An Umbrella Review of the Best and Most Up-to-Date Evidence on the Built Environment and Physical Activity in Older Adults ≥60 Years.

Objectives: To present the best and most up-to-date evidence on associations between built environment (BE) attributes and overall and specific domains of physical activity (PA) (i.e., leisure, transport, walking, and cycling) in older adults (≥60 years). Methods: An umbrella review was undertaken to compile evidence from systematic reviews using the Joanna Briggs Institute methodology. A comprehensive search (updated 16 August 2022), inclusion/exclusion of articles via title/abstract and full-text reviews, data extraction, and critical appraisal were completed. Only reviews with a good critical appraisal score were included. Results: Across three included systematic reviews, each BE attribute category was positively associated with ≥1 PA outcome. A larger number of significant associations with BE attributes were reported for transport walking (13/26), total walking (10/25), and total PA (9/26), compared to leisure walking (4/34) and transport cycling (3/12). Fewer associations have been examined for leisure cycling (1/2). Conclusion: Although the causality of findings cannot be concluded due to most primary studies being cross-sectional, these best and most up-to-date findings can guide necessary future longitudinal and experimental studies for the (re)design of age-friendly communities.

Relationships Between Physical Activity, Boredom Proneness, and Subjective Well-Being Among U.K. Adults During the COVID-19 Pandemic.

This investigation sought to examine physical activity (PA) as a potential determinant of chronic boredom and associated well-being within the context of COVID-related restrictions. A representative sample of U.K. adults (N = 1,521) completed a survey on June 1, 2020. Bivariate analyses demonstrated that individuals who met guidelines and maintained or increased PA scored higher on life satisfaction, worthwhileness, and happiness and lower on anxiety (i.e., indicators of well-being) and boredom proneness (d = 0.13-0.43). Boredom proneness was correlated with all indicators of well-being (r = .38-.54). A series of regression models revealed that PA predicted lower boredom proneness and better life satisfaction, worthwhileness, and happiness. Boredom proneness accounted for the covariance between PA and well-being. Prospective research is needed to confirm causality of the observed relationships.

Protocol for an evaluation of the Designing Communities to Support Healthy Living in Aging Residents Study.

BACKGROUND: In collaboration with building developers, the Housing for Health team is contributing to the design of community-based congregate living facilities to support healthy living in older adults. There may also be opportunities to improve the surrounding neighbourhoods by collaborating with the municipalities where the developments are located. We will evaluate whether one or more of these comprehensive interventions lead to changes in the perceived, microscale, and macroscale neighbourhood-built environment (BE) and amenities, and impacts on the physical activity (PA), healthy eating, and social connections of residents. In parallel, we will gather qualitative data to provide a more in-depth understanding of how the BE may facilitate or hinder resident's healthy living outcomes. METHODS: This project employs a quasi-experimental pre-post design with at least one or more intervention and control sites. The quantitative BE evaluation will include pre- and post-intervention assessments of neighbourhood macroscale (e.g., layout of communities) and microscale (e.g., street details and characteristics) changes using Geographical Information Systems (GIS) and Microscale Audit Pedestrian Streetscapes (MAPS) audits, respectively. The quantitative resident evaluation will include self-report (i.e., surveys) and objective assessments (i.e., accelerometers, Global Positioning System [GPS]) of residents at baseline (3-6-months pre-move-in) and follow-up (3-6-months and 9-12-months post-move-in if possible). The qualitative resident-environment component will involve in-depth semi-structured interviews post-intervention with building residents, family members, and stakeholders involved in the design/development and/or operation of the intervention site(s). Participant observations will be completed in the building and neighbourhood environments of the intervention site(s). DISCUSSION: Findings will provide evidence on whether and how comprehensive changes to the BE and amenities of at least one congregate living facility and the surrounding neighbourhood can impact PA, healthy eating, and social connections of older adults. Successful intervention elements will be scaled up in future work. We will disseminate findings to a broad audience including the scientific community via peer-reviewed publications, conference presentations, and discussion panels; and the private, public, and not-for-profit sectors via reports, public presentations, and/or communications via our partners and their networks. TRIAL REGISTRATION: Protocol ID: 1819-HQ-000051. ClinicalTrials.gov ID: NCT05031273. Registered 29 June 2021 with ClinicalTrials.gov.

