Development and content validity of an application to assess 24-hour movement behaviors in 0-4-year-old children involving end-users and key stakeholders: the My Little Moves app.

BACKGROUND: Recently, research focus has shifted to the combination of all 24-h movement behaviors (physical activity, sedentary behavior and sleep) instead of each behavior separately. Yet, no reliable and valid proxy-report tools exist to assess all these behaviors in 0-4-year-old children. By involving end-users (parents) and key stakeholders (researchers, professionals working with young children), this mixed-methods study aimed to 1) develop a mobile application (app)-based proxy-report tool to assess 24-h movement behaviors in 0-4-year-olds, and 2) examine its content validity. METHODS: First, we used concept mapping to identify activities 0-4-year-olds engage in. Parents (n = 58) and professionals working with young children (n = 21) generated a list of activities, sorted related activities, and rated the frequency children perform these activities. Second, using multidimensional scaling and cluster analysis, we created activity categories based on the sorted activities of the participants. Third, we developed the My Little Moves app in collaboration with a software developer. Finally, we examined the content validity of the app with parents (n = 14) and researchers (n = 6) using focus groups and individual interviews. RESULTS: The app has a time-use format in which parents proxy-report the activities of their child, using eight activity categories: personal care, eating/drinking, active transport, passive transport, playing, screen use, sitting/lying calmly, and sleeping. Categories are clarified by providing examples of children's activities. Additionally, 1-4 follow-up questions collect information on intensity (e.g., active or calm), posture, and/or context (e.g., location) of the activity. Parents and researchers considered filling in the app as feasible, taking 10-30 min per day. The activity categories were considered comprehensive, but alternative examples for several activity categories were suggested to increase the comprehensibility and relevance. Some follow-up questions were considered less relevant. These suggestions were adopted in the second version of the My Little Moves app. CONCLUSIONS: Involving end-users and key stakeholders in the development of the My Little Moves app resulted in a tailored tool to assess 24-h movement behaviors in 0-4-year-olds with adequate content validity. Future studies are needed to evaluate other measurement properties of the app.

Protocol for a cluster randomized clinical trial of a mastery-climate motor skills intervention, Children's Health Activity and Motor Program (CHAMP), on self-regulation in preschoolers.

INTRODUCTION: Self-regulation (SR) is critical to healthy development in children, and intervention approaches (i.e., professional training, classroom-based curricula, parent-focused intervention) have shown to support or enhance SR. However, to our knowledge, none have tested whether changes in children's SR across an intervention relate to changes in children's health behavior and outcomes. This study, the Promoting Activity and Trajectories of Health (PATH) for Children-SR Study uses a cluster-randomized control trial to examine the immediate effects of a mastery-climate motor skills intervention on SR. Secondly, this study examines the associations between changes in SR and changes in children's health behaviors (i.e., motor competence, physical activity, and perceived competence) and outcomes (i.e., body mass index and waist circumference) (ClinicalTrials.gov Identifier, NCT03189862). METHODS AND ANALYSIS: The PATH-SR study will be a cluster-randomized clinical trial. A total of 120 children between the ages of 3.5 to 5 years of age will be randomized to a mastery-climate motor skills intervention (n = 70) or control (n = 50) condition. SR will be assessed using measures that evaluate cognitive SR (cognitive flexibility and working memory), behavioral SR (behavioral inhibition), and emotional SR (emotional regulation). Health behaviors will be assessed with motor skills, physical activity, and perceived competence (motor and physical) and health outcomes will be waist circumference and body mass index. SR, health behaviors, and health outcomes will be assessed before and after the intervention (pre-test and post-test). Given the randomization design, 70 children in the intervention group and 50 in the control group, we have 80% power to detect an effect size of 0.52, at a Type I error level of 0.05. With the data collected, we will test the intervention effect on SR with a two-sample t-test comparing the intervention group and the control group. We will further evaluate the associations between changes in SR and changes in children's health behaviors and health outcomes, using mixed effect regression models, with a random effect to account for within-subject correlations. The PATH-SR study addresses gaps in pediatric exercise science and child development research. Findings hold the potential to help shape public health and educational policies and interventions that support healthy development during the early years. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained through the Health Sciences and Behavioral Sciences Institutional Review Board, University of Michigan (HUM00133319). The PATH-SR study is funded by the National Institutes of Health Common Fund. Findings will be disseminated via print, online media, dissemination events and practitioner and/or research journals. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier, NCT03189862.

