Development of a multi-wear-site, deep learning-based physical activity intensity classification algorithm using raw acceleration data.

BACKGROUND: Accelerometers are widely adopted in research and consumer devices as a tool to measure physical activity. However, existing algorithms used to estimate activity intensity are wear-site-specific. Non-compliance to wear instructions may lead to misspecifications. In this study, we developed deep neural network models to classify device placement and activity intensity based on raw acceleration data. Performances of these models were evaluated by making comparisons to the ground truth and results derived from existing count-based algorithms. METHODS: 54 participants (26 adults 26.9±8.7 years; 28 children, 12.1±2.3 years) completed a series of activity tasks in a laboratory with accelerometers attached to each of their hip, wrist, and chest. Their metabolic rates at rest and during activity periods were measured using the portable COSMED K5; data were then converted to metabolic equivalents, and used as the ground truth for activity intensity. Deep neutral networks using the Long Short-Term Memory approach were trained and evaluated based on raw acceleration data collected from accelerometers. Models to classify wear-site and activity intensity, respectively, were evaluated. RESULTS: The trained models correctly classified wear-sites and activity intensities over 90% of the time, which outperformed count-based algorithms (wear-site correctly specified: 83% to 85%; wear-site misspecified: 64% to 75%). When additional parameters of age, height and weight of participants were specified, the accuracy of some prediction models surpassed 95%. CONCLUSIONS: Results of the study suggest that accelerometer placement could be determined prospectively, and non-wear-site-specific algorithms had satisfactory accuracies. The performances, in terms of intensity classification, of these models also exceeded typical count-based algorithms. Without being restricted to one specific wear-site, research protocols for accelerometers wear could allow more autonomy to participants, which may in turn improve their acceptance and compliance to wear protocols, and in turn more accurate results.

Effects of eHealth Interventions on 24-Hour Movement Behaviors Among Preschoolers: Systematic Review and Meta-Analysis.

BACKGROUND: The high prevalence of unhealthy movement behaviors among young children remains a global public health issue. eHealth is considered a cost-effective approach that holds great promise for enhancing health and related behaviors. However, previous research on eHealth interventions aimed at promoting behavior change has primarily focused on adolescents and adults, leaving a limited body of evidence specifically pertaining to preschoolers. OBJECTIVE: This review aims to examine the effectiveness of eHealth interventions in promoting 24-hour movement behaviors, specifically focusing on improving physical activity (PA) and sleep duration and reducing sedentary behavior among preschoolers. In addition, we assessed the moderating effects of various study characteristics on intervention effectiveness. METHODS: We searched 6 electronic databases (PubMed, Ovid, SPORTDiscus, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) for experimental studies with a randomization procedure that examined the effectiveness of eHealth interventions on 24-hour movement behaviors among preschoolers aged 2 to 6 years in February 2023. The study outcomes included PA, sleep duration, and sedentary time. A meta-analysis was conducted to assess the pooled effect using a random-effects model, and subgroup analyses were conducted to explore the potential effects of moderating factors such as intervention duration, intervention type, and risk of bias (ROB). The included studies underwent a rigorous ROB assessment using the Cochrane ROB tool. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment. RESULTS: Of the 7191 identified records, 19 (0.26%) were included in the systematic review. The meta-analysis comprised a sample of 2971 preschoolers, which was derived from 13 included studies. Compared with the control group, eHealth interventions significantly increased moderate to vigorous PA (Hedges g=0.16, 95% CI 0.03-0.30; P=.02) and total PA (Hedges g=0.37, 95% CI 0.02-0.72; P=.04). In addition, eHealth interventions significantly reduced sedentary time (Hedges g=-0.15, 95% CI -0.27 to -0.02; P=.02) and increased sleep duration (Hedges g=0.47, 95% CI 0.18-0.75; P=.002) immediately after the intervention. However, no significant moderating effects were observed for any of the variables assessed (P>.05). The quality of evidence was rated as "moderate" for moderate to vigorous intensity PA and sedentary time outcomes and "low" for sleep outcomes. CONCLUSIONS: eHealth interventions may be a promising strategy to increase PA, improve sleep, and reduce sedentary time among preschoolers. To effectively promote healthy behaviors in early childhood, it is imperative for future studies to prioritize the development of rigorous comparative trials with larger sample sizes. In addition, researchers should thoroughly examine the effects of potential moderators. There is also a pressing need to comprehensively explore the long-term effects resulting from these interventions. TRIAL REGISTRATION: PROSPERO CRD42022365003; http://tinyurl.com/3nnfdwh3.

