Tracking of MVPA across childhood and adolescence.

OBJECTIVES: Tracking of physical activity from childhood onwards is an important public health issue, but evidence on tracking is limited. This study quantified the tracking of Moderate-Vigorous Physical Activity (MVPA) across childhood and adolescence in a recent cohort from England. DESIGN: Longitudinal, with a socio-economically representative sample from North-East England, over an 8-year period. METHODS: Measures of time spent in MVPA, with an Actigraph GT1M accelerometer, were made at age 7-8y (n = 622, T1), age 9-10y (n = 585, T2), age 12-13y (n = 525, T3) and age 14-16y (n = 361, T4). Tracking of MVPA was assessed using rank order correlations between time spent in MVPA T1-T2, T1-T3, and T1-T4, and by using Cohen's kappa to examine tracking of meeting the MVPA guideline (mean of 60 min/d). We examined whether tracking varied by sex, socio-economic status (SES), initial MVPA, or initial body fatness. RESULTS: Rank order correlations were all statistically significant at p < 0.01 and moderate: 0.58 between T1 and T2; 0.42 between T1 and T3; 0.41 between T1 and T4. Cohen's kappas for meeting the global MVPA guideline were all significant, weakening from moderate to low over the 8 years. Tracking was stronger in higher SES compared to lower SES groups, and there was some evidence that it was stronger in girls than boys, but the other explanatory variables had little influence on tracking. CONCLUSIONS: Tracking of MVPA from mid-childhood to mid-adolescence in this cohort was moderate. This study suggests there is a need to establish high MVPA by mid-childhood, and to mitigate the age-related reduction in MVPA which occurs from mid-childhood.

RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Evaluation of the Use of Activity Trackers in the Clinical Care of Adults Diagnosed With a Chronic Disease: Integrative Systematic Review.

BACKGROUND: Chronic diseases are a leading cause of adult mortality, accounting for 41 million deaths globally each year. Low levels of physical activity and sedentary behavior are major risk factors for adults to develop a chronic disease. Physical activity interventions can help support patients in clinical care to be more active. Commercial activity trackers that can measure daily steps, physical activity intensity, sedentary behavior, and distance moved are being more frequently used within health-related interventions. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a planning and evaluation approach to explore the reach, effectiveness, adoption, implementation, and maintenance of interventions. OBJECTIVE: The objective of this study is to conduct an integrative systematic review and report the 5 main RE-AIM dimensions in interventions that used activity trackers in clinical care to improve physical activity or reduce sedentary behavior in adults diagnosed with chronic diseases. METHODS: A search strategy and study protocol were developed and registered on the PROSPERO platform. Inclusion criteria included adults (18 years and older) diagnosed with a chronic disease and have used an activity tracker within their clinical care. Searches of 10 databases and gray literature were conducted, and qualitative, quantitative, and mixed methods studies were included. Screening was undertaken by more than 1 researcher to reduce the risk of bias. After screening, the final studies were analyzed using a RE-AIM framework data extraction evaluation tool. This tool assisted in identifying the 28 RE-AIM indicators within the studies and linked them to the 5 main RE-AIM dimensions. RESULTS: The initial search identified 4585 potential studies. After a title and abstract review followed by full-text screening, 15 studies were identified for data extraction. The analysis of the extracted data found that the RE-AIM dimensions of adoption (n=1, 7% of studies) and maintenance (n=2, 13% of studies) were underreported. The use of qualitative thematic analysis to understand the individual RE-AIM dimensions was also underreported and only used in 3 of the studies. Two studies used qualitative analysis to explore the effectiveness of the project, while 1 study used thematic analysis to understand the implementation of an intervention. CONCLUSIONS: Further research is required in the use of activity trackers to support patients to lead a more active lifestyle. Such studies should consider using the RE-AIM framework at the planning stage with a greater focus on the dimensions of adoption and maintenance and using qualitative methods to understand the main RE-AIM dimensions within their design. These results should form the basis for establishing long-term interventions in clinical care. TRIAL REGISTRATION: PROSPERO CRD42022319635; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=319635.

24-Hour Movement Behaviours (Physical Activity, Sedentary Behaviour and Sleep) Association with Glycaemic Control and Psychosocial Outcomes in Adolescents with Type 1 Diabetes: A Systematic Review of Quantitative and Qualitative Studies.