Associations of sleep characteristics with cognitive and gross motor development in toddlers.

OBJECTIVE: To examine cross-sectional associations of sleep characteristics (duration, consolidation, timing, variability) with cognitive and gross motor development in toddlers. METHODS: Participants were 205 toddlers (19.6 ± 4.3 months) from the GET-UP! STUDY: Nap/nighttime sleep onset and offset were measured using an accelerometer and used to calculate nap/nighttime sleep duration. Total sleep duration was calculated and classified as meeting or not meeting the sleep recommendation of the Australian 24-Hour Movement Guidelines (11-14 h/d). Nighttime sleep ratio (ie, nighttime sleep duration: total sleep duration), indicative of consolidation, was expressed as a percent value. Nighttime sleep midpoint (ie, the midpoint between nighttime sleep onset and offset), indicating the lateness of sleep schedules, was converted to a decimal hour. For sleep variability, the intraindividual standard deviation of nighttime sleep duration and nighttime sleep midpoint was calculated, respectively. Cognitive development (Bayley Scales of Infant and Toddler Development-III) and specific domains of gross motor development (Peabody Developmental Motor Scales, 2nd edition) were measured. RESULTS: Shorter nap duration (B = -0.87, 95%CI: -1.71, -0.02) and higher nighttime sleep ratio (B = 0.13, 95% CI: 0.02, 0.24) were associated with better cognitive development. Regarding gross motor development, positive associations were found for nighttime sleep duration (object manipulation: B = 0.26, 95% CI: 0.01, 0.51; gross motor quotient: B = 1.21, 95% CI: 0.04, 2.38) and total sleep duration (object manipulation: B = 0.28, 95% CI: 0.03, 0.52); negative associations were found for nighttime sleep midpoint (stationary: B = -0.31; 95% CI: -0.58, -0.06) and nighttime sleep duration variability (stationary: B = -0.32, 95% CI: -0.64, -0.004). CONCLUSIONS: In toddlers, more consolidated sleep may be an indicator of better cognitive development. Promoting longer and more consistent nighttime sleep duration, as well as an earlier nighttime sleep schedule, may facilitate gross motor development. However, our findings for the associations of sleep characteristics with cognitive and gross motor development need to be confirmed in prospective studies.

Learning to Cycle: A Cross-Cultural and Cross-Generational Comparison.

Background: Learning to cycle is an important milestone for children, but the popularity of cycling and the environmental factors that promote the development and practice of this foundational movement skill vary among cultures and across time. This present study aimed to investigate if country of residence and the generation in which a person was born influence the age at which people learn to cycle. Methods: Data were collected through an online survey between November 2019 and December 2020. For this study, a total of 9,589 responses were obtained for adults (self-report) and children (parental report) living in 10 countries (Portugal, Italy, Brazil, Finland, Spain, Belgium, United Kingdom, Mexico, Croatia, and the Netherlands). Participants were grouped according to their year of birth with 20-year periods approximately corresponding to 3 generations: 1960-79 (generation X; n = 2,214); 1980-99 (generation Y; n = 3,994); 2000-2019 (generation Z; n = 3,381). Results: A two-way ANOVA showed a significant effect of country, F(9,8628) = 90.17, p < 0.001, ηp2 = 0.086, and generation, F(2,8628) = 47.21, p < 0.001, ηp2 = 0.122, on the age at which individuals learn to cycle. Countries with the lowest learning age were the Netherlands, Finland and Belgium and countries with the highest learning age were Brazil and Mexico. Furthermore, the age at which one learns to cycle has decreased across generations. There was also a significant country x generation interaction effect on learning age, F(18,8628) = 2.90, p < 0.001; however, this effect was negligible ( ηp2 = 0.006). Conclusions: These findings support the socio-ecological perspective that learning to cycle is a process affected by both proximal and distal influences, including individual, environment and time.

