The association between device-measured sitting time and cardiometabolic health risk factors in children.

BACKGROUND: There is limited evidence of the associations between postural-derived sitting time, waist-worn derived sedentary time and children's health and the moderation effect of physical activity (PA). This study examined associations of children's device-measured sitting time with cardiometabolic health risk factors, including moderation by physical activity. METHODS: Cross-sectional baseline data from children (mean-age 8.2 ± 0.5 years) in Melbourne, Australia (2010) participating in the TransformUs program were used. Children simultaneously wore an activPAL to assess sitting time and an ActiGraph GT3X to assess sedentary time and physical activity intensity. Cardiometabolic health risk factors included: adiposity (body mass index [BMI], waist circumference [WC]), systolic and diastolic blood pressure (SBP, DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, triglycerides, fasting plasma glucose (FPG), serum insulin, and 25-hydroxyvitaminD (25[OH]D). Linear regression models (n = 71-113) assessed associations between sitting time with each health risk factor, adjusted for different PA intensities (i.e. light [LIPA], moderate-vigorous intensities [MVPA], separately on each model), age, sex, adiposity, and clustering by school. Interaction terms examined moderation. The analyses were repeated using device-measured sedentary time (i.e. ActiGraph GT3X) for comparison. RESULTS: Sitting time was positively associated with SBP (b = 0.015; 95%CI: 0.004, 0.026), DBP (b = 0.012; 95%CI:0.004, 0.020), and FPG (b = 0.001; 95%CI: 0.000, 0.000), after adjusting for higher PA intensities. The association between sitting time and insulin (b = 0.003; 95%CI: 0.000, 0.006) was attenuated after adjusting for higher PA intensities. When the models were adjusted for LIPA and MVPA, there was a negative association with LDL (b=-0.001; 95%CI: -0.002, -0.000 and b=-0.001; 95%CI: -0.003, -0.000, respectively). There was a negative association of sedentary time with WCz (b=-0.003; 95%CI: -0.005, 0.000) and BMIz (b=-0.003; 95%CI: -0.006, -0.000) when the models were adjusted by MVPA. Sedentary time was positively associated with triglycerides (b = 0.001; 95%CI: 0.000, 0.001) but attenuated after adjusting for MVPA. No evidence of moderation effects was found. CONCLUSIONS: Higher volumes of sitting and sedentary time were associated with some adverse associations on some cardiometabolic health risk factors in children. These associations were more evident when sitting time was the predictor. This suggests that reducing time spent sitting may benefit some cardiometabolic health outcomes, but future experimental research is needed to confirm causal relationships and identify the biological mechanisms that might be involved. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12609000715279.

Effectiveness of Intervention Strategies to Increase Adolescents' Physical Activity and Reduce Sedentary Time in Secondary School Settings, Including Factors Related to Implementation: A Systematic Review and Meta-Analysis.

BACKGROUND: Globally, just one in five adolescents meet physical activity guidelines and three-quarters of the school day is spent sitting. It is unclear which types of school-based interventions strategies increase physical activity and reduce sedentary time among adolescents, or how these interventions are implemented influences their effectiveness. OBJECTIVE: The three aims of our systematic review were to (a) identify intervention strategies used within secondary school settings to improve students' movement behaviours throughout school-based initiatives, delivered at or by the school; (b) determine the overall effect of the interventions (meta-analysis) on physical activity (all intensities), sedentary time, cognitive/academic, physical health and/or psychological outcomes; and (c) describe factors related to intervention implementation. METHODS: Searches were conducted in MEDLINE complete, EMBASE, CINAHL, SPORTDiscus, APA PsycINFO, and ERIC in January 2023 for studies that (a) included high school-aged adolescents; (b) involved a school-based intervention to increase physical activity and/or decrease sedentary time; and (c) were published in English. Reported effects were pooled in meta-analyses where sufficient data were obtained. RESULTS: Eighty-five articles, representing 61 interventions, met the inclusion criteria, with 23 unique intervention strategies used. Interventions that involved whole-school approaches (i.e., physical activity sessions, environmental modifications, teacher training, peer support and/or educational resources) were favourably associated with most of the outcomes. The meta-analyses showed: (a) non-significant effects for sedentary time (Standardized mean difference [SMD] = -0.02; 95%CI, -0.14, 0.11), physical activity at all intensities (light: SMD= -0.01; 95%CI, -0.08, 0.05; moderate: SMD = 0.06; 95%CI, -0.09, 0.22; vigorous: SMD = 0.08; 95%CI, -0.02, 0.18; moderate-to-vigorous: SMD = 0.05; 95%CI, -0.01, 0.12) and waist circumference (SMD = 0.09; 95%CI, -0.03, 0.21), and (b) a small statistically significant decrease in body mass index (SMD= -0.09, 95%CI -0.16, -0.0). Factors related to intervention implementation were reported in 51% of the articles. CONCLUSION: While some intervention approaches demonstrated promise, small or null effects were found in meta-analyses. Future school-based interventions should utilize a whole-school approach designed to increase adolescents' activity across the day. Consistent reporting of implementation will increase understanding of how interventions are adopted, implemented and sustained. REGISTRATION: PROSPERO (CRD42020169988).

