"Your Kid Has Potential, But They Need Sleep": Teacher Perspectives on School-Based Sleep Promotion in Alberta, Canada.

BACKGROUND: Insufficient sleep is a growing public health concern. Thirty percent of Canadian children and youth are not meeting national sleep recommendations. Inadequate sleep can negatively influence students' academics and physical and psychosocial health. Schools have been identified as ideal health promotion settings to influence children's health including their sleep behaviors. The objective of this study was to explore teachers' perspectives on sleep behaviors and their role in school-based sleep promotion. METHODS: Nineteen elementary teachers were purposively sampled from the greater Edmonton area, Alberta, Canada. Interpretive description was used as the guiding method, and data were generated through one-on-one semi-structured interviews. Inductive descriptive thematic analysis was used to identify interview themes. RESULTS: Three themes related to teachers' perspectives on sleep behaviors and school-based sleep promotion were identified: the importance of students' sleep, prioritizing sleep as part of teaching and learning, and a culture of healthy sleep habits. CONCLUSIONS: This study found that teachers considered sleep to be essential for elementary students' academic success and wellbeing, and a whole school approach was necessary to support a healthy sleep culture in schools.

Canadian after-school care providers' perceived role promoting healthy lifestyles: a focused ethnography.

BACKGROUND: After-school care programs have garnered interest in recent years as the hours of 3:00-6:00 p.m. are an opportune time for children to engage in healthy behaviours, specifically healthy eating and physical activity. Care providers are major influencers within the after-school care setting, impacting health promoting opportunities for children. However, little is known regarding the role care providers play in health promotion interventions in the after-school care setting, specifically those using comprehensive approaches. The purpose of this research was to explore care providers' role and experience promoting healthy eating and physical activity through the after-school care health promotion intervention School's Out … Let's Move (SOLMo). SOLMo was guided by the evidence-based comprehensive school health framework. SOLMo had two main goals: [1] to serve a healthy snack with vegetable or fruit, and milk or water as the drink; [2] to include 30 min of moderate to vigorous physical activity. The intervention included resources and coaching for care providers to promote healthy eating and physical activity for children and took place in four after-school sites over a six-month period. Three of four sites were located in a school. The primary researcher was engaged with the sites over 22-months. METHODS: This research was guided by the qualitative method focused ethnography. Semi-structured interviews with care providers (n = 13) taking part in SOLMo were conducted. Participant observation was included as part of data generation to further understand care provider roles. Latent content analysis was utilized iteratively and concurrently throughout data generation. RESULTS: Overall, care providers were supportive of promoting health behaviours in the after-school setting. Through analysis, five themes and eight subthemes emerged related to care providers' role and experience promoting healthy eating and physical activity through SOLMo: 1) enhanced awareness; 2) improved programming; 3) strong relationships; 4) collaborative approach; and 5) role tension. CONCLUSIONS: As major influencers, care providers play a crucial role in promoting healthy lifestyle behaviours for children. This research provides valuable insight into this role and the implementation of comprehensive health promotion approaches in the after-school setting. Findings contribute to the implementation knowledge base and help inform the promotion of healthy lifestyle behaviours for children.

Outdoor time is associated with physical activity, sedentary time, and cardiorespiratory fitness in youth.

OBJECTIVE: To determine whether time spent outdoors was associated with increased moderate-to-vigorous physical activity (MVPA) and related health benefits in youth. STUDY DESIGN: We performed a cross-sectional study of 306 youth aged 13.6 ± 1.4 years. The exposure of interest was self-reported time spent outdoors after school, stratified into three categories: none, some, and most/all of the time. The main outcome of interest was accelerometer-derived MVPA (Actical: 1500 to >6500 counts/min). Secondary outcomes included sedentary behavior, cardiorespiratory fitness, overweight status, and blood pressure. RESULTS: Among the 306 youth studied, those who reported spending most/all of their after-school time outdoors (n = 120) participated in more MVPA (61.0 ± 24.3 vs 39.9 ± 19.1 min/day; adjusted P < .001), were more likely to achieve the recommended minimum 60 min/day of MVPA (aOR 2.8; 95% CI, 1.3-6.4), spent less time in sedentary activities (539 ± 97 min/day vs 610 ± 146 min/day; adjusted P < .001), and had higher cardiorespiratory fitness (49 ± 5 vs 45 ± 6 mL/kg/min; adjusted P < .001) than youth who reported no time outdoors (n = 52). No differences in overweight/obesity or blood pressure were observed across the groups. CONCLUSIONS: Time spent outdoors is positively associated with MVPA and cardiorespiratory fitness in youth and negatively associated with sedentary behavior. Experimental trials are needed to determine whether strategies designed to increase time spent outdoors exert a positive influence on physical activity and fitness levels in youth.