Feasibility and potential efficacy of a family-based intervention on promoting physical activity levels and fundamental movement skills in preschoolers: A cluster randomised controlled trial.

Physical activity (PA) is crucial for preschool-aged children's health and development. However, limited evidence exists regarding the feasibility of implementing home-based interventions and how program components influence parent cognitions and practices and child PA. This study evaluated the feasibility and potential efficacy of a family-based PA intervention on objectively measured PA, fundamental movement skills (FMS), parental efficacy, support, goal setting and parent-child co-activity. Guided by social cognitive theory, an 8-week cluster randomised controlled trial was conducted in Hong Kong. The trial included parental workshops, FMS training, PA homework, social media activity sharing and exercise equipment provision. Data were collected at baseline (Time 1; April 2019) and at the end of the intervention period (Time 2; approximately 2 months later) from 108 parent-child pairs in five preschools. The intervention led to increased moderate-to-vigorous PA and FMS in children, along with improved parental self-efficacy, goal setting, supportiveness and co-participation. However, parental PA did not show significant changes. Parents expressed high satisfaction, supporting the need for tailoring interventions to address the unique needs and preferences of young children and their parents. Reinforcing the parental role and providing informative materials and training can promote healthy lifestyles in early childhood.

Barriers and facilitators to physical activity for young adult women: a systematic review and thematic synthesis of qualitative literature.

BACKGROUND: Physical activity (PA) has many benefits in preventing diseases and maintaining physical and mental health. Women, in particular, can benefit from regular PA. However, women's PA did not increase over the past decade globally, and the situations faced by women are often gender-specific. Healthy young adult women's PA does not receive as much attention as older women and adolescent girls, yet, they face the same situation of low level of PA. This review aims to explore and synthesise the self-identified barriers and facilitators to young adult women's participation in PA from qualitative research studies and offer suggestions for future studies and programs designed for this population. METHODS: A systematic search was conducted in Pubmed, Web of Science, Scopus, Medline, and SPORTDiscus for studies published between January 2000 to February 2022 to identify qualitative studies on the barriers and facilitators of young adult women's PA between ages 18 to 40. The search yielded 694 studies initially, of which 23 were included. The research quality of included studies was appraised using the Critical Appraisal Skills Programme (CASP) tool. Data were extracted and thematically analysed based on the tenets of the social-ecological model (SEM). RESULTS: Identified barriers and facilitators were grouped into different levels of the SEM, with the most frequently cited factors being time, body image and societal beauty standards, family duty and social support, religious and cultural norms, organisation and community facilities and environment, safety issues and physical environment. Descriptive data were thematically analysed and synthesised in line with the five levels: body image, health and beauty; multiple roles, support, and PA; religious identity, cultural identity, and PA; safety issues and women's fears. CONCLUSIONS: This qualitative synthesis revealed in-depth information on barriers and facilitators influencing young adult women's PA. It highlighted that the factors young adult women face are diverse at different levels yet holistic and intertwined. Future studies on young adult women's PA should address the social-cultural influence and would benefit from applying multilevel strategies employing the SEM model. It is critical to create an open and inclusive environment and offer more opportunities for women. TRIAL REGISTRATION: PROSPERO CRD42021290519.

Acceptability of a parent-focused program for physical literacy development among parents and children during the COVID-19 pandemic: A qualitative study.