The Use of a Nonrefundable Tax Credit to Increase Children's Participation in Physical Activity in Alberta, Canada.

BACKGROUND: Potential income disparities were examined in the (1) awareness and uptake of the Children's Fitness Tax Credit (CFTC), and (2) physical activity (PA) of children from families who did and did not claim the credit in Alberta, Canada in 2012 and 2014. METHODS: Secondary analyses of 3 cross-sectional data sets of grade 5 students (10-11 y) were performed, including Alberta Project Promoting healthy Living for Everyone Schools 2012 (N = 1037), and Raising healthy Eating and Active Living Kids Alberta 2012 (N = 2676), and 2014 (N = 3125). Parents reported whether they claimed the CFTC in the previous year, their education and household income, and their child's gender and PA. Children self-reported their PA from the previous 7 days. In Alberta Project Promoting healthy Living for Everyone Schools, children also wore pedometers. Analyses adjusted for clustering within schools and demographic factors. RESULTS: Higher income families (≥$50,000/y) were more likely to be aware of and to have claimed the CFTC compared with low-income families (<$50,000/y). The CFTC was associated with organized PA with larger associations for higher-income families (odds ratio = 9.03-9.32, Ps < .001) compared with lower-income families (odds ratio = 3.27-4.05, Ps < .01). No associations existed for overall PA or pedometer steps with the CFTC. CONCLUSIONS: Income disparities exist in the awareness, uptake, and potential impact of the CFTC. Tax credits are not effective in promoting overall PA.

A social network analysis of interactions about physical activity and nutrition among APPLE schools staff.

Comprehensive school health (CSH) is a holistic approach to school-based health promotion that involves active participation and buy-in of school community members, including school staff (e.g., support staff, teachers, school health champions, principals). Implementation and sustainability of CSH builds on complex relationships within the school that support school-level health promoting changes and understanding the social relationships that exist in a school setting is critical. Thus, the purpose of this study was to conduct a social network analysis to examine adviceseeking networks of staff within three schools involved with a CSH program called APPLE Schools (A Project Promoting healthy Living for Everyone in Schools) project approach. The degree to which school staff were central in the network (i.e., gave or sought physical activity or nutrition advice, were connected or disconnected to others; indegree/outdegree centrality and betweenness centrality) and the overall structure of the networks were assessed (i.e., optimal levels of density and centralization). School health champions and several other individuals in the network were shown to be key sources of physical activity or nutrition advice and were identified as central players in the network. Whole networks across schools had low density and betweenness centralization, with optimal levels of out-centralization, and low to optimal levels of incentralization. This research allowed us to gain an understanding of network structures and relationship patterns in CSH schools, with specific attention to the coordinating role of school health champions, and other central players within the network. These findings increase our understanding of advice relationships that exist in a school setting and how these relationships may support CSH implementation and sustainability.

Potential Impact of Autonomous Vehicles on Movement Behavior: A Scoping Review.

CONTEXT: This scoping review examines the literature as it relates to autonomous vehicles and impact on movement behavior (i.e., physical activity, sedentary behavior, and sleep) or mode choice (e.g., public transit), beliefs about movement behavior or mode choice, or impact on environments that may influence movement behavior or mode choice. EVIDENCE ACQUISITION: A search was conducted in June 2018 and updated in August 2019 of numerous databases (e.g., SPORTDiscuss, PubMed, and Scopus) and hand searching using terms such as autonomous cars and walking. Documents were included if they were databased studies, published in English, and related to the research question. They were then coded by 6 reviewers for characteristics of the document, design, sample, autonomous vehicles, movement behavior, and findings. The coding and analysis were conducted between August 2018 and September 2019. EVIDENCE SYNTHESIS: Of 1,262 possible studies, 192 remained after a title and abstract scan, and 70 were included after a full-article scan. Most of the studies were conducted in Europe (42%) or North America (40%), involved simulation modeling (50%) or cross-sectional (34%) designs, and were published mostly in transportation (83%) journals or reports. Of the 252 findings, 61% related to movement behavior or mode choice. Though the findings were equivocal in some cases, impacts included decreased demand for active transportation, increased demand for autonomous vehicles, increased sitting and sleeping, and reduced walking. CONCLUSIONS: Though no experimental or longitudinal studies have been published to date, the available research suggests that autonomous vehicles will impact aspects of mode choice and the built environment of people residing in much of the developed world, resulting in reduced walking and more sitting.