Longitudinal differences in levels and bouts of sedentary time by different day types among Australian toddlers and pre-schoolers.

The aim of the present study was to characterize sedentary time (ST) and sedentary bouts among young children, across a typical week and by day type (childcare days, non-childcare days and weekends), over a 12-month period.ST % (ST/accelerometer wear time*100) and number of sedentary bouts/hours were assessed using accelerometers at two time-points 12-months apart in 153 toddlers and 74 pre-schoolers. Differences between baseline and follow-up according to the whole week and the different day types were calculated using linear mixed models with adjustment for age, sex, socio-economic status and zBMI.During the weekend, toddlers had more 20-30 min/h sedentary bouts at follow-up than at baseline (MD: 0.03). In pre-schoolers, ST % (MD:-8.4), the number of 1-4 min/h (MD:-1.45), 5-9 min/h (MD: -0.46) and 10-19 min/h sedentary bouts (MD:-0.11) were lower at baseline, compared to follow-up, on non-childcare days; as were the number of 5-9 min/h sedentary bouts on weekends (MD:0.40). P < 0.05 for all.This study found that longer sedentary bouts (20-30 min/h) tended to decrease among toddlers and pre-schoolers, whereas ST and shorter sedentary bouts increased over 12-months, particularly among pre-schoolers on non-childcare weekdays. Non-childcare days, and home environment may be targeted for intervention to reduce ST and sedentary bouts among pre-schoolers.

Objectively Measured Sedentary Levels and Bouts by Day Type in Australian Young Children.

BACKGROUND: This study aimed to understand whether a higher number of sedentary bouts (SED bouts) and higher levels of sedentary time (SED time) occur according to different day types (childcare days, nonchildcare weekdays, and weekends) in Australian toddlers (1-2.99 y) and preschoolers (3-5.99 y). METHODS: The SED time and bouts were assessed using ActiGraph GT3X+ accelerometers. The sample was composed of 264 toddlers and 343 preschoolers. The SED bouts and time differences were calculated using linear mixed models. RESULTS: The toddlers' percentage of SED time was higher on nonchildcare days compared with childcare days (mean difference [MD] = 2.3; 95% confidence interval, 0.7 to 3.9). The toddlers had a higher number of 1- to 4-minute SED bouts on nonchildcare days compared with childcare days. The preschoolers presented higher percentages of SED time during nonchildcare days (MD = 3.1; 95% confidence interval, 1.6 to 4.5) and weekends (MD = 1.9; 95% confidence interval, 0.4 to 3.4) compared with childcare days. The preschoolers presented a higher number of SED bouts (1-4, 5-9, 10-19, and 20-30 min) during nonchildcare days and weekends compared with childcare days. No SED times or bout differences were found between nonchildcare days and weekends, neither SED bouts >30 minutes on toddlers nor on preschoolers. CONCLUSION: The SED time and bouts seem to be lower during childcare periods, which means that interventions to reduce sedentary time should consider targeting nonchildcare days and weekends.

Physical activity and prospective associations with indicators of health and development in children aged <5 years: a systematic review.

BACKGROUND: Early childhood is a critical period for growth and development, yet the association with physical activity during this important period is unknown. The aim of this review is to critically summarize the evidence on the prospective associations between physical activity and health and development in children aged < 5 years. METHODS: A systematic search in three electronic databases (Pubmed, PsycINFO, and Sportdiscus) was conducted to identify prospective studies examining the associations between physical activity (all types; specified by quantity) and health indicators (body composition, cardiometabolic health, bone health and risks/harm) or development (motor, cognitive and social-emotional development) in young children (mean age < 5 years at baseline). Two independent researchers assessed the methodological quality using the 'Quality Assessment Tool for Quantitative Studies' (EPHPP). This tool covers eight quality criteria: selection bias, study design, confounders, blinding, data collection methods, withdrawals and drop-outs, intervention integrity and data-analysis. RESULTS: Thirty-nine studies, predominantly conducted in preschoolers (ages 3-5 years), were included of which nine were rated as high methodological quality. There was moderate evidence for a positive association between physical activity and motor (n = 11 studies) and cognitive development (n = 10 studies) based on consistent findings from studies having low-to-moderate methodological quality. There was insufficient evidence for an association between physical activity and body composition (n = 15 studies), cardiometabolic health indicators (n = 7 studies), social-emotional development (n = 2 studies) and bone health (n = 2 studies) based on inconsistent findings from studies having weak-to-high methodological quality. CONCLUSIONS: There is a need for more high-quality research in order to determine the dose-response relationship between physical activity and health and development in early childhood. Special attention should be paid to studies in children below the age of 3 years.