Type 1 Diabetes (T1D) is a condition requiring 24-hour management. The way in which an individual combines their 24-hour movement behaviours (24-h MBs), which is comprised of physical activity (PA), sedentary behaviour (SB), and sleep, throughout the day can have a significant impact on physical and mental health. This mixed methods systematic review aimed to investigate 24-h MBs' relationship with glycaemic control and psychosocial outcomes in adolescents (11-18 years) with T1D. Ten databases were searched for quantitative and qualitative English language articles reporting at least one of the behaviours and their relationship with outcomes. There were no restrictions on article publication dates or study design. Articles were subjected to title and abstract screening, full text screening, data extraction and quality assessment. Data were summarised narratively, and a meta-analysis was conducted where possible. From 9922 studies, 84 were included for data extraction (quantitative (n = 76), qualitative (n = 8)). Meta-analyses revealed a significant favourable association between PA and HbA1c (-0.22 [95% CI: -0.35, -0.08; I2 = 92.7%; p = 0.001). SB had an insignificant unfavourable association with HbA1c (0.12 [95% CI: -0.06, 0.28; I2 = 86.1%; p = 0.07]) and sleep had an insignificant favourable association (-0.03 [95% CI: -0.21, 0.15; I2 = 65.9%; p = 0.34]). Importantly, no study investigated how combinations of behaviours collectively interacted and impacted on outcomes.

Birth Weight and Body Composition as Determined by Isotopic Dilution with Deuterium Oxide in 6- to 8-Year-Old South African Children.

Low and high birth weight (BW) are associated with obesity later in life; however, this association has not been extensively studied in African countries. This study determines the association between BW and body composition derived from deuterium oxide (D2O) dilution in 6- to 8-year-old South African children (n = 91; 40 boys, 51 girls). BW was recorded retrospectively from the children's Road-to-Health cards. Weight and height were measured using standard procedures, and D2O dilution was used to determine total body water and, subsequently, to determine body fat. Fatness was classified using the McCarthy centiles, set at 2nd, 85th, and 95th (underfat, overfat and obese). BW correlated with body composition measures, such as body weight (r = 0.23, p = 0.03), height (r = 0.33, p < 0.001), and fat free mass (FFM; r = 0.27, p = 0.01). When multiple regression analysis was employed, BW significantly and positively associated with FFM (ß = 0.24, p = 0.013; 95% CI: 0.032; 0.441) and fat mass (ß = 0.21, p = 0.02, 95%CI: 0.001; 0.412) in girls and boys combined. A total of 13% of the children had a low BW, with 21% being overweight and 17% obese. More girls than boys were overweight and obese. Intervention strategies that promote healthy uterine growth for optimal BW are needed in order to curb the global obesity pandemic.

Validity of low-cost measures for global surveillance of physical activity in pre-school children: The SUNRISE validation study.

OBJECTIVES: To validate parent-reported child habitual total physical activity against accelerometry and three existing step-count thresholds for classifying 3 h/day of total physical activity in pre-schoolers from 13 culturally and geographically diverse countries. DESIGN: Cross-sectional validation study. METHODS: We used data involving 3- and 4-year-olds from 13 middle- and high-income countries who participated in the SUNRISE study. We used Spearman's rank-order correlation, Bland-Altman plots, and Kappa statistics to validate parent-reported child habitual total physical activity against activPAL™-measured total physical activity over 3 days. Additionally, we used Receiver Operating Characteristic Area Under the Curve analysis to validate existing step-count thresholds (Gabel, Vale, and De Craemer) using step-counts derived from activPAL™. RESULTS: Of the 352 pre-schoolers, 49.1 % were girls. There was a very weak but significant positive correlation and slight agreement between parent-reported total physical activity and accelerometer-measured total physical activity (r: 0.140; p = 0.009; Kappa: 0.030). Parents overestimated their child's total physical activity compared to accelerometry (mean bias: 69 min/day; standard deviation: 126; 95 % limits of agreement: -179, 316). Of the three step-count thresholds tested, the De Craemer threshold of 11,500 steps/day provided excellent classification of meeting the total physical activity guideline as measured by accelerometry (area under the ROC curve: 0.945; 95 % confidence interval: 0.928, 0.961; sensitivity: 100.0 %; specificity: 88.9 %). CONCLUSIONS: Parent reports may have limited validity for assessing pre-schoolers' level of total physical activity. Step-counting is a promising alternative - low-cost global surveillance initiatives could potentially use pedometers for assessing compliance with the physical activity guideline in early childhood.