Background: A 3-month parent education program was designed and implemented in Hong Kong to improve physical literacy (PL) among primary school children and their parents during the COVID-19 pandemic. This study aims to probe into the acceptability of the intervention from parental perspectives, providing more insights for future implementation. Methods: Following the 3-month parent-focused PL program, 16 parents (mean age = 43.73 years, 15 mothers) were recruited to participate in semi-structured individual interviews in June 2021. Interviews were analyzed using thematic analysis in NVivo 12. Two coders analyzed interview transcripts deductively based on the interview guide and social cognitive theory (SCT). Results: Three themes were identified that captured the acceptability of the program: (1) Addressing needs through appropriate delivery enhances acceptability of intervention; (2) Positive behavioral and psychological changes to families; (3) Appropriate support of environmental factors can enhance the sustainability of program effects. The high levels of acceptability were attributable to the fact that parents were able to learn and be a gatekeeper to impact their children positively. Moreover, the design and contents of the program were appropriate for the participating parents because the program provided adequate learning resources and interactive learning support without being overly rigid, and the online learning mode was feasible and convenient. Consequent to their participation in the program, parents expressed that they became more aware of the importance of PL, established physical activity routines with their children, and modified their parenting styles which resulted in improved parent-child relationships. Conclusions: The current study provided evidence that engaging parents in the intervention was feasible and acceptable approach in supporting both parents and children to establish physically active routines in the family setting. The insights gained regarding the appropriateness and acceptability of the program in this specific context may be used to inform the design, implementation and sustainability of other parent-focused PL programs.

Examining the criterion validity of two scalable, information technology-based systems designed to measure the quantity and quality of movement behaviours of children from Hong Kong primary schools: a cross-sectional validation study.

OBJECTIVES: Research has shown that having adequate quantity and quality of physical activity can contribute to the health and well-being of children. Nonetheless, existing tools to measure these constructs in children have limitations in terms of their objectivity and scalability. In this study, we provide criterion validity evidence of two systems built on commercially available sensors (ie, gyroscopes and infrared cameras), designed to measure children's moderate-to-vigorous physical activity and fundamental movement skill proficiencies. DESIGN: Cross-sectional. SETTING: Primary schools in Hong Kong. PARTICIPANTS: Data from 30 (age=8.55±1.25 years) and 1174 (age=9.15±1.63 years) children were included for the validation of physical activity and fundamental movement skills measures, respectively. Children's outcomes were simultaneously measured using the developed systems and existing, well-established measures (accelerometers and expert ratings). RESULTS: We found a strong correlation between physical activity outcomes measured using our developed system and accelerometers (Pearson r=0.795). Motor skill proficiency scored using our real-time rating system had strong agreement with expert ratings (percentage agreement=84%-94%, kappa=0.661 to 0.859). DISCUSSION: Results of the current study supported the application of the respective systems in physical education and large-scale research studies. Collection of such data at mass levels could help researchers depict the complex relation between children's quantity and quality of physical activity.

Parent-focused online intervention to promote parents' physical literacy and support children's physical activity: results from a quasi-experimental trial.

BACKGROUND: The development of physical literacy (PL) early in life may influence children's subsequent physical activity (PA) participation and consequent health benefits across the life course. Interventions designed for parents are lacking, but such efforts can potentially enhance the PL of parents and their children's PA participation. Additionally, there is insufficient evidence to support the feasibility of delivering a PL intervention using an online format. Therefore, the purpose of this study was to examine the feasibility and effectiveness of a parent-focused, theory-driven, online-delivered intervention designed to improve the parents' PL and children's PA behaviors. METHODS: A non-randomized trial was conducted to evaluate the effects of the program. 224 Hong Kong families (primary school-aged children and their parents) registered to the program were considered the experimental group and were exposed to an online intervention over three months. Another 220 families in Hong Kong were considered the comparison group and did not receive any intervention. Outcome measures included PA behaviors (daily steps and moderate-to-vigorous PA), parent-child co-activity behaviors, family PA routines, and parent perceived PL. Linear mixed models were used to analyze the differences in terms of changes in measured outcomes between groups over time. RESULTS: No significant group-by-time effects were found for children's or parents' PA behaviors. In terms of the family Co-PA routines, a small positive effect size in favor of the experimental group was found (p = .44, d = 0.2). Group-by-time effects favorable to the experimental group was detected for parent-child co-activity (p < .001, d = 0.7) and parental PL (p < .001, d = 0.9) at post-intervention. The results demonstrated that the intervention was acceptable and that there was potential for scale up. CONCLUSIONS: Findings indicated that the intervention was effective in increasing parent-child co-activity and parent perceived PL. During the pandemic, online intervention delivery was found to be feasible. Using this mode of delivery, the intervention has the potential to reach a wide population in the local context. TRIAL REGISTRATION: The study was prospectively registered at the Chinese Clinical Trial Registry, Registration number: ChiCTR2100041903, Registered 09 January 2021.