Sedentary time and blood pressure in Australian toddlers: The get-up study longitudinal results.

Epidemiological data suggests that the genesis of cardiovascular disease occurs during childhood. Sedentary time (ST) is a main driver of high blood pressure (BP) in adolescents and adults. However, associations between ST and cardiovascular health in young children are uncertain. Prospective associations between ST and BP were assessed among 172 toddlers (88 boys), aged 19.5 ± 3.9 months at baseline, recruited from the GET-UP! Study, Australia and followed over a 12-month period. BP was measured with a digital monitor and z-scores were computed by age and sex for systolic and diastolic BP. Total ST was measured over 7 days using Actigraph accelerometers and expressed over a 24-h period. Multilevel linear regression models were used to assess regression coefficients and standard errors, predicting BP at follow-up from ST at baseline. Analyses controlled for socio-economic status, height, age, gender, group (intervention or control) and zWC at baseline. Adjusted analyses showed that total ST did not predict systolic or diastolic BP (ß = 0.0009, p = 0.368 and ß = 0.002, p = 0.05, respectively). Most likely, longer follow-up periods might be needed to confirm or rule out our results, as the effects of cumulative ST over time on BP values are prone to manifest later in life and track into adolescence and adulthood.

A Narrative Review of Motor Competence in Children and Adolescents: What We Know and What We Need to Find Out.

Lack of physical activity is a global public health problem causing not only morbidity and premature mortality, but it is also a major economic burden worldwide. One of the cornerstones of a physically active lifestyle is Motor Competence (MC). MC is a complex biocultural attribute and therefore, its study requires a multi-sectoral, multi-, inter- and transdisciplinary approach. MC is a growing area of research, especially in children and adolescents due to its positive association with a plethora of health and developmental outcomes. Many questions, however, remain to be answered in this field of research, with regard to: (i) Health and Developmental-related Associations of MC; (ii) Assessment of MC; (iii) Prevalence and Trends of MC; (iv) Correlates and Determinants of MC; (v) MC Interventions, and (vi) Translating MC Research into Practice and Policy. This paper presents a narrative review of the literature, summarizing current knowledge, identifying key research gaps and presenting questions for future investigation on MC in children and adolescents. This is a collaborative effort from the International Motor Competence Network (IMCNetwork) a network of academics and researchers aiming to promote international collaborative research and knowledge translation in the expansive field of MC. The knowledge and deliverables generated by addressing and answering the aforementioned research questions on MC presented in this review have the potential to shape the ways in which researchers and practitioners promote MC and physical activity in children and adolescents across the world.

The Get-Up! study: adiposity and blood pressure in Australian toddlers.

BACKGROUND: Because the elevated blood pressure (BP) in childhood is strongly associated with overweight and is a risk factor for later cardiovascular disease, a need to comprehend the early development of BP and its association with overweight is needed. We assessed differences of BP by weight status in Australian toddlers. METHODS: From the Get-Up! Study in Australia, this sample included 265 toddlers (136 boys), aged 19.6 ±â€Š4.2 months. BP was measured with a digital vital signs monitor. Participants were categorized as nonoverweight and overweight according to the World Health Organization definition for body mass index (BMI). Physical activity was captured with activPAL accelerometers, during childcare hours. To test differences in BP between nonoverweight and overweight children, we performed an analysis of covariance adjusting for sex, age, physical activity, and socioeconomic status. RESULTS: Children with overweight showed higher z systolic BP values (P = .042 for BMI and P = .023 for waist circumference) when compared to nonoverweight children. However, no differences were found for z diastolic BP levels, between overweight and nonoverweight children. After adjustments for potential confounders (socioeconomic status, physical activity, sex, and age), there were no significant differences in BP variables between BMI and waist circumference groups. CONCLUSIONS: No associations between adiposity and BP levels were found in this sample. The unadjusted results, however, showed that children with higher levels of adiposity (BMI and waist circumference) exhibited higher levels of BP. Additional research is needed to determine which environmental and genetic factors might contribute to pediatric hypertension, particularly among toddlers.