Movement behaviours and adherence to guidelines: perceptions of a sample of UK parents with children 0-18 months.

BACKGROUND: Movement behaviours are important for infant (0-12 mo) and toddler (1-2 yrs) health and development, yet very little is known about adherence to the 24-hour movement behaviour guidelines and parents perception of these behaviours in these age groups. This study aimed to examine parental perceptions of movement behaviours and adherence to guidelines in a sample of UK parents with children 0-18 months. METHODS: Participants were 216 parent-child dyads from the cross-sectional Movement Behaviour Assessment in Infants and Toddlers (M-BAIT) study. Tummy time, screen time, restraint time and sleep were measured using a parental questionnaire. A sub-sample of parents were asked about their priority areas for their child's health and development. Frequencies were used to describe the proportion of children meeting movement behaviour guidelines, the number of guidelines met and priority areas for parents. Mann-Whitney U-tests (continuous variables) and chi-square tests (categorical variables) were used to assess the differences between boys and girls. RESULTS: For those under 12 months of age, just over 30% of children met tummy time recommendations, 41.3% met the screen time guidelines, 57.8% met restraint guidelines and 76.2% met sleep guidelines. For those 12 months and over, 24.1% met the screen time guidelines, 56.9% met restraint guidelines and 82.8% met sleep guidelines. Parents identified sleep and physical activity as top priorities for their child. Limiting screen time was deemed least important. CONCLUSION: In this sample of UK infants and toddlers (0-18 months), few adhered to the sedentary behaviour and tummy time guidelines, whereas the majority meet sleep guidelines. This mirrors parental priorities; limiting screen time was seen as less important, with sleep and physical activity deemed most important. These findings suggest greater efforts are needed to raise awareness about screen and tummy time, supporting parents and care-providers to promote positive movement behaviours.

Levels and Correlates of Objectively Measured Sedentary Behavior in Young Children: SUNRISE Study Results from 19 Countries.

PURPOSE: There is a paucity of global data on sedentary behavior during early childhood. The purpose of this study was to examine how device-measured sedentary behavior in young children differed across geographically, economically, and sociodemographically diverse populations, in an international sample. METHODS: This multinational, cross-sectional study included data from 1071 children 3-5 yr old from 19 countries, collected between 2018 and 2020 (pre-COVID). Sedentary behavior was measured for three consecutive days using activPAL accelerometers. Sedentary time, sedentary fragmentation, and seated transport duration were calculated. Linear mixed models were used to examine the differences in sedentary behavior variables between sex, country-level income groups, urban/rural settings, and population density. RESULTS: Children spent 56% (7.4 h) of their waking time sedentary. The longest average bout duration was 81.1 ± 45.4 min, and an average of 61.1 ± 50.1 min·d-1 was spent in seated transport. Children from upper-middle-income and high-income countries spent a greater proportion of the day sedentary, accrued more sedentary bouts, had shorter breaks between sedentary bouts, and spent significantly more time in seated transport, compared with children from low-income and lower-middle-income countries. Sex and urban/rural residential setting were not associated with any outcomes. Higher population density was associated with several higher sedentary behavior measures. CONCLUSIONS: These data advance our understanding of young children's sedentary behavior patterns globally. Country income levels and population density appear to be stronger drivers of the observed differences, than sex or rural/urban residential setting.

Sharing positive behavior change made during COVID-19 lockdown: A mixed-methods coproduction study.

OBJECTIVE: The negative consequences of coronavirus disease 2019 (COVID-19) national lockdowns have been well documented, including the worsening of mental health for many and the amplification of preexisting inequalities. As a counterpoint, the current study uses a mixed-methods coproduction approach to share psychosocial insights into the adoption of positive changes made during national lockdown in Scotland. This study examines the psychosocial patterning of positive behavior changes and the psychosocial processes by which positive change was realized and shared these insights with partner organizations. METHOD: A sequential mixed-methods design included an online survey (N = 2,445) assessing positive changes in sleep and physical activity patterns and the role of sociodemographics, mood, social support, coping, and resilience using multivariate logistic regression analysis. Interviews were performed with a purposive diverse subsample of people self-reporting high levels of positive change (n = 48) and used thematic analysis. RESULTS: The survey identified that positive behavior change was significantly patterned by age, gender, and vulnerability to COVID-19. Higher levels of positive reframing and active coping in relation to stress were associated with higher levels of positive behavior change. Higher symptoms of depression, planning, and self-distraction were associated with less positive behavior change. Thematic analysis showed the centrality of perceptions of time, opportunities to self-reflect and engage with the natural world, access support in diverse ways, actively build routine, and purposefully build self-efficacy and a sense of control were key to initiating positive change. CONCLUSIONS: The current study yields insights into achieving positive behavior change at a time of international crisis. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Failure to Launch: Predictors of Unfavourable Physical Activity and Sedentary Behaviour Trajectories from Childhood to Adolescence: The Gateshead Millennium Study.