The impact of height-adjustable desks and classroom prompts on classroom sitting time, social, and motivational factors among adolescents.

PURPOSE: This quasi-experimental study examined the impact of height-adjustable desks in combination with prompts to break up prolonged sitting time during class time and identified social and motivational factors associated with breaking up sitting time among adolescents. Teachers' perceptions of strategies were also examined. METHODS: Over 17 weeks, 1 classroom in a government secondary school in Melbourne, Australia, was equipped with 27 height-adjustable desks and prompts (posters and desk stickers) to break up classroom sitting time. Teachers received professional development in the use of the desks and prompts. One group of adolescents (n = 55) had 2-5 lessons/week using the height-adjustable desks in an intervention classroom, and a comparison group matched by year level and subject (n = 50) was taught in traditional "seated" classrooms. Adolescents wore an activPAL monitor at baseline (T0), 4 weeks (T1), and 17 weeks (T2) and completed a survey at T0 and T2. Six teachers participated in interviews at T2. Effect sizes were calculated (d). RESULTS: Linear mixed models found that, compared to the traditional "seated" classrooms, the adolescents in the intervention classroom had significantly lower sitting time (T1: -9.7 min/lesson, d = -0.96; T2: -6.7 min/lesson, d = -0.70) and time spent in sitting bouts >15 min (T2: -11.2 min/lesson, d = -0.62), and had significantly higher standing time (T1: 7.3 min/lesson, d = 0.84; T2: 5.8 min/lesson, d = 0.91), number of breaks from sitting (T1: 1.3 breaks/lesson, d = 0.49; T2: 1.8 breaks/lesson, d = 0.67), and stepping time (T1: 2.5 min/lesson, d = 0.66). Intervention classroom adolescents reported greater habit strength (d = 0.58), self-efficacy for breaking up sitting time (d = 0.75), and indicated that having a teacher/classmate remind them to stand as helpful (d = 0.50). CONCLUSION: This intervention shows promise for targeting sitting behaviors in the classroom and indicates that incorporating social and motivational strategies may further enhance outcomes.

Understanding Australian adolescent girls' use of digital technologies for healthy lifestyle purposes: a mixed-methods study.

BACKGROUND: Little is known about girls' use of a broad range of digital technologies to support a healthy lifestyle, particularly during the later adolescent years when they are expected to take greater responsibility for individually managing their health and wellbeing. The present study was designed to gain an in-depth understanding of adolescent girls', 15 to 17 years of age, use of a broad range of digital technologies to support multiple healthy lifestyle purposes. METHODS: This study used a mixed-methods sequential research design (i.e. quantitative and qualitative data in two consecutive phases). A quantitative online survey was conducted to determine the use of digital technologies for healthy lifestyle purposes. Qualitative semi-structured interviews were conducted with a subset of survey respondents to explore factors influencing their technology use and preferences. RESULTS: Descriptive analysis of survey data (online survey, n = 336) demonstrated the popularity of social media and online video sharing platforms, with evidence that the use of digital technologies does not occur in isolation and girls draw on several resources simultaneously to achieve their desired healthy lifestyle outcomes. Thematic analysis of interview data (semi-structured interviews, n = 29) revealed seven interrelated themes around factors influencing girls' use of, and satisfaction with, different digital technologies: accessibility, social connectivity, credibility, relatability, inspiration, safety, and customisability. CONCLUSIONS: The findings reiterate that one size doesn't fit all girls, and often one size might not even fit one girl, and thus highlight the challenge of catering to such varied use cases. Overall, it appears that current digital technology offerings meet the needs and preferences of adolescent girls for healthy lifestyle purposes, however there may be benefit in allowing greater customisation of use, and consumer driven tailoring of content, according to personal preferences and changing circumstances.