Self-reported and Accelerometer-Measured Physical Activity in Children With Cardiomyopathy.

PURPOSE: Children with cardiomyopathy are at risk of heart failure with reduced physical activity (PA) as a cardinal manifestation. Clinical assessment of PA in children is challenging due to the limited validity of subjective reports. The aim of the study was to compare accelerometery measurement with parental report and to identify factors associated with movement behavior (PA, sedentary time, steps per day). METHOD: Fifteen patients with cardiomyopathy (mean, 9.7 years; 64% male) were asked to wear an Actigraph GT3X accelerometer in Edmonton, Canada. Demographics, clinical characteristics, parental-reported PA, and health-related quality of life data were also collected. RESULTS: Participants engaged in a median of 38 minutes of moderate-vigorous PA per day with higher levels in boys versus girls (73.9 [25.03, 78.91] vs 4.13 [2.53, 37.67] minutes, P = .03). Children participating in recreational sports showed a higher level of moderate-vigorous PA (73.92 min/d) compared with those who did not participate (73.9 vs 22.7 min/d, P = .05), and positive family outlook on the child's health was associated with less sedentary time (P = .04). CONCLUSION: Accelerometer measurement in children with cardiomyopathy is an achievable and more objective measure of PA compared with parental report alone and highlighted low levels of PA among these children.

Associations of friendship and children's physical activity during and outside of school: A social network study.

Friendships play a significant role in child development and may influence children's physical activity (PA). Using a whole-network approach, this study examined whether school-based friends are more similar in their pedometer-measured PA compared to children who are not friends, and whether these patterns vary by gender, strength of friendship (best vs. close friends), and during vs. outside of school. The analytical sample included 706 grade 5 students (10- to 11-years-old) in 27 schools who were participating in the APPLE Schools project (Alberta Project Promoting healthy Living for Everyone in schools) in Edmonton and Fort McMurray, Alberta, Canada in the spring of 2013. Data collected included student and parent survey responses, time-stamped pedometer data for nine consecutive days, and close and best within-school and within-grade friendship nominations. We used Multiple Regression - Quadratic Assignment Procedure (MR-QAP) to examine the effect of friendship ties on PA similarity overall, and for during and outside of school periods, controlling for covariates and clustering within schools. When all friendships (i.e., close and best) were considered, female friends exhibited more similar levels of overall PA than non-friends, and these findings held for school days, the during-school period, and non-school days. When close and best friends were examined separately in the same model (non-friends as the referent), both close and best friends were more similar than non-friends. The close friendship findings held for non-school days, and the best friendship findings held for school days, including the during-school and before- and after-school periods. For males, only reciprocated best friends had more similar levels of overall PA compared to unreiprocated friendships and non-friends. Programs and policies that focus on increasing PA in children may benefit from incorporating friendship-based strategies and programming, especially for females.

Behavior Tracking and 3-Year Longitudinal Associations Between Physical Activity, Screen Time, and Fitness Among Young Children.