In a previous study based on this cohort, only 15% of the participants belonged to a favourable physical activity/sedentary behaviour trajectory group (characterised by relatively high moderate-vigorous intensity physical activity and relatively low sedentary behaviour across childhood and adolescence). Since this favourable trajectory is protective against obesity, we aimed to identify factors associated with membership of this group. In this longitudinal study, 671 participants were assessed at ages 7, 9, 12 and 15 years. Participants' demographics, socio-economic status (SES) and physical activity environment such as, sports club participation and commuting school were assessed at ages 7, 9 and 12 and analysed with favourable trajectory membership as an outcome using multinomial logistic regression. Sex (male) and SES (higher) were the non-modifiable factors associated with favourable trajectory group. Of the modifiable factors, commuting to school at age 7, a safe environment to play at age 7 and sports club participation at age 12 were all associated with more than 2.0 times increased probability of being in the most favourable trajectory. Future interventions to promote a favourable trajectory could focus on girls and participants with low SES. Promoting active commuting, safe local spaces to play and sports participation should also help lead to a favourable trajectory for physical activity and sedentary behaviour across childhood and adolescence.

Cross-sectional examination of 24-hour movement behaviours among 3- and 4-year-old children in urban and rural settings in low-income, middle-income and high-income countries: the SUNRISE study protocol.

INTRODUCTION: 24-hour movement behaviours (physical activity, sedentary behaviour and sleep) during the early years are associated with health and developmental outcomes, prompting the WHO to develop Global guidelines for physical activity, sedentary behaviour and sleep for children under 5 years of age. Prevalence data on 24-hour movement behaviours is lacking, particularly in low-income and middle-income countries (LMICs). This paper describes the development of the SUNRISE International Study of Movement Behaviours in the Early Years protocol, designed to address this gap. METHODS AND ANALYSIS: SUNRISE is the first international cross-sectional study that aims to determine the proportion of 3- and 4-year-old children who meet the WHO Global guidelines. The study will assess if proportions differ by gender, urban/rural location and/or socioeconomic status. Executive function, motor skills and adiposity will be assessed and potential correlates of 24-hour movement behaviours examined. Pilot research from 24 countries (14 LMICs) informed the study design and protocol. Data are collected locally by research staff from partnering institutions who are trained throughout the research process. Piloting of all measures to determine protocol acceptability and feasibility was interrupted by COVID-19 but is nearing completion. At the time of publication 41 countries are participating in the SUNRISE study. ETHICS AND DISSEMINATION: The SUNRISE protocol has received ethics approved from the University of Wollongong, Australia, and in each country by the applicable ethics committees. Approval is also sought from any relevant government departments or organisations. The results will inform global efforts to prevent childhood obesity and ensure young children reach their health and developmental potential. Findings on the correlates of movement behaviours can guide future interventions to improve the movement behaviours in culturally specific ways. Study findings will be disseminated via publications, conference presentations and may contribute to the development of local guidelines and public health interventions.

Association between Objectively Determined Physical Activity Levels and Body Composition in 6-8-Year-Old Children from a Black South African Population: BC-IT Study.