Does light-intensity physical activity moderate the relationship between sitting time and adiposity markers in adolescents?

BACKGROUND: While the relationship between sedentary time and adiposity markers may be independent of moderate-to-vigorous intensity physical activity (MVPA) among adolescents, little is known about the role of light-intensity physical activity (LIPA) in this relationship. The aim of this cross-sectional study was to examine whether device-measured LIPA and MVPA moderate the associations between objectively measured sitting time and adiposity markers (body mass index (BMI)) and waist circumference (WC)) among adolescents. METHODS: This study included accelerometer and inclinometer data obtained from 219 adolescents (age = 14.9 ± 1.6 years, mean ± SD), collected during 2014 and 2015 in Melbourne, Australia. ActiGraph GT3X accelerometers were used to determine time spent in total-LIPA (101 counts/min to 3.99 metabolic equivalents (METs)) was dichotomized into low-LIPA (101-799 counts/min) and high LIPA (800 counts/min to 3.99 METs), and MVPA (≥ 4 METs). The average time spent sitting was obtained from activPAL inclinometers. Anthropometric measures were assessed by trained staff. Interactions between sitting and total-LIPA, low-LIPA, high-LIPA, and MVPA on BMI z-score (zBMI) and WC z-score (zWC), respectively, were examined using linear regression, adjusting for age and sex; and moderation by total-LIPA, low-LIPA, high-LIPA, and MVPA were examined by adding interaction terms. Significant interaction effects were probed by comparing associations at the mean and at 1 SD below and above the mean. RESULTS: Total-LIPA significantly moderated the association between sitting time and zBMI, and low-LIPA significantly moderated the association between sitting time and zBMI and zWC. No other associations were found for total-LIPA, high-LIPA, or MVPA. Specifically, at high levels of total-LIPA (+1 SD), there is a negative association between sitting time and zBMI. In addition, at high levels of low-LIPA (+1 SD), there is a negative association between sitting time and zBMI and zWC. CONCLUSION: Associations between sitting and adiposity depended on time spent in total-LIPA and low-LIPA, but not high-LIPA or MVPA. Results suggest that increasing time spent in LIPA may provide protection from the deleterious effects of sitting on adiposity markers among adolescents. Experimental evidence is needed to support these conclusions.

Adoption, implementation and sustainability of school-based physical activity and sedentary behaviour interventions in real-world settings: a systematic review.

BACKGROUND: Globally, many children fail to meet the World Health Organization's physical activity and sedentary behaviour guidelines. Schools are an ideal setting to intervene, yet despite many interventions in this setting, success when delivered under real-world conditions or at scale is limited. This systematic review aims to i) identify which implementation models are used in school-based physical activity effectiveness, dissemination, and/or implementation trials, and ii) identify factors associated with the adoption, implementation and sustainability of school-based physical activity interventions in real-world settings. METHODS: The review followed PRISMA guidelines and included a systematic search of seven databases from January 1st, 2000 to July 31st, 2018: MEDLINE, EMBASE, CINAHL, SPORTDiscus, PsycINFO, CENTRAL, and ERIC. A forward citation search of included studies using Google Scholar was performed on the 21st of January 2019 including articles published until the end of 2018. Study inclusion criteria: (i) a primary outcome to increase physical activity and/or decrease sedentary behaviour among school-aged children and/or adolescents; (ii) intervention delivery within school settings, (iii) use of implementation models to plan or interpret study results; and (iv) interventions delivered under real-world conditions. EXCLUSION CRITERIA: (i) efficacy trials; (ii) studies applying or testing school-based physical activity policies, and; (iii) studies targeting special schools or pre-school and/or kindergarten aged children. RESULTS: 27 papers comprising 17 unique interventions were included. Fourteen implementation models (e.g., RE-AIM, Rogers' Diffusion of Innovations, Precede Proceed model), were applied across 27 papers. Implementation models were mostly used to interpret results (n = 9), for planning evaluation and interpreting results (n = 8), for planning evaluation (n = 6), for intervention design (n = 4), or for a combination of designing the intervention and interpreting results (n = 3). We identified 269 factors related to barriers (n = 93) and facilitators (n = 176) for the adoption (n = 7 studies), implementation (n = 14 studies) and sustainability (n = 7 studies) of interventions. CONCLUSIONS: Implementation model use was predominately centered on the interpretation of results and analyses, with few examples of use across all study phases as a planning tool and to understand results. This lack of implementation models applied may explain the limited success of interventions when delivered under real-world conditions or at scale. TRIAL REGISTRATION: PROSPERO (CRD42018099836).