Anthropometric and dietary predictors of insulin sensitivity in 10- to 14-year-old boys and girls.

The high prevalence of pediatric obesity has made preventing chronic diseases through healthy lifestyle behaviours a priority within pediatrics. Examining the association between diet and insulin sensitivity (IS) in youth may provide important insights for tailoring preventative dietary interventions. The objective of this study was to explore the associations among anthropometry, diet, and IS in 10- to 14-year-olds. In this cross-sectional study, the primary outcome measure was IS, measured noninvasively using a (13)C glucose breath test. Exposure variables included body mass index (BMI) z score and several dietary variables, including glycemic index (GI), glycemic load, and fiber, magnesium, vegetable and fruit, and fat intakes, all of which were derived from a validated, Web-based 24-h recall tool. Multiple regression analyses were performed for boys and girls separately. In total, 378 students (227 girls) aged 12.1 ± 1.2 years were studied. In this sample ∼24% of youth were considered overweight or obese (BMI z score = 0.41 ± 0.93). Multiple regression analyses showed that BMI z score was negatively and independently associated with (13)C insulin sensitivity score ((13)CISS) in both boys and girls (boys: ß = -0.501; girls: ß = -0.446; both p < 0.001). GI was negatively and independently related to (13)CISS in boys (ß = -0.195, p < 0.05) but not in girls. Other dietary variables were not associated with IS. In addition to BMI z score, a low GI diet predicted (13)CISS in boys but not in girls. This finding suggests that interventions that reduce BMI (in both sexes) and include a low GI diet among boys may improve IS.

Physical activity intensity and cardiometabolic risk in youth.

OBJECTIVE: To determine the association between physical activity (PA) intensities and cardiometabolic risk factors in youth. DESIGN: Cross-sectional study using data from the 2008 Healthy Hearts Prospective Cohort Study of Physical Activity and Cardiometabolic Health in Youth. SETTING: Rural and urban communities in Alberta, Canada. PARTICIPANTS: A convenience sample of 605 youth aged 9 to 17 years. Youth were on average aged 12.1 years, 248 were boys (41%), and 157 were overweight or obese (26%). MAIN EXPOSURE: Actical accelerometer-measured PA intensity. MAIN OUTCOMES MEASURES: The primary outcome was body mass index (calculated as weight in kilograms divided by height in meters squared) z score. Secondary outcome measures included waist circumference, systolic blood pressure, and cardiorespiratory fitness (maximal oxygen consumption [[Vdot]O2max]). RESULTS: Body mass index z score, waist circumference, and systolic blood pressure decreased and [Vdot]O2max increased in a dose-response manner across tertiles of vigorous PA (adjusted P < .001). No significant differences in cardiometabolic risk factors were seen across tertiles of moderate or light PA in multivariable analyses. Achieving more than 7 minutes of vigorous PA daily was associated with a reduced adjusted odds ratio of overweight status (0.56; 95% CI, 0.33-0.95) and elevated systolic blood pressure (0.36; 95% CI, 0.16-0.79). The odds of overweight status and elevated blood pressure decreased with increasing time and intensity of PA. CONCLUSIONS: Only vigorous PA was consistently associated with lower levels of waist circumference, body mass index z score, systolic blood pressure, and increased cardiorespiratory fitness in youth. These findings underscore the importance of vigorous PA in guidelines for children and adolescents.

