale of importance (round 2). In round 3, experts were asked to rate the priorities identified by the other panel. RESULTS: There was strong between-panel agreement (panel 1: rs = 0.76, p < 0.01; panel 2: rs = 0.77, p < 0.01) in the priorities identified. The list of the final top 10 priorities included (i) "conduct longitudinal studies to assess changes in fitness and associations with health". This was followed by (ii) "use fitness surveillance to inform decision making", and (iii) "implement regular and consistent international/national fitness surveys using common measures". CONCLUSIONS: The priorities identified in this study provide guidance for future international collaborations and research efforts on the physical fitness of children and adolescents over the next decade and beyond.

Physical activity and active transportation behaviour among rural, peri-urban and urban children in Kenya, Mozambique and Nigeria: The PAAT Study.

BACKGROUND: Physical activity (PA) is associated with numerous health benefits among children and youth. However, few studies have examined how active transportation (AT) and device-based measures of PA vary within and between countries in sub-Saharan Africa. PURPOSE: This cross-sectional study sought to investigate the prevalence and correlates of AT and device-measured PA among children living in urban, peri-urban and rural areas in three African countries representing Eastern, Western and Southern regions of Africa. METHODS: 3,205 participants (53.3% girls; 46.7% boys) aged 10-12 years were recruited in Kenya, Nigeria and Mozambique. Data were collected using a child questionnaire, a parent/guardian questionnaire and PiezoRx® pedometers. ANCOVA and binary logistic regression analyses were used to examine the correlates of AT and PA while controlling for gender, age, parent education and vehicle ownership. RESULTS: Participants accumulated an average of 45.6±23.5 min/day of moderate-to-vigorous physical activity (MVPA) and 11,215±4,273 steps/day. Kenyan and Mozambican children were significantly more active than their Nigerian counterparts (p<0.001). Only 23% met the MVPA guidelines of 60 min/day. 65.1% of participants engaged in AT to school (and 67.8% for the trip back home) with no gender differences. Living in a rural area, lower parent education, lower vehicle ownership and higher motorcycle ownership were associated with higher odds of AT. Other correlates of AT were country-specific. Girls accumulated less daily MVPA than boys in all countries. MVPA was positively associated with living in less urbanized areas in Nigeria and Mozambique. In Kenya, lower parental education and AT were associated with higher MVPA. Nigerian children's daily MVPA decreased with age and the number of parent-perceived barriers to AT. CONCLUSIONS: Majority of children engaged in AT, but still failed to meet MVPA recommendations. Most correlates of AT and PA were country-specific, suggesting that strategies to encourage both behaviours should be informed by local evidence.

Parental-perceived home and neighborhood environmental correlates of accelerometer-measured physical activity among school-going children in Uganda.

The benefits of physical activity (PA) on children's health and well-being are well established. However, many children do not meet the PA recommendations, increasing their risk of being overweight, obese, and non-communicable diseases. Environmental characteristics of homes and neighborhoods may constrain a child's ability to engage in PA, but evidence is needed to inform country-specific interventions in understudied low-income countries. This study assessed the associations between parental-perceived home and neighbourhood, built environment characteristics, and moderate-to-vigorous physical activity (MVPA) among children in Kampala city, Uganda. In this cross-sectional study, data were obtained from 256 children (55.5% girls) aged between 10 and 12 years and their parents. Children's MVPA was measured using waist-worn ActiGraph accelerometers. The environments were assessed using a valid self-reported parent survey. Linear regression models with standard errors (clusters) were used to analyze the relationship between environmental variables and children's MVPA. Sex-specific relationships were assessed using sex-stratified models. Play equipment at home (ß = -2.37, p <0.001; unexpected direction), residential density (ß = 2.70, p<0.05), and crime safety (ß = -5.29, p <0.05; unexpected direction) were associated with children's MVPA. The sex-specific analyses revealed more inconsistent patterns of results with a higher perception of land use mix associated with less MVPA in girls (irrespective of school type attended), and higher perceptions of sidewalk infrastructure (ß = -12.01, p <0.05) and walking and cycling infrastructure (ß = -14.72, p <0.05) associated with less MVPA in girls attending public schools only. A better perception of crime safety was associated with less MVPA among boys and girls attending private schools (ß = -3.80, p <0.05). Few environmental characteristics were related to children's MVPA in Uganda, and findings were largely inconsistent, especially among girls. Future studies are needed to understand the ecological determinants of health-related PA behaviors among children in Uganda.