Physical inactivity in children is a global pandemic in parallel with increasing obesity prevalence. However, studies assessing the association between physical activity (PA) and body composition (BC) report conflicting findings, possibly because of the different methodologies across studies, with objective methods promising reliable results. This study determines the association between objectively determined PA levels and BC in 6-8-year-old children from a black South African population. Ninety-three children aged 6-8 years, who formed part of a larger study on BC using the deuterium dilution method (DDM), were included. Height and weight were measured according to the standard procedures, and body mass index z-score was calculated. Fatness was determined by DDM. An accelerometer was used to measure PA levels. Regression models were performed to determine the relationship between PA and BC. Approximately 23% of the children did not meet the recommended PA guidelines and 27% were overfat. After adjustments were made, more time spent in vigorous PA was significantly associated with lower fat mass (ß = -0.25, p = 0.01, 95%CI: -11.08; -1.20) and fat mass % (ß = -0.20, p = 0.04, 95%CI: -12.63; -0.18). Participation in high PA, especially of high intensity, was associated with reduced adiposity in children. Behavioural changes such as increasing high intensity PA is strongly recommended for reducing adiposity.

Moderate-To-Vigorous Intensity Physical Activity and Sedentary Behaviour across Childhood and Adolescence, and Their Combined Relationship with Obesity Risk: A Multi-Trajectory Analysis.

The combined role of objectively assessed moderate-vigorous intensity physical activity (MVPA) and sedentary behaviour (SB) is unclear in obesity prevention. This study aimed to identify latent groups for MVPA and SB trajectories from childhood to adolescence and examine their relationship with obesity risk at adolescence. From the Gateshead Millennium Study, accelerometer-based trajectories of time spent in MVPA and SB at ages 7, 9, 12, and 15 were derived as assigned as the predictor variable. Fat mass index (FMI), using bioelectrical impedance at age 15, was the outcome variable. From 672 children recruited, we identified three distinct multiple trajectory groups for time spent in MVPA and SB. The group with majority membership (54% of the cohort) had high MVPA and low SB at childhood, but MVPA declined and SB increased by age 15. One third of the cohort (31%) belonged to the trajectory with low MVPA and high time spent sedentary throughout. The third trajectory group (15% of the cohort) that had relatively high MVPA and relatively low SB throughout had lower FMI (-1.7, 95% CI (-3.4 to -1.0) kg/m2, p = 0.034) at age 15 compared to the inactive throughout group. High MVPA and low SB trajectories when combined are protective against obesity.

What have we learned about positive changes experienced during COVID-19 lockdown? Evidence of the social patterning of change.

BACKGROUND: Multiple studies have highlighted the negative impact of COVID-19 and its particular effects on vulnerable sub-populations. Complementing this work, here, we report on the social patterning of self-reported positive changes experienced during COVID-19 national lockdown in Scotland. METHODS: The CATALYST study collected data from 3342 adults in Scotland during weeks 9-12 of a national lockdown. Using a cross-sectional design, participants completed an online questionnaire providing data on key sociodemographic and health variables, and completed a measure of positive change. The positive change measure spanned diverse domains (e.g., more quality time with family, developing new hobbies, more physical activity, and better quality of sleep). We used univariate analysis and stepwise regression to examine the contribution of a range of sociodemographic factors (e.g., age, gender, ethnicity, educational attainment, and employment status) in explaining positive change. RESULTS: There were clear sociodemographic differences across positive change scores. Those reporting higher levels of positive change were female, from younger age groups, married or living with their partner, employed, and in better health. CONCLUSION: Overall our results highlight the social patterning of positive changes during lockdown in Scotland. These findings begin to illuminate the complexity of the unanticipated effects of national lockdown and will be used to support future intervention development work sharing lessons learned from lockdown to increase positive health change amongst those who may benefit.

Public health surveillance of habitual physical activity in adolescents and adults in Namibia: a cross-sectional validation of activity questionnaires against accelerometry.

BACKGROUND: Monitoring population-level physical activity is crucial for examining adherence to global guidelines and addressing obesity. This study validated self-reported moderate-to-vigorous physical activity (MVPA) against an accurate device-based method in Namibia. METHODS: Adolescent girls (n = 52, mean age 16.2 years [SD 1.6]) and adult women (n = 51, mean age 31.3 years [SD 4.7]) completed the PACE+/GPAQ self-report questionnaires and were asked to wear an Actigraph accelerometer for 7 days. Validity of self-reported MVPA was assessed using rank-order correlations between self-report and accelerometry, and classification ability of the questionnaires with Mann-Whitney tests, kappa's, sensitivity and specificity. RESULTS: In the adolescents, Spearman's rank coefficients between self-reported MVPA (days/week) and accelerometry measured MVPA were positive but not significant (r = 0.240; P = 0.104). In the adults, self-reported MVPA (minutes/day) was moderately and significantly correlated with accelerometer-measured MVPA (r = 0.396; P = 0.008). In both groups, there was fair agreement between accelerometry and questionnaire-defined tertiles of MVPA (adolescents κ = 0.267; P = 0.010; adults κ = 0.284; P = 0.008), and measured MVPA was significantly higher in the individuals self-reporting higher MVPA than those reporting lower MVPA. CONCLUSIONS: The PACE+ and GPAQ questionnaires have a degree of validity in adolescent girls and adult females in Namibia, though more suitable for population than individual level measurement.