A Qualitative Exploration of Facilitators and Barriers to Physical Activity Participation among Chinese Retired Adults in Hong Kong.

The purpose of this study was to identify facilitators and barriers associated with physical activity participation among retired Chinese adults in Hong Kong. This study adopts an interview research design in order to generate an in-depth understanding and insights into the participants' thoughts, motivators and experiences of physical activity participation. Independent, semi-structured interviews with 10 retired participants (aged 54-74) were conducted based on an interview protocol with open-ended questions prompting the participants to describe their experiences. Transcribed texts were analysed using thematic analysis, combining both deductive and inductive analysis techniques. Common physical activities reported were walking, stretching exercise and jogging/running. Participants responded that their physical activity level increased since their retirement. We report the interview results according to the themes which emerged from the analysis: (1) physical and mental health, (2) socio-emotional factors, (3) environmental context, (4) family responsibilities. We found that the themes (1), (2) and (3) act either as a facilitator or a barrier for the participants interviewed, while theme (4) family responsibilities act as a barrier. The findings suggested that future physical activity interventions for retired Chinese adults should include more physical activity knowledge, such as the benefits to physical and mental health brought by physical activity and social elements, considering the specific challenges that participants are confronted with (from the family side).

Parental Support, Children's Physical Activity, Dietary Behaviors and Health-Related Quality of Life: Evidence From Three Asian Cities.

BACKGROUND: Parental support is crucial for children's healthy lifestyle formation. The present study examined the relations between parental support (i.e., encouragement and praise), children's perceived autonomy support and behaviors in the domains of physical activity (PA) and diet, and health-related quality of life (HRQoL) simultaneously in Asia. METHOD: Children aged 9 to 12 years and their parents (2065 dyads) in three Asian cities completed the respective questionnaires. Children reported perceived PA and dietary autonomy support, PA frequency, dietary behaviors, and HRQoL. Parents reported their PA and dietary support. The relations between parental support, children's perceived autonomy support an behaviors in the PA, and dietary domains as well as HRQoL were examined using multigroup path analyses. RESULTS: Among three cities, the indirect effects of parental support on children's self-report PA or HRQoL via children's perceived PA autonomy support were significant. A hypothetical sequential indirect effect from parental PA support to children's HRQoL via children's perceived PA autonomy support and self-report PA was observed in Hong Kong. In Hong Kong and Taipei samples, the indirect effect of parental PA support on children's HRQoL via children's self-report PA and the indirect effect of children's perceived PA autonomy support on HRQoL via children's self-report PA were significant. In Hong Kong and Shanghai samples, children's perceived dietary autonomy support showed positive effect on HRQoL via healthy food consumption. CONCLUSIONS: Congruent findings across three cities suggest that parents should provide support via encouragement and praise to facilitate children's perceived autonomy support and further increase PA and HRQoL. Our study adds to the literature by examining relations of parental support and children's healthy lifestyle in Asia and provides insights to parents and researchers.

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.

Effect of family income and physical activity on children's quality of life.

It is unclear whether gender differences exist in the relationship between maternal physical activity (PA) and children's quality of life (QoL). We also know relatively little about the potential role of PA in mitigating the adverse impact of family financial hardship. This study examined the interaction effect of PA with social and demographic factors on QoL among 272 primary school children and their mothers in Hong Kong. Children self-reported their QoL, whereas mothers reported their own and children's PA levels. Mothers also reported their family demographics including monthly household income. Moderated multiple regression models were calculated to examine 1) the relationship between maternal PA and child QoL based on child gender and 2) the relationship between family income status and child QoL based on maternal-child PA level status. The relationship between maternal PA and child QoL varied by child gender (ß = .21, p = .049), with boys of active mothers showing higher QoL. Compared to active families, when both mothers and boys were inactive, there were bigger income differences in child QoL scores (ß = .37, p = .041). No significant differences were observed in girls. The findings have implications for family-based PA interventions and highlights the benefits of PA toward the QoL of male children in disadvantaged families.