Prevalence and socio-demographic correlates of accelerometer measured physical activity levels of school-going children in Kampala city, Uganda.

BACKGROUND: The current international physical activity guidelines for health recommend children to engage in at least 60 minutes of moderate-to-vigorous physical activity (MVPA) daily. Yet, accurate prevalence estimates of physical activity levels of children are unavailable in many African countries due to the dearth of accelerometer-measured physical activity data. The aim of this study was to describe the prevalence and examine the socio-demographic correlates of accelerometer-measured physical activity among school-going children in Kampala city, Uganda. METHODS: A cross-sectional study design was used to recruit a sample of 10-12 years old school-going children (n = 256) from 7 primary schools (3 public schools and 4 private schools) in Kampala city, Uganda. Sedentary time, light-intensity physical activity (LPA), moderate-intensity physical activity (MPA) and vigorous-intensity physical activity (VPA) were measured by accelerometers (ActiGraph GT3X+ [Pensacola, Florida, USA]) over a seven-day period. Socio-demographic factors were assessed by a parent/guardian questionnaire. Weight status was generated from objectively measured height and weight and computed as body mass index (BMI). Multi-level logistic regressions identified socio-demographic factors that were associated with meeting physical activity guidelines. RESULTS: Children's sedentary time was 9.8±2.1 hours/day and MVPA was 56±25.7 minutes/day. Only 36.3% of the children (38.9% boys, 34.3% girls) met the physical activity guidelines. Boys, thin/normal weight and public school children had significantly higher mean daily MVPA levels. Socio-demographic factors associated with odds of meeting physical activity guidelines were younger age (OR = 0.68; 95% CI = 0.55-0.84), thin/normal weight status (OR = 4.08; 95% CI = 1.42-11.76), and socioeconomic status (SES) indicators such as lower maternal level of education (OR = 2.43; 95% CI = 1.84-3.21) and no family car (OR = 0.31; 95% CI = 0.17-0.55). CONCLUSION: Children spent a substantial amount of time sedentary and in LPA and less time in MVPA. Few children met the physical activity guidelines. Lower weight status, lower maternal education level and no family car were associated with meeting physical activity guidelines. Effective interventions and policies to increase physical activity among school-going children in Kampala, are urgently needed.

Development and convergent validity of new self-administered questionnaires of active transportation in three African countries: Kenya, Mozambique and Nigeria.

BACKGROUND: There is currently a rapid physical activity transition taking place in developing countries that includes a decrease in active transportation. Building on findings from an earlier systematic review, this paper describes the development and convergent validity of self-administered child and parent questionnaires assessing active transportation of children in three African countries: Kenya, Mozambique and Nigeria. METHODS: A pilot study was conducted to examine the convergent validity of the developed questionnaires by comparing responses between children and their parents (N = 121; n = 43 for Mozambique, n = 24 for Kenya and n = 54 for Nigeria). After modification, the questionnaires were then administered to a larger convenient sample of both children and parents from Kenya (n = 1123), Mozambique (n = 1097) and Nigeria (n = 831) which defined the main study. The questionnaires assessed active transportation to/from 8 categories of destinations including school, friends' and relatives' home/houses, parks and playgrounds among others. Twenty items were used to assess child - and parent-perceived barriers to active transportation, and the parent questionnaire inquired about parent education and availability of cars, motorcycles, and bicycles. Spearman's rho was used to compare children's mode of travel in the pilot study while the prevalence-adjusted bias-adjusted kappa (PABAK) coefficient was used to compare convergent validity between children's and parents responses on active transportation in the main study. RESULTS: Findings of the main study show that convergent validity for active transportation to and from each destination in the combined sample ranged from 0.472 (from school) to 0.998 (to other places). Convergent validity for challenges/barriers to active transportation to school ranged from fair (0.30 - The route does not have good lighting) to substantial (0.77 - My child has a disability). It varied between countries from fair (n = 11-items) to moderate (n = 9-items) agreement in Kenya and from poor (n = 2-items) to fair (n = 16-items) agreement in Nigeria. Data from Mozambique was however missing and therefore could be included. CONCLUSIONS: The questionnaires provided valid information on the number of trips to/from various destinations and show acceptable and modest convergent validity for measuring barriers to active transport in a sample of children from three African countries. These questionnaires may be suitable for future research on active transport among school children in Sub-Saharan African countries.

