Associations of social jetlag with physical activity and sedentary behaviour in children and adolescents: A systematic review and meta-analysis.

Sleep and daytime movement behaviours occur co-dependently with each other within a finite 24 h day. Sleep parameters other than sleep duration, such as social jetlag and chronotype, have been linked to health problems and unhealthy behaviours among children and adolescents. Given the increasing number of studies examining sleep timing/chronotype and weight-related behaviours, including physical activity and sedentary behaviour, in the past decade, this systematic review and meta-analysis collated and evaluated the evidence on the relationships of social jetlag and chronotype with physical activity and sedentary behaviour among children and adolescents aged 3-17 years. Seven databases were searched on 16 March 2022, and 52 studies were identified as eligible for inclusion, 47 of which were suitable for the meta-analysis. A positive association was found between social jetlag and screen media use (r = 0.14, 95% CI: 0.04-0.24; I2 = 96%; p = 0.008). The morning chronotype was associated with a higher level of physical activity and a lower level of sedentary behaviour than the evening chronotype. No relationship was found between social jetlag and physical activity. The magnitude of heterogeneity among the included studies was high. Further experimental studies are urgently required to understand how circadian preference or misalignment affects activity behaviours. Interventions to promote an active lifestyle in young populations should consider their circadian preference, especially among individuals with the evening chronotype.

Effects of accumulated versus continuous individualized exercise on postprandial glycemia in young adults with obesity.

Background: Elevated postprandial glucose (PPG) is an independent risk factor for cardiovascular disease. Post-meal exercise effectively reduces PPG concentrations. However, the effect of accumulated versus continuous post-meal exercise on PPG control remains unclear. This study aimed to investigate the effects of individualized accumulated or continuous exercise on PPG in young adults with obesity.Twenty young adults with obesity (11 males) completed three 4-h randomized crossover trials with 6-14-day washout periods: (1) sitting (SIT), (2) one 30-min walking bout (CONT), and (3) three 10-min walking bouts separated by 20-min resting (ACCU). Walking was initiated 20 min before individual PPG peak after breakfast, which was predetermined by continuous glucose monitoring. Blood samples were collected at 15-30 min intervals, and the 24-h glucose was monitored via continuous glucose monitoring.Results: The 4-h PPG incremental area under the curve (iAUC) was 12.1%±30.9% and 21.5%±21.5% smaller after CONT (P = 0.022) and ACCU (P < 0.001), respectively, than after SIT. PPG concentrations were lower during CONT at 30-60 min and during ACCU at 30-105 min after breakfast than during SIT (all P < 0.05). The 4-h plasma insulin and C-peptide iAUC, and mean amplitude of glycemic excursions were lower after CONT and ACCU than after SIT (all P < 0.05).Conclusions: Both continuous and accumulated exercises reduced PPG, insulin, and C-peptide concentrations and improved glucose fluctuations. Accumulated exercise maintained lower PPG concentrations for a longer time than continuous exercise in young adults with obesity.Clinical Trial Information: Clinical trial registration No. ChiCTR 2000035064, URL: http://www.chictr.org.cn/showproj.aspx?proj=56584; (registered July 29, 2020).

Both continuous and accumulated walking lowered post-meal glucose, insulin and C-peptide levels and improved glucose fluctuation.Postprandial glucose was kept lower for a longer time in accumulated than continuous walking.Accumulated post-meal exercise (e.g. three 10-min bouts of walking) could be recommended as a feasible and practical alternative protocol for postprandial glucose control, especially for those who have difficulty performing sufficient exercise in one session.

Results and SWOT Analysis of the 2022 Hong Kong Report Card on Physical Activity for Children and Adolescents With Special Educational Needs.