PURPOSE: Understanding the correlates of children's fitness as they develop is needed. The objectives of this study were to 1) examine the longitudinal associations between physical activity (PA), screen time (ST), and fitness; 2) determine if sex moderates associations; and 3) track PA and ST over 3 years. METHODS: Findings are based on 649 children [baseline = 4.5 (0.5) y; follow-up = 7.8 (0.6) y] from Edmonton, Canada. Parental-reported hour per week of PA and ST were measured at baseline and 3 years later. Fitness (vertical jump, sit and reach, waist circumference, grip strength, predicted VO2max, push-ups, and partial curl-ups) was measured using established protocols at follow-up. Sex-specific z scores or low/high fitness groups were calculated. Linear or logistic multiple regression models and Spearman correlations were conducted. RESULTS: Baseline ST was negatively associated with follow-up grip strength [ß = -0.010; 95% confidence interval (CI), -0.019 to -0.001]. Associations between baseline PA and follow-up overall fitness (ß = 0.009; 95% CI, 0.002 to 0.016) were significant, whereas baseline PA and follow-up VO2max (ß = 0.014; 95% CI, 0.000 to 0.027) approached significance (P < .06). No sex interactions were observed. Moderate and large tracking were observed for PA (rs = .30) and ST (rs = .53), respectively. CONCLUSIONS: PA and ST may be important modifiable correlates of overall fitness in young children.

Correction to: Systematic review of the relationships between physical activity and health indicators in the early years (0-4 years).

CORRECTION: After publication of the article [1], it has been brought to our attention that an incorrect reference has been used in this article, both in the main body and additional file 2. The reference in question is #105 in the main body and #74 in additional file 2. Here it is cited as "Lindsay H, Brussoni M. Injuries and helmet use related to non-motorized wheeled activities among pediatric patients. Chronic Dis Inj Canada. 2014;34(2-3):74-81".

Systematic review of the relationships between physical activity and health indicators in the early years (0-4 years).

BACKGROUND: Given the rapid development during the early years (0-4 years), an understanding of the health implications of physical activity is needed. The purpose of this systematic review was to examine the relationships between objectively and subjectively measured physical activity and health indicators in the early years. METHODS: Electronic databases were originally searched in April, 2016. Included studies needed to be peer-reviewed, written in English or French, and meet a priori study criteria. The population was apparently healthy children aged 1 month to 59.99 months/4.99 years. The intervention/exposure was objectively and subjectively measured physical activity. The comparator was various volumes, durations, frequencies, patterns, types, and intensities of physical activity. The outcomes were health indicators ranked as critical (adiposity, motor development, psychosocial health, cognitive development, fitness) and important (bone and skeletal health, cardiometabolic health, and risks/harm). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess the quality of evidence for each health indicator by each study design. RESULTS: Ninety-six studies representing 71,291 unique participants from 36 countries were included. Physical activity interventions were consistently (>60% of studies) associated with improved motor and cognitive development, and psychosocial and cardiometabolic health. Across observational studies, physical activity was consistently associated with favourable motor development, fitness, and bone and skeletal health. For intensity, light- and moderate-intensity physical activity were not consistently associated with any health indicators, whereas moderate- to vigorous-intensity, vigorous-intensity, and total physical activity were consistently favourably associated with multiple health indicators. Across study designs, consistent favourable associations with health indicators were observed for a variety of types of physical activity, including active play, aerobic, dance, prone position (infants; ≤1 year), and structured/organized. Apart from ≥30 min/day of the prone position for infants, the most favourable frequency and duration of physical activity was unclear. However, more physical activity appeared better for health. Evidence ranged from "very low" to "high" quality. CONCLUSIONS: Specific types of physical activity, total physical activity, and physical activity of at least moderate- to vigorous-intensity were consistently favourably associated with multiple health indicators. The majority of evidence was in preschool-aged children (3-4 years). Findings will inform evidence-based guidelines.

Network analysis of inter-organizational relationships and policy use among active living organizations in Alberta, Canada.