Screen-based sedentary behaviour and adiposity among school children: Results from International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) - Kenya.

BACKGROUND: High levels of sedentary behaviours have been independently associated with several negative health indicators, including obesity. Screen time (ST) is often used as a contributing measure of sedentary time. It is recommended that children spend no more than 2 hours on recreational sedentary screen-based activities daily. We describe screen-based sedentary time of urban school children and examine the associations between body mass index (BMI) and percent Body Fat (%BF) with ST levels. METHODS: Data were collected from 563 children aged 9 to 11 years attending 29 non-boarding primary schools in Nairobi, Kenya, as part of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). Data were analysed to test for associations between ST and sex, type of school attended (public verses private), Socioeconomic status, adiposity, and access to electronic devices. We also assessed participants' ST on school and weekend days. RESULTS: Of the participants recruited, 15.5% had high ST levels, 67.9% spent no more than 2 hours in recreational screen activities on school days while 74.2% did not meet the guidelines on weekend days. Participants sex was associated with daily ST (t = 3.5, p<0.001), ST on the weekend (t = 3.9, p <0.001) and total ST per week (t = 3.5, p<0.001) with males having higher ST than females. ST was associated with type of school for daily ST (t = 3.6, p <0.001), ST on the weekend (t = 4.5, p<0.001) and total ST per week (t = 3.6, p<0.001) where private schools pupils had higher ST. ST was not associated with BMI. ST was not associated with %BF except on weekend days (p = 0.038) where those classified as overfat/obese (fat) had higher ST. CONCLUSIONS: A large proportion of children spend more time than recommended on screen activities particularly on weekend days. Strategies to improve healthy living should focus on the reduction of sedentary ST for school-aged children.

Running Performance, Nationality, Sex, and Age in the 10-km, Half-Marathon, Marathon, and the 100-km Ultramarathon IAAF 1999-2015.