Exploring when and how adolescents sit: cross-sectional analysis of activPAL-measured patterns of daily sitting time, bouts and breaks.

BACKGROUND: This study describes patterns of adolescents' objectively-measured sitting volume, sitting bouts, and breaks in sitting during different days and periods of the day, and explored differences by sex and weekdays versus weekend days. METHODS: ActivPAL™ data were collected in August 2014-December 2015 from adolescents attending secondary government schools in Melbourne Australia. Eight periods (early morning, mid-morning, morning break, late morning, lunch, early afternoon, late-afternoon and evening) were extracted for each day. School time, class time and out-of-school time were also extracted for weekdays. The percentage of time sitting, percentage of each hour in prolonged sitting (sitting bout ≥10 min), and number of sitting breaks/hour were calculated for each period. Differences by sex, and week and weekend days were determined using t-tests. RESULTS: Participants (n = 297, 15.4 ± 1.6 years) spent 68% of their day sitting; ~ 30% of each hour in prolonged sitting and 3.1 sitting breaks/hour. Sitting time was greater during class time (75%) and school (70%) compared to out-of-school time (65%). Sitting patterns differed between week and weekend days for all periods except the evening period. Girls had higher proportion of sitting during class than boys (76% vs 72% respectively) and school hours (72% vs 67%), more prolonged sitting during school hours (27% vs 23%), and more sitting breaks per hour during out-of-school time (2.6 vs 2.4), but fewer during class (2.5 vs 3.3) and school hours (2.7 vs 3.3). Sitting patterns did not differ by sex on weekend days. CONCLUSIONS: Adolescents spent two-thirds of their waking hours sitting, with distinct patterns on weekdays and weekend days. Even though boys and girls were exposed to the same school day routine, girls spent more time sitting and had fewer sitting breaks. Class times, school breaks and the evening period were identified as key intervention periods. Further research is needed to understand the behavioural differences, and guide future intervention design.

Longitudinal Changes in Sitting Patterns, Physical Activity, and Health Outcomes in Adolescents.

This study examined two-year changes in patterns of activity and associations with body mass index (BMI) and waist circumference (WC) among adolescents. Inclinometers (activPAL) assessed sitting, sitting bouts, standing, stepping, and breaks from sitting. ActiGraph-accelerometers assessed sedentary time (SED), light-intensity physical activity (LIPA, stratified as low- and high-LIPA), and moderate-to-vigorous physical activity (MVPA). Anthropometric measures were objectively assessed at baseline and self-reported at follow-up. Data from 324 and 67 participants were obtained at baseline and follow-up, respectively. Multilevel mixed-effects linear regression models examined changes over time, and associations between baseline values and BMI and WC at follow-up. There were significant increases in BMI (0.6 kg/m²) and durations of prolonged sitting (26.4 min/day) and SED (52 min/day), and significant decreases in stepping (-19 min/day), LIPA (-33 min/day), low-LIPA (-26 min/day), high-LIPA (-6.3 min/day), MVPA (-19 min/day), and the number of breaks/day (-8). High baseline sitting time was associated (p = 0.086) with higher BMI at follow-up. There were no significant associations between baseline sitting, prolonged sitting, LIPA, or MVPA with WC. Although changes in daily activity patterns were not in a favourable direction, there were no clear associations with BMI or WC. Research with larger sample sizes and more time points is needed.

The impact of height-adjustable desks and prompts to break-up classroom sitting on adolescents' energy expenditure, adiposity markers and perceived musculoskeletal discomfort.