Promoting Physical Activity and Executive Functions Among Children: A Cluster Randomized Controlled Trial of an After-School Program in Australia.

BACKGROUND: The aim of this study was to examine the efficacy of an embedded after-school intervention, on promoting physical activity and academic achievement in primary-school-aged children. METHODS: This 6-month, 2-arm cluster randomized controlled trial involved 4 after-school centers. Two centers were randomly assigned to the intervention, which involved training the center staff on and implementing structured physical activity (team sports and physical activity sessions for 75 min) and academic enrichment activities (45 min). The activities were implemented 3 afternoons per week for 2.5 hours. The control centers continued their usual after-school care practice. After-school physical activity (accelerometry) and executive functions (working memory, inhibition, and cognitive flexibility) were assessed pre- and postintervention. RESULTS: A total of 60 children were assessed (7.7 [1.8] y; 50% girls) preintervention and postintervention (77% retention rate). Children in the intervention centers spent significantly more time in moderate to vigorous physical activity (adjusted difference = 2.4%; 95% confidence interval, 0.6 to 4.2; P = .026) and scored higher on cognitive flexibility (adjusted difference = 1.9 units; 95% confidence interval, 0.9 to 3.0; P = .009). About 92% of the intervention sessions were implemented. The participation rates varied between 51% and 94%. CONCLUSION: This after-school intervention was successful at increasing moderate to vigorous physical activity and enhancing cognitive flexibility in children. As the intervention was implemented by the center staff and local university students, further testing for effectiveness and scalability in a larger trial is required.

Correction to: Comparing and assessing physical activity guidelines for children and adolescents: a systematic literature review and analysis.

An amendment to this paper has been published and can be accessed via the original article.

Comparing and assessing physical activity guidelines for children and adolescents: a systematic literature review and analysis.

BACKGROUND: The impact of declining physical activity and increased sedentary behaviour in children and adolescents globally prompted the development of national and international physical activity guidelines. This research aims to systematically identify and compare national and international physical activity guidelines for children and adolescents and appraise the quality of the guidelines to promote best practice in guideline development. METHODS: This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Only national, or international physical activity and/or sedentary behaviour guidelines were included in the review. Included guidelines targeted children and adolescents aged between 5 and 18 years. A grey literature search was undertaken incorporating electronic databases, custom Google search engines, targeted websites and international expert consultation. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II). RESULTS: The search resulted in 50 national or international guidelines being identified. Twenty-five countries had a national guideline and there were three international guidelines (European Union, Nordic countries (used by Iceland, Norway and Sweden), World Health Organization (WHO)). Nineteen countries and the European Union adopted the WHO guidelines. Guidelines varied in relation to date of release (2008 to 2019), targeted age group, and guideline wording regarding: type, amount, duration, intensity, frequency and total amount of physical activity. Twenty-two countries included sedentary behaviour within the guidelines and three included sleep. Total scores for all domains of the AGREE II assessment for each guideline indicated considerable variability in guideline quality ranging from 25.8 to 95.3%, with similar variability in the six individual domains. Rigorous guideline development is essential to ensure appropriate guidance for population level initiatives. CONCLUSIONS: This review revealed considerable variability between national/international physical activity guideline quality, development and recommendations, highlighting the need for rigorous and transparent guideline development methodologies to ensure appropriate guidance for population-based approaches. Where countries do not have the resources to ensure this level of quality, the adoption or adolopment (framework to review and update guidelines) of the WHO guidelines or guidelines of similar quality is recommended. TRIAL REGISTRATION: Review registration: PROSPERO 2017 CRD42017072558.

Systematic Review and Meta-Analyses: Motor Skill Interventions to Improve Fine Motor Development in Children Aged Birth to 6 Years.