Nikolaidis PT, Onywera VO, and Knechtle B. Running performance, nationality, sex, and age in the 10-km, half-marathon, marathon, and the 100-km ultramarathon IAAF 1999-2015. J Strength Cond Res 31(8): 2189-2207, 2017-The aim of this study was to examine the performance of the world's best runners in the 10-km, half-marathon, marathon, and 100-km races by age, sex, and nationality during 1999-2015, using data from the International Association of Athletics Federations (IAAF). A total of 38,895 runners (17,136 women and 21,759 men) were evaluated, with 2,594 (1,360 women and 1,234 men) in the 10-km; 11,595 (5,225 women and 6,370 men) in the half-marathon; 23,973 (10,208 women and 13,765 men) in the marathon; and 733 (343 women and 390 men) in 100-km events. Most runners in the 10-km event (women 40%, men 67%) and the half-marathon (women 30%, men 57%) were Kenyans. In the marathon, most female and male runners were Ethiopians (women 17%, men 14%) and Kenyans (women 15%, men 43%), respectively. In the 100-km event, most runners were Japanese (20% women, and 80% men). Women were older than the men in the 10-km (32.0 ± 6.0 vs. 25.3 ± 4.3 years, p < 0.001), half-marathon (27.5 ± 4.7 vs. 25.9 ± 4.1 years, p < 0.001), and marathon events (29.5 ± 5.5 vs. 29.1 ± 4.3 years, p < 0.001), but not in 100-km event (36.6 ± 6.1 vs. 35.9 ± 5.5 years, p = 0.097). Men were faster than the women in the 10-km (28:04 ± 0:17 vs. 32:08 ± 0.31 (minutes:seconds), p < 0.001), half-marathon (1:01:58 ± 0:00:52 vs. 1:11:21 ± 0:01:18 (hours:minutes:seconds), p < 0.001), marathon (2:13:42 ± 0:03:01 vs. 2:35:04 ± 0:05:21 (hours:minutes:seconds), p < 0.001), and 100-km events (6:48:01 ± 0:11:29 vs. 7:53:51 ± 0:16:37 (hours:minutes:seconds), p < 0.001). East Africans were not the fastest compared with athletes originating from other countries where only the Ethiopian men were faster than all other men in the marathon. In summary, (a) in the 10-km, half-marathon and marathon events, most runners were from Kenya and Ethiopia, and from Japan and Russia in the 100-km event; (b) women were older than the men in all distance events except the 100-km event;

Health-Related Quality of Life and Lifestyle Behavior Clusters in School-Aged Children from 12 Countries.

OBJECTIVE: To evaluate the relationship between children's lifestyles and health-related quality of life and to explore whether this relationship varies among children from different world regions. STUDY DESIGN: This study used cross-sectional data from the International Study of Childhood Obesity, Lifestyle and the Environment. Children (9-11 years) were recruited from sites in 12 nations (n = 5759). Clustering input variables were 24-hour accelerometry and self-reported diet and screen time. Health-related quality of life was self-reported with KIDSCREEN-10. Cluster analyses (using compositional analysis techniques) were performed on a site-wise basis. Lifestyle behavior cluster characteristics were compared between sites. The relationship between cluster membership and health-related quality of life was assessed with the use of linear models. RESULTS: Lifestyle behavior clusters were similar across the 12 sites, with clusters commonly characterized by (1) high physical activity (actives); (2) high sedentary behavior (sitters); (3) high screen time/unhealthy eating pattern (junk-food screenies); and (4) low screen time/healthy eating pattern and moderate physical activity/sedentary behavior (all-rounders). Health-related quality of life was greatest in the all-rounders cluster. CONCLUSIONS: Children from different world regions clustered into groups of similar lifestyle behaviors. Cluster membership was related to differing health-related quality of life, with children from the all-rounders cluster consistently reporting greatest health-related quality of life at sites around the world. Findings support the importance of a healthy combination of lifestyle behaviors in childhood: low screen time, healthy eating pattern, and balanced daily activity behaviors (physical activity and sedentary behavior). TRIAL REGISTRATION: ClinicalTrials.gov: NCT01722500.

Construct Validity of the Neighborhood Environment Walkability Scale for Africa.