BACKGROUND: Following the 2019 Hong Kong Para Report Card, the 2022 Hong Kong Para Report Card aimed to provide an updated and evidence-based assessment for nine indicators related to physical activity in children and adolescents with special educational needs and to assess the results using a SWOT (strengths, weaknesses, opportunities, and threats) analysis. METHODS: Using a systematic process, the best available data on nine indicators were searched from the past 10 years and were assessed by a research work group. Letter grades were assigned and considered by stakeholders and auditors. RESULTS: Four indicators were assigned a letter grade (overall physical activity: F [mixed device-measured and self-reported data]; sedentary behaviors: D [device-measured data]; active transportation: D-; government strategies & investment: C+). SWOT analysis highlighted opportunities for facilitating children and adolescents with special educational needs to achieve health recommendations. CONCLUSION: There were deteriorating trends in physical activity and sedentary behaviors. Effective, multilevel, and cross-sector interventions are recommended to promote active behavior in children and adolescents with special educational needs.

Report card grades on physical activity for children and adolescents from 18 Asian countries: Patterns, trends, gaps, and future recommendations.

Background: Physical inactivity is a persistent and worsening population health concern in Asia. Led by the Active Healthy Kids Global Alliance, Global Matrix (GM) initiative provides an opportunity to explore how regional and cultural differences across 18 Asian countries relate to physical activity (PA) participation among children and adolescents. Objectives: To synthesize evidence from the GM2.0 to GM4.0 (2016-2022) in Asian countries. Methods: Report Card grades on behavioral/individual and sources of influence indicators were reported from 18 Asian countries. Letter grades were converted into numerical values for quantitative analyses. Based on this, cross-sectional and longitudinal analyses were conducted to investigate patterns and trends. Qualitative evidence synthesis was performed based on Report Card grades and published papers to identify gaps and suggest future recommendations. Results: In total, 18 countries provided grades for at least one round of GM, 12 countries provided grades for at least two rounds, and seven countries provided grades for all three GMs. Of possible grades, 72.8%, 69.2%, and 76.9% of the grades were assigned from GM 2.0 to GM 4.0, respectively. In terms of the Report Card grades, there was a slight decrease in behavioral/individual indicators from "D+" in GM 2.0 to "D-" in GM 3.0 but this reverted to "D" in GM 4.0. For the sources of influence, a "C" grade was given in all three rounds of GM. Longitudinal observation of seven Asian countries that provided grades in all three rounds of GM revealed that grades are generally stable for all indicators with some country-specific fluctuations. In future GM initiatives and research, considerations should be made to provide more accurate and rich data and to better understand contextual challenges in evaluating certain indicators such as Active Transportation, Active Play, and Physical Fitness in particular. Further, macro level factors such as socioeconomic/cultural disparities and gender-specific barriers, ideology, or climate change should also be proactively considered in future research as these factors are becoming increasingly relevant to indicators of GM and United Nation's Sustainable Development Goals. Conclusions: Participation from Asian countries in GM has increased over the years, which demonstrates the region's enthusiasm, capacity, and support for global PA promotion efforts. The efforts to promote a physically active lifestyle among children and adolescents should be a collective interest and priority of the Asia region based on the gaps identified in this paper.

Results from the Hong Kong's 2022 report card on physical activity for children and adolescents.

Background/objective: This paper aimed to summarize the findings of the third (2022) Active Healthy Kids Hong Kong Report Card on Physical Activity for Children and Adolescents and evaluate the secular trends of physical activity related indicators. Methods: Five behavioral indicators (Overall Physical Activity, Organized Sport and Physical Activity, Active Play, Active Transportation, and Sedentary Behavior), three outcome indicators (Physical Fitness, Sleep, and Obesity) and four sources of influence indicators (Family and Peers, School, Community and Environment, and Government) were assigned a letter grade (ranging from A+ to F or incomplete) based on the best available evidence following a harmonized approach developed by the Active Healthy Kids Global Alliance. Data sources included published journal articles, government reports, manual searches, and personal contacts; and consisted of both pre-COVID-19 and after-COVID-19 evidence. Results: Grades for Overall Physical Activity (D-∗∗) and Sedentary Behavior (D) deteriorated compared to the 2018 Report Card. The other three behavioral indicators, Organized Sport and Physical Activity, Active Play, and Active Transportation, were assigned B-, D, and B+, respectively. Physical Fitness (D), Sleep (C-), and Obesity (D-) obtained the same grades as in the 2018 Report Card. School (B) and Government (C+) grades slightly improved, while Community and Environment grade (B) was stable. Family and Peers was not graded due to insufficient evidence. Conclusions: Despite slight improvements in influence indicators, physical activity and sedentary behavior have changed unfavorably for children and adolescents in Hong Kong. Strategic investments are needed to improve adoption and implementation of effective interventions.