Cardiorespiratory fitness and the risk of overweight in youth: the Healthy Hearts Longitudinal Study of Cardiometabolic Health.

The primary objective of this longitudinal study was to determine the association between cardiorespiratory fitness and the risk of overweight status in youth. To accomplish this aim we analyzed data from annual school-based surveys of cardiorespiratory fitness and anthropometry conducted between 2004 and 2006. The first analysis was performed on a cohort of 902 youth aged 6-15 years followed for 12 months to assess the association between cardiorespiratory fitness levels determined from a graded maximal field test and the risk of becoming overweight. The second analysis was conducted on a cohort of 222 youth followed for 2 years to assess the continuous association between annual changes fitness and weight gain. Children with low cardiorespiratory fitness were characterized by higher waist circumference and disproportionate weight gain over the 12-month follow-up period (P < 0.05). Within the entire cohort, the 12-month risk of overweight classification was 3.5-fold (95% confidence = 2.0-6.0, P < 0.001) higher in youth with low cardiorespiratory fitness, relative to fit peers. A time series mixed effects regression model revealed that reductions in cardiorespiratory fitness were significantly and independently associated with increasing BMI (r = -0.18, P < 0.05) in youth. Accordingly, low cardiorespiratory fitness and reductions in fitness over time are significantly associated with weight gain and the risk of overweight in children 6-15 years old. An assessment of cardiorespiratory fitness using a common field test may prove useful for the identification of youth at risk of overweight and serve as a potential target for obesity prevention.

The relationship between weight gain and blood pressure in children and adolescents.

BACKGROUND: The aim of this study was to determine the relationship between the trajectories of weight gain and systolic blood pressure (SBP) in youth. METHODS: Annual surveys of anthropometry, fitness, SBP, and its determinants (cardiac output, systemic vascular resistance, and arterial compliance) were conducted in youth (aged 5 to 19 years) in a school-based setting between 2004 and 2006. Children were stratified according to change in body mass index (BMI) over time. RESULTS: Within the entire cohort (n = 2089), mean SBP (121 +/- 16 SD v 112 +/- 15 SD mm Hg; P < .01) and the prevalence of high blood pressure (48% v 18%, P < .01) were significantly higher and fitness levels were lower (P < .01) in obese children, relative to healthy-weight peers. After 2 years of follow-up, despite similar SBP and BMI at baseline, the average change in SBP was approximately 4.5-fold greater in children with the largest increase in BMI, relative to children who experienced minimal weight gain. This group also experienced a significantly greater increase in stroke volume (P < .05), while the change in heart rate, arterial compliance, and systemic vascular resistance was comparable with that of children who experienced minimal weight gain. Multiple linear regression analysis revealed that SBP increased 0.77 mm Hg for every kilogram of weight gain over a period of 2 years (P < .01). CONCLUSIONS: Overweight and disproportionate weight gain in children are associated with elevated SBP. These data support the need for interventions to prevent excessive weight gain and obesity in children and adolescents.

Overweight, physical activity and high blood pressure in children: a review of the literature.

Obesity is a growing problem in developed countries and is likely a major cause of the increased prevalence of high blood pressure in children. The aim of this review is to provide clinicians and clinical scientists with an overview of the current state of the literature describing the negative influence of obesity on blood pressure and it's determinants in children. In short, we discuss the array of vascular abnormalities seen in overweight children and adolescents, including endothelial dysfunction, arterial stiffening and insulin resistance. We also discuss the potential role of an increased activation of the sympathetic nervous system in the development of high blood pressure and vascular dysfunction associated with obesity. As there is little consensus regarding the methods to prevent or treat high blood pressure in children, we also provide a summary of the evidence supporting relationship between physical activity and blood pressure in children and adolescents. After reviewing a number of physical activity intervention studies performed in children, it appears as though 40 minutes of moderate to vigorous aerobic-based physical activity 3-5 days/week is required to improve vascular function and reduce blood pressure in obese children. Future studies should focus on describing the influence of physical activity on blood pressure control in overweight children.