PURPOSE: The development of valid measures of built environments relevant for physical activity is an important step toward controlling the global epidemic of physical inactivity-related noncommunicable diseases and deaths. This study assessed the construct validity of a self-report neighborhood environment walkability scale adapted for Africa (NEWS-Africa), by examining relationships with self-reported walking for transportation and recreation using pooled data from six sub-Saharan African countries. METHODS: NEWS was systematically adapted to assess urban, periurban, and rural environments in sub-Saharan Africa. Adults (n = 469, 18-85 yr, 49.7% women) from Cameroon, Ghana, Mozambique, Nigeria, South Africa, and Uganda were purposively recruited from neighborhoods varying in walkability and socioeconomic status, with some from villages. Participants completed the 76-item (13 subscales) NEWS-Africa by structured interview and reported weekly minutes of walking for transport and recreation using items from the International Physical Activity Questionnaire. RESULTS: The overall "walkability" index had a positive relationship with both walking for transportation (η = 0.020, P = 0.005) and recreation (η = 0.013, P = 0.028) in the pooled analyses. The mixed-use access and stranger danger scales were positively related with transport walking (η = 0.020, P = 0.006 and η = 0.021, P = 0.040, respectively). Proximity of recreational facilities (η = 0.016, P = 0.015), road/path connectivity (η = 0.025, P = 0.002), path infrastructure (η = 0.021, P = 0.005), and overall places for walking and cycling (η = 0.012, P = 0.029) scales were positively related to recreational walking. Country-specific results were mostly nonsignificant except for South Africa and Uganda. CONCLUSIONS: Of 14 NEWS-Africa scales, 7 were significantly related to walking behavior in pooled analyses, providing partial support for the construct validity of NEWS-Africa. However, effect sizes appeared to be lower than those from other continents. Further study with larger and more diverse samples is needed to determine whether the instrument performs well in each country.

Global Matrix 2.0: Report Card Grades on the Physical Activity of Children and Youth Comparing 38 Countries.

The Active Healthy Kids Global Alliance organized the concurrent preparation of Report Cards on the physical activity of children and youth in 38 countries from 6 continents (representing 60% of the world's population). Nine common indicators were used (Overall Physical Activity, Organized Sport Participation, Active Play, Active Transportation, Sedentary Behavior, Family and Peers, School, Community and the Built Environment, and Government Strategies and Investments), and all Report Cards were generated through a harmonized development process and a standardized grading framework (from A = excellent, to F = failing). The 38 Report Cards were presented at the International Congress on Physical Activity and Public Health in Bangkok, Thailand on November 16, 2016. The consolidated findings are summarized in the form of a Global Matrix demonstrating substantial variation in grades both within and across countries. Countries that lead in certain indicators often lag in others. Average grades for both Overall Physical Activity and Sedentary Behavior around the world are D (low/poor). In contrast, the average grade for indicators related to supports for physical activity was C. Lower-income countries generally had better grades on Overall Physical Activity, Active Transportation, and Sedentary Behaviors compared with higher-income countries, yet worse grades for supports from Family and Peers, Community and the Built Environment, and Government Strategies and Investments. Average grades for all indicators combined were highest (best) in Denmark, Slovenia, and the Netherlands. Many surveillance and research gaps were apparent, especially for the Active Play and Family and Peers indicators. International cooperation and cross-fertilization is encouraged to address existing challenges, understand underlying determinants, conceive innovative solutions, and mitigate the global childhood inactivity crisis. The paradox of higher physical activity and lower sedentary behavior in countries reporting poorer infrastructure, and lower physical activity and higher sedentary behavior in countries reporting better infrastructure, suggests that autonomy to play, travel, or chore requirements and/or fewer attractive sedentary pursuits, rather than infrastructure and structured activities, may facilitate higher levels of physical activity.

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

BACKGROUND: Kenya's 2016 report card aimed to highlight the health and well-being of Kenyan children and youth using the best available evidence on the physical activity of Kenyan children and youth. The report pointed at areas where Kenya was succeeding and areas where more action is required. METHODS: Inclusive analyses of available data sources on the core indicators related to physical activity and body weights of Kenyan children and youth (5 to 17 years) were conducted. These were assigned grades based on a set of specific criteria. RESULTS: Results show that Active Play, Active Transportation, Overweight and Obesity, and Sedentary Behavior were favorable with a grade of B. Overall Physical Activity, Organized Sport Participation, and School (infrastructure, policies, and programs) each received a grade of C, while Family and Peers, Government and Nongovernment organizations, as well as the Community and the Built Environment were assigned grade D. CONCLUSIONS: Over 72% of Kenyan children and youth use active transportation to and from school and in their daily lives. Although majority of the children and youth have normal body weight, there is need to ensure that they meet and maintain the physical activity levels recommended by the World Health Organization. More needs to be done especially in relation to the governmental and nongovernmental organizations, organized sports participation, as well as involvement of family and peers in promoting healthy active lifestyles among Kenyan children and youth. More representative data for all indicators are required in Kenya.