OBJECTIVE: The objective of this study was to systematically review the evidence of motor skill intervention programs on typically developing children's fine motor development aged birth to 6 years. METHODS: Six electronic databases were searched with no date restrictions. Inclusion criteria were any school-, community-, or home-based intervention targeting the development of fine motor skills of children aged birth to 6 years; randomized controlled trials using quasiexperimental, experimental, or single group prepost designs with a minimum sample size of 15 participants per group; and statistical analyses of fine motor skill development at both preintervention and postintervention or addressing the intervention effects on fine motor skill development. Data were extracted on design, participants, intervention components, methodological quality, and efficacy. RESULTS: Twenty-five of the total 31 studies reported positive intervention effects on fine motor skills. The meta-analyses included 19 studies and revealed moderate effect sizes of motor skill programs on fine motor, visual motor, and manual dexterity outcomes. There were substantial differences between intervention settings, facilitators, length, and content with most studies implemented in school settings and facilitated by teachers. CONCLUSION: Fine motor skill development in the early years is an extensive upcoming field of interest for many international researchers. This review study presents evidence on the positive effects of intervention programs that aim to enhance fine motor skills for young children. The findings are promising but need to be interpreted with caution because of the high risk of bias in many of the studies.

Prevalence and risk factors of gross motor delay in pre-schoolers.

AIM: Gross motor skills are important for children's health and development. Delays in these skills are a concern for healthy developmental trajectories and therefore early identification of delay is important. This study screened for gross motor delay in children from low-income communities and investigated potential risk factors associated with gross motor delay. METHODS: This cross-sectional study involved 701 pre-schoolers (Mage = 54.1 ± 8.6 months, 52.8% boys) from childcare services in low-income and remote communities in Australia. Gross motor delay was assessed using the Ages and Stages Questionnaire - third edition. Potential risk factors included: sex, age, birthweight, prematurity status, weight status, childcare service, postcode, parent's education, parent's marital status, parent's employment and family income. RESULTS: Results showed 4.4% of the children were delayed in gross motor skills and 8.8% were at risk of delay. Logistic regression showed being a boy (odds ratio (OR) 1.78, 95% confidence interval (CI) 1.12-2.84), underweight (OR 2.72, 95% CI 1.18-6.30) or overweight (OR 1.83, 95% CI 1.00-3.33), and parental unemployment (OR 1.79, 95% CI 1.01-3.16) were factors associated with a higher odds of children being delayed or at risk of gross motor delay. A higher family income (OR 0.35, 95% CI 0.13-0.93) was associated with lower odds of delay. CONCLUSION: This unique study demonstrated children in low-income communities, especially boys, underweight and overweight children, have higher odds of being at risk of gross motor delay. Therefore, early screening is vital in this population in order to identify delays and potentially intervene with appropriate motor skill interventions.

Associations between gross motor skills and cognitive development in toddlers.

BACKGROUND: The early years of life are critical for motor and cognitive development. A better understanding is needed on the associations between the control and development of motor and cognitive tasks. AIM: This study aimed to examine the association between gross motor skills and cognitive development in toddlers. STUDY DESIGN: Cross-sectional study. SUBJECTS: This study included 335 toddlers (aged 19.80 ±â€¯4.08 months, 53.7% boys) from 30 childcare services in Australia. OUTCOME MEASURES: Children were assessed on gross motor skills (Peabody Developmental Motor Scales 2nd Edition; PDMS-2) and cognitive development (Bayley Scales of Infant and Toddler development 3rd edition; Bayley-III). DATA ANALYSIS: A one-way ANCOVA was conducted to assess associations between gross motor skills and cognitive development controlling for childcare center, sex, age, body mass index and socioeconomic status. RESULTS: The average scores were 96.41 ±â€¯9.84 for gross motor skills (range gross motor quotient 35-165) and 11.45 ±â€¯3.03 for cognitive development (range standard score 1-19). There was a significant positive association between gross motor skills and cognition, F(2,260) = 12.245, p < 0.001. Both locomotion and object manipulation were significantly positively associated with cognition, F(2,266) = 14.607, p < 0.001 and F(2,265) = 9.039, p < 0.001 respectively. CONCLUSIONS: Levels of gross motor skills are positively associated with cognitive development in this sample of Australian toddlers. Results reinforce the need for early commencement of gross motor skill promotion as this might be important for cognitive development in the early years.