Examining the relationship between children's health-related quality of life and their perception of parental support toward physical activity: A longitudinal study.

This study investigated how health-related quality of life (HRQOL) affected perception of parental support for physical activity (PA) in 529 children from the "Fun to Move@JC Project." They self-reported their HRQOL, PA enjoyment and motivation, barriers to PA, and attachment to parents in the first semester (Time 1) and perceived parental PA support in the second semester (Time 2). Mediation analyses were performed to examine the underlying mechanisms. Greater Time 1 HRQOL scores predicted higher Time 2 perceived parental PA support through PA enjoyment and motivation, barriers to PA, and attachment to parents at Time 1. The specific indirect effect via attachment to parents was particularly strong in girls, whereas the association of PA enjoyment with perceived parental PA support was stronger in boys. Our findings suggest that children with poor HRQOL may not perceive parents to be supportive of their PA. Interventions promoting parental PA support should emphasize PA enjoyment and benefits to attachment security for parents of boys and girls, respectively.

The Impact of COVID-19 on Preschool-Aged Children's Movement Behaviors in Hong Kong: A Longitudinal Analysis of Accelerometer-Measured Data.

During the COVID-19 pandemic, many preschool-aged children were forced to remain indoors due to social distancing measures and school closures. In this study, we examined how children's movement behaviors (sedentary behaviors, physical activity, and sleep) were affected by the pandemic. Children's (N = 25, age = 4.4 years, SD = 0.3) movement behaviors were measured before and after the COVID outbreak, respectively. Data collected using accelerometers were analyzed using compositional data analyses. A significant change in the overall time-use composition (F = 5.89, p = 0.002) was found. Results suggested that children spent more time sleeping (8% increase) and in moderate-to-vigorous physical activity (16% increase), with less time spent in sedentary behaviors (9% decrease). However, parent reports suggested that children were less active and had more screen time. In conclusion, the current evidence suggests that children's physical activity is not negatively impacted by the pandemic. However, the continuous surveillance of movement behaviors of young children during the pandemic is needed.

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.

Improving children's fundamental movement skills through a family-based physical activity program: results from the "Active 1 + FUN" randomized controlled trial.

BACKGROUND: Physical activity is related to many positive health outcomes, yet activity levels of many children are low. Researchers have suggested that family-based interventions may improve physical activity behaviors of both children and their parents. In this study, we evaluated the "Active 1 + FUN" program, which was designed based on tenets of self-determination theory. Intervention components included free sporting equipment, ten coach-led workshops and activity sessions, and one booster session. METHODS: We evaluated the intervention program using a randomized controlled trial. One hundred seventy-one families were randomly allocated to either an experimental group or a wait-list control group. Participants were exposed to program contents over a nine-month period, while families in the control did not receive any form of intervention. Measured constructs included moderate-to-vigorous physical activity, co-physical activity behaviors, fundamental movement skills, BMI, and several self-reported questionnaire outcomes. Hierarchical linear modeling was used to compare changes in measured outcomes across the two groups. RESULTS: No significant intervention effects were found for children's and parents' accelerometer-measured moderate-to-vigorous physical activity, or their co-physical activity. However, in terms of children's fundamental movement skills, a significant Time*Group interaction (B = 0.52, 95% CI [0.07, 0.96] for Times 1 to 2; B = 0.24, 95% CI [0.01, 0.48] for Times 1 to 3) in favor of the experimental group was found. CONCLUSIONS: Results suggested that the "Active 1 + FUN" program was effective in improving children's fundamental movement skills. Additional research is needed to examine how family-based initiatives could effectively improve physical activity behaviors too. TRIAL REGISTRATION: ANZCTR, ACTRN12618001524280. Registered 11 September 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375660 .