Relationships between Parental Education and Overweight with Childhood Overweight and Physical Activity in 9-11 Year Old Children: Results from a 12-Country Study.

BACKGROUND: Globally, the high prevalence of overweight and low levels of physical activity among children has serious implications for morbidity and premature mortality in adulthood. Various parental factors are associated with childhood overweight and physical activity. The objective of this paper was to investigate relationships between parental education or overweight, and (i) child overweight, (ii) child physical activity, and (iii) explore household coexistence of overweight, in a large international sample. METHODS: Data were collected from 4752 children (9-11 years) as part of the International Study of Childhood Obesity, Lifestyle and the Environment in 12 countries around the world. Physical activity of participating children was assessed by accelerometry, and body weight directly measured. Questionnaires were used to collect parents' education level, weight, and height. RESULTS: Maternal and paternal overweight were positively associated with child overweight. Higher household coexistence of parent-child overweight was observed among overweight children compared to the total sample. There was a positive relationship between maternal education and child overweight in Colombia 1.90 (1.23-2.94) [odds ratio (confidence interval)] and Kenya 4.80 (2.21-10.43), and a negative relationship between paternal education and child overweight in Brazil 0.55 (0.33-0.92) and the USA 0.54 (0.33-0.88). Maternal education was negatively associated with children meeting physical activity guidelines in Colombia 0.53 (0.33-0.85), Kenya 0.35 (0.19-0.63), and Portugal 0.54 (0.31-0.96). CONCLUSIONS: Results are aligned with previous studies showing positive associations between parental and child overweight in all countries, and positive relationships between parental education and child overweight or negative associations between parental education and child physical activity in lower economic status countries. Relationships between maternal and paternal education and child weight status and physical activity appear to be related to the developmental stage of different countries. Given these varied relationships, it is crucial to further explore familial factors when investigating child overweight and physical activity.

Prevalence of Overweight and Obesity among Primary School Children Aged 8-13 Years in Dar es Salaam City, Tanzania.

Background. The understanding of obesity as a growing health problem in Africa and Tanzania in particular is hampered by lack of data as well as sociocultural beliefs in which overweight and obesity are revered. This study sought to determine the prevalence of overweight and obesity among primary school children aged 8-13 years in Dar es Salaam, Tanzania. Method. A cross-sectional analytical research design was used to study overweight and obesity in primary schools in Dar es Salaam, Tanzania. The target population was 150,000 children aged 8-13 years. Stratified random sampling was used to select 1781 children. Weight and height were taken and WHO standards for children were used to determine weight status. Results. Findings showed that the prevalence of overweight and obesity was 15.9% and 6.7%, respectively (N = 1781). However, 6.2% of the children were underweight. There were significant differences in mean BMI between children in private and public schools (p = 0.021), between male and female (p < 0.001), and across age groups of 8-10 and 11-13 years (p < 0.001). Conclusion. The prevalence of overweight and obesity among primary school children is significant and requires management and prevention strategies.

Male and female Ethiopian and Kenyan runners are the fastest and the youngest in both half and full marathon.