Economic Freedom, Climate Culpability, and Physical Activity Indicators Among Children and Adolescents: Report Card Grades From the Global Matrix 4.0.

BACKGROUND: Macrolevel factors such as economic and climate factors can be associated with physical activity indicators. This study explored patterns and relationships between economic freedom, climate culpability, and Report Card grades on physical activity-related indicators among 57 countries/jurisdictions participating in the Global Matrix 4.0. METHODS: Participating countries/jurisdictions provided Report Card grades on 10 common indicators. Information on economic freedom and climatic factors were gathered from public data sources. Correlations between the key variables were provided by income groups (ie, low- and middle-income countries/jurisdictions and high-income countries/jurisdictions [HIC]). RESULTS: HIC were more economically neoliberal and more responsible for climate change than low- and middle-income countries. Annual temperature and precipitation were negatively correlated with behavioral/individual indicators in low- and middle-income countries but not in HIC. In HIC, correlations between climate culpability and behavioral/individual and economic indicators were more apparent. Overall, poorer grades were observed in highly culpable countries/jurisdictions in the highly free group, while in less/moderately free groups, less culpable countries/jurisdictions showed poorer grades than their counterparts in their respective group by economic freedom. CONCLUSIONS: Global-level physical activity promotion strategies should closely evaluate different areas that need interventions tailored by income groups, with careful considerations for inequities in the global political economy and climate change.

Recent Secular Trends in Child and Adolescent Physical Activity and Sedentary Behavior Internationally: Analyses of Active Healthy Kids Global Alliance Global Matrices 1.0 to 4.0.

BACKGROUND: We examined recent global secular trends in 5 indicators of child and adolescent physical activity and sedentary behavior (Overall Physical Activity, Organized Sport and Physical Activity, Active Play, Active Transportation, and Sedentary Behavior) and 4 influences on these (Family and Peers, School, Community and Environment, and Government). METHODS: Active Healthy Kids Global Alliance letter grades (A+ to F) were assigned numbers from 15 to 2, with 0 assigned for missing/incomplete grades. Trends from Active Healthy Kids Global Alliance Global Matrices 1.0 (2014) to 4.0 (2022) were analyzed using linear mixed-effects models with level of economic development and gender inequity considered as potential moderators. RESULTS: Report card grades were generally relatively stable. Trends generally did not differ significantly by level of economic development (except for Active Transportation and Active Play), but gender inequality did significantly moderate trends for most of the indicators, with higher gender inequality associated with more adverse changes in grades. The number of "incomplete" grades decreased over time, but this did not reach statistical significance. CONCLUSIONS: While trends varied within and between countries, physical activity and sedentary behaviors, and the influences on these behaviors globally, were relatively stable over the past decade or so, albeit at undesirable levels.

Global Matrix 4.0 physical activity report cards grades for children and adolescents: A comparison among 15 Asian countries and regions.