BACKGROUND: Coordinated partnerships and collaborations can optimize the efficiency and effectiveness of service and program delivery in organizational networks. However, the extent to which organizations are working together to promote physical activity, and use physical activity policies in Canada, is unknown. This project sought to provide a snapshot of the funding, coordination and partnership relationships among provincial active living organizations (ALOs) in Alberta, Canada. Additionally, the awareness, and use of the provincial policy and national strategy by the organizations was examined. METHODS: Provincial ALOs (N = 27) answered questions regarding their funding, coordination and partnership connections with other ALOs in the network. Social network analysis was employed to examine network structure and position of each ALO. Discriminant function analysis determined the extent to which degree centrality was associated with the use of the Active Alberta (AA) policy and Active Canada 20/20 (AC 20/20) strategy. RESULTS: The funding network had a low density level (density = .20) and was centralized around Alberta Tourism Parks and Recreation (ATPR; degree centralization = 48.77%, betweenness centralization = 32.43%). The coordination network had a moderate density level (density = .31), and was low-to-moderately centralized around a few organizations (degree centralization = 45.37%, betweenness centrality = 19.92%). The partnership network had a low density level (density = .15), and was moderate-to-highly centralized around ATPR. Most organizations were aware of AA (89%) and AC 20/20 (78%), however more were using AA (67%) compared to AC 20/20 (33%). Central ALOs in the funding network were more likely to use AA and AC 20/20. Central ALOs in the coordination network were more likely to use AC 20/20, but not AA. CONCLUSIONS: Increasing formal and informal relationships between organizations and integrating disconnected or peripheral organizations could increase the capacity of the network to promote active living across Alberta. Uptake of the AA policy within the network is high and appears to be facilitated by the most central ALO. Promoting policy use through a central organization appeared to be an effective strategy for disseminating the province-level physical activity policy and could be considered as a policy-uptake strategy by other regions.

The role of peer victimization in the physical activity and screen time of adolescents: a cross-sectional study.

BACKGROUND: Negative peer experiences may lead adolescents with overweight and obesity to be less active and engage in more sitting-related behaviors. Our study is among the first to empirically test these associations and hypothesized that 1) peer victimization would mediate the negative association between body weight status and moderate-to-vigorous physical activity (MVPA), and 2) peer victimization would mediate the positive association between body weight status and screen time. Differences by gender were also explored. METHODS: Participants were a part of the Year 1 data (2012-2013) from the COMPASS study, a prospective cohort study of high school students in Ontario and Alberta, Canada. The final sample consisted of 18,147 students in grades 9 to 12 from 43 Ontario secondary schools. The predictor variable was weight status (non-overweight vs. overweight/obese), the mediator was peer victimization, and the outcome variables were screen time and MVPA. Multilevel path analysis was conducted, controlling for clustering within schools and covariates. A few differences were observed between males and females; therefore, the results are stratified by gender. RESULTS: For both males and females peer victimization partially mediated the association between weight status and screen time. Specifically, females with overweight/obesity reported 34 more minutes/day of screen time than did females who were not overweight and 2 of these minutes could be attributed to experiencing peer victimization. Similarly, males who were overweight/obese reported 13 more minutes/day of screen time than the males who were not overweight and 1 of these minutes could be attributed to experiencing more victimization. Males and females who were overweight/obese also reported less MVPA compared to those who were not overweight; however, peer victimization did not mediate these associations in the hypothesized direction. CONCLUSIONS: We found that higher rates of peer victimization experienced by adolescents with overweight and obesity partially explained why they engaged in more screen time than adolescents who were not overweight. However, the effects were small and may be of limited practical significance. Because this is one of the first studies to investigate these associations, more research is needed before bully prevention or conflict resolution training are explored as intervention strategies.

Associations between physical activity, screen time, and fitness among 6- to 10-year-old children living in Edmonton, Canada.