In major marathon races such as the 'World Marathon Majors', female and male East African runners particularly from Ethiopia and Kenya are the fastest. However, whether this trend appears for female and male Ethiopians and Kenyans at recreational level runners (i.e. races at national level) and in shorter road races (e.g. in half-marathon races) has not been studied yet. Thus, the aim of the present study was to examine differences in the performance and the age of female and male runners from East Africa (i.e. Ethiopians and Kenyans) between half- and full marathons. Data from 508,108 athletes (125,894 female and 328,430 male half-marathoners and 10,205 female and 43,489 male marathoners) originating from 126 countries and competing between 1999 and 2014 in all road-based half-marathons and marathons held in one country (Switzerland) were analysed using Chi square (χ(2)) tests, mixed-effects regression analyses and one-way analyses of variance. In half-marathons, 48 women (0.038 %) and 63 men (0.019 %) were from Ethiopia and 80 women (0.063 %) and 134 men (0.040 %) from Kenya. In marathons, three women (0.029 %) and 15 men (0.034 %) were from Ethiopia and two women (0.019 %) and 33 men (0.075 %) from Kenya. There was no statistically significant association between the nationality of East Africans and the format of a race. In both women and men, the fastest race times in half-marathons and marathons were achieved by East African runners (p < 0.001). Ethiopian and Kenyan runners were the youngest in both sexes and formats of race (p < 0.001). In summary, women and men from Ethiopia and Kenya, despite they accounted for <0.1 % in half-marathons and marathons, achieved the fastest race times and were the youngest in both half-marathons and marathons. These findings confirmed in the case of half-marathon the trend previously observed in marathon races for a better performance and a younger age in East African runners from Ethiopia and Kenya.

NEWS for Africa: adaptation and reliability of a built environment questionnaire for physical activity in seven African countries.

BACKGROUND: Built environment and policy interventions are effective strategies for controlling the growing worldwide deaths from physical inactivity-related non-communicable diseases. To improve built environment research and develop African specific evidence, it is important to first tailor built environment measures to African contexts and assess their psychometric properties across African countries. This study reports on the adaptation and test-retest reliability of the Neighborhood Environment Walkability Scale in seven sub-Saharan African countries (NEWS-Africa). METHODS: The original NEWS comprising 8 subscales measuring reported physical and social attributes of neighborhood environments was systematically adapted for Africa through extensive input from physical activity and public health researchers, built environment professionals, and residents in seven African countries: Cameroon, Ghana, Kenya, Mozambique, Nigeria, South Africa and Uganda. Cognitive testing of NEWS-Africa was conducted among diverse residents (N = 109, 50 youth [12 - 17 years] and 59 adults [22 - 67 years], 69 % from low socioeconomic status [SES] neighborhoods). NEWS-Africa was translated into local languages and evaluated for 2-week test-retest reliability in adult participants (N = 301; female = 50.2 %; age = 32.3 ± 12.9 years) purposively recruited from neighborhoods varying in walkability (high and low walkable) and SES (high and low income) and from villages in six of seven participating countries. RESULTS: The original 67 NEWS items was expanded to 89 scores (76 individual NEWS items and 13 computed scales). Several modifications were made to individual items, and some new items were added to capture important attributes in the African environment. A new scale on personal safety was created, and the aesthetics scale was enlarged to reflect African specific characteristics. Over 95 % of all NEWS-Africa scores (items plus computed scales) demonstrated evidence of "excellent" (ICCs > .75 %) or "good" (ICCs = 0.60 to 0.74) reliability. Seven (53.8 %) of the 13 computed NEWS scales demonstrated "excellent" agreement and the other six had "good" agreement. No items or scales demonstrated "poor" reliability (ICCs < .40). CONCLUSIONS: The systematic adaptation and initial psychometric evaluation of NEWS-Africa indicates the instrument is feasible and reliable for use with adults of diverse demographic characteristics in Africa. The measure is likely to be useful for research, surveillance of built environment conditions for planning purposes, and to evaluate physical activity and policy interventions in Africa.

Associations Between Parental Perceptions of the Neighborhood Environment and Childhood Physical Activity: Results from ISCOLE-Kenya.