Association between breaks in sitting time and adiposity in Australian toddlers: Results from the GET-UP! study.

BACKGROUND: In youth, research on the health benefits of breaking up sitting time is inconsistent. Our aim was to explore the association between the number of breaks in sitting time and adiposity in Australian toddlers. METHODS: This study comprised 266 toddlers (52% boys), aged 19.6 ± 4.2 months from the GET-UP! Study, Australia. Body mass index (BMI) was calculated and z-scores by age and sex were computed for waist circumference (WC). Participants were classified as overweight according to the WHO criteria for BMI. For WC, participants with a z-score≥1SD were considered overweight. Sitting time was assessed with activPALs during childcare hours and participants were classified by tertiles of the number of breaks/h in sitting time: <26 breaks/h; 26-39 breaks/h, and >39 breaks/h. Logistic regression assessed odds ratios for non-overweight (BMI or waist circumference categories) by number of breaks in sitting time/h, controlling for age, sex, and socioeconomic status. RESULTS: The number of breaks in sitting time significantly predicted a lower weight status (non-overweight) according to WC values (P for trend = 0.032) after adjustments. CONCLUSIONS: Breaking up sitting time was positively associated with toddlers' waist circumference. Future studies are needed to determine whether breaking up sitting time is a protective for cardiometabolic health in toddlers.

Gross motor skills in toddlers: Prevalence and socio-demographic differences.

OBJECTIVES: Gross motor skills (GMS) are a vital component of a child's development. Monitoring levels and correlates of GMS is important to ensure appropriate strategies are put in place to promote these skills in young children. The aim of this study was to describe the current level of GMS development of children aged 11-29months and how these levels differ by age, sex, BMI and socio-economic status. DESIGN: Cross-sectional study. METHODS: This study involved children from 30 childcare services in NSW, Australia. GMS were assessed using the Peabody Developmental Motor Scales Second Edition. Prevalence was reported using the gross motor quotient and both raw and standard scores for locomotor, object manipulation and stationary subtests. Socio-demographics were collected via parent questionnaires. Analyses included t-tests, chi-square tests, one-way ANOVA and linear regression models. RESULTS: This study included 335 children (mean age=19.80±4.08months, 53.9% boys). For the gross motor quotient, 23.3% of the children scored below average. For the GMS subtests, 34.3% of children scored below average for locomotion, 10.1% for object manipulation and 0.3% for stationary. Boys were more proficient in object manipulation than girls (p=0.001). GMS were negatively associated with age and a higher socio-economic status (all p<0.05). There were no associations for BMI. CONCLUSIONS: This is the first descriptive study to show the prevalence of below average at locomotor skills in toddlers is higher than reported in normative samples. Early commencement of GMS promotion is recommended with a focus on locomotor skills and girls' object manipulation skills.

Associations between gross motor skills and physical activity in Australian toddlers.

OBJECTIVES: Physical activity can be promoted by high levels of gross motor skills. A systematic review found a positive relationship in children (3-18 years) but only few studies examined this in younger children. The aim of this study was to examine the association between gross motor skills and physical activity in children aged 11-29 months. DESIGN: Cross-sectional study. METHODS: This study involved 284 children from 30 childcare services in NSW, Australia (Mean age=19.77±4.18months, 53.2% boys). Physical activity was measured using accelerometers (Actigraph GT3X+). Gross motor skills were assessed using the Peabody Developmental Motor Scales Second Edition (PDMS-2). Multilevel linear regression analyses were computed to assess associations between gross motor skills and physical activity, adjusting for sex, age and BMI. RESULTS: Children spent 53.08% of their time in physical activity and 10.39% in moderate to vigorous physical activity (MVPA). Boys had higher total physical activity (p<0.01) and MVPA (p<0.01) than girls. The average gross motor skills score was 96.16. Boys scored higher than girls in object manipulation (p<0.001). There was no association between gross motor skills and total physical activity or MVPA. CONCLUSIONS: Although gross motor skills were not associated with physical activity in this sample, stronger associations are apparent in older children. This study therefore highlights a potential important age to promote gross motor skills.