The objectives of this study were to describe fitness levels; examine associations between physical activity (PA), screen time (ST), and fitness; and examine sex-moderating effects in a sample of children. Participants were 649 children (age, 7.8 ± 0.6 years; 52.4% female) from Edmonton, Canada. Hours/week of PA and ST were parent-reported. PA was also objectively measured with pedometers and expressed in increments of 1000 steps/day. Fitness components (i.e., vertical jump, sit-and-reach, waist circumference, grip strength, predicted maximal oxygen consumption, push-ups, partial curl-ups, overall fitness) were measured according to the Canadian Physical Activity, Fitness, and Lifestyle Approach protocols and expressed as z scores or low/high fitness. Positive associations were observed between PA and overall fitness for both the complete (subjective: ß = 0.009, 95% confidence interval (CI): 0.001-0.017) and partial (≥3 available fitness measures; subjective: ß = 0.006, 95% CI: 0.000-0.011; objective: ß = 0.025, 95% CI: 0.007-0.042) fitness scores. Subjective (ß = 0.011, 95% CI: 0.000-0.022) and objective (ß = 0.043, 95% CI: 0.008-0.078) PAs were positively associated with vertical jump. Children with higher objective PA were more likely to be in the high push-ups group (odds ratio = 1.156, 95% CI: 1.054-1.267). PA was positively associated with predicted maximal oxygen uptake (subjective: ß = 0.040, 95% CI: 0.018-0.063; objective: ß = 0.084, 95% CI: 0.012-0.157) and grip strength (subjective: ß = 0.025, 95% CI: 0.011-0.040) in boys only. ST was negatively associated with grip strength (ß = -0.016, 95% CI: -0.028 to -0.004) in boys. PA was associated with several components of fitness, especially in boys. However, few associations were observed between ST and fitness. Promoting regular PA in young children may address declining fitness levels.

A cross-sectional study of the relationship between parents' and children's physical activity.

BACKGROUND: Though parents' physical activity (PA) is thought to be a predictor of children's PA, findings have been mixed. The purpose of this study was to examine the relationship between pedometer-measured steps/day of parents' and their children and potential moderators of this relationship. We also assessed the parent-child PA relationship as measured by questionnaires. METHODS: Six-hundred and twelve 7-8 year olds and one of their parents wore Steps Count (SC)-T2 pedometers for four consecutive days. Parents reported their PA from the last seven days and their child's usual PA. Hierarchical linear regressions were used to assess the parent-child PA relationships, controlling for covariates. Gender (parent, child), gender homogeneity, weight status (parent, child), weight status homogeneity, and socioeconomic status (SES) variables (parent education, household income, area-level SES) were tested as potential moderators of this relationship. Partial r's were used as an estimate of effect size. RESULTS: Parents' steps was significantly related to children's steps (r partial = .24). For every 1,000 step increase in parents' steps, the children took 260 additional steps. None of the tested interactions were found to moderate this relationship. Using questionnaires, a relatively smaller parent-child PA relationship was found (r partial = .14). CONCLUSION: Physically active parents tend to have physically active children. Interventions designed to get children moving more throughout the day could benefit from including a parent component. Future research should explore the mechanisms by which parents influence their children, and other parent attributes and styles as potential moderators.

Systematic review of sedentary behaviour and health indicators in the early years (aged 0-4 years).

Accumulating evidence suggests that young children spend excessive time being sedentary. The purpose of this systematic review was to determine the relationship between sedentary behaviours and health indicators during the early years (ages 0-4 years). Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, this review aimed to present the best available evidence on the threshold of sedentary behaviour associated with healthy measures of adiposity, bone health, motor skill development, psychosocial health, cognitive development, and cardiometabolic health indicators in infants, toddlers, and preschoolers. Online databases, personal libraries, and government documents were searched for relevant studies. Studies that included an intervention (or experimental) group or prospective analysis were included. Twenty-one unique studies, representing 23 papers and 22 417 participants, met inclusion criteria; 7 studies included information on infants, 13 on toddlers, and 10 on preschoolers. Of these, 11, 6, and 8 studies reported data on adiposity, psychosocial health, and cognitive development, respectively. No included study reported on motor skill development, bone, or cardiometabolic health indicators. In conclusion, this review found low- to moderate-quality evidence to suggest that increased television viewing is associated with unfavourable measures of adiposity and decreased scores on measures of psychosocial health and cognitive development. No evidence existed to indicate that television viewing is beneficial for improving psychosocial health or cognitive development. In several instances a dose-response relationship was evident between increased time spent watching television and decreased psychosocial health or cognitive development. This work may be used as evidence to inform public health guidelines. (PROSPERO registration: CRD4011001280.).

Systematic review of physical activity and health in the early years (aged 0-4 years).