Global effect of COVID-19 pandemic on physical activity, sedentary behaviour and sleep among 3- to 5-year-old children: a longitudinal study of 14 countries.

BACKGROUND: The restrictions associated with the 2020 COVID-19 pandemic has resulted in changes to young children's daily routines and habits. The impact on their participation in movement behaviours (physical activity, sedentary screen time and sleep) is unknown. This international longitudinal study compared young children's movement behaviours before and during the COVID-19 pandemic. METHODS: Parents of children aged 3-5 years, from 14 countries (8 low- and middle-income countries, LMICs) completed surveys to assess changes in movement behaviours and how these changes were associated with the COVID-19 pandemic. Surveys were completed in the 12 months up to March 2020 and again between May and June 2020 (at the height of restrictions). Physical activity (PA), sedentary screen time (SST) and sleep were assessed via parent survey. At Time 2, COVID-19 factors including level of restriction, environmental conditions, and parental stress were measured. Compliance with the World Health Organizations (WHO) Global guidelines for PA (180 min/day [≥60 min moderate- vigorous PA]), SST (≤1 h/day) and sleep (10-13 h/day) for children under 5 years of age, was determined. RESULTS: Nine hundred- forty-eight parents completed the survey at both time points. Children from LMICs were more likely to meet the PA (Adjusted Odds Ratio [AdjOR] = 2.0, 95%Confidence Interval [CI] 1.0,3.8) and SST (AdjOR = 2.2, 95%CI 1.2,3.9) guidelines than their high-income country (HIC) counterparts. Children who could go outside during COVID-19 were more likely to meet all WHO Global guidelines (AdjOR = 3.3, 95%CI 1.1,9.8) than those who were not. Children of parents with higher compared to lower stress were less likely to meet all three guidelines (AdjOR = 0.5, 95%CI 0.3,0.9). CONCLUSION: PA and SST levels of children from LMICs have been less impacted by COVID-19 than in HICs. Ensuring children can access an outdoor space, and supporting parents' mental health are important prerequisites for enabling pre-schoolers to practice healthy movement behaviours and meet the Global guidelines.

Association between Physical Activity and Fundamental Movement Skills in Preschool-Aged Children: Does Perceived Movement Skill Competence Mediate This Relationship?

OBJECTIVES: The purpose of this research is to examine whether perceived fundamental movement skills (FMS) competence mediated the relationship between actual FMS and physical activity (PA) in Hong Kong preschool-aged children. DESIGN: A cross-sectional study. METHODS: 148 preschool-aged children (43% girls; mean age = 4.52 ± 0.67 years) from five preschools/childcare centres completed all assessments. Actual FMS was rated using the Test of Gross Motor Development-2, whilst perceived FMS was assessed via the Pictorial Scale for Perceived Movement Skill Competence. PA was measured through accelerometry. A bootstrap method was used to assess the potential mediating effect of perceived movement skill competence on the relationship between actual FMS and PA. All mediation models were adjusted for sex and age. RESULTS: Mediation analyses showed that the direct path between actual FMS and moderate-to-vigorous physical activity (MVPA) was significant (b = 0.228, p = 0.008), as was the path between MVPA and actual FMS (b = 0.214, p = 0.008). However, perceived FMS competence did not mediate the association between actual FMS and MVPA in the models. CONCLUSIONS: Our results showed evidence of reciprocal pathways between actual FMS and MVPA, reinforcing the need to simultaneously target both domains as part of broader developmental strategies, initiated in early childhood. Unlike emergent adolescence, perceptions of movement skill competence do not play a significant role in influencing the relationship between actual FMS proficiency and MVPA in this developmental period.

Relation between Perceived Barrier Profiles, Physical Literacy, Motivation and Physical Activity Behaviors among Parents with a Young Child.