Adolescents spend large amounts of time sitting at school. Little is known about the impact of reducing and breaking-up prolonged sitting during school lessons on adolescents' health. This study aimed to investigate the impact of an intervention to reduce classroom sitting time on adolescents' energy expenditure (EE; kcal/lesson), body mass index (BMI), waist circumference (WC), and musculoskeletal discomfort. A secondary school classroom was equipped with height-adjustable desks, posters promoting the health benefits of and strategies for breaking-up sitting time, and desk stickers reminding students to periodically stand up. Classroom teachers participated in a professional development session. Using a quasi-experimental design, differences between 49 participants who utilised the intervention classroom 2-5 times/week and a comparison group (39 adolescents, matched by year level and subject) who used traditional classrooms, were examined. EE, BMI and WC were objectively measured and musculoskeletal discomfort was self-reported at baseline, 4-weeks, and 17-weeks. Hierarchical linear and multilevel logistic regression-mixed models were used to examine intervention effects, adjusting for baseline values, sex and age. EE was significantly higher at 4-weeks and 17-weeks (29.4 and 37.7 kcal/lesson, respectively), BMI was higher at 4-weeks (0.34 kg/m2), and WC was lower at 4-weeks and 17-weeks (-3.53 and -2.64 cm, respectively) in the intervention compared to the comparison group. No intervention effect was found for musculoskeletal discomfort. Findings provide preliminary indications that these strategies may benefit health among adolescents in the short term. However, extended longer-duration trials are needed to determine longer-term health effects.

Impact of an 8-Month Trial Using Height-Adjustable Desks on Children's Classroom Sitting Patterns and Markers of Cardio-Metabolic and Musculoskeletal Health.

During school hours, children can sit for prolonged and unbroken periods of time. This study investigated the impact of an 8-month classroom-based intervention focusing on reducing and breaking-up sitting time on children's cardio-metabolic risk factors (i.e., body mass index, waist circumference, blood pressure) and perceptions of musculoskeletal discomfort. Two Year-6 classes (24 students per class) in one primary school were assigned to either an intervention or control classroom. The intervention classroom was equipped with height-adjustable desks and the teacher was instructed in the delivery of pedagogical strategies to reduce and break-up sitting in class. The control classroom followed standard practice using traditional furniture. At baseline, and after 8-months, time spent sitting, standing, stepping, and sitting-bouts (occasions of continuous sitting) as well as the frequency of sit-to-stand transitions were obtained from activPAL inclinometers and the time spent in light-intensity physical activity was obtained from ActiGraph accelerometers. Demographics and musculoskeletal characteristics were obtained from a self-report survey. Hierarchical linear mixed models found that during class-time, children's overall time spent sitting in long bouts (>10 min) were lower and the number of sit-to-stand transitions were higher in the intervention group compared to the control group, while no changes were observed for musculoskeletal pain/discomfort. No significant intervention effects were found for the anthropometrics measures and blood pressure. Height-adjustable desks and pedagogical strategies to reduce/break-up sitting can positively modify classroom sitting patterns in children. Longer interventions, larger and varied sample size may be needed to show health impacts; however, these desks did not increase musculoskeletal pain/discomfort.

Validity of self-measured waist circumference in adults at risk of type 2 diabetes and cardiovascular disease.

BACKGROUND: Waist circumference (WC) is used to indirectly measure abdominal adipose tissue and the associated risk of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Because of its easy implementation and low cost, self-measured WC is commonly used as a screening tool. However, discrepancies between self-measured and objectively measured WC may result in misclassification of individuals when using established cut-off values. The aim of this study was to determine the accuracy of self-measured WC in adults at risk of T2DM and/or CVD, and to determine the anthropometric, demographic and behavioural characteristics associated with bias in self-measured WC. METHODS: Self-measured and objectively measured WC was obtained from 622 participants (58.4% female; mean age 43.4 ± 5.3 years) in the Hoorn Prevention Study. The associations of gender, age, educational level, body mass index, smoking status, dietary habits, physical activity and sedentary behaviour with the discrepancies between self-measured and objectively measured WC were analysed using independents t-test and one-way ANOVA. Bland-Altman plots were used to plot the agreement between the two measures. RESULTS: On average, self-measured WC was overestimated by 5.98 ± 4.82 cm (P < 0.001). Overestimation was consistent across all subgroups, but was more pronounced in those who were younger and those with lower educational attainment. CONCLUSIONS: The results support self-measured WC as a useful tool for large-scale populations and epidemiological studies when objective measurement is not feasible, but overestimation should be taken into account when screening adults at risk of T2DM and/or CVD.