Changes in Physical Activity, Sitting and Sleep across the COVID-19 National Lockdown Period in Scotland.

We examine the impact of the COVID-19 outbreak and concomitant restrictions (i.e., lockdown) on 24-hour movement behaviors (i.e., physical activity, sitting, sleep) in a purposive sample of people (n = 3230) reporting change recruited online. Participants' self-reported time spent in moderate-to-vigorous physical activity (MVPA), walking, sitting and sleep prior to lockdown (T1), during the first national lockdown (T2) and as restrictions initially started to ease (T3). For each 24-hour movement behavior, category-shifts are reported (positive, negative or did not change), as well as the percentage of participants recording positive/negative changes across clusters of behaviors and the percentage of participants recording improvement or maintenance of change across time. From T1 to T2 walking decreased, whereas MVPA, sitting and sleep increased, from T2 to T3 levels returned to pre-lockdown for all but MVPA. Participants who changed one behavior positively were more likely to report a positive change in another and 50% of those who reported positive changes from T1 to T2 maintained or improved further when restrictions started to ease. The current study showed that a large proportion of the sample reported positive changes, most notably those displaying initially poor levels of each behavior. These findings will inform salutogenic intervention development.

Pilot Testing of a Nudge-Based Digital Intervention (Welbot) to Improve Sedentary Behaviour and Wellbeing in the Workplace.

Welbot is a nudge-based digital intervention that aims to reduce sedentary behaviour and improve physical and mental wellbeing at work. The purpose of this study was to pilot test the Welbot intervention. Forty-one (6M/35F) University staff (M age = 43-years) participated in this study, which was a single arm repeated measures trial conducted over three weeks of intervention. The primary outcome was sedentary behaviour (measured subjectively and objectively) and secondary outcomes included: mental wellbeing, procrastination, depression, anxiety and stress, and work engagement. A subset of participants (n = 6) wore an ActivPAL to objectively measure activity data, while another subset of participants (n = 6) completed a qualitative semi-structured interview to ascertain experiences of using Welbot. Following the intervention, a Friedman non-parametric test revealed that participants self-reported significantly less time sitting and more time standing and objectively recorded more steps at the week-1 follow-up. A series of paired t-tests exhibited that changes in all secondary outcomes were in the expected direction. However, only improvements in depression, anxiety, and stress were significant. After using Welbot, thematic analysis demonstrated that participants perceived they had a positive behaviour change, increased awareness of unhealthy behaviours at work, and provided suggestions for intervention improvement. Overall, findings provided indications of the potential positive impact Welbot may have on employees' wellbeing, however, limitations are noted. Recommendations for intervention improvement including personalisation (e.g., individual preferences for nudges and the option to sync Welbot with online calendars) and further research into how users engage with Welbot are provided.

A Mixed Methods Evaluation of a Digital Intervention to Improve Sedentary Behaviour Across Multiple Workplace Settings.

BACKGROUND: Prolonged sedentary behaviour (SB) is associated with risk of chronic diseases. Digital interventions in SB require mixed method evaluations to understand potential for impact in real-world settings. In this study, the RE-AIM QuEST evaluation framework will be used to understand the potential of a digital health promotion application which targets reducing and breaking up SB across multiple workplace settings. METHODS: Four companies and 80 employees were recruited to use a digital application. Questionnaires were used to measure SB, and additional health and work-related outcomes at baseline, one month, three month and six month follow-up. Qualitative data was collected through focus groups with employees and interviews with stakeholders. Questionnaire data was analysed using Wilcoxon Sign Rank tests and qualitative data was thematically analysed. RESULTS: The digital application significantly increased standing time at one month for the total group and transitions per hour in one of the companies. Facilitators and barriers were identified across RE-AIM. CONCLUSIONS: Addressing the barriers which have been identified, while maintaining the positive attributes will be critical to producing an effective digital application which also has the potential for impact in the real world.