The early years represent a critical period for promoting physical activity. However, the amount of physical activity needed for healthy growth and development is not clear. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, we aimed to present the best available evidence to determine the relationship between physical activity and measures of adiposity, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and cardiometabolic health indicators in infants (1 month - 1 year), toddlers (1.1-3.0 years), and preschoolers (3.1-4.9 years). Online databases, personal libraries, and government documents were searched for relevant studies. Twenty-two articles, representing 18 unique studies and 12 742 enrolled participants, met inclusion criteria. The health indicators of interest were adiposity (n = 11), bone and skeletal health (n = 2), motor development (n = 4), psychosocial health (n = 3), cognitive development (n = 1), and cardiometabolic health indicators (n = 3); these indicators were pre-specified by an expert panel. Five unique studies involved infants, 2 involved toddlers, and 11 involved preschoolers. In infants, there was low- to moderate-quality evidence to suggest that increased or higher physical activity was positively associated with improved measures of adiposity, motor skill development, and cognitive development. In toddlers, there was moderate-quality evidence to suggest that increased or higher physical activity was positively associated with bone and skeletal health. In preschoolers, there was low- to high-quality evidence on the relationship between increased or higher physical activity and improved measures of adiposity, motor skill development, psychosocial health, and cardiometabolic health indicators. There was no serious inconsistency in any of the studies reviewed. This evidence can help to inform public health guidelines. (PROSPERO registration: CRD42011001243).

Canadian Physical Activity Guidelines for the Early Years (aged 0-4 years).

The Canadian Society for Exercise Physiology (CSEP), with assistance from multiple partners, stakeholders, and researchers, developed the first Canadian Physical Activity Guidelines for the Early Years (aged 0-4 years). These national guidelines were created in response to an urgent call from public health, health care, child care, and fitness practitioners for healthy active living guidance for the early years. The guideline development process was informed by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument and the evidence assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The recommendations are informed by evidence from a systematic review that examined the relationships between physical activity and health indicators (healthy body weight, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and cardio-metabolic disease risk factors) for three age groups (infants aged <1 year; toddlers aged 1-2 years; preschoolers aged 3-4 years). The new guidelines include a preamble to provide context, followed by the specific recommendations. The final guidelines benefitted from an extensive on-line consultation process with input from over 900 domestic and international stakeholders, end-users, and key informants. The final guideline recommendations state that for healthy growth and development, infants (aged <1 year) should be physically active several times daily - particularly through interactive floor-based play. Toddlers (aged 1-2 years) and preschoolers (aged 3-4 years) should accumulate at least 180 min of physical activity at any intensity spread throughout the day, including a variety of activities in different environments, activities that develop movement skills, and progression toward at least 60 min of energetic play by 5 years of age. More daily physical activity provides greater benefits.

Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0-4 years).

The Canadian Society for Exercise Physiology (CSEP), with assistance from multiple partners, stakeholders, and researchers, developed the first Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0-4 years). These national guidelines are in response to a call from health and health care professionals, child care providers, and fitness practitioners for guidance on sedentary behaviour in the early years. The guideline development process followed the Appraisal of Guidelines for Research Evaluation (AGREE) II framework. The recommendations are informed by evidence from a systematic review that examined the relationships between sedentary behaviour (predominantly screen time) and health indicators (healthy body weight, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and cardio-metabolic disease risk factors) for three age groups (infants aged <1 year; toddlers aged 1-2 years; preschoolers aged 3-4 years). Evidence from the review was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The new guidelines include a preamble to provide context, followed by the specific recommendations. The final guidelines benefitted from extensive on-line consultations with input from >900 domestic and international stakeholders, end-users, and key informants. The final guidelines state: for healthy growth and development, caregivers should minimize the time infants (aged <1 year), toddlers (aged 1-2 years), and preschoolers (aged 3-4 years) spend being sedentary during waking hours. This includes prolonged sitting or being restrained (e.g., stroller, high chair) for more than 1 h at a time. For those under 2 years, screen time (e.g., TV, computer, electronic games) is not recommended. For children 2-4 years, screen time should be limited to under 1 h per day; less is better.