Background: /Objective: This paper aimed to compare the report card grades among 15 Asian jurisdictions participating in the Global Matrix 4.0, and to explore differences in regional cultural and policy factors related to physical activity behaviors. Methods: All participating jurisdictions followed a harmonized process to develop a country report card. Ten required common indicators were assessed, including five behavioral indicators (Overall Physical Activity, Organized Sport and Physical Activity, Active Play, Active Transportation, Sedentary Behavior), four sources of influence indicators (Family and Peers, School, Community and Environment, and Government), and an outcome indicator (Physical Fitness). Letter grades, ranging from A+ to F or incomplete (INC), were assigned to the indicators based on the predefined benchmarks and grading rubric, and were converted to numerical scale for analyses. Results: The country average scores ranged from F (Indonesia) to B- (Japan), with C+/C/C- the most prevalent grades. The mean behavioral score (D+) was lower than sources of influence score (C+). Poor grades (D or F) were observed for Overall Physical Activity among 73.3% (11/15) of the jurisdictions. Government was the indicator with the highest proportion of A or B grades (66.7%), followed by School (53.3%). Physical Fitness (n = 10) and Active Play (n = 8) were two indicators with the largest number of INC grades. Conclusions: Poor grades for physical activity and sedentary behavior were generally found in Asian jurisdictions. The better, though modest, grades on the sources of influence have not been translated into favorable behaviors among children and adolescents. The findings also suggested surveillance gaps for physical fitness, active play, and organized sport participation. National-level investments and action plans are needed to ensure physical activity interventions are developed, effectively implemented, and regularly evaluated in multiple settings.

Efficacy of Exercise on Muscle Function and Physical Performance in Older Adults with Sarcopenia: An Updated Systematic Review and Meta-Analysis.

This study aimed to analyze the efficacy of exercise interventions on muscle strength, muscle mass, and physical performance in older adults with sarcopenia. Randomized controlled studies assessing exercise effects on sarcopenia were searched in Web of Science, PubMed, Cochrane Library, ProQuest, EBSCOhost, Scopus, EMBASE, and VIP and CNKI up to 31 March 2022. Data were expressed as weighted/standardized mean difference (MD/SMD) with 95% confidence intervals (CI). I2 index was employed for heterogeneity. The initial search identified 5379 studies, and 23 studies involving 1252 participants met the inclusion criteria for further analysis. Results revealed that exercise interventions can significantly improve grip strength (MD = 2.38, 95%CI = 1.33-3.43), knee extension strength (SMD = 0.50, 95%CI = 0.36-0.64), muscle mass of lower extremities (MD = 0.28, 95%CI = 0.01-0.56), walking speed (SMD = 0.88, 95%CI = 0.49-1.27), and functional mobility (MD = -1.77, 95%CI = -2.11--1.42) among older adults with sarcopenia. No significant exercise effects were found on fat-free muscle mass, appendicular muscle mass, skeletal muscle mass, and muscle mass of the upper extremities. The results of subgroup analysis indicated that both resistance training and multicomponent exercise could significantly increase the muscle strength, while aerobic exercise did not. The findings suggest that exercise intervention can effectively improve muscle function and physical performance in older adults with sarcopenia, but has limited effects on the muscle mass of the upper extremities. In addition, it is highly recommended to apply group-based and supervised resistance training and multicomponent exercise in the prevention and treatment of sarcopenia among the older population.

Accuracy of Flash Glucose Monitoring During Postprandial Rest and Different Walking Conditions in Overweight or Obese Young Adults.

Aims: To investigate the accuracy of FreeStyle LibreTM flash glucose monitoring (FGM) relevant to plasma glucose (PG) measurements during postprandial rest and different walking conditions in overweight/obese young adults. Methods: Data of 40 overweight/obese participants from two randomized crossover studies were pooled into four trials: (1) sitting (SIT, n = 40); (2) walking continuously for 30 min initiated 20 min before individual postprandial glucose peak (PPGP) (20iP + CONT, n = 40); (3) walking continuously for 30 min initiated at PPGP (iP + CONT, n = 20); and (4) accumulated walking for 30 min initiated 20 min before PPGP (20iP + ACCU, n = 20). Paired FGM and PG were measured 4 h following breakfast. Results: The overall mean absolute relative difference (MARD) between PG and FGM readings was 16.4 ± 8.6% for SIT, 16.2 ± 4.7% for 20iP + CONT, 16.7 ± 12.2% for iP + CONT, and 19.1 ± 6.8% for 20iP + ACCU. The Bland-Altman analysis showed a bias of -1.03 mmol⋅L-1 in SIT, -0.89 mmol⋅L-1 in 20iP + CONT, -0.82 mmol⋅L-1 in iP + CONT, and -1.23 mmol⋅L-1 in 20iP + ACCU. The Clarke error grid analysis showed that 99.6-100% of the values in all trials fell within zones A and B. Conclusion: Although FGM readings underestimated PG, the FGM accuracy was overall clinically acceptable during postprandial rest and walking in overweight/obese young adults.