'Jump start' childcare-based intervention to promote physical activity in pre-schoolers: six-month findings from a cluster randomised trial.

BACKGROUND: Participation in adequate levels of physical activity during the early years is important for health and development. We report the 6-month effects of an 18-month multicomponent intervention on physical activity in early childhood education and care (ECEC) settings in low-income communities. METHODS: A cluster randomised controlled trial was conducted in 43 ECEC settings in disadvantaged areas of New South Wales, Australia. Three-year-old children were recruited and assessed in the first half of 2015 with follow-up 6 months later. The intervention was guided by Social Cognitive Theory and included five components. The primary outcome was minutes per hour in total physical activity during ECEC hours measured using Actigraph accelerometers. Intention-to-treat analysis of the primary outcome was conducted using a generalized linear mixed model. RESULTS: A total of 658 children were assessed at baseline. Of these, 558 (85%) had valid accelerometer data (mean age 3.38y, 52% boys) and 508 (77%) had valid accelerometry data at 6-month follow-up. Implementation of the intervention components ranged from 38 to 72%. There were no significant intervention effects on mins/hr. spent in physical activity (adjusted difference = - 0.17 mins/hr., 95% CI (- 1.30 to 0.97), p = 0.78). A priori sub-group analyses showed a greater effect among overweight/obese children in the control group compared with the intervention group for mins/hr. of physical activity (2.35mins/hr., [0.28 to 4.43], p = 0.036). CONCLUSIONS: After six-months the Jump Start intervention had no effect on physical activity levels during ECEC. This was largely due to low levels of implementation. Increasing fidelity may result in higher levels of physical activity when outcomes are assessed at 18-months. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12614000597695.

Associations of screen time, sedentary time and physical activity with sleep in under 5s: A systematic review and meta-analysis.

Sleep is crucial to children's health and development. Reduced physical activity and increased screen time adversely impact older children's sleep, but little is known about these associations in children under 5 y. This systematic review examined the association between screen time/movement behaviors (sedentary behavior, physical activity) and sleep outcomes in infants (0-1 y); toddlers (1-2 y); and preschoolers (3-4 y). Evidence was selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and synthesized using vote counting based on the direction of association. Quality assessment and a Grading of Recommendations, Assessment, Development and Evaluation was performed, stratified according to child age, exposure and outcome measure. Thirty-one papers were included. Results indicate that screen time is associated with poorer sleep outcomes in infants, toddlers and preschoolers. Meta-analysis confirmed these unfavorable associations in infants and toddlers but not preschoolers. For movement behaviors results were mixed, though physical activity and outdoor play in particular were favorably associated with most sleep outcomes in toddlers and preschoolers. Overall, quality of evidence was very low, with strongest evidence for daily/evening screen time use in toddlers and preschoolers. Although high-quality experimental evidence is required, our findings should prompt parents, clinicians and educators to encourage sleep-promoting behaviors (e.g., less evening screen time) in the under 5s.

Longitudinal changes in moderate-to-vigorous-intensity physical activity in children and adolescents: A systematic review and meta-analysis.

Moderate-to-vigorous-intensity physical activity (MVPA) is important for childhood obesity prevention and treatment, yet declines with age. Timing and magnitude of the decline in MVPA in children and adolescents are unclear but important for informing effective obesity intervention development. This systematic review aimed to determine and compare the year-to-year changes in MVPA among children and adolescents. Longitudinal studies were identified by searching 10 relevant databases up to December 2018. Studies were eligible for inclusion if they reported accelerometer-assessed MVPA (min day-1 ) separately for boys and girls and had follow-up duration of at least 1 year. After screening 9,232 studies, 52 were included representing 22,091 aged 3 to 18 year olds (boys=8,857; girls=13,234). Pooled-analysis of the relative change in MVPA per year showed a decline of -3.4% (95% CI, -5.9 to -0.9) in boys and -5.3% (95% CI, -7.6 to -3.1) in girls, across all age groups. There were notable declines in MVPA at age 9 for both boys (-7.8%, 95% CI, -11.2 to -4.4) and girls (-10.2%, 95% CI, -14.2 to -6.3). The relative decline in MVPA affects both sexes from an early age; however, it is greater among girls. Interventions to promote MVPA should start before adolescence.