Objectives: to reveal distinct subgroups of parents by their perception of 6 types of physical activity barriers and challenges (i.e., lack of time, poor health, lack of company, lack of facilities, childcare responsibility, lack of motivation), and examine its relation with related constructs. Design: cross-sectional survey data. Method: the sample consisted of 424 parents who had at least 1 child of primary school age. Latent profile analysis was conducted to identify latent subgroups within participants. Group differences on physical literacy, autonomous motivation, and self-report physical activity (PA) levels were explored. Results: a four-profile solution was obtained from latent profile analysis, labelled as: "Struggling" (29.0%), "Family burden" (41.3%), "Lazy" (13.0%), and "Barriers free" (16.7%). The "Barriers free" profile experienced the least difficulties with physical activity, but the "Struggling" profile suffered the most severe barriers and challenges. "Family burden" and "Lazy" profiles demonstrated qualitative differences on one or two given challenges. Significant group differences on physical literacy, autonomous motivation, and PA levels were found, showing the "Barriers free" profile as the most robust and adaptive group of parents. Conclusions: the findings suggest that it is common for a substantial portion of parents to experience multiple barriers and challenges to a relatively high degree. Intervention on raising parent's physical literacy to reduce barriers and sustain their motivation may be a target for intervention.

Increasing Students' Activity in Physical Education: Results of the Self-determined Exercise and Learning For FITness Trial.

PURPOSE: To examine the effects of the Self-determined Exercise and Learning For FITness (SELF-FIT) intervention on students' moderate-to-vigorous physical activity (MVPA) and motivation in physical education (PE). METHODS: In a clustered randomized controlled trial, 667 students (mean age, 14.4 yr; SD, 0.78) from 26 schools (i.e., clusters) were randomized into either an experimental group or a waitlist control group. Students in the experimental group received the SELF-FIT intervention, a school-based intervention designed to infuse fitness and game-like elements into PE using self-determination theory principles, whereas those in the control continued their classes using usual practices. Intervention content was provided by teachers who received training from the research team. The primary outcome was percentage of time spent in MVPA during PE. Secondary outcomes included basic psychological need satisfaction, motivation toward PE, leisure-time MVPA, and mental well-being. Data were analyzed using multilevel regression analyses and prespecified interactions were tested (i.e., group-time-sex). RESULTS: Positive intervention effects were found on MVPA during PE (B, 4.00; 95% confidence interval, 2.96-5.04; d = 0.36). Regarding the participants' competence and autonomy need satisfaction, and autonomous motivation, the intervention effects were stronger in girls, compared with boys. CONCLUSIONS: Fitness infusion and game-like elements, used according to self-determination theory principles, can enhance students' physical activity and motivation toward PE. This low-cost intervention has the potential to be scaled up and disseminated in secondary schools.

The A+FMS cluster randomized controlled trial: An assessment-based intervention on fundamental movement skills and psychosocial outcomes in primary schoolchildren.

OBJECTIVES: To evaluate the effectiveness of an assessment-based intervention that emphasizes fun, mastery, and support (A+FMS) on primary schoolchildren's fundamental movement skills (FMS), perceptions of physical and movement skill competence, teacher support and enjoyment. DESIGN: Cluster randomized controlled trial. METHODS: Ten clusters (classes) (n=282; mean age 8.4 years, SD 0.56) were randomised to the A+FMS or wait-list control group in a 1:1 ratio. Teachers in the A+FMS group were required to attend six hours of training and integrate 550min of assessment for learning strategies into their PE lessons for up to a maximum of 13 weeks. FMS competence in jump, skip, hop, overhand throw, dribble and catch was the primary outcome assessed using the Test of Gross Motor Development-3rd Edition. Secondary outcome measures included perceptions of physical and FMS competence, teacher support, and student enjoyment using questionnaires. Multilevel modelling for the analysis of clustered data was used to determine the effectiveness of the intervention. RESULTS: Significant intervention effects were found for locomotor skills (adjusted mean difference, 2.47 units; Cohen's d=0.76), overall FMS competence (3.72 units; Cohen's d=0.93) and perceived teacher support (0.21 units; Cohen's d=0.05). However, there was a group-by-time effect for perceived physical competence (-0.16 units; Cohen's d=-0.07) in favouring of the control group. CONCLUSIONS: An assessment-based teacher-led FMS intervention was effective in improving FMS proficiency in primary schoolchildren. The results highlight the need for increased teacher support to develop positive self-perceptions of competence while promoting children's FMS. Trial registration CUHK_CCRB00479.