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

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

Walking Initiated 20 Minutes before the Time of Individual Postprandial Glucose Peak Reduces the Glucose Response in Young Men with Overweight or Obesity: A Randomized Crossover Study.

BACKGROUND: Although a single bout of postmeal exercise can lower postprandial glucose (PPG), its optimal timing remains unclear. OBJECTIVE: This study aimed to investigate the effect of exercise timing using an individualized approach on PPG in overweight or obese young men. METHODS: Twenty men [age: 23.0 ± 4.3 y; BMI (kg/m2): 27.4 ± 2.8] each completed three 240-min trials in a randomized order separated by 6-14 d: 1) sitting (SIT), 2) walking initiated at each participant's PPG-peak time (PPGP) (iP), and 3) walking initiated 20 min before the PPGP (20iP). For each participant, PPGP was predetermined using continuous glucose monitoring. Walking was performed at 50% maximal oxygen consumption for 30 min. Venous blood was collected at 15- and 30-min intervals for 0-120 min and 120-240 min, respectively. The primary outcome was plasma PPG. Generalized estimating equations were used for comparison between trials. RESULTS: Compared with SIT, the 4-h incremental AUCs (iAUCs) for plasma PPG (-0.6 mmol · L-1 · h; P = 0.047) and insulin (-28.7%, P < 0.001) were reduced in 20iP only, and C-peptide concentrations were lower after iP (-14.9%, P = 0.001) and 20iP (-28.7%, P < 0.001). Plasma insulin (-11.1%, P = 0.006) and C-peptide (-8.3%, P = 0.012) were lower due to the 20iP compared with iP treatment. Finally, PPG reductions due to iP and 20iP occurred only in men with a BMI > 27.5 kg/m2 (iP, -11.2%; 20iP, -14.7%; P = 0.047) and higher glucose iAUC values during SIT (iP, -25.5%; 20iP, -25.7%; P < 0.001). CONCLUSIONS: Walking initiated 20 min before PPGP lowered PPG and plasma insulin and C-peptide concentrations in young men with overweight or obesity, in particular in those with high BMI or glucose iAUC values during SIT; it also lowered plasma insulin and C-peptide concentrations more effectively than did exercise initiated at PPGP. This trial was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx) as ChiCTR1900023175.

Accelerometer-Assessed Physical Activity and Sedentary Time at School for Children with Disabilities: Seasonal Variation.

Schools are salient locations for children with disabilities to accrue physical activity (PA) and to diminish sedentary time (ST). We examined seasonal variation in accelerometer-assessed PA and ST among children with disabilities during the school day in three school settings (physical education (PE) lessons, recess and lunchtime). Children (n = 270) from 13 special schools for those with five disability types (visual impairments, hearing impairments, physical disabilities, intellectual disabilities (ID), and social development problems) participated. Their PA and ST were assessed during three winter and three summer school days using accelerometry. Linear mixed models were performed to determine seasonal variation in the proportion of time they spent in moderate-to-vigorous physical activity (MVPA) and ST in the three settings. On average, the children spent 4.5% (18.6 min) and 4.0% (15.6 min) in MVPA at school during winter and summer days, respectively. They were more physically active during winter (especially during recess and lunchtime), but there were no seasonal differences for ST. Thus, children's year-round engagement in PA needs to be promoted, especially during summer.

Results from the Hong Kong's 2018 report card on physical activity for children and youth.