BACKGROUND: A physical activity transition to declining activity levels, even among children, now poses a serious public health concern because of its contribution to a rising prevalence of noncommunicable diseases. Childhood physical activity levels are associated with parental perceptions of the neighborhood; however, these relationships have not been explored in sub-Saharan Africa (SSA). The objective was to investigate relationships between parental perceptions of the neighborhood and physical activity indicators among Kenyan children. METHODS: Data were collected from children 9 to 11 years old in Nairobi as part of the International Study of Childhood Obesity, Lifestyle and Environment. Child physical activity was assessed by accelerometry, and information on obtaining sufficient physical activity, active transport, and parental perceptions of the neighborhood collected using questionnaires. RESULTS: Of 563 participating children, 45.7%, 12.6%, and 11.4% used active school transportation, met physical activity guidelines, and were sufficiently active, respectively. Parental perception of positive neighborhood social cohesion, positive environs and connectivity, and negative child safety concerns, were associated with child physical activity outcomes. CONCLUSIONS: Aspects of parental perceptions of the neighborhood were associated with child physical activity outcomes and should be further explored to appropriately inform policy and practice in curbing declining physical activity levels among children in SSA.

Adolescent elite Kenyan runners are at risk for energy deficiency, menstrual dysfunction and disordered eating.

Limited data are available on the female athlete triad (Triad) in athletes from minority groups. We explored subclinical and clinical Triad components amongst adolescent elite Kenyan athletes (n = 61) and non-athletes (n = 49). Participants completed demographic, health, sport and menstrual history questionnaires as well as a 5-day weighed dietary record and exercise log to calculate energy availability (EA). Ultrasound assessed calcaneus bone mineral density (BMD). Eating Disorder Inventory subscales and the Three-Factor Eating Questionnaire's cognitive dietary restraint subscale measured disordered eating (DE). EA was lower in athletes than non-athletes (36.5 ± 4.5 vs. 39.5 ± 5.7 kcal ∙ kg FFM(-1) ∙ d(-1), P = 0.003). More athletes were identified with clinical low EA (17.9% vs. 2.2%, OR = 9.5, 95% CI 1.17-77, P = 0.021) and clinical menstrual dysfunction (32.7% vs. 18.3%, χ(2) = 7.1, P = 0.02). Subclinical (75.4% vs. 71.4%) and clinical DE (4.9% vs. 10.2%, P = 0.56) as well as BMD were similar between athletes and non-athletes. More athletes had two Triad components than non-athletes (8.9% vs. 0%, OR = 0.6, 95% CI 0.5-6.9, P = 0.05). Kenyan adolescent participants presented with one or more subclinical and/or clinical Triad component. It is essential that athletes and their entourage be educated on their energy needs including health and performance consequences of an energy deficiency.

Analysis of the Kenyan distance-running phenomenon.

PURPOSE: To investigate the ethnicity of Kenya's most successful international runners, tracking their evolution over the period of their international emergence and current dominance. METHODS: The authors analyzed male track distance events from 800m upwards from all the major global athletics championships from 1964 to 2013, and the annual Top-25 world marathon performances since 1990. RESULTS: The percentage of top-25 marathon performances and medals won by Kenyan and Kalenjin runners have increased over time with Nandi subtribe outperforming the rest of the world outside Africa (r > .70, large effect). However, Europe, North America, Oceania, Asia, and South America decreased over time in top marathon performances and track medals won (r > .70, large effect). The tribe and subtribe distribution was different in the marathon than in the track: Maasais were more likely to feature in medals won in shorter track events than in the top 25 of the world marathon rankings (risk ratio [RR] = 9.67, very large effect). This was also the case for Marakwets (RR = 6.44, very large effect) and Pokots (RR = 4.83, large effect). On the other hand, Keiyos, Kikuyus, Kipsigis, Sabaots, and Tugens were more likely to succeed in the marathon than in shorter track events (RR > 2.0, moderate effect). CONCLUSION: These data emphasize that the previously documented emergence of African distance runners is primarily a Kenyan phenomenon, driven by the Kalenjin tribe and in particular the Nandi subtribe. This supports the complex interaction between genotype, phenotype, and socioeconomic factors driving the remarkable dominance of Kenyan distance runners.