BACKGROUND/OBJECTIVE: The Active Healthy Kids 2018 Hong Kong Report Card provides evidence-based assessment across 12 indicators of physical activity behaviors, sleep, and related community and government initiatives for children and youth. METHODS: The systematic development process provided by the Active Healthy Kids Global Alliance was used. The best available data from the past 10 years were reviewed by a panel of experts. According to predefined benchmarks, letter grades were assigned to 12 indicators (Overall Physical Activity, Organized Sport Participation, Active Play, Active Transportation, Sedentary Behaviors, Physical Fitness, Sleep, Family, School, Community and Environment, Government, and Obesity). RESULTS: Three of the five activity behaviors received C- or C grades: Overall Physical Activity (C-), Sedentary Behaviors (C-), and Organized Sport Participation (C). Active Transportation was graded B + . Same to the 2016 Hong Kong Report Card, Active Play could not be graded. School and Government were graded C. Family and Community and Environment was graded D- and B, respectively. Three new indicators were added after the 2016 Report Card and they were graded from C- (Sleep) to D (Physical Fitness) or D- (Obesity). CONCLUSIONS: Children and youth in Hong Kong have low physical activity and physical fitness levels and high sedentary behaviors despite a generally favorable community environment. A high prevalence of obesity and low levels of family support warrant more public health action. Researchers should address the surveillance gap in active play and peer support.

Associations of Socio-demographic, Family, and Neighborhood Factors with Physical Activity-Related Parenting Practices Among Hong Kong Preschoolers' Parents.

Objectives Regular engagement in physical activity (PA) has numerous health benefits in young children. Young children's parents can influence their children's PA behavior through different PA-related parenting practices. This cross-sectional study examined the independent contributions of socio-demographic, family/home and parent-perceived neighborhood environmental characteristics explaining PA-related parenting practices encouraging or discouraging PA among Hong Kong preschool-aged children (3-5 years-old). Methods Hong Kong Chinese preschoolers' parents were recruited from pre-selected kindergartens and Maternal and Child Health Centers located in areas stratified by residential density and socio-economic status. They self-completed socio-demographic, family/home and perceived neighborhood characteristics and PA-related parenting practices questionnaires. Generalized linear models were used to examine associations of socio-demographic, family/home and neighborhood variables with PA-related parenting practices. Results Socio-demographic and family/home characteristics were significantly correlated with parenting practices encouraging and discouraging PA. Parent-perceived neighborhood characteristics were significantly correlated with parenting practices discouraging PA only. Conclusions for Practice This study identified correlates of PA-related parenting practices among parents of Hong Kong Chinese preschoolers. The findings suggest future PA-promoting interventions among Chinese preschoolers via the promotion of parenting practices encouraging children's PA should consider multiple factors, including family relationships and childcare sharing, promotion of PA and its benefits among parents, and neighborhood social cohesion, traffic safety and safety from crime.

Global Matrix 3.0 Physical Activity Report Card Grades for Children and Youth: Results and Analysis From 49 Countries.

BACKGROUND: Accumulating sufficient moderate to vigorous physical activity is recognized as a key determinant of physical, physiological, developmental, mental, cognitive, and social health among children and youth (aged 5-17 y). The Global Matrix 3.0 of Report Card grades on physical activity was developed to achieve a better understanding of the global variation in child and youth physical activity and associated supports. METHODS: Work groups from 49 countries followed harmonized procedures to develop their Report Cards by grading 10 common indicators using the best available data. The participating countries were divided into 3 categories using the United Nations' human development index (HDI) classification (low or medium, high, and very high HDI). RESULTS: A total of 490 grades, including 369 letter grades and 121 incomplete grades, were assigned by the 49 work groups. Overall, an average grade of "C-," "D+," and "C-" was obtained for the low and medium HDI countries, high HDI countries, and very high HDI countries, respectively. CONCLUSIONS: The present study provides rich new evidence showing that the situation regarding the physical activity of children and youth is a concern worldwide. Strategic public investments to implement effective interventions to increase physical activity opportunities are needed.

Report Card Grades on the Physical Activity of Children and Youth Comparing 30 Very High Human Development Index Countries.

BACKGROUND: To better understand the childhood physical inactivity crisis, Report Cards on physical activity of children and youth were prepared concurrently in 30 very high Human Development Index countries. The aim of this article was to present, describe, and compare the findings from these Report Cards. METHODS: The Report Cards were developed using a harmonized process for data gathering, assessing, and assigning grades to 10 common physical activity indicators. Descriptive statistics were calculated after converting letter grades to interval variables, and correlational analyses between the 10 common indicators were performed using Spearman's rank correlation coefficients. RESULTS: A matrix of 300 grades was obtained with substantial variations within and between countries. Low grades were observed for behavioral indicators, and higher grades were observed for sources of influence indicators, indicating a disconnect between supports and desired behaviors. CONCLUSION: This analysis summarizes the level and context of the physical activity of children and youth among very high Human Development Index countries, and provides additional evidence that the situation regarding physical activity in children and youth is very concerning. Unless a major shift to a more active lifestyle happens soon, a high rate of noncommunicable diseases can be anticipated when this generation of children reaches adulthood.

Children with Intellectual Disability Are Vulnerable to Overweight and Obesity: A Cross-Sectional Study among Chinese Children.

BACKGROUND: The epidemic of childhood obesity has been well documented in typically developing child populations, while situations among children with intellectual disabilities (ID) remain unclear. METHODS: A cross-sectional study was conducted among 524 Chinese children with ID (males: 68.9%, mean age: 12.2 years) in Hong Kong in 2015. Children's height and weight were measured at school. Parents, in the presence of their children, completed a self-administered questionnaire at home about the children's physical activity (PA), eating habits, and sleep duration in a typical week as well as parenting practices regarding children's eating, PA, and their sociodemographic characteristics. RESULTS: Of the participants, 31.3% were overweight or obese, which was higher than their typical counterparts (18.7%-19.9%). Multivariate logistic regression analyses revealed that overweight and obesity in children with ID were linked to their comorbidity with autism, maternal overweight and obesity, parenting practices with less pressure to eat more, children having shorter sleep duration, longer periods of sedentary behavior, and higher intake frequencies of sweetened beverages, fried food, meats, fish, and eggs. CONCLUSIONS: Children with ID are vulnerable to being overweight or obese. Identified risk factors in this study highlight a multifaceted approach to the involvement of parents as well as the modification of some children's questionable behaviors to help them achieve a healthy weight.

Physical Activity and Physical Fitness of Adults with Intellectual Disabilities in Group Homes in Hong Kong.

Adults with intellectual disabilities (ID) typically have a sedentary lifestyle and higher rates of overweight and obesity. This study describes the habitual daily physical activity (PA) and the health-related physical fitness (PF) of adults with mild and moderate ID who resided in four group homes and worked in sheltered workshops. We also assessed the contribution of PF variables towards PA levels and sedentary behavior of this population subgroup. Adults with mild and moderate ID (N = 114) were assessed on PF tests (percent body fat, waist and hip circumferences, 6-min walk (6MWT), arm curl, and sit and reach). PA and sedentary behavior on weekdays were determined using Actigraph accelerometers. Results showed these adults averaged 2% of their daily time (or 10 min) engaged in moderate-to-vigorous PA (MVPA) and 67% of the time (495 min) being sedentary. No significant differences between mild and moderate ID were found for any PA or PF variable. Linear multiple regression analyses showed 6MWT to be the only significant PF variable contributing to the variance of PA and sedentary behavior. In conclusion, adults with ID reside in group home have low PA and low fitness levels. Among fitness variables, the walking test (i.e., cardiovascular fitness) had the highest positive association with participants’ daily PA, MVPA, and negative association with sedentary behavior. Future intervention studies in promoting PA and fitness for adults with ID are warranted.